BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ACTIVAPATCH LONTOGO 4.0

    MDR report key: 6147521 · Received December 4, 2016

    Report

    Report Number
    MW5066546
    Event Type
    Injury
    Date Received
    December 4, 2016
    Date of Event
    October 13, 2016
    Report Date
    December 4, 2016
    Manufacturer
    ACTIVATEK, INC.
    Product Code
    EGJ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I RECEIVED MULTIPLE BURNS BY THE ACTIVAPATCH LONTOGO 4.0 ON (B)(6) 2016 THAT HAVE NOT YET HEALED. NOT SURE HOW IT HAPPENED, WHEN I REMOVED THE PATCH THE BURNS WERE PRESENT. I HAD USED THE EXACT SAME PRODUCT PREVIOUSLY WITHOUT INCIDENT BUT FOR SOME REASON (PROBABLY DEFECTIVE PRODUCT) I WAS BURNED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    794526 ACTIVAPATCH LONTOGO 4.0 ACTIVAPATCH EGJ ACTIVATEK, INC. BEW150102

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Other OTC MEDS: VITAMINS| RX MEDS: BP