BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POLYGRIP (SUPER)

    MDR report key: 1842643 · Received September 20, 2010

    Report

    Report Number
    MW5017502
    Event Type
    Injury
    Date Received
    September 20, 2010
    Date of Event
    February 15, 2000
    Report Date
    September 13, 2010
    Manufacturer
    PROCTOR & GAMBLE
    Product Code
    KOL
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I HAVE USED POLYGRIP FROM THE END OF (B)(6)2000 UNTIL NOW. I CANNOT HAVE MY BLOOD WORK TAKEN JUST BECAUSE I WANT IT CHECKED I'M IN PRISON. THE STUFF DOES NOT WORK WELL, IT GAGES ME AND CAUSE HEADACHES. NUMBNESS IN BUTT AND LEGS AND FEET SOMETIMES NECK AND HEAD. MEMORY LAPSE AND SOME INCREASED HEART RATE. BLURRED VISION AND RINGING IN EARS (ONLY AT TIME). NOTE: I HAD TO STEAL THIS BLACK INK PEN AND WE ARE NOT ALLOWED ANY TAPE. DOSE OR AMOUNT: DENTURE CREAM. FREQUENCY: TWICE DAILY. ROUTE: ORAL. DIAGNOSIS OR REASON FOR USE: DENTURE ADHESIVE CREAM. EVENT ABATED AFTER USE STOPPED OR DOSE REDUCED: NO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POLYGRIP (SUPER) FALSE TEETH KOL PROCTOR & GAMBLE UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Other| S NONE AT THIS TIME