FDA Adverse Event Injury Summary report: N

AXONICS

MDR report key: 22324492 · Received June 24, 2025

Report

Report Number
2124215-2025-39629
Event Type
Injury
Date Received
June 24, 2025
Date of Event
May 14, 2025
Report Date
March 11, 2026
Manufacturer
AXONICS MODULATION TECHNOLOGIES, INC.
Product Code
EZW
UDI-DI
10810005340066
PMA / PMN Number
P180046
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
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 INFORMATION: INITIAL REPORTER, SECTION E, ADDED.

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 DEVICE WAS RETURNED AND ANALYZED. VISUAL INSPECTION OF THE IPG REVEALED NO ABNORMALITIES. THERE WERE NO ERROR CODES DETECTED IN THE LOGS OR REPORTED BY IPGLINK. THE IPG PASSED THE IMPEDANCE CHECK WITH A TEST TINED LEAD. A REVIEW OF THE MANUFACTURING DOCUMENTATION FOR THIS DEVICE REVEALED THAT NO ANOMALIES OR DEVIATIONS RELATED TO THE EVENT OCCURRED DURING MANUFACTURING. THE REPORTED COMPLAINT CANNOT BE CONFIRMED. THERE WERE ZERO ISSUES FOUND WITH IPG DURING INSPECTION, THEREFORE NO PROBLEM DETECTED WAS CHOSEN AS THE CONCLUSION CODE.

Additional Manufacturer Narrative · 0

PRODUCT CODE (D2B) - ADDITIONAL PRODUCT CODE QON. PREMARKET / 510(K) # (G4)- ADDITIONAL PREMARKET/510(K) P190006. THE DEVICE WAS RETURNED AND ANALYZED. VISUAL INSPECTION OF THE IPG REVEALED NO ABNORMALITIES. THERE WERE NO ERROR CODES DETECTED IN THE LOGS OR REPORTED BY IPGLINK. THE IPG PASSED THE IMPEDANCE CHECK WITH A TEST TINED LEAD. A REVIEW OF THE MANUFACTURING DOCUMENTATION FOR THIS DEVICE REVEALED THAT NO ANOMALIES OR DEVIATIONS RELATED TO THE EVENT OCCURRED DURING MANUFACTURING. THE REPORTED COMPLAINT CANNOT BE CONFIRMED. THERE WERE ZERO ISSUES FOUND WITH IPG DURING INSPECTION, THEREFORE NO PROBLEM DETECTED WAS CHOSEN AS THE CONCLUSION CODE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD THE DEVICE EXPLANTED DUE TO LACK OF EFFECT. THE LEAD WAS CUT INTO TWO PIECES WITH A LEAD-LOCKING DEVICE (TO REMOVE THE DEVICE) ATTACHED TO IT. IT IS ASSUMED THAT THE PATIENT IS DOING FINE AS THERE WAS NO FOLLOW UP. THE PATIENT NEVER RECEIVED THERAPY FROM THE DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD THE DEVICE EXPLANTED DUE TO LACK OF EFFECT. THE LEAD WAS CUT INTO TWO PIECES WITH A LEAD-LOCKING DEVICE (TO REMOVE THE DEVICE) ATTACHED TO IT.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD THE DEVICE EXPLANTED DUE TO LACK OF EFFECT. THE LEAD WAS CUT INTO TWO PIECES WITH A LEAD-LOCKING DEVICE (TO REMOVE THE DEVICE) ATTACHED TO IT. IT IS ASSUMED THAT THE PATIENT IS DOING FINE AS THERE WAS NO FOLLOW UP. THE PATIENT NEVER RECEIVED THERAPY FROM THE DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PATIENT HAD THE DEVICE EXPLANTED DUE TO LACK OF EFFECT. THE LEAD WAS CUT INTO TWO PIECES WITH A LEAD-LOCKING DEVICE (TO REMOVE THE DEVICE) ATTACHED TO IT. IT IS ASSUMED THAT THE PATIENT IS DOING FINE AS THERE WAS NO FOLLOW UP. THE PATIENT NEVER RECEIVED THERAPY FROM THE DEVICE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1998523 AXONICS STIMULATOR, ELECTRICAL, IMPLANTABLE, FOR INCONTINENCE EZW AXONICS MODULATION TECHNOLOGIES, INC. 1101 AX1G159574 10810005340066

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Required Intervention| H