MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DBD-REMOVER,STAPLE,SKIN,STERILE

Catalog Number	DYNJ04058
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/23/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "they have been having issues with the staple remover, most of the time it breaks the staple without moving it and does not remove the staples.".
Additional Manufacturer Narrative
The customer reported that they have been having issues with the staple remover; most of the time it breaks the staple without moving it and does not remove the staples.A sample was received for the investigation, and the account returned 100 unused stapler remover packs; upon initial inspection, no visual defects were noted, and four packs were opened and assessed removing staples from a skin mat with no issues noted in removing the staple or the staple breaking.Per the investigation of the samples received, the reported issue was unable to be confirmed, and the root cause was unable to be confirmed with the samples received.No medical intervention, serious injury, or follow-up care has been reported, and the division will monitor 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-REMOVER,STAPLE,SKIN,STERILE
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: sangameswaran saravanakumar ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50840357
• Report Number: 1417592-2026-46127
• Device Sequence Number: 10270677
• Product Code: GDT
• UDI-Device Identifier: 40080196846925
• UDI-Public: 40080196846925
• Combination Product (Y/N): N
• Initial Reporter State: TN
• 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): 09/18/2026

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: DYNJ04058
• Device Lot Number: 24BBH008
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 05/03/2024
• 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: 04/23/2024
• Initial Report FDA Received Date: 09/21/2026
• 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