Vapotherm (VAPO) 10-Q 5 Nov 19 2019 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2019	Nov. 01, 2019
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q3
Trading Symbol	VAPO
Entity Registrant Name	Vapotherm Inc
Entity Central Index Key	0001253176
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Common Stock, Shares Outstanding		21,084,008
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, $0.001 par value per share
Security Exchange Name	NYSE
Entity File Number	001-38740
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	46-2259298
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
Document Quarterly Report	true
Document Transition Report	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Current assets
Cash and cash equivalents	$ 83,522	$ 58,223
Accounts receivable, net	6,848	7,107
Inventory	10,844	13,710
Prepaid expenses and other current assets	2,067	2,683
Total current assets	103,281	81,723
Property and equipment, net	14,307	13,416
Restricted cash	1,852	1,799
Goodwill	539
Intangible assets, net	351
Other long-term assets	406	308
Total assets	120,736	97,246
Current liabilities
Accounts payable	1,644	3,148
Contract liabilities	123	79
Accrued expenses and other current liabilities	8,888	7,653
Short-term line of credit	2,912	3,163
Total current liabilities	13,567	14,043
Long-term loans payable	41,716	31,317
Deferred income tax liability	90
Other long-term liabilities	225	325
Total liabilities	55,598	45,685
Commitments and contingencies (Note 7)
Stockholders' equity
Preferred stock ($0.001 par value) 25,000,000 shares authorized; no shares issued and outstanding as of September 30, 2019 and December 31, 2018
Common stock ($0.001 par value) 175,000,000 shares authorized as of September 30, 2019 and December 31, 2018, 20,801,613 and 16,782,837 shares issued and outstanding as of September 30, 2019 and December 31, 2018, respectively	21	17
Additional paid-in capital	318,178	265,926
Accumulated deficit	(252,991)	(214,382)
Accumulated other comprehensive loss	(70)
Total stockholders' equity	65,138	51,561
Total liabilities and stockholders’ equity	$ 120,736	$ 97,246

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) (Unaudited) - $ / shares	Sep. 30, 2019	Dec. 31, 2018
Statement Of Financial Position [Abstract]
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	20,801,613	16,782,837
Common stock, shares outstanding	20,801,613	16,782,837

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Statement [Abstract]
Net revenue	$ 10,809	$ 9,389	$ 35,094	$ 30,691
Cost of goods sold	5,999	5,775	19,646	18,737
Gross profit	4,810	3,614	15,448	11,954
Operating expenses
Research and development	3,280	1,766	9,720	6,074
Sales and marketing	9,193	7,757	27,786	24,331
General and administrative	3,978	2,804	13,389	7,789
Loss on disposal of property and equipment		17		59
Total operating expenses	16,451	12,344	50,895	38,253
Loss from operations	(11,641)	(8,730)	(35,447)	(26,299)
Other (expense) income
Foreign currency loss	(28)		(37)	(2)
Interest income	242	8	658	21
Interest expense	(1,338)	(908)	(3,783)	(2,022)
Loss on extinguishment of debt				(1,842)
Gain on change in fair value of warrant liabilities		171		553
Net loss	(12,765)	(9,459)	(38,609)	(29,591)
Accretion of preferred stock to redemption value		(81)		(81)
Net loss attributable to common stockholders	$ (12,765)	$ (9,540)	$ (38,609)	$ (29,672)
Net loss per share attributable to common stockholders - basic and diluted	$ (0.65)	$ (10.90)	$ (2.16)	$ (35.59)
Other comprehensive loss, net of tax:
Foreign currency translation adjustments	$ (72)		$ (70)
Total other comprehensive loss	(72)		(70)
Total comprehensive loss	$ (12,837)	$ (9,459)	$ (38,679)	$ (29,591)
Weighted-average number of shares used in calculating net loss per share, basic and diluted	19,531,153	875,453	17,854,730	833,738

