MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer,foreign report with the FDA on 2019-10-16 for POLIGRIP FLAVOUR FREE manufactured by Glaxosmithkline.
| Report Number | 3003721894-2019-00218 |
| MDR Report Key | 9197799 |
| Report Source | CONSUMER,FOREIGN |
| Date Received | 2019-10-16 |
| Date of Report | 2019-07-30 |
| Date Mfgr Received | 2019-07-30 |
| Date Added to Maude | 2019-10-16 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Street | PO BOX 13398 RESEARCH TRIANGLE PARK |
| Manufacturer City | NC 27709 |
| Manufacturer Country | US |
| Manufacturer Postal | 27709 |
| Manufacturer Phone | 8888255249 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | POLIGRIP FLAVOUR FREE |
| Generic Name | DENTURE ADHESIVE |
| Product Code | KOT |
| Date Received | 2019-10-16 |
| Lot Number | JP2C |
| Operator | LAY USER/PATIENT |
| Device Availability | * |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GLAXOSMITHKLINE |
| Manufacturer Address | DUNGARVAN LTD DUNGARVAN, WATERFORD, EI |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2019-10-16 |