MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; GROUNDING, UNIVERS, SPLIT, 15'CORD

Catalog Number	PAD9165L
Medical Device Problem Code	Adhesive Too Strong (4071)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/23/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the adhesive on the pad is too sticky to the protective plastic, yet it does not adhere well to the patient.".
Additional Manufacturer Narrative
The customer reported that the adhesive on the pad is too sticky to the protective plastic and does not adhere well to the patient; investigation also noted that the connector was getting stuck to the pad adhesive.The sample was delivered on (b)(6)2023, but it was lost in transit and cannot be located by medline.In this case, the issue cannot be confirmed, and the cause code was updated to "unconfirmed defect - sample required to determine cause." the division will continue to monitor the issue for trending, and if a sample, photo, and/or additional information becomes available, this complaint will be reopened to be further investigated.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: GROUNDING, UNIVERS, SPLIT, 15'CORD
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: aaron ginsburg ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50774570
• Report Number: 1417592-2026-40715
• Device Sequence Number: 21438261
• Product Code: GEI
• UDI-Device Identifier: 20193489082545
• UDI-Public: 20193489082545
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K212093
• 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: PAD9165L
• Device Lot Number: 27122110002
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 02/27/2023
• 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: 02/23/2023
• 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): 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