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF REDEEMABLE CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS' EQUITY (DEFICIT) (unaudited) - USD ($) $ in Thousands	Total	Redeemable Convertible Preferred Stock	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
Temporary equity, beginning balance at Dec. 31, 2017		$ 152,637
Temporary equity, beginning balance, shares at Dec. 31, 2017		10,515,351
Beginning balance at Dec. 31, 2017	$ (126,857)		$ 1	$ 45,056	$ (171,914)
Beginning balance, shares at Dec. 31, 2017			672,321
Temporary equity issuance of Series D redeemable convertible preferred stock, value		$ 9,919
Temporary equity issuance of Series D redeemable convertible preferred stock, shares		714,285
Net loss	(29,591)				(29,591)
Accretion of Series D issuance costs	(81)			(81)
Temporary equity accretion of Series D issuance costs		$ 81
Issuance of stock upon exercise of options	92			92
Issuance of stock upon exercise of options, shares			57,171
Issuance of restricted stock	150			150
Issuance of restricted stock, shares			89,623
Stock-based compensation expense	367			367
Ending balance at Sep. 30, 2018	(155,920)		$ 1	45,584	(201,505)
Ending balance, shares at Sep. 30, 2018			819,115
Temporary equity, ending balance at Sep. 30, 2018		$ 162,637
Temporary equity, ending balance, shares at Sep. 30, 2018		11,229,636
Temporary equity, beginning balance at Jun. 30, 2018		$ 152,637
Temporary equity, beginning balance, shares at Jun. 30, 2018		10,515,351
Beginning balance at Jun. 30, 2018	(146,585)		$ 1	45,460	(192,046)
Beginning balance, shares at Jun. 30, 2018			775,043
Temporary equity issuance of Series D redeemable convertible preferred stock, value		$ 9,919
Temporary equity issuance of Series D redeemable convertible preferred stock, shares		714,285
Net loss	(9,459)				(9,459)
Accretion of Series D issuance costs	(81)			(81)
Temporary equity accretion of Series D issuance costs		$ 81
Issuance of stock upon exercise of options	42			42
Issuance of stock upon exercise of options, shares			26,073
Issuance of restricted stock	30			30
Issuance of restricted stock, shares			17,999
Stock-based compensation expense	133			133
Ending balance at Sep. 30, 2018	(155,920)		$ 1	45,584	(201,505)
Ending balance, shares at Sep. 30, 2018			819,115
Temporary equity, ending balance at Sep. 30, 2018		$ 162,637
Temporary equity, ending balance, shares at Sep. 30, 2018		11,229,636
Beginning balance at Dec. 31, 2018	51,561		$ 17	265,926	(214,382)
Beginning balance, shares at Dec. 31, 2018			16,782,837
Net loss	(38,609)				(38,609)
Foreign currency translation adjustments	(70)					$ (70)
Issuance of common stock, value	48,308		$ 4	48,304
Issuance of common stock, shares			3,570,750
Issuance of common stock warrants	293			293
Issuance of stock upon repayment of non-recourse loans	144			144
Issuance of stock upon repayment of non-recourse loans, shares			79,854
Issuance of stock upon exercise of warrants, shares			12,164
Issuance of stock upon exercise of options	230			230
Issuance of stock upon exercise of options, shares			145,613
Issuance of restricted stock	526			526
Issuance of restricted stock, shares			210,395
Stock-based compensation expense	2,755			2,755
Ending balance at Sep. 30, 2019	65,138		$ 21	318,178	(252,991)	(70)
Ending balance, shares at Sep. 30, 2019			20,801,613
Beginning balance at Jun. 30, 2019	29,349		$ 17	269,556	(240,226)	2
Beginning balance, shares at Jun. 30, 2019			17,166,368
Net loss	(12,765)				(12,765)
Foreign currency translation adjustments	(72)					(72)
Issuance of common stock, value	48,308		$ 4	48,304
Issuance of common stock, shares			3,570,750
Issuance of stock upon exercise of options	37			37
Issuance of stock upon exercise of options, shares			22,848
Issuance of restricted stock	141			141
Issuance of restricted stock, shares			41,647
Stock-based compensation expense	140			140
Ending balance at Sep. 30, 2019	$ 65,138		$ 21	$ 318,178	$ (252,991)	$ (70)
Ending balance, shares at Sep. 30, 2019			20,801,613

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF REDEEMABLE CONVERTIBLE PREFERRED STOCK AND STOCKHOLDERS' EQUITY (DEFICIT) (Parenthetical) (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Stock issuance costs	$ 3,468		$ 3,468
Series D Preferred Stock
Stock issuance costs		$ 81		$ 81

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Cash flows from operating activities
Net loss	$ (38,609)	$ (29,591)
Adjustments to reconcile net loss to net cash used in operating activities
Depreciation and amortization	2,219	1,561
Stock-based compensation expense	2,755	367
Loss on disposal of property and equipment	112	306
Provision for bad debts	77	101
Loss on extinguishment of debt		1,842
Amortization of discount on debt	171	95
Change in fair value of warrants		(553)
Changes in operating assets and liabilities, net of acquisition:
Accounts receivable	616	896
Inventory	3,382	(1,082)
Prepaid expenses and other assets	528	(1,011)
Accounts payable	(1,551)	(336)
Contract liabilities	(31)	2
Accrued expenses and other current liabilities	1,801	(1,193)
Net cash used in operating activities	(28,530)	(28,596)
Cash flows from investing activities
Acquisition of business, net of cash acquired	(1,560)
Purchases of property and equipment	(3,132)	(3,997)
Net cash used in investing activities	(4,692)	(3,997)
Cash flows from financing activities
Issuance of common stock in connection with public offering of common stock, net of issuance costs	48,308
Proceeds on loans	10,500	30,374
Repayment of loans payable		(20,000)
Debt issuance costs	(322)
Short-term line of credit	(260)	(1,333)
Proceeds from issuance of redeemable convertible preferred stock, net		9,919
Proceeds from exercise of stock options and purchase of restricted stock	374	325
Net cash provided by financing activities	58,600	19,285
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(26)
Net increase (decrease) in cash, cash equivalents and restricted cash	25,352	(13,308)
Cash, cash equivalents and restricted cash
Beginning of period	60,022	28,360
End of period	85,374	15,052
Supplemental disclosures of cash flow information
Interest paid during the period	3,563	2,035
Issuance of warrants in conjunction with debt draw down	293
Property and equipment purchases in accrued expenses	$ 222	$ 472

