FDA Adverse Event Other Summary report: N

SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

MDR report key: 2445517 · Received February 3, 2012

Report

Report Number
3004753838-2012-00031
Event Type
Other
Date Received
February 3, 2012
Date of Event
January 6, 2012
Report Date
January 10, 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

INTERNATIONAL DISTRIBUTOR CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2012, TO REPORT THAT UPON SENSOR REMOVAL, PT NOTICED THAT SENSOR WAS MISSING. NO SYMPTOMS ARE OBSERVED AT THE INSERTION SITE. UPON REQUEST FROM DEXCOM TECHNICAL SUPPORT, INTERNATIONAL DISTRIBUTOR HAS TRIED TO GATHER MORE INFO FROM PT BUT PT HAS BEEN INACCESSIBLE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR MDS DEXCOM, INC. 9500-03 5032592

Patients

Seq Age Sex Outcome Treatment
1 44 YR Other