AMS AMBICOR PENILE PROSTHESIS 72401450

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2020-03-31 for AMS AMBICOR PENILE PROSTHESIS 72401450 manufactured by Boston Scientific Corporation.

Event Text Entries

[188481295] It was reported that the during replacement procedure of another manufacturer device, the ambicor penile prosthesis (app) that they tried was malfunctioning, it would not pump completely.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2183959-2020-01782
MDR Report Key9908261
Report SourceHEALTH PROFESSIONAL
Date Received2020-03-31
Date of Report2020-03-31
Date of Event2020-03-17
Date Mfgr Received2020-03-17
Device Manufacturer Date2018-11-12
Date Added to Maude2020-03-31
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactALYSON HARRIS
Manufacturer Street10700 BREN ROAD W
Manufacturer CityMINNETONKA MN 55343
Manufacturer CountryUS
Manufacturer Postal55343
Manufacturer Phone4089353452
Manufacturer G1BOSTON SCIENTIFIC CORPORATION
Manufacturer Street10700 BREN ROAD WEST
Manufacturer CityMINNETONKA MN 55343
Manufacturer CountryUS
Manufacturer Postal Code55343
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameAMS AMBICOR PENILE PROSTHESIS
Generic NameDEVICE IMPOTENCE MECHANICAL/HYDRAULIC
Product CodeFHW
Date Received2020-03-31
Returned To Mfg2020-03-31
Model Number72401450
Catalog Number72401450
Lot Number1000190999
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerBOSTON SCIENTIFIC CORPORATION
Manufacturer Address10700 BREN ROAD W MINNETONKA MN 55343 US 55343


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-31

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