MAUDE Adverse Event Report: Parker Medical Parker; Endotracheal Tube, High Volume Low Pressure (PFHV), Cuffed, Parker, 7.5mm

Model Number	H-PFHV-75 (I-PFHV-75)
Medical Device Problem Code	Disconnection (1171)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/28/2026
Type of Reportable Event	Malfunction

• Brand Name: Parker
• Common Device Name: Endotracheal Tube, High Volume Low Pressure (PFHV), Cuffed, Parker, 7.5mm
• Manufacturer (Section D): Parker Medical; 9457 s. university blvd.; pmb 331; highlands ranch CO 80126
• Manufacturer (Section G): Well Lead Medical Co., Ltd.; c-4 jinhu industrial estate,; hualong; panyu, guangzhou 51143 4; JA 511434
• Manufacturer Contact: candacy bush ; 2710 northridge dr. nw, suite a; grand rapids, MI 49544
• MDR Report Key: 25905926
• Report Number: 3004748541-2026-00139
• Device Sequence Number: 8385514
• Product Code: BTR
• UDI-Device Identifier: 10607411952743
• UDI-Public: (01)10607411952743
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K110269
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Distributor
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/20/2026

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
• Operator of Device: Health Professional
• Device Model Number: H-PFHV-75 (I-PFHV-75)
• Device Catalogue Number: H-PFHV-75 (I-PFHV-75)
• Device Lot Number: Unknown
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/26/2026
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 07/22/2026
• Supplement Report FDA Received Date: 08/20/2026
• 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
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown