MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; GLOVE,SURG,ADVANTAG PI UNDRGLV,LF,PF,6.5

Catalog Number	AVT0265
Medical Device Problem Codes	Material Fragmentation (1261); Material Separation (1562); Material Split, Cut or Torn (4008)
Health Effect - Clinical Code	Foreign Body In Patient (2687)
Date of Event	08/01/2026
Type of Reportable Event	Malfunction

• Brand Name: MEDLINE
• Common Device Name: GLOVE,SURG,ADVANTAG PI UNDRGLV,LF,PF,6.5
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -279
• Manufacturer Contact: gregory gohl ; three lakes drive; northfield, IL 60093--279
• MDR Report Key: 50762972
• Report Number: 1417592-2026-09814
• Device Sequence Number: 9668320
• Product Code: KGO
• UDI-Device Identifier: 10197344099696
• UDI-Public: 10197344099696
• Combination Product (Y/N): N
• Initial Reporter State: NV
• Initial Reporter Country: US
• PMA/510(K) Number: K191915
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Type of Report: Initial
• Report Date (Section B): 09/14/2026

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: AVT0265
• Device Lot Number: 5098787365
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/25/2026
• Initial Report FDA Received Date: 09/14/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 09/01/2025
• 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: Unknown
• Patient Sequence Number: 1
• Patient Age: 74 YR
• Patient Sex: Male
• Patient Weight: 91 LB
• Patient Race: White