Monday, December 05, 2011

Warning Letter to Precision from the FDA

These are worth reading if only for the detail that the FDA goes into. Here is the latest one:

Cheryl A. Cahill, President
Precision Formulations, LP
800 W. Sandy Lake Rd., Suite 200
Coppell, Texas 75019

Dear Ms. Cahill:

The U.S. Food and Drug Administration (FDA) inspected your facility located at 800 W. Sandy Lake Road, Suite 200, Coppell, Texas, on May 2-19, 2011. During our inspection, we evaluated the manufacturing of several of your products, including Braz a Vie Acai, (b)(4)(2.5 fl. oz.), (b)(4)(2.5 fl. oz.), (b)(4), and (b)(4). Because you label these products as dietary supplements, we evaluated whether the products were prepared, packed, and held under conditions that comply with the Current Good Manufacturing Practice (CGMP)regulations for dietary supplements in 21 CFR Part 111. However, this letter should not be interpreted to mean that FDA agrees with your characterization of the products or their ingredients.

During the inspection, our investigators found a number of violations of the dietary supplement CGMP regulations. These violations cause your products to be adulterated within the meaning of Section 402(g)(1) of the Federal Food, Drug, and Cosmetic Act (the Act) [21 U.S.C. § 342(g)(1)] in that they have been prepared, packed, or held under conditions that do not meet current good manufacturing practice regulations for dietary supplements. These inspectional observations were provided to you on the FDA-483 form issued at the conclusion of our inspection on May 19, 2011.

You can find the Act and FDA regulations through links at FDA's home page at http://www.fda.gov1.

The following violations were observed during the inspection:

1. You failed to conduct at least one appropriate test or examination to verify the identity of the dietary ingredient, (b)(4), as required by 21 CFR 111.75(a)(1)(i), for Lot # (b)(4), (b)(4), and (b)(4) prior to using it in the manufacture of Braz a Vie Acai, Lot #(b)(4).

We received your reply to the FDA-483 dated June 10, 2011. Your response is inadequate because the documentation you provided with your response indicates that the samples from the (b)(4) referenced lots of (b)(4) were not submitted to your contract laboratory until 5/3/2011 and the results were not reported until 5/20/2011. According to your Quarantine Release Report, you released Braz a Vie Acai, Lot #(b)(4) on 4/20/2011, which was before the samples of the (b)(4) were submitted for identity testing. Your response only addresses a single lot and fails to indicate whether you have made changes to your procedures that will ensure that all components will be tested to verify identity before use in the manufacture of your dietary supplement products.

2. You failed to establish the specifications required by 21 CFR 111.70. Specifically:

• You failed to establish component specifications, as required by 21 CFR 111.70(b)(2), for the (b)(4), Lot # (b)(4), (b)(4), and (b)(4) that are necessary to ensure that specifications for the purity, strength, and composition of Braz a Vie Acai, Lot #(b)(4), manufactured using these components are met. You told our investigators that you have not established component specifications for purity, strength and composition.

• You failed to establish product specifications for the strength of the finished batch of dietary supplement, as required by 21 CFR 111.70(e). Specifically, you have not established specifications for the strength of the dietary ingredients (b)(4) found in the proprietary blend used in your (b)(4) Lot # (b)(4) and (b)(4) Lot # (b)(4) products. The supplement facts panel for both products declares (b)(4) of the proprietary blend per (b)(4) fluid ounce serving. You told our investigators that you check the finished product against the finished product label declaration. This does not satisfy the requirement to establish specifications for strength of the finished batch of dietary supplement.

In your June 10, 2011 response letter, you stated that MMRs (master manufacturing records) with more detailed specifications are being put together and will be completed by August 31, 2011. Your response is inadequate because you have not provided documentation to indicate that you have established specifications for specific points, steps, or stages in the manufacturing process where control is necessary to ensure the quality of the dietary supplement.

3. You did not prepare a written master manufacturing record (MMR) for each batch size of dietary supplement that you manufacture to ensure uniformity in the finished batch from batch to batch, as required by 21 CFR 111.205(a). Specifically, you manufacture batches of product in various sizes; however, your MMR for (b)(4), Braz a Vie Acai, and (b)(4) are for (b)(4) only.

In your June 10, 2011 response you stated that your MMRs are under review to have additional instructions and specifications added to the manufacturing process. You stated this would be completed by August 31, 2011. Your response is inadequate because you have not indicated that you have developed MMRs for each batch size or forwarded them for our review.

