FDA Adverse Event Malfunction Summary report: N

DEXCOM G6 CONTINUOUS GLUCOSE MONITORING SYSTEM

MDR report key: 15269912 · Received August 22, 2022

Report

Report Number
3004753838-2022-153456
Event Type
Malfunction
Date Received
August 22, 2022
Date of Event
July 28, 2022
Report Date
November 7, 2022
Manufacturer
DEXCOM, INC.
Product Code
QBJ
UDI-DI
00386270001788
PMA / PMN Number
DEN170088
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

(B)(4).

Additional Manufacturer Narrative · 0

(B)(4).

Additional Manufacturer Narrative · 0

(B)(4). THIS MDR WAS PREVIOUSLY SUBMITTED ON 9/28/2022 WITH MFR# 3004753838-2022-153456-01. THE ACK2 WAS RECEIVED ON 9/28/2022 BY CDRH WITH COREID: CI1664401219133.12942087@FDSLV86002_TE2. PER ESG/CDRH EMAIL ON 9/30/2022, ¿ THE CESUB HELPDESK HAS COMMUNICATED THEY ARE AWARE OF MULTIPLE MDRS THAT FAILED TO PROCESS AND MULTIPLE ACK3S THAT FAILED TO SEND BETWEEN SEPTEMBER 7 AND SEPTEMBER 26 DUE TO AN INFRASTRUCTURE ISSUE, AND THEY ARE WORKING AS FAST AS THEY CAN TO REPROCESS THE MDRS THAT NEED TO BE REPROCESSED AND RESEND ACK3S THAT FAILED TO SEND. THEIR GOAL IS TO COMPLETE THIS TASK AND RESPOND TO ALL OPEN ACK3 TICKETS BY OCTOBER 7.¿ AS OF OCTOBER 28, 2022, THE ISSUE HAS NOT BEEN RESOLVED. AS PER ESG/CDRH EMAIL ON 10/28/2022, WE SHOULD NOW RESUBMIT THIS MDR.

Description of Event or Problem · 0

IT WAS REPORTED THAT SIGNAL LOSS OVER ONE HOUR OCCURRED. A REVIEW OF THE SHARE LOGS WAS PERFORMED AND A LOSS OF CONNECTION WAS FOUND WITHIN THE INVESTIGATION WINDOW. HOWEVER, THE DEVICE OPERATED WITHIN SPECIFICATION. THE ALLEGATION WAS NOT CONFIRMED. THE PROBABLE CAUSE COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT SIGNAL LOSS OVER ONE HOUR OCCURRED. THE PRODUCT WAS EVALUATED. AN EXTERNAL VISUAL INSPECTION WAS PERFORMED AND PASSED. VOLTAGE TEST WAS PERFORMED AND PASSED. PAIRING TEST WAS PERFORMED AND PASSED. A REVIEW OF THE SHARE LOGS WAS PERFORMED AND SIGNAL LOSS WAS FOUND WITHIN THE INVESTIGATION WINDOW. HOWEVER, THE DEVICE OPERATED WITHIN SPECIFICATION. THE ALLEGATION WAS NOT CONFIRMED. THE PROBABLE CAUSE COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT SIGNAL LOSS OVER ONE HOUR OCCURRED. THE PRODUCT WAS EVALUATED. AN EXTERNAL VISUAL INSPECTION WAS PERFORMED AND PASSED. VOLTAGE TEST WAS PERFORMED AND PASSED. PAIRING TEST WAS PERFORMED AND PASSED. A REVIEW OF THE SHARE LOGS WAS PERFORMED AND SIGNAL LOSS WAS FOUND WITHIN THE INVESTIGATION WINDOW. HOWEVER, THE DEVICE OPERATED WITHIN SPECIFICATION. THE ALLEGATION WAS NOT CONFIRMED. THE PROBABLE CAUSE COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2388506 DEXCOM G6 CONTINUOUS GLUCOSE MONITORING SYSTEM CONTINUOUS GLUCOSE MONITOR QBJ DEXCOM, INC. 9445-24 P12948137 00386270001788

Patients

Seq Age Sex Outcome Treatment
1 64 YR Female