MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DBD-LD PACK-LF

Catalog Number	DYNJ0731657L
Medical Device Problem Codes	Material Puncture/Hole (1504); Material Deformation (2976)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/01/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the bulb syringes inside the l&d custom packs were found as shown in pictures, and "they are also noticing holes in some of the bulb syringes.".
Additional Manufacturer Narrative
The account reported finding bulb syringe was crushed in pack, and the complaint stated that they are also noticing holes in some of the bulb syringes.Medline received two photos and no physical sample was available; finished good production records and finished good pack build were reviewed.A bulb syringe was observed crushed, confirming the reported issue.Based on the component's location in the pack it is unlikely that placement contributed to the reported issue; it is possible the item became damaged due to rough handling of the pack, or components may be received damaged from the supplier or can become damaged during transit or storage, 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-LD PACK-LF
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: rizwan shaik ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50754773
• Report Number: 1417592-2026-39285
• Device Sequence Number: 9224511
• Product Code: MLS
• UDI-Device Identifier: 40193489958042
• UDI-Public: 40193489958042
• Combination Product (Y/N): N
• Initial Reporter State: TX
• 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: DYNJ0731657L
• Device Lot Number: 24ABK435
• 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: 03/01/2024
• 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