| Brand Name | DEXCOM G6 CONTINUOUS GLUCOSE MONITORING SYSTEM |
| Common Device Name | CONTINUOUS GLUCOSE MONITOR |
| Manufacturer (Section D) |
| DEXCOM, INC. |
| 6340 sequence dr. |
| san diego CA 92121 |
|
| Manufacturer Contact |
|
jaime
chavez
|
| 6340 sequence dr. |
| san diego, CA 92121
|
|
8582000200
|
|
| MDR Report Key | 25045921 |
| Report Number | 3004753838-2026-142484 |
| Device Sequence Number | 13193141 |
| Product Code |
QBJ
|
| UDI-Device Identifier | 00386270000590 |
| UDI-Public | (01)00386270000590(11)200629(10)P09845824 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NJ |
| Initial Reporter Country | US |
| PMA/510(K) Number | DEN170088 |
| 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 |
| Report Date (Section B) |
07/09/2026 |
| 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 | MT24078 |
| Device Catalogue Number | STK-OR-001 |
| Device Lot Number | P09845824 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Follow-Up |
| Initial Date Received by Manufacturer | 04/17/2026 |
| Supplement Date Received by Manufacturer | 06/15/2026
|
| Initial Report FDA Received Date | 04/30/2026 |
| Supplement Report FDA Received Date | 07/09/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 06/29/2020 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
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 | OMNIPOD 5 |
| Patient Age | 61 YR |
| Patient Sex | Male |
| Patient Weight | 108 KG |