MAUDE Adverse Event Report: COLOPLAST A/S TITAN TOUCH NB INFR ZERO 14CM; INFLATABLE PENILE PROSTHESIS

Model Number	EN28142400
Medical Device Problem Code	Inflation Problem (1310)
Health Effect - Clinical Codes	No Information (3190); No Code Available (3191)
Date of Event	11/07/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Without the benefit of examination and testing, coloplast is precluded from commenting on the condition of the device or the cause of the occurrence.Should additional facts prompt us to alter or supplement any information of conclusions contained in the original mdr or in any prior supplemental reports, a follow-up report will be submitted.
Event or Problem Description
According tot he available information, 14 cm titan touch was explanted because it was too short.Patient was revised with 20 cm titan touch.
Additional Manufacturer Narrative
This follow-up mdr is created to document additional information.
Event or Problem Description
Additional information received: difficulty to pump.The device is not available for return to coloplast.Device was replaced with another titan.No infection.
Additional Manufacturer Narrative
This follow-up mdr is created to document the conclusion of the investigation.A device was received in a condition making evaluation impossible.However, because quality's examination may not conclusively confirm or disprove the report of incorrect sizing, quality accepts the physician's observations of such as the reason for surgical intervention.Quality reviewed the manufacturing records for this device and confirmed that there were no discrepancies that would have contributed to this complaint and verified that the devices from this lot met all specifications prior to release.Review of nonconforming reports revealed no nonconformance with this lot that would have contributed to the event.A review of the complaint database revealed no significant trends in complaints of this type for lot 4028728.The most likely root cause of the event cannot be determined at this time.If additional information is received, quality will re-evaluate this complaint in accordance to procedures.Management routinely reviews events such as this and monitors complaint levels.Additionally, events of this type are captured in the product risk documentation.Based on this information, no further corrective action is required at this time.

• Brand Name: TITAN TOUCH NB INFR ZERO 14CM
• Common Device Name: INFLATABLE PENILE PROSTHESIS
• Manufacturer (Section D): COLOPLAST A/S; holtedam 1; humlebaek, 3050 ; DA 3050
• MDR Report Key: 7045373
• Report Number: 2125050-2017-00580
• Device Sequence Number: 1358526
• Product Code: FHW
• UDI-Device Identifier: 05708932539074
• UDI-Public: 05708932539074
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: P000006
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2015
• Device Explanted Year: 2017
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 06/15/2018

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 Number: EN28142400
• Device Catalogue Number: EN28142400
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/01/2018
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 11/07/2017
• Supplement Date Received by Manufacturer: 11/07/2017; 11/07/2017
• Initial Report FDA Received Date: 11/20/2017
• Supplement Report FDA Received Date: 01/08/2018; 06/21/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Age: 71 YR