MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DRAPE,SHOULDER,BEACH CHAIR,ST,5/CS

Catalog Number	DYNJP8412
Medical Device Problem Code	Material Split, Cut or Torn (4008)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/24/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The customer reported that upon opening the shoulder drape and applying to case there was a big slit in it; no picture available as the drape did touch the patient.No sample was returned for investigation, and complaint history and nonconformance trending for this product and this customer for the past six months were reviewed with no additional complaints.Without the sample, medline was unable to confirm the reported issue, and the cause was unconfirmed/sample required to determine cause.If the sample becomes available, the complaint will be reopened, and the division will monitor for trending.There were no reports of death, serious injury, medical intervention, or follow up care.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.
Event or Problem Description
It was reported that "upon opening drape and applying to case, there was a big slit in it.".

• Brand Name: MEDLINE
• Common Device Name: DRAPE,SHOULDER,BEACH CHAIR,ST,5/CS
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: namirah khan ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50752721
• Report Number: 1417592-2026-38994
• Device Sequence Number: 9241507
• Product Code: PUI
• UDI-Device Identifier: 40080196740841
• UDI-Public: 40080196740841
• 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): 09/10/2026

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: DYNJP8412
• Device Lot Number: 39922040120
• Was Device Available for Evaluation?: No
• 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: 05/24/2023
• 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
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown