MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; IV START KIT W/CHLORAPREP

Catalog Number	DYND74262
Medical Device Problem Code	Loss of or Failure to Bond (1068)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/12/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "when the dressing is pulled apart the sticky part is not coming off with the tab when you separate it.".
Additional Manufacturer Narrative
The account reported finding adhesive issue with iv start kit; when the dressing is pulled apart the sticky part is not coming off with the tab when you separate it.A photo was received for our investigation, and per evaluation of the photos received, the photos show 3 dressings and the paper frame was separated from the dressing itself so they would be unable to be placed or used; finished good production records were unable to be reviewed, and there are no issues with the finished good pack build that likely contributed to the reported issue.Per our investigation of the photos received, we were able to confirm the reported issue.The issue derives from the raw materials process when the force between frame liner and the film is too weak, and we are working with the component manufacturing facility for further evaluation and corrective actions.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: IV START KIT W/CHLORAPREP
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: koushik pothamshetty ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50817288
• Report Number: 1417592-2026-44506
• Device Sequence Number: 10680788
• Product Code: LRS
• UDI-Device Identifier: 40080196862925
• UDI-Public: 40080196862925
• Combination Product (Y/N): N
• Initial Reporter State: MO
• 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: DYND74262
• Device Lot Number: 24BBJ434
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 04/22/2024
• 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: 04/12/2024
• Initial Report FDA Received Date: 09/18/2026
• 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