• 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 INFLATABLE PENILE PROSTHESIS; DEVICE IMPOTENCE MECHANICAL/HYDRAULIC

  • 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 INFLATABLE PENILE PROSTHESIS; DEVICE IMPOTENCE MECHANICAL/HYDRAULIC Back to Search Results
Model Number 72404310
Device Problems Failure to Cycle (1142); Connection Problem (2900)
Patient Problem Discomfort (2330)
Event Date 07/27/2019
Event Type  Injury  
Event Description
It was reported that the patient experienced a pump connector disorder with an inflatable penile prosthesis (ipp).The ipp pump, cylinder, and reservoir was explanted and a new ipp pump, cylinder and reservoir was implanted.Additional information was reported that the connector had been worn down, and the patient had difficulties cycling the device.Should additional relevant details become available or the product was returned, a supplemental report will be submitted upon completion of product analysis.
 
Event Description
It was reported that the patient experienced a pump connector disorder with an inflatable penile prosthesis (ipp).The ipp pump, cylinder, and reservoir was explanted and a new ipp pump, cylinder and reservoir was implanted.Additional information was reported that the connector had been worn down, and the patient had difficulties cycling the device.Should additional relevant details become available or the product was returned, a supplemental report will be submitted upon completion of product analysis.
 
Manufacturer Narrative
Device analysis: connector disorder was reported.No connectors were received.The ams700 momentary squeeze pump was visually inspected.No leak was found.The pump was not functionally tested due to contamination.The allegation of connector disorder could not be confirmed as no connectors were returned.No device malfunction was confirmed for the pump component.Based on the results of this investigation, no escalation is required.If further information is received at a later date, the product investigation will be reopened to address the additional information.
 
Search Alerts/Recalls

  New Search  |  Submit an Adverse Event Report

Brand Name
AMS INFLATABLE PENILE PROSTHESIS
Type of Device
DEVICE IMPOTENCE MECHANICAL/HYDRAULIC
Manufacturer (Section D)
BOSTON SCIENTIFIC CORPORATION
10700 bren road w
minnetonka MN 55343
MDR Report Key8915176
MDR Text Key155031022
Report Number2183959-2019-65758
Device Sequence Number1
Product Code FHW
UDI-Device Identifier00878953003986
UDI-Public00878953003986
Combination Product (y/n)N
PMA/PMN Number
N970012
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type foreign,health professional
Type of Report Initial,Followup
Report Date 10/21/2019
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
Device Operator Lay User/Patient
Device Expiration Date02/06/2021
Device Model Number72404310
Device Catalogue Number72404310
Device Lot Number120127004
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer09/09/2019
Initial Date Manufacturer Received 08/05/2019
Initial Date FDA Received08/21/2019
Supplement Dates Manufacturer Received10/08/2019
Supplement Dates FDA Received10/21/2019
Patient Sequence Number1
Patient Outcome(s) Hospitalization; Required Intervention;
Patient Age65 YR
-
-