FDA Adverse Event Other Summary report: N

SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

MDR report key: 2549048 · Received April 18, 2012

Report

Report Number
3004753838-2012-00101
Event Type
Other
Date Received
April 18, 2012
Date of Event
March 25, 2012
Report Date
March 26, 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 CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2012 TO REPORT THAT UPON SENSOR REMOVAL, DUE TO A SENSOR FAILURE DURING SESSION STARTUP, SENSOR WAS MISSING. PT IS WORRIED THAT SENSOR IS BROKEN INSIDE HER SKIN. AT THE TIME OF HER CALL TO DEXCOM TECHNICAL SUPPORT, PT WAS NOT COMPLAINING OF ANY ADD'L COMPLICATIONS AND HAD NO FURTHER CONCERNS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR MDS DEXCOM, INC. 9500-03 5032589

Patients

Seq Age Sex Outcome Treatment
1 48 YR Other