MAUDE Adverse Event Report: BOSTON SCIENTIFIC CORPORATION AMS 800 Artificial Urinary Sphincter; Device incontinence mechanical/hydraulic

Model Number	72404131
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	Pain (1994)
Date of Event	09/11/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Correction to g2: report source\ \ model number/catalog number: 72400024\ serial number: n/a \ batch/lot number: 1100634467\ model/catalog description: balloon fgs 61-70 cm\ unique identifier (udi) #: ((b)(4) \ \ model number/catalog number: 72404127\ serial number: n/a \ batch/lot number: 1100710614\ model/catalog description: control pump fgs iz\ 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 prior to distribution.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.A risk review was completed and confirmed that the event of pain and mechanical issue was 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 the cause that contributed to the reported event cannot be established.Therefore, a conclusion code of cause not established was assigned to this investigation.
Additional Manufacturer Narrative
Concomitant products implanted at the time of the event:\ model number/catalog number: 72400024.\ serial number: (b)(6).\ batch/lot number: 1100634467.\ model/catalog description: balloon fgs 61-70 cm.\ unique identifier (udi) #: (b)(4).\ \ model number/catalog number: 72404127.\ serial number: n/a.\ batch/lot number: 1100710614.\ model/catalog description: control pump fgs iz.\ unique identifier (udi) #: (b)(4).
Event or Problem Description
It was reported that a patient with an artificial urinary sphincter (aus) stated his device stopped functioning following implantation.The patient also stated he experienced pain.A surgical procedure was performed to remove the aus.No additional information was provided.
Event or Problem Description
It was reported that a patient with an artificial urinary sphincter (aus) stated his device stopped functioning following implantation.The patient also stated he experienced pain.A surgical procedure was performed to remove the aus.No additional information was provided.

• Brand Name: AMS 800 Artificial Urinary Sphincter
• Common Device Name: Device incontinence mechanical/hydraulic
• 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 Key: 50843111
• Report Number: 2124215-2026-50232
• Device Sequence Number: 10060579
• Product Code: EZY
• UDI-Device Identifier: 00878953003092
• Combination Product (Y/N): Y
• Initial Reporter Country: US
• PMA/510(K) Number: P000053
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 09/21/2026

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 Date: 08/10/2026
• Device Model Number: 72404131
• Device Catalogue Number: 72404131
• Device Lot Number: 1100567338
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/25/2026
• Initial Report FDA Received Date: 09/21/2026
• Date Device Manufactured: 08/10/2024
• 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: Required Intervention; Hospitalization
• Patient Age: 71 YR
• Patient Sex: Male