MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; IV ADMIN SET, 15DR, 2 PRESLIT PORTS, 96"

Catalog Number	DYNDTA1812
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/12/2026
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "these iv sets are leaking when in use.".
Additional Manufacturer Narrative
The customer reported leaking when in use and clarified that the device is leaking from the lower port; no injury was reported.A photo was received for the investigation, but the photos were of the outer case and the individual packaging, and no photos or samples of the device were provided for evaluation; the manufacturer was notified and no investigation was received after two follow ups.Based on the complaint details and the investigation, the complaint is not confirmed without receipt of physical samples or detailed photographic evidence depicting the reported issue.No root cause was identified, and the division 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: IV ADMIN SET, 15DR, 2 PRESLIT PORTS, 96"
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: kehkashan khan ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50856812
• Report Number: 1417592-2026-47959
• Device Sequence Number: 13250154
• Product Code: FPA
• UDI-Device Identifier: 10888277689367
• UDI-Public: 10888277689367
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K093773
• 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): 09/22/2026

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: DYNDTA1812
• Device Lot Number: 0332505A179
• 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: 03/12/2026
• Initial Report FDA Received Date: 09/22/2026
• 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