FDA Adverse Event Other Summary report: N

AMERICAN MEDICAL SYSTEMS

MDR report key: 501901 · Received November 21, 2003

Report

Report Number
MW1030410
Event Type
Other
Date Received
November 21, 2003
Date of Event
October 23, 2003
Report Date
November 18, 2003
Manufacturer
AMERICAN MEDICAL SYSTEMS
Product Code
FHW
Report Source
Voluntary report
Reporter Location
SC, US
Reporter Occupation
RISK MANAGER

Narratives

Description of Event or Problem · 1

FAILED IMPLANT PER MD.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 AMERICAN MEDICAL SYSTEMS PENILE IMPLANT FHW AMERICAN MEDICAL SYSTEMS UNK UNK

Patients

Seq Age Sex Outcome Treatment
1 58 YR Other