MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP MEDLINE GUARDIAN EXTRA-WIDE WHEELCHAIR, 24" WIDE SEAT, ELEVATING LEG RESTS; WC, XW, 24", RDLA, ELR, 500 LB

Catalog Number	KX248V21E
Medical Device Problem Code	No Apparent Adverse Event (3189)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/07/2026
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported that the wheel on the wheelchair was not functioning as intended ("the rubber came off the rear wheel, and it bent the wheel").There were no reports of death, serious injury, medical intervention, or follow up care.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
Customer stated "the rubber came off the rear wheel, and it bent the wheel".

• Brand Name: MEDLINE GUARDIAN EXTRA-WIDE WHEELCHAIR, 24" WIDE SEAT, ELEVATING LEG RESTS
• Common Device Name: WC, XW, 24", RDLA, ELR, 500 LB
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093 2753
• Manufacturer Contact: sean konrath ; three lakes drive; northfield, IL 60093-2753
• MDR Report Key: 25113967
• Report Number: 1417592-2026-00980
• Device Sequence Number: 10258918
• Product Code: IOR
• UDI-Device Identifier: 00193489179937
• UDI-Public: 00193489179937
• Combination Product (Y/N): N
• Initial Reporter State: NY
• Initial Reporter Country: US
• PMA/510(K) Number: K990463
• 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): 05/07/2026

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: KX248V21E
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/07/2026
• Initial Report FDA Received Date: 05/07/2026
• Date Device Manufactured: 11/01/2025
• 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: Unknown