FDA Adverse Event Other Summary report: N

POLIGRIP EXTRA STRENGTH

MDR report key: 1623544 · Received March 3, 2010

Report

Report Number
9681138-2010-00074
Event Type
Other
Date Received
March 3, 2010
Report Date
March 3, 2010
Manufacturer
GLAXOSMITHKLINE
Product Code
KOL
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
NOT APPLICABLE

Narratives

Description of Event or Problem · 1

THIS CASE WAS REPORTED BY A CONSUMER AND DESCRIBED THE OCCURRENCE OF ANEMIA IN A (B)(6) FEMALE PT WHO RECEIVED POLIGRIP EXTRA STRENGTH (B)(4) FOR DENTURE ADHESION. A PHYSICIAN OR OTHER HEALTHCARE PROFESSIONAL HAS NOT VERIFIED THIS REPORT. CONCURRENT MEDICAL CONDITIONS INCLUDED CODEINE ALLERGY AND HIGH BLOOD PRESSURE. CONCURRENT MEDICATIONS INCLUDED UNSPECIFIED ANTI-HYPERTENSIVE. ON AN UNK DATE, THE PT STARTED POLIGRIP EXTRA STRENGTH (DENTAL). AT AN UNK TIME AFTER STARTING POLIGRIP EXTRA STRENGTH, THE PT EXPERIENCED ANEMIA, TIREDNESS, FATIGUE, MUSCLE PAIN IN ARM, MUSCLE PAIN IN HAND, BLURRED VISION, DEPRESSION, PAIN IN RIGHT SIDE OF STOMACH AND FREQUENT HEADACHES. THE PT INDICATED SHE WAS OFF WORK FOR THREE MONTHS DUE TO THE DEPRESSION. THE MUSCLE PAIN AFFECTS HER BECAUSE SHE IS UNABLE TO REACH BACKWARDS OR PICK OR PULL STUFF UP. THE BLURRED VISION WAS NOT HELPED BY CHANGING HER CORRECTIVE LENSES TWICE. AN OPTOMETRIST WAS UNABLE TO FIND ANYTHING. THIS CASE WAS ASSESSED AS MEDICALLY SERIOUS BY GSK. POLIGRIP EXTRA STRENGTH WAS REDUCED. THE PT'S MUSCLE PAIN WAS TREATED WITH "PHYSIO." AT THE TIME OF REPORTING, THE OUTCOME OF THE EVENTS WAS UNK. MFR'S COMMENT: (SUPER) POLIGRIP IS MFG IN (B)(4). THE LOT NUMBER FOR THIS PRODUCT IS KNOWN; HOWEVER, IT IS UNK WHETHER THE PRODUCT WILL BE RETURNED FOR QUALITY ASSURANCE TESTING. (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 POLIGRIP EXTRA STRENGTH DENTURE ADHESIVE CREAM KOL GLAXOSMITHKLINE Z09071A

Patients

Seq Age Sex Outcome Treatment
1 67 YR Other ANTI-HYPERTENSIVE (UNSPECIFIED)