Vapotherm (VAPO) 10-Q 8 Aug 23 2023 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2023	Aug. 03, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Quarterly Report	true
Document Transition Report	false
Entity Interactive Data Current	Yes
Document Period End Date	Jun. 30, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
Entity Registrant Name	Vapotherm, Inc.
Entity Central Index Key	0001253176
Entity Tax Identification Number	46-2259298
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Filer Category	Accelerated Filer
Entity File Number	001-38740
Entity Shell Company	false
Entity Emerging Growth Company	false
Entity Small Business	true
Entity Incorporation, State or Country Code	DE
Entity Address, Address Line One	100 Domain Drive
Entity Address, City or Town	Exeter
Entity Address, State or Province	NH
Entity Address, Postal Zip Code	03833
City Area Code	603
Local Phone Number	658-0011
Entity Common Stock, Shares Outstanding		49,071,682
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	VAPO
Security Exchange Name	NYSE

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 18,000	$ 15,738
Accounts receivable, net of expected credit losses of $193 and $227, respectively	8,918	9,102
Inventories, net	25,144	32,980
Prepaid expenses and other current assets	4,518	2,081
Total current assets	56,580	59,901
Property and equipment, net	24,444	26,636
Operating lease right-of-use assets	4,673	5,805
Restricted cash	1,109	1,109
Goodwill	562	536
Deferred income tax assets	128	96
Other long-term assets	2,588	2,112
Total assets	90,084	96,195
Current liabilities
Accounts payable	2,160	2,739
Contract liabilities	1,301	1,216
Accrued expenses and other current liabilities	11,661	15,609
Total current liabilities	15,122	19,564
Long-term loans payable, net	101,820	96,994
Other long-term liabilities	7,598	7,827
Total liabilities	124,540	124,385
Commitments and contingencies (Note 9)
Stockholders' deficit
Preferred stock ($0.001 par value) 25,000,000 shares authorized; no shares issued and outstanding as of June 30, 2023 and December 31, 2022
Common stock ($0.001 par value) 175,000,000 shares authorized as of June 30, 2023 and December 31, 2022, 49,047,502 and 28,516,047 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectively	49	29
Additional paid-in capital	488,419	461,940
Accumulated other comprehensive loss	(44)	(157)
Accumulated deficit	(522,880)	(490,002)
Total stockholders' deficit	(34,456)	(28,190)
Total liabilities and stockholders' deficit	$ 90,084	$ 96,195

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Expected credit losses	$ 193	$ 227
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	25,000,000	25,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	175,000,000	175,000,000
Common stock, shares issued	49,047,502	28,516,047
Common stock, shares outstanding	49,047,502	28,516,047

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Income Statement [Abstract]
Net revenue	$ 16,037,000	$ 12,971,000	$ 33,768,000	$ 34,593,000
Cost of revenue	9,177,000	10,606,000	20,696,000	24,336,000
Gross profit	6,860,000	2,365,000	13,072,000	10,257,000
Operating expenses
Research and development	3,723,000	6,310,000	7,710,000	11,859,000
Sales and marketing	8,276,000	11,833,000	17,868,000	25,155,000
General and administrative	5,019,000	5,323,000	10,789,000	14,277,000
Impairment of goodwill	0	14,701,000	0	14,701,000
Impairment of long-lived and intangible assets	0	4,036,000	432,000	4,036,000
(Gain) loss on disposal of property and equipment	(2,000)		53,000
Total operating expenses	17,016,000	42,203,000	36,852,000	70,028,000
Loss from operations	(10,156,000)	(39,838,000)	(23,780,000)	(59,771,000)
Other (expense) income
Interest expense	(4,642,000)	(2,849,000)	(8,973,000)	(4,596,000)
Interest income	26,000	40,000	54,000	57,000
Foreign currency gain (loss)	9,000	(46,000)	(145,000)	(115,000)
Loss on extinguishment of debt				(1,114,000)
Net loss before income taxes	(14,763,000)	(42,693,000)	(32,844,000)	(65,539,000)
Provision (benefit) for income taxes	25,000	(10,000)	34,000	82,000
Net loss	(14,788,000)	(42,683,000)	(32,878,000)	(65,621,000)
Other comprehensive income (loss):
Foreign currency translation adjustments	(22,000)	(185,000)	113,000	(240,000)
Total other comprehensive (loss) income	(22,000)	(185,000)	113,000	(240,000)
Total comprehensive loss	$ (14,810,000)	$ (42,868,000)	$ (32,765,000)	$ (65,861,000)
Net loss per share - basic	$ (0.29)	$ (1.61)	$ (0.72)	$ (2.48)
Net loss per share - diluted	$ (0.29)	$ (1.61)	$ (0.72)	$ (2.48)
Weighted-average number of shares used in calculating net loss per share, basic	50,625,778	26,574,027	45,644,863	26,448,257
Weighted-average number of shares used in calculating net loss per share, diluted	50,625,778	26,574,027	45,644,863	26,448,257

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' DEFICIT (Unaudited) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income (Loss)	Accumulated Deficit
Beginning balance at Dec. 31, 2021	$ 66,667	$ 26	$ 443,358	$ 26	$ (376,743)
Beginning balance, shares at Dec. 31, 2021		26,126,253
Issuance of common stock upon exercise of options	12		12
Issuance of common stock upon exercise of options, shares		1,227
Issuance of common stock with restricted stock units and awards	10		10
Issuance of common stock with restricted stock units and awards, shares		60,488
Issuance of common stock for services	76		76
Issuance of common stock for services, shares		3,683
Issuance of common stock to satisfy contingent and consideration	5,630	$ 1	5,629
Issuance of common stock to satisfy contingent and consideration, shares		368,168
Issuance of common stock warrants	1,157		1,157
Stock-based compensation expense	3,370		3,370
Foreign currency translation adjustments	(55)			(55)
Net loss	(22,938)				(22,938)
Ending balance at Mar. 31, 2022	53,929	$ 27	453,612	(29)	(399,681)
Ending balance, shares at Mar. 31, 2022		26,559,819
Beginning balance at Dec. 31, 2021	66,667	$ 26	443,358	26	(376,743)
Beginning balance, shares at Dec. 31, 2021		26,126,253
Net loss	(65,621)
Ending balance at Jun. 30, 2022	13,739	$ 27	456,290	(214)	(442,364)
Ending balance, shares at Jun. 30, 2022		26,692,883
Beginning balance at Mar. 31, 2022	53,929	$ 27	453,612	(29)	(399,681)
Beginning balance, shares at Mar. 31, 2022		26,559,819
Issuance of common stock upon exercise of options	43		43
Issuance of common stock upon exercise of options, shares		16,380
Issuance of common stock with restricted stock units and awards	2		2
Issuance of common stock with restricted stock units and awards, shares		49,218
Issuance of common stock under the Employee Stock Purchase Plan	135		135
Issuance of common stock under the Employee Stock Purchase Plan, shares		62,973
Issuance of common stock for services	88		88
Issuance of common stock for services, shares		4,493
Stock-based compensation expense	2,410		2,410
Foreign currency translation adjustments	(185)			(185)
Net loss	(42,683)				(42,683)
Ending balance at Jun. 30, 2022	13,739	$ 27	456,290	(214)	(442,364)
Ending balance, shares at Jun. 30, 2022		26,692,883
Beginning balance at Dec. 31, 2022	(28,190)	$ 29	461,940	(157)	(490,002)
Beginning balance, shares at Dec. 31, 2022		28,516,047
Issuance of common stock and pre-funded warrants and accompanying warrants in private placement, net	20,943	$ 17	20,926
Issuance of common stock and pre-funded warrants and accompanying warrants in private placement, net, Shares		17,502,244
Issuance of common stock upon exercise of options, shares		228
Issuance of common stock with restricted stock units and awards, shares		175,732
Issuance of common stock for services	59		59
Issuance of common stock for services, shares		21,687
Issuance of common stock warrants	28		28
Stock-based compensation expense	2,761		2,761
Foreign currency translation adjustments	135			135
Net loss	(18,090)				(18,090)
Ending balance at Mar. 31, 2023	(22,354)	$ 46	485,714	(22)	(508,092)
Ending balance, shares at Mar. 31, 2023		46,215,938
Beginning balance at Dec. 31, 2022	(28,190)	$ 29	461,940	(157)	(490,002)
Beginning balance, shares at Dec. 31, 2022		28,516,047
Net loss	(32,878)
Ending balance at Jun. 30, 2023	(34,456)	$ 49	488,419	(44)	(522,880)
Ending balance, shares at Jun. 30, 2023		49,047,502
Beginning balance at Mar. 31, 2023	(22,354)	$ 46	485,714	(22)	(508,092)
Beginning balance, shares at Mar. 31, 2023		46,215,938
Issuance of common stock upon exercise of pre funded warrants	3	$ 3
Issuance of common stock upon exercise of pre funded warrants shares		2,592,121
Issuance of common stock with restricted stock units and awards, shares		11,844
Issuance of common stock under the Employee Stock Purchase Plan	77		77
Issuance of common stock under the Employee Stock Purchase Plan, shares		204,099
Issuance of common stock for services	58		58
Issuance of common stock for services, shares		23,500
Issuance of common stock warrants	43		43
Stock-based compensation expense	2,527		2,527
Foreign currency translation adjustments	(22)			(22)
Net loss	(14,788)				(14,788)
Ending balance at Jun. 30, 2023	$ (34,456)	$ 49	$ 488,419	$ (44)	$ (522,880)
Ending balance, shares at Jun. 30, 2023		49,047,502

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($)	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Cash flows from operating activities
Net loss	$ (32,878,000)	$ (65,621,000)
Adjustments to reconcile net loss to net cash used in operating activities
Stock-based compensation expense	5,405,000	5,944,000
Depreciation and amortization	2,445,000	2,739,000
Provision for credit losses	(2,000)	285,000
Provision for inventory valuation	283,000	815,000
Non-cash lease expense	733,000	1,082,000
Change in fair value of contingent consideration		(3,113,000)
Impairment of goodwill	0	14,701,000
Impairment of long-lived and intangible assets	432,000	4,036,000
Loss on disposal of property and equipment	53,000
Placed units reserve	418,000	198,000
Interest paid in-kind	4,553,000
Amortization of discount on debt	368,000	320,000
Deferred income taxes	34,000	82,000
Loss on extinguishment of debt		1,114,000
Changes in operating assets and liabilities:
Accounts receivable	212,000	3,520,000
Inventories	7,646,000	(2,683,000)
Prepaid expenses and other assets	(2,794,000)	(408,000)
Accounts payable	(315,000)	(2,441,000)
Contract liabilities	72,000	(812,000)
Accrued expenses and other current liabilities	(2,840,000)	(8,884,000)
Operating lease liabilities, current and long-term	(1,213,000)	(1,013,000)
Net cash used in operating activities	(17,388,000)	(50,139,000)
Cash flows from investing activities
Purchases of property and equipment	(1,408,000)	(6,289,000)
Net cash used in investing activities	(1,408,000)	(6,289,000)
Cash flows from financing activities
Proceeds from issuance of common stock and pre-funded warrants and accompanying warrants in private placement, net of issuance costs	20,943,000
Proceeds from loans, net of discount		99,094,000
Repayment of loans		(40,000,000)
Payments of debt extinguishment costs		(817,000)
Payment of debt issuance costs		(1,567,000)
Repayments on revolving loan facility		(6,608,000)
Payment of contingent consideration		(135,000)
Proceeds from exercise of stock options		55,000
Proceeds from exercise of warrants	3,000
Net cash provided by financing activities	21,023,000	50,157,000
Effect of exchange rate changes on cash, cash equivalents and restricted cash	35,000	(62,000)
Net increase (decrease) in cash, cash equivalents and restricted cash	2,262,000	(6,333,000)
Cash, cash equivalents and restricted cash
Beginning of period	16,847,000	57,324,000
End of period	19,109,000	50,991,000
Supplemental disclosures of cash flow information
Interest paid during the period	2,720,000	3,294,000
Property and equipment purchases in accounts payable and accrued expenses	175,000	224,000
Issuance of common stock to satisfy contingent consideration		5,630,000
Issuance of common stock warrants in conjunction with long term debt	71,000	1,157,000
Issuance of common stock upon vesting of restricted stock units		12,000
Employee Stock Purchase Plan
Cash flows from financing activities
Proceeds from issuance of common stock under Employee Stock Purchase Plan	$ 77,000	$ 135,000