4. Your master manufacturing records (MMRs) for (b)(4), Acai, and (b)(4) do not include the following information required by 21 CFR 111.210:

• The identity and weight or measure of each dietary ingredient that will be declared on the Supplement Facts label [21 CFR 111.210(d)]. Specifically, your MMR for (b)(4) fails to declare the identity and weight or measure of several dietary ingredients such as (b)(4) and (b)(4) that are declared on the Supplement Facts label of the dietary supplement.
 

• A statement of theoretical yield of a manufactured dietary supplement expected at each point, step, or stage of the manufacturing process where control is needed to ensure the quality of the dietary supplement, and the expected yield when you finish manufacturing the dietary supplement, including the maximum and minimum percentages of theoretical yield beyond which a deviation investigation of a batch is necessary and material review is conducted and disposition decision is made [21 CFR 111.210(f)]. Specifically, your MMRs for (b)(4), Braz a Vie Acai, and (b)(4) do not contain any of this information.

• A description of packaging and a representative label, or a cross-reference to the physical location of the actual or representative label [21 CFR 111.210(g)]. Specifically, your MMRs for (b)(4) , Braz a Vie Acai, and (b)(4) products do not contain this information.

• Written instructions, including procedures for sampling and a cross-reference to procedures for tests or examinations; specific actions necessary to perform and verify points, steps, or stages in the manufacturing process where control is necessary to ensure the quality of the dietary supplement and that the dietary supplement is packaged and labeled as specified in the master manufacturing record; and corrective action plans for use when a specification is not met [21 CFR 111.210(h)]. Specifically, your MMRs for (b)(4), Braz a Vie Acai, and (b)(4) products do not contain this information.

In your June 10, 2011 response you stated that your MMRs are under review to have additional instructions and specifications added to the manufacturing process. You stated this would be completed by August 31, 2011. Your response is inadequate because you have not indicated that you have completed your revisions and forwarded these records for our review.

5. Your batch production records (BPRs) for your (b)(4), Braz a Vie Acai and (b)(4) products do not include the following information required by 21 CFR 111.260:

• The unique identifier that you assigned to packaging used [21 CFR 111.260(d)]. Specifically, the BPR for (b)(4), Lot # (b)(4), does not include complete lot number information for bottles used.

• A statement of the actual yield and a statement of the percentage of theoretical yield at appropriate phases of processing [21 CFR 111.260(f)]. Specifically, your BPR for (b)(4), Lot #(b)(4), Braz a Vie Acai, Lot #(b)(4), (b)(4), Lot # (b)(4), and (b)(4), Lot # (b)(4), lack this information.

• Documentation, at the time of performance, of the manufacture of the batch including the initials of the person weighing or measuring each component used in the batch, the initials of the person responsible for verifying the weight or measure of each component used in the batch, the initials of the person responsible for adding the component to the batch, and the initials of the person responsible for verifying the addition of components to the batch [21 CFR 111.260(j)(2)(iv)]. Specifically, the BPR for (b)(4) Lot # (b)(4) is missing this information for the reverse osmosis water and organic green tea leaf components. The BPR for (b)(4) Lot # (b)(4) is missing the initials for the person who added each component. The BPR for (b)(4), Lot # (b)(4), is missing all of the above information for the reverse osmosis water component.

• Documentation at the time of performance that quality control reviewed the BPR for the results of any tests and examinations on the finished batches of dietary supplements [21 CFR 111.260(l)(1)(ii)]. Specifically,

o Your BPR for (b)(4), Lot #(b)(4), indicates on the Quarantine Release Report that it was released on 3/27/2011. However, your records indicate that quality control reviewed the microbiology results on 4/4/2011.

o Your BPR for Braz a Vie Acai, Lot #(b)(4), indicates on the Quarantine Release Report that it was released on 4/20/2011. Your records indicate that microbiology results were not completed until 4/23/2011, although quality control documented having reviewed the record on 4/20/2011.

o Your BPR for (b)(4), Lot # (b)(4), indicates on the Quarantine Release Report that it was released on 3/26/2011. Your records indicate that microbiology results were not completed until 3/29/2011 although quality control documented having reviewed the record on 3/26/2011. In addition, the results of finished product dietary ingredient analyses for (b)(4) were not completed until 4/8/2011.

o Your BPR for (b)(4), Lot # (b)(4), indicates on the Quarantine Release Report that it was released on 2/5/11. Your records indicate that the microbiology results were not completed until 2/8/11, although quality control documented having reviewed the record on 2/5/11. In addition, the results of finished product dietary ingredient analyses for (b)(4) were not completed until 2/14/2011.

You told our investigators that some results are checked and the product is released verbally but that documentation for these dietary supplements can take up to one week before it is completed. In addition, you have a practice to release finished product after you receive an acceptable (b)(4) hour microbiology test result, but do not wait for the completed (b)(4) microbiological result.

