FDA Adverse Event Malfunction Summary report: N

DEXCOM G7 CONTINUOUS GLUCOSE MONITORING SYSTEM

MDR report key: 21000740 · Received December 23, 2024

Report

Report Number
3004753838-2024-336676
Event Type
Malfunction
Date Received
December 23, 2024
Date of Event
November 27, 2024
Report Date
March 4, 2025
Manufacturer
DEXCOM, INC.
Product Code
QBJ
UDI-DI
00386270002518
PMA / PMN Number
K213919
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KY, 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). B5: DESCRIBE EVENT OR PROBLEM ¿ CORRECTION G3: DATE RECEIVED BY MANUFACTURER - ADDITIONAL H2: ADDITIONAL INFORMATION - CORRECTION.

Description of Event or Problem · 0

IT WAS REPORTED THAT AN ALERT/NOTIFICATION SETTINGS ISSUE OCCURRED. NO PRODUCT OR DATA WAS PROVIDED FOR EVALUATION. THE ALLEGATION AND A PROBABLE CAUSE COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Description of Event or Problem · 0

THE PRODUCT WAS EVALUATED. AN EXTERNAL VISUAL INSPECTION WAS PERFORMED AND PASSED. RECEIVER CHARGE AND BOOT TESTS WERE PERFORMED AND PASSED. FUNCTIONAL TESTS WERE PERFORMED AND THE AUDIO TEST FAILED. AN ALARM/ALERT MANUAL TEST WAS PERFORMED AND FAILED. AN INTERNAL VISUAL INSPECTION WAS PERFORMED AND FAILED DUE TO AN ASSEMBLY ERROR; IT WAS NOTED THE SPEAKER INSTALLED TILTED. PICTURES WERE TAKEN. THE SPEAKER AND VIBRATOR RESISTANCES WERE MEASURED AND PASSED. THE PERFORMANCE DATA WAS REVIEWED FINDING NO ERROR RELATED TO THE COMPLAINT. THE ALLEGATION WAS CONFIRMED AS NO AUDIO OUTPUT. THE PROBABLE CAUSE WAS DETERMINED TO BE ASSEMBLY ERROR VIA PRODUCT. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT NO ALERT/NOTIFICATION OCCURRED. THE PRODUCT WAS EVALUATED. AN EXTERIOR VISUAL INSPECTION WAS PERFORMED ANDECEIVER CHARGE AND BOOT TESTS WERE PERFORMED AND PASSED. FUNCTIONAL TEST PASSED RELEVANT TESTS AND FAILED IN SERIAL NUMBER VERIFICATION TEST. AN ALARM/ALERT MANUAL TEST WAS PERFORMED AND FAILED. AN INTERNAL VISUAL INSPECTION WAS PERFORMED AND FAILED DUE TO FOREIGN OBJECT DAMAGE TO SPEAKER/FOD. THE SPEAKER/VIBRATOR RESISTANCE WAS MEASURED AND PASSED. RECEIVER SPEAKER/SOUND MANUAL TEST WAS PERFORMED AND FAILED DUE TO LOW SOUND. THE PERFORMANCE DATA WAS EVALUATED. THE ALLEGATION WAS CONFIRMED AS NO AUDIO OUTPUT. THE PROBABLE CAUSE OF NO AUDIO OUTPUT COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
76727 DEXCOM G7 CONTINUOUS GLUCOSE MONITORING SYSTEM CONTINUOUS GLUCOSE MONITOR QBJ DEXCOM, INC. 18038136 00386270002518

Patients

Seq Age Sex Outcome Treatment
1 6 YR Female