PRECISE PAIN RELIEVING HEAT PATCH UNK

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2012-09-28 for PRECISE PAIN RELIEVING HEAT PATCH UNK manufactured by Kiribai Kobayashi Pharmaceutical Co, Ltd..

Event Text Entries

[52897477] This was a spontaneous report from a pt and concerned her (b)(6) male son from the united states: (b)(6). The pt's weight was (b)(6) and height was (b)(6). The pt's medical history and concurrent conditions included: cerebral palsy and sinus problems. Other medical history included the pt had no known drug allergies. Concomitant medications included montelukast for sinus disorder, tizanidine hydrochloride for muscle contractions, loratadine for sinus disorder, and ibuprofen for pain, the pt was treated with precise pain relieving heat patch (topical) one patch as needed initiated on an unspecified date for muscle aches. On (b)(6) 2012, the pt experienced a headache, water blisters and redness at the application site. Action taken with precise pain relieving heat patch was withdrawn. At the time of this report, the pt had not recovered from water blisters, application site red and headache. This report was not serious and not reportable. Case upgraded to serious based on add'l info received from the pt's mother on september 18, 2012. A completed and signed medical authorization letter containing contact info for the prescribing physician was received. Version 1 was created to enter the physician's address the schedule due diligence. Pt demographics were updated. The pt's medical history and concurrent conditions included cerebral palsy that was a birth related injury, muscle pain, "never happened before" (no reaction upon previous exposure to drug" and non smoker. The pt denied any history of alcohol use and drug abuse. The pt was treated with precise pain relieving heat patch (patch, topical, lot 100802 (previously bpc010) one patch applied to right knee for 5. 5 to 6 hours initiated on (b)(6) 2012. Concomitant medications included zanaflex (tizanidine hydrochloride) every night since (b)(6) 2011 for muscle spasm and loratadine every night since (b)(6) 2008 for sinus congestion. On (b)(6) 2012 (previously (b)(6) 2012) when the patch was removed, there was redness (application site redness). After the pt returned home from school, his knee was extremely red with blisters. He also complained of a headache. The reported stated, after consulting with the pt's physician by telephone, neosporin (bacitracin, zinc, neomycin, polymyxin b sulfate) (unspecified formulation, route, dose and frequency) and gauze was administered for several days. The reporter stated, the pt was recovering but has scarring on his knee. At the time of the report, product use was withdrawn and the outcome of the events was recovering. This report was serious (medically significant) and reportable (serious injury).
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3003120375-2012-00743
MDR Report Key2774345
Report SourceCONSUMER
Date Received2012-09-28
Date of Report2012-09-18
Date of Event2012-01-01
Date Facility Aware2012-09-18
Report Date2012-09-26
Date Reported to FDA2012-09-26
Date Reported to Mfgr2012-09-26
Date Mfgr Received2012-09-18
Date Added to Maude2012-10-05
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Manufacturer CityDALTON GA 30721
Manufacturer CountryUS
Manufacturer Postal30721
Manufacturer Phone8004328629
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NamePRECISE PAIN RELIEVING HEAT PATCH
Generic NameADHESIVE BACKED THERMAL SKIN PATCHES
Product CodeOMW
Date Received2012-09-28
Model NumberUNK
Catalog NumberUNK
Lot Number1008022
ID NumberUNK
Device Expiration Date2013-07-01
OperatorLAY USER/PATIENT
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerKIRIBAI KOBAYASHI PHARMACEUTICAL CO, LTD.
Manufacturer AddressSANDA


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2012-09-28

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