SYNVISC ONE
Report
- Report Number
- 2246315-2017-00323
- Event Type
- Malfunction
- Date Received
- January 5, 2018
- Date of Event
- November 20, 2017
- Report Date
- December 11, 2017
- Manufacturer
- GENZYME BIOSURGERY (RIDGEFIELD)
- Product Code
- MOZ
- PMA / PMN Number
- P940015
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- VA, US
- Reporter Occupation
- HEALTH PROFESSIONAL
Narratives
BASED ON ADDITIONAL INFORMATION RECEIVED ON 22-JAN-2018 FROM NURSE, THE CASE WAS MEDICALLY CONFIRMED. THIS UNSOLICITED CASE FROM UNITED STATES WAS RECEIVED ON 11-DEC-2017 FROM A NON-HEALTHCARE PROFESSIONAL. THIS CASE CONCERNS (B)(6) YEAR OLD FEMALE PATIENT WHO RECEIVED TREATMENT WITH SYNVISC ONE AND HAD DIFFICULTY WALKING, SEVERE PAIN/PAIN AND SWELLING/KNEE SWELLING ON THE SAME DAY, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AFTER FEW HOURS AND HAD LARGE AMOUNT OF WHITE CELLS AFTER 1 DAY. ALSO DEVICE MALFUNCTION WAS IDENTIFIED FOR THE REPORTED LOT NUMBER. MEDICAL HISTORY INCLUDED GASTROESOPHAGEAL REFLUX DISEASE (GERD), ANXIETY, OSTEOARTHRITIS. PATIENT WAS ALLERGIC TO IODINE (SHORTNESS OF BREATH) AND TETRACYCLINE (NAUSEA AND VOMITING). CONCOMITANT MEDICATIONS INCLUDED PARACETAMOL (TYLENOL), ASCORBIC ACID, ACETYLSALICYLIC ACID (ASA), BIOTIN, CETIRIZINE HYDROCHLORIDE (ZYRTEC), CALCIUM, TOCOPHEROL (VITAMIN E), DICLOFENAC SODIUM (DICLOFENAC), ECONAZOLE, FAMOTIDINE (PEPCID), LORAZEPAM (ATIVAN), FISH OIL, ONDANSETRON HYDROCHLORIDE (ZOFRAN), ROSUVASTATIN CALCIUM (CRESTOR), CURCUMA LONGA RHIZOME (TURMERIC) AND CYANOCOBALAMIN (VITAMIN B12). ON (B)(6) 2017, THE PATIENT INITIATED TREATMENT WITH INTRA-ARTICULAR SYNVISC ONE INJECTION, AT A DOSE OF 6 ML, ONCE INTO THE LEFT KNEE (BATCH/LOT NUMBER: 7RSL021, EXPIRY DATE: 31-MAY-2020) FOR OSTEOARTHROSIS PRIMARY LEFT KNEE. ON THE SAME DAY, FEW HOURS AFTER THE INJECTION, PATIENT HAD KNEE EFFUSION. PATIENT WAS SEEN ON (B)(6) 2017 BY PHYSICIAN WITH COMPLAINTS OF PAIN, KNEE SWELLING AND DIFFICULTY WALKING ON IT. THE SAME DAY, 60 CC OF CLOUDY FLUID WAS ASPIRATED AND SENT FOR CULTURE, GRAM STAIN AND CELL COUNT. PATIENT WAS PLACED ON ORAL CEFADROXIL (DURICEF) AND OXYCODONE HYDROCHLORIDE/PARACETAMOL (PERCOCET) FOR PAIN. ON FOLLOW UP, PATIENT WAS FEELING SIGNIFICANTLY BETTER WITH DECREASED SWELLING. GRAM STAIN WAS NEGATIVE BUT HER CELL COUNT SHOWED A LARGE AMOUNT OF WHITE CELLS ON (B)(6) 2017 (LATENCY: 1 DAY). PATIENT WAS PLACED ON METHYLPREDNISOLONE (MEDROL DOSE PACK) AND CONTINUED CEFADROXIL. ALSO