Description of Business

Description of Business	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Description of Business	1. Description of Business Vapotherm, Inc. (the “Company”) is a global medical technology company primarily focused on the care of patients of all ages suffering from respiratory distress, whether associated with complex lung diseases such as chronic obstructive pulmonary disease (“COPD”), congestive heart failure, pneumonia, asthma and COVID-19 or other systemic conditions. The Company’s mission is to improve the lives of patients suffering from complex lung disease and other forms of respiratory distress while reducing the cost of their care through integrated device and digital solutions. The Company’s device solutions are focused on High Velocity Nasal Insufflation (“HVNI”, or “High Velocity Therapy”), which delivers non-invasive ventilatory support to patients by providing heated, humidified, oxygenated air at high velocities through a small-bore nasal interface, and on closed loop control systems such as our Oxygen Assist Module (“OAM”), designed to automatically maintain a patient’s pulse oxygen saturation (“SpO2”) levels within a specified range for a defined period of time. The Company’s digital solutions are focused on remote patient monitoring, using proprietary algorithms to predict impending respiratory episodes before they occur and coordinate timely intervention, obviating the need for costly hospital admissions and minimizing patient distress. Although the Company exited its standalone remote patient monitoring business, the Company is using the underlying technology to develop digital capabilities for the Company’s devices. While these device and digital solutions function independently, the Company believes leveraging the two together can create a unique healthcare ecosystem, focused on delivering high quality, efficient respiratory care in a variety of settings. High Velocity Therapy is an advanced form of high flow therapy that is differentiated due to its ability to deliver breathing gases, including oxygen, at a high velocity, for the treatment of spontaneously breathing patients suffering from respiratory distress, including Type 1 hypoxic respiratory distress, like that experienced by patients with pneumonia or COVID-19, or Type 2 hypercapnic respiratory distress, like that experienced by patients with COPD. The Company’s HVT 2.0 and Precision Flow systems (together, “High Velocity Therapy systems”), which use High Velocity Therapy technology, are clinically validated alternatives to, and address many limitations of, the current standard of care for the treatment of respiratory distress in a hospital setting. The Company’s next generation High Velocity Therapy system, known as HVT 2.0, received initial 510k clearance from the FDA in 2021, transitioned to full market release in August 2022, and received clearance for expanded respiratory distress indications in December 2022. The Company sells its High Velocity Therapy systems to hospitals through a direct sales organization in the United States, the United Kingdom, Germany, Belgium and Spain and through distributors in other select countries outside of those countries. In late 2020, the Company launched its OAM in select international markets, which can be used with most versions of the Company’s Precision Flow system, and OAM capability has been built into the HVT 2.0 for future use. The OAM helps clinicians maintain a patient’s SpO2 within a target SpO2 range over a greater period of time while requiring significantly fewer manual adjustments to the equipment. Maintenance of the prescribed oxygen saturation range may reduce the health risks associated with dosing too much, or too little, oxygen, particularly in neonates. In neonates, these risks include visual or developmental impairment or death. The OAM is sold through a direct sales organization in select international markets and through distributors in select international markets. The Company is in the process of seeking FDA approval to market the OAM in the United States. In addition, the Company employs field-based clinical managers who focus on medical education and training in the effective use of its products and help facilitate increased adoption and utilization. The Company focuses on physicians, respiratory therapists and nurses who work in acute hospital settings, including emergency departments and adult, pediatric and neonatal intensive care units. The Company’s relationship with these clinicians is particularly important, as it enables the Company’s products to follow patients through the care continuum. In the fourth quarter of 2022, in conjunction with the Company’s path to profitability and annual operating planning efforts, the Company completed its exit of the Vapotherm Access standalone remote patient monitoring reporting unit, which included Vapotherm Access, formerly “HGE Healthcare Solutions, LLC” or “HGE,” and Pulmonary Care Innovations, PLLC d/b/a RespirCare (“RespirCare”). Effective October 31, 2022, the Company terminated its master service agreement with RespirCare, which resulted in the deconsolidation of RespirCare from the Company’s condensed consolidated financial statements (see Note 10). Issuance of Securities through a Private Placement On February 10, 2023 (the “Closing Date”), the Company issued in a private placement (the “February 2023 Private Placement”) an aggregate of 17,502,244 shares of common stock, and in the case of certain investors, in lieu of shares of common stock, pre-funded warrants to purchase an aggregate of 4,402,508 shares of common stock (the “Pre-Funded Warrants”), and, in each case, accompanying warrants to purchase an aggregate of up to 21,904,752 shares of common stock (the “Warrants”) at a purchase price of $ 1.05 per unit for aggregate gross proceeds to the Company of approximately $ 23.0 million, before deducting fees to the placement agent and other offering expenses of $ 2.1 million. The Warrants expire five years following the Closing Date, have an exercise price of $ 1.17 per share, and were immediately exercisable upon issuance. The Pre-Funded Warrants expire 30 years following the Closing Date or when exercised in full, have an exercise price of $ 0.001 per share, and were immediately exercisable upon issuance. The exercise price and number of shares of common stock issuable upon the exercise of the Warrants and the Pre-Funded Warrants will be subject to adjustment in the event of any stock dividends and splits, reverse stock split, recapitalization, reorganization or similar transaction, as described in the Warrants and the Pre-Funded Warrants agreements. The Warrants and Pre-Funded Warrants are classified as a component of permanent equity because they are freestanding financial instruments that are legally detachable and separately exercisable from the shares of common stock with which they were issued, are immediately exercisable, do not embody an obligation for the Company to repurchase its shares, and permit the holders to receive a fixed number of shares of common stock upon exercise. In addition, the Warrants and Pre-Funded Warrants do not provide any guarantee of value or return.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Basis of Presentation The condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). The information included in this Quarterly Report on Form 10-Q should be read in conjunction with our audited consolidated financial statements and the accompanying notes included in our Annual Report on Form 10-K for the year ended December 31, 2022 (the “2022 Form 10-K”). Our accounting policies are described in the “ Notes to Consolidated Financial Statements ” in our 2022 Form 10-K and are updated, as necessary, in this report. The year-end condensed consolidated balance sheet data presented for comparative purposes was derived from our audited financial statements but does not include all disclosures required by U.S. GAAP. Principles of Consolidation These condensed consolidated financial statements include the accounts of the Company, which includes its wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated upon consolidation. Segment Information Operating segments are defined as components of an enterprise for which separate discrete financial information is available and evaluated regularly by the chief operating decision maker in deciding how to allocate resources and in assessing performance. The Company globally manages the business within one reporting segment, Vapotherm, Inc., and two reporting units, Vapotherm and Vapotherm UK Ltd. (“Vapotherm UK”). Segment information is consistent with how the chief operating decision maker reviews the business, makes investing and resource allocation decisions and assesses operating performance. As of June 30, 2023, the majority of the Company’s long-term assets are located in the United States. Long-term assets located outside the United States totaled $ 14.6 million , including $ 9.8 million located in Mexico, at June 30, 2023. Long-term assets located outside the United States totaled $ 14.9 million , including $ 9.9 million located in Mexico, at December 31, 2022 . Use of Estimates The preparation of condensed consolidated financial statements in conformity with U.S. GAAP requires the Company to make judgments, assumptions, and estimates that affect the reported amounts of assets, liabilities, revenue and expenses, and the related disclosure of contingent assets and liabilities. The Company evaluates its estimates on an ongoing basis. The Company bases its estimates on historical experience and various other assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Significant estimates relied upon in preparing these condensed consolidated financial statements include calculation of stock-based compensation, valuation of warrants, realizability of inventories, allowance for doubtful accounts and credit losses, accrued expenses, the valuation allowances against deferred income tax assets, and assessments of impairment with respect to long-lived and intangible assets, including goodwill. Actual results may differ from these estimates. Unaudited Interim Financial Information The accompanying condensed consolidated balance sheet as of June 30, 2023, and the condensed consolidated statements of comprehensive loss and stockholders’ deficit for the three and six months ended June 30, 2023 and 2022 and the condensed consolidated statements of cash flows for the six months ended June 30, 2023 and 2022 are unaudited. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of the Company’s financial position as of June 30, 2023 and the results of its operations for the three and six months ended June 30, 2023 and 2022 and the cash flows for the six months ended June 30, 2023 and 2022. The financial data and other information disclosed in these notes related to the three and six months ended June 30, 2023 and 2022 are also unaudited. The results of operations for the three and six months ended June 30, 2023 and 2022 are not necessarily indicative of the operating results for the full year or for any other subsequent interim period. Financial Instruments and Concentrations of Credit Risk As of June 30, 2023, the Company’s financial instruments included cash and cash equivalents, restricted cash, accounts receivable, accounts payable and debt, the carrying amounts of which approximated fair value due to their short-term nature or market interest rates. All of the Company’s cash and cash equivalents are maintained at creditworthy financial institutions. At June 30, 2023, deposits exceed the amount of any insurance provided and are exposed to credit loss. The Company extends credit to customers in the normal course of business but typically does not require collateral or any other security to support amounts due. Management performs ongoing credit evaluations of its customers. The Company recognizes an allowance for credit losses equal to its current estimate of all contractual cash flows that the Company does not expect to collect. The Company’s estimate considers relevant information about past events, current conditions, and reasonable and supportable forecasts. Provisions for the allowance for credit losses are recorded in general and administrative expenses in the accompanying condensed consolidated statements of comprehensive loss. Supplier Risk The Company obtains some of the components and subassemblies included in its High Velocity Therapy systems and its OAM from single source suppliers. The partial or complete loss of one or more of these suppliers could cause significant production delays, an inability to meet customer demand and a substantial loss in revenue. Foreign Currency and Foreign Operations The functional currency of the Company is the currency of the primary economic environment in which the entity operates, which is the U.S. dollar. For the Company’s non-U.S. subsidiaries that transact in a functional currency other than the U.S. dollar, assets and liabilities are translated at current rates of exchange at the balance sheet date. Income and expense items are translated at the average foreign currency exchange rates for the period. Adjustments resulting from the translation of the financial statements of its foreign operations into U.S. dollars are excluded from the determination of net loss and are recorded in accumulated other comprehensive loss, a separate component of stockholders’ deficit. Realized foreign currency gains or losses arising from transactions denominated in foreign currencies are recorded in other (expense) income in the condensed consolidated statements of comprehensive loss. Unrealized foreign currency gains or losses arising from transactions denominated in foreign currencies are recorded in accumulated other comprehensive (loss) income. Cash, Cash Equivalents, and Restricted Cash The Company considers all highly liquid temporary investments purchased with original maturities of 90 days or less to be cash equivalents. The Company holds restricted cash related to certificates of deposits and collateral in relation to lease agreements. As of June 30, 2023, $ 1.1 million of its $ 19.1 million of cash, cash equivalents and restricted cash balance was located outside the United States. As of December 31, 2022 , $ 1.0 million of its $ 16.8 million of cash, cash equivalents and restricted cash balance was located outside of the United States. The Company’s cash, cash equivalents and restricted cash balances are primarily held by Canadian Imperial Bank of Commerce Innovation Banking (“CIBC”) and Bank of America, N.A. The following table presents the components of total cash, cash equivalents, and restricted cash as set forth in the Company’s condensed consolidated statements of cash flows: June 30, December 31, Cash and cash equivalents $ 18,000 $ 15,738 Restricted cash 1,109 1,109 Total cash, cash equivalents, and restricted cash $ 19,109 $ 16,847 Leases The Company’s operating leases primarily consist of real estate leases for office, manufacturing, research and development, and warehouse space, as well as certain vehicle and equipment leases. Accounting Standards Codification (“ASC”), Leases (“ASC 842”) requires lessees to recognize leases on the balance sheet as a lease liability with a corresponding right-of-use asset, subject to certain permitted accounting policy elections. Under ASC 842, the Company determines whether a contract is or contains a lease at the inception of the contract. This determination is based on whether the contract provides the Company the right to control the use of a physically distinct asset and substantially all of the capacity of an asset. Leases with an initial noncancelable term of twelve months or less that do not include an option to purchase the underlying asset that the Company is reasonably certain to exercise are classified as short-term leases. The Company has elected as an accounting policy to exclude from the consolidated balance sheets the right-of-use assets and lease liabilities related to short-term leases. The Company recognizes rent expense for its operating leases on a straight-line basis over the term of the lease. Certain of the Company’s leases include options to extend or terminate the lease at its sole discretion. The Company does not consider in the measurement of right-of-use assets and lease liabilities an option to extend or terminate a lease if the Company is not reasonably certain to exercise the option. Certain of the Company’s leases include covenants that oblige the Company, at its sole expense, to repair and maintain the leased asset periodically during the lease term. The Company is not a party to any leases that contain residual value guarantees. Many of the Company’s leases include fixed and variable payments. Among other charges, variable payments related to real estate leases include real estate taxes, insurance, operating expenses, and common area maintenance, which are usually billed at actual amounts incurred proportionate to the Company’s rented square feet of the building. Variable payments related to vehicle and equipment leases relate to usage of the underlying asset, sales and use tax, and value-added tax. Variable payments that do not depend on an index or rate are expensed as incurred and are not included in the measurement of the lease liability. In accordance with the guidance in ASC 842, components of a lease should be split into three categories: lease components (e.g. buildings, vehicles, etc.), non-lease components (e.g. common area maintenance, consumables, etc.), and non-components (e.g. property taxes, insurance, etc.). The fixed and in-substance fixed contract consideration (including any related to non-components) must be allocated to the lease components and non-lease components based on their relative fair values. The Company elected the accounting policy to not separate lease and non-lease components for its real estate, vehicle, and equipment leases. Therefore, each lease component and the related non-lease components and non-components are accounted for together as a single component. The Company measures its lease liability for each leased asset as the present value of lease payments, as defined in ASC 842, discounted using a discount rate specific to the terms of the underlying lease. The Company’s right-of-use assets are equal to the related lease liabilities, adjusted for lease incentives received including tenant improvement allowances, initial direct costs incurred related to the lease, and payments made to the lessor prior to the lease commencement date. The interest rate implicit in lease contracts is typically not readily determinable. As a result, the Company estimates its incremental borrowing rate for each leased asset based on the interest rate the Company would incur to borrow an amount equal to the lease payments on a collateralized basis over a similar term in a similar economic environment. When impairment indicators are present, the Company evaluates the recoverability of its right-of-use assets. If the assessment indicates an impairment, the affected assets are written down to fair value (See Note 10). Goodwill Goodwill represents the difference between the purchase price and the fair value of the identifiable tangible and intangible net assets when accounted for using the purchase method of accounting in a business combination. Goodwill is not amortized but reviewed for impairment. Goodwill is reviewed annually, as of October 1, and whenever events or changes in circumstances indicate that the carrying value of the goodwill may not be recoverable. The Company compares the fair value of its reporting units to their carrying values. If the carrying value of the net assets assigned to a reporting unit exceeds the fair value of the reporting unit, the Company would record an impairment loss equal to the difference (See Note 6). Intangible Assets Intangible assets are related to customer relationships, developed technology, and customer agreements and are amortized on a straight-line basis over their useful lives. Amortization is recorded within sales and marketing expenses in the condensed consolidated statements of comprehensive loss for customer-related intangible assets while amortization of other intangible assets is included within general and administrative expenses in the condensed consolidated statements of comprehensive loss. Intangible assets are evaluated for impairment whenever events or circumstances indicate an asset may be impaired (See Note 6). Product Warranty The Company provides its customers with a standard one-year warranty on its capital equipment sales. Warranty costs are accrued based on actual historical trends and estimated at the time of sale. The warranty liability is included within accrued expenses and other current liabilities in the condensed consolidated balance sheets. A roll-forward of the Company’s warranty liability from December 31, 2022 to June 30, 2023 is as follows: Balance at December 31, 2022 $ 281 Provisions for warranty obligations 156 Settlements ( 101 ) Balance at June 30, 2023 $ 336 Revenue Recognition The Company’s revenue is primarily derived from the sale of products, leases and services. Product revenue consists of capital equipment and single-use disposables that are shipped and billed to customers both domestically and internationally. The Company’s main capital equipment products are the High Velocity Therapy systems. The Company’s main disposable products are single-use disposables and nasal interfaces, or cannulas, and adaptors. Lease revenue consists of two components which include capital equipment that the Company leases to its customers and, in certain situations, an allocation from disposable revenue to other lease revenue upon the sale of disposable products in bundled arrangements involving the placement of the High Velocity Therapy capital units for use by the customer at no upfront charge in connection with the customer’s ongoing purchase of disposable products. Service revenue consists of fees associated with routine service of capital units and the sale of extended service contracts and preventative maintenance plans, which are purchased by a small portion of the Company’s customer base. In addition, the Company sells small quantities of component parts in the United States, United Kingdom, and to third-party international service centers who provide service on the High Velocity Therapy capital units outside of the United States and United Kingdom. Freight revenue is based upon actual freight costs plus a percentage markup of such costs associated with the shipment of products domestically, and to a lesser extent, internationally, and is included in service revenue. Rebates and fees consist of contractually obligated administrative fees and percentage-of-sales rebates paid to Group Purchasing Organizations (“GPOs”), Integrated Delivery Networks (“IDNs”) and distributor partners and are accounted for as a reduction to the corresponding of revenue category. During the three and six months ended June 30, 2022 , service revenue also included $ 1.0 million and $ 2.0 million, respectively, of fees from the standalone remote patient monitoring services sold through Vapotherm Access. Under the Financial Accounting Standard Board’s (“FASB”) ASC 606, Revenue from Contracts with Customers (“ASC 606”), revenue is recognized when a customer obtains control of promised goods or services, in an amount that reflects the consideration which the Company expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of ASC 606, the Company performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the Company satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. At contract inception, once the contract is determined to be within the scope of ASC 606, the Company assesses the goods or services promised within each contract and assesses whether each promised good or service is distinct and determines those that are performance obligations. The Company then recognizes as revenue the amount of the transaction price that is allocated to the respective performance obligation when (or as) the performance obligation is satisfied. Sales, value-added, and other taxes collected on behalf of third parties are excluded from revenue. The Company’s standard payment terms are generally 30 days from the date of sale. Contracts with customers may contain multiple performance obligations. For such arrangements, the transaction price is allocated to each performance obligation based on the estimated relative stand-alone selling prices of the promised products or services underlying each performance obligation. The Company determines stand-alone selling prices based on the price at which the performance obligation is sold separately. If the stand-alone selling price is not observable through past transactions, the Company estimates the stand-alone selling price taking into account available information such as market conditions and internally approved pricing guidelines related to the performance obligations. Revenue is generally recognized when the customer obtains control of the Company’s product, which generally occurs at a point in time upon shipment based on the contractual shipping terms of a contract. Product and service revenue is measured as the amount of consideration the Company expects to receive in exchange for transferring products or services to a customer. To the extent the transaction price includes variable consideration, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing the expected value amount method to which the Company expects to be entitled. As such, revenue on sales is recorded net of prompt pay discounts and payments made to GPOs, IDNs and distributors. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Determination of whether to include estimated amounts in the transaction price is based largely on an assessment of the Company’s anticipated performance and all information (historical, current and forecasted) that is reasonably available. The Company believes that the estimates it has established are reasonable based upon current facts and circumstances. Applying different judgments to the same facts and circumstances could result in different estimates. When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying a practical expedient under ASC 606, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less. None of the Company’s contracts contained a significant financing component during the three or six months ended June 30, 2023 or 2022. The Company’s contracts with its customers generally have a duration of less than one year. Therefore, the Company has elected to apply a practical expedient and recognizes the incremental costs of obtaining contracts as an expense. These costs are included in sales and marketing expenses in the accompanying condensed consolidated statements of comprehensive loss. Lease Revenue The Company also enters into agreements to lease its capital equipment. For such sales, the Company accounts for revenue under ASC 842, Leases (“ASC 842”), and assesses and classifies these transactions as sales-type or operating leases based on whether the lease transfers ownership of the equipment to the lessee by the end of the lease term. This criterion is met in situations in which the lease agreement provides for the transfer of title at or shortly after the end of the lease term. Equipment included in arrangements including transfer of title are accounted for as sales-type leases and the Company recognizes the present value of the lease payments due over the lease term as revenue at the inception of the lease. The Company records the present value of future lease payments in prepaid expenses and other current assets in the accompanying condensed consolidated balance sheets; these amounts totaled $ 0.1 million and less than $ 0.1 million at June 30, 2023 and December 31, 2022 , respectively. Equipment included in arrangements that do not include the transfer of title, nor any of the sales-type or direct financing lease criteria, are accounted for as operating leases and revenue is recognized on a straight-line basis over the term of the lease. The Company also enters into agreements involving the placement of its High Velocity Therapy capital units for use by the customer at no upfront charge in connection with the customer’s ongoing purchase of disposable products. In these bundled arrangements, revenue recognized for the sale of the disposables is allocated between disposable revenue and other lease revenue based on the estimated relative stand-alone selling prices of the individual performance obligations. Shipping and Handling Costs Amounts billed to customers for shipping and handling are included in service revenue. Shipping and handling costs are included in cost of sales. Shipping and handling activities are accounted for as activities to fulfill a contract and are accrued when the customer obtains control of the Company’s product. The total costs of shipping and handling for the three months ended June 30, 2023 and 2022 were $ 0.2 million and $ 0.1 million , respectively. The total costs of shipping and handling for the six months ended June 30, 2023 and 2022 were $ 0.5 million and $ 0.6 million , respectively. Sales and Value-Added Taxes When required by local jurisdictions, the Company bills its customers for sales tax and value-added tax calculated on each sales invoice and records a liability for the sales and value-added tax payable, which is included in accrued expenses and other current liabilities in the condensed consolidated balance sheets. Sales tax and value-added tax billed to a customer are not included in the Company’s revenue. Stock-Based Compensation The Company maintains an equity incentive plan to provide long-term incentives for employees, consultants, and members of the board of directors. The plan allows for the issuance of non-statutory and incentive stock options, restricted stock, unrestricted stock, stock units, including restricted stock units and performance stock units, and stock appreciation rights to employees, consultants and non-employee directors. The Company recognizes stock-based compensation expense for awards of equity instruments to employees and non-employees based on the grant date fair value of those awards in accordance with ASC Topic 718, Stock Compensation (“ASC 718”). ASC 718 requires all equity-based compensation awards, including grants of restricted stock, restricted stock units, performance stock units and stock options, to be recognized as expense in the condensed consolidated statements of comprehensive loss based on their grant date fair values. The fair value of each option grant is estimated on the grant date using the Black-Scholes option pricing model. The fair value of restricted stock and restricted stock units is measured at the market value of the related shares of the Company’s common stock on the grant date. The fair value is then amortized on a straight-line basis over the requisite service period of the awards, which is generally the vesting period and is generally three to four years . For performance-based awards, the related compensation cost is amortized over the performance period on an accelerated attribution basis. Compensation cost associated with performance awards is based on fair value on the date of grant and the number of units expected to be earned after assessing the probability that certain performance criteria will be met and the associated targeted payout level that is forecasted will be achieved. Cumulative adjustments are recorded each quarter to reflect estimated outcomes of the performance-related conditions until the results are determined and settled. Use of a valuation model requires management to make certain assumptions with respect to selected model inputs, including the expected life (weighted average period of time that the options granted are expected to be outstanding), the volatility of the Company’s common stock and an assumed risk-free interest rate. Expected volatility is based on the historical volatility of the Company’s common stock. The expected life is estimated using the historical life of options issued under the Company’s equity plan. The risk-free interest rate is based on U.S. Treasury rates with a remaining term that approximates the expected life assumed at the date of grant. No dividend yield is assumed as the Company does not pay, and does not expect to pay, dividends on its common stock. The Company estimates forfeitures based on historical experience with pre-vested forfeitures. To the extent actual forfeitures differ from the estimate, the difference is recorded to compensation expense in the period of the forfeiture. The Company recognizes stock-based compensation expense for shares of its common stock issued pursuant to the Vapotherm, Inc. 2018 Employee Stock Purchase Plan (“ESPP”) on a straight-line basis over the related offering period. The Company estimates the fair value of shares to be issued under the ESPP based on a combination of options valued using the Black-Scholes option pricing model. The expected life is determined based on the contractual term. Dividend yield, risk-free interest rate, forfeiture rates, and expected volatility are estimated in a manner similar to option grants described above. Income Tax The Company accounts for income taxes using the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the condensed consolidated financial statements or in the Company’s tax returns. Deferred taxes are determined based on the difference between the financial reporting and tax basis of assets and liabilities using enacted tax rates in effect in the years in which the differences are expected to reverse. Changes in deferred tax assets and liabilities are recorded in the provision for income taxes. The Company assesses the likelihood that its deferred tax assets will be recovered from future taxable income and, to the extent it believes, based upon the weight of available evidence, that it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is established through a charge to income tax expense. Potential for recovery of deferred tax assets is evaluated by estimating the future taxable profits expected and considering prudent and feasible tax planning strategies. The Company accounts for uncertainty in income taxes recognized in the condensed consolidated financial statements by applying a two-step process to determine the amount of tax benefit to be recognized. First, the tax position must be evaluated to determine the likelihood that it will be sustained upon external examination by the taxing authorities. If the tax position is deemed more likely-than-not to be sustained, the tax position is then assessed to determine the amount of benefit to recognize in the condensed consolidated financial statements. The amount of the benefit that may be recognized is the largest amount that has a greater than 50% likelihood of being realized upon ultimate settlement. The provision for income taxes includes the effects of any resulting tax reserves, or unrecognized tax benefits, that are considered appropriate as well as the related net interest and penalties. The Company’s major tax jurisdictions are the state of New Hampshire, the United States, United Kingdom, Germany, Mexico, and Singapore. The provision for income taxes for the three and six months ended June 30, 2023 each totaled less than $ 0.1 million and related to income earned by the Company’s foreign subsidiaries after accounting for transfer pricing adjustments. The benefit for income taxes for the three months ended June 30, 2022 totaled less than $ 0.1 million and related to a benefit for net deferred income tax assets deemed more likely than not to be realized by the Company’s foreign subsidiaries. The provision for income taxes for the six months ended June 30, 2022 totaled $ 0.1 million and related to deferred tax liabilities for differences in the book and tax basis of indefinite-lived assets, partially offset by a benefit for net deferred income tax assets deemed more likely than not to be realized by the Company’s foreign subsidiaries. Utilization of the net operating loss and tax credit carryforwards may be subject to a substantial annual limitation under Sections 382 and 383 of the Internal Revenue Code of 1986, as amended (the “Code”), due to ownership change limitations that have occurred previously or that could occur in the future. These ownership changes may limit the amount of net operating loss and tax credit carryforwards that can be utilized to offset future taxable income and reduce taxes, respectively. The Company has not currently completed an evaluation of ownership changes through December 31, 2022 to assess whether utilization of the Company’s net operating loss and tax credit carryforwards would be subject to an annual limitation under Sections 382 and 383 of the Code. To the extent an ownership change is determined to have occurred under Sections 382 and 383 of the Code, the net operating loss and tax credit carryforwards may be subject to limitation. Recently Adopted Accounting Pronouncements Credit Losses (Topic 326) In June 2016, the FASB issued ASU No. 2016-13 , Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”). Subsequent to the issuance of ASU 2016-13, the FASB clarified the guidance through several ASUs. The collective new guidance (ASC 326) generally requires that credit losses be reported using an expected losses model rather than the incurred losses model that is currently used and establishes additional disclosures related to credit risks. The Company adopted this guidance using the modified retrospective method in the first quarter of fiscal year 2023 . The adoption did not have a material impact on the Company’s condensed consolidated financial statements.

