BEUDAMED
    FDA Adverse Event Other Summary report: N

    SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

    MDR report key: 2195637 · Received July 25, 2011

    Report

    Report Number
    3004753838-2011-00223
    Event Type
    Other
    Date Received
    July 25, 2011
    Date of Event
    June 30, 2011
    Report Date
    June 30, 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 ABSENCE OF ANY EVIDENCE OF PHYSICAL HARM OR NECESSITY FOR INTERVENTION.

    Description of Event or Problem · 1

    PT CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2011 TO REPORT THAT AFTER NOTING A SENSOR FAILURE, HE DECIDED TO REMOVE THE SENSOR. PT FELT THE REMAINING PART OF THE SENSOR IN HIS SKIN AND WAS ABLE TO PULL IT OUT. PT REPORTS NO INJURY AT THE SITE OF INSERTION. PT DID NOT NEED TO SEEK MEDICAL INTERVENTION. DURING HIS CALL TO DEXCOM TECHNICAL SUPPORT, PT WAS DOING FINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR MDS DEXCOM, INC. 9500-03 5015549

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR Other