MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; ELECTRODE,ECG,TAB,10/CARD,4000/CS,INDIVI

Catalog Number	MDSMIW616201
Medical Device Problem Codes	Loss of or Failure to Bond (1068); Material Deformation (2976)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/25/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that electrodes are not sticking.Adhesive appears to be globbed onto the tab in some cases.
Additional Manufacturer Narrative
The customer reported electrodes are not sticking and adhesive appears to be globbed onto the tab in some cases.Medline received 6 ea medgel resting tab ecg electrodes in individual sheets; upon doing visual inspection it was noticed that the adhesive on one of the electrode tabs was mushed on to one side, and functional testing was performed by placing the tabs to stick and waiting ten min to see what would happen.None of the tabs fell from where they were placed, and the complaint was not confirmed.Based on the review of the details provided for the complaint investigation, medline was unable to confirm the complaint issue or that the product failed to meet specifications.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: ELECTRODE,ECG,TAB,10/CARD,4000/CS,INDIVI
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: maya mcknight ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50721470
• Report Number: 1417592-2026-36478
• Device Sequence Number: 16011502
• Product Code: DRX
• UDI-Device Identifier: 40888277699183
• UDI-Public: 40888277699183
• Combination Product (Y/N): N
• Initial Reporter State: FL
• 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): 09/08/2026

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: MDSMIW616201
• Device Lot Number: 85922070005
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 04/25/2024
• 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: 03/25/2024
• 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