BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PARKER

    MDR report key: 23501760 · Received November 7, 2025

    Report

    Report Number
    3004748541-2025-00114
    Event Type
    Malfunction
    Date Received
    November 7, 2025
    Date of Event
    September 25, 2025
    Report Date
    March 4, 2026
    Manufacturer
    PARKER MEDICAL
    Product Code
    BTR
    UDI-DI
    00607411952746
    PMA / PMN Number
    K984528
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    THE PRODUCT INVOLVED IN THE REPORT HAS NOT BEEN RETURNED FOR EVALUATION. A REVIEW OF THE DEVICE HISTORY RECORD IS NOT POSSIBLE AS NO LOT NUMBER WAS PROVIDED. THE DOCUMENTED UDI IS BASED ON THE STOCK/PRODUCT CODE PROVIDED BY THE REPORTER; THE UDI-PI IS NOT AVAILABLE AS NO LOT NUMBER WAS PROVIDED. ALL INFORMATION REASONABLY KNOWN AS OF 07 NOV 2025 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AIRLIFE. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AIRLIFE. AIRLIFE HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AIRLIFE COMPLAINT DATABASE AND IDENTIFIED AS (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21 CFR 803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT AN AIRLIFE. PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY RISK ASSESSMENT THE ULTIMATE RISK IS LOW, AS THAT IS THE HIGHEST RISK OF THE PATIENT/CAREGIVER AND REGULATORY/COMPLIANCE CONSIDERATIONS: 1. PATIENT/ CAREGIVER PERFORMED RISK ASSESSMENT WITH RMA-20024B REV 3. THE COMPLAINT MOST CLOSELY ALIGNS WITH RISK ID R36 WITH A POTENTIAL CAUSE OF HAZARD BEING "THE INFLATION LINE FOR THE CUFF DISCONNECTS FROM THE TUBE". SEVERITY = 6, LIKELIHOOD OF OCCURRENCE = 2, CALCULATED OCCURRENCE = (B)(4). PER REF-20001-C1 REV 2, THESE LEVELS INDICATE LOW RISK. 2. REGULATORY/ COMPLIANCE: REVIEWED REF-20001-C1 REV 2, AND THERE IS LOW REGULATORY/ COMPLIANCE RISK. 3. BRAND RECOGNITION AND CUSTOMER IMPACT: REVIEWED REF-20001-C1 REV 2, AND THERE IS LOW BRAND RECOGNITION/CUSTOMER IMPACT. DEVICE HISTORY RECORD (DHR) REVIEW: NO LOT NUMBER WAS PROVIDED; THEREFORE, NO DEVICE HISTORY RECORD (DHR) REVIEW WAS CONDUCTED. COMPLAINT HISTORY REVIEW: THE COMPLAINT HISTORY WAS REVIEWED IN GRAND AVENUE FROM REPORTED DATES (B)(6) 2023 THROUGH (B)(6) 2025, FOR PART NUMBER I-PFHV-75 AND FAILURE MODE "A1202 - DECOUPLING". THERE WERE 3 OTHER COMPLAINTS REPORTED FOR THE SAME ISSUE AND PART NUMBER UNDER (B)(4) DURING THE SAME TIMEFRAME. SALES = (B)(4) EA. CALCULATED OCCURRENCE (P1) = (B)(4). OCCURRENCE RANKING = 3.

    Additional Manufacturer Narrative · 0

    THE PRODUCT INVOLVED IN THE REPORT HAS NOT BEEN RETURNED FOR EVALUATION A REVIEW OF THE DEVICE HISTORY RECORD IS NOT POSSIBLE AS NO LOT NUMBER WAS PROVIDED. THE DOCUMENTED UDI IS BASED ON THE STOCK/PRODUCT CODE PROVIDED BY THE REPORTER; THE UDI-PI IS NOT AVAILABLE AS NO LOT NUMBER WAS PROVIDED ALL INFORMATION REASONABLY KNOWN AS OF 07 NOV 2025 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AIRLIFE. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AIRLIFE. AIRLIFE HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AIRLIFE COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT-(B)(4) THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT AN AIRLIFE. PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT INFLATING TUBE DETACHED.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT INFLATING TUBE DETACHED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    55733 PARKER ENDOTRACHEAL TUBE, HIGH VOLUME LOW PRESSURE (PFHV), CUFFED, PARKER, 7.5MM BTR PARKER MEDICAL I-PFHV-75 (H-PFHV-75) UNKNOWN 00607411952746

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown Other