MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION AMS 700 INFLATABLE PENILE PROSTHESIS WITH TENACIO PUMP WITH INHIBIZONE; DEVICE IMPOTENCE MECHANICAL/HYDRAULIC

Model Number	72404429
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/22/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that the patient did not like the tenacio pump connected to his inflatable penile prosthesis (ipp) device because he felt it was hard to grip and slippery.The ipp cylinders and pump were explanted, and a new set of preconnected cylinders and pump were connected to the existing reservoir.There were no patient complications.
Event or Problem Description
It was reported that the patient did not like the tenacio pump connected to his inflatable penile prosthesis (ipp) device because he felt it was hard to grip and slippery.The ipp cylinders and pump were explanted, and a new set of preconnected cylinders and pump were connected to the existing reservoir.There were no patient complications.

• Brand Name: AMS 700 INFLATABLE PENILE PROSTHESIS WITH TENACIO PUMP WITH INHIBIZONE
• Common Device Name: DEVICE IMPOTENCE MECHANICAL/HYDRAULIC
• Manufacturer (Section D): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer (Section G): BOSTON SCIENTIFIC CORPORATION; 300 boston scientific way; marlborough MA 01752
• Manufacturer Contact: farshad fahimi ; 4100 hamline avenue north; building c; saint paul, MN 55112
• MDR Report Key: 20217364
• Report Number: 2124215-2024-57349
• Device Sequence Number: 7202745
• Product Code: FHW
• UDI-Device Identifier: 00191506021306
• UDI-Public: 00191506021306
• Combination Product (Y/N): Y
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: N970012
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 10/23/2024

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 03/28/2026
• Device Model Number: 72404429
• Device Catalogue Number: 72404429
• Device Lot Number: 1100480363
• 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: 08/22/2024
• Supplement Date Received by Manufacturer: 10/03/2024
• Initial Report FDA Received Date: 09/13/2024
• Supplement Report FDA Received Date: 10/23/2024
• Date Device Manufactured: 03/28/2024
• 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: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 59 YR
• Patient Sex: Male