FDA Adverse Event Injury Summary report: N

SCULPTRA (POLY-L-LACTIC ACID)

MDR report key: 1882344 · Received October 22, 2010

Report

Report Number
3003496686-2010-62599
Event Type
Injury
Date Received
October 22, 2010
Date of Event
May 14, 2010
Report Date
October 21, 2010
Manufacturer
SANOFI-AVENTIS, U.S. LLC
Product Code
LMH
PMA / PMN Number
P030050
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

INITIAL REPORT: THIS NON-SERIOUS SPONTANEOUS CASE REPORT FROM (B)(6) REPORTED BY A NURSE ON 13-OCT-2010, UPON MEDICAL REVIEW, HAS BEEN UPGRADED TO SERIOUS BASED ON THE RECLASSIFICATION FOR THE EVENT(S) FOLLOWING ASSESSMENT UTILIZING THE COMPANY'S NEW DEVICE REPORTING TREE (B)(4). THIS CASE INVOLVES A FEMALE PATIENT WHO RECEIVED POLY-L-LACTIC ACID ON (B)(6)2009 AND (B)(6)2009, INJECTED INTO THE NASOLABIAL FOLDS, TEMPLES, CHEEK LINES, AND HANDS. POLY-L-LACTIC ACID WAS RECONSTITUTED WITH 5 ML OF STERILE WATER AND 2 ML 2% LIDOCAINE. ON (B)(6)-2010, 13 MONTHS AFTER THE LAST INJECTION, THE PATIENT DEVELOPED GRANULOMAS ON THE RIGHT TEMPLE, RIGHT CHEEK, AND BOTH HANDS. THE LESIONS, 5 ON THE RIGHT SIDE OF HER FACE, 7 ON HER RIGHT HAND, AND 4 ON HER LEFT HAND WERE 1-2 MM IN SIZE. THERE WERE NO SIGNS OF INFLAMMATION AND NO EVIDENCE OF A SYSTEMIC PROCESS. NO BIOPSY WAS PERFORMED. THERE WAS NO EVIDENCE OF PERMANENT IMPAIRMENT OF A BODY FUNCTION OR BODY STRUCTURE. RELEVANT MEDICAL HISTORY: FITZPATRICK SKIN TYPE II, NO HISTORY OF IMMUNOLOGICAL OR COLLAGEN-VASCULAR DISEASE. RELEVANT CONCOMITANT MEDICATIONS: NOT REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SCULPTRA (POLY-L-LACTIC ACID) FACIAL FILLER LMH SANOFI-AVENTIS, U.S. LLC UNK

Patients

Seq Age Sex Outcome Treatment
1 Other| R CON MEDS = UNKNOWN| PREV MEDS = UNKNOWN