MAUDE MDR 2634178

MDR report key
2634178
Report number
2135225-2012-00058
Event key
0
Event type
3
Date of event
2012-05-24
Date received
2012-06-20
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
0

Manufacturer Contact#

Contact
JELENA SOCAVA
Address
4133 COURTNEY RD. SUITE 10 FRANKSVILLE WI 53126 US
Phone
262-262-2628
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1RADIESSE VOICE GELRADIESSE INJECTABLE IMPLANTMERZ AESTHETICS, INC.MIX8602M0UNKNOWNR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-06-2001. H

Event Narratives#

D

Patient 1

THIS COMPLAINT WAS E-MAILED TO MERZ AESTHETICS, INC. BY PATIENT'S DAUGHTER. SHE WROTE THAT HER MOTHER WAS INJECTED WITH RADIESSE VOICE GEL INTO LEFT VOCAL FOLD ON (B)(6) 2012, FOR A PARALYZED LEFT VOCAL FOLD FOLLOWING LEFT LUNG REMOVAL. THREE DAYS LATER, SHE FELT WEAK AND HAD A NEED TO COUGH. TWO WEEKS LATER, SHE HAS A FEVER, COUGH, AND UNCONTROLLED TACHYCARDIA/A-FIB, UNABLE TO CARDIOVERT. A CT SCAN REVEALED A "NODULE" IN HER REMAINING LUNG OF 6MM WHICH WAS NOT THERE TWO MONTHS AGO WHEN THEY FOUND THE LEFT LUNG CANCER. ON (B)(6) 2012, PATIENT'S DAUGHTER PROVIDED ADDITIONAL INFORMATION. HER MOTHER IS NOW HOSPITALIZED AS OF (B)(6) 2012, FOR UNCONTROLLED TACHYCARDIA/ATRIAL FIBRILLATION. SHE STATED THE DOCTORS WERE SUPPOSED TO "CARDIOVERT WITH PADDLES" BUT DECIDED TO WAIT AND ATTEMPT TO CONTROL EVENTS WITH MEDICATIONS. THE PATIENT IS TAKING CARDARONE AND HEPARIN. THE PATIENT ALSO HAS FEVER AND IS COUGHING. THE NODULE IN THE RIGHT LUNG LOBE WILL BE EXAMINED FURTHER ONCE THE PATIENT IS STABLE. AT THIS TIME, IT IS UNKNOWN IF THE NODULE IS CANCER OR RADIESSE VOICE GEL. PER PATIENT'S DAUGHTER, DR. (B)(6) WAS THE RADIESSE VOICE GEL INJECTING PHYSICIAN. ON (B)(6) 2012, DR. (B)(6) STATED THAT HE DOES NOT AGREE THAT RADIESSE VOICE GELL CAUSED ANY OF THE PATIENT'S ADVERSE EVENT. NO OTHER INFORMATION WAS PROVIDED. ON (B)(6) 2012, PATIENT'S DAUGHTER STATED HER "MOTHER-IN-LAW" IS OUT OF A-FIB, IS ON MEDICATION, NAME NOT PROVIDED; SHE IS STILL IN THE HOSPITAL, NOW HAS "STOMACH TROUBLES;" THE HEART IS "OK." AS OF (B)(4) 2012, DESPITE SEVERAL ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION, NONE WAS RECEIVED.

N

Patient 1

THE DEVICE HISTORY RECORDS WERE NOT REVIEWED AS THE LOT NUMBER WAS NOT PROVIDED.