FDA Adverse Event Other Summary report: N

COREGA DENTURE ADHESIVE CREAM

MDR report key: 3988082 · Received July 25, 2014

Report

Report Number
9681138-2014-00013
Event Type
Other
Date Received
July 25, 2014
Report Date
July 24, 2014
Manufacturer
GAXOSMITHKLINE
Product Code
KOT
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
PE
Reporter Occupation
NOT APPLICABLE

Narratives

Description of Event or Problem · 1

THIS CASE WAS REPORTED BY A CONSUMER (DAUGHTER OF PATIENT) AND DESCRIBED THE OCCURRENCE OF DEATH, UNKNOWN CAUSE IN (B)(6) YEAR-OLD FEMALE PATIENT WHO REC'D GSK DENTURE ADHESIVE (FORMULATION UNKNOWN) (COREGA DENTURE ADHESIVE CREAM) CREAM FOR DENTAL PROSTHESIS ADHESION. A PHYSICIAN OR OTHER HEALTH CARE PROFESSIONAL HAS NOT VERIFIED THIS REPORT. CONCURRENT MEDICAL CONDITIONS INCLUDED DENTURE WEARER. ON AN UNKNOWN DATE, THE PATIENT STARTED GSK DENTURE ADHESIVE (FORMULATION UNKNOWN), UNKNOWN DOSING. AT AN UNKNOWN TIME AFTER STARTING GSK DENTURE ADHESIVE (FORMULATION UNKNOWN), THE PATIENT DIED. THE CAUSE OF DEATH WAS UNKNOWN. IT IS UNKNOWN WHETHER AN AUTOPSY WAS PERFORMED. CASE REPORTED BY DISTRIBUTOR TO GSK (B)(4). THE MANUFACTURER'S REPORT NUMBER FOR THIS CASE IS 9681138-2014-00013. COREGA (DISTRIBUTED AS SUPER POLIGRIP IN THE UNITED STATES) IS MANUFACTURED IN (B)(4). WHILE THE LOT NUMBER FOR THIS PRODUCT IS AVAILABLE, IT IS UNKNOWN WHETHER THE PRODUCT WILL BE RETURNED FOR QUALITY ASSURANCE TESTING. (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
436637 COREGA DENTURE ADHESIVE CREAM GSK DENTURE ADHESIVE (FORMULATION UNK) KOT GAXOSMITHKLINE NA P13482

Patients

Seq Age Sex Outcome Treatment
1 93 YR Other ZINC (UNK - UNK)| GARLIC (UNK - UNK)| LUTEIN (UNK - UNK)