• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION AMS 700 CX MS Pump; prosthesis, penis, inflatable

  • Print
  • Share
  • E-mail
-
Super Search Devices@FDA
510(k) | DeNovo | Registration & Listing | Adverse Events | Recalls | PMA | HDE | Classification | Standards
CFR Title 21 | Radiation-Emitting Products | X-Ray Assembler | Medsun Reports | CLIA | TPLC
 

BOSTON SCIENTIFIC CORPORATION AMS 700 CX MS Pump; prosthesis, penis, inflatable Back to Search Results
Model Number 72404234-14
Medical Device Problem Code Inadequacy of Device Shape and/or Size (1583)
Health Effect - Clinical Codes Pain (1994); Discomfort (2330)
Date of Event 04/22/2026
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that the patient with this inflatable penile prosthesis (ipp) experienced discomfort and pain associated with the left cylinder.A surgical procedure was performed, during which it was determined that the left cylinder was oversized.As a result, the ipp was explanted and replaced.No additional patient complications were reported.
 
Additional Manufacturer Narrative
Model number/catalog number: 720185-01.Serial number: n/a.Batch/lot number: 1100543471.Model/catalog description: reservoir flat iz 100 ml.Unique identifier (udi) #: (b)(4).
 
Event or Problem Description
It was reported that the patient with this inflatable penile prosthesis (ipp) experienced discomfort and pain associated with the left cylinder.A surgical procedure was performed, during which it was determined that the left cylinder was oversized.As a result, the ipp was explanted and replaced.No additional patient complications were reported.
 
Additional Manufacturer Narrative
Model number/catalog number: 720185-01.Serial number: n/a.Batch/lot number: 1100543471.Model/catalog description: reservoir flat iz 100 ml.Unique identifier (udi) #: (b)(4).The device is not available for analysis; therefore, no physical analysis of the product could be performed.The reported device performance allegation cannot be confirmed.The device history record (dhr) review confirmed that the device met all material, assembly and performance specifications.A review of the device instructions for use (ifu) was completed and did not reveal any evidence of device misuse, off label use, or failure to follow instructions.The patient symptoms of discomfort and pain are known risk associated with this device type/procedure, and it is noted as such as in the instructions for use.A risk review was completed and confirmed that the events of pain/discomfort and incorrect cylinder size were defined in the product risk documentation.This event type has been accounted for during analysis to support acceptable risk benefit for the product.Based on the information available, a conclusion code of caused not established was assigned to this investigation.
 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand Name
AMS 700 CX MS Pump
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 Key25857810
Report Number2124215-2026-38495
Device Sequence Number5456502
Product Code JCW
UDI-Device Identifier00878953009803
UDI-Public(01)00878953009803(17)260204(10)1100442143
Combination Product (Y/N)Y
Initial Reporter StateGA
Initial Reporter CountryUS
PMA/510(K) Number
N970012
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2024
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) 08/27/2026
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 Expiration Date02/04/2026
Device Model Number72404234-14
Device Catalogue Number72404234-14
Device Lot Number1100442143
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 06/23/2026
Supplement Date Received by Manufacturer07/28/2026
Initial Report FDA Received Date07/17/2026
Supplement Report FDA Received Date08/27/2026
Date Device Manufactured02/05/2024
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 Number1
Outcome Attributed to Adverse Event Hospitalization; Required Intervention;
Patient Age74 YR
Patient SexMale
-
-