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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ALLERGAN (PRINGY) JUVEDERM VOLBELLA WITH LIDOCAÏNE 32G; IMPLANT, DERMAL, FOR AESTHETIC USE

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ALLERGAN (PRINGY) JUVEDERM VOLBELLA WITH LIDOCAÏNE 32G; IMPLANT, DERMAL, FOR AESTHETIC USE Back to Search Results
Catalog Number 96180JS
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Inflammation (1932); Subcutaneous Nodule (4548)
Event Date 01/15/2022
Event Type  Injury  
Event Description
Healthcare professional reported a patient was pretreated with topical emla and injected with 0.8mls of juvéderm® volift¿ with lidocaine on the lips and 1ml of juvéderm® volbella¿ with lidocaine in the "barr code" region.Patient was given ice and pain killers for the next 24 hours posttreatment.About a month after the first injection, patient received a third dose of a covid 19 vaccine from moderna.About three weeks later, patient felt that their lip had hardened.Patient consulted with the clinic 15 days later and clinic noted patient had "granulomas.", biopsy was not provided.Patient started treatment with dacortin 30mg, ciprofloxacin 400mg, claritromicin 500mg, and ebastina 20 mg.It was noted there was slow disapparition of symptoms and weekly control.About a month after the symptoms began, induration was present again and patient was treated with hyaluronidase injection.Another hyaluronidase injection was done two weeks later and it was noted the patient was better.Event is still ongoing.This is the same event and the same patient reported under mdr report # 3005113652-2022-00110 (allergan complaint # (b)(4)).This mdr is being submitted for the first suspect product, juvéderm® volbella¿ with lidocaine.
 
Manufacturer Narrative
Concomitant therapies: emla (pre-treatment), pain killers and ice (post-treatment), and eutirox 75 mg.The filler was injected into the patient and is not accessible for return.The syringe was not returned for evaluation.Further information regarding event, product, or patient details has been requested.No additional information is available at this time.The event is a physiological complication and analysis of the device generally does not assist allergan in determining a probable cause for this event.A review of the device history record has been initiated.If any new, changed or corrected information is noted, a supplemental medwatch will be submitted.This is a known potential adverse event addressed in the product labeling.
 
Event Description
Additional information received noting events resolved about two months after date of onset.
 
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Brand Name
JUVEDERM VOLBELLA WITH LIDOCAÏNE 32G
Type of Device
IMPLANT, DERMAL, FOR AESTHETIC USE
Manufacturer (Section D)
ALLERGAN (PRINGY)
route de promery
zone artisanale de pre-mairy
pringy
Manufacturer (Section G)
ALLERGAN (PRINGY)
route de promery
zone artisanale de pre-mairy
pringy
Manufacturer Contact
chris sprague
12331-a riata trace parkway
building 3
austin, TX 78727
8479375615
MDR Report Key13605855
MDR Text Key286437497
Report Number3005113652-2022-00101
Device Sequence Number1
Product Code LMH
Combination Product (y/n)Y
Reporter Country CodeSP
PMA/PMN Number
P110033
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Foreign,Health Professional,Company Representative
Reporter Occupation Physician
Type of Report Initial,Followup
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
Device Operator Health Professional
Device Expiration Date03/31/2023
Device Catalogue Number96180JS
Device Lot NumberV15LB10263
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 02/16/2022
Initial Date FDA Received02/25/2022
Supplement Dates Manufacturer Received03/31/2022
Supplement Dates FDA Received04/08/2022
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured04/04/2021
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Treatment
JUVÉDERM® VOLIFT¿ WITH LIDOCAINE,
Patient Outcome(s) Required Intervention;
Patient Age63 YR
Patient SexFemale
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