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

Catalog Number	DYNJ82937
Medical Device Problem Code	Corroded (1131)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/02/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that there were "rusty instruments".
Additional Manufacturer Narrative
The account reported finding rusty instruments.A photo and a sample were received for investigation; the sample was of two mosquito hemostats and no other pack contents were received, finished good production records were reviewed with no non-conformances noted, and finished good pack build was reviewed with no issues that might have an impact on the issue.The reported problem was confirmed, as both hemostats had what appears to be rust on both sides of them.Based on the complaint details the root cause is considered to be a vendor product issue relating to the component manufacturing process, and the supplier 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-ARTERIOGRAM PACK
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: pranay abbu ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50804393
• Report Number: 1417592-2026-43665
• Device Sequence Number: 10611050
• Product Code: OEZ
• UDI-Device Identifier: 40195327224869
• UDI-Public: 40195327224869
• Combination Product (Y/N): N
• Initial Reporter State: WI
• 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): 09/16/2026

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: DYNJ82937
• Device Lot Number: 23FBF104
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 08/04/2023
• 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: 08/02/2023
• Initial Report FDA Received Date: 09/17/2026
• Was Device Evaluated by Manufacturer? (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