MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; PRESSURE MONITORING KIT - 84IN

Catalog Number	DYNJTRANS84
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/11/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the line has been primed, pressure bag is set, when they go to flush the line into the patient they are using it spray out of the side of the stopcock.Also, leaking from litte knob you turn to redirect flow.".
Additional Manufacturer Narrative
The customer reported finding equipment failures at the start of use: the line had been primed, the pressure bag was set, and when they went to flush the line into the patient it sprayed out of the side of the stopcock, also leaking from the little knob used to redirect flow.No sample or photo was received for the investigation; finished good production records were reviewed and there were no line down situations, deviations, run-withouts, or non-conformance reports that might have had an impact on this issue, and the finished good pack build was reviewed.The customer's reported complaint description cannot be confirmed, no sample was returned for evaluation.Without receiving product for evaluation, medline was unable to definitively determine a root cause for this incident; no correction is required since no sample was returned for evaluation and a root cause for this event is inconclusive.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: PRESSURE MONITORING KIT - 84IN
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: zelek alexander ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50869632
• Report Number: 1417592-2026-48910
• Device Sequence Number: 15781503
• Product Code: OEZ
• UDI-Device Identifier: 40889942582632
• UDI-Public: 40889942582632
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K883718
• 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: DYNJTRANS84
• Device Lot Number: 22IBQ037
• 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: 09/11/2023
• 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: Unknown