BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HYALURONIC ACID SYRINGE PEN

    MDR report key: 12138072 · Received July 7, 2021

    Report

    Report Number
    MW5102398
    Event Type
    Injury
    Date Received
    July 7, 2021
    Date of Event
    April 19, 2021
    Report Date
    July 2, 2021
    Manufacturer
    UNK
    Product Code
    NSC
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    LIPO LAB PPC SOLUTION ((B)(4) PRODUCT): PHOSPHATIDYCHOLINE, DEOXYCHOLATE. YIPNER (MADE IN (B)(4)).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1023045 HYALURONIC ACID SYRINGE PEN PEN INJECTOR NSC UNK 0220210415

    Patients

    Seq Age Sex Outcome Treatment
    1 24 YR Hospitalization