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	3. Fair Value Measurements In accordance with ASC 820, Fair Value Measurements and Disclosures, the Company generally defines fair value as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date (exit price). The Company uses a three-tier fair value hierarchy, which classifies the inputs used in measuring fair values. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurements), and the lowest priority to unobservable inputs (Level 3 measurements). The three levels of the fair value hierarchy are described below: Level 1 – inputs are quoted prices (unadjusted) in active markets for identical assets or liabilities that the reporting entity has the ability to access at the measurement date. Level 2 – inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly. If the asset or liability has a specified (contractual) term, a Level 2 input must be observable for substantially the full term of the asset or liability. Level 3 – unobservable inputs for the asset or liability in which there is little, if any, market activity for the asset or liability at the measurement date. As of June 30, 2023, the Company had two items, cash equivalents and an embedded derivative, measured at fair value on a recurring basis. The Company’s cash equivalents primarily consist of money market deposits which totaled approximately $ 4.3 million at June 30, 2023 and are valued based on Level 1 of the fair value hierarchy. The Company’s embedded derivative relates to the Company’s financing arrangement (see Note 8). Its fair value is deemed to be immaterial at June 30, 2023 and is valued based on Level 3 of the fair value hierarchy. There were no transfers in or out of Level 1, 2 or 3 during the three and six months ended June 30, 2023. During the first and second quarters of 2023 , the Company granted SLR warrants to purchase 108,377 shares and 385,361 shares, respectively, of common stock (the “SLR PIK Warrants”). The issuance of the PIK Warrants were made pursuant to amendments to the Company’s financing arrangement (see Note 8). These equity-classified PIK Warrants were valued using the Black-Scholes pricing model, which falls within Level 3 of the fair value hierarchy. During the first quarter of 2022, the Company granted warrants to purchase 107,373 shares of common stock in connection with its financing arrangement (See Note 8). These equity-classified warrants were valued using the Black-Scholes pricing model, which falls within Level 3 of the fair value hierarchy. The fair value of warrants are estimated on the date of grant using the Black-Scholes pricing model with the following assumptions: 2023 2022 Expected dividend yield 0.0 % 0.0 % Risk free interest rate 3.9 %- 4.6 % 1.9 % Expected stock price volatility 20.6 %- 20.9 % 79.3 % Expected term (years) 2.5 10.0

Accounts Receivable

Accounts Receivable	6 Months Ended
	Jun. 30, 2023
Receivables [Abstract]
Accounts Receivable	4. Accounts Receivable Accounts receivable consists of the following: June 30, December 31, United States $ 5,587 $ 6,611 International 3,524 2,718 Total accounts receivable 9,111 9,329 Less: Allowance for expected credit losses ( 193 ) ( 227 ) Accounts receivable, net of expected credit losses $ 8,918 $ 9,102 A roll-forward of the Company’s allowance for credit losses from December 31, 2022 to June 30, 2023 is as follows: Balance at December 31, 2022 $ 227 Change in provision for credit losses ( 2 ) Write-offs (recoveries) of uncollectible balances ( 32 ) Balance at June 30, 2023 $ 193 No individual customer accounted for 10% or more of net revenue for the three or six months ended June 30, 2023 or 2022 . Two customers accounted for an aggregate of 23.8 % of total accounts receivable at June 30, 2023 . No individual customer accounted for 10% or more of total accounts receivable at December 31, 2022 .

Inventories

Inventories	6 Months Ended
	Jun. 30, 2023
Inventory Disclosure [Abstract]
Inventories	5. Inventories Inventory balances, net of reserves, consist of the following: June 30, December 31, Raw materials $ 13,279 $ 15,897 Finished goods 11,153 16,215 Component parts 712 868 Total inventories $ 25,144 $ 32,980 The Company recorded a provision for excess and obsolete inventory of $ 0.1 million and $ 0.7 million for the three months ended June 30, 2023 and 2022, respectively. The Company recorded a provision for excess and obsolete inventory of $ 0.3 million and $ 0.8 million for the six months ended June 30, 2023 and 2022 , respectively.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	6. Goodwill and Intangible Assets The changes in the carrying amount of goodwill during the six months ended June 30, 2023 is as follows: Goodwill Balance at December 31, 2022 $ 536 Foreign currency exchange rate changes 26 Balance at June 30, 2023 $ 562 During the second quarter of 2022, a substantial decline in the Company’s stock price and other factors, including leadership changes in the Vapotherm Access reporting unit, represented indicators of long-lived asset impairment for the Vapotherm Access asset group, which triggered an interim impairment assessment. The Company determined that the carrying value of Vapotherm Access intangible assets was not recoverable based on the excess of the carrying value of the asset group over the undiscounted future cash flows. The decrease in the undiscounted future cash flows from the asset group was primarily attributable to a significant decrease in future forecasted revenues, which reflected the notification of non-renewal of certain HGE customer relationships during the second quarter of 2022, as well as uncertainty related to the Company’s ability to scale its standalone remote patient monitoring business given slower than expected patient enrollment. As a result, the Company recognized an impairment charge of $ 4.0 million to write down HGE customer relationships and developed technology to their estimated fair value during the second quarter of 2022. The fair value of the intangible assets was estimated using discounted cash flows under the income approach, which the Company considers to be a Level 3 measurement. There were no impairments of intangible assets during the three or six months ended June 30, 2023. The factors listed above, along with the long-lived asset impairment, also represented indicators of goodwill impairment which triggered an interim impairment assessment during the second quarter of 2022. Based on the results of the optional qualitative assessment, the Company determined that there were no indicators of impairment for the Vapotherm UK reporting unit, but the fair value of the Vapotherm Access reporting unit was more likely than not less than its carrying value. There is no goodwill allocated to the Vapotherm reporting unit. To perform the quantitative assessment for the Vapotherm Access reporting unit, the Company determined the fair value using the income approach. The Company utilized a discounted cash flow analysis, which involves estimating the expected after-tax cash flows that will be generated by the reporting unit and then discounting those cash flows to present value, reflecting the relevant risks associated with the reporting unit and the time value of money. This approach requires the use of significant estimates and assumptions, including forecasted revenue growth rates, forecasted earnings before interest, taxes, depreciation and amortization margins, and discount rates. The Company’s forecasts are based on historical experience, expected market demand, and other industry information. The Company determined that the carrying value of the Vapotherm Access reporting unit exceeded the fair value, with the decrease in the fair value being primarily attributable to a significant decrease in future forecasted revenues, as discussed above. As a result, during the second quarter of 2022, the Company recognized an impairment charge of $ 14.7 million to write down the goodwill of the Vapotherm Access reporting unit to its estimated fair value. There were no impairments of goodwill during the three or six months ended June 30, 2023. There was no amortization expense recognized within operating expenses during the three or six months ended June 30, 2023. The Company recognized $ 0.1 million and $ 0.2 million of amortization expense within sales and marketing expenses related to the intangible assets during the three and six months ended June 30, 2022, respectively. The Company also recognized less than $ 0.1 million of amortization expense within general and administrative expenses related to intangible assets during each of the three and six months ended June 30, 2022 .

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	6 Months Ended
	Jun. 30, 2023
Payables and Accruals [Abstract]
Accrued Expenses and Other Current Liabilities	7. Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consist of the following: June 30, December 31, Operating lease liabilities, current portion $ 2,706 $ 2,313 Accrued bonuses 1,792 2,981 Accrued payroll and employee-related costs 906 938 Accrued taxes 842 1,322 Accrued interest 784 689 Accrued commissions 726 727 Accrued professional fees 571 621 Accrued vacation liability 509 601 Accrued termination benefits 508 2,474 Product warranty reserve 336 281 Accrued inventory 248 310 Accrued freight 203 422 Other 1,530 1,930 Total accrued expenses and other current liabilities $ 11,661 $ 15,609

Debt

Debt	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Debt	8. Debt Current Credit Facilities On February 18, 2022 (the “Effective Date”), the Company entered into a Loan and Security Agreement (the “SLR Loan Agreement”) with SLR Investment Corp. (“SLR”) which provided for a term A loan facility of $ 100.0 million (the “SLR Term A Loan Facility”) and a term B loan facility of $ 25.0 million (the “SLR Term B Loan Facility”) . The SLR Term A Loan Facility was funded to the Company on the Effective Date. In connection with this funding, the Company granted SLR warrants to purchase 107,373 shares of the Company’s common stock at an exercise price of $ 13.97 per share, which were fully vested upon issuance, are exercisable at the option of the holder, in whole or in part, and expire in February 2032. The SLR Term B Loan Facility was available to the Company upon achievement of a certain minimum revenue level as more fully described in the SLR Loan Agreement. The proceeds of the SLR Term A Loan Facility were used to repay all indebtedness under the Company’s prior loan agreement with CIBC, as described below. On August 1, 2022, the Company entered into an Amendment No. 1 to the SLR Loan Agreement (the “First Amendment,” together with the SLR Loan Agreement, as amended, the “Amended SLR Loan Agreement”) with SLR. Pursuant to the First Amendment, the Company was provided with a one-month extension of its covenant-free period through August 31, 2022. On September 30, 2022, the Company entered into an Amendment No. 2 to the SLR Loan Agreement (the “Second Amendment,” together with the Amended SLR Loan Agreement, as amended, the “Second Amended SLR Loan Agreement”), with SLR. Pursuant to the Second Amendment: • the Company’s minimum net product revenue covenant was modified for the remainder of 2022; • a minimum liquidity covenant of $ 20.0 million was added; • the London Interbank Offered Rate was replaced with the Secured Overnight Financing Rate (the “SOFR”); • the exit fee was increased from 6.95 % to 7.45 % of the aggregate principal amount of the Second Amended SLR Loan Agreement; and • the SLR Term B Loan Facility and related facility fee were eliminated. Concurrently with the closing of the Second Amendment, the Company amended and restated SLR’s warrants to purchase 107,373 shares of the Company’s common stock to reset the exercise price to $ 1.63 per share. On November 22, 2022 (the “Third Amendment Effective Date”), the Company entered into an Amendment No. 3 to the SLR Loan Agreement (the “Third Amendment,” together with the Second Amended SLR Loan Agreement, as amended, the “Third Amended SLR Loan Agreement”) with SLR. Pursuant to the Third Amendment: • the Company’s minimum net product revenue covenant was modified for 2023; • the minimum liquidity covenant was reduced to $ 5 million from $ 20 million (the “Amended Liquidity Covenant”); and • an option was added, at the Company’s sole discretion, to pay up to 8 % of the interest under the Third Amended SLR Loan Agreement in-kind (rather than solely in cash as provided for prior to the Third Amendment Effective Date) during 2023 (the “PIK Interest”), subject to payment of a fee equal to 10 % of the PIK Interest, and the issuance of additional warrants to the lenders equal to 5 % of the PIK Interest. In addition, the Third Amendment provided that if the Company raised $ 15 million of net cash equity proceeds (the “Equity Raise”) prior to July 1, 2023, the 2023 minimum revenue covenant would be waived and the Company need only demonstrate net product revenue of at least $ 25 million (measured on trailing six-month basis for the period ending September 30, 2023) for the fiscal year ending December 31, 2023. Upon satisfaction of the Equity Raise, the Company’s PIK Interest option would be reduced to up to 4 % of the interest rate under the Third Amended SLR Loan Agreement. Concurrently with the closing of the Third Amendment, the Company amended and restated SLR’s warrants to purchase 107,373 shares of the Company’s common stock to reset the exercise price to $ 0.48 per share. On February 10, 2023 (the “Fourth Amendment Effective Date”), the Company entered into an Amendment No. 4 to the SLR Loan Agreement (the “Fourth Amendment,” together with the Third Amended SLR Loan Agreement, the “Fourth Amended SLR Loan Agreement”) with SLR. The Fourth Amendment includes the option for the Company to pay up to 9 % of the interest in-kind (rather than up to 8 % as provided for prior to the Fourth Amendment Effective Date) during 2023. Under the Fourth Amendment, the PIK Interest option is reduced to 4 % of the interest if the Company raises $ 25 million of net cash equity proceeds prior to July 1, 2023 and is further reduced to 0 % of the interest if the Company raises $ 30 million of net cash equity proceeds prior to January 1, 2024. Additionally, if the Company elects PIK Interest of 9 %, the amount of warrants to be granted to SLR increases to be 5 % times the amount of PIK Interest for the first 4 % of the PIK Interest selected and 12.20 % times on the next 5 % of the amount of PIK Interest selected to provide for a weighted average of 9 %, and the Company’s monthly interest expense increases by 1 % for the month in which such PIK Interest is selected. The Fourth Amendment also provides for a reset of the exercise price of the warrants to be issued in connection with the Company’s election of PIK Interest, including existing PIK Warrants, equal to the lower of the Company’s closing stock price for (a) the 10-day trailing average closing price ending on the day before the interest payment date, (b) the day before the interest payment date, or (c) $ 1.17 per share. On April 17, 2023, the Company entered into an Amendment No. 5 to the SLR Loan Agreement (the “Fifth Amendment,” together with the Fourth Amended SLR Loan Agreement, the “Fifth Amended SLR Loan Agreement”)) with SLR to exclude the Company’s Singapore subsidiary operating account from the requirement of a control agreement in favor of SLR, provided the account balance is the lower of (i) $ 250,000 or (ii) the amount required to fund expenditures therefrom within the next ten business days. The Fifth Amendment also contains other customary provisions, such as expense reimbursement. Pursuant to the Fifth Amended SLR Loan Agreement, advances under the Fifth Amended SLR Loan Agreement bear interest at a floating rate per annum equal to (a) the greater of (i) 1.00 % or (ii) the one-month SOFR, plus (b) (i) 8.30 % under a PIK Interest option of 4 % or 0 %, or (ii) 9.30 % under a PIK Interest option of 9 %. At June 30, 2023, the interest rate was 14.57 % . The Company paid interest in-kind totaling $ 2.4 million and $ 4.5 million during the three and six months ended June 30, 2023, respectively. The outstanding balance under the Fifth Amended SLR Loan Agreement was $ 104.5 million at June 30, 2023 . The Fifth Amended SLR Loan Agreement provides for interest-only payments for the first 48 months following the Effective Date. Thereafter, principal payments on the Fifth Amended SLR Loan Agreement are due monthly in 12 equal installments; provided that the Company has the option to extend the interest-only period for an additional 12 months upon achievement of a certain minimum revenue level as more fully described in the Fifth Amended SLR Loan Agreement. The Fifth Amended SLR Loan Agreement will mature on February 1, 2027 (the “Maturity Date”). The Fifth Amended SLR Loan Agreement may be prepaid in full, subject to a prepayment charge of (i) 2.0 %, if such prepayment occurs after February 18, 2023 but on or prior to February 17, 2024, and (ii) 1.0 %, if such prepayment occurs after February 18, 2024 but on or prior to the Maturity Date (the “Prepayment Penalty”). In addition to the payment of principal and accrued interest, the Company will be required to make a payment of 7.45 % of the aggregate principal amount of the Fifth Amended SLR Loan Agreement funded (the “Facility Exit Fee”), which is payable on the earliest to occur of (i) the Maturity Date, (ii) the acceleration of the Fifth Amended SLR Loan Agreement prior to the Maturity Date, and (iii) the prepayment date of the Fifth Amended SLR Loan Agreement prior to the Maturity Date. The Facility Exit Fee of $ 7.5 million is considered fully earned by SLR as of the Effective Date and is being accrued to interest expense over the term of the Fifth Amended SLR Loan Agreement. In connection with the Fifth Amended SLR Loan Agreement, the Company has incurred direct financing costs related to fees and non-cash consideration paid to SLR and fees paid to third parties of $ 2.1 million and $ 1.6 million, respectively, as of June 30, 2023. The Fifth Amended SLR Loan Agreement is secured by a lien on substantially all of the assets, including intellectual property, of the Company. The Fifth Amended SLR Loan Agreement contains customary covenants and representations, including, without limitation, a minimum revenue covenant equal to a percentage of each month’s forecasted net product revenue as defined in the Fifth Amended SLR Loan Agreement (tested on a trailing six month basis at the end of each fiscal month, commencing with the six month period ending on August 31, 2022), the Amended Liquidity Covenant, and other financial covenants, reporting obligations, and limitations on dispositions, changes in business or ownership, mergers or acquisitions, indebtedness, encumbrances, distributions and investments, transactions with affiliates and capital expenditures. As of June 30, 2023, the Company was in compliance with all financial covenants under the Fifth Amended SLR Loan Agreement. The events of default under the Fifth Amended SLR Loan Agreement include, without limitation, and subject to customary grace periods, (1) the Company’s failure to make any payments of principal or interest under the Fifth Amended SLR Loan Agreement or any other loan documents, (2) the Company’s breach or default in the performance of any covenant under the Fifth Amended SLR Loan Agreement, (3) the occurrence of a material adverse effect or an event that is reasonably likely to result in a material adverse effect, (4) the existence of an attachment or levy on a material portion of the Company’s funds or of the Company’s subsidiaries, (5) the Company’s insolvency or bankruptcy, or (6) the occurrence of certain material defaults with respect to any other of our indebtedness in excess of $ 500,000 . If an event of default occurs, SLR is entitled to take enforcement action, including an incremental 5 % interest rate increase or acceleration of amounts due under the Fifth Amended SLR Loan Agreement (the “Mandatory Prepayment Option”). The Company determined the Mandatory Prepayment Option to be an embedded derivative that is required to be bifurcated from the Fifth Amended SLR Loan Agreement. The Company determined the combined probability of an event of default and SLR exercising the Mandatory Prepayment Option to be remote and deemed its fair value to be immaterial as of June 30, 2023 . The Company re-evaluates the fair value of the Mandatory Prepayment Option at the end of each reporting period. The Fifth Amended SLR Loan Agreement also contains other customary provisions, such as expense reimbursement and confidentiality. SLR has indemnification rights and the right to assign the Fifth Amended SLR Loan Agreement, subject to customary restrictions. The annual principal maturities of the Company’s Fifth Amended SLR Loan Agreement as of June 30, 2023 are as follows: 2023 (remaining 6 months) $ - 2024 - 2025 - 2026 87,049 2027 17,409 Less: Unamortized deferred financing costs ( 2,638 ) Long-term loans payable $ 101,820 Prior Credit Facilities On February 18, 2022, the Company used $ 47.4 million of the SLR Term A Loan Facility to pay off all obligations owing under, and to terminate, its prior Loan and Security Agreement (the “CIBC Loan Agreement”) with CIBC which provided for a revolving loan facility of $ 12.0 million and a term loan facility of $ 40.0 million. As a result of the termination of the CIBC Loan Agreement, the Company recorded a loss on extinguishment of debt of $ 1.1 million, which included the prepayment penalty, write-off of the remaining unamortized deferred financing costs, and legal fees during the three months ended March 31, 2022.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	9. Commitments and Contingencies Lease Commitments The Company’s operating lease commitments as of December 31, 2022 are described in Note 11 of the notes to the financial statements included in the 2022 Form 10-K. The following table presents operating lease cost and information related to operating lease liabilities for the periods indicated: Six Months Ended June 30, 2023 2022 Operating lease cost $ 1,075 $ 1,380 Variable lease cost 193 233 Total $ 1,268 $ 1,613 Operating cash flow impacts: Cash paid for amounts included in measurement of lease $ 1,556 $ 1,476 Operating right of use assets obtained in exchange for new $ - $ 1,254 Weighted average remaining lease term - operating leases 3.5 3.1 Weighted average discount rate - operating leases 9.2 % 8.1 % As of June 30, 2023, future maturities of lease liabilities under the Company’s noncancelable operating leases are as follows: Total Due 2023 (remaining 6 months) $ 1,616 2024 3,239 2025 1,299 2026 811 2027 525 Thereafter 1,133 Total payments 8,623 Less interest ( 1,409 ) Total present value of lease payments $ 7,214 Legal Matters From time to time, the Company may become involved in various legal proceedings, including those that may arise in the ordinary course of business. The Company believes there is no litigation pending that could have, individually, or in the aggregate, a material adverse effect on the results of its operations or financial condition. Guarantees During the second quarter of 2022, in connection with the Company’s plan to move substantially all of its manufacturing operations from New Hampshire to Mexico, the Company entered into an agreement with TACNA Services, Inc. (“TACNA”) under which TACNA manages the Company’s manufacturing operations in Mexico. In furtherance thereof, Baja Fur, S.A. de C.V. (the “Lessee”), a subsidiary of TACNA, entered into a lease agreement (the “Lease”) with Fraccionadora Residencial Hacienda Agua Caliente, S. de R.L. de C.V. (the “Lessor”), whereby the Lessee agreed to lease property in Tijuana, México to be used as the Company’s manufacturing facility in Mexico. Under Mexican law, the Lease became a legally binding agreement on July 8, 2022. As an inducement to the Lessee and Lessor to enter into the Lease, the Company entered into an absolute unconditional corporate guaranty agreement (the “Guaranty Agreement”) pursuant to which the Company agreed to guaranty the prompt and complete payment and performance when due, whether by acceleration or otherwise, of all obligations, liabilities and covenants of the Lessee to the Lessor pursuant to the Lease, including all amounts due under the Lease. The Guaranty Agreement will terminate once all obligations arising under the Lease have been satisfied in full and the Lease has been terminated or fully performed. The total obligation outstanding under the Guaranty Agreement was $ 1.4 million as of June 30, 2023 and was recorded as an operating lease liability in these condensed consolidated financial statements. Other Commitments As of June 30, 2023, the Company has non-cancellable purchase commitments for inventories, capital equipment and services as follows: Total Due 2023 (remaining 6 months) $ 7,869 2024 2,650 2025 600 $ 11,119