REPORTED THAT THERE WAS NO GROWTH AFTER 14 DAYS IN SYNOVIAL FLUID CULTURE.IT WAS REPORTED THAT PATIENT WAS FEELING SIGNIFICANTLY BETTER AND SWELLING WAS DECREASED CORRECTIVE TREATMENT: CEFADROXIL, METHYLPREDNISOLONE AND OXYCODONE HYDROCHLORIDE/PARACETAMOL FOR SWELLING/KNEE SWELLING, SEVERE PAIN/PAIN; ASPIRATION, CEFADROXIL, 60 CC CLOUDY FLUID WAS ASPIRATED, METHYLPREDNISOLONE FOR EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED; METHYLPREDNISOLONE FOR DIFFICULTY WALKING AND CEFADROXIL FOR LARGE AMOUNT OF WHITE CELLS. OUTCOME: UNKNOWN FOR LARGE AMOUNT OF WHITE CELLS, DEVICE MALFUNCTION; RECOVERING FOR DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING SERIOUSNESS CRITERIA: REQUIRED INTERVENTION FOR DEVICE MALFUNCTION, DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED, SWELLING/KNEE SWELLING A PHARMACEUTICAL TECHNICAL COMPLAINT (PTC) WAS INITIATED WITH GLOBAL PTC NUMBER (B)(4) AN INVESTIGATION WAS INITIATED AS A RESULT OF AN UNEXPECTED INCREASE IN THE NUMBER OF LABELLED ADVERSE EVENTS RECEIVED FROM THE US MARKET FOR SYNVISC ONE, LOT 7RSL021. THE PRODUCT MET ALL RELEASE TESTING AT TIME OF MANUFACTURE IN JUNE 2017. RETAIN SAMPLES WERE RETESTED DUE TO THE UNEXPECTED INCREASE IN ADVERSE EVENTS. HIGHER THAN EXPECTED ENDOTOXIN RESULTS WERE OBTAINED. IN ADDITION, THE PRESENCE OF MICROBIAL CONTAMINATION WAS ALSO CONFIRMED. THE CAUSE OF THESE EVENTS IS UNDER INVESTIGATION. ONCE THIS INVESTIGATION IS COMPLETED, CORRECTIVE AND PREVENTIVE ACTIONS WILL BE IMPLEMENTED. REPORTER CAUSALITY: THE REPORTER SUSPECTED THAT KNEE EFFUSION AND KNEE PAIN WERE RELATED TO SYNVISC ONE. ADDITIONAL INFORMATION WAS RECEIVED ON 09-JAN-2018. GLOBAL PTC NUMBER WAS ADDED ADDITIONAL INFORMATION WAS RECEIVED ON 22-JAN-2018 FROM NURSE. THE CASE WAS MEDICALLY CONFIRMED. PATIENT'S WEIGHT AND HEIGHT WERE ADDED. MEDICAL HISTORY AND CONCOMITANT MEDICATIONS WERE ADDED. THE EVENT TERM SEVERE PAIN WAS UPDATED TO SEVERE PAIN/PAIN, SWELLING WAS UPDATED TO SWELLING/KNEE SWELLING AND EFFUSION WAS UPDATED TO EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED. THE EVENTS DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING WERE UPDATED TO SERIOUS. DOSE AND INDICATION OF SYNVISC ONE WAS ADDED. LABORATORY TEST RESULTS WERE ADDED. CORRECTIVE TREATMENT FOR DIFFICULTY WALKING WAS ADDED. CORRECTIVE TREATMENT (METHYLPREDNISOLONE AND OXYCODONE HYDROCHLORIDE/PARACETAMOL) WAS ADDED FOR SEVERE PAIN/PAIN, METHYLPREDNISOLONE WAS ADDED FOR EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING. EVENT ONSET OF DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING WAS UPDATED FROM (B)(6) 2017 TO (B)(6) 2017 AND LARGE AMOUNT OF WHITE CELLS WAS UPDATED FROM 2017 TO (B)(6) 2017. CLINICAL COURSE WAS UPDATED AND TEXT WAS AMENDED ACCORDINGLY. ADDITIONAL INFORMATION WAS RECEIVED ON 29-JAN-2018 FROM THE PATIENT. IT WAS REPORTED THAT PATIENT WAS FEELING SIGNIFICANTLY BETTER AND SWELLING WAS DECREASED PHARMACOVIGILANCE COMMENT: SANOFI COMPANY COMMENT FOLLOW UP DATED 22-JAN-2018: THIS CASE CONCERNS A PATIENT WHO HAS RECEIVED SYNVISC ONE INJECTION FROM THE RECALLED LOT AND LATER EXPERIENCED DIFFICULTY WALKING, PAIN, SWELING AND EFFUSION IN KNEE FOR WHICH PATIENT RECEIVED MEDROL DOSE PACK. A TEMPORAL RELATIONSHIP CAN BE ESTABLISHED WITH THE PRODUCT ADMINISTRATION. FURTHERMORE, THE CONCERNED LOT NUMBER HAS BEEN IDENTIFIED TO HAVE MALFUNCTION BY THE COMPANY. THEREFORE, THE CAUSAL RELATIONSHIP OF THE EVENT TO THE PRODUCT CANNOT BE EXCLUDED.
BASED ON ADDITIONAL INFORMATION RECEIVED ON 22-JAN-2018 FROM NURSE, THE CASE WAS MEDICALLY CONFIRMED. THIS UNSOLICITED CASE FROM UNITED STATES WAS RECEIVED ON 11-DEC-2017 FROM A NON-HEALTHCARE PROFESSIONAL. THIS CASE CONCERNS (B)(6) YEAR OLD FEMALE PATIENT WHO RECEIVED TREATMENT WITH SYNVISC ONE AND HAD DIFFICULTY WALKING, SEVERE PAIN/PAIN AND SWELLING/KNEE SWELLING ON THE SAME DAY, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AFTER FEW HOURS AND HAD LARGE AMOUNT OF WHITE CELLS AFTER 1 DAY. ALSO DEVICE MALFUNCTION WAS IDENTIFIED FOR THE REPORTED LOT NUMBER. MEDICAL HISTORY INCLUDED GASTROESOPHAGEAL REFLUX DISEASE (GERD), ANXIETY, OSTEOARTHRITIS. PATIENT WAS ALLERGIC TO IODINE (SHORTNESS OF BREATH) AND TETRACYCLINE (NAUSEA AND VOMITING). CONCOMITANT MEDICATIONS INCLUDED PARACETAMOL (TYLENOL), ASCORBIC ACID, ACETYLSALICYLIC ACID (ASA), BIOTIN, CETIRIZINE HYDROCHLORIDE (ZYRTEC), CALCIUM, TOCOPHEROL (VITAMIN E), DICLOFENAC SODIUM (DICLOFENAC), ECONAZOLE, FAMOTIDINE (PEPCID), LORAZEPAM (ATIVAN), FISH OIL, ONDANSETRON HYDROCHLORIDE (ZOFRAN), ROSUVASTATIN CALCIUM (CRESTOR), CURCUMA LONGA RHIZOME (TURMERIC) AND CYANOCOBALAMIN (VITAMIN B12). ON (B)(6) 2017, THE PATIENT INITIATED TREATMENT WITH INTRA-ARTICULAR SYNVISC ONE INJECTION, AT A DOSE OF 6 ML, ONCE INTO THE LEFT KNEE (BATCH/LOT NUMBER: 7RSL021, EXPIRY DATE: 31-MAY-2020) FOR OSTEOARTHROSIS PRIMARY LEFT KNEE. ON THE SAME DAY, FEW HOURS AFTER THE INJECTION, PATIENT HAD KNEE EFFUSION. PATIENT WAS SEEN