MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; PENCIL,CAUTERY,PUSHBUTTON,STERILE,LF,SS

Catalog Number	ESPB3000Z
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Burning Sensation (2146)
Date of Event	10/30/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that product caused burn in the or.
Additional Manufacturer Narrative
According to the customer, while using the cautery pencil the scrub tech felt a burning sensation on the "index finger through the glove" but "no skin burn"; the scrub tech changed the gloves and was able to complete the procedure.The customer did not provide neither the sample nor the picture for evaluation.At this time, medline could not confirm the complaint, as it was not able to conduct the investigation, and the cause was documented as sample required to determine cause.If the customer provides any additional information, this complaint will be re-opened.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 is a reportable event.If additional information becomes available this report will be reopened and reevaluated.This medical device report (mdr) is being submitted as part of retrospective review activities, which include review of historical data in accordance with regulations at 21 cfr part 803.The information included in this mdr reflects the information reasonably known to the manufacturer at the time of this retrospective review and submission.

• Brand Name: MEDLINE
• Common Device Name: PENCIL,CAUTERY,PUSHBUTTON,STERILE,LF,SS
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: vamshi pinnamshetty ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50495162
• Report Number: 1417592-2026-26752
• Device Sequence Number: 16109865
• Product Code: GEI
• UDI-Device Identifier: 30080196775938
• UDI-Public: 30080196775938
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K091672
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Type of Report: Initial
• Report Date (Section B): 08/27/2026

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: ESPB3000Z
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/30/2023
• Initial Report FDA Received Date: 08/28/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Unknown