Description of Business

Description of Business	9 Months Ended
	Sep. 30, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Description of Business	Vapotherm, Inc. (the “Company”) was founded in 1993 and reincorporated under the laws of the State of Delaware in 2013. Since inception, the Company has focused on the development and commercialization of its proprietary Hi-VNI Technology products that are used to treat patients of all ages suffering from respiratory distress. The Company’s Hi-VNI Technology delivers non-invasive ventilatory support by providing heated, humidified and oxygenated air at a high velocity to patients through a comfortable small-bore nasal interface. The Company’s Precision Flow systems, which use Hi-VNI 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 offers four versions of its Precision Flow systems: Precision Flow Hi-VNI, Precision Flow Plus, Precision Flow Classic and Precision Flow Heliox. The Company generates revenue primarily from sales of its Precision Flow systems, which include capital units and single-use disposables, and to a lesser extent, sales of its companion products, which include the Vapotherm Transfer Unit 2.0, the Q50 compressor and various adaptors. The Company sells Precision Flow systems to hospitals through a direct sales force in the United States and in the United Kingdom and through distributors in select other countries outside of the United States. In addition, the Company utilizes clinical educators who are typically experienced users of Hi-VNI Technology and who focus on medical education efforts to facilitate adoption and increase utilization. The Company is focused on physicians, respiratory therapists and nurses who work in acute hospital settings, including the emergency department and adult, pediatric and neonatal intensive care units (the “ICUs”). The Company’s relationship with these clinicians is particularly important, as it enables its products to follow patients through the care continuum. Since inception, the Company has financed its operations primarily through public offerings of its common stock, private placements of its convertible preferred stock, sales of its Precision Flow systems and amounts borrowed under its credit facilities. The Company has devoted the majority of its resources to research and development activities related to its Precision Flow systems, including regulatory initiatives and sales and marketing activities. The Company has invested heavily in its sales and marketing function by increasing the number of sales representatives and clinical educators to facilitate adoption and increase utilization of its Hi-VNI Technology products and expanded its digital marketing initiatives and medical education programs. The Company is subject to risks common to companies in the medical device industry, including, but not limited to, the successful development and commercialization of its Precision Flow products, fluctuations in operating results and financial risks, protection of proprietary knowledge and patent risks, dependence on key personnel and collaborative partners, competition, technological and manufacturing risks, customer acceptance and demand, compliance with the Food and Drug Administration and other governmental regulations, management of growth and effectiveness of marketing by the Company and by third parties. On November 16, 2018, the Company completed an initial public offering of 4,600,000 shares of common stock at a price of $14.00 per share, which raised net proceeds of $57.4 million after deducting the underwriting discount of $4.5 million and offering expenses of $2.5 million. On February 28, 2019, the Company acquired its United Kingdom based distributor. See Note 15 “Business Combinations” to these condensed consolidated financial statements for details of this transaction. In August 2019, the Company completed a public offering of 3,570,750 shares of common stock, which included the full exercise by the underwriters of their option to purchase 465,750 shares of common stock, at a price of $14.50 per share, which raised net proceeds of $48.3 million after deducting the underwriting discount of $3.1 million and offering expenses of $0.4 million.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2019
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, 2018 (the “2018 Form 10-K”). Our accounting policies are described in the “ Notes to Consolidated Financial Statements ” in our 2018 Form 10-K and updated, as necessary, in this report. The year-end 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 financial statements of Solus Medical Ltd. (“Solus”), a wholly owned subsidiary of the Company based in the United Kingdom, which was acquired in the first quarter of 2019. All intercompany accounts and transactions have been eliminated upon consolidation. 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, fair values of acquired assets and liabilities, including goodwill and intangibles assets, realizability of inventories, allowance for bad debt, accrued expenses and the valuation allowances against deferred income tax assets. Actual results may differ from these estimates. Unaudited Interim Financial Information The accompanying condensed condensed condensed Recently Adopted Accounting Pronouncements Statement of Cash Flows (Topic 230): Restricted Cash In November 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash (“ASU 2016-18”). ASU 2016-18 amends Accounting Standards Codification to add or clarify guidance on the classification and presentation of restricted cash in the statement of cash flows. The new standard requires cash and cash equivalents balances on the statement of cash flows to include restricted cash and cash equivalent balances. ASU 2016-18 requires the company to provide appropriate disclosures about its accounting policies pertaining to restricted cash in accordance with U.S. GAAP. Additionally, changes in restricted cash and restricted cash equivalents that result from transfers between cash, cash equivalents, and restricted cash and restricted cash equivalents should not be presented as cash flow activities in the statement of cash flows. A company with a material balance of amounts generally described as restricted cash and restricted cash equivalents must disclose information about the nature of the restrictions. The new standard is effective for interim and annual periods beginning after December 15, 2018. The Company had not previously included restricted cash as a component of cash and cash equivalents as presented on its consolidated statements of cash flows. The Company adopted the new standard in the first quarter of fiscal 2019, under the retrospective adoption method, and the prior year restricted cash presentation has been reclassified to conform to current year presentation. Clarifying the Definition of a Business (Topic 805): In January 2017, the FASB issued ASU No. 2017-01 Clarifying the Definition of a Business (Topic 805) Revenue from Contracts with Customers condensed Recently Issued Accounting Pronouncements Leases (Topic 842): In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) (“ASU 2016-02”). ASU 2016-02 establishes a comprehensive new lease accounting model. The new standard clarifies the definitions of a lease, requires a dual approach to lease classification similar to current lease classifications, and causes lessees to recognize leases on the balance sheet as a lease liability with a corresponding right-of-use asset for leases with a lease term of more than twelve months. In July 2019, the FASB issued a proposed ASU that would defer the effective date for ASU 2016-02 to interim and annual periods beginning after December 15, 2020. The Company is currently evaluating the period in which it intends to adopt the new standard. The new standard originally required a modified retrospective transition for capital or operating leases existing at or entered into after the beginning of the earliest comparative period presented in the financial statements, but it does not require transition accounting for leases that expire prior to the date of the initial application. In July 2018, the FASB issued ASU No. 2018-11 Leases (Topic 842) (“ASU 2018-11”) which provided another transition method in addition to the existing transition method by allowing entities to initially apply the new leases standard at the adoption date and recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption. The Company has not yet determined the effects, if any, that the adoptions of ASU 2016-02 and ASU 2018-11 may have on its financial position, results of operations, cash flows, or disclosures. 