BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SUPER POLIGRIP

    MDR report key: 2003642 · Received February 23, 2011

    Report

    Report Number
    MW5019556
    Event Type
    Injury
    Date Received
    February 23, 2011
    Product Code
    KOL
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I (B)(6) STATES, MY MEDICAL CONDITIONS HAVE BECOME WORSE SINCE MY BOUT WITH SUPER POLIGRIP ON (B)(6) 2004. I STARTED USING SUPER POLIGRIP (2 TIMES A DAY). MY IMMUNE SYSTEM HAS WEAKENED, I HAVE NUMBNESS TO MY ARM, LEGS, CHEST PAIN EVERY DAY, BREATHING PROBLEMS, HEADACHES, DIZZY AT TIMES. I HAVE EXHAUSTED. MY REMEDIES TO (GSK) GLAXOSMITHKLINE NEXT STEP WITH BE COURT. I HAVE ALL LABORATORY REPORTS, DOCTORS REPORTS. I ALSO HAVE NEUROPATHY. I AM SENDING COPIES OF MY MEDICAL REPORTS. I HAD THERAPY CAN'T REMEMBER DATES. I'M SURE HAD THERAPY 2005 ALSO 2010. DATES OF USE: (B)(6) 2004 - (B)(6) 2010.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SUPER POLIGRIP DENTURE CREAM KOL

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other| R| S