BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    G4 PLATINUM CONTINUOUS GLUCOSE MONITORING SYSTEM

    MDR report key: 3830311 · Received May 23, 2014

    Report

    Report Number
    3004753838-2014-05617
    Event Type
    Malfunction
    Date Received
    May 23, 2014
    Date of Event
    April 14, 2014
    Report Date
    April 28, 2014
    Manufacturer
    DEXCOM, INC.
    Product Code
    MDS
    PMA / PMN Number
    P120005
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PATIENT CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2014 AND CLAIMED THAT ON (B)(6) /2014, UPON SENSOR APPLICATOR REMOVAL, SENSOR REMAINED IN APPLICATOR. NO MEDICAL INTERVENTION WAS NECESSARY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    307728 G4 PLATINUM CONTINUOUS GLUCOSE MONITORING SYSTEM MDS, PRODUCT CODE: MDS MDS DEXCOM, INC. 9500-27 5136461

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Other