| Brand Name | Dexcom G7 15 Day 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. |
| 232 s dobson rd |
|
| mesa AZ 85202 |
|
| Manufacturer Contact |
|
jaime
chavez
|
| 6340 sequence dr. |
| san diego, CA 92121
|
|
+1(858)200-0200
|
|
| MDR Report Key | 50954598 |
| Report Number | 3004753838-2026-264642 |
| Device Sequence Number | 9499487 |
| Product Code |
QBJ
|
| UDI-Device Identifier | 00386270004734 |
| UDI-Public | (01)00386270004734(11)260701(17)271231(10)1726198006 |
| Combination Product (Y/N) | N |
| Initial Reporter State | CA |
| 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) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer |
| Type of Report
| Initial |
| Report Date (Section B) |
09/30/2026 |
| 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 | 9510-007 |
| Device Catalogue Number | STP-FT-010 |
| Device Lot Number | 1726198006 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
No
|
| Initial Date Received by Manufacturer | 09/12/2026 |
| Initial Report FDA Received Date | 09/30/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 07/01/2026 |
| 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 | 56 YR |
| Patient Sex | Male |
| Patient Weight | 325 LB |