BEUDAMED
    FDA Adverse Event Other Summary report: N

    SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

    MDR report key: 2107874 · Received May 24, 2011

    Report

    Report Number
    3004753838-2011-00162
    Event Type
    Other
    Date Received
    May 24, 2011
    Date of Event
    May 3, 2011
    Report Date
    May 10, 2011
    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 POSSIBLE BROKEN SENSOR WIRE WAS A REPORTABLE EVENT, EVEN IN THE ABSCENCE OF ANY EVIDENCE OF PHYSICAL HARM OR NECESSITY FOR INTERVENTION.

    Description of Event or Problem · 1

    PATIENT'S MOTHER CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2011 TO REPORT A FAILED SENSOR. PATIENT'S MOTHER LATER CALLED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2011 TO ADD THAT THE SENSOR IN QUESTION MAY HAVE BROKEN. WHEN THE SENSOR WIRE WAS REMOVED, PATIENT'S MOTHER NOTICED THAT THE WIRE WAS MISSING. PATIENT'S MOTHER DID NOT SEE ANY SIGN OF THE WIRE AT THE INSERTION SITE. NO MEDICAL INTERVENTION WAS REQUIRED, AND PATIENT WAS FINE AT THE TIME OF HER MOTHER'S FOLLOW-UP CALL TO DEXCOM TECHNICAL SUPPORT.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 8 YR Other