FDA Adverse Event Other Summary report: N

NEW POLIGRIP SG

MDR report key: 1690068 · Received May 12, 2010

Report

Report Number
9681138-2010-00163
Event Type
Other
Date Received
May 12, 2010
Report Date
May 12, 2010
Manufacturer
GLAXOSMITHKLINE
Product Code
KOL
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
JA
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 MALE PT WHO RECEIVED TRIPLE SALT DENTAL ADHESIVE CREAM (POLIGRIP EX, (B)(4)) FOR DENTURES. A PHYSICIAN OR OTHER HEALTH CARE PROFESSIONAL HAS NOT VERIFIED THIS REPORT. CO-SUSPECT MEDICATION INCLUDED NEW POLIGRIP SG (FORMULATION UNK). ON AN UNK DATE, THE PT STARTED NEW POLIGRIP SG AND AFTER AN UNK TIME, HE DEVELOPED ANEMIA. THE PT THEN SWITCHED TO POLIGRIP EX. ON AN UNK DATE, THE PT SWITCHED BACK TO USING NEW POLIGRIP SG. AT AN UNK TIME AFTER STARTING POLIGRIP SG AND POLIGRIP EX, THE PT DEVELOPED BRACHIALGIA, NUMBNESS OF UPPER EXTREMITIES, ARM NUMBNESS AND A SLIGHTLY PAINFUL FEELING IN THE ARMS. THIS CASE WAS ASSESSED AS MEDICALLY SERIOUS BY GSK. AT THE TIME OF REPORTING, THE OUTCOME OF THE EVENTS WAS UNK. FOLLOW-UP INFO RECEIVED ON (B)(6) 2010: THIS CASE CONCERNS A (B)(6) MALE PT. IN (B)(6) 2007, THE PT STARTED POLIGRIP EX AT LESS THAN 3 CM A DAY TWICE DAILY. IT WAS REPORTED THAT THE PT EXPERIENCED ANEMIA BEFORE HE STARTED USING POLIGRIP EX, IT WAS REPORTED THAT ON AN UNK DATE, AFTER USING POLIGRIP EX, THE PT FELT NUMBNESS IN THE ARM. TREATMENT WITH POLIGRIP EX WAS DISCONTINUED ON (B)(6) 2010 AND SWITCHED BACK TO POLIGRIP SG. AT THE TIME OF REPORTING, THE OUTCOME OF THE EVENTS WAS UNRESOLVED. POLIGRIP IS MFG IN (B)(4), AND NEITHER THE PRODUCT NOR LOT NUMBER FOR THE PRODUCT IS AVAILABLE. (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 NEW POLIGRIP SG DENTURE ADHESIVE KOL GLAXOSMITHKLINE UNK

Patients

Seq Age Sex Outcome Treatment
1 62 YR Other POLIGRIP EX (FORMULATION (B)(4) NOT DISTRIBUTED| IN USA)