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”). This standard 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. In July 2019, the FASB issued a proposed ASU that would defer the effective date for ASU 2016-02 to interim and annual periods beginning after December 15, 2022. The Company has not yet determined the effects, if any, that the adoption of ASU 2016-13 may have on its financial position, results of operations, cash flows, or disclosures. Foreign Currency 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 our non-U.S. subsidiary that transacts 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 our 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’ equity. There were no assets or liabilities of foreign subsidiaries that were translated at period-end exchange rates as of December 31, 2018. See Note 15 “Business Combinations” to these condensed consolidated financial statements for details of the Solus acquisition. The f unctional currency for this entity is its local currency, Pound Sterling (GBP). 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. Intangible Assets Intangible assets related to customer agreements are amortized on a straight-line basis, over their useful lives. Amortization is recorded within sales and marketing expenses in the condensed Goodwill Goodwill represents the excess of purchase consideration over the fair value of net tangible and identifiable intangible assets acquired in a transaction accounted for using the purchase method of accounting. 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 the reporting unit exceeds the fair value of the reporting unit, the Company would record an impairment loss equal to the difference. As described in Note 14 “Segment Reporting”, the Company operates in one operating segment and has two reporting units, Vapotherm and Solus. Disaggregated Revenue The following table shows the Company’s net revenue disaggregated into categories the Company considers meaningful to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors: Three Months Ended September 30, Nine Months Ended September 30, 2019 2019 US International Total US International Total Net revenue by: Product Revenue Capital $ 1,408 $ 647 $ 2,055 $ 4,517 $ 2,198 $ 6,715 Disposable 5,962 1,865 7,827 20,023 5,353 25,376 Subtotal Product Revenue 7,370 2,512 9,882 24,540 7,551 32,091 Lease Revenue 463 - 463 1,410 - 1,410 Service and Other Revenue 202 262 464 812 781 1,593 Total Revenue $ 8,035 $ 2,774 $ 10,809 $ 26,762 $ 8,332 $ 35,094 Three Months Ended September 30, Nine Months Ended September 30, 2018 2018 US International Total US International Total Net revenue by: Product Revenue Capital $ 1,809 $ 570 $ 2,379 $ 5,317 $ 2,551 $ 7,868 Disposable 5,130 1,167 6,297 16,673 3,808 20,481 Subtotal Product Revenue 6,939 1,737 8,676 21,990 6,359 28,349 Lease Revenue 328 - 328 992 - 992 Service and Other Revenue 270 115 385 996 354 1,350 Total Revenue $ 7,537 $ 1,852 $ 9,389 $ 23,978 $ 6,713 $ 30,691 Service and other revenue includes sales of non-Vapotherm products sold by Solus. Net revenue by U.S. and International 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 revenue. Product Returns 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 time of sale. The Company provides its customers with the right to return products for a refund of the purchase price or for an account credit, if the return is made within a specified number of days from the original invoice date. The Company records a product return liability based upon an estimate of specific returns and a review of historical returns experienced. Adjustments are made to the product return liability as returns data and historical experience change. The provision for product return estimates is recorded as a reduction of revenue. The product return liability of less than $0.1 million is included in other current liabilities as of September 30, 2019. Stock Split On November 2, 2018, the Company’s Board of Directors and stockholders approved a 14:1 reverse stock split. The effect of this event has been reflected in all of the share quantities and per share amounts throughout these financial statements. The shares of common stock retained a par value of $0.001. Business Combinations The Company uses its best estimates and assumptions to assign fair value to the tangible and intangible assets acquired and liabilities assumed at the acquisition date. The Company’s estimates are inherently uncertain and subject to refinement. During the measurement period, which may be up to one year from the acquisition date, the Company may record adjustments to the fair value of these tangible and intangible assets acquired and liabilities assumed, with the corresponding offset to goodwill. In addition, uncertain tax positions and tax-related valuation allowances are initially recorded in connection with a business combination as of the acquisition date. The Company continues to collect information and re-evaluates these estimates and assumptions quarterly and records any adjustments to the Company’s preliminary estimates to goodwill provided that the Company is within the measurement period. Upon the conclusion of the measurement period or final determination of the fair value of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments will be recorded in the Company’s condensed Property and Equipment Property and equipment are recorded at cost. Depreciation is recognized over the estimated useful lives of the related assets using the straight-line method for consolidated financial statement purposes. The Company uses other depreciation methods (generally, accelerated depreciation methods) for tax purposes, where appropriate. Amortization of leasehold improvements is computed using the straight-line method over the shorter of the remaining lease term or the estimated useful lives of the improvements and is included in depreciation expense. When impairment indicators are present, the Company evaluates the recoverability of its long-lived assets. If the assessment indicates an impairment, the affected assets are written down to fair value. Repairs and maintenance are expensed as incurred. Expenditures that increase the value or productive capacity of assets are capitalized. When property and equipment are retired, sold, or otherwise disposed of, the asset’s carrying amount and related accumulated depreciation are removed from the accounts and any gain or loss is included in operating expenses. The lives used in computing straight-line depreciation for financial reporting purposes are as follows: Number of Years Property and equipment placed in service: Equipment 3 - 7 Furniture 5 - 7 Manufacturing equipment 3 - 10 Software 3 Demonstration, placements and evaluation units 3 - 5 Leasehold improvements Lesser of life of lease or 10 years The Company’s policy is to periodically review the estimated useful life of all property and equipment. This review during fiscal year 2019 indicated that the estimated useful life of all property and equipment is consistent with fiscal year 2018, with the exception of manufacturing equipment. The maximum useful life increased from 7 years to 10 years. 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 September 30, 2019, $0.3 million of our $85.4 million of cash, cash equivalents and restricted cash balance was located outside the U.S. 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: September 30, 2019 December 31, 2018 Cash and cash equivalents $ 83,522 $ 58,223 Restricted cash 1,852 1,799 Total cash, cash equivalents, and restricted cash $ 85,374 $ 60,022

