Form 10-Q - Quarterly report [Sections 13 or 15(d)]

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

(Mark One)
☒		QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

FOR THE QUARTERLY PERIOD ENDED September 30, 2023

☐

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

FOR THE TRANSITION PERIOD FROM ______________ TO ______________

Commission File Number 001-38538

electroCore, Inc.

(Exact name of Registrant as specified in its charter)

Delaware		20-3454976
(State or other jurisdiction of incorporation or organization)		(I.R.S. Employer Identification No.)

200 Forge Way, Suite 205, Rockaway, NJ 07866

(Address of principal executive offices, including zip code)

(973) 290-0097

(Registrant’s telephone number, including area code)

Securities registered pursuant to Section 12(b) of the Act:


Title of each class	Trading Symbol(s)	Name of each exchange on which registered
Common Stock, par value $0.001 per share	ECOR	The Nasdaq Capital Market

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer	☐	Accelerated filer	☐
Non-accelerated filer	☒	Smaller reporting company	☒
Emerging growth company	☒

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☒

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). ☐ Yes ☒ No

As of November 1, 2023, the registrant had 6,002,420 shares of common stock outstanding.

	PART I. FINANCIAL INFORMATION	Page Number
	Cautionary Note Regarding Forward-Looking Statements	3
Item 1.	Financial Statements
	Condensed Consolidated Balance Sheets as of September 30, 2023 (unaudited) and December 31, 2022	4
	Condensed Consolidated Statements of Operations for the Three and Nine Months Ended September 30, 2023 and 2022 (unaudited)	5
	Condensed Consolidated Statements of Comprehensive Loss for the Three and Nine Months Ended September 30, 2023 and 2022 (unaudited)	6
	Condensed Consolidated Statements of Equity for the Three and Nine Months Ended September 30, 2023 and 2022 (unaudited)	7
	Condensed Consolidated Statements of Cash Flows for the Nine Months Ended September 30, 2023 and 2022 (unaudited)	9
	Notes to Condensed Consolidated Financial Statements (unaudited)	10
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	20
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	27
Item 4.	Controls and Procedures	28
	PART II. OTHER INFORMATION
Item 1.	Legal Proceedings	29
Item 1A.	Risk Factors	29
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	30
Item 3.	Defaults Upon Senior Securities	30
Item 4.	Mine Safety Disclosures	30
Item 5.	Other Information	30
Item 6.	Exhibits	31
	Signatures	32

REFERENCES TO ELECTROCORE

In this Quarterly Report on Form 10-Q, unless otherwise stated or the context otherwise requires, references to the “Company,” “electroCore,” “we,” “us” and “our” refer to electroCore, Inc. a Delaware corporation and its subsidiaries.

CAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTS

This Quarterly Report on Form 10-Q, or Quarterly Report, contains forward-looking statements that involve risks and uncertainties. Our actual results could differ materially from those discussed in the forward-looking statements. The statements contained in this report that are not purely historical are forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, or the Securities Act, and Section 21E of the Securities Exchange Act of 1934, as amended, or the Exchange Act. Forward-looking statements are often identified by the use of words such as, but not limited to, “anticipate,” “believe,” “can,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “project,” “seek,” “should,” “strategy,” “target,” “will,” “would” and similar expressions or variations intended to identify forward-looking statements. These statements are based on the beliefs and assumptions of our management based on information currently available to them. Such forward-looking statements are subject to risks, uncertainties and other important factors that could cause actual results and the timing of certain events to differ materially from future results expressed or implied by such forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to risks and uncertainties included in our Form 10-Qs, our Annual Report on Form 10-K for the year ended December 31, 2022, in our other filings with the U.S. Securities and Exchange Commission or in materials incorporated by reference therein, including the information in the sections entitled “Risk Factors” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in such filings. Furthermore, any such forward-looking statements in this Quarterly Report speak only as of the date of this report. Except as required by law, we undertake no obligation to update or revise any forward-looking statements to reflect events or circumstances after the date of such statements.

The electroCore logo, gammaCore, Truvaga, TAC-STIM, and other trademarks of electroCore, Inc. appearing in this Quarterly Report are the property of electroCore, Inc. All other trademarks, service marks and trade names in this Quarterly Report are the property of their respective owners. We have omitted the ® and ™ designations, as applicable, for the trademarks used in this Quarterly Report.

ELECTROCORE, INC. AND SUBSIDIARIES

Condensed Consolidated Balance Sheets

(unaudited)

(in thousands, except share data)

	September 30,			December 31,
	2023			2022
Assets
Current assets:
Cash and cash equivalents	$	13,460		$	17,712
Restricted cash		250			250
Accounts receivable, net		589			401
Inventories, net		2,495			1,982
Prepaid expenses and other current assets		1,045			828
Total current assets		17,839			21,173
Inventories, noncurrent		813			2,194
Property and equipment, net		178			50
Operating lease right of use assets, net		518			565
Other assets, net		760			774
Total assets	$	20,108		$	24,756
Liabilities and Equity
Current liabilities:
Accounts payable	$	3,033		$	2,129
Accrued expenses and other current liabilities		5,390			4,842
Current portion of operating lease liabilities		85			74
Total current liabilities		8,508			7,045
Noncurrent liabilities:
Operating lease liabilities, noncurrent		560			625
Total liabilities		9,068			7,670
Commitments and contingencies (see Note 12)		—			—
Mezzanine Equity:
Preferred Stock, par value $0.001 per share; 10,000,000 shares authorized at September 30, 2023 and December 31, 2022; 0 shares issued and outstanding at September 30, 2023 and 71,173 shares issued and outstanding at December 31, 2022 ($0.001 per share liquidation value)		—			—
Stockholders' equity:
Common Stock, par value $0.001 per share; 500,000,000 shares authorized at September 30, 2023 and December 31, 2022; 5,998,836 shares issued and outstanding at September 30, 2023 and 4,744,886 shares issued and outstanding at December 31, 2022		6			5
Additional paid-in capital		172,304			163,520
Accumulated deficit		(161,172	)		(146,370	)
Accumulated other comprehensive loss		(98	)		(69	)
Total equity		11,040			17,086
Total liabilities and equity	$	20,108		$	24,756

See accompanying notes to unaudited condensed consolidated financial statements.

ELECTROCORE, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Operations

(unaudited)

(in thousands, except per share data)

	Three months ended September 30,						Nine months ended September 30,
	2023			2022			2023			2022
Net sales	$	4,508		$	1,976		$	10,839		$	6,032
Cost of goods sold		661			258			1,704			976
Gross profit		3,847			1,718			9,135			5,056
Operating expenses
Research and development		1,249			1,617			4,213			3,892
Selling, general and administrative		6,724			5,657			20,233			18,121
Total operating expenses		7,973			7,274			24,446			22,013
Loss from operations		(4,126	)		(5,556	)		(15,311	)		(16,957	)
Other (income) expense
Interest and other income		(94	)		(103	)		(298	)		(145	)
Other expense		—			—			—			5
Total other (income) expense		(94	)		(103	)		(298	)		(140	)
Loss before income taxes		(4,032	)		(5,453	)		(15,013	)		(16,817	)
Benefit from income taxes		—			—			211			445
Net loss	$	(4,032	)	$	(5,453	)	$	(14,802	)	$	(16,372	)
Net loss per share of common stock - Basic and Diluted	$	(0.68	)	$	(1.20	)	$	(2.87	)	$	(3.45	)
Weighted average common shares outstanding - Basic and Diluted		5,945			4,544			5,149			4,746

See accompanying notes to unaudited condensed consolidated financial statements.

ELECTROCORE, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Comprehensive Loss

(unaudited)

(in thousands)

	Three months ended September 30,						Nine months ended September 30,
		2023			2022		2023			2022
Net loss	$	(4,032	)	$	(5,453	)	$	(14,802	)	$	(16,372	)
Other comprehensive loss:
Foreign currency translation adjustment		(22	)		(82	)		(29	)		(167	)
Other comprehensive loss		(22	)		(82	)		(29	)		(167	)
Comprehensive loss	$	(4,054	)	$	(5,535	)	$	(14,831	)	$	(16,539	)

See accompanying notes to unaudited condensed consolidated financial statements.

ELECTROCORE, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Equity

(unaudited)

(in thousands)

	Mezzanine Equity					Stockholders' Equity
						Common				Additional						Accumulated other
	Preferred Stock					Stock				paid-in			Accumulated			comprehensive			Total
	Shares			Amount		Shares		Amount		capital			deficit			income (loss)			equity
Balances as of January 1, 2023		71		$	—		4,745	$	5	$	163,520		$	(146,370	)	$	(69	)	$	17,086
Net loss		—			—		—		—		—			(5,867	)		—			(5,867	)
Other comprehensive income		—			—		—		—		—			—			56			56
Issuance of stock related to employee compensation plans, net of forfeitures		—			—		1		—		—			—			—			—
Preferred stock redemption		(71	)		—		—		—		—			—			—			—
Share based compensation		—			—		—		—		572			—			—			572
Balances as of March 31, 2023		—			—		4,746		5		164,092			(152,237	)		(13	)		11,847
Net loss		—			—		—		—		—			(4,903	)		—			(4,903	)
Other comprehensive income		—			—		—		—		—			—			(63	)		(63	)
Issuance of stock related to employee compensation plan, net of forfeitures		—			—		6		—		—			—			—			—
Share based compensation		—			—		—		—		183			—			—			183
Balances as of June 30, 2023		—			—		4,752		5		164,275			(157,140	)		(76	)		7,064
Net loss		—			—		—		—		—			(4,032	)		—			(4,032	)
Other comprehensive income		—			—		—		—		—			—			(22	)		(22	)
Sale of common stock and warrants		—			—		1,233		1		8,143			—			—			8,144
Financing fees		—			—		—		—		(657	)		—			—			(657	)
Issuance of stock related to employee compensation plan, net of forfeitures		—			—		14		—		—			—			—			—
Share based compensation		—			—		—		—		543			—			—			543
Balances as of September 30, 2023		—		$	—		5,999	$	6	$	172,304		$	(161,172	)	$	(98	)	$	11,040

See accompanying notes to unaudited condensed consolidated financial statements.

ELECTROCORE, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Equity

(unaudited)

(in thousands)

	Mezzanine Equity				Stockholders' Equity
					Common				Additional					Accumulated other
	Preferred Stock				Stock				paid-in		Accumulated			comprehensive			Total
	Shares		Amount		Shares		Amount		capital		deficit			income (loss)			equity
Balance, January 1, 2022		—	$	—		4,714	$	5	$	160,838	$	(124,208	)	$	13		$	36,648
Net loss		—		—		—		—		—		(5,582	)		—			(5,582	)
Other comprehensive loss		—		—		—		—		—		—			(27	)		(27	)
Issuance of stock related to employee compensation plans, net of forfeitures		—		—		1		—		—		—			—			—
Share based compensation		—		—		—		—		777		—			—			777
Balance, March 31, 2022		—		—		4,715		5		161,615		(129,790	)		(14	)		31,816
Net loss		—		—		—		—		—		(5,337	)		—			(5,337	)
Other comprehensive income		—		—		—		—		—		—			(58	)		(58	)
Issuance of stock related to employee compensation plans, net of forfeitures		—		—		27		—		—		—			—			—
Share based compensation		—		—		—		—		752		—			—			752
Balance, June 30, 2022		—		—		4,742		5		162,367		(135,127	)		(72	)		27,173
Net loss		—		—		—		—		—		(5,453	)		—			(5,453	)
Other comprehensive income		—		—		—		—		—		—			(82	)		(82	)
Issuance of stock related to employee compensation plans, net of forfeitures		—		—		3		—		—		—			—			—
Share based compensation		—		—		—		—		566		—			—			566
Balances as of September 30, 2022		—	$	—		4,745	$	5	$	162,933	$	(140,580	)	$	(154	)	$	22,204

See accompanying notes to unaudited condensed consolidated financial statements.

ELECTROCORE, INC. AND SUBSIDIARIES

Condensed Consolidated Statements of Cash Flows

(unaudited)

(in thousands)

	Nine months ended September 30,
	2023			2022
Cash flows from operating activities:
Net loss	$	(14,802	)	$	(16,372	)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation		1,298			2,095
Depreciation and amortization		735			400
Net noncash lease expense		46			34
Inventory reserve charge		258			—
Increase in provision for bad debts		54			—
Changes in operating assets and liabilities:
Accounts receivable		(241	)		74
Inventories		(72	)		58
Prepaid expenses and other current assets		(219	)		(22	)
Accounts payable		904			963
Accrued expenses and other current liabilities		549			184
Operating lease liabilities		(55	)		(45	)
Net cash used in operating activities		(11,545	)		(12,631	)
Cash flows from investing activities:
Purchase of equipment		(165	)		—
Net cash used in investing activities		(165	)		—
Cash flows from financing activities:
Proceeds from share issue		8,144			—
Financing costs		(657	)		—
Net cash provided by financing activities		7,487			—
Effect of changes in exchange rates on cash and cash equivalents		(29	)		(163	)
Net decrease in cash and cash equivalents and restricted cash		(4,252	)		(12,794	)
Cash and cash equivalents and restricted cash – beginning of period		17,962			34,689
Cash and cash equivalents and restricted cash – end of period	$	13,710		$	21,895
Supplemental cash flows disclosures:
Proceeds from sale of state net operating losses	$	211		$	445
Interest paid	$	8		$	6
Supplemental schedule of noncash activity:
Insurance premium financing	$	433		$	522

See accompanying notes to unaudited condensed consolidated financial statements.

ELECTROCORE, INC. AND SUBSIDIARIES

Notes to Condensed Consolidated Financial Statements

(unaudited)

Note 1. The Company

electroCore, Inc. and its subsidiaries (“electroCore” or the “Company”) is a commercial stage bioelectronic medicine and wellness company dedicated to improving health through its non-invasive vagus nerve stimulation (“nVNS”) technology platform. The Company’s focus is the commercialization of medical devices for the management and treatment of certain medical conditions and consumer product offerings utilizing nVNS to promote general wellbeing and human performance in the United States and select overseas markets.

electroCore, headquartered in Rockaway, NJ, has two wholly owned subsidiaries: electroCore UK Ltd and electroCore Germany GmbH. The Company has paused operations in Germany, with sales into the country and the rest of Europe being managed by electroCore UK Ltd.

