VASERLIPO SYSTEM 110-0032

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-10-31 for VASERLIPO SYSTEM 110-0032 manufactured by Bausch + Lomb.

Event Text Entries

[125653071] The product was returned and evaluated. The reported problem could not be duplicated. Testing was completed without any issue; no problems were found. A review of the device history records is in progress. Based on all available information, no causal factors can be determined and no conclusion can be drawn.
Patient Sequence No: 1, Text Type: N, H10


[125653072] A doctor reported a patient underwent abdominal liposuction treatment on (b)(6) 2018. The treatment was described as uneventful. The patient returned to the office on (b)(6) 2018 and had some bruises which was expected. Patient returned on (b)(6) 2018 for a scheduled lymphatic massage and mentioned to the doctor she may be having an allergic reaction to the tape that was used for dressing. The doctor examined the area and observed skin peeling. At that point, it wasn? T immediately apparent to the doctor that the patient had burns. The patient returned on (b)(6) 2018 and it was then apparent that the patient sustained mostly 2nd degree and some 1st degree burns on the stomach area. A photo provided by the doctor showed visible skin burn, crust and scarring. Patient was treated with nitro bid creams, antibiotics cream, xerofoam and aloe burn cream. The doctor managed the patient conservatively and the majority of her burn areas have improved and are still healing. There is a quarter size area that appears to be a 3rd degree burn that the doctor is still managing conservatively. Patient has some skin scarring and modularity at the burn sites; there may be permanent scarring that will need future cosmetic care.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3011423170-2018-00105
MDR Report Key8024181
Report SourceHEALTH PROFESSIONAL
Date Received2018-10-31
Date of Report2018-10-16
Date of Event2018-09-10
Device Manufacturer Date2018-04-13
Date Added to Maude2018-10-31
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. JULI MOORE
Manufacturer Street3365 TREE CT. INDUSTRIAL BLVD
Manufacturer CitySAINT LOUIS MO 63122
Manufacturer CountryUS
Manufacturer Postal63122
Manufacturer Phone636-226-31
Manufacturer G1SOLTA MEDICAL, INC.
Manufacturer Street11720 N CREEK PARKWAY N STE 100
Manufacturer CityBOTHELL WA 98011
Manufacturer CountryUS
Manufacturer Postal Code98011
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameVASERLIPO SYSTEM
Generic NameSYSTEM, SUCTION, LIPOPLASTY
Product CodeMUU
Date Received2018-10-31
Returned To Mfg2018-10-09
Model Number110-0032
Catalog Number110-0032
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerBAUSCH + LOMB
Manufacturer Address1400 NORTH GOODMAN STREET ROCHESTER NY 14609 US 14609


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2018-10-31

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