Accounts Receivable

Accounts Receivable	9 Months Ended
	Sep. 30, 2019
Receivables [Abstract]
Accounts Receivable	3. Accounts Receivable Accounts receivable owed to the Company by its customers and distributors consists of the following: September 30, 2019 December 31, 2018 United States $ 4,743 $ 4,948 International 2,364 2,493 Total accounts receivable 7,107 7,441 Less: Allowance for doubtful accounts (259 ) (334 ) Accounts receivable, net of allowance for doubtful accounts $ 6,848 $ 7,107 No individual customer accounted for 10% or more of revenue for the three or nine months ended September 30, 2019 or September 30, 2018. No individual customers accounted for 10% or more of total accounts receivable at either September 30, 2019 or December 31, 2018.

Financial Instruments

Financial Instruments	9 Months Ended
	Sep. 30, 2019
Investments All Other Investments [Abstract]
Financial Instruments	4. Financial Instruments As of September 30, 2019 and December 31, 2018, the Company’s financial instruments were comprised of cash, accounts receivables, accounts payable and debt, the carrying amounts of which approximated fair value due to the short-term nature and market interest rates. The Company’s cash equivalents primarily consist of money market deposits which total approximately $80.6 million at September 30, 2019 and are valued based on Level 1 of the fair value hierarchy. As described in Note 12 “Warrants”, during 2019, the Company granted warrants to purchase 19,790 shares of common stock in connection with an amendment to its financing arrangement described in Note 6 “Debt”. These equity-classified warrants were valued using the Black-Scholes pricing model, which falls within Level 3 of the fair value hierarchy. The assumptions used in the Black-Scholes pricing model were as follows at the date of grant: Expected dividend yield 0.0 % Risk free interest rate 2.4 % Expected stock price volatility 60.9 % Expected term (years) 10.0

Inventories

Inventories	9 Months Ended
	Sep. 30, 2019
Inventory Disclosure [Abstract]
Inventories	5. Inventories Inventories as of September 30, 2019 and December 31, 2018 consist of the following: September 30, 2019 December 31, 2018 Component parts $ 5,838 $ 5,601 Finished goods 5,006 8,109 Total inventory $ 10,844 $ 13,710