Note 2. Summary of Significant Accounting Policies

(a)	Basis of Presentation

The accompanying condensed consolidated financial statements were prepared in conformity with accounting principles generally accepted in the United States of America (“U.S. GAAP”) and with instructions to Form 10-Q and Article 10 of Regulation S-X under the Securities Exchange Act of 1934, as amended. In the opinion of management, the Company has made all necessary adjustments, which include normal recurring adjustments necessary for a fair presentation of the Company’s condensed consolidated financial position and results of operations for the interim periods presented. Certain information and disclosures normally included in the annual consolidated financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. These interim condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and accompanying notes for the year ended December 31, 2022, included in the Company’s Annual Report on Form 10-K filed with the Securities and Exchange Commission on March 8, 2023. The results for the three and nine months ended September 30, 2023 are not necessarily indicative of the results to be expected for a full year, any other interim periods or any future year or period.

At a special stockholders meeting held on February 13, 2023, the Company's stockholders approved an amendment to the Company's certificate of incorporation to effect of a reverse stock split of the Company's common stock at a ratio between 1-for-5 to 1-for-50 in order to achieve a minimum bid price of $1.00 per share for a minimum of 10 consecutive trading days, as required for continued listing of the common stock on the Nasdaq Capital Market pursuant to Nasdaq Listing Rule 5550(a)(2). The board of directors authorized a 1-for-15 ratio for the reverse stock split, which became effective on February 15, 2023. The accompanying condensed consolidated financial statements and notes to condensed consolidated financial statements give retroactive effect to the reverse stock split for all prior periods presented.

(b)	Principles of Consolidation

The accompanying condensed consolidated financial statements include the accounts of electroCore and its wholly owned subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.

(c)	Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include allowances for doubtful accounts, trade credits, rebates, co-payment assistance and sales returns, valuation of inventory, estimated useful life of licensed products and cloud computing arrangements, stock compensation, incremental borrowing rate and contingencies.

(d)	Cash, Cash Equivalents and Restricted Cash

The following table provides a reconciliation of cash, cash equivalents and restricted cash to the balance reflected on the Condensed Consolidated Statement of Cash Flows for September 30, 2023 and 2022:

(in thousands)	September 30, 2023		September 30, 2022
Cash and cash equivalents	$	13,460	$	21,645
Restricted cash		250		250
Total cash, cash equivalents and restricted cash	$	13,710	$	21,895

As of September 30, 2023 and December 31, 2022, cash equivalents represented funds held in a money market account.

(e)	Restricted Cash

The Company's restricted cash consists of cash that the Company is contractually obligated to maintain in accordance with the terms of its corporate credit card arrangement with Citibank, N.A and established in April 2022.

(f)	Licensed Products

The Company licenses a portion of its devices through its cash pay channels. The cost of these licensed devices is capitalized and included in Other Assets in the accompanying Condensed Consolidated Balance Sheets at September 30, 2023 and December 31, 2022, and is being recognized as cost of goods sold on the straight-line method over the estimated 12-36 month useful life of the devices. If certain licensed devices are returned and no longer meet quality specifications or the carrying amount of certain licensed devices are no longer deemed to be recoverable, the Company records a charge to cost of goods sold to write down such licensed devices to zero. The net book value of these licensed devices at September 30, 2023 and December 31, 2022 was $735,000 and $538,000, respectively. Changes in the value of these licensed devices in Other Assets is captured on the Statement of Cash Flows with inventories.

(g)	Warrant Accounting

The Company accounts for common stock warrants in accordance with applicable accounting guidance provided in ASC Topic 815-40, Derivatives and Hedging – Contracts in Entity’s Own Equity, or ASC Topic 815-40, as either derivative liabilities or equity instruments depending on the specific terms of the warrant.

(h)	Prior Year Presentation

Prior year presentation has been conformed to current year presentation.

Note 3. Going Concern, Significant Risks and Uncertainties

Going Concern

The Company has experienced significant net losses and cash used in operations, and it expects to continue to incur net losses and cash used in operations for the near future as it works to increase market acceptance of its medical devices and wellness products. The Company has never been profitable and has incurred net losses and cash used in operations in each year since its inception.

Sales to the United States Department of Veteran Affairs comprised 60.2% of the Company's revenue during the nine months ended September 30, 2023. The Company expects that a majority of its remaining 2023 sales will be made pursuant to its qualifying contract under the Federal Supply Schedule, or FSS, which was secured by the Company in December 2018, as well as open market sales to individual facilities within the government channels. The FSS is scheduled to expire on January 15, 2024. The Company has submitted a renewal application for extension of its qualifying contract under the FSS from the Department of Veterans Affairs Office of Procurement and Logistics, but there is no assurance the FSS will be renewed, if at all, or renewed at terms favorable to the Company.

The Company has historically funded its operations from the sale of its common stock. On July 31, 2023, the Company entered into a registered direct offering with certain institutional and accredited investors, and concurrent private placements with such investors and certain of the Company’s officers and directors, resulting in net proceeds to the Company of approximately $7.5 million after deducting the placement agent fees and expenses, and other offering expenses payable by the Company. See Note 8, Shareholders' Equity, Securities Purchase Agreements.

The Company’s expected cash requirements for the next 12 months and beyond are largely based on the commercial success of its products. The Company believes its cash and cash equivalents and anticipated revenue will enable it to fund its operating expenses, working capital, and capital expenditure requirements, as currently planned, through 12 months from the date of the accompanying financial statements. There are significant risks and uncertainties as to its ability to achieve these operating results. Due to the risks and uncertainties, there can be no assurance that the Company will have sufficient cash flow and liquidity to fund its planned activities, which could force it to significantly reduce or curtail its activities and potentially cease operations. These conditions raise substantial doubt about the Company's ability to continue as a going concern within one year of the date of these accompanying financial statements are issued. The accompanying financial statements do not include any adjustment that might result from the outcome of this uncertainty.

Concentration of Revenue Risks

The Company earns a significant amount of its revenue (i) in the United States from the Department of Veterans Affairs and Department of Defense ("VA/DoD") pursuant to its qualifying contract under the FSS and open market sales to individual Department of Veterans Affairs facilities, and (ii) in the United Kingdom from the National Health Service. The VA/DoD accounted for 10% or more of total net sales during the three and nine months ended September 30, 2023 and 2022. During the three and nine months ended September 30, 2022, the National Health Service accounted for 10% or more of total net sales. The following table reflects the respective concentration as a percentage of the Company's net sales for the three and nine months ended September 30, 2023 and 2022:

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Revenue channel:
Rx gammaCore - VA/DoD	60.7	%	58.1	%	60.2	%	59.7	%
National Health Service	8.1	%	17.6	%	9.2	%	16.1	%

No VA/DoD facility accounted for more than 10% of total VA/DoD net sales during the three and nine months ended September 30, 2023. Two and three VA/DoD facilities accounted for more than 10% of total VA/DoD net sales during the three and nine months ended September 30, 2022, respectively. During the three and nine months ended September 30, 2023 and 2022, one facility accounted for more than 10% of net sales from the National Health Service.

Foreign Currency Exchange

The Company has foreign currency exchange risk related to revenue and operating expenses in currencies other than the local currencies in which it operates. The Company is exposed to currency risk from the potential changes in the functional currency values of its assets, liabilities, and cash flows denominated in foreign currencies.

Note 4. Revenue

Product Net Sales

(in thousands)	Three months ended September 30,				Nine months ended September 30,
Channel		2023		2022		2023		2022
Rx gammaCore - Department of Veteran Affairs and Department of Defense	$	2,737	$	1,167	$	6,523	$	3,597
Rx gammaCore - U.S. Commercial		439		392		1,310		1,133
Outside the United States		464		417		1,298		1,189
Truvaga		267		—		704		—
TAC-STIM		601		—		1,000		—
Other		—		—		4		113
	$	4,508	$	1,976	$	10,839	$	6,032

Geographical Net Sales

The following table presents net sales disaggregated by geographic market:

(in thousands)	Three months ended September 30,				Nine months ended September 30,
Product revenue		2023		2022		2023		2022
United States	$	4,044	$	1,559	$	9,541	$	4,843
United Kingdom		412		347		1,117		968
Other		33		25		98		128
License revenue
Japan		19		45		83		93
Total Net Sales	$	4,508	$	1,976	$	10,839	$	6,032

The Company generally invoices the customer and recognizes revenue once its performance obligations are satisfied, at which point payment is unconditional. Agreed upon payment terms with customers are within 30 days of shipment. Accordingly, contracts with customers do not include a significant financing component.

Note 5. Inventories

As of September 30, 2023 and December 31, 2022, inventories consisted of the following:

(in thousands)	September 30, 2023		December 31, 2022
Raw materials	$	1,058	$	944
Work in process		1,899		2,879
Finished goods		351		353
Total inventories, net		3,308		4,176
Less: noncurrent inventories		813		2,194
Current inventories	$	2,495	$	1,982

The reserve for obsolete inventory was $0.5 million and $0.7 million as of September 30, 2023 and December 31, 2022, respectively. The Company records charges for obsolete inventory in cost of goods sold. As of September 30, 2023 and December 31, 2022, noncurrent inventory was comprised of approximately $0.0 million and $0.1 million in raw materials and $0.8 million and $2.1 million of work in process, respectively. Inventory classified under the category “Work in process” consists of prefabricated assembled product.

Note 6. Leases

For each of the three and nine months ended September 30, 2023 and 2022, the Company recognized lease expense of $38,000 and $114,000. This expense does not include non-lease components associated with the lease agreements as the Company elected not to include such charges as part of the lease expense.

Supplemental Balance Sheet Information for Operating Leases:

(in thousands)	September 30, 2023			December 31, 2022
Operating leases:
Operating lease right of use assets	$	518		$	565
Operating lease liabilities:
Current portion of operating lease liabilities		85			74
Noncurrent operating lease liabilities		560			625
Total operating lease liabilities	$	645		$	699
Weighted average remaining lease term (in years)		5.4			6.1
Weighted average discount rate		13.8	%		13.8	%

Future minimum lease payments under non-cancellable operating leases as of September 30, 2023:

(in thousands)
Remainder of 2023	$	41
2024		168
2025		171
2026		161
2027		157
2028 and thereafter		216
Total future minimum lease payments		914
Less: Amounts representing interest		(269	)
Total	$	645

Note 7. Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities as of September 30, 2023 and December 31, 2022 consisted of the following:

(in thousands)	September 30, 2023		December 31, 2022
Accrued professional fees	$	715	$	524
Accrued bonuses and incentive compensation		1,873		2,042
Accrued litigation legal fees expense		1,035		1,001
Accrued insurance expense		433		264
Accrued vacation and other employee related expenses		573		534
Accrued severance and other related charges		113		—
Accrued valued-added tax		224		133
Deferred revenue		180		152
Other		244		192
	$	5,390	$	4,842

Finance and Security Agreement

On July 5, 2023, the Company entered into a Commercial Insurance Premium Finance and Security Agreement (the "2023 Agreement"). The 2023 Agreement provides for a single borrowing by the Company of approximately $618,000 with a ten-month term and an annual interest rate of 6.03%. The proceeds from this transaction were used to partially fund the premiums due under certain of the Company's insurance policies. The amounts payable are secured by the Company's right under such policies. The Company began paying monthly installments of approximately $62,000 in July 2023. As of September 30, 2023 the remaining balance under the Agreement was approximately $433,000.

On July 5, 2022, the Company entered into a Commercial Insurance Premium Finance and Security Agreement (the "2022 Agreement"). The 2022 Agreement provides for a single borrowing by the Company of approximately $783,000 with a nine-month term and an annual interest rate of 2.49%. The proceeds from this transaction were used to partially fund the premiums due under certain of the Company's insurance policies. All borrowings under the 2022 Agreement were repaid as of September 30, 2023.

During the three and nine months ended September 30, 2023, the Company recognized $4,000 and $13,000 in aggregate interest expense related to the 2023 Agreement and 2022 Agreement, respectively.

Note 8. Shareholders' Equity

Securities Purchase Agreements

On July 31, 2023, the Company entered into a Securities Purchase Agreement (“First SPA”) in connection with a registered direct offering and concurrent private placement with certain institutional and accredited investors pursuant to which the Company issued and sold an aggregate of 1,062,600 shares of common stock, 613,314 pre-funded common stock purchase warrants that are exercisable upon issuance, and warrants to purchase up to an aggregate of 837,955 shares of common stock. On July 31, 2023, the Company also entered into a Securities Purchase Agreement (“Second SPA”) in connection with a concurrent private placement with six of the Company’s officers and directors pursuant to which the Company issued and sold 169,968 shares of common stock and warrants to purchase up to an aggregate of 84,982 shares of common stock. The combined effective offering price of the securities sold pursuant to the First SPA and the Second SPA was $4.4125 per share of common stock and related common stock purchase warrant. The common stock purchase warrants will be exercisable commencing six months after the date of issuance at a price of $4.35 per share and will expire five years after they first become exercisable. The net proceeds to the Company resulting from the First SPA and Second SPA was approximately $7.5 million, after deducting the placement agent fees and expenses, and other offering expenses payable by the Company, and excluding the proceeds, if any, from the exercise of the common stock purchase warrants sold in the concurrent private placements.

Reverse Stock Split

On February 13, 2023, the Company held a special meeting (the “Special Meeting”) of stockholders of the Company. At the Special Meeting, the Company’s shareholders voted to approve an amendment to the Company’s Certificate of Incorporation to effect a reverse stock split of the Company’s common stock at a ratio between 1-for-5 and 1-for-50.

Following the Special Meeting, the board of directors of the Company approved a 1-for-15 Reverse Stock Split. The Reverse Stock Split became effective on February 15, 2023.

Upon the effectiveness of the Reverse Stock Split, every 15 shares of common stock were automatically combined and converted into one share of common stock. Appropriate adjustments were also made to all outstanding derivative securities of the Company, including all outstanding equity awards and warrants.

No fractional shares were issued in connection with the Reverse Stock Split. Instead, all fractional shares received a cash payment based on the closing sales price on the Nasdaq Capital Market of the Company’s common stock on February 14, 2023.

Redemption and Elimination of Series A Preferred Stock

All shares of Series A Preferred Stock that were not present in person or by proxy as of immediately prior to the opening of the polls at the Special Meeting were automatically redeemed by the Company (the “Initial Redemption”). Any outstanding shares of Series A Preferred Stock that had not been so redeemed were redeemed automatically upon the approval at the Special Meeting of the Reverse Stock Split (the “Subsequent Redemption”). Each share of Series A Preferred Stock redeemed was entitled to receive an amount equal to $0.01 in cash for each 10 whole shares of Series A Preferred Stock owned immediately prior to the Redemption.

On March 6, 2023, the Company filed a certificate of elimination (the “Certificate of Elimination”), with the Secretary of State of the State of Delaware with respect to the Series A Preferred Stock. The Certificate of Elimination (i) eliminated the previous designation of 80,000 shares of Series A Preferred Stock from the Company’s Certificate of Incorporation, none of which were outstanding at the time of the filing of the Certificate of Elimination, and (ii) caused such shares of Series A Preferred Stock to resume their status as authorized but unissued and non-designated shares of preferred stock.

