Brand Name | EVERSENSE SENSOR |
Type of Device | CONTINUOUS GLUCOSE MONITORING SYSTEM |
Manufacturer (Section D) |
SENSEONICS INC |
20451 seneca meadows parkway |
germantown MD 20876 7005 |
|
Manufacturer (Section G) |
SENSEONICS INC |
20451 seneca meadows parkway |
|
germantown MD 20876 7005 |
|
Manufacturer Contact |
sachin
thanawala
|
20451 seneca meadows parkway |
germantown, MD 20876-7005
|
3015561625
|
|
MDR Report Key | 9383175 |
MDR Text Key | 168462415 |
Report Number | 3009862700-2019-00341 |
Device Sequence Number | 1 |
Product Code |
QCD
|
UDI-Device Identifier | 00817491022349 |
UDI-Public | 00817491022349 |
Combination Product (y/n) | N |
PMA/PMN Number | P160048 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
11/05/2019 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 04/25/2020 |
Device Model Number | 102096-67A |
Device Catalogue Number | FG-4200-00-301 |
Device Lot Number | WP06187 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
11/05/2019 |
Initial Date FDA Received | 11/27/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 04/25/2019 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
Patient Age | 44 YR |