Restructuring

Restructuring	6 Months Ended
	Jun. 30, 2023
Restructuring and Related Activities [Abstract]
Restructuring	10. Restructuring On April 27, 2022 , the Company committed to a plan (the “April 2022 Restructuring”) to relocate substantially all of its manufacturing operations from Exeter, New Hampshire to a company operated manufacturing facility in Tijuana, Mexico and announced a reduction in force at the Exeter, New Hampshire facility that eliminated positions related to production, quality and operations services. As part of the April 2022 Restructuring, the Company also incurred severance related expenses due to senior level personnel retirements and transitions. For the six months ended June 30, 2023, the Company incurred restructuring expenses of approximately $ 0.2 million related to impairments of right-of-use assets, as further discussed below, and termination benefits including severance, benefits and other payroll-related charges. The termination benefits are classified in the Company’s condensed consolidated statements of comprehensive loss in the manner in which the employees’ salaries and related costs were classified. The Company does not expect to incur additional costs associated with the April 2022 Restructuring. In connection with the April 2022 Restructuring and the relocation of manufacturing operations to Mexico, in December 2022, the Company vacated most of its leased space in its Exeter, New Hampshire facility and is in the process of marketing the designated space (“Domain Sublease”) for a sublease or subleases through the remaining term of the operating lease. The Company has not yet secured a sublease tenant or tenants, which triggered an interim impairment assessment during the first quarter of 2023. The Company re-evaluated its sublease assumptions and timeline based on current market conditions and determined the carrying value of the asset group was not recoverable based on the excess of the carrying value of the asset group over the undiscounted future cash flows. The decrease in the undiscounted future cash flows from the asset group was due to a delayed timeline for securing a sublease tenant or tenants. As a result, the Company recognized an impairment charge of $ 0.2 million for the Domain Sublease asset group, to write down the operating lease right-of-use assets to their estimated fair value during the six months ended June 30, 2023. The fair value of the operating lease right-of-use assets were estimated using discounted cash flows under the income approach, which the Company considers to be a Level 3 measurement. In late August 2022, in conjunction with the Company’s path to profitability and annual operating planning efforts, the Company committed to a plan (the “August 2022 Restructuring”) to exit the Vapotherm Access standalone remote patient monitoring business and its pulmonology practice, RespirCare, and to restructure its commercial organization in the United States. As a result of the August 2022 Restructuring, the Company eliminated positions related to patient care, marketing and administrative services at Vapotherm Access and RespirCare and executed a reduction in force of the Company’s United States field teams. As part of the August 2022 Restructuring, the Company also incurred severance related expenses due to personnel transitions. For the six months ended June 30, 2023, the Company incurred restructuring expenses of approximately $ 0.3 million, related to impairments of right-of-use assets, as further discussed below, and termination benefits including severance, benefits and other payroll-related charges. The termination benefits are classified in the Company’s condensed consolidated statements of comprehensive loss in the manner in which the employees’ salaries and related costs were classified. The Company does not expect to incur additional costs associated with the August 2022 Restructuring. In connection with the August 2022 Restructuring, in August 2022, the Company vacated Vapotherm Access’ leased space in Fort Washington, Pennsylvania. In the first quarter of 2023, the Company determined that the operating lease right-of-use asset is considered abandoned due to failed attempts to market the facility for a sublease and the Company no longer expects to sublease the facility through the remaining lease term. As a result, the Company recognized an impairment charge of $ 0.2 million for asset group, to write off the operating lease right-of-use asset to its estimated fair value during the six months ended June 30, 2023. The fair value of the operating lease right-of-use asset was estimated using discounted cash flows under the income approach, which the Company considers to be a Level 3 measurement. The following table summarizes the restructuring activity from December 31, 2022 to June 30, 2023: Termination Benefits Asset Impairments Total Balance at December 31, 2022 $ 2,474 $ - $ 2,474 April 2022 Restructuring costs incurred 24 180 204 August 2022 Restructuring costs incurred 32 252 284 Non-cash restructuring costs - ( 432 ) ( 432 ) Restructuring costs paid ( 1,914 ) - ( 1,914 ) Balance at March 31, 2023 $ 616 $ - $ 616 Restructuring costs paid ( 129 ) - ( 129 ) Balance at June 30, 2023 $ 487 $ - $ 487 The restructuring accrual at June 30, 2023 is expected to be paid by the end of 2023. The following table summarizes the classification of restructuring expense, including related impairment of right-of-use assets, in the condensed consolidated statements of comprehensive loss: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Cost of revenue $ - $ 480 $ 56 $ 480 Research and development - 566 - 888 Sales and marketing - 888 - 390 General and administrative - 390 - 566 Impairment of right-of-use assets - - 432 - Total restructuring expense $ - $ 2,324 $ 488 $ 2,324 There were no restructuring charges or impairments of right-of-use assets recorded during the three months ended June 30, 2023. There were no impairments of right-of-use assets recorded during the three or six months ended June 30, 2022 .

Warrants

Warrants	6 Months Ended
	Jun. 30, 2023
Warrants and Rights Note Disclosure [Abstract]
Warrants	11. Warrants The Company’s warrant activity is summarized as follows: Common Stock Warrants Number of Weighted Outstanding at December 31, 2022 124,514 $ 2.34 Warrants granted 26,800,998 0.97 Warrants exercised ( 2,592,121 ) - Outstanding at June 30, 2023 24,333,391 $ 1.08 The Company’s outstanding warrants at June 30, 2023 have exercise prices ranging from $ 0.001 per share to $ 14.00 per share and expire at periods ranging from June 10, 2024 through February 10, 2053 . In connection with its PIK Interest option, the Company has granted SLR the PIK Warrants to purchase an aggregate of 493,738 shares of common stock during the six months ended June 30, 2023. The PIK Warrants had a weighted average exercise price of $ 0.65 per share on the date of grant, were fully vested upon issuance, are exercisable at the option of the holder, in whole or in part, and have expiration dates ranging from January 3, 2033 through June 1, 2033 . In connection with its February 2023 Private Placement, the Company issued the Pre-Funded Warrants to purchase an aggregate of 4,402,508 shares of common stock and accompanying Warrants to purchase an aggregate of 21,904,752 shares of common stock. The Pre-Funded Warrants and Warrants were fully vested upon issuance, are exercisable at the option of the holder, in whole or in part, and expire on February 10, 2053 and February 10, 2028 , respectively (see Note 1). In June 2023, a warrant to purchase 2,592,121 shares of common stock was exercised. Upon exercise, the exercise price of $ 0.001 per share was satisfied through payment of cash to the Company.

Revenue

Revenue	6 Months Ended
	Jun. 30, 2023
Revenue from Contract with Customer [Abstract]
Revenue	12. Revenue Disaggregated Revenue The following table shows the Company’s net revenue disaggregated into categories the Company considers meaningful: Three Months Ended June 30, Six Months Ended June 30, 2023 2023 US International Total US International Total Net revenue by: Product revenue Capital equipment $ 2,518 $ 602 $ 3,120 $ 5,016 $ 1,412 $ 6,428 Disposable 7,878 3,049 10,927 17,226 6,118 23,344 Subtotal product revenue 10,396 3,651 14,047 22,242 7,530 29,772 Lease revenue Capital equipment 35 81 116 73 173 246 Other 305 105 410 660 213 873 Service and other revenue 1,111 353 1,464 2,131 746 2,877 Total net revenue $ 11,847 $ 4,190 $ 16,037 $ 25,106 $ 8,662 $ 33,768 Three Months Ended June 30, Six Months Ended June 30, 2022 2022 US International Total US International Total Net revenue by: Product revenue Capital equipment $ 1,093 $ 925 $ 2,018 $ 3,467 $ 1,709 $ 5,176 Disposable 5,839 2,074 7,913 16,910 5,882 22,792 Subtotal product revenue 6,932 2,999 9,931 20,377 7,591 27,968 Lease revenue Capital equipment 77 62 139 315 225 540 Other 328 83 411 721 181 902 Service and other revenue 2,161 329 2,490 4,584 599 5,183 Total net revenue $ 9,498 $ 3,473 $ 12,971 $ 25,997 $ 8,596 $ 34,593 United States and International net revenue is based on the customer location to which the product is shipped. No individual foreign country represents more than 10 % of the Company’s total net revenue for the three or six months ended June 30, 2023 or 2022. Contract Balances from Contracts with Customers Contract liabilities consist of deferred revenue and other contract liabilities associated with rebates and fees payable to GPOs, IDNs and distributor partners. Deferred revenues are included in contract liabilities in the accompanying condensed consolidated balance sheets. The following table presents changes in contract liabilities during the six months ended June 30, 2023: Deferred Other Contract Balance at December 31, 2022 $ 1,021 $ 195 Additions 725 122 Subtractions ( 568 ) ( 194 ) Balance at June 30, 2023 $ 1,178 $ 123

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2023
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	13. Stock-Based Compensation As of June 30, 2023, 285,198 shares of common stock remained available for issuance under the Vapotherm, Inc. 2018 Equity Incentive Plan (as amended and restated, the “2018 Equity Plan”), assuming target performance under outstanding performance stock units. To date, stock options, performance awards, restricted stock awards, restricted stock units and performance stock units have been granted under the 2018 Equity Plan. Stock-based compensation expense was allocated based on the employees’ and non-employees’ functions as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 Cost of revenue $ 51 $ 199 $ 98 $ 427 Research and development 556 492 1,152 979 Sales and marketing 986 810 2,100 1,888 General and administrative 992 997 2,055 2,650 Total $ 2,585 $ 2,498 $ 5,405 $ 5,944 Stock Options The Company granted options to purchase an aggregate of 848,575 shares of common stock at exercise prices ranging from $ 1.21 to $ 2.70 per share, with a weighted average exercise price of $ 2.65 per share, during the six months ended June 30, 2023. The Company granted options to purchase an aggregate of 1,223,550 shares of common stock at exercise prices ranging from $ 2.89 to $ 20.71 per share, with a weighted average exercise price of $ 6.68 per share, during the six months ended June 30, 2022. The weighted average fair value of stock options granted during the six months ended June 30, 2023 and 2022 was $ 2.18 and $ 4.72 per share, respectively. The weighted average assumptions used in the Black-Scholes options pricing model are as follows: Six Months Ended June 30, 2023 2022 Expected dividend yield 0.0 % 0.0 % Risk free interest rate 3.9 % 2.6 % Expected stock price volatility 103.8 % 83.4 % Expected term (years) 6.1 6.3 Restricted Stock Units A summary of restricted stock unit activity for the six months ended June 30, 2023 is as follows: Weighted Average Grant Date Shares Fair Value Unvested at December 31, 2022 1,320,306 $ 10.78 Granted 170,543 2.28 Vested ( 232,763 ) 17.83 Canceled ( 53,576 ) 7.89 Unvested at June 30, 2023 1,204,510 $ 8.34 Performance Stock Units The Company has granted performance stock units. The quantity of shares that will ultimately vest and be issued upon settlement of the performance stock units range from 0 % to 200 % of a targeted number of shares and will be determined based on, and subject to, individual grant milestones. A summary of performance stock units activity for the six months ended June 30, 2023 is as follows: Weighted Average Grant Date Shares Fair Value Unvested at December 31, 2022 177,698 $ 18.78 Granted - - Vested - - Canceled - - Unvested at June 30, 2023 177,698 $ 18.78 Employee Stock Purchase Plan As of June 30, 2023, 907,751 shares of common stock remained available for issuance under the ESPP. The ESPP provides for successive discrete offering periods of approximately six months or as determined by the plan administrator. The offering periods begin on each January 1 st and July 1 st or the first trading day thereafter. The ESPP permits eligible employees to elect to purchase shares of common stock through fixed whole percentage contributions from eligible compensation during each offering period, not to exceed 10 % of the eligible compensation a participant receives during an offering period and not to accrue at a rate which exceeds $ 25,000 of the fair value of the stock (determined on the grant date(s)) for each calendar year. A participant may purchase the lower of (a) a number of shares of common stock determined by dividing such participant’s accumulated payroll deductions on the exercise date by the option price, (b) 5,000 shares, or (c) such other lesser maximum number of shares as shall have been established by the plan administrator. Amounts deducted and accumulated by the participant will be used to purchase shares of common stock at the end of each offering period. The purchase price of the shares will be 85 % of the lower of the fair value of common stock on the first trading day of each offering period or on the purchase date. Participants may end their participation during an offering period up to ten days in advance of the exercise date and will be paid their accumulated contributions that have not been used to purchase shares of common stock. Participation ends automatically upon termination of employment. The fair value of the purchase right for the ESPP option is estimated on the date of grant using the Black-Scholes pricing model with the following assumptions during 2023: Expected dividend yield 0.0 % Risk free interest rate 4.8 % Expected stock price volatility 192.5 % Expected term (years) 0.5

Net Loss Per Share

Net Loss Per Share	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Net Loss Per Share	14. Net Loss Per Share As of June 30, 2023, the remaining outstanding Pre-Funded Warrants to purchase 1,810,387 shares of common stock that were issued in connection with the February 2023 Private Placement were included in the basic and diluted net loss per share calculation (see Note 1). The Company excluded the following potential shares of common stock, based on amounts outstanding at each period end, from the computation of diluted net loss per share for the periods indicated because including them would have had an anti-dilutive effect: As of June 30, 2023 2022 Warrants to purchase common stock 22,523,004 135,871 Options to purchase common stock 3,806,498 3,018,656 Unvested restricted stock units and 1,382,208 900,654 27,711,710 4,055,181

Related Party Transactions

Related Party Transactions	6 Months Ended
	Jun. 30, 2023
Related Party Transactions [Abstract]
Related Party Transactions	15. Related Party Transactions The Company recorded sales of 0.3 million and less than $ 0.1 million during the three months ended June 30, 2023 and 2022, respectively, and sales of $ 1.4 million and $ 0.1 million during the six months ended June 30, 2023 and 2022, respectively, to an entity in which a member of the Company’s board of directors holds a management position. There was a credit of $ 0.2 million due to the entity at June 30, 2023 . There were no outstanding balances due from the entity at December 31, 2022.