Stock Purchase Warrants

The following table presents a summary of stock purchase warrants outstanding as of September 30, 2023:

	Number of Warrants (in thousands)		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)			Aggregate Intrinsic Value (in thousands)
Outstanding, January 1, 2023		1	$	229.50		3.0	$	—
Stock purchase warrants (a)		923
Exercised		—
Expired		—
Outstanding, September 30, 2023		924	$	4.35		5.3	$	1,596
Exercisable, September 30, 2023		1	$	229.50		2.2	$	—

(a) 613,314 pre-funded warrants were excluded from the aforementioned table. Such pre-funded warrants were not exercised as of September 30, 2023.

Note 9. Net Loss Per Share

Basic net loss per share is computed by dividing net loss by the weighted-average number of shares of common stock outstanding during the period. Diluted loss per share is computed by dividing net loss by the weighted-average number of shares of common stock outstanding adjusted to give effect to potentially dilutive securities. Due to their nominal exercise price of $0.001 per share, 613,314 pre-funded warrants are considered common stock equivalents and are included in weighted average shares outstanding in the accompanying condensed consolidated statement of operations as of the closing date of the Company's July 2023 Securities Purchase Agreements. Restricted stock and unit awards, stock options, and warrants (other than the pre-funded warrants) have not been included in the diluted loss per share calculation as their inclusion would have had an anti-dilutive effect.

The potential common stock equivalents that have been excluded from the computation of diluted loss per share consist of the following:

	Nine months ended September 30,
(in thousands)	2023	2022
Outstanding stock options	537	418
Restricted stock and unit awards	231	62
Stock purchase warrants	924	1
	1,692	481

Note 10. Income Taxes

The Company may be eligible, from time to time, to receive cash from the sale of its net operating losses under New Jersey's Department of the Treasury - Division of Taxation NOL Transfer Program. On January 10, 2023, the Company received a net cash payment of $211,000 from the sale of its New Jersey state net operating losses.

Note 11. Stock Based Compensation

The following table presents a summary of activity related to stock options during the nine months ended September 30, 2023:

	Number of Options (in thousands)			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)
Outstanding, January 1, 2023		440		$	55.65		7.5
Granted		206
Exercised		—
Cancelled		(109	)
Outstanding, September 30, 2023		537		$	38.42		7.9
Exercisable, September 30, 2023		253		$	72.07		6.5

The intrinsic value is calculated as the difference between the fair market value at September 30, 2023 and the exercise price per share of the stock options. As of September 30, 2023, all options outstanding had no material intrinsic value. The options granted to employees generally vest over a three or four-year period.

The following table presents a summary of activity related to restricted and deferred stock units (“Stock Units”) granted during the nine months ended September 30, 2023:

	Number of Shares (in thousands)			Weighted Average Grant Date Fair Value
Nonvested, January 1, 2023		127		$	11.85
Granted		137
Vested		(25	)
Cancelled		(8	)
Nonvested, September 30, 2023		231		$	7.74

In general, Stock Units granted to employees vest over two to four-year periods.

Immediately following the Company’s annual meeting of stockholders, the Company generally grants each non-employee director an equity award that vests over a 12-month period. Upon a non-employee director’s initial appointment or election to the board of directors, the Company grants such non-employee director an equity award subject to vesting as determined by the board of directors.

The Company recognized stock compensation expense for its equity awards as follows:

	Three months ended September 30,					Nine months ended September 30,
(in thousands)	2023		2022		2023		2022
Selling, general and administrative	$	477	$	454	$	1,102	$	1,835
Research and development		60		106		178		240
Cost of goods sold		6		6		18		20
Total expense	$	543	$	566	$	1,298	$	2,095

Total unrecognized compensation cost related to unvested awards as of September 30, 2023 was $2.1 million and is expected to be recognized over the next 1.7 years.

Valuation Information for Stock-Based Compensation

The fair value of each stock option award during the three and nine months ended September 30, 2023 and 2022 was estimated on the date of grant using the Black-Scholes model. Effective July 1, 2023, expected volatility was based 100% on the Company's historical common stock volatility. For the periods presented below, and prior to July 1, 2023, expected volatility was based on a composite comprising of 50% of the Company's historical common stock volatility; the remaining 50% was based on historical volatility of its peers. The risk-free interest rate was based on the average U.S. Treasury rate that most closely resembled the expected life of the related award. The expected term of the award was calculated using the simplified method. No dividend was assumed as the Company does not pay regular dividends on its common stock and does not anticipate paying any dividends in the foreseeable future.

The weighted average assumptions used in the Black-Scholes option pricing model in valuing stock options granted in the three and nine months ended September 30, 2023 and 2022 are summarized in the table below.

	Nine months ended September 30,
	2023				2022
Fair value at grant date	$	3.95		$	0.53
Expected volatility	122.4		%		84.0	%
Risk-free interest rate	4.1		%		1.7	%
Expected holding period, in years	5.8				6.0
Dividend yield		—	%		—	%

Note 12. Contingencies

Stockholders Litigation

On July 8, 2019, and August 1, 2019, purported stockholders of the Company served putative class action lawsuits in the Superior Court of New Jersey for Somerset County, captioned Paul Kuehl vs. electroCore, Inc., et al., Docket No. SOM-L 000876-19 and Shirley Stone vs. electroCore, Inc., et al., Docket No. SOM-L 001007-19, respectively. In addition to the Company, the defendants include present and past directors and officers, Evercore Group L.L.C., Cantor Fitzgerald & Co., JMP Securities LLC and BTIG, LLC, the underwriters for its IPO; and two of the Company’s stockholders. On August 15, 2019, the Superior Court entered an order consolidating the Kuehl and Stone actions, which proceeded under Docket No. SOM-L 000876-19.

Each plaintiff was appointed a co-lead plaintiff. The plaintiffs filed a consolidated amended complaint, which sought certification of a class of stockholders who purchased common stock in the IPO or whose purchases are traceable to that offering. The consolidated amended complaint alleged that the defendants violated Sections 11, 12(a)(2) and 15 of the Securities Act with respect to the registration statement and related prospectus for the IPO. The complaint sought unspecified compensatory damages, interest, costs and attorneys’ fees.

On December 14, 2021, the Superior Court granted the defendants’ motion to dismiss based on the federal forum selection clause in our certificate of incorporation with prejudice and granted the defendants’ motion to dismiss without prejudice. On January 27, 2022, the plaintiffs filed a notice of appeal to the Appellate Division. The appeal was fully briefed, and oral argument was heard on April 19, 2023. On May 15, 2023, the Appellate Division unanimously affirmed the dismissal. The time for further appeals has expired.

On September 26, 2019, and October 31, 2019, purported stockholders of the Company served putative class action lawsuits in the United States District Court for the District of New Jersey captioned Allyn Turnofsky vs. electroCore, Inc., et al., Case 3:19-cv-18400, and Priewe vs. electroCore, Inc., et al., Case 1:19-cv-19653, respectively. In addition to the Company, the defendants include present and past directors and officers, and Evercore Group L.L.C., Cantor Fitzgerald & Co., JMP Securities LLC and BTIG, LLC, the underwriters for the IPO. The plaintiffs each seek to represent a class of stockholders who (i) purchased the Company’s common stock in the IPO or whose purchases are traceable to the IPO, or (ii) who purchased common stock between the IPO and September 25, 2019. The complaints each alleged that the defendants violated Sections 11 and 15 of the Securities Act and Sections 10(b) and 20(a) of the Exchange Act, with respect to (i) the registration statement and related prospectus for the IPO, and (ii) certain post-IPO disclosures filed with the SEC. The complaints sought unspecified compensatory damages, interest, costs and attorneys’ fees. The Priewe case was voluntarily dismissed on February 19, 2020.

In the Turnofsky case, on November 25, 2019, several plaintiffs and their counsel moved to be selected as lead plaintiff and lead plaintiff’s counsel. On April 24, 2020, the Court granted the motion of Carole Tibbs and the firm Bragar, Eagel & Squire, P.C. On July 17, 2020, the plaintiffs filed an amended complaint in Turnofsky. In addition to the prior claims, the amended complaint added an additional director defendant and two investors as defendants and adds a claim against the Company and the underwriters for violating Section 12(a)(2) of the Securities Act.

On September 15, 2020, the Company and the other defendants filed a motion to dismiss the amended complaint for failure to state a claim. On November 6, 2020, the plaintiffs filed their opposition to the motion to dismiss. The Company and the other defendants filed reply papers in support of the motion on December 7, 2020. Argument of the motion to dismiss occurred on June 18, 2021. On August 13, 2021, the Court dismissed the amended complaint with leave to re-plead. On October 4, 2021, the plaintiffs filed a second amended complaint in the Turnofsky case. The defendants moved to dismiss, and briefing on the motion was complete on January 7, 2022. On July 13, 2023, the court dismissed the second amended complaint with leave to re-plead. The plaintiffs did not file a third amended complaint. On August 23, 2023, the plaintiffs provided the court with an order of dismissal, and the court entered the order on August 24, 2023. On September 8, 2023, plaintiff Carole Tibbs filed a notice of appeal to the United States Court of Appeals for the Third Circuit. The appeal has been docketed as number 23-2655. The principal brief of appellant and appendix are to be filed by December 4, 2023. The appellees’ brief is due on January 3, 2024, and appellant’s reply brief is due January 24, 2023.

On March 4, 2021, purported stockholder Richard Maltz brought a purported stockholder derivative action in the United States District Court for the District of New Jersey. The action is captioned Richard Maltz, derivatively on behalf of electroCore, Inc., vs. Francis R. Amato, et al., Case 3:21-cv-04135. The defendants include present and past directors and officers of the Company. The plaintiff purports to pursue derivative claims on behalf of the Company in connection with the IPO and actions occurring between the IPO and September 25, 2019. The complaint alleges that demand on the board of directors is excused. The complaint purports to allege claims against the defendants for violating Section 14(a) of the Exchange Act, breaching fiduciary duties, unjust enrichment and waste of corporate assets. The complaint also purports to allege claims for contribution in connection with the Turnofsky case described above, pursuant to Section 11(f) of the Securities Act and Sections 10(b) and 21D of the Exchange Act. The complaint seeks unspecified compensatory damages, interest, costs and attorneys’ fees; declaratory relief; and an order requiring changes to corporate governance and internal procedures and a vote on proposed amendments to the Bylaws and Certificate of Incorporation.

On March 8, 2021, purported stockholder Erin Yuson brought a purported stockholder derivative action in the United States District Court for the District of New Jersey. The action is captioned Erin Yuson, derivatively on behalf of electroCore, Inc., vs. Francis R. Amato, et al., Case 3:21-cv-04481. The defendants include present and past directors and officers of the Company. The plaintiff purports to pursue derivative claims on behalf of the Company in connection with a 2019 proxy statement and actions occurring from the IPO through September 25, 2019. The complaint alleges that demand on the board of directors is excused. The complaint purports to allege claims against the defendants for violating Section 14(a) of the Exchange Act and breaching fiduciary duties. The complaint seeks unspecified compensatory damages, interest, costs and attorneys’ fees; declaratory relief; and an order requiring changes to corporate governance and internal procedures and a vote on proposed amendments to the Bylaws and Certificate of Incorporation.

The plaintiffs in the Maltz and Yuson derivative actions agreed to consolidate and stay those actions. The actions are stayed until and through the resolution of any motion for summary judgment in the Turnofsky federal securities class action. A stipulation to that effect was filed by the plaintiffs on April 14, 2021, and ordered by the court on April 30, 2021. On June 9, 2023, the cases were administratively dismissed without prejudice.

The Company intends to continue to vigorously defend itself in these matters. However, in light of, among other things, the preliminary stage of these litigation matters, the Company is unable to determine the reasonable probability of loss or a range of potential loss. Accordingly, the Company has not established an accrual for potential losses, if any, that could result from any unfavorable outcome, and there can be no assurance that these litigation matters will not result in substantial defense costs and/or judgments or settlements that could adversely affect the Company’s financial condition.

The Company is subject to various claims, complaints and legal actions in the normal course of business from time to time. The Company is not aware of any further currently pending litigation for which it believes the outcome could have a material adverse effect on its operations or financial position. The Company expenses associated legal fees including those relating to the stockholder litigation described in this Note 12 in the period they are incurred.

Note 13. Severance and other related charges

During the three and nine months ended September 30, 2023, the Company entered into separation agreements with former employees of which agreements required aggregate payments totaling $113,000 and $445,000, respectively. The charge for these payments is included in Selling, general and administrative expense in the accompanying Condensed Statement of Operations for the nine months ended September 30, 2023. As of September 30, 2023, the Company has an outstanding payable of $113,000 in connection with these charges. This outstanding payable is included in Accrued expenses and other current liabilities in the accompanying Condensed Consolidated Balance Sheet as of September 30, 2023 (see Note 7).

Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations

MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL

CONDITION AND RESULTS OF OPERATIONS

You should read this section in conjunction with our unaudited interim condensed consolidated financial statements and related notes included in this Quarterly Report on Form 10-Q and our audited consolidated financial statements and related notes thereto and management’s discussion and analysis of financial condition and results of operations for the year ended December 31, 2022 included in our Annual Report on Form 10-K, filed with the Securities and Exchange Commission, or SEC. As discussed in the section titled “Cautionary Note Regarding Forward-Looking Statements,” the following discussion and analysis contains forward-looking statements that involve risks and uncertainties, as well as assumptions that, if they never materialize or prove incorrect, could cause our results to differ materially from those expressed or implied by such forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to, those identified below, and those under the caption "Risk Factors" in the aforementioned Annual Report and this Form 10-Q.

Note: Information concerning the shares of our common stock and related share prices in this Item 2 has been adjusted to reflect the 1- for-15 reverse split of our common stock that was made effective on February 15, 2023. (See Note 2 - “Basis of Presentation” to the accompanying condensed consolidated financial statements).

Overview

We are a commercial stage bioelectronic medicine and wellness company dedicated to improving health through our non-invasive vagus nerve stimulation (“nVNS”) technology platform. Our focus is the commercialization of medical devices for the management and treatment of certain medical conditions and the development and commercialization of consumer product offerings utilizing nVNS to promote general wellbeing and human performance in the United States and select overseas markets.

nVNS is a platform bioelectronic technology that modulates neurotransmitters and immune function through its effects on both the peripheral and central nervous systems. Our nVNS treatment is delivered through a proprietary high-frequency burst waveform that safely and comfortably passes through the skin and stimulates therapeutically relevant fibers in the vagus nerve. Various scientific publications suggest that nVNS works through several mechanistic pathways including the modulation of neurotransmitters.

