FDA Adverse Event
Injury
Summary report: N
DEPEND UNDERGARMENTS : GARMENT, PROTECTIVE, FOR INCONTINENCE : EYQ
MDR report key: 8713400
·
Received June 19, 2019
Report
- Report Number
- 9615625-2019-00001
- Event Type
- Injury
- Date Received
- June 19, 2019
- Date of Event
- March 5, 2019
- Report Date
- June 19, 2019
- Manufacturer
- KIMBERLY-CLARK PERSONAL HYGIENIC PRODUCTS CO. ,LTD
- Product Code
- EYQ
- PMA / PMN Number
- EXEMPT
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA, US
- Reporter Occupation
- 003
Narratives
Additional Manufacturer Narrative · 1
A MANUFACTURER LOT CODE WAS NOT PROVIDED. WITH NO MEANS TO ASCERTAIN THE MANUFACTURER/ASSET LINE AND DAY OF PRODUCTION, NO FURTHER INVESTIGATION ON DOCUMENTS AND SUPPORTING RECORDS CAN BE PERFORMED.
Description of Event or Problem · 1
CONSUMER REPORTED HE EXPERIENCED A BURNING, PAINFUL IRRITATION IN THE GROIN AREA AND WAS USING CREAM AND TOILET PAPER AS A BARRIER WHILE WEARING THE PADS. HE HAD BLOOD IN HIS URINE AFTER WEARING A PAD FOR THREE DAYS. HE WAS DIAGNOSED WITH A URINARY TRACT INFECTION AND HOSPITALIZED FOR ONE DAY. WHILE IN THE HOSPITAL HE WAS ADMINISTERED IV ANTIBIOTICS AND GIVEN 850MG PILLS THAT HE TOOK FOR TWO WEEKS. HE NO LONGER HAD BLOOD IN HIS URINE AND HIS SYMPTOMS HAD IMPROVED. HE STOPPED USING THE PADS.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 504514 | DEPEND UNDERGARMENTS : GARMENT, PROTECTIVE, FOR INCONTINENCE : EYQ | GARMENT, PROTECTIVE, FOR INCONTINENCE | EYQ | KIMBERLY-CLARK PERSONAL HYGIENIC PRODUCTS CO. ,LTD | INCONTINENCE SHIELDS FOR MEN, LIGHT ABSORBENCY |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 87 YR | Hospitalization |