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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: Allergan (Costa Rica) Style 68 Saline Filled Breast Implant; prosthesis, breast, inflatable, internal, saline

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Allergan (Costa Rica) Style 68 Saline Filled Breast Implant; prosthesis, breast, inflatable, internal, saline Back to Search Results
Catalog Number 68-270
Medical Device Problem Code Fluid/Blood Leak (1250)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/08/2026
Type of Reportable Event Serious Injury
Event or Problem Description
Healthcare professional reported "deflation".Later healthcare professional reported "leak".This record is for the right side.The device was explanted.
 
Event or Problem Description
Healthcare professional reported "deflation".Later healthcare professional reported "leak".This record is for the right side.The device was explanted.
 
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.Further information from the reporter regarding event, product, or patient details has been requested.No additional information is available at this time.Reason for reoperation: deflation.
 
Additional Manufacturer Narrative
Additional, changed, and/or corrected data: d.9, h.3, h.6 device evaluation: per the investigation procedure, the device is analyzed through visual inspection microscopic inspection if openings are observed and a weight verification.Per the analysis performed, the assessments of the complaints and any potential manufacturing issue are displayed along with any further actions required: ¿ deflation: observed an opening through microscopic inspection assessed as unidentified (tear) opening.No further actions are required as it is not related to the manufacturing process.None of the other observations performed during the device analysis creases are found to be potentially related to the manufacturing process, and, therefore, no further actions are required for these observations.
 
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Brand Name
Style 68 Saline Filled Breast Implant
Common Device Name
prosthesis, breast, inflatable, internal, saline
Manufacturer (Section D)
Allergan (Costa Rica)
900 parkway global park
zona franca
la aurora de heredia
CS 
Manufacturer (Section G)
Allergan (Costa Rica)
900 parkway global park
zona franca
la aurora de heredia
CS  
Manufacturer Contact
terry ingram
2525 dupont drive
irvine, CA 92612
+1(847)936-6324
MDR Report Key50122463
Report Number9617229-2026-14560
Device Sequence Number5636641
Product Code FWM
UDI-Device Identifier10888628000209
UDI-Public(01)10888628000209(17)170215
Combination Product (Y/N)N
Initial Reporter StateOH
Initial Reporter CountryUS
PMA/510(K) Number
P990074
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2013
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Physician
Type of Report Initial
Report Date (Section B) 08/03/2026
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? Yes
Operator of Device Health Professional
Device Expiration Date02/15/2017
Device Catalogue Number68-270
Device Lot Number2432861
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Initial Date Received by Manufacturer 07/09/2026
Initial Report FDA Received Date08/03/2026
Date Device Manufactured03/15/2013
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;
Patient Age47 YR
Patient SexFemale
Patient Weight148 LB
Patient RaceWhite
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