| Brand Name | Parker Flex-Tip |
| Common Device Name | Parker Trach Vac with Flex-Tip and PVC Cuff (H-PFTVVC), 8.0mm |
| Manufacturer (Section D) |
| Salter Labs |
| 30 spur drive |
| el paso TX 79906 |
|
| 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 | 50600214 |
| Report Number | 3004748541-2026-00152 |
| Device Sequence Number | 10711581 |
| Product Code |
BTR
|
| UDI-Device Identifier | 10749065191755 |
| UDI-Public | (01)10749065191755 |
| 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 |
| Report Date (Section B) |
09/03/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
No
|
| Operator of Device |
Health Professional
|
| Device Model Number | I-PFTVVCS-75-100 (H-PFTVVCS-75-100) |
| Device Catalogue Number | I-PFTVVCS-75-100 (H-PFTVVCS-75 |
| Device Lot Number | Unknown |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 09/04/2026 |
| 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 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Unknown |