Subsequent Event

Subsequent Event	6 Months Ended
	Jun. 30, 2023
Subsequent Events [Abstract]
Subsequent Event	16. Subsequent Event As previously announced, on July 20, 2023, at an annual meeting of stockholders, the Company’s stockholders approved an amendment to the Company’s Tenth Amended and Restated Certificate of Incorporation, as amended, to give the Board of Directors discretion to effect a reverse stock split of the Company’s issued and outstanding shares of common stock at a ratio of between 1-for- 3 and 1-for- 8 , inclusive, such ratio, and the decision to effect the reverse split, to be determined by the Board of Directors in its sole discretion. On August 8, 2023, the Board of Directors of the Company approved a 1-for-8 reverse stock split and a corresponding reduction in authorized shares of the Company’s common stock, effective as of 12:01 a.m., Eastern Time, on August 18, 2023 (the “Effective Time”), with shares expected to begin trading on a split-adjusted basis at market open on August 18, 2023 under the existing symbol “VAPO” and new CUSIP number 922107 305. In connection with the reverse stock split, every eight (8) shares of the Company’s common stock issued and outstanding as of the Effective Time will be automatically converted into one (1) share of the Company’s common stock. Fractional shares will not be issued in connection with the reverse stock split and stockholders who would otherwise hold fractional shares because the number of shares of the Company’s common stock they hold before the reverse stock split is not evenly divisible by eight (8) will be entitled to receive a cash payment in lieu of such fractional shares. The terms of outstanding warrants and equity-based awards (including exercise price and number of shares issuable thereunder) will be proportionately adjusted, in accordance with the terms of the applicable agreement. In addition, the number of shares of the Company’s common stock reserved for issuance under the Company’s equity compensation plans immediately prior to the Effective Time will be reduced proportionately. As of the Effective Time, the Company’s issued and outstanding shares of common stock will be decreased from 49,081,339 pre-split shares to approximately 6,135,000 post-split shares and the number of authorized shares of the Company’s common stock will be decreased from 175,000,000 to 21,875,000 shares. The effect of the reverse stock split on per share amounts and weighted average common shares outstanding for each of the three and six months ended June 30, 2023 and 2022 on a pro forma basis are as follows: Three Months Ended June 30, Six Months Ended June 30, (unaudited) 2023 2022 2023 2022 Pro forma net loss per share - basic and diluted $ ( 2.34 ) $ ( 12.85 ) $ ( 5.76 ) $ ( 19.85 ) Pro forma weighted-average number of shares used 6,328,215 3,321,744 5,705,602 3,306,026

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). The information included in this Quarterly Report on Form 10-Q should be read in conjunction with our audited consolidated financial statements and the accompanying notes included in our Annual Report on Form 10-K for the year ended December 31, 2022 (the “2022 Form 10-K”). Our accounting policies are described in the “ Notes to Consolidated Financial Statements ” in our 2022 Form 10-K and are updated, as necessary, in this report. The year-end condensed consolidated balance sheet data presented for comparative purposes was derived from our audited financial statements but does not include all disclosures required by U.S. GAAP.
Principles of Consolidation	Principles of Consolidation These condensed consolidated financial statements include the accounts of the Company, which includes its wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated upon consolidation.
Segment Information	Segment Information Operating segments are defined as components of an enterprise for which separate discrete financial information is available and evaluated regularly by the chief operating decision maker in deciding how to allocate resources and in assessing performance. The Company globally manages the business within one reporting segment, Vapotherm, Inc., and two reporting units, Vapotherm and Vapotherm UK Ltd. (“Vapotherm UK”). Segment information is consistent with how the chief operating decision maker reviews the business, makes investing and resource allocation decisions and assesses operating performance. As of June 30, 2023, the majority of the Company’s long-term assets are located in the United States. Long-term assets located outside the United States totaled $ 14.6 million , including $ 9.8 million located in Mexico, at June 30, 2023. Long-term assets located outside the United States totaled $ 14.9 million , including $ 9.9 million located in Mexico, at December 31, 2022 .
Use of Estimates	Use of Estimates The preparation of condensed consolidated financial statements in conformity with U.S. GAAP requires the Company to make judgments, assumptions, and estimates that affect the reported amounts of assets, liabilities, revenue and expenses, and the related disclosure of contingent assets and liabilities. The Company evaluates its estimates on an ongoing basis. The Company bases its estimates on historical experience and various other assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Significant estimates relied upon in preparing these condensed consolidated financial statements include calculation of stock-based compensation, valuation of warrants, realizability of inventories, allowance for doubtful accounts and credit losses, accrued expenses, the valuation allowances against deferred income tax assets, and assessments of impairment with respect to long-lived and intangible assets, including goodwill. Actual results may differ from these estimates.
Unaudited Interim Financial Information	Unaudited Interim Financial Information The accompanying condensed consolidated balance sheet as of June 30, 2023, and the condensed consolidated statements of comprehensive loss and stockholders’ deficit for the three and six months ended June 30, 2023 and 2022 and the condensed consolidated statements of cash flows for the six months ended June 30, 2023 and 2022 are unaudited. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of the Company’s financial position as of June 30, 2023 and the results of its operations for the three and six months ended June 30, 2023 and 2022 and the cash flows for the six months ended June 30, 2023 and 2022. The financial data and other information disclosed in these notes related to the three and six months ended June 30, 2023 and 2022 are also unaudited. The results of operations for the three and six months ended June 30, 2023 and 2022 are not necessarily indicative of the operating results for the full year or for any other subsequent interim period.
Financial Instruments and Concentrations of Credit Risk	Financial Instruments and Concentrations of Credit Risk As of June 30, 2023, the Company’s financial instruments included cash and cash equivalents, restricted cash, accounts receivable, accounts payable and debt, the carrying amounts of which approximated fair value due to their short-term nature or market interest rates. All of the Company’s cash and cash equivalents are maintained at creditworthy financial institutions. At June 30, 2023, deposits exceed the amount of any insurance provided and are exposed to credit loss. The Company extends credit to customers in the normal course of business but typically does not require collateral or any other security to support amounts due. Management performs ongoing credit evaluations of its customers. The Company recognizes an allowance for credit losses equal to its current estimate of all contractual cash flows that the Company does not expect to collect. The Company’s estimate considers relevant information about past events, current conditions, and reasonable and supportable forecasts. Provisions for the allowance for credit losses are recorded in general and administrative expenses in the accompanying condensed consolidated statements of comprehensive loss.
Supplier Risk	Supplier Risk The Company obtains some of the components and subassemblies included in its High Velocity Therapy systems and its OAM from single source suppliers. The partial or complete loss of one or more of these suppliers could cause significant production delays, an inability to meet customer demand and a substantial loss in revenue.
Foreign Currency and Foreign Operations	Foreign Currency and Foreign Operations The functional currency of the Company is the currency of the primary economic environment in which the entity operates, which is the U.S. dollar. For the Company’s non-U.S. subsidiaries that transact in a functional currency other than the U.S. dollar, assets and liabilities are translated at current rates of exchange at the balance sheet date. Income and expense items are translated at the average foreign currency exchange rates for the period. Adjustments resulting from the translation of the financial statements of its foreign operations into U.S. dollars are excluded from the determination of net loss and are recorded in accumulated other comprehensive loss, a separate component of stockholders’ deficit. Realized foreign currency gains or losses arising from transactions denominated in foreign currencies are recorded in other (expense) income in the condensed consolidated statements of comprehensive loss. Unrealized foreign currency gains or losses arising from transactions denominated in foreign currencies are recorded in accumulated other comprehensive (loss) income.
Cash, Cash Equivalents, and Restricted Cash	Cash, Cash Equivalents, and Restricted Cash The Company considers all highly liquid temporary investments purchased with original maturities of 90 days or less to be cash equivalents. The Company holds restricted cash related to certificates of deposits and collateral in relation to lease agreements. As of June 30, 2023, $ 1.1 million of its $ 19.1 million of cash, cash equivalents and restricted cash balance was located outside the United States. As of December 31, 2022 , $ 1.0 million of its $ 16.8 million of cash, cash equivalents and restricted cash balance was located outside of the United States. The Company’s cash, cash equivalents and restricted cash balances are primarily held by Canadian Imperial Bank of Commerce Innovation Banking (“CIBC”) and Bank of America, N.A. The following table presents the components of total cash, cash equivalents, and restricted cash as set forth in the Company’s condensed consolidated statements of cash flows: June 30, December 31, Cash and cash equivalents $ 18,000 $ 15,738 Restricted cash 1,109 1,109 Total cash, cash equivalents, and restricted cash $ 19,109 $ 16,847
Leases	Leases The Company’s operating leases primarily consist of real estate leases for office, manufacturing, research and development, and warehouse space, as well as certain vehicle and equipment leases. Accounting Standards Codification (“ASC”), Leases (“ASC 842”) requires lessees to recognize leases on the balance sheet as a lease liability with a corresponding right-of-use asset, subject to certain permitted accounting policy elections. Under ASC 842, the Company determines whether a contract is or contains a lease at the inception of the contract. This determination is based on whether the contract provides the Company the right to control the use of a physically distinct asset and substantially all of the capacity of an asset. Leases with an initial noncancelable term of twelve months or less that do not include an option to purchase the underlying asset that the Company is reasonably certain to exercise are classified as short-term leases. The Company has elected as an accounting policy to exclude from the consolidated balance sheets the right-of-use assets and lease liabilities related to short-term leases. The Company recognizes rent expense for its operating leases on a straight-line basis over the term of the lease. Certain of the Company’s leases include options to extend or terminate the lease at its sole discretion. The Company does not consider in the measurement of right-of-use assets and lease liabilities an option to extend or terminate a lease if the Company is not reasonably certain to exercise the option. Certain of the Company’s leases include covenants that oblige the Company, at its sole expense, to repair and maintain the leased asset periodically during the lease term. The Company is not a party to any leases that contain residual value guarantees. Many of the Company’s leases include fixed and variable payments. Among other charges, variable payments related to real estate leases include real estate taxes, insurance, operating expenses, and common area maintenance, which are usually billed at actual amounts incurred proportionate to the Company’s rented square feet of the building. Variable payments related to vehicle and equipment leases relate to usage of the underlying asset, sales and use tax, and value-added tax. Variable payments that do not depend on an index or rate are expensed as incurred and are not included in the measurement of the lease liability. In accordance with the guidance in ASC 842, components of a lease should be split into three categories: lease components (e.g. buildings, vehicles, etc.), non-lease components (e.g. common area maintenance, consumables, etc.), and non-components (e.g. property taxes, insurance, etc.). The fixed and in-substance fixed contract consideration (including any related to non-components) must be allocated to the lease components and non-lease components based on their relative fair values. The Company elected the accounting policy to not separate lease and non-lease components for its real estate, vehicle, and equipment leases. Therefore, each lease component and the related non-lease components and non-components are accounted for together as a single component. The Company measures its lease liability for each leased asset as the present value of lease payments, as defined in ASC 842, discounted using a discount rate specific to the terms of the underlying lease. The Company’s right-of-use assets are equal to the related lease liabilities, adjusted for lease incentives received including tenant improvement allowances, initial direct costs incurred related to the lease, and payments made to the lessor prior to the lease commencement date. The interest rate implicit in lease contracts is typically not readily determinable. As a result, the Company estimates its incremental borrowing rate for each leased asset based on the interest rate the Company would incur to borrow an amount equal to the lease payments on a collateralized basis over a similar term in a similar economic environment. When impairment indicators are present, the Company evaluates the recoverability of its right-of-use assets. If the assessment indicates an impairment, the affected assets are written down to fair value (See Note 10).
Goodwill	Goodwill Goodwill represents the difference between the purchase price and the fair value of the identifiable tangible and intangible net assets when accounted for using the purchase method of accounting in a business combination. Goodwill is not amortized but reviewed for impairment. Goodwill is reviewed annually, as of October 1, and whenever events or changes in circumstances indicate that the carrying value of the goodwill may not be recoverable. The Company compares the fair value of its reporting units to their carrying values. If the carrying value of the net assets assigned to a reporting unit exceeds the fair value of the reporting unit, the Company would record an impairment loss equal to the difference (See Note 6).
Intangible Assets	Intangible Assets Intangible assets are related to customer relationships, developed technology, and customer agreements and are amortized on a straight-line basis over their useful lives. Amortization is recorded within sales and marketing expenses in the condensed consolidated statements of comprehensive loss for customer-related intangible assets while amortization of other intangible assets is included within general and administrative expenses in the condensed consolidated statements of comprehensive loss. Intangible assets are evaluated for impairment whenever events or circumstances indicate an asset may be impaired (See Note 6).
Product Warranty	Product Warranty The Company provides its customers with a standard one-year warranty on its capital equipment sales. Warranty costs are accrued based on actual historical trends and estimated at the time of sale. The warranty liability is included within accrued expenses and other current liabilities in the condensed consolidated balance sheets. A roll-forward of the Company’s warranty liability from December 31, 2022 to June 30, 2023 is as follows: Balance at December 31, 2022 $ 281 Provisions for warranty obligations 156 Settlements ( 101 ) Balance at June 30, 2023 $ 336
Revenue Recognition	Revenue Recognition The Company’s revenue is primarily derived from the sale of products, leases and services. Product revenue consists of capital equipment and single-use disposables that are shipped and billed to customers both domestically and internationally. The Company’s main capital equipment products are the High Velocity Therapy systems. The Company’s main disposable products are single-use disposables and nasal interfaces, or cannulas, and adaptors. Lease revenue consists of two components which include capital equipment that the Company leases to its customers and, in certain situations, an allocation from disposable revenue to other lease revenue upon the sale of disposable products in bundled arrangements involving the placement of the High Velocity Therapy capital units for use by the customer at no upfront charge in connection with the customer’s ongoing purchase of disposable products. Service revenue consists of fees associated with routine service of capital units and the sale of extended service contracts and preventative maintenance plans, which are purchased by a small portion of the Company’s customer base. In addition, the Company sells small quantities of component parts in the United States, United Kingdom, and to third-party international service centers who provide service on the High Velocity Therapy capital units outside of the United States and United Kingdom. Freight revenue is based upon actual freight costs plus a percentage markup of such costs associated with the shipment of products domestically, and to a lesser extent, internationally, and is included in service revenue. Rebates and fees consist of contractually obligated administrative fees and percentage-of-sales rebates paid to Group Purchasing Organizations (“GPOs”), Integrated Delivery Networks (“IDNs”) and distributor partners and are accounted for as a reduction to the corresponding of revenue category. During the three and six months ended June 30, 2022 , service revenue also included $ 1.0 million and $ 2.0 million, respectively, of fees from the standalone remote patient monitoring services sold through Vapotherm Access. Under the Financial Accounting Standard Board’s (“FASB”) ASC 606, Revenue from Contracts with Customers (“ASC 606”), revenue is recognized when a customer obtains control of promised goods or services, in an amount that reflects the consideration which the Company expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of ASC 606, the Company performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the Company satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. At contract inception, once the contract is determined to be within the scope of ASC 606, the Company assesses the goods or services promised within each contract and assesses whether each promised good or service is distinct and determines those that are performance obligations. The Company then recognizes as revenue the amount of the transaction price that is allocated to the respective performance obligation when (or as) the performance obligation is satisfied. Sales, value-added, and other taxes collected on behalf of third parties are excluded from revenue. The Company’s standard payment terms are generally 30 days from the date of sale. Contracts with customers may contain multiple performance obligations. For such arrangements, the transaction price is allocated to each performance obligation based on the estimated relative stand-alone selling prices of the promised products or services underlying each performance obligation. The Company determines stand-alone selling prices based on the price at which the performance obligation is sold separately. If the stand-alone selling price is not observable through past transactions, the Company estimates the stand-alone selling price taking into account available information such as market conditions and internally approved pricing guidelines related to the performance obligations. Revenue is generally recognized when the customer obtains control of the Company’s product, which generally occurs at a point in time upon shipment based on the contractual shipping terms of a contract. Product and service revenue is measured as the amount of consideration the Company expects to receive in exchange for transferring products or services to a customer. To the extent the transaction price includes variable consideration, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing the expected value amount method to which the Company expects to be entitled. As such, revenue on sales is recorded net of prompt pay discounts and payments made to GPOs, IDNs and distributors. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Determination of whether to include estimated amounts in the transaction price is based largely on an assessment of the Company’s anticipated performance and all information (historical, current and forecasted) that is reasonably available. The Company believes that the estimates it has established are reasonable based upon current facts and circumstances. Applying different judgments to the same facts and circumstances could result in different estimates. When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying a practical expedient under ASC 606, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less. None of the Company’s contracts contained a significant financing component during the three or six months ended June 30, 2023 or 2022. The Company’s contracts with its customers generally have a duration of less than one year. Therefore, the Company has elected to apply a practical expedient and recognizes the incremental costs of obtaining contracts as an expense. These costs are included in sales and marketing expenses in the accompanying condensed consolidated statements of comprehensive loss.
Lease Revenue	Lease Revenue The Company also enters into agreements to lease its capital equipment. For such sales, the Company accounts for revenue under ASC 842, Leases (“ASC 842”), and assesses and classifies these transactions as sales-type or operating leases based on whether the lease transfers ownership of the equipment to the lessee by the end of the lease term. This criterion is met in situations in which the lease agreement provides for the transfer of title at or shortly after the end of the lease term. Equipment included in arrangements including transfer of title are accounted for as sales-type leases and the Company recognizes the present value of the lease payments due over the lease term as revenue at the inception of the lease. The Company records the present value of future lease payments in prepaid expenses and other current assets in the accompanying condensed consolidated balance sheets; these amounts totaled $ 0.1 million and less than $ 0.1 million at June 30, 2023 and December 31, 2022 , respectively. Equipment included in arrangements that do not include the transfer of title, nor any of the sales-type or direct financing lease criteria, are accounted for as operating leases and revenue is recognized on a straight-line basis over the term of the lease. The Company also enters into agreements involving the placement of its High Velocity Therapy capital units for use by the customer at no upfront charge in connection with the customer’s ongoing purchase of disposable products. In these bundled arrangements, revenue recognized for the sale of the disposables is allocated between disposable revenue and other lease revenue based on the estimated relative stand-alone selling prices of the individual performance obligations.
Shipping and Handling Costs	Shipping and Handling Costs Amounts billed to customers for shipping and handling are included in service revenue. Shipping and handling costs are included in cost of sales. Shipping and handling activities are accounted for as activities to fulfill a contract and are accrued when the customer obtains control of the Company’s product. The total costs of shipping and handling for the three months ended June 30, 2023 and 2022 were $ 0.2 million and $ 0.1 million , respectively. The total costs of shipping and handling for the six months ended June 30, 2023 and 2022 were $ 0.5 million and $ 0.6 million , respectively.
Sales and Value-Added Taxes	Sales and Value-Added Taxes When required by local jurisdictions, the Company bills its customers for sales tax and value-added tax calculated on each sales invoice and records a liability for the sales and value-added tax payable, which is included in accrued expenses and other current liabilities in the condensed consolidated balance sheets. Sales tax and value-added tax billed to a customer are not included in the Company’s revenue.
Stock-Based Compensation	Stock-Based Compensation The Company maintains an equity incentive plan to provide long-term incentives for employees, consultants, and members of the board of directors. The plan allows for the issuance of non-statutory and incentive stock options, restricted stock, unrestricted stock, stock units, including restricted stock units and performance stock units, and stock appreciation rights to employees, consultants and non-employee directors. The Company recognizes stock-based compensation expense for awards of equity instruments to employees and non-employees based on the grant date fair value of those awards in accordance with ASC Topic 718, Stock Compensation (“ASC 718”). ASC 718 requires all equity-based compensation awards, including grants of restricted stock, restricted stock units, performance stock units and stock options, to be recognized as expense in the condensed consolidated statements of comprehensive loss based on their grant date fair values. The fair value of each option grant is estimated on the grant date using the Black-Scholes option pricing model. The fair value of restricted stock and restricted stock units is measured at the market value of the related shares of the Company’s common stock on the grant date. The fair value is then amortized on a straight-line basis over the requisite service period of the awards, which is generally the vesting period and is generally three to four years . For performance-based awards, the related compensation cost is amortized over the performance period on an accelerated attribution basis. Compensation cost associated with performance awards is based on fair value on the date of grant and the number of units expected to be earned after assessing the probability that certain performance criteria will be met and the associated targeted payout level that is forecasted will be achieved. Cumulative adjustments are recorded each quarter to reflect estimated outcomes of the performance-related conditions until the results are determined and settled. Use of a valuation model requires management to make certain assumptions with respect to selected model inputs, including the expected life (weighted average period of time that the options granted are expected to be outstanding), the volatility of the Company’s common stock and an assumed risk-free interest rate. Expected volatility is based on the historical volatility of the Company’s common stock. The expected life is estimated using the historical life of options issued under the Company’s equity plan. The risk-free interest rate is based on U.S. Treasury rates with a remaining term that approximates the expected life assumed at the date of grant. No dividend yield is assumed as the Company does not pay, and does not expect to pay, dividends on its common stock. The Company estimates forfeitures based on historical experience with pre-vested forfeitures. To the extent actual forfeitures differ from the estimate, the difference is recorded to compensation expense in the period of the forfeiture. The Company recognizes stock-based compensation expense for shares of its common stock issued pursuant to the Vapotherm, Inc. 2018 Employee Stock Purchase Plan (“ESPP”) on a straight-line basis over the related offering period. The Company estimates the fair value of shares to be issued under the ESPP based on a combination of options valued using the Black-Scholes option pricing model. The expected life is determined based on the contractual term. Dividend yield, risk-free interest rate, forfeiture rates, and expected volatility are estimated in a manner similar to option grants described above.
Income Tax	Income Tax The Company accounts for income taxes using the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been recognized in the condensed consolidated financial statements or in the Company’s tax returns. Deferred taxes are determined based on the difference between the financial reporting and tax basis of assets and liabilities using enacted tax rates in effect in the years in which the differences are expected to reverse. Changes in deferred tax assets and liabilities are recorded in the provision for income taxes. The Company assesses the likelihood that its deferred tax assets will be recovered from future taxable income and, to the extent it believes, based upon the weight of available evidence, that it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is established through a charge to income tax expense. Potential for recovery of deferred tax assets is evaluated by estimating the future taxable profits expected and considering prudent and feasible tax planning strategies. The Company accounts for uncertainty in income taxes recognized in the condensed consolidated financial statements by applying a two-step process to determine the amount of tax benefit to be recognized. First, the tax position must be evaluated to determine the likelihood that it will be sustained upon external examination by the taxing authorities. If the tax position is deemed more likely-than-not to be sustained, the tax position is then assessed to determine the amount of benefit to recognize in the condensed consolidated financial statements. The amount of the benefit that may be recognized is the largest amount that has a greater than 50% likelihood of being realized upon ultimate settlement. The provision for income taxes includes the effects of any resulting tax reserves, or unrecognized tax benefits, that are considered appropriate as well as the related net interest and penalties. The Company’s major tax jurisdictions are the state of New Hampshire, the United States, United Kingdom, Germany, Mexico, and Singapore. The provision for income taxes for the three and six months ended June 30, 2023 each totaled less than $ 0.1 million and related to income earned by the Company’s foreign subsidiaries after accounting for transfer pricing adjustments. The benefit for income taxes for the three months ended June 30, 2022 totaled less than $ 0.1 million and related to a benefit for net deferred income tax assets deemed more likely than not to be realized by the Company’s foreign subsidiaries. The provision for income taxes for the six months ended June 30, 2022 totaled $ 0.1 million and related to deferred tax liabilities for differences in the book and tax basis of indefinite-lived assets, partially offset by a benefit for net deferred income tax assets deemed more likely than not to be realized by the Company’s foreign subsidiaries. Utilization of the net operating loss and tax credit carryforwards may be subject to a substantial annual limitation under Sections 382 and 383 of the Internal Revenue Code of 1986, as amended (the “Code”), due to ownership change limitations that have occurred previously or that could occur in the future. These ownership changes may limit the amount of net operating loss and tax credit carryforwards that can be utilized to offset future taxable income and reduce taxes, respectively. The Company has not currently completed an evaluation of ownership changes through December 31, 2022 to assess whether utilization of the Company’s net operating loss and tax credit carryforwards would be subject to an annual limitation under Sections 382 and 383 of the Code. To the extent an ownership change is determined to have occurred under Sections 382 and 383 of the Code, the net operating loss and tax credit carryforwards may be subject to limitation.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements Credit Losses (Topic 326) In June 2016, the FASB issued ASU No. 2016-13 , Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”). Subsequent to the issuance of ASU 2016-13, the FASB clarified the guidance through several ASUs. The collective new guidance (ASC 326) generally requires that credit losses be reported using an expected losses model rather than the incurred losses model that is currently used and establishes additional disclosures related to credit risks. The Company adopted this guidance using the modified retrospective method in the first quarter of fiscal year 2023 . The adoption did not have a material impact on the Company’s condensed consolidated financial statements.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2023
Accounting Policies [Abstract]
Components of Cash, Cash Equivalents and Restricted Cash	The following table presents the components of total cash, cash equivalents, and restricted cash as set forth in the Company’s condensed consolidated statements of cash flows: June 30, December 31, Cash and cash equivalents $ 18,000 $ 15,738 Restricted cash 1,109 1,109 Total cash, cash equivalents, and restricted cash $ 19,109 $ 16,847
Summary of Roll-Forward Warranty Liability	A roll-forward of the Company’s warranty liability from December 31, 2022 to June 30, 2023 is as follows: Balance at December 31, 2022 $ 281 Provisions for warranty obligations 156 Settlements ( 101 ) Balance at June 30, 2023 $ 336

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Assumptions Used in Black-Scholes Options Pricing Model at the Date of Grant	The fair value of warrants are estimated on the date of grant using the Black-Scholes pricing model with the following assumptions: 2023 2022 Expected dividend yield 0.0 % 0.0 % Risk free interest rate 3.9 %- 4.6 % 1.9 % Expected stock price volatility 20.6 %- 20.9 % 79.3 % Expected term (years) 2.5 10.0

Accounts Receivable (Tables)

Accounts Receivable (Tables)	6 Months Ended
	Jun. 30, 2023
Receivables [Abstract]
Summary of Accounts Receivable	Accounts receivable consists of the following: June 30, December 31, United States $ 5,587 $ 6,611 International 3,524 2,718 Total accounts receivable 9,111 9,329 Less: Allowance for expected credit losses ( 193 ) ( 227 ) Accounts receivable, net of expected credit losses $ 8,918 $ 9,102
Summary of Allowance for Credit Losses	A roll-forward of the Company’s allowance for credit losses from December 31, 2022 to June 30, 2023 is as follows: Balance at December 31, 2022 $ 227 Change in provision for credit losses ( 2 ) Write-offs (recoveries) of uncollectible balances ( 32 ) Balance at June 30, 2023 $ 193

Inventories (Tables)

Inventories (Tables)	6 Months Ended
	Jun. 30, 2023
Inventory Disclosure [Abstract]
Schedule of Inventory Balances, Net of Reserves	Inventory balances, net of reserves, consist of the following: June 30, December 31, Raw materials $ 13,279 $ 15,897 Finished goods 11,153 16,215 Component parts 712 868 Total inventories $ 25,144 $ 32,980

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in Carrying Amount of Goodwill	The changes in the carrying amount of goodwill during the six months ended June 30, 2023 is as follows: Goodwill Balance at December 31, 2022 $ 536 Foreign currency exchange rate changes 26 Balance at June 30, 2023 $ 562

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	6 Months Ended
	Jun. 30, 2023
Payables and Accruals [Abstract]
Schedule of Accrued Expenses and Other Current Liabilities	Accrued expenses and other current liabilities consist of the following: June 30, December 31, Operating lease liabilities, current portion $ 2,706 $ 2,313 Accrued bonuses 1,792 2,981 Accrued payroll and employee-related costs 906 938 Accrued taxes 842 1,322 Accrued interest 784 689 Accrued commissions 726 727 Accrued professional fees 571 621 Accrued vacation liability 509 601 Accrued termination benefits 508 2,474 Product warranty reserve 336 281 Accrued inventory 248 310 Accrued freight 203 422 Other 1,530 1,930 Total accrued expenses and other current liabilities $ 11,661 $ 15,609

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Schedule of Annual Principal Maturities of Term Loans	The annual principal maturities of the Company’s Fifth Amended SLR Loan Agreement as of June 30, 2023 are as follows: 2023 (remaining 6 months) $ - 2024 - 2025 - 2026 87,049 2027 17,409 Less: Unamortized deferred financing costs ( 2,638 ) Long-term loans payable $ 101,820

Commitments and Contingencies (

Commitments and Contingencies (Tables)	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Summary of Operating Lease Cost and Information Related to Operating Lease Liabilities	The following table presents operating lease cost and information related to operating lease liabilities for the periods indicated: Six Months Ended June 30, 2023 2022 Operating lease cost $ 1,075 $ 1,380 Variable lease cost 193 233 Total $ 1,268 $ 1,613 Operating cash flow impacts: Cash paid for amounts included in measurement of lease $ 1,556 $ 1,476 Operating right of use assets obtained in exchange for new $ - $ 1,254 Weighted average remaining lease term - operating leases 3.5 3.1 Weighted average discount rate - operating leases 9.2 % 8.1 %
Summary of Future Maturities of Lease Liabilities under Noncancelable Operating Leases	As of June 30, 2023, future maturities of lease liabilities under the Company’s noncancelable operating leases are as follows: Total Due 2023 (remaining 6 months) $ 1,616 2024 3,239 2025 1,299 2026 811 2027 525 Thereafter 1,133 Total payments 8,623 Less interest ( 1,409 ) Total present value of lease payments $ 7,214
Summary of Non-Cancellable Purchase Commitments	As of June 30, 2023, the Company has non-cancellable purchase commitments for inventories, capital equipment and services as follows: Total Due 2023 (remaining 6 months) $ 7,869 2024 2,650 2025 600 $ 11,119

Restructuring (Tables)

Restructuring (Tables)	6 Months Ended
	Jun. 30, 2023
Restructuring and Related Activities [Abstract]
Summary of Restructuring Activity	The following table summarizes the restructuring activity from December 31, 2022 to June 30, 2023: Termination Benefits Asset Impairments Total Balance at December 31, 2022 $ 2,474 $ - $ 2,474 April 2022 Restructuring costs incurred 24 180 204 August 2022 Restructuring costs incurred 32 252 284 Non-cash restructuring costs - ( 432 ) ( 432 ) Restructuring costs paid ( 1,914 ) - ( 1,914 ) Balance at March 31, 2023 $ 616 $ - $ 616 Restructuring costs paid ( 129 ) - ( 129 ) Balance at June 30, 2023 $ 487 $ - $ 487
Summary of Classification of Restructuring Expense, Including Related Impairment of Right-of-use Assets	The following table summarizes the classification of restructuring expense, including related impairment of right-of-use assets, in the condensed consolidated statements of comprehensive loss: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Cost of revenue $ - $ 480 $ 56 $ 480 Research and development - 566 - 888 Sales and marketing - 888 - 390 General and administrative - 390 - 566 Impairment of right-of-use assets - - 432 - Total restructuring expense $ - $ 2,324 $ 488 $ 2,324

Warrants (Tables)

Warrants (Tables)	6 Months Ended
	Jun. 30, 2023
Warrants and Rights Note Disclosure [Abstract]
Summary of Warrants Activity	The Company’s warrant activity is summarized as follows: Common Stock Warrants Number of Weighted Outstanding at December 31, 2022 124,514 $ 2.34 Warrants granted 26,800,998 0.97 Warrants exercised ( 2,592,121 ) - Outstanding at June 30, 2023 24,333,391 $ 1.08

Revenue (Tables)

Revenue (Tables)	6 Months Ended
	Jun. 30, 2023
Revenue from Contract with Customer [Abstract]
Net Revenue Disaggregated into Categories	Disaggregated Revenue The following table shows the Company’s net revenue disaggregated into categories the Company considers meaningful: Three Months Ended June 30, Six Months Ended June 30, 2023 2023 US International Total US International Total Net revenue by: Product revenue Capital equipment $ 2,518 $ 602 $ 3,120 $ 5,016 $ 1,412 $ 6,428 Disposable 7,878 3,049 10,927 17,226 6,118 23,344 Subtotal product revenue 10,396 3,651 14,047 22,242 7,530 29,772 Lease revenue Capital equipment 35 81 116 73 173 246 Other 305 105 410 660 213 873 Service and other revenue 1,111 353 1,464 2,131 746 2,877 Total net revenue $ 11,847 $ 4,190 $ 16,037 $ 25,106 $ 8,662 $ 33,768 Three Months Ended June 30, Six Months Ended June 30, 2022 2022 US International Total US International Total Net revenue by: Product revenue Capital equipment $ 1,093 $ 925 $ 2,018 $ 3,467 $ 1,709 $ 5,176 Disposable 5,839 2,074 7,913 16,910 5,882 22,792 Subtotal product revenue 6,932 2,999 9,931 20,377 7,591 27,968 Lease revenue Capital equipment 77 62 139 315 225 540 Other 328 83 411 721 181 902 Service and other revenue 2,161 329 2,490 4,584 599 5,183 Total net revenue $ 9,498 $ 3,473 $ 12,971 $ 25,997 $ 8,596 $ 34,593
Schedule of Changes in Contract Liabilities	The following table presents changes in contract liabilities during the six months ended June 30, 2023: Deferred Other Contract Balance at December 31, 2022 $ 1,021 $ 195 Additions 725 122 Subtractions ( 568 ) ( 194 ) Balance at June 30, 2023 $ 1,178 $ 123

