MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; WC,RECL,16",RDLA,ELR, 300 LB

Catalog Number	MDS808350
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/01/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the recline mechanism is stuck reclined back.
Additional Manufacturer Narrative
It was reported that the recline mechanism is stuck reclined back, and no fall or injury was reported.Medline reviewed the photos provided and noted that the product appeared to be in used condition due to wrinkled upholstery; the reclining pistons appeared to be reclined back, and the pistons and reclining system appeared intact with no signs of possible physical defects.Investigation results were not confirmed, and a physical sample was not provided, so only a visual review could be conducted and a functional or dimensional inspection could not be executed.The issue could not be identified based on the photos provided; the cause was documented as an unconfirmed defect with sample required to determine cause, 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: WC,RECL,16",RDLA,ELR, 300 LB
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: venkat gaanuthula ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50897029
• Report Number: 1417592-2026-50797
• Device Sequence Number: 5853007
• Product Code: IOR
• UDI-Device Identifier: 00080196752457
• UDI-Public: 00080196752457
• Combination Product (Y/N): N
• Initial Reporter State: CA
• 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): 09/24/2026

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: MDS808350
• Device Lot Number: 73622100002
• 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: 02/01/2024
• 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): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown