- Delivery Method:
- VIA UPS
Recipient NameMr. Jack Chen
- Guangdong Kemei Pharmaceutical Technology Co. Ltd.
2,4, No.16 (#6 Plant), Jiye Road, 3rd & 4th Floor
Songgang Songxia Industrial Park
- Issuing Office:
- Center for Drug Evaluation and Research | CDER
Warning Letter 320-22-07
December 14, 2021
Dear Mr. Chen:
Your firm is registered as a human drug manufacturer. The U.S. Food and Drug Administration (FDA) conducted testing of a consumer antiseptic hand rub drug product (also referred to as a consumer hand sanitizer), labeled as IMC WASH-FREE HAND SANITIZER. This drug product was declared to be manufactured at your facility, Guangdong Kemei Pharmaceutical Technology Co. Ltd, FEI 3017086967, at 2,4, No.16 (#6 Plant), Jiye Road 3rd & 4th Floor, Songgang Songxia Industrial Park, Shishan Foshan, China. Following an attempt to import IMC WASH-FREE HAND SANITIZER into the United States, it was detained and refused admission at the border.
The results of the FDA laboratory testing of a batch of this product detained at the border demonstrate that this drug product declared to be manufactured at your facility is adulterated within the meaning of section 501(d)(2) of the Federal Food, Drug, and Cosmetic Act (FD&C Act or the Act), 21 U.S.C. 351(d)(2), in that a substance was substituted wholly or in part therefor. In addition, this product is adulterated within the meaning of section 501(a)(2)(B) of the FD&C Act (21 U.S.C. 351(a)(2)(B)), in that the substitution demonstrates that the quality assurance within your facility is not functioning in accordance with Current Good Manufacturing Practice (CGMP) requirements.
In addition, IMC WASH-FREE HAND SANITIZER is an unapproved new drug introduced or delivered for introduction into interstate commerce in violation of section 505(a) of the FD&C Act, 21 U.S.C. 355(a), and is misbranded under sections 502(j), (a), (e), (x) and (ee) of the FD&C Act, 21 U.S.C. 352(j), (a), (e), (x) and (ee). Introduction or delivery for introduction of such products into interstate commerce is prohibited under sections 301(d) and (a) of the FD&C Act, 21 U.S.C. 331(d) and (a). These violations are described in more detail below.
IMC WASH-FREE HAND SANITIZER, declared to be manufactured at your facility, is labeled to contain 75% of the active ingredient ethyl alcohol (ethanol). However, FDA laboratory testing of a batch of this product detained at the border found that the drug product contained an average 35% ethanol volume/volume (v/v) and an average of 32% methanol v/v. Therefore, this hand sanitizer drug product is adulterated under section 501(d)(2) of the FD&C Act in that the active ingredient, ethanol, was substituted wholly or in part with methanol, a dangerous chemical when in contact with human skin or ingested.
Methanol is not an acceptable ingredient for hand sanitizers and should not be used due to its toxic effects. Skin exposure to methanol can cause dermatitis, as well as transdermal absorption with systemic toxicity. Substantial methanol exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system, or death. Although all persons using these products on their hands are at risk, young children who accidentally ingest these products, and adolescents and adults who drink these products as an alcohol (ethanol) substitute, are most at risk for methanol poisoning.
On December 15, 2020, FDA notified the public of the methanol contamination of your hand sanitizer drug products at the following webpage: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use
After several unsuccessful attempts to contact you, FDA contacted your firm’s consignees to discuss marketed action.
On December 23, 2020, one of your firm’s consignees, Shane Erickson Inc., recalled one lot of Wash-Free Hand Sanitizer (50ml, 100ml and 300ml size bottles) and one lot of Thrifty White Pharmacy Wash-Free Hand Sanitizer due to potential presence of undeclared methanol (wood alcohol), as noted on the following FDA website: shane-erickson-inc-dba-innovative-marketing-consultants-issues-voluntary-nationwide-recall-wash-free
On January 14-15, 2021, FDA received correspondence from your firm stating you were not the manufacturer of IMC brand products and that you had given your “FDA certificates” to this third-party that likely manufactured the contaminated hand sanitizer products.
On January 25, 2021, FDA held a teleconference with your firm. We recommended you consider removing all of your firm’s hand sanitizer drug products currently in distribution to the U.S. market that were labeled as or declared as manufactured by your firm, Guangdong Kemei Pharmaceutical Technology Co. Ltd. Your firm agreed to support the recall of IMC hand sanitizer products. However, to date, your firm has not committed to recall.
In response to this letter, provide the following:
- A detailed investigation into how the drug product described above, which was declared to be manufactured at your facility and which was labeled as containing ethanol, was substituted in part or in whole with methanol.
- A list of all raw materials used to manufacture all of your hand sanitizer drug products, including the suppliers’ names, addresses, and contact information.
- A list of all batches of any hand sanitizer drug products shipped to the United States by your firm, and a full reconciliation of all material you distributed.
- Copies of the complete batch records for all batches distributed to the U.S.
The substitution and contamination with methanol in a drug product declared to be manufactured in your facility demonstrates that the quality assurance within your facility is not functioning in accordance with CGMP requirements under section 501(a)(2)(B) of the FD&C Act.1
Unapproved New Drug and Misbranding Violations
IMC WASH-FREE HAND SANITIZER is a “drug” as defined by section 201(g)(1)(B) of the FD&C Act, 21 U.S.C. 321(g)(1)(B), because it is intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease, and/or under section 201(g)(1)(C) of the FD&C Act, 21 U.S.C. 321(g)(1)(C), and because it is intended to affect the structure or any function of the body. Specifically, this product is intended for use as a consumer topical antiseptic. Examples of claims observed on the IMC WASH-FREE HAND SANITIZER product label and labeling that provide evidence of the intended uses (as defined in 21 CFR 201.128) of the product include, but may not be limited to, the following:
“WASH-FREE HAND SANITIZER… Drug Facts…Purpose…Antiseptic…Use(s) to help reduce bacteria on skin…Directions…Apply a small amount in you palm and rub hands together briskly until dry…”
This topical antiseptic product is a “new drug” within the meaning of section 201(p) of the FD&C Act, 21 U.S.C. 321(p), because it is not generally recognized as safe and effective (GRASE) for use under the conditions prescribed, recommended, or suggested in its labeling. New drugs may not be introduced or delivered for introduction into interstate commerce without prior approval from FDA, as described in section 505(a) of the FD&C Act, 21 U.S.C. 355(a), unless they are lawfully marketed under section 505G of the FD&C Act (which is not the case for this product, as further described below) or other exceptions not applicable here. No FDA-approved application pursuant to section 505 of the FD&C Act, 21 U.S.C. 355, is in effect for this drug product, nor are we aware of any adequate and well-controlled clinical studies in the published literature that support a determination that your IMC WASH-FREE HAND SANITIZER drug product is GRASE for use under the conditions suggested, recommended, or prescribed in its labeling. Accordingly, this product is an unapproved new drug marketed in violation of sections 505(a) and 301(d) of the FD&C Act, 21 U.S.C 355(a) and 331(d).
We note that over-the-counter (OTC) topical antiseptic products had been the subject of rulemaking under the Agency’s OTC Drug Review. In particular, such products were addressed in a tentative final monograph (TFM) entitled “Topical Antimicrobial Drug Products for Over-the-Counter Human Use; Tentative Final Monograph for Health-Care Antiseptic Drug Products,” Proposed Rule, 59 FR 31402 (June 17, 1994) (1994 TFM), as further amended by “Safety and Effectiveness of Consumer Antiseptics; Topical Antimicrobial Drug Products for Over-the-Counter Human Use; Proposed Amendment of the Tentative Final Monograph; Reopening of Administrative Record,” Proposed Rule, 81 FR 42912 (June 30, 2016)(Consumer Antiseptic Rubs Proposed Rule). Over the course of these rulemakings, three active ingredients (benzalkonium chloride, ethyl alcohol (ethanol), and isopropyl alcohol) were classified as Category III for use in consumer antiseptic rub products, meaning that additional safety and effectiveness data are needed to support a determination that a drug product containing one of these active ingredients would be GRASE for use as a consumer antiseptic rub.
Section 505G of the FD&C Act addresses nonprescription drugs marketed without an approved application. Under section 505G(a)(3) of the FD&C Act, drugs that were classified as Category III for safety and effectiveness in a TFM that is the most recently applicable proposal or determination for such drug issued under 21 CFR Part 330 – and that were not classified as Category II for safety or effectiveness – are not required to have an approved application under section 505 in order to be marketed, as long as they are in conformity with the relevant conditions of use outlined in the applicable TFM, including the active ingredient, and comply with all other applicable requirements.