Historically, vagus nerve stimulation or VNS, required an invasive surgical procedure to implant a costly medical device. This limitation has generally limited VNS from being used by anyone other than the most severe patients. Our medical devices and wellness products are self-administered and intended for regular or intermittent use over many years.

Our business is supported by our in-house capabilities spanning research and development, regulatory affairs and compliance, sales and marketing, product testing, assembly, fulfillment, and customer support. We derive revenues from the sale of medical devices and wellness products in the United States and select overseas markets. We have two principal product categories:

•	Handheld, personal use medical devices for the management and treatment of certain medical conditions; and
•	Handheld, personal use consumer product offerings utilizing nVNS technology to promote general wellbeing and human performance.

We believe our nVNS treatment may be used in the future to effectively treat additional medical conditions, promote general wellbeing, or improve human performance.

Our goal is to be a leader in non-invasive neuromodulation by using our proprietary nVNS platform technology to deliver better health. To achieve this, we offer multiple propositions:

•	Prescription gammaCore medical devices for the treatment of certain medical conditions such as primary headache;
•	Our Truvaga product for the support of general health and wellbeing; and
•	Our TAC-STIM product for human performance as defined by the United States Air Force Research Laboratory.

Our gammaCore product is a prescription medical device currently FDA cleared for a variety of primary headache conditions. It is available by prescription only and our flagship model, gammaCore Sapphire, is a portable, reusable, rechargeable and reloadable personal use option for patients to use at home or on the go. Prescriptions are written by a health care provider and dispensed from a specialty pharmacy, through the patient’s healthcare provider or fulfilled directly to certain patients directly from our facility in Rockaway, NJ. After the initial prescription is filled, access to additional therapy can be refilled for certain of our gammaCore medical devices periodically through the input of a prescription-only authorization.

Our Truvaga product is a personal use consumer electronics wellness product that does not require a prescription and is available direct-to-consumer from electroCore at www.truvaga.com. Our Truvaga product is not intended for medical use.

Our TAC-STIM product is a form of nVNS for human performance and has been developed in collaboration with the United States Department of Defense Biotech Optimized for Operational Solutions and Tactics, or "BOOST" program.

In June 2023, we announced that our TAC-STIM product, had been selected to be a part of the Air Force Research Laboratories, or “AFRL”, Real-Time Assessing and Augmenting Cognitive Performance in Extreme Environments, or “A2PEX” Grant Program. A2PEX is a five-year project led by the Florida Institute for Human and Machine Cognition, or “IHMC” that includes internationally recognized leaders in wearable technologies from industry and academia. The goal of A2PEX is to build a wearable system to sense, assess and augment cognitive performance in operational environments. Sensors developed by A2PEX partners will develop electrophysiological and biomarker sensors to assess Airmen stress/fatigue in extreme environments. electroCore’s proprietary TAC-STIM nVNS product has been commissioned by IHMC for integration into the A2PEX system with the goal of mitigating fatigue and augmenting performance.

We are exploring strategies to make our TAC-STIM product available to other branches of the active-duty military and certain human performance professionals in the United States and abroad.

Our TAC-STIM product is not a medical device and is not intended to diagnose, cure, mitigate, prevent, or treat a disease or condition.

We have focused most of our historical sales efforts in two channels, the United States Department of Veterans Affairs and United States Department of Defense, or VA/DoD, and the United Kingdom utilizing our FDA cleared and CE marked gammaCore medical device.

The United States Department of Veteran Affairs comprised 60.7% and 60.2% of our revenue during the three and nine months ended September 30, 2023, respectively. We expect that a majority of our 2023 sales will be made pursuant to our qualifying contract under the Federal Supply Schedule or FSS, which was secured by us in December 2018, as well as open market sales to individual facilities within the government channels. The FSS is scheduled to expire on January 15, 2024. We have submitted a renewal application for extension of our qualifying contract under the FSS from the Department of Veterans Affairs Office of Procurement and Logistics, but there is no assurance the FSS will be renewed, if at all, or renewed at terms favorable to us. Our sales function in this channel is comprised of electroCore employees and independent contractors.

Sales under the Med Tech Funding Mandate, or MTFM, program for cluster headache in the UK comprised 6.5% and 7.8% of our revenue during the three and nine months ended September 30, 2023, respectively. During the remainder of 2023, we plan on continued expansion under this program, as well as continue to utilize distribution partners to commercialize our nVNS technology in territories outside the United States and United Kingdom. In October 2023, we were notified by NHS Supply Chain that it intends to continue to include the gammaCore device within their framework agreement, commencing March 2024 through March 2026 with an option to extend for a further two years. In the remainder of 2023, we expect NICE to review the guidance document and any changes in recommendation or pricing may adversely impact our ability to work with NHS England on the MTFM program.

We believe there may be significant opportunities beyond these two areas. Specifically, we believe there may be a large commercial opportunity for our gammaCore medical device with additional insurance covered lives, cash pay, physician dispense, and direct-to-consumer approaches, along with wellness and human performance propositions through our Truvaga and TAC-STIM products. Therefore, during the remainder of 2023, we will continue our investments to expand our efforts in these channels and markets.

We face a variety of challenges and risks that we will need to address and manage as we pursue our strategies, including our ability to develop and retain an effective sales force, achieve market acceptance of our gammaCore medical device among physicians, patients, and third-party payers, expand the use of our gammaCore medical device to additional therapeutic indications, and to develop our nascent wellness and human performance business.

Because of the numerous risks and uncertainties associated with our commercialization efforts, as well as research and product development activities, we are unable to predict the timing or amount of increased expenses, or when, if ever, we will be able to achieve or maintain profitability. Even if we are able to increase sales of our products, we may not become profitable. If we fail to become profitable or are unable to sustain profitability, then we may be unable to continue our operations at planned levels and be forced to reduce or terminate our operations.

Our expected cash requirements for the next 12 months and beyond are based on the commercial success of our products and our ability to control operating expenses. There are significant risks and uncertainties as to our ability to achieve these operating results. Due to these risks and uncertainties, we may need to reduce our activities significantly more than our current operating plan and cash flow projections assume in order to fund operations for the next 12 months. There can be no assurance that we will have sufficient cash flow and liquidity to fund our planned activities, which could force us to significantly reduce or curtail our activities and, ultimately, potentially cease operations. These conditions raise substantial doubt about our ability to continue as a going concern. See “Liquidity Outlook.”

Critical Accounting Policies and Estimates

The significant accounting policies and basis of presentation of our condensed consolidated financial statements are described in Note 2 “Summary of Significant Accounting Policies” of the consolidated financial statements included in our Annual Report on Form 10-K, filed with the Securities and Exchange Commission, or SEC on March 8, 2023 ("2022 Annual Report"), and in Note 2 "Summary of Significant Accounting Policies" of the condensed consolidated financial statements included within this quarterly report on Form 10-Q.

The preparation of our financial statements is in accordance with accounting principles generally accepted in the United States of America, or GAAP, which require us to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, expenses and other related disclosures. While we believe our estimates, assumptions and judgments are reasonable, they are based on information presently available. Actual results may differ significantly from these estimates due to changes in judgments, assumptions and conditions as a result of unforeseen events or otherwise, which could have a material impact on our financial position and results of operations.

The critical accounting policies, and the judgements, estimates, and assumptions associated with such policies, that we believe have the greatest potential impact on the condensed consolidated financial statements are disclosed in the section titled Critical Accounting Policies and Estimates in Part II of our 2022 Annual Report.

Results of Operations

Comparison of the three months ended September 30, 2023 to the three months ended September 30, 2022

The following table sets forth amounts from our condensed consolidated statements of operations for the three months ended September 30, 2023 and 2022:

	For the three months ended September 30,
	2023			2022			Change
(in thousands)
Consolidated statements of operations:
Net sales	$	4,508		$	1,976		$	2,532
Cost of goods sold		661			258			403
Gross profit		3,847			1,718			2,129
Operating expenses
Research and development		1,249			1,617			(368	)
Selling, general and administrative		6,724			5,657			1,067
Total operating expenses		7,973			7,274			699
Loss from operations		(4,126	)		(5,556	)		1,430
Other (income) expense
Interest and other income		(94	)		(103	)		9
Total other (income) expense		(94	)		(103	)		9
Loss before income taxes		(4,032	)		(5,453	)		1,421
Benefit from income taxes		—			—			-
Net loss	$	(4,032	)	$	(5,453	)	$	1,421

Net Sales

Net sales for the three months ended September 30, 2023 increased 128% as compared to the three months ended September 30, 2022. The increase of $2.5 million is due to an increase in net sales across major channels including our prescription gammaCore medical devices sold in the U.S. and abroad; and revenue from the sales of our nonprescription general well being and human performance Truvaga and TAC-STIM products.

The following table sets forth our product net sales:

(in thousands)	Three months ended September 30,
Product		2023		2022
Rx gammaCore - Department of Veteran Affairs and Department of Defense	$	2,737	$	1,167
Rx gammaCore - U.S. Commercial		439		392
Outside the United States		464		417
Truvaga		267		—
TAC-STIM		601		—
	$	4,508	$	1,976

Gross Profit

Gross profit increased by $2.1 million for the three months ended September 30, 2023 compared to the three months ended September 30, 2022. Gross margin was 85% and 87% for the three months ended September 30, 2023 and 2022, respectively. Our evolving commercial strategy has resulted in the launch of cash payment models under which we license a portion of our devices. The cost of the licensed device is being recognized as cost of goods sold over the estimated useful life of the device. There was no effect in the current quarter in the incremental increase in gross margin associated with the licensing of a portion of our devices, while there was a 9.0% incremental increase in the three months ended September 30, 2022. In recent quarters, we have sold an increasing number of longer duration therapy, resulting in a higher average selling price, as well as selling an increased number of refill kits with a lower cost of goods.

Research and Development

Research and development expense for the three months ended September 30, 2023 of $1.2 million decreased $368,000 as compared to the prior year period. This decrease in research and development expense was due to a decrease in compensation associated with cost cutting measures offset by our targeted investments to support the future iterations of our therapy delivery platform, including the use of our intellectual property around the delivery of smart phone-integrated and smart phone-connected non-invasive therapies.

Selling, General and Administrative

Selling, general and administration expense of $6.7 million for the three months ended September 30, 2023 increased by $1.1 million, or 19%, as compared to $5.7 million for the previous year period. This increase was primarily due to greater variable selling and marketing costs consistent with our increase in net sales.

Other (Income) Expense

Other (Income) Expense for the three months ended September 30, 2023 was consistent with the comparable prior year period.

Comparison of the nine months ended September 30, 2023 to the nine months ended September 30, 2022

The following table sets forth amounts from our condensed consolidated statements of operations for the nine months ended September 30, 2023 and 2022:

	For the nine months ended September 30,
	2023			2022			Change
	(in thousands)
Consolidated statements of operations:
Net sales	$	10,839		$	6,032		$	4,807
Cost of goods sold		1,704			976			728
Gross profit		9,135			5,056			4,079
Operating expenses
Research and development		4,213			3,892			321
Selling, general and administrative		20,233			18,121			2,112
Total operating expenses		24,446			22,013			2,433
Loss from operations		(15,311	)		(16,957	)		1,646
Other (income) expense
Interest and other income		(298	)		(145	)		(153	)
Other expense		—			5			(5	)
Total other (income) expense		(298	)		(140	)		(158	)
Loss before income taxes		(15,013	)		(16,817	)		1,804
Benefit for income taxes		211			445			(234	)
Net loss	$	(14,802	)	$	(16,372	)	$	1,570

Net Sales

Net sales for the nine months ended September 30, 2023 increased 80% as compared to the prior year period. The increase of $4.8 million is due to an increase in net sales across major channels including our prescription gammaCore medical devices sold in the U.S. and abroad; and revenue from the sales of our nonprescription Truvaga and TAC-STIM products, as well as increased prescription gammaCore medical device sales outside the United States. We expect that the majority of remaining 2023 fiscal year revenue will continue to come from our U.S. channels. The amount of revenue we recognize from the sale of our TAC-STIM product, however, may fluctuate significantly from quarter to quarter.

The following table sets forth our channel net sales:

(in thousands)	Nine months ended September 30,
Product		2023		2022
Rx gammaCore - Department of Veteran Affairs and Department of Defense	$	6,523	$	3,597
Rx gammaCore - U.S. Commercial		1,310		1,133
Outside the United States		1,298		1,189
Truvaga		704		—
TAC-STIM		1,000		—
Other		4		113
	$	10,839	$	6,032

Gross Profit

Gross profit increased $4.1 million for the nine months ended September 30, 2023 compared to the prior year. Gross margin of 84% for the nine months ended September 30, 2023 was consistent with results for the nine months ended September 30, 2022. Our evolving commercial strategy has resulted in the launch of cash payment models under which we license a portion of our devices. The cost of the licensed device is being recognized as cost of goods sold over the estimated useful life of the device. The incremental increase in gross margin associated with the licensing of a portion of our devices was 1.8% and 8.0% in the nine months ended September 30, 2023 and 2022, respectively. In recent quarters, we have sold an increasing number of longer duration therapy, resulting in a higher average selling price, as well as selling an increased number of refill kits with a lower cost of goods. Gross profit and gross margin in the remainder of 2023 will be largely dependent on revenue levels, product mix, and any changes in the estimated useful lives of licensed devices.

Research and Development

Research and development expense increased by $321,000 or 8% for the nine months ended September 30, 2023 compared to the prior year period. This increase was primarily due to targeted investments to support the future iterations of our therapy delivery platform, including the use of our intellectual property around the delivery of smart phone-integrated and smart phone-connected non-invasive therapies. This increase was partially offset by a decrease in compensation expense associated with cost cutting measures effected April 1, 2023. In the remainder of 2023, we plan to continue to invest in the next generation of our therapy delivery platform, although we expect our level of investment to decrease during the remainder of the year.

Selling, General and Administrative

Selling, general and administrative expense of $20.2 million for the nine months ended September 30, 2023 increased $2.1 million compared to $18.1 million for the previous year period. This increase was due to severance charges totaling $445,000, as well as our greater variable selling and marketing costs consistent with our increase in sales. continuing targeted investments in sales and marketing to support our commercial efforts, offset by decreases in insurance and stock-based compensation expenses. In the remainder of 2023, we plan on continuing to make targeted investments in sales and marketing to support our commercial efforts, particularly around sales and marketing efforts across all major U.S. channels.

Other (Income) Expense

The increase in Other (Income) Expense is primarily due to rising interest rates.

Benefit from Income Taxes

We may be eligible, from time to time, to receive cash from the sale of our net operating losses under New Jersey's Department of the Treasury - Division of Taxation NOL Transfer Program. On January 10, 2023, we received a payment of approximately $211,000 from the sale of our New Jersey state net operating losses.

