BEUDAMED
    FDA Adverse Event Other Summary report: N

    COREGA ADHESIVE STRIPS

    MDR report key: 1182393 · Received September 22, 2008

    Report

    Report Number
    1020379-2008-00003
    Event Type
    Other
    Date Received
    September 22, 2008
    Report Date
    September 22, 2008
    Manufacturer
    GLAXOSMITHKLINE RTP
    Product Code
    KOL
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THIS REPORT IS NOT MEDICALLY CONFIRMED AND CONSENT TO CONTACT THE PATIENT'S TREATING PHYSICIAN IS CURRENTLY BEING SOUGHT. THE MANUFACTURER REPORT ID NUMBER FOR THIS CASE IS 1020379-2008-00003. POLIGRIP STRIPS ARE MANUFACTURED IN (B) (4). THE LOT NUMBER FOR THIS PRODUCT IS AVAILABLE AND QUALITY TESTING IS PENDING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COREGA ADHESIVE STRIPS DENTURE ADHESIVE STRIPS KOL GLAXOSMITHKLINE RTP 805001402660080000

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Other