ON (B)(6) 2017 BY PHYSICIAN WITH COMPLAINTS OF PAIN, KNEE SWELLING AND DIFFICULTY WALKING ON IT. THE SAME DAY, 60 CC OF CLOUDY FLUID WAS ASPIRATED AND SENT FOR CULTURE, GRAM STAIN AND CELL COUNT. PATIENT WAS PLACED ON ORAL CEFADROXIL (DURICEF) AND OXYCODONE HYDROCHLORIDE/PARACETAMOL (PERCOCET) FOR PAIN. ON FOLLOW UP, PATIENT WAS FEELING SIGNIFICANTLY BETTER WITH DECREASED SWELLING. GRAM STAIN WAS NEGATIVE BUT HER CELL COUNT SHOWED A LARGE AMOUNT OF WHITE CELLS ON (B)(6) 2017 (LATENCY: 1 DAY). PATIENT WAS PLACED ON METHYLPREDNISOLONE (MEDROL DOSE PACK) AND CONTINUED CEFADROXIL. ALSO REPORTED THAT THERE WAS NO GROWTH AFTER 14 DAYS IN SYNOVIAL FLUID CULTURE. CORRECTIVE TREATMENT: CEFADROXIL, METHYLPREDNISOLONE AND OXYCODONE HYDROCHLORIDE/PARACETAMOL FOR SWELLING/KNEE SWELLING, SEVERE PAIN/PAIN; ASPIRATION, CEFADROXIL, 60 CC CLOUDY FLUID WAS ASPIRATED, METHYLPREDNISOLONE FOR EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED; METHYLPREDNISOLONE FOR DIFFICULTY WALKING AND CEFADROXIL FOR LARGE AMOUNT OF WHITE CELLS OUTCOME: UNKNOWN FOR LARGE AMOUNT OF WHITE CELLS, DEVICE MALFUNCTION; RECOVERING FOR DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING SERIOUSNESS CRITERIA: REQUIRED INTERVENTION FOR DEVICE MALFUNCTION, DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED, SWELLING/KNEE SWELLING A PHARMACEUTICAL TECHNICAL COMPLAINT (PTC) WAS INITIATED WITH GLOBAL PTC NUMBER 51097 AN INVESTIGATION WAS INITIATED AS A RESULT OF AN UNEXPECTED INCREASE IN THE NUMBER OF LABELLED ADVERSE EVENTS RECEIVED FROM THE US MARKET FOR SYNVISC ONE, LOT 7RSL021. THE PRODUCT MET ALL RELEASE TESTING AT TIME OF MANUFACTURE IN JUNE 2017. RETAIN SAMPLES WERE RETESTED DUE TO THE UNEXPECTED INCREASE IN ADVERSE EVENTS. HIGHER THAN EXPECTED ENDOTOXIN RESULTS WERE OBTAINED. IN ADDITION, THE PRESENCE OF MICROBIAL CONTAMINATION WAS ALSO CONFIRMED. THE CAUSE OF THESE EVENTS IS UNDER INVESTIGATION. ONCE THIS INVESTIGATION IS COMPLETED, CORRECTIVE AND PREVENTIVE ACTIONS WILL BE IMPLEMENTED. REPORTER CAUSALITY: THE REPORTER SUSPECTED THAT KNEE EFFUSION AND KNEE PAIN WERE RELATED TO SYNVISC ONE. ADDITIONAL INFORMATION WAS RECEIVED ON 09-JAN-2018. GLOBAL PTC NUMBER WAS ADDED ADDITIONAL INFORMATION WAS RECEIVED ON 22-JAN-2018 FROM NURSE. THE CASE WAS MEDICALLY CONFIRMED. PATIENT'S WEIGHT AND HEIGHT WERE ADDED. MEDICAL HISTORY AND CONCOMITANT MEDICATIONS WERE ADDED. THE EVENT TERM SEVERE PAIN WAS UPDATED TO SEVERE PAIN/PAIN, SWELLING WAS UPDATED TO SWELLING/KNEE