BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POLIGRIP TOOTH CREAM

    MDR report key: 1832352 · Received August 31, 2010

    Report

    Report Number
    MW5017355
    Event Type
    Injury
    Date Received
    August 31, 2010
    Date of Event
    August 25, 2010
    Report Date
    August 31, 2010
    Product Code
    KOL
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WV, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    I TOOK PRESCRIBED AMOX TRX CL 500-12 TAB (AUGMENTIN 500 TAB). I ALSO USED POLIGRIP TOOTH DENTURE CREAM AT THE SAME TIME. MY ALLERGIC REACTION WAS A HEADACHE, RUNNY NOSE, DRY THROAT, FEVER AND ACHES ALL OVER MY BODY. DOSE OR AMOUNT: TO LINE DENTURE, FREQUENCY: ONCE A MONTH. DATES OF USE: (B)(6)2010. DIAGNOSIS OR REASON FOR USE: TO LINE DENTURES. EVENT ABATED AFTER USE: YES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POLIGRIP TOOTH CREAM NONE KOL

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Other