MAUDE Adverse Event Report: ALLERGAN (PRINGY) JUVEDERM VOLIFT W/LIDO 2X1ML ROW; IMPLANT, DERMAL, FOR AESTHETIC USE

Catalog Number 96656RX

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

Patient Problems Inflammation (1932); Cytomegalovirus (CMV) Infection (2220); Subcutaneous Nodule (4548)

Event Date 07/23/2021

Event Type  Injury  

Event Description

Healthcare professional (hcp) reported that patient was injected with 2ml juvéderm® voluma¿ with lidocaine and 2ml juvéderm® volift¿ with lidocaine in cheeks and lips.Approximately two and a half months later, after an episode of cold sores, patient developed edema and erythema similar to "granuloma-like reaction." biopsy was not provided.Patient was treated with predsim 40 mg for 15 days, clavulin bd for 7 days, and valtrex for 10 days.Patient was also treated with 3000 iu of hyaluronidase (biometil) into the nodules.Symptoms are evolving with partial improvement, but with persistence of nodules.This is the same event and the same patient reported under mdr id# 3005113652-2021-03194 (allergan complaint #(b)(4)).This mdr is being submitted for the suspect product, juvéderm® volift¿ with lidocaine.

Manufacturer Narrative

(b)(4).Further information from the reporter regarding event, product, or patient details has been requested.No additional information is available at this time.The events are physiological complications and analysis of the device generally does not assist allergan in determining a probable cause for these events.Clarification: the filler was injected into the patient and is not accessible for return.The syringe was discarded.A review of the device history record has been completed.No deviations or non-conformances noted.This is a known potential adverse event addressed in the product labeling.

• Brand Name: JUVEDERM VOLIFT W/LIDO 2X1ML ROW
• Type of Device: IMPLANT, DERMAL, FOR AESTHETIC USE
• Manufacturer (Section D): ALLERGAN (PRINGY); route de promery; zone artisanale de pre-mairy; pringy
• MDR Report Key: 12602223
• MDR Text Key: 282810544
• Report Number: 3005113652-2021-03195
• Device Sequence Number: 1
• Product Code: LMH
• Combination Product (y/n): Y
• PMA/PMN Number: P110033
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial
• Report Date: 10/07/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/09/2021
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 08/31/2022
• Device Catalogue Number: 96656RX
• Device Lot Number: V17LB00672
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 08/12/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Treatment: JUVÉDERM® VOLUMA¿ WITH LIDOCAINE
• Patient Outcome(s): Required Intervention
• Patient Age: 49 YR