MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2011-11-14 for AMS SPHINCTER 800 URINARY PROSTHESIS AUS 72404127 manufactured by American Medical Systems, Inc..
[2351621]
On (b)(6) 2011, an aus was implanted. It was reported on (b)(6) 2011, the pump component was removed due to the patient complaint of pain in the right testicle. The physician performed a microsurgical denervation of the right spermatic cord. A new pump was implanted in the left hemiscrotum.
Patient Sequence No: 1, Text Type: D, B5
[9463722]
Should additional information become available regarding this event, it will be reevaluated and a follow-up report will be sent.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2183959-2011-00530 |
| MDR Report Key | 2340035 |
| Report Source | 05 |
| Date Received | 2011-11-14 |
| Date of Report | 2011-10-21 |
| Date of Event | 2011-10-20 |
| Date Mfgr Received | 2011-10-21 |
| Device Manufacturer Date | 2011-07-01 |
| Date Added to Maude | 2011-11-18 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | JON CORNELL, SR. MANAGER |
| Manufacturer Street | 10700 BREN RD., WEST |
| Manufacturer City | MINNETONKA MN 55343 |
| Manufacturer Country | US |
| Manufacturer Postal | 55343 |
| Manufacturer Phone | 9529306670 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | AMS SPHINCTER 800 URINARY PROSTHESIS |
| Generic Name | ARTIFICIAL URINARY SPHINCTER |
| Product Code | FAG |
| Date Received | 2011-11-14 |
| Model Number | AUS |
| Catalog Number | 72404127 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AMERICAN MEDICAL SYSTEMS, INC. |
| Manufacturer Address | 10700 BREN RD., WEST MINNETONKA MN 55343 US 55343 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2011-11-14 |