BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 520646 · Received March 23, 2004

    Report

    Report Number
    MW1031710
    Event Type
    Injury
    Date Received
    March 23, 2004
    Date of Event
    March 21, 2004
    Report Date
    March 22, 2004
    Manufacturer
    *
    Product Code
    LYY
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Description of Event or Problem · 1

    IN 2004 AFTER BEING EXPOSED TO A LATEX BALLOON DISPLAY, PT BEGAN EXPERIENCING AN ALLERGIC REACTION AND HAD AN ASTHMA ATTACK. THEY EXPERIENCED SOB, CONGESTION, LARYNGITIS, COUGHING, SNEEZING, REDDENED CHECKS AND NOSE. RASH STARTED ON THEIR NOSE AND CHEEKS. PEAK FLOW DROPPED TO 270. FEELING ITCHY ALL OVER. FOLLOWED DR ORDER-ALLERGY AND ASTHMA PROTOCOL USED VENTOLIN MDI X 2, TOOK BENADRYL 50 MG PO + USE BENADRYL CREAM ON RASH. CONTINUED TO MONITOR PEAK FLOW READINGS FOR 24 HOURS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * LATEX LYY * * *

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR Life Threatening