FDA Adverse Event Malfunction Summary report: N

AXONICS

MDR report key: 22205909 · Received June 13, 2025

Report

Report Number
2124215-2025-38231
Event Type
Malfunction
Date Received
June 13, 2025
Date of Event
May 15, 2025
Report Date
February 17, 2026
Manufacturer
AXONICS MODULATION TECHNOLOGIES, INC.
Product Code
EZW
UDI-DI
10810005340141
PMA / PMN Number
P180046
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NY, US
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

PRODUCT CODE (D2B): ADDITIONAL PRODUCT CODE QON. PREMARKET/510(K) # (G4): ADDITIONAL PREMARKET/510(K) P190006.

Additional Manufacturer Narrative · 0

PRODUCT CODE (D2B) - ADDITIONAL PRODUCT CODE QON PREMARKET / 510(K) # (G4)- ADDITIONAL PREMARKET/510(K) P190006.

Additional Manufacturer Narrative · 0

PRODUCT CODE (D2B) - ADDITIONAL PRODUCT CODE QON. PREMARKET / 510(K) # (G4)- ADDITIONAL PREMARKET/510(K) P190006. THE INVESTIGATION SHOWED THAT A WIRE WAS STICKING OUT OF THE TINED LEAD. REGARDLESS, THE TINED LEAD IS FULLY FUNCTIONAL, WITH ZERO IMPEDANCES ISSUES SEEN DURING DEVICE TESTING. THE REPORTED DEVICE PERFORMANCE ALLEGATION WAS CONFIRMED AS THE LEAD WIRE WAS STICKING OUT OF THE BODY. BASED ON THE DHR REVIEW, THERE WERE NO ISSUES FOUND THAT WOULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED ISSUE. A DEVICE FRACTURE/FAILURE IS AN INHERENT ADVERSE EVENT THAT IS POSSIBLE WITH IMPLANT PROCEDURE. BASED ON THE INFORMATION AVAILABLE A CONCLUSION CODE OF UNINTENDED USE ERROR CAUSED OR CONTRIBUTED TO EVENT. WAS ASSIGNED TO THIS INVESTIGATION.

Additional Manufacturer Narrative · 0

PRODUCT CODE (D2B) - ADDITIONAL PRODUCT CODE QON. PREMARKET / 510(K) # (G4)- ADDITIONAL PREMARKET/510(K) P190006. THE INVESTIGATION SHOWED THAT A WIRE WAS STICKING OUT OF THE TINED LEAD. REGARDLESS, THE TINED LEAD IS FULLY FUNCTIONAL, WITH ZERO IMPEDANCES ISSUES SEEN DURING DEVICE TESTING. THE REPORTED DEVICE PERFORMANCE ALLEGATION WAS CONFIRMED AS THE LEAD WIRE WAS STICKING OUT OF THE BODY. BASED ON THE DHR REVIEW, THERE WERE NO ISSUES FOUND THAT WOULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED ISSUE. A DEVICE FRACTURE/FAILURE IS AN INHERENT ADVERSE EVENT THAT IS POSSIBLE WITH IMPLANT PROCEDURE. BASED ON THE INFORMATION AVAILABLE A CONCLUSION CODE OF UNINTENDED USE ERROR CAUSED OR CONTRIBUTED TO EVENT. WAS ASSIGNED TO THIS INVESTIGATION.

Description of Event or Problem · 0

IT WAS REPORTED THAT WHEN THE PHYSICIAN ATTEMPTED THE STAGE 2 IMPLANT FOR THE SUBJECT, THE PHYSICIAN NOTICED A LEAD FRACTURE. A FRACTURE WAS NOTED IN THE LEAD COATING WITH EXPOSED WIRE. THE LEAD WAS EXPLANTED, AND A NEW LEAD WAS IMPLANTED WITH THE DEVICE. NO PATIENT COMPLICATIONS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT WHEN THE PHYSICIAN ATTEMPTED THE STAGE 2 IMPLANT FOR THE SUBJECT, THE PHYSICIAN NOTICED A LEAD FRACTURE. A FRACTURE WAS NOTED IN THE LEAD COATING WITH EXPOSED WIRE. THE LEAD WAS EXPLANTED, AND A NEW LEAD WAS IMPLANTED WITH THE DEVICE. NO PATIENT COMPLICATIONS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT WHEN THE PHYSICIAN ATTEMPTED THE STAGE 2 IMPLANT FOR THE SUBJECT, THE PHYSICIAN NOTICED A LEAD FRACTURE. A FRACTURE WAS NOTED IN THE LEAD COATING WITH EXPOSED WIRE. THE LEAD WAS EXPLANTED, AND A NEW LEAD WAS IMPLANTED WITH THE DEVICE. NO PATIENT COMPLICATIONS WERE REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT WHEN THE PHYSICIAN ATTEMPTED THE STAGE 2 IMPLANT FOR THE SUBJECT, THE PHYSICIAN NOTICED A LEAD FRACTURE. A FRACTURE WAS NOTED IN THE LEAD COATING WITH EXPOSED WIRE. THE LEAD WAS EXPLANTED, AND A NEW LEAD WAS IMPLANTED WITH THE DEVICE. NO PATIENT COMPLICATIONS WERE REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
635830 AXONICS STIMULATOR, ELECTRICAL, IMPLANTABLE, FOR INCONTINENCE EZW AXONICS MODULATION TECHNOLOGIES, INC. 1201 AL1M731028 10810005340141

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown