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

Model Number ES28182400

Device Problem Device Appears to Trigger Rejection (1524)

Patient Problem No Information (3190)

Event Date 09/18/2019

Event Type  Injury  

Manufacturer Narrative

The lot number was reviewed for complaint trend, nonconforming reports and capa review.No trends were noted.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 or conclusions contained in the original mdr or in any prior supplemental reports, a follow-up report will be submitted.

Event Description

According to the available information.Functioning implant extruded through proximal corpora.

Manufacturer Narrative

This follow-up was created to document the updated device information.A touch pump and two cylinders were received for evaluation.As examination of the device may not conclusively confirm or disprove the report of extrusion quality accepts the physician's observations as to the reason for surgical intervention.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.

• 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
• MDR Report Key: 9204933
• MDR Text Key: 162816636
• Report Number: 2125050-2019-00882
• Device Sequence Number: 1
• Product Code: FHW
• UDI-Device Identifier: 05708932539074
• UDI-Public: 05708932539074
• Combination Product (y/n): N
• PMA/PMN Number: P000006
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative
• Type of Report: Initial,Followup
• Report Date: 11/20/2019

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?: No
• Device Operator: Lay User/Patient
• Device Model Number: ES28182400
• Device Catalogue Number: ES2818
• Device Lot Number: 5537090
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/31/2019
• Initial Date Manufacturer Received: 09/18/2019
• Initial Date FDA Received: 10/17/2019
• Supplement Dates Manufacturer Received: 09/18/2019
• Supplement Dates FDA Received: 11/20/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 72 YR