MAUDE MDR 6938536

MDR report key
6938536
Report number
2024601-2017-00007
Event key
0
Event type
3
Date received
2017-10-10
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Contact
MS. SUZANNE WOJCIK
Address
301 W HOWARD LANE SUITE 100 AUSTIN TX 78753 US
Phone
737-737-7372
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1KYBELLA SKIN GRIDMARKER, SKINALLERGAN (IRVINE)FZZKYBELLA SKIN GRIDNIR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-10-1001. R

Event Narratives#

N

Patient 1

(B)(4). FURTHER INFORMATION FROM THE REPORTER REGARDING EVENT, PRODUCT, OR PATIENT DETAILS HAS BEEN REQUESTED. NO ADDITIONAL INFORMATION IS AVAILABLE AT THIS TIME. THE EVENTS OF NERVE DAMAGE, DENT, HANGING WRINKLY SKIN, DISTRESSED, SKIN GOT INFLAMED AND DISFIGUREMENT ARE PHYSIOLOGICAL COMPLICATIONS AND ANALYSIS OF THE DEVICE GENERALLY DOES NOT ASSIST ALLERGAN IN DETERMINING A PROBABLE CAUSE FOR THESE EVENTS. DEVICE LABELING FOR THE REPORTED EVENTS: WARNINGS AND PRECAUTIONS: FOR TOPICAL USE ONLY. DO NO INJECT THROUGH THE TRANSFERRED GRID MARKINGS. DO NOT USE ON BROKE OR DAMAGED SKIN.

D

Patient 1

PATIENT REPORTED BEING INJECTED WITH KYBELLA BY A DOCTOR AND HAD BEEN LEFT WITH "NERVE DAMAGE WHICH IS NOT RESOLVING AFTER 6 WEEKS" AND "A DENT" ON THEIR NECK WITH "TWO BITS OF HANGING WRINKLY SKIN" THAT "WILL NEED COSMETIC SURGERY CORRECTION." PATIENT WAS DISTRESSED AND CLAIMED THAT THE PRODUCT HAS LEFT THE PATIENT WITH "DISFIGUREMENT." THE PATIENT NOTED THEY COULD NOT SMILE AND THAT THEIR "FACE SKIN GOT INFLAMED" AS WELL AS THEIR LIPS. PATIENT HAD GONE TO THE EMERGENCY ROOM WHICH INFORMED THE PATIENT OF HAVING NERVE DAMAGE. PATIENT NOTES THE SHAPE OF THEIR FACE IS DIFFERENT THAN BEFORE AND IS NOT BETTER. PATIENT STILL HAS ALL SYMPTOMS AND SAGGING SKIN. IT IS UNKNOWN IF THE SKIN GRID WAS USED.