MAUDE Adverse Event Report: AXONICS, INC AXONICS; NEUROSTIMULATOR

Model Number 4101

Device Problems Adverse Event Without Identified Device or Use Problem (2993); Migration (4003)

Patient Problem Incontinence (1928)

Event Date 04/09/2024

Event Type  Injury  

Event Description

The patient underwent a pocket revision surgery due to migration.

• Brand Name: AXONICS
• Type of Device: NEUROSTIMULATOR
• Manufacturer (Section D): AXONICS, INC; 26 technology dr; irvine CA 92618
• Manufacturer Contact: linda phan ; 26 technology dr; irvine, CA 92618
• MDR Report Key: 19215081
• MDR Text Key: 341413712
• Report Number: 3002968685-2024-00084
• Device Sequence Number: 1
• Product Code: EZW
• UDI-Device Identifier: 10810005340455
• UDI-Public: 10810005340455
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: P180046
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 04/30/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/30/2024
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Other
• Device Expiration Date: 07/29/2023
• Device Model Number: 4101
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 04/09/2024
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 07/29/2022
• 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
• Treatment: TINED LEAD, MODEL 1201
• Patient Outcome(s): Required Intervention
• Patient Age: 58 YR
• Patient Sex: Female