MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; TEST,HCG,PREGNANCY,COMBO,CASS,20/10 MIU

Catalog Number	MPH22025HCG
Medical Device Problem Code	False Positive Result (1227)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/03/2025
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "the hcg combo pregnancy test cassette has generated a false positive test in our urgent care department in palo alto".
Additional Manufacturer Narrative
The customer reported receiving "medline premium hcg pregnancy tests" that "false positive"; per the facility, the test was redone using serum blood to confirm results, with no report of serious injury or delayed/canceled treatment, and no medical treatment needed.At this time, a sample(s) was not received for investigation, and investigation included review of recent complaint trends/scar activity for the last three trend reports.The complaint was not confirmed, and no trends were identified for the specified material number and its corresponding defect type.No further action was taken because without the sample or picture, it is difficult to truly identify the root cause of the issue, and the division will continue to monitor trends.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: TEST,HCG,PREGNANCY,COMBO,CASS,20/10 MIU
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: ankitha komirishetty ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50896474
• Report Number: 1417592-2026-50729
• Device Sequence Number: 14952738
• Product Code: JHI
• UDI-Device Identifier: 10884389191880
• UDI-Public: 10884389191880
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: K062361
• 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): 09/24/2026

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: MPH22025HCG
• Device Lot Number: 0000981238
• Was Device Available for Evaluation?: No
• 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: 10/03/2025
• Initial Report FDA Received Date: 09/25/2026
• 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