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Lot Number UNKNOWN
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Embolism (1829); Erythema (1840); Skin Discoloration (2074)
Event Type  Injury  
Manufacturer Narrative
(b)(4) initial literature report. Pharmacovigilance comments: the serious event of embolism and the non-serious events of skin discolouration and erythema were considered expected and possibly related to the treatment with an unspecified hyaluronic acid filler. Serious criteria included hospitalization and the need for multiple medical interventions with hyaluronidase, iv dexamethasone, high doses of unspecified antibiotics and antibiotic soaked gauze pads. Potential etiologies for the event of embolism include vascular compromise due to vascular occlusion or compression and potential contributory factors include injection technique. The case meets the criteria for expedited reporting to the regulatory authorities. Engineering evaluation: the information in this single case does not suggest involvement of a nonconforming product or quality problem and will not initiate a corrective or preventive action. Manufacturing narrative: lot number was not reported. Exemption number: (b)(4).
Event Description
Case reference number (b)(4) is a literature report detected on 24-oct-2018 by med info. This case (referred as patient nr. (b)(6) in table 1 in the article) refers to a (b)(6) female patient that received treatment with an unspecified ha filler to the forehead. In addition, this case is also linked with eight other cases that is also included in the same article (linked case: (b)(4)). Citation of the article: zhang et al. Local cooling as a step of treatment for tissue ischemia caused by hyaluronic acid injection-induced embolism a report of 9 cases. Plast reconstr surg glob open 2018; 8:6(8). Patient specific information: table 1. Patient cases of local cooling treatment of tissue ischemia caused by hyaluronic acid injection-induced embolism patient number 7 - gender: female - age: 35 - injection site: forehead - injection dosage: 3 ml - admission time (after injection): 30 min - local cooling outcome duration: 5d; no scarring. General information: from 2014 till date, a total of 9 patients were administered the antibiotic saline gauze local cooling as a step for treatment of tissue ischemic syndrome caused by hyaluronic acid injection-induced embolism (table 1). All 9 patients were female, with age ranging from 20 to 35 years. Injection sites included the nasolabial folds (5 patients), alar groove (1 patient), glabellar lines (1 patient), and labial tubercle (1 patient), forehead augmentation (1 patient), and the injected volume of hyaluronic acid was 0. 4-3 ml. The timing of postembolism hyaluronidase injection ranged between 5 minutes and 3 days postoperatively. Symptoms of patients noted during consultation included local persistent severe pain, while signs included dark purple patches and mottling of the skin in localized areas, which displays clinical manifestations includes severe pain, dark purple patches, and mottling of the skin in localized areas in the early stage of tissue ischemia caused by hyaluronic acid injection-induced embolism. The most serious sign observed in patients was black scabs or blisters at the center of the lesion, with a history of scattered purulent spots for about 3 days. Each admitted patient was first injected with hyaluronidase at a concentration of 150-300 u/ml at sites filled with hyaluronic acid and areas showing abnormal skin color. After injection, the affected sites were massaged for 30 minutes, followed by local cooling using an antibiotic saline-soaked gauze pad at each site. The method of local cooling was as follows: antibiotic saline was refrigerated at 4°c for more than 2 hours. Then sterile gauze pads were soaked in the chilled antibiotic saline and applied at areas of skin showing dark purple discoloration. Gauze pads were replaced every 30 minutes, with a 30-minute rest period between 2 consecutive local coolings; alternatively, local cooling was reapplied only when the patient experienced localized pain. The patient was observed once per half an hour by nurse and twice a day by doctors. Local cooling is used at least 5 days for every patient who is suffered from ha induced embolism in our unit. Systemic medication administered to patients included high doses of antibiotics and an intravenous infusion of dexamethasone at a dose of 5-10 mg/d over 3 consecutive days. In all cases, local symptoms were considerably relieved within 3 days of treatment. All patients experienced residual redness in local skin areas after completion of treatment, which persisted for a maximum duration of 3 months. Clinically, local cooling did reduce the early symptoms of localized pain and facilitated effective treatment of the 9 patients with hyaluronic acid injection-induced local embolism.
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Manufacturer (Section D)
seminariegatan 21
uppsala, SE-75 2 28
SW SE-752 28
Manufacturer (Section G)
seminariegatan 21
uppsala, SE-75 2 28
SW SE-752 28
Manufacturer Contact
amy poteate
14501 north freeway
fort worth, TX 76177
MDR Report Key8041631
MDR Text Key126361425
Report Number9710154-2018-00073
Device Sequence Number1
Product Code LMH
Combination Product (y/n)N
Reporter Country CodeCH
PMA/PMN Number
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Reporter Occupation
Type of Report Initial
Report Date 11/06/2018
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received11/06/2018
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Lot NumberUNKNOWN
Was Device Available for Evaluation? No
Is the Reporter a Health Professional?
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received10/24/2018
Was Device Evaluated by Manufacturer? No Answer Provided
Is the Device Single Use? No Answer Provided
Is This a Reprocessed and Reused Single-Use Device?
Type of Device Usage Unkown

Patient Treatment Data
Date Received: 11/06/2018 Patient Sequence Number: 1