In your June 10, 2011 response, you stated that an additional hire was approved that will ensure that Quarantine tags, which include the unique lot number, are applied to all raw materials, packaging, and labels; new MMRs will state where yield data will be available; you stated that you are changing the sequencing that you close out batch production records; you authorized a new hire to give more time for the Lab Manager to put the completed batch records together properly and in sequence; and your SOP for release will be modified to cover more details on microbiological release, early and routine. You also provided the batch ticket from (b)(4) Lot # (b)(4).

This response is inadequate because it does not address how you will ensure that lot numbers are documented in the BPR; the BPR must contain yield data, not a reference in the MMR to where it can be found; and you have not provided your modified SOP or provided details on how your proposed changes will ensure that your BPRs contain documentation at the time of performance that quality control personnel reviewed the results of any tests or examinations. The batch ticket provided does not correspond to the lot numbers referenced above, nor have you explained how you will ensure that this type of error does not occur in the future.

6. You failed to identify each unique lot within each unique shipment of labels in a manner that allows you to trace the lot to the supplier, the date received, the name of the label, the status of the label (e.g. quarantined, approved, or rejected); and to the dietary supplement that you distributed, as required by 21 CFR 111.160(d)(1). Specifically, on your Label Receiving Report dated (b)(4), you documented receiving (b)(4) sleeve labels for your (b)(4) product with an Item Key of (b)(4). This is a general number used for this label regardless of the date the labels are received. There is no information contained in the section for Lot No. In addition, the Quarantine Release Report in your BPR for Braz a Vie Acai Lot # (b)(4) lists the Label # (b)(4). However, this is a general part number, not a unique lot number. It is pre-printed on each label for this product.

In your June 10, 2011 response, you stated that an additional warehouse hire was approved who will assure that the Quarantine tags, which include the unique lot number, are applied to all the components, packaging and labels in the future. You also stated that you are recommending that a small, unique part number and "revision" number be printed on each label supplied by your customer and you will do this on labels you approve in house. We will verify your correction at the time of the next inspection.

7. You failed to control the issuance and use of labels and reconciliation of any issuance and use discrepancies, as required by 21 CFR 111.410(b). Specifically, according to the Precision Formulations Usage Report in the BPR for (b)(4) Lot # (b)(4), (b)(4) labels were used. However, in the notes section the form indicates that only (b)(4) bottles were labeled while (b)(4) bottles were not labeled. The form does not account for the (b)(4) labels that were not used.

Your June 10, 2011 response does not address the discrepancy described above.

This letter is not an all-inclusive list of violations at your facility. It is your responsibility to ensure that your products comply with the Act and FDA's implementing regulations.

Failure to promptly correct the violations specified above may result in enforcement action without further notice. Enforcement action may include seizure of violative products and/or injunction against the manufacturers and distributors of violative products.

We note that your BPR for (b)(4) Lot #(b)(4) indicates bottles should be hot filled at (b)(4) degrees. However, your records show that the (b)(4) temperatures recorded for this batch never reached this temperature. In your June 10, 2011 response, you stated that you have changed your specification to (b)(4), and that the (b)(4) temperature does not correspond to the bottle fill temperature. If the (b)(4) temperature is not a measurement of bottle fill temperature, it is unclear how you monitor the bottle fill temperature and document that your product meets this specification.

Please advise this office in writing within 15 days from your receipt of this letter of the specific steps you have taken to correct the violations noted above and to ensure that similar violations do not occur. Your response should include any documentation necessary to show that correction has been achieved. If you cannot complete all corrections before you respond, state the reason for the delay and the date by which you will complete the corrections.

Please send your reply to the Food and Drug Administration, Attention: Seri L. Essary, Compliance Officer, at the above letterhead address. If you have any questions regarding any issue in this letter, please contact Seri Essary at (214) 253-5335.
 

Friday, December 02, 2011

December, 2011 Actos News: Takeda May Face 10,000 U.S. Suits Over Actos Cancer Claims

I just attended the JPML hearing regarding petitions to centralize the Actos litigation. A full court room in the USDCT in Savannah, GA.  Takeda seeks an MDL placement in Illinois, given that it is based in that state. Others seek Louisiana among other states. I'm hearing a decision will be made by year end.

On the heels of that hearing there is this report from Bloomberg:

Takeda may face as many as 10,000 lawsuits in U.S. courts over allegations that its Actos diabetes drug causes bladder cancer, and a group of judges is preparing to decide where they should be consolidated.
U.S. regulators found in June that an analysis of a company-sponsored study showed some users of Actos, the world’s best-selling diabetes medication, faced an increased risk of developing the potentially fatal disease.