Cash Flows

The following table sets forth the significant sources and uses of cash for the periods noted below:

	For the nine months ended September 30,
	2023			2022
(in thousands)
Net cash (used in) provided by
Operating activities	$	(11,545	)	$	(12,631	)
Investing activities	$	(165	)	$	—
Financing activities	$	7,487		$	—

Operating Activities

Net cash used in operating activities was $11.5 million and $12.6 million for the nine months ended September 30, 2023 and 2022, respectively. This decrease is primarily due to the decrease in our net loss adjusted for non-cash expense items.

Investing Activities

During the nine months ended September 30, 2023, cash used in investing activities was related to equipment purchases. No cash was provided by investing activities during the nine months ended September 30, 2022.

Financing Activities

Net cash provided by financing activities for the nine months ended September 30, 2023 was $7.5 million which was attributable to (i) our July 31, 2023 Securities Purchase Agreement (“First SPA”) in connection with a registered direct offering and concurrent private placement with certain institutional and accredited investors pursuant to which the Company issued and sold an aggregate of 1,062,600 shares of common stock, 613,314 pre-funded common stock purchase warrants that are exercisable upon issuance, and warrants to purchase up to an aggregate of 837,955 shares of common stock and (ii) a Securities Purchase Agreement (“Second SPA”) in connection with a concurrent private placement with certain of the Company's officers and directors pursuant to which we issued and sold 169,968 shares of common stock and warrants to purchase up to an aggregate of 84,982 shares of common stock.

Liquidity Outlook

In the remainder of 2023, we expect to continue to incur substantial negative cash flows from operations. We intend to continue to make targeted investments in sales and marketing, as well as the next generation of our therapy delivery platform.

We expect that a majority of our remaining 2023 sales will be made pursuant to our qualifying contract under the Federal Supply Schedule, or FSS, as well as open market sales to individual facilities within the government channels. The FSS is scheduled to expire on January 15, 2024. We have submitted a renewal application for extension of our qualifying contract under the FSS from the Department of Veterans Affairs Office of Procurement and Logistics, but there is no assurance the FSS will be renewed, if at all, or renewed at terms favorable to us. In addition, other possible changes including those relating to the payer and competitive landscape, our commercialization strategy, our development activities, and regulatory matters, may occur beyond our control that would cause us to consume our available capital more quickly.

We have historically funded our operations from the sale of our common stock. As described immediately above, on July 31, 2023, we entered into a registered direct offering with certain institutional and accredited investors, and concurrent private placements with such investors and certain of our officers and directors, resulting in net proceeds of approximately $7.5 million after deducting the placement agent fees and expenses, and other offering expenses payable by us.

Our expected cash requirements for the next 12 months and beyond are largely based on the commercial success of our products. We believe our cash and cash equivalents will enable us to fund our operating expenses, working capital, and capital expenditure requirements, as currently planned, through 12 months from the date of the accompanying financial statements. There are significant risks and uncertainties as to our ability to achieve these operating results. Due to these risks and uncertainties, there can be no assurance that we will have sufficient cash flow and liquidity to fund our planned activities, which could force us to significantly reduce or curtail our activities and, ultimately, potentially cease operations. These conditions raise substantial doubt about our ability to continue as a going concern within one year of the date these accompanying financial statements are issued. The accompanying financial statements do not include any adjustment that might result from the outcome of this uncertainty.

On January 18, 2022, we filed a Form S-3 registration statement, or the 2022 Shelf Registration Statement, with the SEC, for the issuance of common stock, preferred stock, warrants, rights, debt securities and units, which we refer to collectively as the Shelf Securities, up to an aggregate amount of $75.0 million. The 2022 Shelf Registration Statement was declared effective on January 25, 2022. The proposed maximum offering price per unit and the proposed maximum aggregate offering price per class of security will be determined from time to time by us in connection with the issuance by us of the securities registered under the 2022 Shelf Registration Statement. Until such time as the aggregate market value of our securities held by non-affiliates equals or exceeds $75.0 million, the aggregate maximum offering price of all securities issued by us in any given 12-calendar month period pursuant to this and any of our other registration statements may not exceed one-third of the aggregate market value of our securities held by non-affiliates. Approximately $7.3 million of the securities issued or issuable pursuant to our July 31, 2023 Registered Direct Financing were issued pursuant to the 2022 Shelf Registration Statement. We have agreed, subject to certain limited exceptions, not to issue, enter into any agreement to issue or announce the issuance or proposed issuance of any shares of Common Stock or any securities convertible into or exchangeable for shares of our Common Stock on or before January 29, 2024, without the prior written consent of the lead institutional investors in the transactions conducted pursuant to the First SPA. We have also agreed generally not to effect or enter into an agreement to effect any issuance of our securities involving a Variable Rate Transaction, as defined in the First SPA, until August 2, 2024.

Item 3. Quantitative and Qualitative Disclosures About Market Risk

We develop our products in the United States and sell those products into several countries. As a result, our financial results could be affected by factors such as changes in foreign currency exchange rates or weak economic conditions in foreign markets. Most of our sales in Europe are denominated in British Pound Sterling and our license agreement with Teijin is denominated in Japanese Yen. As our sales in currencies other than the U.S. dollar increase, our exposure to foreign currency fluctuations may increase. In addition, changes in exchange rates also may affect the end-user prices of our products compared to those of our foreign competitors, who may be selling their products based on local currency pricing. These factors may make our products less competitive in some countries.

If the U.S. dollar uniformly increased or decreased in strength by 10% relative to the foreign currencies in which our sales were denominated, our net income would have correspondingly increased or decreased by an immaterial amount for the three months ended September 30, 2023.

Our exposure to market interest rate risk is confined to our cash and cash equivalents and marketable securities. The goals of our investment policy are preservation of capital, fulfillment of liquidity needs and fiduciary control of cash and investments. We also seek to maximize income from our investments without assuming significant risk. To achieve our goals, we may maintain a portfolio of cash equivalents and investments in a variety of securities of high credit quality. The securities in our investment portfolio, if any, are not leveraged, are classified as available for sale and are, due to their very short-term nature, subject to minimal interest rate risk. We currently do not hedge interest rate exposure. Because of the short-term maturities of our cash equivalents, we do not believe that an increase in market rates would have any material negative impact on interest income recognized in our statement of operations. We have no investments denominated in foreign currencies and therefore our investments are not subject to foreign currency exchange risk. We contract with investigational sites, suppliers and other vendors in Europe and internationally. In addition, our license agreement requires payments to us to be denominated in Japanese Yen. We are subject to fluctuations in foreign currency rates in connection with these agreements. We do not hedge our foreign currency exchange rate risk.

All of the potential changes noted above are based on sensitivity analyses performed on our financial position as of September 30, 2023.

Item 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures

We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in our reports under the Exchange Act, is recorded, processed, summarized and reported within the time periods specified in the rules and forms, and that such information is accumulated and communicated to us, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decision making regarding required disclosure. In designing and evaluating our disclosure controls and procedures, we recognize that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives, as ours are designed to do, and we apply our judgment in evaluating whether the benefits of the controls and procedures that we adopt outweigh their costs.

As required by Rule 13a-15(b) of the Exchange Act, an evaluation as of September 30, 2023 was conducted under the supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of our disclosure controls and procedures (as defined in Rule 13a-15(e) under the Exchange Act). Based on this evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures, as of September 30, 2023 were not effective due to the material weakness described below.

Management's Report in Internal Control Over Financial Reporting

During October 2023, a vendor notified us that it had not received a payment we made via wire transfer based on instructions the Company believed were sent by the vendor. We continue to investigate the matter, but our internal controls over vendor management, as designed, would not have timely prevented an unauthorized payment based on incorrect vendor information from occurring. As such, the Company has concluded that a material weakness exists in its internal controls over financial reporting. This material weakness did not result in any identified misstatement, and there were no changes to previously reported financial results.

Remediation Plan for the Material Weakness

Management is committed to the remediation of the material weakness described above. In the fourth quarter of 2023, management has implemented and will continue to implement measures designed to ensure that the control deficiencies contributing to the material weakness are remediated, such that these controls are designed, implemented, and operating effectively.

Remediation efforts include but are not limited to (a) enhance processes and procedures around payment security, (b) verifying changes to vendor information on a timely basis, and (c) using alternate channels to verify changes to vendor payment information.

Management will test and evaluate the implementation of internal controls and revised processes to ascertain whether they are designed and operating effectively to provide reasonable assurance that they will prevent or detect a material error in our financial statements.

The material weakness will not be considered remediated, however, until the applicable controls operate for a sufficient period of time and management has concluded, through testing, that controls are operating effectively.

Changes in Internal Control over Financial Reporting

Except as described above, there was no change in our internal control over financial reporting as such term is defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act, that occurred during the three months ended September 30, 2023 that has materially affected or is reasonably likely to materially affect our internal control over financial reporting.

PART II— OTHER INFORMATION

Item 1. LEGAL PROCEEDINGS

The information set forth in Note 12. Commitments and Contingencies of the condensed consolidated financial statements included with this quarterly report on Form 10-Q is incorporated here by reference to this Part II Item 1.

Item 1A.

RISK FACTORS

You should carefully consider the risk factors included in Item 1A. of our Annual Report on Form 10-K for the year ended December 31, 2022 (Annual Report) filed with the SEC on March 8, 2023 and our Quarterly Report on Form 10-Q filed with the SEC on May 3, 2023 (“Q1 10-Q”), in addition to the following risk factor, and the other information in this report on Form 10-Q, including the section of this report titled “Management’s Discussion and Analysis of Financial Condition and Results of Operations” and our financial statements and related notes. If any of the events described in our Annual Report, Q1 10-Q, the following risk factor and the risks described elsewhere in this report on Form 10-Q occur, our business, operating results and financial condition could be seriously harmed. This report on Form 10-Q also contains forward-looking statements that involve risks and uncertainties. Our actual results could differ materially from those anticipated in the forward-looking statements as a result of factors that are described in our Annual Report, Q1 10-Q, below and elsewhere in this report.

Updated Risk Factor

We have identified a material weakness in our internal control over financial reporting, and determined that our disclosure controls were not effective. If we are unable to remediate this material weakness, or if we experience additional material weaknesses in the future, we may not be able to accurately or timely report our financial condition or results of operations and investors may lose confidence in our financial reports and the market price of our common stock could be adversely affected.

As a public company, we are required to maintain effective disclosure controls and procedures and implement and maintain internal control over financial reporting and to report any material weaknesses in such internal control. Section 404 of the Sarbanes-Oxley Act requires that we evaluate and determine the effectiveness of our internal control over financial reporting. Beginning with our second annual report following our IPO, for our fiscal year ended December 31, 2020, management has provided a report on internal control over financial reporting. The Sarbanes-Oxley Act also requires that our management report on internal control over financial reporting be attested to by our independent registered public accounting firm, to the extent we (i) are no longer an “emerging growth company,” as defined by the JOBS Act, and (ii) have annual revenues greater than $100 million in the most recent fiscal year for which audited financial statements are available. We do not expect to have our independent registered public accounting firm attest to our management report on internal control over financial reporting for so long as we are an emerging growth company or have annual revenues under $100 million. If and when we have to design and implement the internal control over financial reporting required to comply with this obligation, such process will be time consuming, costly, and complicated.

In preparation of our condensed consolidated financial statements for this Quarterly Report, we determined that a material weakness in our internal control over financial reporting existed relating to payment security controls and procedures, which weakness did not result in any identified material misstatement, nor any change to previously reported financial results. In addition, management determined that our disclosure controls were ineffective as of September 30, 2023 due to the existence of this material weakness. To remediate this material weakness, we are undertaking efforts that include but are not limited to, (a) enhancing processes and procedures around payment security, (b) verifying changes to vendor information on a timely basis, and (c) using alternate channels to verify changes to vendor payment information. The material weakness will not be considered remediated until the applicable controls operate for a sufficient period of time and management has concluded, through testing, that controls are operating effectively. We can give no assurance that this implementation will remediate this material weakness in our internal control or that material weaknesses or significant deficiencies in our internal control over financial reporting will not be identified in the future.

If we are unable to remediate this material weakness, or if we experience additional material weaknesses in the future or otherwise fail to maintain an effective system of internal controls, we may not be able to accurately or timely report our financial condition or results of operations and investors may lose confidence in the accuracy and completeness of our financial reports and the market price of our common stock could be adversely affected, and we could become subject to investigations by the stock exchange on which our securities are listed, the SEC, or other regulatory authorities, which could require additional financial and management resources.

Item 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

None.

Item 3. DEFAULTS UPON SENIOR SECURITIES

None.

Item 4. MINE SAFETY DISCLOSURES

Not applicable.

Item 5. OTHER INFORMATION

(a) Resignation and Reappointment of a Director. Consistent with the certificate of incorporation and amended and restated bylaws of the Company, and in order to achieve a more equal balance of membership among the three classes of members of the board of directors of the Company, the board has determined that one of the Class III directors with a term expiring at the 2024 Annual Meeting of Stockholders should move to Class II with a term expiring at the 2026 Annual Meeting of Stockholders. Accordingly, on November 6, 2023, Thomas J. Errico, M.D., resigned as a Class III director with a term expiring at the 2024 Annual Meeting of Stockholders, and was immediately reappointed to the board as a Class II director with a term expiring at the 2026 Annual Meeting of Stockholders. The resignation and reappointment of Dr. Errico was effected solely to create a more equal balancing of the board classes and was not due to any disagreement with the Company, the board or the management of the Company. For all other purposes, including equity award vesting and other compensation matters, Dr. Errico’s service on the board of directors is deemed to have continued uninterrupted. Dr. Errico will continue to serve on the Company’s Compensation and Nominating and Governance Committees, and he will continue as the Chair of the Nominating and Governance Committee.

(b) Not applicable.

During the quarter ended September 30, 2023, no director or Section 16 officer adopted or terminated any Rule 10b5-1 trading arrangements or non-Rule 10b5-1 trading arrangements (in each case, as defined in Item 408(a) of Regulation S-K promulgated by the Securities and Exchange Commission).

Item 6. EXHIBITS

Exhibit Number		Description
10.1**		electroCore, Inc. Non-Employee Director Compensation Policy

31.1*		Certification of Principal Executive Officer Pursuant to Rules 13a-14(a) and 15d-14(a) under the Securities Exchange Act of 1934, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

31.2*		Certification of Principal Financial Officer Pursuant to Rules 13a-14(a) and 15d-14(a) under the Securities Exchange Act of 1934, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

32.1*		Certification of Principal Executive Officer Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

32.2*		Certification of Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

101.INS		Inline XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.

