This Medium Cuff replacement for OMRON Blood pressure Monitor devices is listed as opened never used as the packaging is just so, with a very minor cosmetic damage. The item inside however is in a pristine condition, showing no signs of damage or previous use. It has been tested using a mini pump and i am pleased to say hold air perfectly with no leakages at all. It comes with all spare nozzle adaptors and the user manual, all of which are in a fine condition. Please see images.