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2023
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Summary of Allocated Stock Based Compensation Expense	Stock-based compensation expense was allocated based on the employees’ and non-employees’ functions as follows: Three Months Ended Six Months Ended 2023 2022 2023 2022 Cost of revenue $ 51 $ 199 $ 98 $ 427 Research and development 556 492 1,152 979 Sales and marketing 986 810 2,100 1,888 General and administrative 992 997 2,055 2,650 Total $ 2,585 $ 2,498 $ 5,405 $ 5,944
Schedule of Weighted Average Assumptions Used in Black-Scholes Options Pricing Model	The weighted average assumptions used in the Black-Scholes options pricing model are as follows: Six Months Ended June 30, 2023 2022 Expected dividend yield 0.0 % 0.0 % Risk free interest rate 3.9 % 2.6 % Expected stock price volatility 103.8 % 83.4 % Expected term (years) 6.1 6.3
Schedule of Fair Value of ESPP Used in Black-Scholes Options Pricing Model	The fair value of the purchase right for the ESPP option is estimated on the date of grant using the Black-Scholes pricing model with the following assumptions during 2023: Expected dividend yield 0.0 % Risk free interest rate 4.8 % Expected stock price volatility 192.5 % Expected term (years) 0.5
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Summary of Restricted Stock Units, Restricted Stock Awards and Performance Stock Units	A summary of restricted stock unit activity for the six months ended June 30, 2023 is as follows: Weighted Average Grant Date Shares Fair Value Unvested at December 31, 2022 1,320,306 $ 10.78 Granted 170,543 2.28 Vested ( 232,763 ) 17.83 Canceled ( 53,576 ) 7.89 Unvested at June 30, 2023 1,204,510 $ 8.34
Performance Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Summary of Restricted Stock Units, Restricted Stock Awards and Performance Stock Units	A summary of performance stock units activity for the six months ended June 30, 2023 is as follows: Weighted Average Grant Date Shares Fair Value Unvested at December 31, 2022 177,698 $ 18.78 Granted - - Vested - - Canceled - - Unvested at June 30, 2023 177,698 $ 18.78

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Schedule of Computation of Diluted Net Loss Per Share	The Company excluded the following potential shares of common stock, based on amounts outstanding at each period end, from the computation of diluted net loss per share for the periods indicated because including them would have had an anti-dilutive effect: As of June 30, 2023 2022 Warrants to purchase common stock 22,523,004 135,871 Options to purchase common stock 3,806,498 3,018,656 Unvested restricted stock units and 1,382,208 900,654 27,711,710 4,055,181

Subsequent Event (Tables)

Subsequent Event (Tables)	6 Months Ended
	Jun. 30, 2023
Subsequent Events [Abstract]
Schedule of Effect of the Reverse Stock Split on per Share and Weighted Average Common Shares Outstanding	The effect of the reverse stock split on per share amounts and weighted average common shares outstanding for each of the three and six months ended June 30, 2023 and 2022 on a pro forma basis are as follows: Three Months Ended June 30, Six Months Ended June 30, (unaudited) 2023 2022 2023 2022 Pro forma net loss per share - basic and diluted $ ( 2.34 ) $ ( 12.85 ) $ ( 5.76 ) $ ( 19.85 ) Pro forma weighted-average number of shares used 6,328,215 3,321,744 5,705,602 3,306,026

Description of Business - Addit

Description of Business - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Feb. 10, 2023	Jun. 30, 2023
Pre-Funded Warrants
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Warrants to purchase share of common stock		1,810,387
Warrants
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Warrants to purchase share of common stock		2,592,121
Warrants exercise price		$ 0.001
Private Placement | Common Stock
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Shares issued	17,502,244
Common stock price per share	$ 1.05
Proceeds from issuance of common stock	$ 23
Offering expenses	$ 2.1
Private Placement | Pre-Funded Warrants
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Warrants to purchase share of common stock	4,402,508
Warrant expiration year	30 years
Warrants exercise price	$ 0.001
Private Placement | Warrants
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Warrants to purchase share of common stock	21,904,752
Warrant expiration year	5 years
Warrants exercise price	$ 1.17

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2023 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2023 USD ($) Reportingunit Segment	Jun. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of reporting segment | Segment			1
Number of reporting units | Reportingunit			2
Maturity period of highly liquid investments with original maturities			90 days
Cash, cash equivalents and restricted cash balance	$ 19,109,000	$ 50,991,000	$ 19,109,000	$ 50,991,000	$ 16,847,000	$ 57,324,000
Standard product warranty period			1 year
Standard payment term to customer			30 days
Revenue, performance obligation, description of payment terms			When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying a practical expedient under ASC 606, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less.
Revenue	16,037,000	12,971,000	$ 33,768,000	34,593,000
Revenue, remaining performance obligation, amount	0	0	$ 0	$ 0
Dividend yield assumed			0%	0%
Provision (benefit) for income taxes	$ 25,000	(10,000)	$ 34,000	$ 82,000
Change in Accounting Principle, Accounting Standards Update, Adoption Date	Jan. 01, 2023		Jan. 01, 2023
Change in Accounting Principle, Accounting Standards Update, Adopted [true false]	true		true
Change in Accounting Principle, Accounting Standards Update, Immaterial Effect [true false]	true		true
Accounting Standards Update [Extensible Enumeration]			us-gaap:AccountingStandardsUpdate201613Member
Minimum
Summary Of Significant Accounting Policies [Line Items]
Vesting period			3 years
Maximum
Summary Of Significant Accounting Policies [Line Items]
Vesting period			4 years
Provision (benefit) for income taxes	$ 100,000	100,000	$ 100,000
Shipping and Handling
Summary Of Significant Accounting Policies [Line Items]
Shipping and handling costs	200,000	100,000	500,000	600,000
Service
Summary Of Significant Accounting Policies [Line Items]
Revenue		$ 1,000,000		$ 2,000,000
Prepaid Expenses and Other Current Assets
Summary Of Significant Accounting Policies [Line Items]
Current value of future lease payments	100,000		100,000
Prepaid Expenses and Other Current Assets | Maximum
Summary Of Significant Accounting Policies [Line Items]
Current value of future lease payments					100,000
Outside U.S.
Summary Of Significant Accounting Policies [Line Items]
Long-term assets	14,600,000		14,600,000		14,900,000
Cash, cash equivalents and restricted cash balance	1,100,000		1,100,000		1,000,000
Mexico
Summary Of Significant Accounting Policies [Line Items]
Long-term assets	$ 9,800,000		$ 9,800,000		$ 9,900,000

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Components of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022	Jun. 30, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Cash and cash equivalents	$ 18,000	$ 15,738
Restricted cash	1,109	1,109
Total cash, cash equivalents, and restricted cash	$ 19,109	$ 16,847	$ 50,991	$ 57,324

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Summary of Roll-Forward Warranty Liability (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Accounting Policies [Abstract]
Balance, beginning of period	$ 281
Provisions for warranty obligations	156
Settlements	(101)
Balance, end of period	$ 336

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Details) - USD ($)	Jun. 30, 2023	Mar. 31, 2023	Mar. 31, 2022
Class Of Warrant Or Right [Line Items]
Fair value, assets, transfers in and out of level 1, 2 or 3	$ 0
Fair value, liabilities, transfers in and out of level 1, 2 or 3	$ 0
Financing Arrangement | Common Stock Warrants
Class Of Warrant Or Right [Line Items]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights	385,361	108,377	107,373
Level 1 | Money Market Deposits
Class Of Warrant Or Right [Line Items]
Cash equivalents	$ 4,300,000

Fair Value Measurements - Sched

Fair Value Measurements - Schedule of Assumptions Used in Black-Scholes Options Pricing Model at the Date of Grant (Details)	Jun. 30, 2023	Jun. 30, 2022
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Expected term (years)	2 years 6 months	10 years
Expected Dividend Yield
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation	0	0
Risk Free Interest Rate
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation		1.9
Risk Free Interest Rate | Maximum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation	4.6
Risk Free Interest Rate | Minimum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation	3.9
Expected Stock Price Volatility
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation		79.3
Expected Stock Price Volatility | Maximum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation	20.9
Expected Stock Price Volatility | Minimum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Key inputs used in valuation	20.6

Accounts Receivable - Summary o

Accounts Receivable - Summary of Accounts Receivable (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Accounts Notes And Loans Receivable [Line Items]
Total accounts receivable	$ 9,111	$ 9,329
Less: Allowance for expected credit losses	(193)	(227)
Accounts receivable, net of expected credit losses	8,918	9,102
United States
Accounts Notes And Loans Receivable [Line Items]
Total accounts receivable	5,587	6,611
International
Accounts Notes And Loans Receivable [Line Items]
Total accounts receivable	$ 3,524	$ 2,718

Accounts Receivable - Summary_2

Accounts Receivable - Summary of Allowance for Credit Losses (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Accounts Notes And Loans Receivable [Line Items]
Balance at December 31,2022	$ 227
Change in provision for credit losses	(2)	$ 285
Balance at June 30, 2023	193
Uncollectible Balances
Accounts Notes And Loans Receivable [Line Items]
Write-offs (recoveries) of uncollectible balances	$ (32)

Accounts Receivable - Additiona

Accounts Receivable - Additional Information (Details) - Customer	6 Months Ended		12 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Net Revenue | Customer Concentration Risk | Customer
Accounts Notes And Loans Receivable [Line Items]
Number of customer accounted more than 10%	0	0
Accounts Receivable | Credit Concentration Risk
Accounts Notes And Loans Receivable [Line Items]
Number of customer accounted more than 10%			0
Accounts Receivable | Credit Concentration Risk | Two Customers
Accounts Notes And Loans Receivable [Line Items]
Number of customer accounted more than 10%	2
Concentration Risk, Percentage	23.80%

Inventories - Schedule of Inven

Inventories - Schedule of Inventory Balances, Net of Reserves (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 13,279	$ 15,897
Finished goods	11,153	16,215
Component parts	712	868
Total inventories	$ 25,144	$ 32,980

Inventories - Additional Inform

Inventories - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Inventory Disclosure [Abstract]
Provision for excess and obsolete inventory	$ 0.1	$ 0.7	$ 0.3	$ 0.8

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Goodwill
Beginning Balance	$ 536
Foreign currency exchange rate changes	26
Ending Balance	$ 562

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Additional Information (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Acquired Finite Lived Intangible Assets [Line Items]
Goodwill	$ 562,000		$ 562,000		$ 536,000
Impairment of goodwill	0	$ 14,701,000	0	$ 14,701,000
Impairment of intangible assets	0		0
Customer Relationships and Developed Technology
Acquired Finite Lived Intangible Assets [Line Items]
Impairment of intangible assets		$ 4,000,000
Impairment, Intangible Asset, Finite-Lived, Statement of Income or Comprehensive Income [Extensible Enumeration]		Impairment of intangible assets
Sales and Marketing
Acquired Finite Lived Intangible Assets [Line Items]
Amortization expense of intangible assets		$ 100,000		200,000
General and Administrative | Maximum
Acquired Finite Lived Intangible Assets [Line Items]
Amortization expense of intangible assets		100,000		$ 100,000
Operating Expenses
Acquired Finite Lived Intangible Assets [Line Items]
Amortization expense of intangible assets	0		0
Vapotherm Access and RespirCare
Acquired Finite Lived Intangible Assets [Line Items]
Impairment of goodwill		$ 14,700,000
Vapotherm Reporting Unit
Acquired Finite Lived Intangible Assets [Line Items]
Goodwill	$ 0		$ 0

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities - Schedule of Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Operating lease liabilities, current portion	$ 2,706	$ 2,313
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Total accrued expenses and other current liabilities	Total accrued expenses and other current liabilities
Accrued bonuses	$ 1,792	$ 2,981
Accrued payroll and employee-related costs	906	938
Accrued taxes	842	1,322
Accrued interest	784	689
Accrued commissions	726	727
Accrued professional fees	571	621
Accrued vacation liability	509	601
Accrued termination benefits	508	2,474
Product warranty reserve	336	281
Accrued inventory	248	310
Accrued freight	203	422
Other	1,530	1,930
Total accrued expenses and other current liabilities	$ 11,661	$ 15,609

Debt - Additional Information (

Debt - Additional Information (Details) - USD ($)									3 Months Ended	6 Months Ended
	Dec. 31, 2023	Jun. 30, 2023	Apr. 17, 2023	Feb. 10, 2023	Nov. 22, 2022	Sep. 30, 2022	Sep. 29, 2022	Feb. 18, 2022	Jun. 30, 2023	Jun. 30, 2023	Jun. 30, 2022
Debt Instrument [Line Items]
Loss on extinguishment of debt											$ 1,114,000
Warrants
Debt Instrument [Line Items]
Warrants to purchase share of common stock		2,592,121							2,592,121	2,592,121
Warrants exercise price		$ 0.001							$ 0.001	$ 0.001
SLR Investment Corporation ("SLR")
Debt Instrument [Line Items]
Warrants to purchase share of common stock					107,373	107,373
Warrants exercise price				$ 1.17	$ 0.48	$ 1.63
Subsidiary operating account balance			$ 250,000
Debt instrument, covenant description										The events of default under the Fifth Amended SLR Loan Agreement include, without limitation, and subject to customary grace periods, (1) the Company’s failure to make any payments of principal or interest under the Fifth Amended SLR Loan Agreement or any other loan documents, (2) the Company’s breach or default in the performance of any covenant under the Fifth Amended SLR Loan Agreement, (3) the occurrence of a material adverse effect or an event that is reasonably likely to result in a material adverse effect, (4) the existence of an attachment or levy on a material portion of the Company’s funds or of the Company’s subsidiaries, (5) the Company’s insolvency or bankruptcy, or (6) the occurrence of certain material defaults with respect to any other of our indebtedness in excess of $500,000. If an event of default occurs, SLR is entitled to take enforcement action, including an incremental 5% interest rate increase or acceleration of amounts due under the Fifth Amended SLR Loan Agreement (the “Mandatory Prepayment Option”). The Company determined the Mandatory Prepayment Option to be an embedded derivative that is required to be bifurcated from the Fifth Amended SLR Loan Agreement. The Company determined the combined probability of an event of default and SLR exercising the Mandatory Prepayment Option to be remote and deemed its fair value to be immaterial as of June 30, 2023. The Company re-evaluates the fair value of the Mandatory Prepayment Option at the end of each reporting period.
Minimum amount of other indebtedness		$ 500,000							$ 500,000	$ 500,000
Minimum liquidity covenant					$ 5,000,000	$ 20,000,000
Increase in incremental interest rate										5%
Facility exit fee payable, percentage on aggregate principal amount						7.45%	6.95%
Percentage of paid in kind interest rate			9%	9%
Paid in kind interest percentage in fee payment					10%
Paid in kind interest percentage in issuance of warrants					5%
Net cash equity proceeds raise threshold					$ 15,000,000
Minimum product revenue covenant					$ 25,000,000
Percentage of paid in kind interest rate reduced upon satisfaction of equity raise		4%							4%	4%
Amount paid in kind interest rate									$ 2,400,000	$ 4,500,000
Net cash equity proceeds		$ 25,000,000
Percentage of increase in paid in kind interest rate				1%
Strike price for warrants description				The Fourth Amendment also provides for a reset of the exercise price of the warrants to be issued in connection with the Company’s election of PIK Interest, including existing PIK Warrants, equal to the lower of the Company’s closing stock price for (a) the 10-day trailing average closing price ending on the day before the interest payment date, (b) the day before the interest payment date, or (c) $1.17 per share.
Payment of direct financing costs										2,100,000
SLR Investment Corporation ("SLR") | Warrants
Debt Instrument [Line Items]
Increase in percentage of times warrants granted option one				5%
Percentage of paid in kind interest rate option one				4%
Increase in percentage of times warrants granted option two				12.20%
Percentage of paid in kind interest rate option two				5%
Percentage of paid in kind interest provide for weighted average				9%
SLR Investment Corporation ("SLR") | Scenario Forecast
Debt Instrument [Line Items]
Percentage of paid in kind interest rate reduced upon satisfaction of equity raise	0%
Net cash equity proceeds	$ 30,000,000
SLR Investment Corporation ("SLR") | Maximum
Debt Instrument [Line Items]
Percentage of paid in kind interest rate				9%	8%
Percentage of paid in kind interest rate reduced upon satisfaction of equity raise					4%
SLR Investment Corporation ("SLR") | SLR Term A Loan Facility
Debt Instrument [Line Items]
Outstanding balance under loan		$ 104,500,000						$ 100,000,000	$ 104,500,000	$ 104,500,000
Warrants to purchase share of common stock								107,373
Warrants exercise price								$ 13.97
Debt instrument, interest rate										14.57%
Loan agreement, payment terms										The Fifth Amended SLR Loan Agreement provides for interest-only payments for the first 48 months following the Effective Date. Thereafter, principal payments on the Fifth Amended SLR Loan Agreement are due monthly in 12 equal installments; provided that the Company has the option to extend the interest-only period for an additional 12 months upon achievement of a certain minimum revenue level as more fully described in the Fifth Amended SLR Loan Agreement.
Percentage of paid in kind interest rate option one			4%
Percentage of paid in kind interest rate option two			0%
SLR Investment Corporation ("SLR") | SLR Term A Loan Facility | Minimum
Debt Instrument [Line Items]
Debt instrument rate			8.30%
Debt instrument, interest rate			1%
SLR Investment Corporation ("SLR") | SLR Term A Loan Facility | Maximum
Debt Instrument [Line Items]
Debt instrument rate			9.30%
SLR Investment Corporation ("SLR") | SLR Term B Loan Facility
Debt Instrument [Line Items]
Outstanding balance under loan								$ 25,000,000
Third Parties
Debt Instrument [Line Items]
Payment of direct financing costs										$ 1,600,000
February 18, 2023 to February 17, 2024 | SLR Investment Corporation ("SLR") | SLR Term A Loan Facility
Debt Instrument [Line Items]
Percentage of prepayment charge			2%
After February 18, 2024 but on or prior to February 1, 2027 | SLR Investment Corporation ("SLR") | SLR Term A Loan Facility
Debt Instrument [Line Items]
Percentage of prepayment charge			1%
Facility Exit Fee | SLR Investment Corporation ("SLR")
Debt Instrument [Line Items]
Facility exit fee payable, percentage on aggregate principal amount			7.45%
Facility exit fee			$ 7,500,000
Canadian Imperial Bank of Commerce Innovation Banking | CIBC Loan Agreement
Debt Instrument [Line Items]
Loss on extinguishment of debt								1,100,000
Canadian Imperial Bank of Commerce Innovation Banking | CIBC Loan Agreement | SLR Term A Loan Facility
Debt Instrument [Line Items]
Amount to pay off all obligations owing and termination of agreements								47,400,000
Canadian Imperial Bank of Commerce Innovation Banking | Revolving Credit Line
Debt Instrument [Line Items]
Outstanding balance under line of credit								12,000,000
Canadian Imperial Bank of Commerce Innovation Banking | Term Facility
Debt Instrument [Line Items]
Outstanding balance under line of credit								$ 40,000,000

