MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DBQ-BAR,BED ASSIST

Catalog Number	MDS6800BA
Medical Device Problem Code	Unstable (1667)
Health Effect - Clinical Codes	Bruise/Contusion (1754); Fall (1848); Head Injury (1879)
Date of Event	11/07/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "he was gripping with his right hand when the product moved and slipped off the bed.".
Additional Manufacturer Narrative
The customer reported her husband fell out of the bed when using this product when the product moved and slipped off the bed; he hit his head and developed bruises and a bump, but no medical intervention was necessary.The complaint could not be confirmed as there were no lot/serial numbers, samples, pictures or videos received.Without a sample received, it is difficult to determine a true root cause for the reported issue, and the cause code was updated to unconfirmed defect - sample required to determine cause.No further investigation will be conducted at this time.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: DBQ-BAR,BED ASSIST
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: jarred meyers ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50872074
• Report Number: 1417592-2026-49241
• Device Sequence Number: 10743234
• Product Code: QTC
• UDI-Device Identifier: 00884389102865
• UDI-Public: 00884389102865
• Combination Product (Y/N): N
• Initial Reporter State: MA
• 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): 09/23/2026

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: MDS6800BA
• 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: 11/07/2024
• 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