BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    G4 PLATINUM CONTINUOUS GLUCOSE MONITORING SYSTEM

    MDR report key: 3971812 · Received July 31, 2014

    Report

    Report Number
    3004753838-2014-05855
    Event Type
    Malfunction
    Date Received
    July 31, 2014
    Date of Event
    June 24, 2014
    Report Date
    July 2, 2014
    Manufacturer
    DEXCOM, INC.
    Product Code
    MDS
    PMA / PMN Number
    P120005
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PATIENT CONTACTED DEXCOM TECHNICAL SUPPORT ON (B)(6) 2014 TO REPORT THAT ON (B)(6) 2014 PATIENT EXPERIENCED A POSSIBLE BROKEN SENSOR WIRE UPON APPLICATOR REMOVAL. PATIENT DID NOT REPORT ANY INJURY OR ANY MEDICAL INTERVENTION AT THE TIME OF CONTACT WITH DEXCOM TECHNICAL SUPPORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    446659 G4 PLATINUM CONTINUOUS GLUCOSE MONITORING SYSTEM MDS MDS DEXCOM, INC. 9500-35

    Patients

    Seq Age Sex Outcome Treatment
    1