Brand Name | EVERSENSE SENSOR |
Type of Device | 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 | 9944355 |
MDR Text Key | 187117120 |
Report Number | 3009862700-2020-00230 |
Device Sequence Number | 1 |
Product Code |
QCD
|
UDI-Device Identifier | 00817491021410 |
UDI-Public | 00817491021410 |
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 |
consumer |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
09/23/2018 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/09/2020 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
No Information
|
Device Expiration Date | 12/08/2018 |
Device Model Number | 102096-67A |
Device Catalogue Number | FG-4200-00-301 |
Device Lot Number | WP04043 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 10/23/2018 |
Date Manufacturer Received | 09/23/2018 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 05/08/2018 |
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 | 49 YR |
|
|