MAUDE Adverse Event Report: DEXCOM, INC. DEXCOM G7 CONTINUOUS GLUCOSE MONITORING SYSTEM

Model Number	9500-161
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/18/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported that a detached or missing sensor wire occurred.The sensor was inserted into the arm on (b)(6) 2025.Product has been received but is pending evaluation.A follow up report will be submitted upon completion.No injury or medical intervention was reported.
Additional Manufacturer Narrative
(b)(4).B5 describe event or problem - additional information d4 primary udi number - additional information g3 date received by mfg - additional information g6 type of report - updated/follow-up h2 type of follow up - additional information h6 codes: component code - additional information.
Event or Problem Description
Product has been received but is pending evaluation.A follow up report will be submitted upon completion.No injury or medical intervention was reported.
Additional Manufacturer Narrative
(b)(4).Was reported in error.Please disregard initial reporting of this event as this event has now been deemed not reportable.
Event or Problem Description
After submission of the initial mdr product was received on 3/12/2025 it was determined this complaint is not reportable per corpft-140202.

• Brand Name: DEXCOM G7 CONTINUOUS GLUCOSE MONITORING SYSTEM
• Common Device Name: CONTINUOUS GLUCOSE MONITOR
• Manufacturer (Section D): DEXCOM, INC.; 6340 sequence dr.; san diego CA 92121
• Manufacturer Contact: ashley spoto ; 6340 sequence dr.; san diego, CA 92121 ; 8582000200
• MDR Report Key: 21620238
• Report Number: 3004753838-2025-062892
• Device Sequence Number: 12438891
• Product Code: QBJ
• UDI-Device Identifier: 00386270002839
• UDI-Public: 00386270002839
• Combination Product (Y/N): N
• Initial Reporter State: WV
• Initial Reporter Country: US
• PMA/510(K) Number: K213919
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 07/18/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Lay User/Patient
• Device Model Number: 9500-161
• Device Catalogue Number: STP-AT-012
• Device Lot Number: 1824327003
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/12/2025
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 02/19/2025
• Supplement Date Received by Manufacturer: 04/16/2025; 07/09/2025
• Initial Report FDA Received Date: 03/17/2025
• Supplement Report FDA Received Date: 05/13/2025; 07/18/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: TRESIBA
• Patient Age: 53 YR
• Patient Sex: Female
• Patient Weight: 91 KG