MAUDE Adverse Event Report: MEDLINE INDUSTIRES, LP- NAMIC NAMIC; MMII,MP,3V,200S,RH,OFF,OEM

Catalog Number	80038301
Medical Device Problem Codes	Loose or Intermittent Connection (1371); Connection Problem (2900)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
According to the facility, the syringe was spinning off the manifold when attached.The customer contact reports this incident occurred during use; however no injury occurred.The customer contact is unsure if the defect is related to the syringe or manifold.No additional information at this time.To date, no information has been received to indicate that a user or a patient experienced a death, serious injury, medical intervention, follow-up care, or other adverse health impact associated with the reported problem/issue.In an abundance of caution, and in response to an fda 483 issued for cfn 1417592 on 22-jan-2024, this medwatch is being filed for the reported problem/issue.If additional relevant information becomes available a supplemental medwatch will be filed.
Event or Problem Description
According to the facility, the syringe was spinning off the manifold when attached.

• Brand Name: NAMIC
• Common Device Name: MMII,MP,3V,200S,RH,OFF,OEM
• Manufacturer (Section D): MEDLINE INDUSTIRES, LP- NAMIC; 10 glen falls technical park; glen falls NY 12801
• Manufacturer Contact: alyssa reasner ; three lakes drive; northfield, IL 60093-2753
• MDR Report Key: 24821242
• Report Number: 3015910259-2026-00111
• Device Sequence Number: 6027879
• Product Code: DTL
• UDI-Device Identifier: 10193489066500
• UDI-Public: 10193489066500
• Combination Product (Y/N): N
• Initial Reporter Country: AS
• PMA/510(K) Number: K782095
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Non-Healthcare Professional
• Remedial Action: Recall
• Type of Report: Initial
• Report Date (Section B): 04/08/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: 80038301
• Device Lot Number: 0000138736
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/16/2026
• Initial Report FDA Received Date: 04/08/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 09/19/2024
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: R-26-025
• Patient Sequence Number: 1
• Patient Sex: Unknown