Source: 
http://www.bloomberg.com/news/2011-12-01/takeda-may-face-10-000-u-s-suits-over-actos-cancer-claims.html

From the FDA 
[6-15-2011] The U.S. Food and Drug Administration (FDA) is informing the public that use of the diabetes medication Actos (pioglitazone) for more than one year may be associated with an increased risk of bladder cancer. Information about this risk will be added to the Warnings and Precautions section of the label for pioglitazone-containing medicines. The patient Medication Guide for these medicines will also be revised to include information on the risk of bladder cancer.


Facts about pioglitazone
  • Sold as a single-ingredient product under the brand-name Actos. Also sold in combination with metformin (Actoplus Met, Actoplus Met XR) and glimepiride (Duetact).
  • Used along with diet and exercise to improve control of blood sugar in adults with type 2 diabetes mellitus.
  • From January 2010 through October 2010, approximately 2.3 million patients filled a prescription for a pioglitazone-containing product from outpatient retail pharmacies.2
This safety information is based on FDA's review of data from a planned five-year interim analysis of an ongoing, ten-year epidemiological study1, described in FDA's September 2010 ongoing safety review1 and in the Data Summary below. The five-year results showed that although there was no overall increased risk of bladder cancer with pioglitazone use, an increased risk of bladder cancer was noted among patients with the longest exposure to pioglitazone, and in those exposed to the highest cumulative dose of pioglitazone.
FDA is also aware of a recent epidemiological study conducted in France2 which suggests an increased risk of bladder cancer with pioglitazone. Based on the results of this study, France has suspended the use of pioglitazone and Germany has recommended not to start pioglitazone in new patients.
FDA recommends that healthcare professionals should:
  • Not use pioglitazone in patients with active bladder cancer.
  • Use pioglitazone with caution in patients with a prior history of bladder cancer. The benefits of blood sugar control with pioglitazone should be weighed against the unknown risks for cancer recurrence.
FDA will continue to evaluate data from the ongoing ten-year epidemiological study. The Agency will also conduct a comprehensive review of the results from the French study. FDA will update the public when more information becomes available.

Additional Information for Patients
  • There may be an increased chance of having bladder cancer when you take pioglitazone.
  • You should not take pioglitazone if you are receiving treatment for bladder cancer.
  • Tell your doctor right away if you have any of the following symptoms of bladder cancer: blood or red color in urine; urgent need to urinate or pain while urinating; pain in back or lower abdomen.
  • Read the Medication Guide you get along with your pioglitazone medicine. It explains the risks associated with the use of pioglitazone.
  • Talk to your healthcare professional if you have questions or concerns about pioglitazone medicines.
  • Report side effects from the use of pioglitazone medicines to the FDA MedWatch program, using the information in the "Contact Us" box at the bottom of the page.
 

Tuesday, November 29, 2011

FDA sues dietary supplement maker ATF Fitness

The FDA has sued a dietary supplement manufacturer, ATF Fitness Products and Manufacturing ATF Dedicated Excellence (MADE), for non-compliance with the Federal Food, Drug, and Cosmetic Act.
The company has been charged with, by the US Department of Justice, adulteration and mislabeling of its products, besides violation of current Good Manufacturing Practice (cGMP) regulations.


ATF buys dietary supplements including vitamins and minerals from MADE which markets them across the US under the brands Sci-Fit, Nature's Science and For Store Only.

Source:  http://otc.pharmaceutical-business-review.com/news/fda-sues-dietary-supplement-maker-for-violating-laws-281111

Monday, November 28, 2011

Nevada Supreme Court

Walgreens logoImage via WikipediaThe Nevada Supreme Court has rules that "when a pharmacist has knowledge of a customer-specific risk with respect to a prescribed medication, the pharmacist has a duty to exercise reasonable care in warning the customer or notifying the prescribing doctor of this risk."


The case is Klasch adv. Walgreens, and the opinion may be found here.  


In that case, a consumer  had a prescription filled at a Walgreen's pharmacy. The consumer had completed a patient profile that indicated  known allergies. When a prescription was to be filled, a Walgreens employee called  the consumer (Klasch) and conveyed that her prescription had been flagged because of her sulfa allergy.  In response, Klasch reportedly indicated that she had taken Bactrim in the past and that she had not experienced any adverse reaction to it.  Satisfied with this clarification, a pharmacist then manually overrode the computer system’s flag, and the prescription was released. The consumer took the drug, and developed a horrible condition called SJS. She  ultimately died from the complications of that condition, which the survivors in a lawsuit claim were caused by the prescription filled by Walgreens. 


