| Brand Name | TACTRA |
| Common Device Name | PROSTHESIS PENILE |
| Manufacturer (Section D) |
| BOSTON SCIENTIFIC CORPORATION |
| 300 boston scientific way |
| marlborough MA 01752 |
|
| Manufacturer (Section G) |
| BOSTON SCIENTIFIC CORPORATION |
| cashel road |
|
| clonmel |
|
EI
|
|
| Manufacturer Contact |
|
farshad
fahimi
|
| 4100 hamline avenue north |
| building c |
| saint paul, MN 55112
|
|
| MDR Report Key | 23322219 |
| Report Number | 2124215-2025-73598 |
| Device Sequence Number | 21319373 |
| Product Code |
FAE
|
| UDI-Device Identifier | 08714729979357 |
| UDI-Public | (01)08714729979357(17)290321(10)40184180 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | IN |
| PMA/510(K) Number | K183619 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2024 |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Foreign,Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
10/17/2025 |
| 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 |
Lay User/Patient
|
| Device Model Number | 720081-01 |
| Device Catalogue Number | 720081-01 |
| Device Lot Number | 0040184180 |
| 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 | 09/25/2025 |
| Initial Report FDA Received Date | 10/17/2025 |
| Date Device Manufactured | 03/22/2024 |
| 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 | 54 YR |
| Patient Sex | Male |