However, IMC WASH-FREE HAND SANITIZER does not conform to the 1994 TFM, as further amended by the 2016 Consumer Antiseptic Rubs Proposed Rule, nor any other TFM, proposed rule, or final rule, and do not meet the conditions under section 505G(a)(3) of the FD&C Act for marketing without an approved application under section 505.
According to the product label, IMC WASH-FREE HAND SANITIZER purportedly contains the active ingredient ethyl alcohol 75% v/v. However, as previously discussed, FDA laboratory analyses of a batch of this product detained at the border demonstrated that IMC WASH-FREE HAND SANITIZER contains ethanol in a concentration that is less than the 75% v/v stated on its product label and less than the amount of ethanol described in the 1994 TFM. Such a product does not conform with the TFM or the applicable requirements, nor is it consistent with the formulations described in the guidance setting forth FDA’s temporary policies for hand sanitizers during the COVID-19 public health emergency.
FDA laboratory analyses also demonstrated that batches of IMC WASH-FREE HAND SANITIZER contain significant concentrations of the undeclared ingredient methyl alcohol (methanol). Use of methanol as an active ingredient is not in conformance with the 1994 TFM, nor is methanol included in the formulations described in FDA’s Temporary Policy for Preparation of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency (COVID-19) Guidance for Industry. Furthermore, methanol is not acceptable as an inactive ingredient in hand sanitizers. As previously discussed, methanol has significant and sometimes fatal toxic effects and, therefore, does not meet the requirements under 21 CFR 330.1(e) that a product’s inactive ingredients be safe and suitable.
Additionally, this methanol-containing drug product, IMC WASH-FREE HAND SANITIZER, is misbranded under sections 502(j), (a), (e), (x), and (ee) of the FD&C Act, 21 U.S.C. 352(j), (a), (e), (x), and (ee).
It is misbranded under section 502(j) of the FD&C Act, 21 U.S.C. 352(j), because it is dangerous to health when used according to its labeling as a hand sanitizer. As previously stated, skin exposure to methanol could lead to systemic absorption, and substantial methanol exposure can potentially result in, among other things, blindness, permanent nervous system damage, and even death.
This hand sanitizer is misbranded under section 502(a) of the FD&C Act, 21 U.S.C 352(a), because its labeling is false or misleading. As noted above, IMC WASH-FREE HAND SANITIZER is labeled to contain ethyl alcohol 75% v/v. However, FDA laboratory analysis of batches of this product demonstrate that the product contains a concentration of ethyl alcohol (ethanol) that is less than what is stated on the product label and contains a significant concentration of methyl alcohol (methanol), an ingredient that is not declared on the product label. Section 201(n) of the FD&C Act, 21 U.S.C. 321(n), provides that “in determining whether the labeling or advertising is misleading there shall be taken into account . . . not only representations made or suggested . . . but also the extent to which the labeling or advertising fails to reveal facts material in the light of such representations or material with respect to consequences which may result . . .” Thus, the misleading representation of the concentration of the active ingredient ethyl alcohol (ethanol), and the failure of the product label to disclose the presence of the methyl alcohol (methanol) in the product, causes this product to be misbranded under section 502(a) of the FD&C Act, 21 U.S.C. 352(a).
The failure of this product to list methyl alcohol (methanol) as an ingredient on its label also causes it to be misbranded under section 502(e)(1)(A) of the FD&C Act, 21 U.S.C 352(e)(1)(A).
IMC WASH-FREE HAND SANITIZER is also misbranded under section 502(x) of the FD&C Act, 21 U.S.C. 352(x) because the product label fails to disclose a complete domestic address or domestic telephone number through which the responsible person may receive a report of a serious adverse event with such drug.
Lastly, this product is misbranded under section 502(ee) of the FD&C Act, 21 U.S.C. 352(ee) because IMC WASH-FREE HAND SANITIZER is a nonprescription drug subject to section 505G of the FD&C U.S.C. 355h, but does not comply with the requirements for marketing under that section and is not the subject of an application approved under section 505 of the FD&C Act 21 U.S.C. 355.
The introduction or delivery for introduction of a misbranded drug into interstate commerce is prohibited under section 301(a) of the FD&C Act, 21 U.S.C. 331(a).
