| 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 (Section G) |
| Dexcom, Inc. |
| 6340 sequence dr. |
|
| san diego CA 92121 |
|
| Manufacturer Contact |
|
jaime
chavez
|
| 6340 sequence dr. |
| san diego, CA 92121
|
|
+1(858)200-0200
|
|
| MDR Report Key | 50923863 |
| Report Number | 3004753838-2026-261552 |
| Device Sequence Number | 14801268 |
| Product Code |
QBJ
|
| UDI-Device Identifier | 00386270001788 |
| UDI-Public | (01)00386270001788(11)211128(17)221127(10)5300283 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MA |
| 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) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer |
| Type of Report
| Initial |
| Report Date (Section B) |
09/28/2026 |
| 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 Expiration Date | 11/27/2022 |
| Device Model Number | 9445-24 |
| Device Catalogue Number | STT-OM-001 |
| Device Lot Number | 5300283 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Initial Date Received by Manufacturer | 09/04/2026 |
| Initial Report FDA Received Date | 09/28/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 11/28/2021 |
| 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 |
| Patient Age | 82 YR |
| Patient Sex | Female |
| Patient Weight | 165 LB |