| Brand Name | Advanta 2 Bed |
| Common Device Name | BED, AC-POWERED ADJUSTABLE HOSPITAL |
| Manufacturer (Section D) |
| BAXTER HEALTHCARE CORPORATION |
| deerfield IL |
|
| Manufacturer (Section G) |
| HILL-ROM MEXICO |
| ave.del telefono |
| no. 200 col. huinala |
| apodaca, nuevo leon NA 66640 |
|
MX
66640
|
|
| Manufacturer Contact |
|
|
| 25212 w. illinois route 120 |
| round lake, IL 60073
|
|
+1(224)270-5355
|
|
| MDR Report Key | 50593087 |
| Report Number | 3006697241-2026-00325 |
| Device Sequence Number | 10103595 |
| Product Code |
FNL
|
| UDI-Device Identifier | 00887761000933 |
| UDI-Public | (01)00887761000933(11)170614 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NE |
| Initial Reporter Country | US |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Company Representative |
| 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? |
No
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Other
|
| Device Model Number | P1190A |
| Device Catalogue Number | P1190A000016 |
| Device Lot Number | N/A |
| Was Device Available for Evaluation? |
Yes
|
| Date Returned to Manufacturer | 08/14/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 09/03/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 06/14/2017 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|