The complaint alleged that  Walgreens’ pharmacist breached her duty of care by failing to adequately warn Klasch of the prescribed medication’s risks in light of her allergy to it or, alternatively, by failing to call her doctor to clarify whether he really meant to prescribe a medication to which she was allergic.


The Court held that : "The learned-intermediary doctrine does not foreclose a pharmacist’s potential for liability when the pharmacist has knowledge of a customer-specific risk."


The Court denied a Motion for Summary Judgment, in its ruling. It's worth reading. 


  














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Wednesday, November 23, 2011

Recent State Court decision detailing Post -Mensing Rulings (Reglan)

From a PA State Court, this decision does a good job noting recent post Mensing decisions:


Merck Agrees to Pay US $950 M to Settle Vioxx Claims

RofecoxibImage via WikipediaMerck will pay $950 million and a unit of the company will plead guilty to a criminal misdemeanor charge to resolve a U.S. probe of its illegal marketing of the painkiller Vioxx.


The criminal plea is tied to Merck’s off-label promotion of rofecoxib for rheumatoid arthritis (RA) from 1999 until 2002, since the drug did not have an indication for RA at that time. The civil settlement is tied to a broader range of allegedly illegal conduct by Merck, including statements about the cardiovascular safety of rofecoxib made by Merck representatives. The company will also enter into an expansive corporate integrity agreement with the government.


From a press release:



Under civil settlement agreements signed with the United States and individually with 43 states and the District of Columbia, Merck will pay approximately two-thirds of the reserved charge to resolve civil allegations related to Vioxx. As a result, the United States and the participating states have released Merck from civil liability related to the governments' allegations regarding the sale and marketing of Vioxx in the United States. Previously disclosed litigation with seven states remains outstanding.
The civil settlement does not constitute any admission by Merck of any liability or wrongdoing.
"We believe that Merck acted responsibly and in good faith in connection with the conduct at issue in these civil settlement agreements, including activities concerning the safety profile of Vioxx," said Bruce N. Kuhlik, executive vice president and general counsel of Merck.
Separately, the company agreed to plead guilty to a misdemeanor under the Federal Food, Drug, and Cosmetic Act arising out of the marketing of Vioxx by company representatives to physicians in the United States for the treatment of rheumatoid arthritis before the FDA's approval of that indication in April 2002. The company will pay a fine of approximately one-third of the reserved amount to the federal government as part of the plea agreement.

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Tuesday, November 22, 2011

Georgia November 21, 2011 Yaz News

FdaImage via WikipediaAs the litigation moves along in the cases involving the Yaz birth control products, there is this news from recent discovery responses:

Bayer may have considering marketing the birth- control pills for unapproved uses  according to company e-mails.


Bayer reps discussed promoting the contraceptive known as Yaz, a spinoff of Yasmin, for treatment of all types of  premenstrual syndrome. Salespeople for Bayer unit Berlex Laboratories Inc., acquired in the 2006 purchase of Schering AG, received an e-mail that year from a company official citing a Woman’s Day magazine article about Yaz.

From the email: “This article is a nice way of using YAZ for PMS treatment instead of just focusing on the specific” class of women battling premenstrual dysphoric disorder, the most severe form of PMS, wrote Matt Sample, a Berlex sales consultant, according to a copy of the e-mail produced as evidence.

The FDA approved Yaz only for the most severe form of PMS. Yaz is approved to treat Treat premenstrual dysphoric disorder (PMDD).

Premenstrual dysphoric disorder—PMDD—is the most severe form of PMS. That is, the only actual difference between the two syndromes is the severity of their symptoms. Even that is not always clear, since there are severe cases of PMS that do not happen to meet the criteria for PMDD.

One characteristic that can distinguish PMDD from PMS is the intensity of the emotional or psychological symptoms. In PMS, physical symptoms or emotional symptoms can be the primary cause of concern. The related cardinal feature of premenstrual dysphoric disorder is the degree to which it interferes with work and relationships. Of course, severe (or even moderate) PMS can have a tremendous impact on a woman's enjoyment of life and her productivity at work and at home. Source

The FDA warned that women taking the pills were 74 percent more likely to suffer blood clots than women on other low-estrogen contraceptives. The FDA examined data on 835,826 women who took pills containing the hormone, including Bayer’s Yasmin line of birth-control pills, according to the FDA report.



 http://www.bloomberg.com/news/2011-11-21/bayer-may-have-touted-birth-control-pills-for-unapproved-use-e-mails-show.html#


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Monday, November 21, 2011

Army drops use of anti-malarial drug

From the source below. The news today is that the Army will stop using Mefloquine. Mefloquine is used to treat malaria (a serious infection that is spread by mosquitoes in certain parts of the world and can cause death) and to prevent malaria in travelers who visit areas where malaria is common. Mefloquine is in a class of medications called antimalarials. It works by killing the organisms that cause malaria.