101.SCH		Inline XBRL Taxonomy Extension Schema Document

101.CAL		Inline XBRL Taxonomy Extension Calculation Linkbase Document

101.DEF		Inline XBRL Taxonomy Extension Definition Linkbase Document

101.LAB		Inline XBRL Taxonomy Extension Label Linkbase Document

101.PRE		Inline XBRL Taxonomy Extension Presentation Linkbase Document

104		Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101)

*	Filed herewith.
**	Incorporated by reference to the Company's Current Report on Form S-1 as filed with the Commission on August 24, 2023

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

	Company Name

Date: November 8, 2023	By:	/s/ DANIEL S. GOLDBERGER
		Daniel S. Goldberger
		Chief Executive Officer (Principal Executive Officer)

Date: November 8, 2023	By:	/s/ BRIAN M. POSNER
		Brian M. Posner
		Chief Financial Officer (Principal Financial and Accounting Officer)

EXHIBIT 31.1

CERTIFICATION

I, Daniel S. Goldberger, certify that:

1.	I have reviewed this Quarterly Report on Form 10-Q of electroCore, Inc.;

2.	Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.	Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.	The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have:

(a)

Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b)

Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c)

Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d)

Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5.	The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a)

All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b)

Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: November 8, 2023	/s/ Daniel S. Goldberger
	Daniel S. Goldberger
	Chief Executive Officer
	(Principal Executive Officer)

EXHIBIT 31.2

CERTIFICATION

I, Brian M. Posner, certify that:

1.	I have reviewed this Quarterly Report on Form 10-Q of electroCore, Inc.;

2.	Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.	Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.	The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have:

(a)

(b)

(c)

(d)

5.	The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a)

(b)

Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: November 8, 2023	/s/ BRIAN M. POSNER
	Brian M. Posner
	Chief Financial Officer
	(Principal Financial and Accounting Officer)

EXHIBIT 32.1

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report on Form 10-Q of electroCore, Inc, (the “Company”) for the period ended September 30, 2023 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), the undersigned, Daniel S. Goldberger, as Chief Executive Officer of the Company, hereby certifies, pursuant to 18 U.S.C. Section 1350, that to the best of my knowledge:

1. The Report complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

2. The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: November 8, 2023	/s/ Daniel S. Goldberger
	Daniel S. Goldberger
	Chief Executive Officer
	(Principal Executive Officer)

EXHIBIT 32.2

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report on Form 10-Q of electroCore, Inc. (the “Company”) for the period ended September 30, 2023 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), the undersigned, Brian M. Posner, Chief Financial Officer of the Company, hereby certifies, pursuant to 18 U.S.C. Section 1350, that to the best of my knowledge:

1. The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

2. The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: November 8, 2023	/s/ BRIAN M. POSNER
	Brian M. Posner
	Chief Financial Officer
	(Principal Financial and Accounting Officer)

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2023	Nov. 01, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Trading Symbol	ECOR
Entity Registrant Name	electroCore, Inc.
Entity Central Index Key	0001560258
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Current Reporting Status	Yes
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		6,002,420
Entity File Number	001-38538
Entity Tax Identification Number	20-3454976
Entity Address, Address Line One	200 Forge Way
Entity Address, Address Line Two	Suite 205
Entity Address, City or Town	Rockaway
Entity Address, State or Province	NJ
Entity Address, Postal Zip Code	07866
City Area Code	(973)
Local Phone Number	290-0097
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, par value $0.001 per share
Security Exchange Name	NASDAQ
Entity Incorporation, State or Country Code	DE
Document Quarterly Report	true
Document Transition Report	false

Condensed Consolidated Balance Sheets (unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 13,460	$ 17,712
Restricted cash	250	250
Accounts receivable, net	589	401
Inventories, net	2,495	1,982
Prepaid expenses and other current assets	1,045	828
Total current assets	17,839	21,173
Inventories, noncurrent	813	2,194
Property and equipment, net	178	50
Operating lease right of use assets, net	518	565
Other assets, net	760	774
Total assets	20,108	24,756
Current liabilities:
Accounts payable	3,033	2,129
Accrued expenses and other current liabilities	5,390	4,842
Current portion of operating lease liabilities	85	74
Total current liabilities	8,508	7,045
Noncurrent liabilities:
Operating lease liabilities, noncurrent	560	625
Total liabilities	9,068	7,670
Commitments and contingencies (see Note 12)
Mezzanine Equity:
Preferred Stock, par value $0.001 per share; 10,000,000 shares authorized at September 30, 2023 and December 31, 2022; 0 shares issued and outstanding at September 30, 2023 and 71,173 shares issued and outstanding at December 31, 2022 ($0.001 per share liquidation value)
Stockholders' equity:
Common Stock, par value $0.001 per share; 500,000,000 shares authorized at September 30, 2023 and December 31, 2022; 5,998,836 shares issued and outstanding at September 30, 2023 and 4,744,886 shares issued and outstanding at December 31, 2022	6	5
Additional paid-in capital	172,304	163,520
Accumulated deficit	(161,172)	(146,370)
Accumulated other comprehensive loss	(98)	(69)
Total equity	11,040	17,086
Total liabilities and equity	$ 20,108	$ 24,756

Condensed Consolidated Balance Sheets (unaudited) (Parenthetical) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
Statement Of Financial Position [Abstract]
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	71,173
Preferred stock, shares outstanding	0	71,173
Preferred stock, liquidation value per share		$ 0.001
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	5,998,836	4,744,886
Common stock, shares outstanding	5,998,836	4,744,886

Condensed Consolidated Statements of Operations (unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Net sales	$ 4,508	$ 1,976	$ 10,839	$ 6,032
Cost of goods sold	661	258	1,704	976
Gross profit	3,847	1,718	9,135	5,056
Operating expenses
Research and development	1,249	1,617	4,213	3,892
Selling, general and administrative	6,724	5,657	20,233	18,121
Total operating expenses	7,973	7,274	24,446	22,013
Loss from operations	(4,126)	(5,556)	(15,311)	(16,957)
Other (income) expense
Interest and other income	(94)	(103)	(298)	(145)
Other expense				5
Total other (income) expense	(94)	(103)	(298)	(140)
Loss before income taxes	(4,032)	(5,453)	(15,013)	(16,817)
Benefit from income taxes			211	445
Net loss	$ (4,032)	$ (5,453)	$ (14,802)	$ (16,372)
Net loss per share of common stock - Basic (in dollars per share)	$ (0.68)	$ (1.2)	$ (2.87)	$ (3.45)
Net loss per share of common stock - Diluted (in dollars per share)	$ (0.68)	$ (1.2)	$ (2.87)	$ (3.45)
Weighted average common shares outstanding - Basic (in shares)	5,945	4,544	5,149	4,746
Weighted average common shares outstanding - Diluted (in shares)	5,945	4,544	5,149	4,746

Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement Of Income And Comprehensive Loss [Abstract]
Net loss	$ (4,032)	$ (5,453)	$ (14,802)	$ (16,372)
Other comprehensive loss:
Foreign currency translation adjustment	(22)	(82)	(29)	(167)
Other comprehensive loss	(22)	(82)	(29)	(167)
Comprehensive loss	$ (4,054)	$ (5,535)	$ (14,831)	$ (16,539)

Condensed Consolidated Statements of Equity (unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Preferred Stock	Common Stock	Additional paid-in capital	Accumulated deficit	Accumulated other comprehensive income (loss)
Balances at Dec. 31, 2021	$ 36,648		$ 5	$ 160,838	$ (124,208)	$ 13
Balances, Mezzanine Equity at Dec. 31, 2021
Balances, shares at Dec. 31, 2021			4,714
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(5,582)				(5,582)
Other comprehensive income	(27)					(27)
Issuance of stock related to employee compensation plans, net of forfeitures, shares			1
Share based compensation	777			777
Balances at Mar. 31, 2022	31,816		$ 5	161,615	(129,790)	(14)
Balances, Mezzanine Equity at Mar. 31, 2022
Balances, shares at Mar. 31, 2022			4,715
Balances at Dec. 31, 2021	36,648		$ 5	160,838	(124,208)	13
Balances, Mezzanine Equity at Dec. 31, 2021
Balances, shares at Dec. 31, 2021			4,714
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(16,372)
Other comprehensive income	(167)
Balances at Sep. 30, 2022	22,204		$ 5	162,933	(140,580)	(154)
Balances, Mezzanine Equity at Sep. 30, 2022
Balances, shares at Sep. 30, 2022			4,745
Balances at Mar. 31, 2022	31,816		$ 5	161,615	(129,790)	(14)
Balances, Mezzanine Equity at Mar. 31, 2022
Balances, shares at Mar. 31, 2022			4,715
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(5,337)				(5,337)
Other comprehensive income	(58)					(58)
Issuance of stock related to employee compensation plans, net of forfeitures, shares			27
Share based compensation	752			752
Balances at Jun. 30, 2022	27,173		$ 5	162,367	(135,127)	(72)
Balances, Mezzanine Equity at Jun. 30, 2022
Balances, shares at Jun. 30, 2022			4,742
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(5,453)				(5,453)
Other comprehensive income	(82)					(82)
Issuance of stock related to employee compensation plans, net of forfeitures, shares			3
Share based compensation	566			566
Balances at Sep. 30, 2022	22,204		$ 5	162,933	(140,580)	(154)
Balances, Mezzanine Equity at Sep. 30, 2022
Balances, shares at Sep. 30, 2022			4,745
Balances at Dec. 31, 2022	17,086		$ 5	163,520	(146,370)	(69)
Balances, Mezzanine Equity at Dec. 31, 2022
Balances, shares at Dec. 31, 2022		71	4,745
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(5,867)				(5,867)
Other comprehensive income	56					56
Issuance of stock related to employee compensation plans, net of forfeitures, shares			1
Preferred stock redemption, shares		(71)
Share based compensation	572			572
Balances at Mar. 31, 2023	11,847		$ 5	164,092	(152,237)	(13)
Balances, Mezzanine Equity at Mar. 31, 2023
Balances, shares at Mar. 31, 2023			4,746
Balances at Dec. 31, 2022	17,086		$ 5	163,520	(146,370)	(69)
Balances, Mezzanine Equity at Dec. 31, 2022
Balances, shares at Dec. 31, 2022		71	4,745
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(14,802)
Other comprehensive income	(29)
Balances at Sep. 30, 2023	11,040		$ 6	172,304	(161,172)	(98)
Balances, Mezzanine Equity at Sep. 30, 2023
Balances, shares at Sep. 30, 2023			5,999
Balances at Mar. 31, 2023	11,847		$ 5	164,092	(152,237)	(13)
Balances, Mezzanine Equity at Mar. 31, 2023
Balances, shares at Mar. 31, 2023			4,746
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(4,903)				(4,903)
Other comprehensive income	(63)					(63)
Issuance of stock related to employee compensation plans, net of forfeitures, shares			6
Share based compensation	183			183
Balances at Jun. 30, 2023	7,064		$ 5	164,275	(157,140)	(76)
Balances, Mezzanine Equity at Jun. 30, 2023
Balances, shares at Jun. 30, 2023			4,752
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(4,032)				(4,032)
Other comprehensive income	(22)					(22)
Issuance of stock related to employee compensation plans, net of forfeitures, shares			14
Sale of common stock and warrants	8,144		$ 1	8,143
Sale of common stock and warrants (shares)			1,233
Financing fees	(657)			(657)
Share based compensation	543			543
Balances at Sep. 30, 2023	11,040		$ 6	$ 172,304	$ (161,172)	$ (98)
Balances, Mezzanine Equity at Sep. 30, 2023
Balances, shares at Sep. 30, 2023			5,999

Condensed Consolidated Statements of Cash Flows (unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash flows from operating activities:
Net loss	$ (14,802)	$ (16,372)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation	1,298	2,095
Depreciation and amortization	735	400
Net noncash lease expense	46	34
Inventory reserve charge	258
Increase in provision for bad debts	54
Changes in operating assets and liabilities:
Accounts receivable	(241)	74
Inventories	(72)	58
Prepaid expenses and other current assets	(219)	(22)
Accounts payable	904	963
Accrued expenses and other current liabilities	549	184
Operating lease liabilities	(55)	(45)
Net cash used in operating activities	(11,545)	(12,631)
Cash flows from investing activities:
Purchase of equipment	(165)
Net cash used in investing activities	(165)
Cash flows from financing activities:
Proceeds from share issue	8,144
Financing costs	(657)
Net cash provided by financing activities	7,487
Effect of changes in exchange rates on cash and cash equivalents	(29)	(163)
Net decrease in cash and cash equivalents and restricted cash	(4,252)	(12,794)
Cash and cash equivalents and restricted cash – beginning of period	17,962	34,689
Cash and cash equivalents and restricted cash – end of period	13,710	21,895
Supplemental cash flows disclosures:
Proceeds from sale of state net operating losses	211	445
Interest paid	8	6
Supplemental schedule of noncash activity:
Insurance premium financing	$ 433	$ 522

The Company

9 Months Ended

Sep. 30, 2023

The Company

The Company

Note 1. The Company

Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 2023

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Note 2. Summary of Significant Accounting Policies

(a)	Basis of Presentation

(b)	Principles of Consolidation

(c)	Use of Estimates

(d)	Cash, Cash Equivalents and Restricted Cash

(in thousands)	September 30, 2023		September 30, 2022
Cash and cash equivalents	$	13,460	$	21,645
Restricted cash		250		250
Total cash, cash equivalents and restricted cash	$	13,710	$	21,895

As of September 30, 2023 and December 31, 2022, cash equivalents represented funds held in a money market account.

(e)	Restricted Cash

(f)	Licensed Products

(g)	Warrant Accounting

(h)	Prior Year Presentation

Prior year presentation has been conformed to current year presentation.

