MAUDE Adverse Event Report: TRI-STATE DE MEXICO, S. DE R.L. DE C.V MEDLINE; DRESSING CHANGE KIT LARGE

Catalog Number	EBSI1082A
Medical Device Problem Code	Loss of or Failure to Bond (1068)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/30/2026
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported on 04/04 that a dressing placed over the central line lifted off the skin shortly after application.Due to loss of adhesion, the central line site required re-cleaning and placement of a new sterile dressing.The initial dressing was discarded.It has been determined that the reported event could cause or contribute to serious injury if it were to occur again.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.
Event or Problem Description
It was reported on 04/04 that a dressing placed over the central line lifted off the skin shortly after application.Due to loss of adhesion, the central line site required re-cleaning and placement of a new sterile dressing.The initial dressing was discarded.

• Brand Name: MEDLINE
• Common Device Name: DRESSING CHANGE KIT LARGE
• Manufacturer (Section D): TRI-STATE DE MEXICO, S. DE R.L. DE C.V; calzada presidente venustiano; carranza #301; mexicali, baja california 21397 ; MX 21397
• Manufacturer Contact: nithla mathivanan ; three lakes drive; northfield, IL 60093-2753
• MDR Report Key: 24900270
• Report Number: 3004519921-2026-00014
• Device Sequence Number: 8764013
• Product Code: OXQ
• UDI-Device Identifier: 10653160368861
• UDI-Public: 10653160368861
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 04/16/2026

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
• Device Catalogue Number: EBSI1082A
• Device Lot Number: 2025050990
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/04/2026
• Initial Report FDA Received Date: 04/16/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 05/09/2025
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Male