MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; DBD-HEART CABG PK

Catalog Number	DYNJ64040D
Medical Device Problem Code	Device Slipped (1584)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/15/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that in the last two weeks the clamp has slipped off of the aorta 3 times for 2 different surgeons in the middle of the procedure.
Additional Manufacturer Narrative
The account reported that the clamp slipped off of the aorta 3 times for 2 different surgeons in the middle of the procedure.No sample or photo was received for the investigation; finished good production records were reviewed, finished good pack build was reviewed, and trending was reviewed with 0 additional reported complaint(s) for this issue for the account and component in the past 24 months.The defect could not be confirmed as there were no samples or detailed pictures received, and the cause was documented as sample required to determine cause.This complaint has been provided to the vendor for further evaluation, and the supplier 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: DBD-HEART CABG PK
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: sangameswaran saravanakumar ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50885418
• Report Number: 1417592-2026-50188
• Device Sequence Number: 21521196
• Product Code: OEZ
• UDI-Device Identifier: 10195327391867
• UDI-Public: 10195327391867
• Combination Product (Y/N): N
• Initial Reporter State: MO
• 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: DYNJ64040D
• Device Lot Number: 24HMF875
• 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: 01/15/2025
• Initial Report FDA Received Date: 09/24/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Unknown