Additionally, we note that under 21 CFR 201.61(a), “[t]he principal display panel of an over-the-counter drug in package form shall bear as one of its principal features a statement of identity of the commodity.” Under section 505G(a)(3) of the FD&C Act and the 1994 TFM, the statement of identity for health-care antiseptic drug products, a category that included consumer antiseptic rub drug products, must contain “the established name of the drug, if any” (59 FR 31442). Currently, there is no established name for consumer antiseptic rub drug products that have the active ingredient ethyl alcohol and are formulated as a gel. However, we recommend that you include the name “alcohol gel” as part of the statement of identity that appears on the principal display panel of the label for IMC WASH-FREE HAND SANITIZER which will allow consumers to make an informed decisions regarding your topical antiseptic.
CGMP Consultant Recommended
Based upon the nature of the violations we identified at your firm, we strongly recommend engaging a consultant qualified as set forth in 21 CFR 211.34 to evaluate your operations and to assist your firm in meeting CGMP requirements if your firm intends to resume manufacturing drugs for the U.S. market. We also recommend that the qualified consultant perform a comprehensive audit of your entire operation for CGMP compliance and that the consultant evaluates the completion and efficacy of your corrective actions and preventive actions before you pursue resolution of your firm’s compliance status with FDA. Your use of a consultant does not relieve your firm’s obligation to comply with CGMP. Your firm’s executive management remains responsible for resolving all deficiencies and systemic flaws to ensure ongoing CGMP compliance.
The violations cited in this letter are not intended to be an all-inclusive list of violations associated with your drug products. You are responsible for investigating and determining the causes of any violations and for preventing their recurrence or the occurrence of other violations. Note that FDA placed all drugs and drug products manufactured by your firm on Import Alert 66-78 on January 7, 2021, as the methods used in and controls used for the manufacture, processing, packing, or holding of these products do not appear to conform to current good manufacturing practices within the meaning of section 501(a)(2)(B) of the FD&C Act. Drugs and drug products that appear to be adulterated may be detained or refused admission without physical examination.
All drugs and drug products manufactured by your firm may remain listed on this import alert until there is evidence establishing that the conditions that gave rise to the appearance of the violation have been resolved, and the Agency has confidence that future entries will be in compliance with the FD&C Act. This may include an inspection prior to the Agency considering the appearance of adulteration to be addressed.
If you decide you want to manufacture drugs for the United States in the future, request a Regulatory Meeting to discuss corrective actions.
This letter notifies you of our findings and provides you an opportunity to address the above deficiencies. After you receive this letter, respond to this office in writing within 15 working days. Specify what you have done to address any violations and to prevent their recurrence. In response to this letter, you may provide additional information for our consideration as we continue to assess your activities and practices. If you cannot do so within 15 working days, state your reasons for delay and your schedule for completion.
Send your electronic reply to CDER-OC-OMQ-Communications@fda.hhs.gov.
Please identify your response with FEI 3017086967 and ATTN: LaKeesha Foster Sifontes.
Office of Manufacturing Quality
Office of Compliance
Center for Drug Evaluation and Research
Registered US Agent
Vizocom ICT LLC
860 Jamacha Rd. Ste. 104
El Cajon, CA 92019
1 Due to an increased demand for alcohol-based hand sanitizers during the COVID-19 pandemic, FDA published the Guidance for Industry: Temporary Policy for Preparation of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency (COVID-19) on March 19, 2020, and subsequently updated the guidance several times, most recently on February 10, 2021. This guidance communicates the Agency’s temporary policy that we do not intend to take action against firms for CGMP violations under section 501(a)(2)(B) of the FD&C Act if such firms prepare alcohol-based hand sanitizers for consumer use (or for use as a health care personnel hand rub) during the public health emergency, provided certain circumstances described in the guidance are present. These circumstances include preparation of hand sanitizer products using only the ingredients and formulas set forth in the guidance. In addition to the violative sample results detailed above that demonstrate the substitution of hand sanitizer products manufactured at your facility, a review of the purported formulations on the drug product’s labeling further indicates that this product is not prepared consistent with FDA’s temporary policy set forth in the guidance. Therefore, this product does not fall within the Agency’s temporary policy not to take action against firms manufacturing hand sanitizer products for violations of section 501(a)(2)(B) of the FD&C Act.