SWELLING AND EFFUSION WAS UPDATED TO EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED. THE EVENTS DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING WERE UPDATED TO SERIOUS. DOSE AND INDICATION OF SYNVISC ONE WAS ADDED. LABORATORY TEST RESULTS WERE ADDED. CORRECTIVE TREATMENT FOR DIFFICULTY WALKING WAS ADDED. CORRECTIVE TREATMENT (METHYLPREDNISOLONE AND OXYCODONE HYDROCHLORIDE/PARACETAMOL) WAS ADDED FOR SEVERE PAIN/PAIN, METHYLPREDNISOLONE WAS ADDED FOR EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING. EVENT ONSET OF DIFFICULTY WALKING, SEVERE PAIN/PAIN, EFFUSION/KNEE EFFUSION/60 CC OF CLOUDY FLUID ASPIRATED AND SWELLING/KNEE SWELLING WAS UPDATED FROM (B)(6) 2017 TO (B)(6) 2017 AND LARGE AMOUNT OF WHITE CELLS WAS UPDATED FROM 2017 TO (B)(6) 2017. CLINICAL COURSE WAS UPDATED AND TEXT WAS AMENDED ACCORDINGLY. PHARMACOVIGILANCE COMMENT: SANOFI COMPANY COMMENT FOLLOW UP DATED 22-JAN-2018: THIS CASE CONCERNS A PATIENT WHO HAS RECEIVED SYNVISC ONE INJECTION FROM THE RECALLED LOT AND LATER EXPERIENCED DIFFICULTY WALKING, PAIN, SWELING AND EFFUSION IN KNEE FOR WHICH PATIENT RECEIVED MEDROL DOSE PACK. A TEMPORAL RELATIONSHIP CAN BE ESTABLISHED WITH THE PRODUCT ADMINISTRATION. FURTHERMORE, THE CONCERNED LOT NUMBER HAS BEEN IDENTIFIED TO HAVE MALFUNCTION BY THE COMPANY. THEREFORE, THE CAUSAL RELATIONSHIP OF THE EVENT TO THE PRODUCT CANNOT BE EXCLUDED.
THIS UNSOLICITED CASE FROM UNITED STATES WAS RECEIVED ON 11-DEC-2017 FROM A NON-HEALTHCARE PROFESSIONAL. THIS CASE CONCERNS (B)(6) FEMALE PATIENT WHO RECEIVED TREATMENT WITH SYNVISC ONE AND LATER AFTER 1 DAY HAD DIFFICULTY WALKING, SEVERE PAIN, EFFUSION AND SWELLING AND AFTER UNKNOWN LATENCY THERE WAS DEVICE MALFUNCTION, HAD LARGE AMOUNT OF WHITE CELLS. NO PAST DRUG, MEDICAL HISTORY, CONCOMITANT MEDICATION OR CONCURRENT CONDITION WAS PROVIDED. ON (B)(6) 2017, THE PATIENT INITIATED TREATMENT WITH INTRA-ARTICULAR SYNVISC ONE INJECTION ONCE (DOSE AND INDICATION: UNKNOWN) INTO THE LEFT KNEE (BATCH/LOT NUMBER: 7RSL021, EXPIRY DATE: 31-MAY-2020). ON (B)(6) 2017, (1 DAY AFTER RECEIVING SYNVISC ONE INJECTION), THE PATIENT HAD SEVERE PAIN AND DIFFICULTY WALKING. THE SAME DAY, EFFUSION WAS NOTED AND AN ASPIRATION WAS DONE WITH A GRAM STAIN, CULTURE, AND CELL COUNT AND SHE WAS PLACED ON ANTIBIOTICS. ON (B)(6) 2017 THE PATIENT REPORTED BEING SIGNIFICANTLY BETTER WITH MINIMAL PAIN AND SWELLING AND THE PATIENT REMAINED ON CEFADROXIL (DURICEF). ON AN UNKNOWN DATE IN 2017, THE