MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; LUER LOCK ACCESS DEVICE

Catalog Number	LLAD
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Code	Exposure to Body Fluids (1745)
Date of Event	11/05/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "sheath is not retracting back over the needle after the blood collection tube is removed causing blood to free flow onto the floor, nurse, patient.".
Additional Manufacturer Narrative
Customer reported receiving a medline luer lock access device that was leaking blood during use; while removing the blood collection tube, the device did not retract back over the needle causing blood to free flow onto the floor, nurse, and patient, and the customer reported no impact to the patient or user and no serious injury, medical intervention, or follow up care.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: LUER LOCK ACCESS DEVICE
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: arthem smalyukh ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50915681
• Report Number: 1417592-2026-52032
• Device Sequence Number: 12148756
• Product Code: JKA
• UDI-Device Identifier: 20193489103219
• UDI-Public: 20193489103219
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K200027
• 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): 09/25/2026

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: LLAD
• Device Lot Number: 89724060001
• 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: 11/05/2024
• Initial Report FDA Received Date: 09/28/2026
• 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