BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SEVEN PLUS CONTINUOUS GLUCOSE MONITORING SYSTEM

    MDR report key: 3892001 · Received June 24, 2014

    Report

    Report Number
    3004753838-2014-09655
    Event Type
    Malfunction
    Date Received
    June 24, 2014
    Date of Event
    June 3, 2014
    Report Date
    June 3, 2014
    Manufacturer
    DEXCOM, INC.
    Product Code
    MDS
    PMA / PMN Number
    P050012
    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 TO REPORT A HARDWARE FAILURE THE PATIENT EXPERIENCED ON (B)(6) 2014. PATIENT DID NOT REPORT ANY INJURY OR MEDICAL INTERVENTION AT THE TIME OF CONTACT WITH DEXCOM TECHNICAL SUPPORT. DEXCOM TECHNICAL SUPPORT ADVISED PATIENT TO RESET THE DEVICE ON (B)(6) 2014.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    368849 SEVEN PLUS CONTINUOUS GLUCOSE MONITORING SYSTEM MDS MDS DEXCOM, INC. MT20649

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Other