Debt

Debt	9 Months Ended
	Sep. 30, 2019
Debt Disclosure [Abstract]
Debt	6. Debt Revolving Credit Line On November 16, 2016, the Company entered a Business Financing Agreement (the “Revolver Agreement”) with Western Alliance Bank, an Arizona Corporation, which replaced its then existing revolving line of credit. The Revolver Agreement made available $7.0 million of revolving credit upon the closing date. Availability under the Revolver Agreement is calculated based upon 80% of the eligible receivables (net of pre-paid deposits, pre-billed invoices, other offsets, and contras related to each specific account debtor). The original maturity date was September 30, 2018. The Company refinanced the Revolver Agreement in April 2018, increasing the credit line to $7.5 million and extending the maturity date to September 30, 2020. The principal is due upon maturity. On March 22, 2019, the Company entered into an amendment to the (as amended, the “Amended Revolver Agreement”), which increased the allowable permitted indebtedness under the Amended Revolver Agreement in connection with the Company’s credit card program from $0.3 million to $0.5 million. At September 30, 2019, the interest rate was 6.75%. The outstanding balance under the Amended Revolver Agreement was $2.9 million at September 30, 2019 and there was $0.3 million remaining availability based on eligible receivables. At December 31, 2018, the interest rate was 7.3%. The outstanding balance under the Revolver Agreement Term Loans On November 16, 2016, the Company entered into a Loan and Security Agreement (the “Loan Agreement”) with Solar Capital Ltd. (“Solar”). Pursuant to the Loan Agreement, a total of $20.0 million was available in three tranches. The first tranche was drawn down in the amount of $10.0 million upon closing which paid off the Company’s then existing term loan balance of $6.0 million in full. The Company achieved the minimum revenue threshold required to draw down the second tranche of $5.0 million of term debt financing and obtained a signed term sheet for an equity financing in excess of $10.0 million, which allowed the Company to draw down the third and final tranche of $5.0 million term debt financing. The Company drew down $5.0 million tranches in each of January 2017 and March 2017. The Company pledged all assets as collateral with a double negative pledge on intellectual property. On April 6, 2018, the Company entered into a Credit Agreement and Guaranty (the “Credit Agreement and Guaranty”) with Perceptive Credit Holdings II, LP (“Perceptive”). Pursuant to the Credit Agreement and Guaranty, a total of $42.5 million was available in three tranches. The first tranche was drawn down in the amount of $20.0 million on the closing date, April 6, 2018, which paid off the Loan Agreement in full. On July 20, 2018, pursuant to the Credit Agreement and Guaranty, the Company drew down the second tranche of $10.0 million. In connection with this draw down, the Company granted Perceptive warrants to purchase 18,846 shares of Series D preferred stock which were converted into warrants to purchase shares of common stock at the time of the initial public offering. The warrants have an exercise price of $15.92 per share, were fully vested upon issuance, exercisable at the option of the holder, in whole or in part, and expire in July 2028. On September 27, 2018, the Company entered into the first amendment to the Credit Agreement and Guaranty (the “Amendment”, together with the Credit Agreement and Guaranty, the “Amended Credit Agreement and Guaranty”) with Perceptive. Pursuant to the Amended Credit Agreement and Guaranty, the Company was permitted to draw the final $12.5 million of availability at any time through March 31, 2019 and the minimum 2018 revenue requirement of $43.2 million that was required to draw down the final tranche was eliminated. Concurrently with the closing of the Amendment, the Company drew down $2.0 million of the remaining $12.5 million available. In connection with this draw down, the Company granted to Perceptive warrants to purchase 3,769 shares of its Series D preferred stock which were converted into warrants to purchase shares of common stock at the time of the initial public offering. The warrants have an exercise price of $15.92 per share, were fully vested upon issuance, are exercisable at the option of the holder, in whole or in part, and expire in September 2028. As of December 31, 2018, the Company had drawn $32.0 million of the $42.5 million available under the Credit Agreement and Guaranty, and on March 22, 2019, the Company drew the remaining $10.5 million. In connection with this draw down, the Company granted Perceptive warrants to purchase 19,790 shares of common stock. The warrants have an exercise price of $15.92 per share, were fully vested upon issuance, are exercisable at the option of the holder, in whole or in part, and expire in March 2029. On March 22, 2019, the Company entered into a second amendment to the Amended Credit Agreement and Guaranty increasing the allowable permitted indebtedness in connection with the Company’s credit card program from $0.3 million to $0.5 million. Pursuant to the Amended Credit Agreement and Guaranty, the outstanding principal amount accrues interest at an annual rate equal to 9.06% plus the greater of (a) one-month LIBOR and (b) 1.75% per year. At September 30, 2019, the interest rate was 11.19%. The outstanding balance, including accretion of the additional final payment due upon maturity and described below, was $42.6 million at September 30, 2019 and there was no remaining availability. On the maturity date, in addition to the payment of principal and accrued interest, the Company will be required to make a payment of 0.5% of the total amount borrowed under the Amended Credit and Guaranty Agreement unless the Company has already made such a payment in connection with an acceleration or prepayment of borrowings under the agreement. The Amended Credit Agreement and Guaranty requires the Company to comply with a minimum liquidity covenant at all times and a minimum revenue covenant measured at the end of each fiscal quarter. As of September 30, 2019, the Company was in compliance with all covenants. The annual principal maturities of the Amended Credit Agreement and Guaranty as of September 30, 2019 are as follows: 2019 $ - 2020 - 2021 - 2022 - 2023 42,560 Less: Discount on loans payable (844 ) Long-term loans payable $ 41,716

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2019
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	7. Commitments and Contingencies 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 is currently engaged in a litigation with Engineered Medical Systems, Inc. (“EMS”), a former supplier of a component of our Precision Flow systems. EMS filed a complaint against the Company in Indiana state court on June 12, 2018 alleging breach of contract and other causes of action and seeking damages of at least $800,000 and all other forms of just and appropriate relief. This matter was subsequently removed to the United States District Court for the Southern District of Indiana. The Company filed a complaint against EMS in Superior Court in Rockingham County, New Hampshire on June 15, 2018 alleging breach of contract, violation of the New Hampshire Consumer Protection Act, and other causes of action and seeking damages of at least $2.1 million and all other forms of just and appropriate relief. Each party filed a motion to dismiss against the other party’s complaint. EMS’ motion to dismiss in Superior Court in Rockingham County, New Hampshire was denied and discovery is now underway in the New Hampshire matter. Following this decision, EMS withdrew its complaint in Indiana. The Company does not believe this matter will have a material adverse impact on its operations or financial condition. The Company believes there are no other litigation pending that could have, individually, or in the aggregate, a material adverse effect on the results of its operations or financial condition.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Income Taxes	8. Income Taxes There is no provision for income taxes for the three or nine months ended September 30, 2019 or September 30, 2018 because the Company has historically incurred operating losses and maintains a full valuation allowance against its net deferred tax assets. Utilization of the net operating loss and research and development credit carryforwards may be subject to a substantial annual limitation under Section 382 of the Internal Revenue Code of 1986 due to ownership change limitations that have occurred previously or that could occur in the future. On February 28, 2019, the Company acquired all outstanding equity securities of Solus. For the period from March 1, 2019 to September 30, 2019, Solus had a book loss of $0.5 million, resulting from revenue of $1.7 million. Due to the short period of ownership, and related book loss, the tax provision for Solus is immaterial.