From the article:


Mefloquine is a zombie drug. It’s dangerous, and it should have been killed off years ago,” said Dr. Remington Nevin, an epidemiologist and Army major who has published research that he said showed the drug can be potentially toxic to the brain. He believes the drop in prescriptions is a tacit acknowledgement of the drug’s serious problems.
Over the past three years, the Army slashed by almost 75 percent the amount of mefloquine it prescribes, even as it sent thousands more soldiers to malaria-prone Afghanistan.
The decrease in doses followed two orders from military and Pentagon leaders in 2009. One, from the Army’s surgeon general, ordered the branch to limit its use to specific circumstances. Other branches, however, continue to favor mefloquine.

Friday, November 18, 2011

November 17, 2011 Update: encore100® Toric and encore100® Sphere Limited Lot Recall Q&As

Contact lensImage via Wikipedia
From the Cooper Vision Site:

encore100® Toric and encore100® Sphere Limited Lot Recall Q&As

Q: What is the cause of the encore100 Toric and encore100 Sphere recall?
A: The recall was initiated on limited lots of encore100 Toric and encore100 Sphere because
CooperVision identified certain lots that did not meet our updated quality requirements due to the
level of a residue (silicone oil).  The presence of the residue may cause hazy vision or discomfort,
severe eye pain or eye injuries requiring medical treatment. Not everyone experiences the same
symptoms.

Q: What happens if a contact lens wearer puts an impacted lens in their eye?

A: We have received complaint reports for the encore100 Toric lenses that began as hazy vision.
After the recall, some patient complaints were received that began as hazy vision but progressed to
severe eye pain or eye injuries requiring medical treatment.  Not every patient has the same
symptoms. Health and safety of patients are our top priority so the recall was expanded to the limited
lots of encore100 Sphere lenses.

Q: What should I do if I personally experience these symptoms?

A: Remove the lenses from your eyes immediately if you are currently wearing them. Contact your
eye care practitioner to let them know you are experiencing symptoms. Follow your eye care
practitioner’s instructions.

Q: If I have symptoms how long will they last?

A: If the lens is removed promptly after the onset of symptoms it likely will clear up within 15 to 30
minutes. If you leave the lens in your eye for a prolonged period of time the symptoms may progress
to a more serious condition. Contact your eye care practitioner to let them know you are
experiencing symptoms.

Q: Has anyone had permanent damage to their eye because of these symptoms?

A: To date we have not received any reports of permanent damage to a patient’s eye after wearing
the affected lens.

Q: What should be done with product that I currently have at home?

A: A small percentage of encore100 Toric and encore100 Sphere lenses are affected by this
situation. Please check the lot number on the carton or blister label you have by using the search
box on the www.coopervision.com/international-recalll website to see if your product has been
impacted by the recall, and if so, discontinue wear and return the lenses to your eye care
practitioner.  You may also call our Consumer Care hotline at 1-855-526-6737.

Q: Will I be able to re-order my encore100 Toric and encore100 Sphere lenses?

A: We expect that encore100 Toric will be available for ordering in the spring of 2012.  We anticipate
minimal disruption to availability of encore100 Sphere and you may continue to order through your
practitioner.

http://coopervision.com/pv_obj_cache/pv_obj_id_B84970CE53ADAF9E19484A5FD2C6ABD949630000/filename/encore100_Toric_and_encore100_Sphere_Consumer_FAQs_v7.pdf

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Georgia Law: Recent Order Limiting Ex Parte Interviews with Treating Doctors

From our office:


Keime Inc dba Barry's Vitamins Conducts a Nationwide Voluntary Recall of Virility Max Dietary Supplement

Logo of the U.S. Food and Drug Administration ...Image via WikipediaNovember 10, 2011 - Keime Incorporated announced today that it is conducting a voluntary recall of one lot of the companies dietary supplement product sold under the following name:  Virility Max.  The company has been informed by representatives of the FDA that lab analysis by FDA for Lot 10090571, found the product contained sulfoaildenafil, an analog of sildenafil. Sildenafil is an active ingredient of an FDA approved drug for erectile dysfunction (ED), making Virility Max an unapproved drug.  


