MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2014-03-21 for AMS 700 * manufactured by American Medical Systems, Inc..
[4270124]
Inflatable penile prosthesis (ipp) was removed. Operative report simply says "malfunction". Manufacturer is finalizing the return of both devices involved in this incident.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3702970 |
| MDR Report Key | 3702970 |
| Date Received | 2014-03-21 |
| Date of Report | 2014-03-21 |
| Date of Event | 2014-03-13 |
| Report Date | 2014-03-21 |
| Date Reported to FDA | 2014-03-21 |
| Date Reported to Mfgr | 2014-03-27 |
| Date Added to Maude | 2014-03-27 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | AMS 700 |
| Generic Name | PROSTHESIS, PENIS, INFLATABLE |
| Product Code | JCW |
| Date Received | 2014-03-21 |
| Model Number | * |
| Catalog Number | * |
| Lot Number | 72401850 |
| ID Number | * |
| Device Availability | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AMERICAN MEDICAL SYSTEMS, INC. |
| Manufacturer Address | 10700 BREN RD., W MINNETONKA MN 55343 US 55343 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2014-03-21 |