FDA Adverse Event Other Summary report: N

SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR

MDR report key: 2593866 · Received May 25, 2012

Report

Report Number
3004753838-2012-00146
Event Type
Other
Date Received
May 25, 2012
Date of Event
April 30, 2012
Report Date
April 30, 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 AN INTERRUPTION IN SENSOR READINGS, PT COULDN'T LOCATE THE SENSOR WIRE AND IS CONCERNED THAT SENSOR MAY BE INSIDE OF HER SKIN. AT THE TIME OF HIS CALL TO DEXCOM TECHNICAL SUPPORT, BESIDES REDNESS AND TENDERNESS AROUND THE INSERTION SITE, PT REPORTS THAT SHE WAS FEELING FINE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SEVEN CONTINUOUS GLUCOSE MONITORING SENSOR MDS DEXCOM, INC. 9500-03 5029987

Patients

Seq Age Sex Outcome Treatment
1 53 YR Other