MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP - NAMIC NAMIC; CIL,LP,10,FLL-MLL

Catalog Number	91021102
Medical Device Problem Code	Loose or Intermittent Connection (1371)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/06/2026
Type of Reportable Event	Malfunction
Event or Problem Description
The 10" extension tubing will not stay connected to copilot.
Additional Manufacturer Narrative
It was reported that the 10" extension tubing will not stay connected to copilot.Another of the same lot was used and worked.There were no reports of death, serious injury, medical intervention, or follow up care.

• Brand Name: NAMIC
• Common Device Name: CIL,LP,10,FLL-MLL
• Manufacturer (Section D): MEDLINE INDUSTRIES, LP - NAMIC; 10 glens falls technical park; glens falls NY 12801 3864
• Manufacturer Contact: lauren glaeser ; three lakes drive; northfield, IL 60093-2753
• MDR Report Key: 25118246
• Report Number: 3015910259-2026-00119
• Device Sequence Number: 13330130
• Product Code: DQO
• UDI-Device Identifier: 10193489068733
• UDI-Public: 10193489068733
• Combination Product (Y/N): N
• Initial Reporter State: KS
• Initial Reporter Country: US
• PMA/510(K) Number: K822100
• 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
• Operator of Device: Health Professional
• Device Catalogue Number: 91021102
• Device Lot Number: 0000184380
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/08/2026
• Initial Report FDA Received Date: 05/07/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 12/01/2025
• 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