Brand Name | DEXCOM G4 PLATINUM CONTINUOUS GLUCOSE MONITORING SYSTEM |
Type of Device | CONTINUOUS GLUCOSE MONITOR |
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 |
ying
chen
|
6340 sequence drive |
san diego, CA 92121
|
8582000200
|
|
MDR Report Key | 8204411 |
MDR Text Key | 131724769 |
Report Number | 3004753838-2018-163659 |
Device Sequence Number | 1 |
Product Code |
MDS
|
Combination Product (y/n) | N |
Reporter Country Code | GM |
PMA/PMN Number | P120005 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer,foreign |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
12/02/2018 |
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
|
Device Operator |
Lay User/Patient
|
Device Model Number | MT20649-1 |
Device Catalogue Number | STR-GL-004 |
Device Lot Number | 5240379 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/25/2019 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
12/02/2018 |
Initial Date FDA Received | 12/28/2018 |
Supplement Dates Manufacturer Received | 07/01/2019
|
Supplement Dates FDA Received | 07/29/2019
|
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Age | 67 YR |
Patient Weight | 66 |
|
|