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock-Based Compensation	9. Stock-Based Compensation On January 23, 2019, the Company established a French Qualifying Subplan which allows for the granting of stock options to purchase shares of common stock for employees and officers who are residents of France. The options under the French Qualifying Subplan reside under the umbrella of the 2018 Stock Incentive Plan. The fair value of each option grant is estimated using the Black-Scholes option pricing model. 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. For performance-based awards, related compensation cost is amortized over the performance period on an accelerated attribution basis. Compensation expense associated with performance awards are based upon the 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, net of estimated forfeitures. Cumulative adjustments are recorded each quarter to reflect estimated outcome of the performance-related conditions until the date results are determined and settled. The weighted average assumptions used in the Black-Scholes options pricing model are as follows: Nine Months Ended September 30, 2019 2018 Expected dividend yield 0.0 % 0.0 % Risk free interest rate 2.1 % 2.6 % Expected stock price volatility 63.5 % 58.9 % Expected term (years) 6.2 5.8 Stock-based compensation expense was allocated based on the employees’ and non-employees’ functions as follows: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Cost of goods sold $ 9 $ 5 $ 147 $ 23 Research and development 11 11 266 39 Sales and marketing (102 ) 60 657 134 General and administrative 222 57 1,685 171 Total $ 140 $ 133 $ 2,755 $ 367 Stock Options The Company granted options to purchase 871,346 shares of common stock at exercise prices ranging from $13.35 to $19.40 per share, with a weighted average exercise price of $17.36 per share, during the nine months ended September 30, 2019. The Company granted options to purchase 345,948 shares of common stock at exercise prices ranging from $1.68 to $3.78 per share, with a weighted average exercise price of $2.27 per share, during the nine months ended September 30, 2018. The weighted average fair value of stock options granted during the nine months ended September 30, 2019 and 2018 was $10.88 and $1.27, respectively. Restricted Stock A summary of restricted stock activity for the nine months ended September 30, 2019 is as follows: Weighted Average Grant Date Shares Fair Value Unvested at December 31, 2018 399,485 $ 1.68 Granted/purchased 78,476 17.54 Vested (210,395 ) 3.31 Canceled - - Unvested at September 30, 2019 267,566 $ 4.02

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2019
Earnings Per Share [Abstract]
Earnings Per Share	10. Earnings Per Share Net Loss per Share The Company excluded the following potential common shares, based on amounts outstanding at each period end, from the computation of diluted net loss per share attributable to common stockholders for the periods indicated because including them would have had an anti-dilutive effect: As of September 30, 2019 2018 Options to purchase common stock 1,407,448 757,635 Warrants to purchase redeemable convertible preferred stock (as converted to common stock) 182,076 230,296 Unvested restricted stock 267,566 604,455 Redeemable convertible preferred stock (as converted to common stock) - 11,143,571 1,857,090 12,735,957

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2019
Related Party Transactions [Abstract]
Related Party Transactions	11. Related Party Transactions As described in Note 15 “Redeemable Convertible Preferred Stock In connection with our initial public offering in November 2018, all outstanding redeemable convertible preferred stock converted to common stock on a one-to-one basis. The Company has two stockholders that are vendors of the Company. The total amount billed from these vendors during both the three months ended September 30, 2019 and 2018 was less than $0.1 million. The total amount billed from these vendors during the nine months ended September 30, 2019 and 2018 was less than $0.1 million and $1.2 million, respectively. The accounts payable balance for these vendors was $0.5 million as of both September 30, 2019 and December 31, 2018. In addition, the Company sells its products to a hospital customer who is an affiliate of a current stockholder. The total amount billed to this customer during the three months ended September 30, 2019 and 2018 was $0.3 million and $0.5 million, respectively. The total amount billed to this customer during the nine months ended September 30, 2019 and 2018 was $1.0 million and $1.6 million, respectively. The accounts receivable balance for this customer was $0.1 million as of September 30, 2019 and December 31, 2018, respectively. All transactions are at arms’ length and occur at published list prices.

Warrants

Warrants	9 Months Ended
	Sep. 30, 2019
Warrants And Rights Note Disclosure [Abstract]
Warrants	12. Warrants Common Stock Warrants Number of Shares Weighted Average Exercise Price Outstanding at December 31, 2018 230,295 $ 14.50 Warrants granted 19,790 15.92 Warrants exercised (68,009 ) (14.00 ) Outstanding at September 30, 2019 182,076 $ 14.84 On March 22, 2019, in connection with an amendment to the Credit Agreement and Guaranty as further described in Note 6 “Debt”, the Company granted warrants to purchase 19,790 shares of common stock. The warrants have an exercise price of $15.92 per share, were fully vested upon issuance, are exercisable at the option of the holder, in whole or in part, and expire in March 2029. The estimated fair value at the time of issuance was approximately $0.3 million, and is recorded as a discount against the principal owed on the related debt, and is being amortized over the contractual term of the debt instrument. During 2019, warrants to purchase 68,009 shares of common stock were net exercised, which resulted in the issuance of 12,164 shares of common stock.

