MAUDE Adverse Event Report: COLOPLAST A/S TITAN TOUCH INFR ZERO ANG 18CM; INFLATABLE PENILE PROSTHESIS

Model Number ES28182400

Device Problem Connection Problem (2900)

Patient Problem No Information (3190)

Event Date 08/26/2019

Event Type  Injury  

Manufacturer Narrative

The device was not received for evaluation as it remains implanted.Without the benefit of analyzing the device, quality cannot confirm any observations or comment on the condition of the product.If the device becomes available, or additional information is received, the complaint will be re-evaluated according to procedures.A review of the device history record confirmed the devices from this lot met all specifications prior to release.A review of the complaint history database, nonconformances and capas revealed no trends for this lot.

Event Description

According to the available information the penile implant was revised due to a malfunction.Additional information indicated that there appeared to be a leak somewhere in the system.When an incision was made and tubing was exposed, the connector was found to have dislodged.When the tubing was connected, the tubing was not inserted entirely which resulted in a missed connection with the pump and reservoir junction.The tubing was re-spliced and new connectors were inserted and snapped together.

• Brand Name: TITAN TOUCH INFR ZERO ANG 18CM
• Type of Device: INFLATABLE PENILE PROSTHESIS
• Manufacturer (Section D): COLOPLAST A/S; holtedam 1; humlebaek, 3050 ; DA 3050
• Manufacturer (Section G): COLOPLAST MANUFACTURING US, LLC; 1601 west rivier road north; minneapolis MN 55411
• Manufacturer Contact: stephanie perryman ; 1601 west rivier road north; minneapolis, MN 55411 ; 6124345685
• MDR Report Key: 8982243
• MDR Text Key: 157127535
• Report Number: 2125050-2019-00722
• Device Sequence Number: 1
• Product Code: FHW
• UDI-Device Identifier: 05708932539128
• UDI-Public: 05708932539128
• Combination Product (y/n): N
• PMA/PMN Number: P000006
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional
• Type of Report: Initial
• Report Date: 09/05/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/10/2019
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Model Number: ES28182400
• Device Catalogue Number: ES2818
• Device Lot Number: 5673518
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/26/2019
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 47 YR