BEUDAMED
    FDA Adverse Event Other Summary report: N

    SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

    MDR report key: 2440879 · Received February 1, 2012

    Report

    Report Number
    3004753838-2012-00026
    Event Type
    Other
    Date Received
    February 1, 2012
    Date of Event
    December 21, 2011
    Report Date
    January 6, 2012
    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'S FATHER CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2012 TO REPORT THAT UPON SENSOR REMOVAL, SENSOR WIRE APPEARED SHORTER THAN USUAL. PT'S FATHER BELIEVES THAT A SENSOR FRAGMENT HAS REMAINED INSIDE PT'S SKIN. AT THE TIME OF HIS CALL TO DEXCOM TECHNICAL SUPPORT, PT'S FATHER REPORTS THAT PT APPEARS TO BE DOING FINE AND THAT NO MEDICAL INTERVENTION WAS SOUGHT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR MDS DEXCOM, INC. 9500-03 5029984

    Patients

    Seq Age Sex Outcome Treatment
    1 3 YR Other