MAUDE Adverse Event Report: Medline Industries LP Medline; DBD-HIP PACK BASIN SET

Catalog Number	DYNJ44454G
Medical Device Problem Code	Material Twisted/Bent (2981)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/15/2026
Type of Reportable Event	Malfunction

• Brand Name: Medline
• Common Device Name: DBD-HIP PACK BASIN SET
• Manufacturer (Section D): Medline Industries LP; three lakes dr; northfield IL 60093
• Manufacturer Contact: michael crook ; three lakes dr; northfield, IL 60093
• MDR Report Key: 50902919
• Report Number: 1417592-2026-51371
• Device Sequence Number: 10711986
• Product Code: OJH
• UDI-Device Identifier: 10198459436819
• UDI-Public: 10198459436819
• Combination Product (Y/N): N
• Initial Reporter State: WI
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Type of Report: Initial
• Report Date (Section B): 09/25/2026

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: DYNJ44454G
• Device Lot Number: 26DMI285
• 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: 09/15/2026
• Initial Report FDA Received Date: 09/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Patient Sequence Number: 1
• Patient Sex: Unknown