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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION Conceal; prosthesis, penis, inflatable

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BOSTON SCIENTIFIC CORPORATION Conceal; prosthesis, penis, inflatable Back to Search Results
Model Number 720185-01
Medical Device Problem Code Migration (4003)
Health Effect - Clinical Code Pain (1994)
Date of Event 05/28/2026
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
The device is not available for analysis; therefore, no physical or visual analysis of the product could be performed.There was no report of a device performance allegation.The reported patient symptom is a known risk associated with this device type and indicated as such in the instructions for use.Based on the information available, a conclusion code of known inherent risk of device was assigned to this investigation.
 
Event or Problem Description
It was reported that the patient with this inflatable penile prosthesis (ipp) experienced pain.The reservoir migrated to the abdominal area.As a result, the reservoir was explanted and replaced.No further patient complications were reported.
 
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Brand Name
Conceal
Common Device Name
prosthesis, penis, inflatable
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 Key25631194
Report Number2124215-2026-34092
Device Sequence Number15841051
Product Code JCW
UDI-Device Identifier00878953005669
UDI-Public(01)00878953005669(17)270529(10)1100737386
Combination Product (Y/N)Y
Initial Reporter StateMS
Initial Reporter CountryUS
PMA/510(K) Number
N970012
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2025
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Health Professional,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 08/17/2026
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? No
Operator of Device Lay User/Patient
Device Model Number720185-01
Device Catalogue Number720185-01
Device Lot Number1100737386
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 05/28/2026
Supplement Date Received by Manufacturer07/20/2026
Initial Report FDA Received Date06/25/2026
Supplement Report FDA Received Date08/17/2026
Date Device Manufactured05/29/2025
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 Number1
Outcome Attributed to Adverse Event Required Intervention; Hospitalization;
Patient Age66 YR
Patient SexMale
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