GRAM STAIN AND CULTURE WERE NEGATIVE BUT HER CELL COUNT SHOWED A LARGE AMOUNT OF WHITE CELLS. THE PATIENT SAID THAT IT ALSO SAYS "REPORT FLUID TNC". SINCE AN UNKNOWN DATE IN (B)(6) 2017, AFTER UNKNOWN LATENCY, THERE WAS DEVICE MALFUNCTION. CORRECTIVE TREATMENT: CEFADROXIL (DURICEF) FOR SWELLING, SEVERE PAIN, LARGE AMOUNT OF WHITE CELLS ASPIRATION, CEFADROXIL (DURICEF) FOR EFFUSION; NOT REPORTED FOR DIFFICULTY WALKING OUTCOME: UNKNOWN FOR LARGE AMOUNT OF WHITE CELLS, DEVICE MALFUNCTION; RECOVERING FOR DIFFICULTY WALKING, SEVERE PAIN, EFFUSION AND SWELLING. SERIOUSNESS CRITERIA: IMPORTANT MEDICAL EVENT FOR DEVICE MALFUNCTION. AN INVESTIGATION WAS INITIATED AS A RESULT OF AN UNEXPECTED INCREASE IN THE NUMBER OF LABELLED ADVERSE EVENTS RECEIVED FROM THE US MARKET FOR SYNVISC ONE, LOT 7RSL021. THE PRODUCT MET ALL RELEASE TESTING AT TIME OF MANUFACTURE IN JUNE 2017. RETAIN SAMPLES WERE RETESTED DUE TO THE UNEXPECTED INCREASE IN ADVERSE EVENTS. HIGHER THAN EXPECTED ENDOTOXIN RESULTS WERE OBTAINED. IN ADDITION, THE PRESENCE OF MICROBIAL CONTAMINATION WAS ALSO CONFIRMED. THE CAUSE OF THESE EVENTS IS UNDER INVESTIGATION. ONCE THIS INVESTIGATION IS COMPLETED, CORRECTIVE AND PREVENTIVE ACTIONS WILL BE IMPLEMENTED. PHARMACOVIGILANCE COMMENT: SANOFI COMPANY COMMENT DATED 20-DEC-2017: THIS CASE CONCERNS A PATIENT WHO HAS RECEIVED SYNVISC ONE INJECTION FROM THE RECALLED LOT AND LATER EXPERIENCED EVENTS. A TEMPORAL RELATIONSHIP CAN BE ESTABLISHED WITH THE PRODUCT ADMINISTRATION. FURTHERMORE, THE CONCERNED LOT NUMBER HAS BEEN IDENTIFIED TO HAVE MALFUNCTION BY THE COMPANY. THEREFORE, THE CAUSAL RELATIONSHIP OF THE EVENT TO THE PRODUCT CANNOT BE EXCLUDED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 11348 | SYNVISC ONE | INTRA-ARTICULAR HYALURONIC ACID | MOZ | GENZYME BIOSURGERY (RIDGEFIELD) | 7RSL021 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 70 YR | Other| R | ASA(CON.)| ASA(CON.)| ASCORBIC ACID(CON.)| ASCORBIC ACID(CON.)| ATIVAN(CON.)| ATIVAN(CON.)| BIOTIN(CON.)| BIOTIN(CON.)| CALCIUM(CON.)| CALCIUM(CON.)| CRESTOR(CON.)| CRESTOR(CON.)| DICLOFENAC(CON.)| DICLOFENAC(CON.)| ECONAZOLE(CON.)| ECONAZOLE(CON.)| FISH OIL(CON.)| FISH OIL(CON.)| IODINE(PREV.)| IODINE(PREV.)| PEPCID(CON.)| PEPCID(CON.)| TETRACYCLINE(PREV.)| TETRACYCLINE(PREV.)| TURMERIC(CON.)| TURMERIC(CON.)| TYLENOL(CON.)| TYLENOL(CON.)| VITAMIN B12(CON.)| VITAMIN B12(CON.)| VITAMIN E(CON.)| VITAMIN E(CON.)| ZOFRAN(CON.)| ZOFRAN(CON.)| ZYRTEC(CON.)| ZYRTEC(CON.) |