MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DRAPE,U/ SHT,SPLIT,PLASTIC,ST,24/CS

Catalog Number	DYNJP2499
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	12/02/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "while draping, when removing cover to show adhesive strip, the adhesive came off with cover.".
Additional Manufacturer Narrative
The customer reported that the adhesive was weak and coming off of the drape when removing the paper backing, and there was no reported death or serious injury associated with this event.A sample was returned by the customer; the sample was reviewed, one each dynjp2499 was received, and the paper backing was pulled on three sides of the adhesive, and the adhesive did not come off of the drape.Analysis of complaint data was performed over the past two years for weak adhesive, and it was determined that there are four additional unrelated complaints; therefore, there is no trend.Based on the results of the investigation medline was unable to confirm the complaint issue or that the product failed to meet specifications, and 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: DRAPE,U/ SHT,SPLIT,PLASTIC,ST,24/CS
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: sasidhar lakku ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50734028
• Report Number: 1417592-2026-36978
• Device Sequence Number: 10620665
• Product Code: PUI
• UDI-Device Identifier: 10080196739462
• UDI-Public: 10080196739462
• Combination Product (Y/N): N
• Initial Reporter State: KS
• 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: DYNJP2499
• Device Lot Number: 85825058575
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 12/09/2025
• 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: 12/02/2025
• Initial Report FDA Received Date: 09/11/2026
• 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