NUVAGEN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-08-29 for NUVAGEN manufactured by Ruspak Corporation.

Event Text Entries

[118878390] This non-serious spontaneous medical device complaint report from a customer (us) was received by (b)(4) (distributor) on (b)(6) 2018. This customer complaint was forwarded to (b)(4) (product holder) on (b)(6) 2018. Information has been received from a consumer concerning a (b)(6)-year-old patient who was using nuvagen collagen powder. The patient's medical history and concomitant medication information was not provided. On an unspecified date the patient started to use nuvagen collagen powder (1 gm packet) for an unknown indication. Lot number was 170308a and expiry date was feb-2022. The patient reported using nuvagen collagen powder for three days and changed it daily. On (b)(6) 2018, during the initial application, the patient noted burning sensation. It was reported that the sensation worsened the longer it was on. Burning sensation was intense enough to prevent the patient from sleeping. No other side effects were noted. There was no report of rash or itching or hives or shortness of breath or tachycardia. The physician ordered vitamin e. Complaint sample was not available at the time of this report. (b)(4) initiated the process to retrieve the remaining collagen powder back from the patient. The outcome of the event was not reported. The causality for the event 'burning sensation' was not reported. Case comments: the event application site burning is assessed as non-serious and possibly related to nuvagen collagen powder based on the temporal relationship and spontaneous nature of the report. The event is unlisted as per the product label.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1000526113-2018-70004
MDR Report Key7830378
Date Received2018-08-29
Date of Report2018-10-04
Date of Event2018-08-02
Date Mfgr Received2018-09-29
Date Added to Maude2018-08-29
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer Street6911 BRYAN DAIRY ROAD SUITE # 210
Manufacturer CityLARGO FL 33777
Manufacturer CountryUS
Manufacturer Postal33777
Manufacturer G11. BELCHER PHARMACEUTICALS, LLC
Manufacturer Street2. RUSPAK CORPORATION (MANUFACTURER)
Manufacturer CountryUS
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameNUVAGEN
Generic NameNUVAGEN
Product CodeKOZ
Date Received2018-08-29
Lot Number170308A
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerRUSPAK CORPORATION
Manufacturer Address5 MANHATTAN STREET, P.O BOX 29 LYONS, 14489, TEL: 315-9469777 US


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2018-08-29

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