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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: DEXCOM, INC. MDS

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DEXCOM, INC. MDS Back to Search Results
Catalog Number UNKNOWN
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Hyperglycemia (1905); Urinary Tract Infection (2120); Vomiting (2144)
Event Date 06/22/2016
Event Type  Injury  
Manufacturer Narrative
(b)(4). Diabetes mellitus is a known cause of hyperglycemia and its associated effects.
 
Event Description
Patient's caregiver contacted dexcom on (b)(6) 2106 to report that the patient experienced an adverse event on (b)(6) 2016. At the time of contact, the patient was in the hospital due to having a bladder infection, dehydration and throwing up. It was reported that the symptoms did not arise from wearing the dexcom continuous glucose monitor (cgm) but rather, was due to the patient experiencing high blood glucose. It was further stated that the dexcom cgm did not malfunction. Patient's caregiver stated that as of (b)(6) 2016, the patient was doing well. No additional event or patient information was provided. No product or data was returned for evaluation. The reported event could not be confirmed. A root cause could not be determined.
 
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Brand NameNA
Type of DeviceMDS
Manufacturer (Section D)
DEXCOM, INC.
6340 sequence drive
san diego CA 92121
Manufacturer (Section G)
DEXCOM, INC.
6340 sequence drive
san diego CA 92121
Manufacturer Contact
kipp durbin
6340 sequence drive
san diego, CA 92121
8582000200
MDR Report Key5804411
MDR Text Key49879055
Report Number3004753838-2016-38815
Device Sequence Number1
Product Code MDS
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
P120005
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type other
Reporter Occupation
Type of Report Initial
Report Date 06/22/2016
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received07/19/2016
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Catalogue NumberUNKNOWN
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received06/22/2016
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? No Answer Provided
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 07/19/2016 Patient Sequence Number: 1
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