MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; BED, SEMI ELECTRIC, MEDLITE

Catalog Number	MDR107002L
Medical Device Problem Code	Fracture (1260)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/29/2023
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "this drivearm came apart during the bed test after it was cleaned.It doesn't want to go back together.".
Additional Manufacturer Narrative
The customer reported the drive arm came apart during the bed test after it was cleaned, and per customer phone call, the issue is with the foot motor; per photo and customer report, the foot actuator snapped in half.A physical sample was not provided; a photo depicting the defect was provided and only a visual review of the defect can be conducted, and after reviewing the photo it was discovered that the actuator extension arm appears to have fractured from the actuator.The investigation results were confirmed.Given the evidence provided in the photo the root cause of this issue is unknown; no product changes were identified that could have contributed to the alleged product failure, 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: BED, SEMI ELECTRIC, MEDLITE
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: michael mazeska ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50917349
• Report Number: 1417592-2026-52310
• Device Sequence Number: 5753174
• Product Code: LLI
• UDI-Device Identifier: 40080196294320
• UDI-Public: 40080196294320
• Combination Product (Y/N): N
• Initial Reporter State: NY
• 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): 09/25/2026

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: MDR107002L
• 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: 09/02/2023
• 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): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Patient Sex: Unknown