FDA Adverse Event Injury Summary report: N

JUVEDERM ULTRA

MDR report key: 1062087 · Received June 17, 2008

Report

Report Number
3005113652-2008-00037
Event Type
Injury
Date Received
June 17, 2008
Date of Event
June 25, 2007
Report Date
May 21, 2008
Manufacturer
PRINGY
Product Code
LMH
PMA / PMN Number
P050047
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
LA, US
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

APPROX ONE YEAR AFTER TREATMENT WITH JUVEDERM ULTRA IN THE FOREHEAD AND NASOLABIAL FOLDS, THE PT EXPERIENCED SWELLING AND BLANCHING AT TREATMENT SITE. A HARD LUMP HAS REMAINED ON THE FOREHEAD, AND THERE IS WHITE SKIN DISCOLORATION. NO MEDICATION WAS PRESCRIBED. FOLLOW UP FINDINGS: THE PT STATES THAT A PHYSICIAN WHO IS NOT THE INITIAL TREATING PHYSICIAN NOTED THAT THE PRODUCT WAS INJECTED TOO SUPERFICIALLY AND NOTED A LUMP IN THE PT'S FOREHEAD AND NASOLABIAL FOLD. FOLLOW UP FINDINGS: RECENT FOLLOW UP WITH THE TREATING PHYSICIAN NOTES THAT THE PT HAS NUMEROUS HEALTH ISSUES, HAS TAKEN MANY CONCOMITANT MEDICAL THERAPIES, AND IS NOT PSYCHOLOGICALLY SOUND. THE PHYSICIAN NOTED EDEMA AFTER TREATMENT WITH JUVEDERM ULTRA WHICH RESOLVED WITHIN A WEEK AFTER TREATMENT. THE PHYSICIAN STATED THE INJECTION MAY HAVE BEEN TOO SUPERFICIAL OR IS A POSSIBLE GRANULOMA, ALTHOUGH NO LAB TESTS WERE REPORTEDLY DONE. THE TREATING PHYSICIAN NOTES THAT ANOTHER PHYSICIAN ATTEMPTED TO REDUCE THE LUMP BY TAKING A NEEDLE TO IT. ALLERGAN WILL FOLLOW UP WITH THE PHYSICIAN WHO IS NOT THE TREATING PHYSICIAN FOR ANY ADD'L INFO. RECENT FOLLOW UP FROM THE TREATING PHYSICIAN NOTES THAT BLANCHING, EDEMA, AND PAIN HAVE RESOLVED. THE TREATING PHYSICIAN PRESCRIBED NO TREATMENTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 JUVEDERM ULTRA JUVEDERM LMH PRINGY NA HV24243247

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention VICOPROFEN| HYDROCODONE| NEXIUM| LANTUS| NOVOLOG