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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 68-510
Medical Device Problem Code Fluid/Blood Leak (1250)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 07/17/2026
Type of Reportable Event Serious Injury
Event or Problem Description
Healthcare professional reported "deflation".This record is for the left side.Device was explanted.
 
Event or Problem Description
Healthcare professional reported "deflation".This record is for the left side.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: d9, h3, h6.Device evaluation: per the investigation procedure, the device is analyzed through visual inspection microscopic inspection if openings are observed and a weight verification (if applicable).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 Key50173481
Report Number9617229-2026-14841
Device Sequence Number15924458
Product Code FWM
UDI-Device Identifier10888628000285
UDI-Public(01)10888628000285(17)110627
Combination Product (Y/N)N
Initial Reporter StateFL
Initial Reporter CountryUS
PMA/510(K) Number
P990074
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2007
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 10/02/2026
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 Date06/27/2011
Device Catalogue Number68-510
Device Lot Number1469043
Was Device Available for Evaluation? Yes
Date Returned to Manufacturer09/14/2026
Is the Reporter a Health Professional? Yes
Initial Date Received by Manufacturer 07/17/2026
Supplement Date Received by Manufacturer09/22/2026
Initial Report FDA Received Date08/07/2026
Supplement Report FDA Received Date10/02/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured07/31/2007
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 Age54 YR
Patient SexFemale
Patient Weight110 LB
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