MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DBD-MIDWEST DENTAL IMPLANTOLOGY

Catalog Number	DYNJ84952A
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/08/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the tape on the sani sleeve in the pack is breaking too easily.
Additional Manufacturer Narrative
Customer 1865826 is saying that the tape on the sani sleeve in the pack is breaking too easily.A sample was received, and the account provided one unused sani sleeve for the investigation; upon initial inspection, no visual defects were noted, and no issues were noted removing the tape from the original packaging or when securing the yankauer.Based on the complaint details, the defect reported cannot be confirmed.No root cause was identified, and the quality team will monitor this issue for trending purposes.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: DBD-MIDWEST DENTAL IMPLANTOLOGY
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: venkata chittajallu ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50714458
• Report Number: 1417592-2026-35708
• Device Sequence Number: 21492719
• Product Code: OFX
• UDI-Device Identifier: 40195327542178
• UDI-Public: 40195327542178
• Combination Product (Y/N): N
• Initial Reporter State: IL
• 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: DYNJ84952A
• Device Lot Number: 24BMC238
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 04/10/2024
• 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: 04/08/2024
• 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): 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