BEUDAMED
    FDA Adverse Event Other Summary report: N

    SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

    MDR report key: 1616875 · Received February 25, 2010

    Report

    Report Number
    3004753838-2010-00016
    Event Type
    Other
    Date Received
    February 25, 2010
    Date of Event
    June 17, 2009
    Report Date
    June 17, 2009
    Manufacturer
    DEXCOM, INC.
    Product Code
    MDS
    PMA / PMN Number
    P050012
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEXCOM, INC. AND FDA AGREED DURING A FACILITY INSPECTION THAT ANY BROKEN SENSOR WIRE WAS A REPORTABLE EVENT, EVEN IN THE ABSENCE OF ANY EVIDENCE OF PHYSICAL HARM OR NECESSITY FOR INTERVENTION.

    Description of Event or Problem · 1

    POSSIBLE BROKEN SENSOR WIRE (RETAINED DISTAL END). PATIENT REMOVED AND DISCARDED PROXIMAL SEGMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR MDS DEXCOM, INC. 9500-03 090319420

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Other