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

Catalog Number	DYNJ65823B
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/15/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the no 15 blades were chipped.".
Additional Manufacturer Narrative
The account reported finding 15 blades were chipped.A photo was received for the investigation, and the photos show around the tip of the blade, there was a chip in the metal; finished good production records and finished good pack build were reviewed, and no non-conformances or issues were noted that would have contributed to or impacted the issue.Based on the complaint details, photo evaluation and investigation, medline confirmed the reported issue.Medline determined that the root cause is considered to be a vendor product issue relating to the component manufacturing process; the vendor reviewed in-process records and did not identify any problems that could have caused this damage, was unable to determine a root cause for the defect reported, believed this was an isolated incident, and notified the head of the department and inspection supervisors of the complaint and asked them to remain vigilant for the defect.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-MINOR PACK
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: ayan asim ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50772947
• Report Number: 1417592-2026-40494
• Device Sequence Number: 18571294
• Product Code: FDE
• UDI-Device Identifier: 40195327516216
• UDI-Public: 40195327516216
• Combination Product (Y/N): N
• Initial Reporter State: IL
• 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: DYNJ65823B
• Device Lot Number: 24BMH398
• 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: 05/15/2024
• Initial Report FDA Received Date: 09/15/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Unknown