MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DBD-O2 CANNULA,ADULT,SOFTECH,4' TUB,SC

Catalog Number	HUD1827
Medical Device Problem Code	Nonstandard Device (1420)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/17/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the prongs are not consistent on length, 3 prongs are 3/5 long and 2 are 4/8 (half inch long).".
Additional Manufacturer Narrative
It was reported that the customer states the prongs are not consistent on length, 3 prongs are 3/5 long and 2 are 4/8 (half inch long).The customer needs the 4/8 (an half).No sample or photo received for the investigation; trending was reviewed and there have been 0 additional reported complaint(s) for this issue for the account in the past 6 months.Due to the actual sample not available, medline was not able to confirm what may have caused the nasal prongs to have inconsistent lengths; sample required to determine cause.Per the soundway drawings for the hudson rci softech cannulas, the nasal lengths are between 10-13mm, 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-O2 CANNULA,ADULT,SOFTECH,4' TUB,SC
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: venkat gaanuthula ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50747997
• Report Number: 1417592-2026-38909
• Device Sequence Number: 8494808
• Product Code: CAT
• UDI-Device Identifier: 20193489149316
• UDI-Public: 20193489149316
• Combination Product (Y/N): N
• Initial Reporter State: AZ
• 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): 09/11/2026

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: HUD1827
• 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: 01/17/2024
• Initial Report FDA Received Date: 09/14/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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