The active drug ingredient is not listed on the product label.  The undeclared ingredient may interact with nitrates found in some prescription drugs, such as nitroglycerin and may lower blood pressure to dangerous levels.  Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.  Additionally, the product may cause side effects, such as headaches and flushing.
Virility Max is used for sexual enhancement.  It is distributed in 10 count, white plastic bottles to retail customers in the South Florida area.  


No illnesses have been reported to the company to date in connection with this product.
Customers who have this product in their possession should stop using it immediately and contact their physician if they have experienced any problems that may be related to taking this produc

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Breast Cancer: FDA Revokes Avastin Approval

A section of the south campus of the Genentech...Image via WikipediaFrom ABC:

The U.S. Food and Drug Administration today announced it will revoke the approval of Avastin for breast cancer, citing a lack of evidence that the benefits outweigh the risks.
Avastin was approved for metastatic breast cancer in February 2008 under the agency's accelerated approval program, which offers patients early access to promising drugs while confirmatory clinical trials are carried out.
"Unfortunately the additional studies failed to confirm Avastin's initial promise," FDA Commissioner Dr. Margaret Hamburg said today.
The additional studies, carried out by Avastin maker Genentech, found only a small effect on tumor growth and no evidence that patients lived longer than they would taking standard chemotherapy. Because the drug can cause severe high blood pressure, bleeding, heart failure and perforations in the nose, stomach and intestines, an FDA advisory panel in June recommended revoking its approval.


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Wednesday, November 16, 2011

Cooper Expands Recall Of Avaira Lenses

Lens cover for storing contact lensImage via Wikipedia
The Cooper Companies  contact lenses unit CooperVision expanded a recall of some of its Avaira brand lenses. Under the expanded recall, CooperVision is now including limited lots of Avaira Sphere contact lenses, in addition to limited units of Avaira Toric lenses.

Cooper, along with the FDA, found certain lots of Avaira Sphere lenses did not meet new quality requirements linked to silicone oil residue levels, and plans to replace them with available inventory.


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Kimberly-Clark Recalls Kotex Tampons

Kimberly Clark has recalled about 1,400 cases of Kotex tampons out of fear they may be contaminated with bacteria.
The recall applies specifically to 18-count and 36-count boxes of Kotex Natural Balance Security Unscented Tampons Regular Absorbency with sku numbers 15063 and 15068. All other Natural Balance tampons with other SKU numbers are safe to use, the company said.
The recalled tampons were sold at Walmart, Fry's and Smith's stores in Texas, Iowa, Kansas, Missouri, Nebraska, New Mexico, Arizona and Utah.

Tuesday, November 15, 2011

Mizuho OSI Modular Table Systems Recall

From the FDA site: 
Product: OSI Modular Table Systems (including Modular Bases, Jackson Spinal, Imaging, Lateral, & Orthopedic Tops)
Manufacturing From: January 1992 - June 2011
Distribution From: January 1992 - June 2011
The affected models and lot numbers can be found below:
ModelProduct Name
5803/5803IAdvanced Control Modular Base, 120VAC 60Hz or 230VAC 50/60Hz
5890Retractable “I” Base - Manual tilt & lock functions
5891Non-Retractable “I” Base - Manual tilt & lock functions
5892Advanced Control Retractable “I” Base - electric powered tilt & lock
5855Orthopedic Trauma Table Top
5895Maximum Access Lateral Top
5927Radiolucent Imaging Top with Tempur-Med
5840-726Imaging Top w/ Tempur-med pad (part of Model 5827 System)
5840-831Spinal Surgery Table Top (part of Jackson Spinal Surgery Top System)
5943Jackson Spinal Table
5843APJackson Spinal Surgery Top w/Advanced Control Pad System 100/120VAC 50/60Hz
5943APIJackson Spinal Surgery Top w/Advanced Control Pad System 230VAC 50/60Hz
5996/5996IAdvanced Control Pad System Variable Speed
6977AXIS Jackson System with Advanced Control Pad System 100/230 VAC 50/60Hz
Use: For patient positioning during a diverse set of orthopedic trauma, thoracic, and spinal surgery procedures.
Recalling Firm: 
Mizuho Orthopedic Systems Inc
30031 Ahem Avenue
Union City, CA 94587
Reason for Recall: There are reports of injury related incidents while using Mizuho OSI Modular Table Systems. The incorrect removal of the T-pins that support the bottom base, instead of the T-pins that support the top, may result in the lower table top and patient falling to the floor. Another potential concern is unexpected movement/tilting of the table which may result in unanticipated movement and/or patient falls during surgery. Both of the above may result in serious injury or death

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Pine Nut Recall Sees Second Lawsuit

