MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; REGULATOR,SUCTION,C/I,BARB,OHMEDA,YELLOW

Catalog Number	RTACIBOMY
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/06/2026
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the section where the regulator is changed from intermittent to consistent has broken.
Additional Manufacturer Narrative
The account reported finding the device had a broken adjustment knob; the complaint stated the section where the regulator is changed from intermittent to consistent has broken.Photos were received for investigation, and medline quality visually evaluated the photos; one photo shows the top part of the regulator with the adjustment knob missing, and the other photo shows the back of the device with the adjustment knob missing from this angle as well.The reported issue was confirmed based on the received photos.Cause was documented as "cannot determine cause w/received sample," no trends were identified, and the quality team 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: REGULATOR,SUCTION,C/I,BARB,OHMEDA,YELLOW
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: madelyn ruppert ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50870454
• Report Number: 1417592-2026-49072
• Device Sequence Number: 9224094
• Product Code: KDP
• UDI-Device Identifier: 10197344066018
• UDI-Public: 10197344066018
• Combination Product (Y/N): N
• Initial Reporter State: TX
• 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): 09/22/2026

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: RTACIBOMY
• 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: 01/06/2026
• 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