MAUDE Adverse Event Report: Axonics Modulation Technologies, Inc. Axonics; Stimulator, Electrical, Implantable, For Incontinence

Model Number	4101
Medical Device Problem Code	Migration (4003)
Health Effect - Clinical Code	Weight Changes (2607)
Date of Event	02/01/2026
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that a patient with a recharge-free snm ipg and snm tined lead had a system revision after their symptom relief had decreased due to a fall.Lead migration was confirmed on x-ray.The patient also felt the device more superficial due to weight loss.The procedure was successful.The patient was content, having no fecal incontinence episodes and being able to void on their own.No other patient complications were reported as a result of this event.
Additional Manufacturer Narrative
Block d2b: product code - additional product code qon.Block d10: serial number: unknown, batch/lot number: unknown, model/catalog description: unknown tined lead, unique identifier (udi) #: unknown.Block g4: premarket / 510(k) # - additional premarket/510(k) p190006.

• Brand Name: Axonics
• Common Device Name: Stimulator, Electrical, Implantable, For Incontinence
• Manufacturer (Section D): Axonics Modulation Technologies, Inc.; 15515 sand canyon ave; irvine CA 92618
• Manufacturer (Section G): Axonics Inc; 26 technology dr; irvine CA 92618
• Manufacturer Contact: farshad fahimi ; 4100 hamline avenue north; building c; saint paul, MN 55112
• MDR Report Key: 50216516
• Report Number: 2124215-2026-43062
• Device Sequence Number: 6098677
• Product Code: EZW
• UDI-Device Identifier: 10810005340455
• UDI-Public: (01)10810005340455(11)240912(17)250912
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: P180046
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 09/04/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Expiration Date: 09/12/2025
• Device Model Number: 4101
• Device Catalogue Number: 4101
• Device Lot Number: AX1T061493
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/21/2026
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 08/11/2026
• Supplement Report FDA Received Date: 09/04/2026
• Date Device Manufactured: 09/12/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization; Required Intervention
• Patient Age: 49 YR
• Patient Sex: Unknown