Brand Name | EVERSENSE SENSOR |
Type of Device | EVERSENSE CONTINUOUS GLUCOSE MONITORING SYSTEM |
Manufacturer (Section D) |
SENSEONICS INC. |
20451 seneca meadows parkway |
germantown,, md |
|
Manufacturer (Section G) |
SENSEONICS INC. |
20451 seneca meadows parkway |
|
germantown,, md |
|
Manufacturer Contact |
vallikannu
somasundaram
|
20451 seneca meadows parkway |
germantown, md
|
|
MDR Report Key | 9811168 |
MDR Text Key | 182723200 |
Report Number | 3009862700-2020-00215 |
Device Sequence Number | 1 |
Product Code |
QCD
|
UDI-Device Identifier | 00817491022349 |
UDI-Public | 00817491022349 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P160048 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
11/19/2019 |
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 | 01/17/2020 |
Device Model Number | 102096-67A |
Device Catalogue Number | FG-4200-00-301 |
Device Lot Number | WP05751 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/23/2019 |
Initial Date Manufacturer Received |
11/19/2019 |
Initial Date FDA Received | 03/10/2020 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 02/25/2019 |
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 Age | 59 YR |
|
|