MAUDE Adverse Event Report: UMANO MEDICAL INC. FLORENCE; AC-POWER AJDUSTABLE MEDICAL BED

Model Number	FL23SE-STD
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/06/2021
Type of Reportable Event	Malfunction
Event or Problem Description
The manufacturer was informed on (b)(6) 2021, of an alleged reduced brake force.There was no patient involvement.

• Brand Name: FLORENCE
• Common Device Name: AC-POWER AJDUSTABLE MEDICAL BED
• Manufacturer (Section D): UMANO MEDICAL INC.; 230 boulevard nilus-leclerc; l'islet, qc G0R 2 C0; CA G0R 2C0
• MDR Report Key: 12505226
• Report Number: 3009591865-2021-00021
• Device Sequence Number: 4068160
• Product Code: FNL
• UDI-Device Identifier: 10670482000040
• UDI-Public: 011067048200004011130409
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: distributor
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 09/21/2021

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: No Information
• Device Model Number: FL23SE-STD
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/02/2021
• Initial Report FDA Received Date: 09/21/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1