MAUDE Adverse Event Report: CVS PHARMACY, INC. CVS HEAVY DUTY ANTIBACTERIAL BANDAGES; TAPE AND BANDAGE, ADHESIVE

Model Number HEAVY DUTY ANTIBACTERIAL BANDAGES 875956

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Chemical Exposure (2570); Partial thickness (Second Degree) Burn (2694)

Event Date 01/17/2022

Event Type  Injury  

Event Description

On (b)(6) 2022 i used a (b)(6) heavy duty antibacterial bandage to cover a cut.Later in the day i had second degree chemical burns.As of (b)(6) 2022 the area is almost healed.Photos at (b)(6).Fda safety report id # (b)(4).

• Brand Name: CVS HEAVY DUTY ANTIBACTERIAL BANDAGES
• Type of Device: TAPE AND BANDAGE, ADHESIVE
• Manufacturer (Section D): CVS PHARMACY, INC.; one cvs drive; mail code 200qa; woonsocket RI 02895
• MDR Report Key: 13599883
• MDR Text Key: 286261114
• Report Number: MW5107697
• Device Sequence Number: 1
• Product Code: KGX
• UDI-Device Identifier: 5042826471
• UDI-Public: 5042826471
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Patient
• Type of Report: Initial
• Report Date: 02/18/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Model Number: HEAVY DUTY ANTIBACTERIAL BANDAGES 875956
• Device Lot Number: 00139136
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 02/24/2022
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 69 YR
• Patient Sex: Male
• Patient Weight: 86 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White