ICY HOT SMARTRELIEF TENS THERAPY BACK STARTER KIT

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-12-26 for ICY HOT SMARTRELIEF TENS THERAPY BACK STARTER KIT manufactured by Sanofi Aventis U.s. Llc.

Event Text Entries

[131489855] Burns [burns third degree] ([device use issue]). Blisters [blister]. Scabs [scab]. Expired device used [expired device used]. Case narrative: initial information received on 08-jun-2018 regarding an unsolicited valid serious case received from a consumer from united states. This case involves female patient who experienced burns, blisters and scabs, while she was using of medical device smart relief tens therapy [icy hot smart relief tens therapy back starter kit and expired device was used. The patient's past medical history, medical treatment(s), vaccination(s) and family history were not provided. On an unknown date, the patient started using icy hot smart relief tens therapy back starter kit (smart relief tens therapy) dosage unknown (lot - 15g115 expiry date: 30-sep-2017 (expired device used). The patient developed an event of a serious burns (burns third degree) blisters (burn blister), scabs (scab). The patient mentioned that he has titanium rods in his back (device use issue) and he was informed that use of smart relief tens therapy was not recommend to customers with any metal implants, rods or cardiac pacemakers (device use issue). Seriousness criteria: medically significant for all except expired device used. It was not reported if the patient received a corrective treatment. Outcome: not applicable for device use issue; unknown for all other events. Qa results received on 03-aug-2018 from the qa department: lot batch number: 15g115, expiry date: 30-sep-2017, sample status: not available (device not returned). Qa findings revealed: a thorough investigation ((ihsr, capa protocol and review of (b)(4) [2014]) has been done to investigate the likelihood of the ihsr producing burns in some users. This investigation found that it is highly unlikely for the smart relief to produce tissue trauma. The maximum current and power density calculated for the smartrelief is a tiny fraction of the limits in the fda guidance. The complete investigation is located in the device files. It was also reported that the consumer used the device in the presence of titanium rods in his back. The warnings on the carton of the device state, do not use this device under any circumstance if you have a cardiac pacemaker, implanted defibrillator, or other implanted metallic or electronic device. The consumer also reported that when they were sweating, the pad seemed to be melting completely. If the gel becomes over-hydrated due to moisture on the skin or application of other topicals, it may begin to change consistency and peel away from the pad. Additionally, the provided lot number (15g115) indicates an expiry date of 9/30/2017. Devices are not tested for safety or efficacy beyond date of expiry. The coa for electrode lot b-14-08-07a confirmed that all inspection items were passed. Device return is not expected at this time; therefore, investigation cannot proceed. Additional follow up information received on 03-aug-2018 from qa department: qa findings received. Additional event - expired device added. Text amended accordingly.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3003496686-2018-00001
MDR Report Key8197646
Date Received2018-12-26
Date of Report2018-12-20
Date of Event2015-07-01
Date Added to Maude2018-12-26
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag0
Reprocessed and Reused Flag3
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Manufacturer ContactMS. DARLENE KADEL
Manufacturer Street55 CORPORATE DRIVE, MS 55B-220 A
Manufacturer CityBRIDGEWATER NJ 08807
Manufacturer CountryUS
Manufacturer Postal08807
Manufacturer G1SANOFI AVENTIS U.S. LLC
Manufacturer Street55 CORPORATE DRIVE
Manufacturer CityBRIDGEWATER NJ 08807
Manufacturer CountryUS
Manufacturer Postal Code08807
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameICY HOT SMARTRELIEF TENS THERAPY BACK STARTER KIT
Generic NameNUH
Product CodeNUH
Date Received2018-12-26
Lot Number15G115
Device Expiration Date2017-09-30
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerSANOFI AVENTIS U.S. LLC
Manufacturer Address55 CORPORATE DRIVE BRIDGEWATER NJ 08807 US 08807


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2018-12-26

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