FDA Adverse Event Injury Summary report: N

SCULPTRA (POLY-L-LACTIC ACID)

MDR report key: 2433502 · Received January 27, 2012

Report

Report Number
3002807108-2012-05411
Event Type
Injury
Date Received
January 27, 2012
Date of Event
September 6, 2011
Report Date
January 27, 2012
Manufacturer
AVENTIS PHARMA GRUPPO LEPETIT S.R.L.
Product Code
LMH
PMA / PMN Number
P030050
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SP
Reporter Occupation
PHYSICAL THERAPIST

Narratives

Description of Event or Problem · 1

AFTER MEDICAL REVIEW, THIS NON-SERIOUS REPORT HAS BEEN UPGRADED TO SERIOUS BASED ON THE RECLASSIFICATION FOR THE EVENT FOLLOWING ASSESSMENT UTILIZING THE COMPANY'S NEW DEVICE REPORTING TREE. THIS CASE WAS REPORTED ON (B)(6) 2012 BY A PHYSICIAN - LOCAL REFERENCE (B)(4). THIS CASE INVOLVES A (B)(6) FEMALE, TREATED WITH POLY-L-LACTIC ACID (SCULPTRA) BY SUBDERMAL INJECTION (BATCH 1A00376, EXPIRATION DATE 2013) FOR AN UNK INDICATION. POLY-L-LACTIC ACID WAS RECONSTITUTED WITH 5 ML OF STERILE WATER + 1 ML OF LIDOCAINE. INJECTIONS SITES INCLUDED THE LEFT AND RIGHT MARIONETTE LINES, CHEEKS, CHEEKBONES AND TEMPORAL. ON (B)(6) 2011, APPROX 7 MONTHS AFTER TREATMENT WITH POLY-L-LACTIC ACID, THIS PT EXPERIENCED SEVERAL VISIBLE NODULES ON THE CHEEKS. SOME NODULES WERE DESCRIBED AS MEDIUM/SMALL ON THE CHEEKBONES AND OTHERS, AS BIG, ON THE LATERAL MOUTH. CORRECTIVE TREATMENT INCLUDED CORTICOSTEROIDS AND MEDIUM FREQUENCY ULTRASOUND RADIO FREQUENCY. THE NODULES HAVE LASTED MORE THAN 30 DAYS. THE PHYSICIAN DID NOT KNOW IF THE ADVERSE EVENT WOULD LEAD TO PERMANENT IMPAIRMENT OF A BODY FUNCTION OR PERMANENT DAMAGE TO A BODY STRUCTURE. NO BIOPSY WAS PERFORMED. IT WAS NOT REPORTED IF ANY SURGICAL INTERVENTION WAS REQUIRED. ALTERNATIVE ETIOLOGY FOR THE EVENT IS UNK. THE OUTCOME OF THE EVENT AT THE TIME OF THIS REPORT WAS RECOVERING. IT WAS NOTED THAT THE PT WAS PREVIOUSLY SUBMITTED TO OTHER AESTHETIC TREATMENTS AND NO PREVIOUS SIMILAR EVENTS NEITHER AFTER POLY-L-LACTIC ACID NOR WITH OTHER PRODUCTS WAS EXPERIENCED. NO ACUTE/CHRONIC CUTANEOUS DISEASES. NO PREVIOUS GRANULOMATOUS DISEASE, RECENT HORMONAL CHANGES OR TENDENCY TOWARDS PATHOLOGIC SCARRING. THE PT'S CHILDREN HAVE INTESTINAL AUTOIMMUNE DISEASE. SIGNIFICANT/RELEVANT MEDICAL HISTORY INCLUDES AUTOIMMUNE DISORDER. NO CONCOMITANT MEDICATIONS ARE BEING ADMINISTERED. ACTION TAKEN: UNK. CORRECTIVE TREATMENT: CORTICOSTEROIDS AND MEDIUM FREQUENCY ULTRASOUND RADIO FREQUENCY. OUTCOME: RECOVERING/RESOLVING. PTC RESULTS ARE PENDING.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SCULPTRA (POLY-L-LACTIC ACID) FACIAL FILLER LMH AVENTIS PHARMA GRUPPO LEPETIT S.R.L. 1A00376

Patients

Seq Age Sex Outcome Treatment
1 51 YR Other| R LIDOCAINE| PREV MEDS =UNK