FDA Adverse Event Injury Summary report: N

RESTYLANE LIDOCAINE, RESTYLANE LIDOCAINE

MDR report key: 3066216 · Received April 6, 2013

Report

Report Number
2032896-2013-00011
Event Type
Injury
Date Received
April 6, 2013
Date of Event
June 21, 2012
Report Date
April 5, 2013
Manufacturer
Q-MED
Product Code
LMH
PMA / PMN Number
P040024
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
DA
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

(B)(4) IS A SPONTANEOUS CASE REPORT SENT BY A OTHER HEALTH PROFESSIONAL WHICH REFERS TO A FEMALE AGED (B)(6). THE PATIENT'S PAST MEDICAL HISTORY INCLUDED RENAL PARENCHYMA STONE REMOVAL, PARTIAL NEPHRECTOMY, CRP INCREASED, PYELONEPHRITIS, DRUG HYPERSENSITIVITY AND RENAL TRAUMA IN CHILDHOOD. NO PREVIOUS TREATMENTS WITH THE FILLERS. ON (B)(6) 2012, THE PATIENT WAS TREATED WITH RESTYLANE LIDOCAINE (LOT 11555, EXP DATE ON 07/2013) WITH 29G (THE RED ONE IN THE PACKET) WITH FAN AND LINEAR TECHNIQUE ON HAPPYCORNER/ORAL SOMMISSURES + LINES LATERAL FROM THE MOUTH 0.5 ML EACH SIDE. RESTYLANE PERLANE LIDOCAINE (LOT 11614, EXP DATE ON 08/2013) WITH 29G (RED) WITH FAN AND LINER TECHNIQUE ON NASOLABIAL FOLDS + ORAL COMMISSURES 0.5 ML EACH SIDE. PATIENT SEEN AT CLINIC ON 3RD DAY AFTER COSMETIC TREATMENT (RESTYLANE + PERLANE) OBVIOUS SIGNS OF INFLAMMATION IN TREATED AREA - POSSIBLE INFECTION. PATIENT TREATED WITH HERACILLIN 5 MG, 1TBL X 3 TIMES A DAY. NO EFFECT. SIX DAYS AFTER COSMETIC TREATMENT REFERRED TO (B)(6). THE ADVERSE EVENT IS: DEEP TISSUE INFECTION IN TREATED AREAS (IMPLANT SITE INFECTION) WHICH BEGAN ON (B)(6) 2012. THE REACTION WAS DEEMED SERIOUS BY THE REPORTER BECAUSE IT REQUIRED INTERVENTION. PATIENT SEEN AT HOSPITAL ON (B)(6) 2012; AFEBRIL WITH REDNESS, SWELLING AND TENDERNESS AROUND MOUTH. PATIENT ADMITTED TO I.V. ANTIBIOTICS TREATMENT BETWEEN ON (B)(6) 2012. PATIENT TREATED FOLLOWING: ON (B)(6) 2012 WITH ANTIBIOTICS DICILLIN 1 G X 3 DAILY (I.V.) AND BENZYLPENICILLIN 1.2 G X 3 DAILY (I.V.). ON (B)(6) 2012 WITH AZITHROMYCIN 500 MG X 1 DAILY TABLET AND MOXAFLOXACIN 100 MG X 1 DAILY I.V. ON (B)(6) 2012 WITH AMYLOX 400 MG X 1 DAILY AND AZITHROMYCIN 500 MG X 1 DAILY TABLET. ON (B)(6) 2012 PATIENT CONTACTED THE HOSPITAL AGAIN FOR RECURRENT INFECTION SYMPTOMS DESPITE THE PER ORAL ANTIBIOTICS. ON (B)(6) 2012 1 WEEK I.V. TREATMENT THE SWELLING RESOLVED AND ONLY SMALL ERYTHEMATOUS AREA ON LEFT NASOLABIAL FOLD. THE SETTING FOR THE EVENT WAS A MULTIPLE AREAS. THE REACTION WAS DEEMED SERIOUS BY THE REPORTER BECAUSE IT REQUIRED HOSPITALIZATION AND INTERVENTION. THE OUTCOME FOR DEEP TISSUE INFECTION IN TREATED AREAS IS RECOVERING/RESOLVING. REMAINING ONLY MINOR ERYTHEMATOUS AREA ON LEFT NASOLABIAL FOLD AREA.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
142371 RESTYLANE LIDOCAINE, RESTYLANE LIDOCAINE INJECTABLE DERMAL FILLER LMH Q-MED 11555

Patients

Seq Age Sex Outcome Treatment
1 56 YR Hospitalization| R