FDA Adverse Event Malfunction Summary report: N

DEXCOM G7 CONTINUOUS GLUCOSE MONITORING SYSTEM

MDR report key: 21255351 · Received January 28, 2025

Report

Report Number
3004753838-2025-023928
Event Type
Malfunction
Date Received
January 28, 2025
Date of Event
December 18, 2024
Report Date
September 18, 2025
Manufacturer
DEXCOM, INC.
Product Code
QBJ
PMA / PMN Number
K213919
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

(B)(4). 3004753838-2025-023928 WAS REPORTED IN ERROR. PLEASE DISREGARD INITIAL REPORTING OF THIS EVENT AS THIS EVENT HAS NOW BEEN DEEMED NOT REPORTABLE.

Additional Manufacturer Narrative · 0

(B)(4).

Description of Event or Problem · 0

AFTER SUBMISSION OF THE INITIAL MDR, PRODUCT WAS RECEIVED ON 5/17/2025 AND IT WAS DETERMINED THIS COMPLAINT IS NOT REPORTABLE PER (B)(4).

Description of Event or Problem · 0

IT WAS REPORTED THAT A BROKEN SENSOR WIRE OCCURRED. THE SENSOR WAS INSERTED INTO THE ARM ON 12/16/2024. DATA WAS RECEIVED BUT NOT INVESTIGATED AS DATA WILL NOT CONFIRM THE ISSUE. THE ALLEGATION AND A PROBABLE CAUSE COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1549778 DEXCOM G7 CONTINUOUS GLUCOSE MONITORING SYSTEM CONTINUOUS GLUCOSE MONITOR QBJ DEXCOM, INC. 9500-161 1824183001

Patients

Seq Age Sex Outcome Treatment
1 8 YR Male TANDEM T: SLIM X2 INSULIN PUMP