:Original raster version: :Image:Food and Drug...Image via Wikipedia


The Food and Drug Administration (FDA) is warning consumers not to eat Turkish pine nuts distributed by Sunrise Commodities, based in Englewood Cliffs, New Jersey, after FDA tests confirmed the presence of Salmonella on the product.
FDA is collaborating with the Centers for Disease Control and Prevention (CDC) and State public health and agriculture officials to investigate a multistate outbreak of Salmonella Enteritidis infections. To date, the CDC reports there are at least 42 illnesses associated with the outbreak in Maryland, New Jersey, New York, Pennsylvania and Virginia.
As part of FDA’s investigation, the Agency collected and tested samples of Turkish pine nuts from a warehouse used by Sunrise Commodities and from a warehouse used by a customer of Sunrise Commodities. Additional testing by the FDA confirmed Salmonella Enteritidis, matching the outbreak strain, was found on FDA's positive samples of pine nuts. FDA's State partners also collected samples of pine nuts distributed by Sunrise Commodities; some of those samples tested positive for SalmonellaEnteritidis and matched the outbreak strain. 
 
Sunrise Commodities has voluntarily recalled four lots of the implicated product, totaling more than 21,000 pounds of pine nuts. Each lot was packed in 22-pound boxes and included the markings:
  • Warehouse Lot 27963 with the identifying code “PO#: 50165”
  • Warehouse Lot 29628 with the identifying code “PO#: 50558”
  • Warehouse Lot 27713 with the identifying code “PO#: 49595”
  • Warehouse Lot 27427 with the identifying code “PO#: 50032”
Sunrise Commodities distributed the Turkish pine nuts in bulk to various food vendors in Florida, New Jersey, New York and Canada. Sunrise Commodities issued a recall notification to its customers dated November 3, 2011, alerting them of the test results and of the epidemiologic investigation and asking them to notify their subsequent customers of the recall.

Already lawsuits have been filed:
Kimberly Waterbury filed suit Tuesday in federal court on behalf of herself and her minor child against American Pistachio Commodity Corp., which does business as Sunrise Commodities of Englewood Cliffs,  New Jersey
The suit claims that Sunrise Commodities was strictly liable for the contaminated product. The suit also claims the company was negligent for not using reasonable care in the manufacture, distribution and sale of the product, and for violating federal, state and/or local food safety regulations. 


http://www.democratandchronicle.com/article/20111115/NEWS01/111115031



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Study Suggests Multaq Doubled Deaths From Heart Disease

Multaq  - a drug that is approved to treat patients whose hearts intermittently race with quick and inefficient contractions may have double the risk of serious injury for those who have some type of erratic heart rhythm, according to a recent study.  
A Multaq trial of more than 3200 patients was recently halted, supposedly because of the dangers to trial participants. 
The study was paid for by Paris-based Sanofi and published in the New England Journal of Medicine. There were 21 deaths from cardiovascular causes in the Multaq group, compared with 10 among those getting placebo.
From the NEJM:

BACKGROUND

Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular anti-arrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk permanent atrial fibrillation.

METHODS

We assigned patients who were at least 65 years of age with at least a 6-month history of permanent atrial fibrillation and risk factors for major vascular events to receive dronedarone or placebo. The first coprimary outcome was stroke, myocardial infarction, systemic embolism, or death from cardiovascular causes. The second coprimary outcome was unplanned hospitalization for a cardiovascular cause or death.

RESULTS

After the enrollment of 3236 patients, the study was stopped for safety reasons. The first coprimary outcome occurred in 43 patients receiving dronedarone and 19 receiving placebo (hazard ratio, 2.29; 95% confidence interval [CI], 1.34 to 3.94; P=0.002). There were 21 deaths from cardiovascular causes in the dronedarone group and 10 in the placebo group (hazard ratio, 2.11; 95% CI, 1.00 to 4.49; P=0.046), including death from arrhythmia in 13 patients and 4 patients, respectively (hazard ratio, 3.26; 95% CI, 1.06 to 10.00; P=0.03). Stroke occurred in 23 patients in the dronedarone group and 10 in the placebo group (hazard ratio, 2.32; 95% CI, 1.11 to 4.88; P=0.02). Hospitalization for heart failure occurred in 43 patients in the dronedarone group and 24 in the placebo group (hazard ratio, 1.81; 95% CI, 1.10 to 2.99; P=0.02).

CONCLUSIONS

Dronedarone increased rates of heart failure, stroke, and death from cardiovascular causes in patients with permanent atrial fibrillation who were at risk for major vascular events. Our data show that this drug should not be used in such patients. (Funded by Sanofi-Aventis; PALLAS ClinicalTrials.gov number, NCT01151137.)