inforMED
InjuryLMH

REVANESSE VERSA+ (WITH LIDOCAINE) 1.2 ML

Received Oct 26, 2023 · Event occurred Sep 27, 2023

Report 3004423487-2023-00039 · MDR key 18012126

Device

Generic name

Revanesse Versa+ (with Lidocaine) 1.2 Ml

Model number

PN40083

Lot number

22L122

Product problems

  • Adverse Event Without Identified Device or Use Problem
  • Adverse Event Without Identified Device or Use Problem

Patient

65 YR · Female

  • Swelling/ Edema
  • Swelling/ Edema

Narrative

Description of Event or Problem

ADVERSE EVENT INFORMATION: BASED ON THE INITIAL INFORMATION PROVIDED BY THE CLINIC, THE PATIENT WAS INJECTED WITH REVANESSE VERSA+ (WITH LIDOCAINE) 1.2 ML PN40083, LOT NUMBER 22L122 ON (B)(6) 2023 WITH 1.0ML OF VERSA ON THE LIPS. THE PATIENT STARTED TO EXPERIENCE UNILATERAL LIP SWELLING, 15 DAYS POST INJECTION. PRIOR TO TREATMENT BLT CREAM WAS USED. THE CLINIC INFORMED THE MANUFACTURER, THAT THE PATIENT WAS GIVEN DOXYCYCLENE 100MG BID FOR A WEEK AND THE SWELLING HAD NOT RESOLVED, SO THE PATIENT WAS BROUGHT BACK TO THE CLINIC WAS GIVEN A VIAL OF HYLENEX TO DISSOLVE THE FILLER. FOLLOW UP COMMUNICATIONS WITH CLINIC: FOLLOWING RECEIPT OF INITIAL REPORT, MANUFACTURER HAS REACHED OUT TO THE CLINIC FOR ADDITION INFORMATION PERTAINING TO THE REPORTED ADVERSE INCIDENT. THIS INFORMATION IS REQUIRED FOR PROLLENIUM'S MEDICAL DIRECTOR TO MAKE A SUITABLE MEDICAL ASSESSMENT OF THE CASE PRESENTED.

Remedial action

  • Patient Monitoring