FDA Adverse Event
Injury
Summary report: N
DERMABOND
MDR report key: 3200956
·
Received July 2, 2013
Report
- Report Number
- 2210968-2013-11836
- Event Type
- Injury
- Date Received
- July 2, 2013
- Report Date
- June 14, 2013
- Manufacturer
- ETHICON INC.
- Product Code
- MPN
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
(B)(4). CONCLUSION: NO CONCLUSION CAN BE DRAWN AT THIS TIME. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A SUPPLEMENTAL 3500A FORM WILL BE SUBMITTED ACCORDINGLY.
Description of Event or Problem · 1
IT WAS REPORTED THAT A PATIENT UNDERWENT A SURGICAL PROCEDURE ON AN UNKNOWN DATE AND A TOPICAL SKIN ADHESIVE WAS USED. THE PATIENT EXPERIENCED A CONTACT DERMATITIS WHICH WAS TREATED WITH A NUMBING AGENT AND STEROIDS. ADDITIONAL INFORMATION HAS BEEN REQUESTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 301662 | DERMABOND | TOPICAL SKIN ADHESIVE | MPN | ETHICON INC. | UNK | UNK |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Required Intervention |