MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; SHOWER COMMODE WC, ALUMINUM, 275 LB

Catalog Number	G1-503WCPX1
Medical Device Problem Code	Corroded (1131)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/09/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "both front wheel rusting" and "heavy rust in the bearings of the front casters.Casters will no longer swivel.".
Additional Manufacturer Narrative
The customer reported heavy rust in the bearings of the front casters, and the casters will no longer swivel; no injury or fall reported.A photo depicting the defect was provided and only a visual review of the defect could be conducted; a physical sample was not provided, and a functional or dimensional inspection could not be executed via a photo.Investigation results were confirmed, and the bearings of the front casters appear to have rusted.Based on the photos provided and the incident report the root cause of this issue is unknown; no trends were identified, no product changes were identified that could have contributed to the alleged product failure, and the division will monitor through trending.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: SHOWER COMMODE WC, ALUMINUM, 275 LB
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: vamshi pinnamshetty ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50873351
• Report Number: 1417592-2026-49449
• Device Sequence Number: 16131387
• Product Code: INM
• UDI-Device Identifier: 00193489028754
• UDI-Public: 00193489028754
• Combination Product (Y/N): N
• Initial Reporter State: MI
• 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: G1-503WCPX1
• Device Lot Number: 164240400001
• 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: 05/09/2025
• Initial Report FDA Received Date: 09/23/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 04/01/2024
• 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