MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; PML,72,ADULT,FLL-MLL,-,OEM

Catalog Number	000000000080641722
Medical Device Problem Code	Crack (1135)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/12/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that pressure tubing that connects manifold to white port of swan ganz catheter had a small hole in the hub.Pack has 5 each, all are compromised.
Additional Manufacturer Narrative
The reporter described pressure tubing that connects manifold to white port of swan ganz catheter had a small hole in the hub and the pack has 5 each, all are compromised.One sample was returned for evaluation, and visual inspection of the assembly confirmed that there was a crack in the female luer fitting, which when interfaced with a syringe of fluid, produced a leak.Complaint is confirmed for cracked luer fitting, and true root cause of damage could not be not confirmed.Current controls documented in nmc-00725 have been reviewed and deemed adequate when followed, no further action is necessary at this time.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: PML,72,ADULT,FLL-MLL,-,OEM
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: felipe bifareti ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50915408
• Report Number: 1417592-2026-51999
• Device Sequence Number: 5776948
• Product Code: DRI
• UDI-Device Identifier: 20193489067504
• UDI-Public: 20193489067504
• Combination Product (Y/N): N
• Initial Reporter State: TX
• 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: 000000000080641722
• Device Lot Number: 0000067653
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 06/02/2023
• 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: 04/12/2023
• Initial Report FDA Received Date: 09/28/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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