FDA Adverse Event Malfunction Summary report: N

DEXCOM G6 CONTINUOUS GLUCOSE MONITORING SYSTEM

MDR report key: 9014836 · Received September 12, 2019

Report

Report Number
3004753838-2019-65673
Event Type
Malfunction
Date Received
September 12, 2019
Date of Event
August 14, 2019
Report Date
February 18, 2021
Manufacturer
DEXCOM, INC.
Product Code
QBJ
PMA / PMN Number
DEN170088
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
GM
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

(B)(4).

Description of Event or Problem · 0

AN INTERNAL VISUAL INSPECTION REVEALED FOREIGN OBJECT DAMAGE ON THE SPEAKER DUST COVER. THE CUSTOMER'S COMPLAINT OF LOW AUDIO OUTPUT WAS CONFIRMED WITH A ROOT CAUSE DETERMINED TO BE FOREIGN OBJECT DAMAGE.

Additional Manufacturer Narrative · 1

(B)(4).

Additional Manufacturer Narrative · 1

(B)(4).

Description of Event or Problem · 1

THE PRODUCT WAS EVALUATED. THE DEVICE WAS VISUALLY INSPECTED AND PASSED. THE RECEIVER WAS CHARGED AND REBOOTED. THE RECEIVER LOGS PASSED. THE LOG WAS DOWNLOADED AND REVIEWED FINDING NO ERRORS RELATED TO THE COMPLAINT. A RECEIVER FUNCTIONAL TEST WAS PERFORMED AND IT FAILED SPEAKER TESTS. A GLOBAL COMMUNICATION TOOL TONE AT MEDIUM TEST WAS PERFORMED AND IT FAILED SOUND TESTS. "TRY IT" MANUAL FUNCTIONAL TESTS WERE PERFORMED AND THE TESTS FAILED. THE RECEIVER CASE WAS OPENED FOR AN INTERNAL VISUAL INSPECTION AND IT FAILED DUE TO FOD FOUND INSIDE THE SPEAKER DIAPHRAM. THE SPEAKER RESISTANCE WAS MEASURED AND IT REGISTERED WITHIN SPECIFICATION. THE ALLEGATION WAS CONFIRMED. THE PROBABLE CAUSE IS FOD.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE RECEIVER HAD LOW AUDIO OUTPUT. NO PRODUCT OR DATA WAS PROVIDED FOR EVALUATION. CONFIRMATION OF THE ALLEGATION AND A ROOT CAUSE COULD NOT BE DETERMINED. NO INJURY OR MEDICAL INTERVENTION WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
796122 DEXCOM G6 CONTINUOUS GLUCOSE MONITORING SYSTEM CONTINUOUS GLUCOSE MONITOR QBJ DEXCOM, INC. MT24078-1 5253193

Patients

Seq Age Sex Outcome Treatment
1 31 YR