FDA Adverse Event Injury Summary report: N

AXONICS

MDR report key: 22206253 · Received June 13, 2025

Report

Report Number
2124215-2025-38250
Event Type
Injury
Date Received
June 13, 2025
Date of Event
May 8, 2025
Report Date
September 21, 2025
Manufacturer
AXONICS MODULATION TECHNOLOGIES, INC.
Product Code
EZW
PMA / PMN Number
P180046
Adverse Event
Yes
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.

Additional Manufacturer Narrative · 0

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

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A RED LIGHT ON THE BOTTOM OF THEIR REMOTE. THE PATIENT HAD AN IN-OFFICE VISIT TO GET THEIR ELECTRODES CHECK AND AN X-RAY OR POTENTIAL REVISION IS THE NEXT COURSE OF ACTION. A REVISION PROCEDURE WAS SCHEDULED FOR (B)(6) 2025; HOWEVER, IT HAS NOT BEEN CONFIRMED IF THE REVISION OCCURRED. THERE WERE NO PATIENT COMPLICATIONS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A RED LIGHT ON THE BOTTOM OF THEIR REMOTE. THE PATIENT HAD AN IN-OFFICE VISIT TO GET THEIR ELECTRODES CHECK AND AN X-RAY OR POTENTIAL REVISION WAS THE NEXT COURSE OF ACTION. A REVISION PROCEDURE OCCURRED AND THE PATIENT IS DOING WELL. THE PATIENT IS WORKING WELL WITH THE SETTINGS AND THE REPRESENTATIVE. THERE WERE NO PATIENT COMPLICATIONS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A RED LIGHT ON THE BOTTOM OF THEIR REMOTE. THE PATIENT HAD AN IN-OFFICE VISIT TO GET THEIR ELECTRODES CHECK AND AN X-RAY OR POTENTIAL REVISION WAS THE NEXT COURSE OF ACTION. A REVISION PROCEDURE OCCURRED AND THE PATIENT IS DOING WELL. THE PATIENT IS WORKING WELL WITH THE SETTINGS AND THE REPRESENTATIVE. THERE WERE NO PATIENT COMPLICATIONS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD A RED LIGHT ON THE BOTTOM OF THEIR REMOTE. THE PATIENT HAD AN IN-OFFICE VISIT TO GET THEIR ELECTRODES CHECK AND AN X-RAY OR POTENTIAL REVISION WAS THE NEXT COURSE OF ACTION. A REVISION PROCEDURE OCCURRED AND THE PATIENT IS DOING WELL. THE PATIENT IS WORKING WELL WITH THE SETTINGS AND THE REPRESENTATIVE. THERE WERE NO PATIENT COMPLICATIONS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
376204 AXONICS STIMULATOR, ELECTRICAL, IMPLANTABLE, FOR INCONTINENCE EZW AXONICS MODULATION TECHNOLOGIES, INC. 1201 AL1R542517

Patients

Seq Age Sex Outcome Treatment
1 70 YR Female Required Intervention| H