Debt - Schedule of Annual Princ

Debt - Schedule of Annual Principal Maturities of Term Loans (Details) - Loans Payable - SLR Investment Corp ("SLR") $ in Thousands	Jun. 30, 2023 USD ($)
Debt Instrument [Line Items]
2023 (remaining 6 months)
2024
2025
2026	87,049
2027	17,409
Less: Unamortized deferred financing costs	(2,638)
Long-term loans payable	$ 101,820

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) $ in Millions	Jun. 30, 2023 USD ($)
Loss Contingencies [Line Items]
Obligation outstanding under guaranty agreement	$ 1.4

Commitments and Contingencies_2

Commitments and Contingencies - Summary of Operating Lease Cost and Information Related to Operating Lease Liabilities (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Lease cost:
Operating lease cost	$ 1,075	$ 1,380
Variable lease cost	193	233
Total	1,268	1,613
Operating cash flow impacts:
Cash paid for amounts included in measurement of lease liabilities	1,556	1,476
Operating right of use assets obtained in exchange for new operating lease liabilities	$ 0	$ 1,254
Weighted average remaining lease term - operating leases (in years)	3 years 6 months	3 years 1 month 6 days
Weighted average discount rate - operating leases	9.20%	8.10%

Commitments and Contingencies_3

Commitments and Contingencies - Summary of Future Maturities of Lease Liabilities under Noncancelable Operating Leases (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Commitments and Contingencies Disclosure [Abstract]
2023 (remaining 6 months)	$ 1,616
2024	3,239
2025	1,299
2026	811
2027	525
Thereafter	1,133
Total payments	8,623
Less interest	(1,409)
Total present value of lease payments	$ 7,214
Operating Lease, Liability, Statement of Financial Position [Extensible List]	us-gaap:OtherLiabilities

Commitments and Contingencies_4

Commitments and Contingencies - Summary of Non-Cancellable Purchase Commitments (Details) $ in Thousands	Jun. 30, 2023 USD ($)
Commitments and Contingencies Disclosure [Abstract]
2023 (remaining 6 months)	$ 7,869
2024	2,650
2025	600
Non cancellable purchase commitments	$ 11,119

Restructuring - Additional Info

Restructuring - Additional Information (Details) - USD ($)	3 Months Ended			6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Restructuring Cost and Reserve [Line Items]
Restructuring expenses	$ 0		$ 2,324,000	$ 488,000	$ 2,324,000
Impairment of right-of-use assets	$ 0		4,036,000	$ 432,000	4,036,000
Impairment of right of use assets			$ 0		$ 0
April 2022 Restructuring
Restructuring Cost and Reserve [Line Items]
Restructuring committed date				Apr. 27, 2022
Restructuring expenses		$ 204,000
April 2022 Restructuring | Domain Sublease Asset Group
Restructuring Cost and Reserve [Line Items]
Impairment of right-of-use assets				$ 200,000
April 2022 Restructuring | Impairments of Right-of-use Assets and Termination Benefits including Severance, Benefits and Other Payroll-Related Charges
Restructuring Cost and Reserve [Line Items]
Restructuring expenses				200,000
August 2022 Restructuring
Restructuring Cost and Reserve [Line Items]
Restructuring expenses		$ 284,000
August 2022 Restructuring | Vapotherm Access Asset Group
Restructuring Cost and Reserve [Line Items]
Impairment of right-of-use assets				200,000
August 2022 Restructuring | Impairments of Right-of-use Assets and Termination Benefits including Severance, Benefits and Other Payroll-Related Charges
Restructuring Cost and Reserve [Line Items]
Restructuring expenses				$ 300,000

Restructuring - Summary of Rest

Restructuring - Summary of Restructuring Activity (Details) - USD ($)	3 Months Ended			6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Restructuring Cost and Reserve [Line Items]
Balance	$ 616,000	$ 2,474,000		$ 2,474,000
Restructuring costs incurred	0		$ 2,324,000	488,000	$ 2,324,000
Non-cash restructuring costs		(432,000)
Restructuring costs paid	(129,000)	(1,914,000)
Balance	487,000	616,000		487,000
Termination Benefits
Restructuring Cost and Reserve [Line Items]
Balance	616,000	2,474,000		2,474,000
Non-cash restructuring costs		0
Restructuring costs paid	(129,000)	(1,914,000)
Balance	487,000	616,000		487,000
Asset Impairments
Restructuring Cost and Reserve [Line Items]
Balance	0	0		0
Non-cash restructuring costs		(432,000)
Restructuring costs paid	0	0
Balance	$ 0	0		$ 0
April 2022 Restructuring
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred		204,000
April 2022 Restructuring | Termination Benefits
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred		24,000
April 2022 Restructuring | Asset Impairments
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred		180,000
August 2022 Restructuring
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred		284,000
August 2022 Restructuring | Termination Benefits
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred		32,000
August 2022 Restructuring | Asset Impairments
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred		$ 252,000

Restructuring - Summary of Clas

Restructuring - Summary of Classification of Restructuring Expense, Including Related Impairment of Right-of-use Assets (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Restructuring Cost and Reserve [Line Items]
Total restructuring expense	$ 0	$ 2,324,000	$ 488,000	$ 2,324,000
Cost of Revenue
Restructuring Cost and Reserve [Line Items]
Total restructuring expense	0	480,000	56,000	480,000
Research and Development
Restructuring Cost and Reserve [Line Items]
Total restructuring expense	0	566,000	0	888,000
Sales and Marketing
Restructuring Cost and Reserve [Line Items]
Total restructuring expense	0	888,000	0	390,000
General and Administrative
Restructuring Cost and Reserve [Line Items]
Total restructuring expense	0	390,000	0	566,000
Impairment of Right-of-use Assets
Restructuring Cost and Reserve [Line Items]
Total restructuring expense	$ 0	$ 0	$ 432,000	$ 0

Warrants - Summary of Warrants

Warrants - Summary of Warrants Activity (Details) - Common Stock Warrants	6 Months Ended
	Jun. 30, 2023 $ / shares shares
Class of Warrant or Right [Line Items]
Number of shares, beginning balance	124,514
Number of shares, warrants granted	26,800,998
Number of shares, warrants exercised	(2,592,121)
Number of shares, ending balance	24,333,391
Weighted average exercise price, beginning balance | $ / shares	$ 2.34
Weighted average exercise price, warrants granted | $ / shares	0.97
Weighted average exercise price, ending balance | $ / shares	$ 1.08

Warrants - Additional Informati

Warrants - Additional Information (Details) - $ / shares	Jun. 30, 2023	Mar. 31, 2023	Feb. 28, 2023	Feb. 10, 2023	Dec. 31, 2022
Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants to purchase share of common stock	1,810,387
Pre-Funded Warrants | Private Placement
Class of Warrant or Right [Line Items]
Warrants to purchase share of common stock				4,402,508
Warrants exercise price				$ 0.001
Warrants
Class of Warrant or Right [Line Items]
Warrants to purchase share of common stock	2,592,121
Warrants exercise price	$ 0.001
Warrants | Private Placement
Class of Warrant or Right [Line Items]
Warrants to purchase share of common stock				21,904,752
Warrants exercise price				$ 1.17
Maximum | Pre-Funded Warrants | Private Placement
Class of Warrant or Right [Line Items]
Warrants and Rights Outstanding, Maturity Date			Feb. 10, 2053
Minimum | Warrants | Private Placement
Class of Warrant or Right [Line Items]
Warrants and Rights Outstanding, Maturity Date			Feb. 10, 2028
SLR Investment Corp ("SLR") | SLR Term A Loan Facility
Class of Warrant or Right [Line Items]
Warrants to purchase share of common stock	493,738
Warrants exercise price	$ 0.65
SLR Investment Corp ("SLR") | SLR Term A Loan Facility | Maximum
Class of Warrant or Right [Line Items]
Warrants and Rights Outstanding, Maturity Date	Jan. 03, 2033
SLR Investment Corp ("SLR") | SLR Term A Loan Facility | Minimum
Class of Warrant or Right [Line Items]
Warrants and Rights Outstanding, Maturity Date	Jun. 01, 2033
Common Stock Warrants
Class of Warrant or Right [Line Items]
Warrants exercise price	$ 1.08				$ 2.34
Common Stock Warrants | Periods ranging from June 10, 2024 through February 10, 2053 | Maximum
Class of Warrant or Right [Line Items]
Warrants exercise price		$ 14
Warrants and Rights Outstanding, Maturity Date		Feb. 10, 2053
Common Stock Warrants | Periods ranging from June 10, 2024 through February 10, 2053 | Minimum
Class of Warrant or Right [Line Items]
Warrants exercise price		$ 0.001
Warrants and Rights Outstanding, Maturity Date		Jun. 10, 2024

Revenue - Net Revenue Disaggreg

Revenue - Net Revenue Disaggregated into Categories (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Disaggregation Of Revenue [Line Items]
Total net revenue	$ 16,037	$ 12,971	$ 33,768	$ 34,593
US
Disaggregation Of Revenue [Line Items]
Total net revenue	11,847	9,498	25,106	25,997
International
Disaggregation Of Revenue [Line Items]
Total net revenue	4,190	3,473	8,662	8,596
Capital Equipment Product Revenue
Disaggregation Of Revenue [Line Items]
Total net revenue	3,120	2,018	6,428	5,176
Capital Equipment Product Revenue | US
Disaggregation Of Revenue [Line Items]
Total net revenue	2,518	1,093	5,016	3,467
Capital Equipment Product Revenue | International
Disaggregation Of Revenue [Line Items]
Total net revenue	602	925	1,412	1,709
Disposable Product Revenue
Disaggregation Of Revenue [Line Items]
Total net revenue	10,927	7,913	23,344	22,792
Disposable Product Revenue | US
Disaggregation Of Revenue [Line Items]
Total net revenue	7,878	5,839	17,226	16,910
Disposable Product Revenue | International
Disaggregation Of Revenue [Line Items]
Total net revenue	3,049	2,074	6,118	5,882
Product Revenue
Disaggregation Of Revenue [Line Items]
Total net revenue	14,047	9,931	29,772	27,968
Product Revenue | US
Disaggregation Of Revenue [Line Items]
Total net revenue	10,396	6,932	22,242	20,377
Product Revenue | International
Disaggregation Of Revenue [Line Items]
Total net revenue	3,651	2,999	7,530	7,591
Lease Revenue, Capital Equipment
Disaggregation Of Revenue [Line Items]
Total net revenue	116	139	246	540
Lease Revenue, Capital Equipment | US
Disaggregation Of Revenue [Line Items]
Total net revenue	35	77	73	315
Lease Revenue, Capital Equipment | International
Disaggregation Of Revenue [Line Items]
Total net revenue	81	62	173	225
Lease Revenue, Other
Disaggregation Of Revenue [Line Items]
Total net revenue	410	411	873	902
Lease Revenue, Other | US
Disaggregation Of Revenue [Line Items]
Total net revenue	305	328	660	721
Lease Revenue, Other | International
Disaggregation Of Revenue [Line Items]
Total net revenue	105	83	213	181
Service, Other
Disaggregation Of Revenue [Line Items]
Total net revenue	1,464	2,490	2,877	5,183
Service, Other | US
Disaggregation Of Revenue [Line Items]
Total net revenue	1,111	2,161	2,131	4,584
Service, Other | International
Disaggregation Of Revenue [Line Items]
Total net revenue	$ 353	$ 329	$ 746	$ 599

Revenue - Additional Informatio

Revenue - Additional Information (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Minimum
Disaggregation of Revenue [Line Items]
Percentage of revenue from contract with customer excluding assessed tax	10%	10%	10%	10%

Revenue - Schedule of Changes i

Revenue - Schedule of Changes in Contract Liabilities (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2023 USD ($)
Deferred Revenue
Balance at December 31, 2022	$ 1,021
Additions	725
Subtractions	(568)
Balance at June 30, 2023	1,178
Contract Liabilities
Balance at December 31, 2022	195
Additions	122
Subtractions	(194)
Balance at June 30, 2023	$ 123

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Allocated Stock Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	$ 2,585	$ 2,498	$ 5,405	$ 5,944
Cost of Revenue
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	51	199	98	427
Research and Development
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	556	492	1,152	979
Sales and Marketing
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	986	810	2,100	1,888
General and Administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	$ 992	$ 997	$ 2,055	$ 2,650

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - USD ($)	1 Months Ended	6 Months Ended
	Nov. 30, 2018	Jun. 30, 2023	Jun. 30, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock options/units, granted		848,575	1,223,550
Exercise price range, lower range limit		$ 1.21	$ 2.89
Exercise price range, upper range limit		2.7	20.71
Weighted average exercise price		2.65	6.68
Weighted average grant date fair value		$ 2.18	$ 4.72
Performance stock units percentage of a targeted number of shares, minimum		0%
Performance stock units percentage of a targeted number of shares, maximum		200%
2018 Equity Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock reserved for issuance		285,198
Employee Stock Purchase Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock reserved for issuance		907,751
Maximum percentage to purchase shares of eligible compensation a participant receives during each offering period	10%
Maximum amount of shares a participant can accrue at discounted rate of the fair market value.	$ 25,000
Maximum number of shares per participant	5,000
Purchase price as a percentage of its market price on first trading day of each offering period	85%

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Weighted Average Assumptions Used in Black-Scholes Options Pricing Model (Details)	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected dividend yield	0%	0%
Risk free interest rate	3.90%	2.60%
Expected stock price volatility	103.80%	83.40%
Expected term (years)	6 years 1 month 6 days	6 years 3 months 18 days

Stock-Based Compensation - Su_2

Stock-Based Compensation - Summary of Restricted Stock Units, Restricted Stock Awards and Performance Stock Units (Details)	6 Months Ended
	Jun. 30, 2023 $ / shares shares
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares, Unvested, Beginning balance | shares	1,320,306
Shares, Granted | shares	170,543
Shares, Vested | shares	(232,763)
Shares, Canceled | shares	(53,576)
Shares, Unvested Ending balance | shares	1,204,510
Weighted Average Grant Date Fair Value, Unvested, Beginning balance | $ / shares	$ 10.78
Weighted Average Grant Date Fair Value, Granted | $ / shares	2.28
Weighted Average Grant Date Fair Value, Vested | $ / shares	17.83
Weighted Average Grant Date Fair Value, Canceled | $ / shares	7.89
Weighted Average Grant Date Fair Value, Unvested Ending balance | $ / shares	$ 8.34
Performance Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares, Unvested, Beginning balance | shares	177,698
Shares, Unvested Ending balance | shares	177,698
Weighted Average Grant Date Fair Value, Unvested, Beginning balance | $ / shares	$ 18.78
Weighted Average Grant Date Fair Value, Unvested Ending balance | $ / shares	$ 18.78

Stock-Based Compensation - Sc_2

Stock-Based Compensation - Schedule of Fair Value of ESPP Used in Black-Scholes Options Pricing Model (Details)	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Expected dividend yield	0%	0%
Risk free interest rate	3.90%	2.60%
Expected stock price volatility	103.80%	83.40%
Expected term (years)	6 years 1 month 6 days	6 years 3 months 18 days
Employee Stock Purchase Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Expected dividend yield	0%
Risk free interest rate	4.80%
Expected stock price volatility	192.50%
Expected term (years)	6 months

Net Loss Per Share - Additional

Net Loss Per Share - Additional Information (Details)	Jun. 30, 2023 shares
Pre-Funded Warrants
Warrants to purchase share of common stock	1,810,387

Net Loss Per Share - Schedule o

Net Loss Per Share - Schedule of Computation of Diluted Net Loss Per Share (Details) - shares	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	27,711,710	4,055,181
Warrants to Purchase Common Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	22,523,004	135,871
Options to Purchase Common Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	3,806,498	3,018,656
Unvested restricted stock units and performance stock units
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	1,382,208	900,654

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Related Party Transaction [Line Items]
Revenues	$ 16,037	$ 12,971	$ 33,768	$ 34,593
Related Party
Related Party Transaction [Line Items]
Revenues	300		1,400	$ 100
Outstanding due	$ 200		$ 200		$ 0
Maximum | Related Party
Related Party Transaction [Line Items]
Revenues		$ 100

Subsequent Event - Additional I

Subsequent Event - Additional Information (Details)	Aug. 08, 2023	Jul. 20, 2023	Aug. 18, 2023 shares	Jun. 30, 2023 $ / shares shares	Dec. 31, 2022 $ / shares shares
Subsequent Event [Line Items]
Common stock, par value | $ / shares				$ 0.001	$ 0.001
Common stock, shares issued			49,081,339	49,047,502	28,516,047
Common stock, shares outstanding			49,081,339	49,047,502	28,516,047
Common stock, shares authorized				175,000,000	175,000,000
Scenario Forecast
Subsequent Event [Line Items]
Common stock, shares issued			6,135,000
Common stock, shares outstanding			6,135,000
Common stock, shares authorized			21,875,000
Subsequent Events
Subsequent Event [Line Items]
Stock split description	1-for-8
Subsequent Events | Common Stock | Minimum
Subsequent Event [Line Items]
Stock split description		1-for-3
Stock split ratio		3
Subsequent Events | Common Stock | Maximum
Subsequent Event [Line Items]
Stock split description		1-for-8
Stock split ratio		8

Subsequent Event - Summary of E

Subsequent Event - Summary of Effect of Reverse Stock Split on Per share and Weighted Average Common Shares Outstanding (Details) - Restated - $ / shares	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Schedule Of Earnings Per Share [Line Items]
Net loss per share - basic	$ (2.34)	$ (12.85)	$ (5.76)	$ (19.85)
Net loss per share - diluted	$ (2.34)	$ (12.85)	$ (5.76)	$ (19.85)
Weighted-average number of shares used in calculating net loss per share, basic	6,328,215	3,321,744	5,705,602	3,306,026
Weighted-average number of shares used in calculating net loss per share, diluted	6,328,215	3,321,744	5,705,602	3,306,026