MAUDE Adverse Event Report: Medline Industries, LP MEDLINE; PICC LINE INSERTION PACK

Catalog Number	DYNJ38868N
Medical Device Problem Code	Premature Activation (1484)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/17/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The customer reported at least 6 picc packs where the secureportiv had been activated and appeared already popped and unable to be used.A sample was received; medline provided the secureportiv samples to the vendor for evaluation, reviewed the dhr and pack build for the kit, and the vendor reviewed production records.The complaint was confirmed.Based on the vendor's evaluation of the sample as well as their manufacturing process for the component, they confirmed that a root cause for the reported issue is most likely due to equipment maintenance; preventative actions have been implemented to address the issue, and the supplier quality team will monitor this issue for trending purposes.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.
Event or Problem Description
It was reported that "we have seen at least 6 picc packs where the secureportiv have been activated.They do not appear cracked or broken, just already popped and unable to be used.".

• Brand Name: MEDLINE
• Common Device Name: PICC LINE INSERTION PACK
• Manufacturer (Section D): Medline Industries, LP; three lakes drive; northfield IL 60093 -275
• Manufacturer Contact: shravan ingole ; three lakes drive; northfield, IL 60093--275
• MDR Report Key: 50943989
• Report Number: 1417592-2026-53987
• Device Sequence Number: 13167707
• Product Code: LRO
• UDI-Device Identifier: 40198459036836
• UDI-Public: 40198459036836
• Combination Product (Y/N): N
• Initial Reporter State: CO
• 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): 09/28/2026

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: DYNJ38868N
• Device Lot Number: 24IBV068
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 01/27/2025
• 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: 12/17/2024
• Initial Report FDA Received Date: 09/30/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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