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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SUNEVA MEDICAL, INC. BELLAFILL DERMAL FILLER IMPLANT, DERMAL, FOR AESTHETIC USE

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SUNEVA MEDICAL, INC. BELLAFILL DERMAL FILLER IMPLANT, DERMAL, FOR AESTHETIC USE Back to Search Results
Model Number GBF0508 (SUSPECTED)
Device Problem Use of Device Problem (1670)
Patient Problems Unspecified Infection (1930); Patient Problem/Medical Problem (2688)
Event Type  Injury  
Manufacturer Narrative
Doctor reports infection in one of the locations injected with bellafill in acne scars on the cheeks. The patient was treated with antibiotics. It is unknown at this time if medical intervention was required to prevent permanent impairment or damage. Rationale for delayed submission of this mdr: at the time of report receipt on 04/21/2020 and 04/22/2020, suneva had determined that an mdr was not required; however subsequent review found that a conservative mdr was warranted, as it is unknown at this time if medical intervention was required to prevent permanent impairment or damage. Timeline: initial report on 04/21/2020: per the injector, the patient was injected in several acne scars on the cheeks at the same time in (b)(6) 2019. Only one (1) of those scars presented with signs of infection (hardness, swelling, redness, and drainage at the injection site). The patient was improving on antibiotics. 04/22/2020: the doctor relayed that they feel this was an infection secondary to the injection procedure and not the bellafill, per se. 07/22/2020: additional information was requested from the account, including current patient status and lot numbers. 07/29/2020: no response from the account. A reminder was sent for the requested additional information. 07/30/2020: shipping history has been reviewed to determine potential bellafill lots based on the doctor-relayed injection timeframe of (b)(6) 2019. A follow up mdr will be filed once any updates are received. The bellafill lot used in the patient's procedure is unknown and bellafill use cannot be confirmed at this time. Shipping history has been reviewed to determine potential bellafill lots based on the doctor-relayed injection timeframe of (b)(6) 2019. Fda will be informed of the results of the reviews of the potential bellafill lots. Bellafill dermal filler is indicated for the correction of nasolabial folds and moderate to severe, atrophic, distensible facial acne scars on the cheek in patients over the age of 21 years. The bellafill ifu contains the following precaution: "as with all transcutaneous procedures, artefill (now bellafill) injection carries a risk of infection. The usual precautions associated with injectable materials should be followed. " bellafill syringes are single use devices and are typically discarded after use. Per the bellafill ifu: "the syringe and any unused material should be discarded after a single treatment visit. ".
 
Event Description
Doctor reports infection in one of the locations injected with bellafill in acne scars on the cheeks. The patient was treated with antibiotics. It is unknown at this time if medical intervention was required to prevent permanent impairment or damage.
 
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Brand NameBELLAFILL DERMAL FILLER
Type of DeviceIMPLANT, DERMAL, FOR AESTHETIC USE
Manufacturer (Section D)
SUNEVA MEDICAL, INC.
5870 pacific center blvd.
san diego, ca
Manufacturer (Section G)
SUNEVA MEDICAL, INC.
5870 pacific center blvd.
san diego, ca
Manufacturer Contact
stacy lewis
5870 pacific center blvd.
san diego, ca 
7685492
MDR Report Key10353924
MDR Text Key207818152
Report Number3003707320-2020-00007
Device Sequence Number1
Product Code LMH
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
P020012
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type health professional
Reporter Occupation
Type of Report Initial,Followup
Report Date 07/31/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received07/31/2020
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Model NumberGBF0508 (SUSPECTED)
Device Catalogue NumberGBF0508 (SUSPECTED)
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received04/21/2020
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 07/31/2020 Patient Sequence Number: 1
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