Going Concern, Significant Risks and Uncertainties

9 Months Ended

Sep. 30, 2023

Going Concern, Significant Risks and Uncertainties

Significant Risks and Uncertainties

Note 3. Going Concern, Significant Risks and Uncertainties

Going Concern

Concentration of Revenue Risks

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Revenue channel:
Rx gammaCore - VA/DoD	60.7	%	58.1	%	60.2	%	59.7	%
National Health Service	8.1	%	17.6	%	9.2	%	16.1	%

Foreign Currency Exchange

Revenue

9 Months Ended

Sep. 30, 2023

Revenue

Revenue

Note 4. Revenue

Product Net Sales

(in thousands)	Three months ended September 30,				Nine months ended September 30,
Channel		2023		2022		2023		2022
Rx gammaCore - Department of Veteran Affairs and Department of Defense	$	2,737	$	1,167	$	6,523	$	3,597
Rx gammaCore - U.S. Commercial		439		392		1,310		1,133
Outside the United States		464		417		1,298		1,189
Truvaga		267		—		704		—
TAC-STIM		601		—		1,000		—
Other		—		—		4		113
	$	4,508	$	1,976	$	10,839	$	6,032

Geographical Net Sales

The following table presents net sales disaggregated by geographic market:

(in thousands)	Three months ended September 30,				Nine months ended September 30,
Product revenue		2023		2022		2023		2022
United States	$	4,044	$	1,559	$	9,541	$	4,843
United Kingdom		412		347		1,117		968
Other		33		25		98		128
License revenue
Japan		19		45		83		93
Total Net Sales	$	4,508	$	1,976	$	10,839	$	6,032

Inventories

9 Months Ended

Sep. 30, 2023

Inventories

Inventories

Note 5. Inventories

As of September 30, 2023 and December 31, 2022, inventories consisted of the following:

(in thousands)	September 30, 2023		December 31, 2022
Raw materials	$	1,058	$	944
Work in process		1,899		2,879
Finished goods		351		353
Total inventories, net		3,308		4,176
Less: noncurrent inventories		813		2,194
Current inventories	$	2,495	$	1,982

Leases

9 Months Ended

Sep. 30, 2023

Leases

Leases

Note 6. Leases

Supplemental Balance Sheet Information for Operating Leases:

(in thousands)	September 30, 2023			December 31, 2022
Operating leases:
Operating lease right of use assets	$	518		$	565
Operating lease liabilities:
Current portion of operating lease liabilities		85			74
Noncurrent operating lease liabilities		560			625
Total operating lease liabilities	$	645		$	699
Weighted average remaining lease term (in years)		5.4			6.1
Weighted average discount rate		13.8	%		13.8	%

Future minimum lease payments under non-cancellable operating leases as of September 30, 2023:

(in thousands)
Remainder of 2023	$	41
2024		168
2025		171
2026		161
2027		157
2028 and thereafter		216
Total future minimum lease payments		914
Less: Amounts representing interest		(269	)
Total	$	645

Accrued Expenses and Other Current Liabilities

9 Months Ended

Sep. 30, 2023

Accrued Expenses and Other Current Liabilities

Accrued Expenses and Other Current Liabilities

Note 7. Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities as of September 30, 2023 and December 31, 2022 consisted of the following:

(in thousands)	September 30, 2023		December 31, 2022
Accrued professional fees	$	715	$	524
Accrued bonuses and incentive compensation		1,873		2,042
Accrued litigation legal fees expense		1,035		1,001
Accrued insurance expense		433		264
Accrued vacation and other employee related expenses		573		534
Accrued severance and other related charges		113		—
Accrued valued-added tax		224		133
Deferred revenue		180		152
Other		244		192
	$	5,390	$	4,842

Finance and Security Agreement

During the three and nine months ended September 30, 2023, the Company recognized $4,000 and $13,000 in aggregate interest expense related to the 2023 Agreement and 2022 Agreement, respectively.

Shareholders' Equity

9 Months Ended

Sep. 30, 2023

Shareholders' Equity

Shareholders' Equity

Note 8. Shareholders' Equity

Securities Purchase Agreements

Reverse Stock Split

Following the Special Meeting, the board of directors of the Company approved a 1-for-15 Reverse Stock Split. The Reverse Stock Split became effective on February 15, 2023.

Redemption and Elimination of Series A Preferred Stock

Stock Purchase Warrants

The following table presents a summary of stock purchase warrants outstanding as of September 30, 2023:

	Number of Warrants (in thousands)		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)			Aggregate Intrinsic Value (in thousands)
Outstanding, January 1, 2023		1	$	229.50		3.0	$	—
Stock purchase warrants (a)		923
Exercised		—
Expired		—
Outstanding, September 30, 2023		924	$	4.35		5.3	$	1,596
Exercisable, September 30, 2023		1	$	229.50		2.2	$	—

(a) 613,314 pre-funded warrants were excluded from the aforementioned table. Such pre-funded warrants were not exercised as of September 30, 2023.

Net Loss Per Share

9 Months Ended

Sep. 30, 2023

Net Loss Per Share

Net Loss Per Share

Note 9. Net Loss Per Share

The potential common stock equivalents that have been excluded from the computation of diluted loss per share consist of the following:

	Nine months ended September 30,
(in thousands)	2023	2022
Outstanding stock options	537	418
Restricted stock and unit awards	231	62
Stock purchase warrants	924	1
	1,692	481

Income taxes

9 Months Ended

Sep. 30, 2023

Income Taxes

Income Taxes

Note 10. Income Taxes

Stock Based Compensation

9 Months Ended

Sep. 30, 2023

Stock Based Compensation

Stock Based Compensation

Note 11. Stock Based Compensation

The following table presents a summary of activity related to stock options during the nine months ended September 30, 2023:

	Number of Options (in thousands)			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)
Outstanding, January 1, 2023		440		$	55.65		7.5
Granted		206
Exercised		—
Cancelled		(109	)
Outstanding, September 30, 2023		537		$	38.42		7.9
Exercisable, September 30, 2023		253		$	72.07		6.5

The following table presents a summary of activity related to restricted and deferred stock units (“Stock Units”) granted during the nine months ended September 30, 2023:

	Number of Shares (in thousands)			Weighted Average Grant Date Fair Value
Nonvested, January 1, 2023		127		$	11.85
Granted		137
Vested		(25	)
Cancelled		(8	)
Nonvested, September 30, 2023		231		$	7.74

In general, Stock Units granted to employees vest over two to four-year periods.

The Company recognized stock compensation expense for its equity awards as follows:

	Three months ended September 30,					Nine months ended September 30,
(in thousands)	2023		2022		2023		2022
Selling, general and administrative	$	477	$	454	$	1,102	$	1,835
Research and development		60		106		178		240
Cost of goods sold		6		6		18		20
Total expense	$	543	$	566	$	1,298	$	2,095

Total unrecognized compensation cost related to unvested awards as of September 30, 2023 was $2.1 million and is expected to be recognized over the next 1.7 years.

Valuation Information for Stock-Based Compensation

	Nine months ended September 30,
	2023				2022
Fair value at grant date	$	3.95		$	0.53
Expected volatility	122.4		%		84.0	%
Risk-free interest rate	4.1		%		1.7	%
Expected holding period, in years	5.8				6.0
Dividend yield		—	%		—	%

Contingencies

9 Months Ended

Sep. 30, 2023

Contingencies

Contingencies

Note 12. Contingencies

Stockholders Litigation

Severance and other related charges

9 Months Ended

Sep. 30, 2023

Severance and other related charges

Severance and other related charges

Note 13. Severance and other related charges

Summary of Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2023

Accounting Policies [Abstract]

Basis of Presentation

(a)	Basis of Presentation

Principles of Consolidation

(b)	Principles of Consolidation

Use of Estimates

(c)	Use of Estimates

Cash, Cash Equivalents and Restricted Cash

(d)	Cash, Cash Equivalents and Restricted Cash

(in thousands)	September 30, 2023		September 30, 2022
Cash and cash equivalents	$	13,460	$	21,645
Restricted cash		250		250
Total cash, cash equivalents and restricted cash	$	13,710	$	21,895

As of September 30, 2023 and December 31, 2022, cash equivalents represented funds held in a money market account.

Restricted Cash

(e)	Restricted Cash

Licensed Products

(f)	Licensed Products

Warrant Accounting

(g)	Warrant Accounting

Prior Year Presentation

(h)	Prior Year Presentation

Prior year presentation has been conformed to current year presentation.

Summary of Significant Accounting Policies (Tables)

9 Months Ended

Sep. 30, 2023

Accounting Policies [Abstract]

Schedule of cash equivalents and restricted cash

(in thousands)	September 30, 2023		September 30, 2022
Cash and cash equivalents	$	13,460	$	21,645
Restricted cash		250		250
Total cash, cash equivalents and restricted cash	$	13,710	$	21,895

Going Concern, Significant Risks and Uncertainties (Tables)

9 Months Ended

Sep. 30, 2023

Going Concern, Significant Risks and Uncertainties

Schedule of revenue channels accounted for 10% or more of the Company's net sales

	Three months ended September 30,				Nine months ended September 30,
	2023		2022		2023		2022
Revenue channel:
Rx gammaCore - VA/DoD	60.7	%	58.1	%	60.2	%	59.7	%
National Health Service	8.1	%	17.6	%	9.2	%	16.1	%

Revenue (Tables)

9 Months Ended

Sep. 30, 2023

Revenue

Schedule of net sales disaggregated by channel

(in thousands)	Three months ended September 30,				Nine months ended September 30,
Channel		2023		2022		2023		2022
Rx gammaCore - Department of Veteran Affairs and Department of Defense	$	2,737	$	1,167	$	6,523	$	3,597
Rx gammaCore - U.S. Commercial		439		392		1,310		1,133
Outside the United States		464		417		1,298		1,189
Truvaga		267		—		704		—
TAC-STIM		601		—		1,000		—
Other		—		—		4		113
	$	4,508	$	1,976	$	10,839	$	6,032

Schedule of net sales disaggregated by geographic market

(in thousands)	Three months ended September 30,				Nine months ended September 30,
Product revenue		2023		2022		2023		2022
United States	$	4,044	$	1,559	$	9,541	$	4,843
United Kingdom		412		347		1,117		968
Other		33		25		98		128
License revenue
Japan		19		45		83		93
Total Net Sales	$	4,508	$	1,976	$	10,839	$	6,032

Inventories (Tables)

9 Months Ended

Sep. 30, 2023

Inventories

Schedule of inventories stated at lower of cost or market

(in thousands)	September 30, 2023		December 31, 2022
Raw materials	$	1,058	$	944
Work in process		1,899		2,879
Finished goods		351		353
Total inventories, net		3,308		4,176
Less: noncurrent inventories		813		2,194
Current inventories	$	2,495	$	1,982

Leases (Tables)

9 Months Ended

Sep. 30, 2023

Leases

Supplemental Balance Sheet Information for Operating Leases

(in thousands)	September 30, 2023			December 31, 2022
Operating leases:
Operating lease right of use assets	$	518		$	565
Operating lease liabilities:
Current portion of operating lease liabilities		85			74
Noncurrent operating lease liabilities		560			625
Total operating lease liabilities	$	645		$	699
Weighted average remaining lease term (in years)		5.4			6.1
Weighted average discount rate		13.8	%		13.8	%

Schedule of future minimum lease payments under non-cancellable operating leases

(in thousands)
Remainder of 2023	$	41
2024		168
2025		171
2026		161
2027		157
2028 and thereafter		216
Total future minimum lease payments		914
Less: Amounts representing interest		(269	)
Total	$	645

Accrued Expenses and Other Current Liabilities (Tables)

9 Months Ended

Sep. 30, 2023

Accrued Expenses and Other Current Liabilities

Schedule of accrued expenses and other current liabilities

(in thousands)	September 30, 2023		December 31, 2022
Accrued professional fees	$	715	$	524
Accrued bonuses and incentive compensation		1,873		2,042
Accrued litigation legal fees expense		1,035		1,001
Accrued insurance expense		433		264
Accrued vacation and other employee related expenses		573		534
Accrued severance and other related charges		113		—
Accrued valued-added tax		224		133
Deferred revenue		180		152
Other		244		192
	$	5,390	$	4,842

Shareholders' Equity (Tables)

9 Months Ended

Sep. 30, 2023

Shareholders' Equity

Schedule of stock purchase warrants outstanding

	Number of Warrants (in thousands)		Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)			Aggregate Intrinsic Value (in thousands)
Outstanding, January 1, 2023		1	$	229.50		3.0	$	—
Stock purchase warrants (a)		923
Exercised		—
Expired		—
Outstanding, September 30, 2023		924	$	4.35		5.3	$	1,596
Exercisable, September 30, 2023		1	$	229.50		2.2	$	—

(a) 613,314 pre-funded warrants were excluded from the aforementioned table. Such pre-funded warrants were not exercised as of September 30, 2023.

Net Loss Per Share (Tables)

9 Months Ended

Sep. 30, 2023

Net Loss Per Share

Schedule of common stock equivalents excluded from computation of diluted loss per share

	Nine months ended September 30,
(in thousands)	2023	2022
Outstanding stock options	537	418
Restricted stock and unit awards	231	62
Stock purchase warrants	924	1
	1,692	481

Stock Based Compensation (Tables)

9 Months Ended

Sep. 30, 2023

Stock Based Compensation

Summary of Activity Related to Stock Options

	Number of Options (in thousands)			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)
Outstanding, January 1, 2023		440		$	55.65		7.5
Granted		206
Exercised		—
Cancelled		(109	)
Outstanding, September 30, 2023		537		$	38.42		7.9
Exercisable, September 30, 2023		253		$	72.07		6.5

Summary of Activity Related to Restricted Stock and Deferred Stock Units Granted

	Number of Shares (in thousands)			Weighted Average Grant Date Fair Value
Nonvested, January 1, 2023		127		$	11.85
Granted		137
Vested		(25	)
Cancelled		(8	)
Nonvested, September 30, 2023		231		$	7.74

Schedule of Recognized Stock Compensation for Equity Awards

	Three months ended September 30,					Nine months ended September 30,
(in thousands)	2023		2022		2023		2022
Selling, general and administrative	$	477	$	454	$	1,102	$	1,835
Research and development		60		106		178		240
Cost of goods sold		6		6		18		20
Total expense	$	543	$	566	$	1,298	$	2,095

Summary of Weighted Average Assumptions Used in Valuing Plans

	Nine months ended September 30,
	2023				2022
Fair value at grant date	$	3.95		$	0.53
Expected volatility	122.4		%		84.0	%
Risk-free interest rate	4.1		%		1.7	%
Expected holding period, in years	5.8				6.0
Dividend yield		—	%		—	%

The Company (Details)	Sep. 30, 2023 subsidiary
The Company
Number of wholly owned subsidiaries	2

Summary of Significant Accounting Policies - Additional Information (Details)	Feb. 15, 2023	Feb. 13, 2023 d $ / shares	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)
Accounting Policies [Line Items]
Finite-Lived License Agreements, Gross			$ 0
Reverse stock split ratio	1-for-15
Reverse stock split, Stock Price Trigger \| $ / shares		$ 1
Reverse stock split, Threshold Consecutive Trading Days \| d		10
Licensing Agreements [Member]
Accounting Policies [Line Items]
Net book value of licensed devices			$ 735,000	$ 538,000
Minimum [Member]
Accounting Policies [Line Items]
Estimated useful life			12 months
Reverse stock split ratio		1-for-5
Maximum [Member]
Accounting Policies [Line Items]
Estimated useful life			36 months
Reverse stock split ratio		1-for-50

Summary of Significant Accounting Policies - Schedule of cash equivalents and restricted cash (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022	Sep. 30, 2022
Accounting Policies [Abstract]
Cash and cash equivalents	$ 13,460	$ 17,712	$ 21,645
Restricted cash	250		250
Total cash, cash equivalents and restricted cash	$ 13,710		$ 21,895

