| Brand Name | Eversense Sensor |
| Common Device Name | Eversense Continuous Glucose Monitor System |
| Manufacturer (Section D) |
| Senseonics Inc. |
| 20451 seneca meadows parkway |
| germantown MD 20876 -700 |
|
| Manufacturer (Section G) |
| Senseonics Inc. |
| 20451 seneca meadows parkway |
|
| germantown MD 20876 -700 |
|
| Manufacturer Contact |
|
vallikannu
somasundaram
|
| 20451 seneca meadows parkway |
| germantown, MD 20876--700
|
|
| MDR Report Key | 50938640 |
| Report Number | 3009862700-2026-03206 |
| Device Sequence Number | 10722417 |
| Product Code |
SBA
|
| UDI-Device Identifier | 00817491024282 |
| UDI-Public | 00817491024282 |
| Combination Product (Y/N) | Y |
| Initial Reporter Country | US |
| PMA/510(K) Number | P160048 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2025 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer |
| Type of Report
| Initial |
| Report Date (Section B) |
09/29/2026 |
| 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 | 05/22/2026 |
| Device Model Number | 103606-600 |
| Device Catalogue Number | FG-7500-00-301 |
| Device Lot Number | 01F269S |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/01/2026 |
| Initial Report FDA Received Date | 09/29/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 06/09/2025 |
| 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 |
| Patient Age | 81 YR |
| Patient Sex | Male |
|
|