MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; SHEET, DRAPE, SPLIT, ST,10/CS

Catalog Number	DYNJP2498
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	08/20/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that split drape with adhesive (b)(6) no longer sticks appropriately.This has been continuing for months.
Additional Manufacturer Narrative
It was reported that split drape with adhesive (b)(6) no longer sticks appropriately and this has been continuing for months.Medline reviewed the complaint history and nonconformance trends for this product and this customer for the past 24 months; there are no additional complaints for this customer and one additional unrelated complaint for this product.One each dynjp2498 was received and the sample was reviewed; the adhesive adhered to the skin with no issue, and the manufacturer is using the appropriate adhesive.Based on the returned sample and the product trending the issue is not confirmed; the cause was listed as not confirmed with received sample, and based on the investigation results, no further actions are being taken at this time.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: SHEET, DRAPE, SPLIT, ST,10/CS
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: zelek alexander ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50713668
• Report Number: 1417592-2026-35651
• Device Sequence Number: 21492834
• Product Code: PUI
• UDI-Device Identifier: 40080196739494
• UDI-Public: 40080196739494
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• 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): 09/05/2026

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: DYNJP2498
• Device Lot Number: 31124050005F
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 09/20/2024
• 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: 08/20/2024
• Initial Report FDA Received Date: 09/10/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Unknown