Going Concern, Significant Risks and Uncertainties - Additional Information (Details) $ in Millions		3 Months Ended		9 Months Ended
	Jul. 31, 2023 USD ($)	Sep. 30, 2023 facility	Sep. 30, 2022 facility	Sep. 30, 2023 facility	Sep. 30, 2022
Risks And Uncertainties [Line Items]
Revenue percentage		60.20%		60.20%
Federal supply schedule expire date				Jan. 15, 2024
Net Sales \| Revenue from Rights Concentration Risk \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales		60.70%	58.10%	60.20%	59.70%
Net Sales \| Revenue from Rights Concentration Risk \| National Health Service [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales		8.10%	17.60%	9.20%	16.10%
Minimum \| Net Sales \| Government Contracts Concentration Risk \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales		10.00%
Minimum \| Net Sales \| Revenue from Rights Concentration Risk \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales					10.00%
Minimum \| Net Sales \| Revenue from Rights Concentration Risk \| National Health Service [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales			10.00%		10.00%
Stock Purchase Agreement
Risks And Uncertainties [Line Items]
Sale of Stock, Consideration Received on Transaction \| $	$ 7.5
Securities Purchase Agreement
Risks And Uncertainties [Line Items]
Sale of Stock, Consideration Received on Transaction \| $	$ 7.5
Zero facilities [Member] \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Number of facilities			0	0
Zero facilities [Member] \| Minimum \| Net Sales \| Revenue from Rights Concentration Risk \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales		10.00%		10.00%
Facility one [Member]
Risks And Uncertainties [Line Items]
Number of facilities		1
Facility one [Member] \| National Health Service [Member]
Risks And Uncertainties [Line Items]
Number of facilities				1
Facility one [Member] \| Minimum \| Net Sales \| Revenue from Rights Concentration Risk \| National Health Service [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales		10.00%	10.00%	10.00%	10.00%
Two facilities [Member] \| Minimum \| Net Sales \| Revenue from Rights Concentration Risk \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales			10.00%		10.00%
Three facilities [Member] \| Minimum \| Net Sales \| Revenue from Rights Concentration Risk \| VA/DoD [Member]
Risks And Uncertainties [Line Items]
Percentage of net sales			10.00%		10.00%

Going Concern, Significant Risks and Uncertainties - Schedule of company's net sales (Details) - Net Sales - Revenue from Rights Concentration Risk	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
VA/DoD [Member]
Concentration Risk [Line Items]
Revenue, percentage	60.70%	58.10%	60.20%	59.70%
National Health Service [Member]
Concentration Risk [Line Items]
Revenue, percentage	8.10%	17.60%	9.20%	16.10%

Revenue - Summary of Net Sales Disaggregated by Channel (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation Of Revenue [Line Items]
Total Net Sales	$ 4,508	$ 1,976	$ 10,839	$ 6,032
Rx gammaCore - Department of Veteran Affairs and Department of Defense [Member]
Disaggregation Of Revenue [Line Items]
Total Net Sales	2,737	1,167	6,523	3,597
Rx gammaCore - U.S. Commercial [Member]
Disaggregation Of Revenue [Line Items]
Total Net Sales	439	392	1,310	1,133
Outside the United States [Member]
Disaggregation Of Revenue [Line Items]
Total Net Sales	464	417	1,298	1,189
Truvaga [Member]
Disaggregation Of Revenue [Line Items]
Total Net Sales	267		704
TAC-STIM [Member]
Disaggregation Of Revenue [Line Items]
Total Net Sales	601		1,000
Other [Member]
Disaggregation Of Revenue [Line Items]
Total Net Sales			$ 4	$ 113

Revenue - Summary of Net Sales Disaggregated by Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation Of Revenue [Line Items]
Total Net Sales	$ 4,508	$ 1,976	$ 10,839	$ 6,032
United States
Disaggregation Of Revenue [Line Items]
Total Net Sales	4,044	1,559	9,541	4,843
United Kingdom
Disaggregation Of Revenue [Line Items]
Total Net Sales	412	347	1,117	968
Other
Disaggregation Of Revenue [Line Items]
Total Net Sales	33	25	98	128
JAPAN
Disaggregation Of Revenue [Line Items]
Total Net Sales	$ 19	$ 45	$ 83	$ 93

Revenue - Additional Information (Details)	9 Months Ended
Revenue - Additional Information (Details)	Sep. 30, 2023
Revenue
Payment term for customers	30 days

Inventories - Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Inventories
Raw materials	$ 1,058	$ 944
Work in process	1,899	2,879
Finished goods	351	353
Total inventories, net	3,308	4,176
Less: noncurrent inventories	813	2,194
Current inventories	$ 2,495	$ 1,982

Inventories - Additional Information (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Inventory [Line Items]
Reserves for obsolete inventory	$ 0.5	$ 0.7
Noncurrent inventory raw materials	0.0	0.1
Noncurrent inventory work in process	$ 0.8	$ 2.1

Leases - Supplemental Balance Sheet Information for Operating Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Operating leases:
Operating lease right of use assets	$ 518	$ 565
Operating lease liabilities:
Current portion of operating lease liabilities	85	74
Noncurrent operating lease liabilities	560	625
Total operating lease liabilities	$ 645	$ 699
Weighted average remaining lease term (in years)	5 years 4 months 24 days	6 years 1 month 6 days
Weighted average discount rate	13.80%	13.80%

Leases - Future Minimum Lease Payments under Non-Cancellable Operating Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Leases
Remainder of 2023	$ 41
2024	168
2025	171
2026	161
2027	157
2028 and thereafter	216
Total future minimum lease payments	914
Less: Amounts representing interest	(269)
Total	$ 645	$ 699

Leases - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Lessor, Lease, Description [Line Items]
Recognized lease expenses	$ 38,000	$ 114,000

Accrued Expenses and Other Current Liabilities - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Accrued Liabilities Current [Abstract]
Accrued professional fees	$ 715	$ 524
Accrued bonuses and incentive compensation	1,873	2,042
Accrued litigation legal fees expense	1,035	1,001
Accrued insurance expense	433	264
Accrued vacation and other employee related expenses	573	534
Accrued severance and other related charges	113
Accrued valued-added tax	224	133
Deferred revenue	180	152
Other	244	192
Accrued expenses and other current liabilities	$ 5,390	$ 4,842

Accrued Expenses and Other Current Liabilities (Details) - Finance and Security Agreement - USD ($)			1 Months Ended	3 Months Ended	9 Months Ended
	Jul. 05, 2023	Jul. 05, 2022	Jul. 31, 2023	Sep. 30, 2023	Sep. 30, 2023
Accrued Expenses and Other Current Liabilities [Line Item]
Borrowings under agreement		$ 783,000
Debt instrument, term	10 months	9 months
Interest expense				$ 4,000	$ 13,000
Remaining balance of notes payable				$ 433,000	$ 433,000
Debt instrument, face amount	$ 618,000
Annual interest rate of borrowing	6.03%	2.49%
Debt instrument, frequency of periodic payment	monthly
Debt instrument, installment payment			$ 62,000

Stockholders' Equity - Schedule of Stock Purchase Warrants (Details) - Stock Purchase Warrants [Member] - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Number of Warrants, Outstanding	1
Number of Warrants, Granted	923
Number of Warrants, Exercised
Number of Warrants, Expired
Number of Warrants, Outstanding	924	1
Number of Warrants, Exercisable	1
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Weighted Average Exercise Price, Beginning balance	$ 229.5
Weighted Average Exercise Price, Ending balance	4.35	$ 229.5
Weighted Average Exercise Price, Exercisable	$ 229.5
Share Based Compensation Arrangement By Share Based Payment Award Equity Instruments Other Than Options Outstanding Weighted Average Remaining Contractual Terms [Roll Forward]
Weighted Average Remaining Contractual Term (Years), Outstanding, January 1, 2022		3 years
Weighted Average Remaining Contractual Term (Years), Outstanding, September 30, 2023	5 years 3 months 18 days
Weighted Average Remaining Contractual Term (Years), Exercisable	2 years 2 months 12 days
Sharebased Compensation Arrangement By Sharebased Payment Award Equity Instruments Other Than Options Aggregate Intrinsic Value [Roll Forward]
Aggregate Intrinsic Value, Outstanding, January 1, 2023
Aggregate Intrinsic Value, Outstanding, September 30, 2023	$ 1,596
Aggregate Intrinsic Value, Exercisable, September 30, 2023

Stockholders' Equity - Additional Information (Details) $ / shares in Units, $ in Millions	Jul. 31, 2023 USD ($) $ / shares shares	Feb. 15, 2023	Feb. 13, 2023	Sep. 30, 2023 $ / shares shares	Mar. 06, 2023 shares
Stock Purchase Agreement [Line Items]
Reverse stock split ratio		1-for-15
Minimum
Stock Purchase Agreement [Line Items]
Reverse stock split ratio			1-for-5
Maximum
Stock Purchase Agreement [Line Items]
Reverse stock split ratio			1-for-50
Series A Preferred Stock [Member]
Stock Purchase Agreement [Line Items]
Preferred stock redemption, Share					80,000
Preferred Stock
Stock Purchase Agreement [Line Items]
Preferred Stock, Redemption Price Per Share \| $ / shares				$ 0.01
Number of basis shares to receive redemption amount				10
Stock Purchase Agreement
Stock Purchase Agreement [Line Items]
Sale of stock, price per share \| $ / shares	$ 4.4125
Sale of Stock, Consideration Received on Transaction \| $	$ 7.5
Stock Purchase Agreement \| Common Stock \| Warrant
Stock Purchase Agreement [Line Items]
Class of Warrant or Right, Period from which Warrants or Rights Exercisable	6 months
Class of warrant or right, exercise price of warrants or rights \| $ / shares	$ 4.35
Class of Warrant or Right, Expiration Period	5 years
Stock Purchase Agreement \| Common Stock \| Maximum \| Warrant
Stock Purchase Agreement [Line Items]
Aggregate number of shares to be issued for common stock purchase warrants	837,955
First SPA [Member] \| Common Stock
Stock Purchase Agreement [Line Items]
Aggregate number of shares issued	1,062,600
First SPA [Member] \| Common Stock \| Warrant
Stock Purchase Agreement [Line Items]
Aggregate number of shares issued	613,314
Second SPA [Member] \| Common Stock \| Private Placement Transaction
Stock Purchase Agreement [Line Items]
Aggregate number of shares issued	169,968
Number of officers and directors	6
Second SPA [Member] \| Common Stock \| Maximum \| Private Placement Transaction \| Warrant
Stock Purchase Agreement [Line Items]
Aggregate number of shares issued	84,982

Net Loss Per Share - Additional Information (Details) - $ / shares	9 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Net Loss Per Share
Common stock, par value	$ 0.001	$ 0.001
First SPA [Member] \| Common Stock \| Warrant
Net Loss Per Share
Pre-funded warrants which are considered as common stock equivalents	613,314

Net Loss Per Share - Schedule of Common Stock Equivalents Excluded from Computation of Diluted Loss per Share (Details) - shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	1,692	481
Outstanding stock options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	537	418
Restricted stock and unit awards
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	231	62
Stock purchase warrants
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	924	1

Income Taxes - Additional Information (Details)	Jan. 10, 2023 USD ($)
Operating Loss Carryforwards [Line Items]
Proceeds from operating activity	$ 211,000

Stock Based Compensation - Additional Information (Details) - USD ($) $ in Thousands		9 Months Ended
	Jul. 01, 2023	Sep. 30, 2023
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation cost related to unvested awards		$ 2,100
Unrecognized compensation expected to be recognized		1 year 8 months 12 days
Intrinsic value		$ 0
Share-Based Compensation Arrangement by Share-Based Payment Award, Fair Value Assumptions, Weighted Average Volatility Rate	100.00%	50.00%
Share-Based Compensation Arrangement by Share-Based Payment Award, Fair Value Assumptions, Weighted Average Volatility Rate of Peer Entities		50.00%
Share-based compensation arrangement by share-based payment award, fair value assumptions, Expected dividend payments		$ 0
Non Employee Director [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		12 months
Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		3 years
Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		4 years
Stock Units \| Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		2 years
Stock Units \| Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		4 years

Stock Based Compensation - Summary of Activity Related to Stock Options (Details) - $ / shares shares in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Number of Options
Number of Options, Outstanding, Begining	440
Number of Options, Granted	206
Number of Options, Exercised
Number of Options, Cancelled	(109)
Number of Options, Outstanding, Ending	537	440
Number of Options, Exercisable	253
Weighted Average Exercise Price
Weighted Average Exercise Price, Outstanding, Begining	$ 55.65
Weighted Average Exercise Price, Outstanding, Ending	38.42	$ 55.65
Weighted Average Exercise Price, Exercisable	$ 72.07
Weighted Average Remaining Contractual Term (Years), Outstanding	7 years 10 months 24 days	7 years 6 months
Weighted Average Remaining Contractual Term (Years), Exercisable	6 years 6 months

Stock Based Compensation - Summary of Activity Related to Restricted Stock and Deferred Stock Units Granted (Details) - Stock Units shares in Thousands	9 Months Ended
	Sep. 30, 2023 $ / shares shares
Number of Shares
Number of Shares, Nonvested, Ending	127
Number of Shares, Granted	137
Number of Shares, Vested	(25)
Number of Shares, Cancelled	(8)
Number of Shares, Nonvested, Begining	231
Weighted Average Grant Date Fair Value
Weighted Average Exercise Price, Beginning balance \| $ / shares	$ 11.85
Weighted Average Exercise Price, Ending balance \| $ / shares	$ 7.74

Stock Based Compensation - Schedule of Recognized Stock Compensation for Equity Awards (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock based compensation	$ 543	$ 566	$ 1,298	$ 2,095
Selling, General and Administrative
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock based compensation	477	454	1,102	1,835
Research and Development
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock based compensation	60	106	178	240
Cost of Goods Sold
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock based compensation	$ 6	$ 6	$ 18	$ 20

Stock Based Compensation - Summary of Weighted Average Assumptions Used in Valuing Plans (Details) - $ / shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Stock Based Compensation
Fair value at grant date	$ 3.95	$ 0.53
Expected volatility	122.40%	84.00%
Risk-free interest rate	4.10%	1.70%
Expected holding period, in years	5 years 9 months 18 days	6 years
Dividend yield

Contingencies - Additional Information (Details)	Jul. 17, 2020 INVESTORS
Class Of Warrant Or Right [Line Items]
Number of investors as defendants	2

Severance and other related charges - Additional Information (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023
Selling, General and Administrative
Defined Benefit Plan Disclosure [Line Items]
Postemployment benefits outstanding payable		$ 113,000
Former Employees
Defined Benefit Plan Disclosure [Line Items]
Postemployment benefits outstanding payable	$ 113,000	$ 445,000