MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP - SPT MEDLINE; DBD-XI ROBOT PACK

Catalog Number	DYNJ58652C
Medical Device Problem Codes	Device Slipped (1584); Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/14/2026
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported on 04/14 that the velcro detached from the drape.An approved alternative drape clamp was then applied; however, the drape slipped through the clamp.Upon attempting to re-secure the drape, the material tore and the drape broke apart, resulting in loss of securement of the suction tubing.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
It was reported on 04/14 that the velcro detached from the drape.An approved alternative drape clamp was then applied; however, the drape slipped through the clamp.Upon attempting to re-secure the drape, the material tore and the drape broke apart, resulting in loss of securement of the suction tubing.

• Brand Name: MEDLINE
• Common Device Name: DBD-XI ROBOT PACK
• Manufacturer (Section D): MEDLINE INDUSTRIES, LP - SPT; 1170 s northpoint boulevard; waukegan IL 60085 6757
• Manufacturer Contact: nithla mathivanan ; three lakes drive; northfield, IL 60093-2753
• MDR Report Key: 25179104
• Report Number: 1423395-2026-00147
• Device Sequence Number: 10428015
• Product Code: FDE
• UDI-Device Identifier: 10193489884067
• UDI-Public: 10193489884067
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: N/A
• 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,Followup
• Report Date (Section B): 06/20/2026

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: DYNJ58652C
• Device Lot Number: 26CMB229
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/14/2026
• Supplement Date Received by Manufacturer: 05/19/2026
• Initial Report FDA Received Date: 05/14/2026
• Supplement Report FDA Received Date: 06/20/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/04/2026
• 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 Age: 51 YR
• Patient Sex: Female