MAUDE Adverse Event Report: CVS PHARMACY, INC. EXTRA LARGE FLEXIBLE FABRIC ANTIBACTERIAL ADHESIVE PADS; TAPE AND BANDAGE, ADHESIVE

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

Patient Problem Superficial (First Degree) Burn (2685)

Event Date 04/06/2022

Event Type  Injury  

Event Description

Was burned by the antibacterial on an adhesive pad used to cover a skin abrasion on my forearm.

• Brand Name: EXTRA LARGE FLEXIBLE FABRIC ANTIBACTERIAL ADHESIVE PADS
• Type of Device: TAPE AND BANDAGE, ADHESIVE
• Manufacturer (Section D): CVS PHARMACY, INC.; 1 cvs dr; woonsocket RI 02895
• MDR Report Key: 14117463
• MDR Text Key: 289435936
• Report Number: MW5108994
• Device Sequence Number: 1
• Product Code: KGX
• Combination Product (y/n): Y
• 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: 04/08/2022

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?: No
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 04/14/2022
• Patient Sequence Number: 1
• Treatment: ADDERALL 50MG; AMLODOPINE 5MG; CBD OIL 1/2 EYE-DROPPER; LOZARTAN 50MG; VITAMIN C 500MG - 1000MG
• Patient Age: 58 YR
• Patient Sex: Male
• Patient Weight: 74 KG
• Patient Race: White