MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; WC, K4, 20", SB DDLA, ELR

Catalog Number	K4206N24E
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/14/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the spoke on the back right wheel cracked.".
Additional Manufacturer Narrative
According to the customer, on (b)(6) 2025 "while pushing my son "[through]" a parking lot" they "heard a crack and "[saw]" the right wheel slanted in"; the customer reported there was no serious injury, medical intervention, or follow-up care related to the reported incident.A physical sample was not provided; a photo depicting the defect was provided and only a visual review of the defect can be conducted.Investigation results were confirmed, and after reviewing the photo it was discovered that one of the spokes of the right wheel is fractured.Given the evidence provided in the photo the root cause of this issue is unknown; no trends were identified for the specified material number and its corresponding defect type.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: WC, K4, 20", SB DDLA, ELR
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: narendra nambula ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50868088
• Report Number: 1417592-2026-48681
• Device Sequence Number: 10715109
• Product Code: IOR
• UDI-Device Identifier: 00193489099754
• UDI-Public: 00193489099754
• Combination Product (Y/N): N
• Initial Reporter State: AZ
• Initial Reporter Country: US
• PMA/510(K) Number: K990463
• 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: K4206N24E
• Device Lot Number: 16424010001
• Was Device Available for Evaluation?: Yes
• 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: 12/17/2025
• Initial Report FDA Received Date: 09/23/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Male
• Patient Weight: 196 LB