Stockholders' Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2019
Equity [Abstract]
Stockholders' Equity	13. Stockholders’ Equity Preferred Stock As of September 30, 2019 and December 31, 2018, the Company has authorized 25,000,000 shares of preferred stock, respectively, at a par value of $0.001. As of September 30, 2019 and December 31, 2018, there were no shares of preferred stock outstanding. Prior to the Company’s initial public offering in November 2018, the Company had redeemable convertible preferred stock (Series A, B, C and D) outstanding. In connection with the initial public offering, all outstanding redeemable convertible preferred stock converted to common stock on a one-to-one basis. Common Stock As of September 30, 2019 and December 31, 2018, the Company has authorized 175,000,000 shares of common stock, respectively, at a par value of $0.001. Each share of common stock is entitled to one vote. The holders of common stock are also entitled to receive dividends whenever funds are legally available and when declared by the Board of Directors, subject to the prior rights of holders of all classes of stock outstanding.

Segment Reporting

Segment Reporting	9 Months Ended
	Sep. 30, 2019
Segment Reporting [Abstract]
Segment Reporting	14. Segment Reporting 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 Solus. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance. All assets are in the United States, United Kingdom or at contracted suppliers.

Business Combinations

Business Combinations	9 Months Ended
	Sep. 30, 2019
Business Combinations [Abstract]
Business Combinations	15. Business Combinations On February 28, 2019, the Company completed the acquisition of all outstanding equity securities of Solus Medical Ltd. (“Solus”) . The Company has not yet finalized the purchase accounting for the Solus acquisition. The following table summarizes the preliminary purchase price allocation that includes the fair values of the separately identifiable assets acquired and liabilities assumed as of February 28, 2019: Cash $ 466 Accounts receivable 411 Inventory 492 Prepaids and other assets 11 Property and equipment 1 Goodwill 584 Intangible assets 455 Total assets acquired 2,420 Accounts payable and accrued expenses (222 ) Contract liabilities (75 ) Deferred taxes (97 ) Total liabilities assumed (394 ) Total purchase price $ 2,026 The excess of purchase consideration over the fair value of net tangible and identifiable intangible assets acquired was recorded as goodwill. The fair values assigned to tangible and identifiable intangible assets acquired and liabilities assumed are based on management’s estimates and assumptions. The fair values of assets acquired and liabilities assumed, including income taxes payable and deferred taxes, may be subject to change as additional information is received and certain tax returns are finalized. Accordingly, the provisional measurements of fair value of the income taxes payable and deferred taxes set forth above are subject to change. The Company expects to finalize the valuation as soon as practicable, but not later than one year from the acquisition date. In determining the purchase price allocation, the Company considered, among other factors, the opportunity provided by a supplier agreement with the National Health Service. The fair value of the intangible assets associated with this agreement were estimated using a discounted cash flow method with the application of the multi-period excess earnings method. Under this method, an intangible asset’s fair value is equal to the present value of the incremental after-tax cash flows attributable to only the subject intangible assets after deducting contributory asset charges. An income and expenses forecast was built based upon specific intangible asset revenue and expense estimates. The rate used to discount the estimated future net cash flows to their present values for each intangible asset was based upon a weighted average cost of capital calculation. The discount rate was determined after consideration of market rates of return on debt and equity capital, the weighted average return on invested capital and the risk associated with achieving forecasted sales related to the assets acquired from Solus. The total weighted average amortization period for the intangible assets is approximately 3.83 years. The intangible assets are being amortized on a straight-line basis, which is consistent with the pattern that the economic benefits of the intangible assets are expected to be utilized based upon estimated cash flows generated from such assets. Goodwill associated with the acquisition was primarily attributable to the market expansion opportunity in the United Kingdom. The goodwill attributable to the United Kingdom jurisdiction is not deductible for tax purposes. The Company has included the financial results of Solus in the condensed consolidated financial statements from the date of acquisition. The transaction costs associated with the acquisition were approximately $0.2 million and were recorded in general and administrative expense as incurred. Pro Forma Financial Information The following unaudited pro forma information for the three and nine months ended September 30, 2019 and 2018, respectively, presents consolidated information as if the Solus acquisition occurred on January 1, 2018, which is the first day of the Company’s fiscal year 2018: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Net revenue $ 10,809 $ 9,985 $ 35,331 $ 32,826 Net loss $ (12,765 ) $ (9,840 ) $ (38,895 ) $ (30,416 ) Net loss per share, basic $ (0.65 ) $ (11.24 ) $ (2.18 ) $ (36.48 )

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	16. Goodwill and Intangible Assets The changes in the carrying amount of goodwill and intangible assets during 2019 are as follows: Goodwill Intangible Assets Balance at December 31, 2018 $ - $ - Acquired during the period 584 455 Amortization - (69 ) Foreign currency exchange rate changes (45 ) (35 ) Balance at September 30, 2019 $ 539 $ 351 The following table presents a summary of acquired intangible assets: As of September 30, 2019 Period of amortization Gross Carrying Amount Accumulated Amortization Customer agreements 3.83 $ 420 $ 69 Total identifiable intangible assets $ 420 $ 69 The Company recognized less than $0.1 million of amortization expense within sales and marketing expenses related to the intangible assets during both the three and nine months ended September 30, 2019. The Company did not recognize any amortization expense related to the intangible assets during either the three or nine months ended September 30, 2018 as the assets were acquired as part of the acquisition of Solus in February 2019 The estimated amortization expense for intangible assets for each of the five succeeding fiscal years is as follows: Estimated Amortization Expense: Remainder of 2019 $ 27 2020 108 2021 108 2022 108 Total $ 351

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2019
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, 2018 (the “2018 Form 10-K”). Our accounting policies are described in the “ Notes to Consolidated Financial Statements ” in our 2018 Form 10-K and updated, as necessary, in this report. The year-end 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 financial statements of Solus Medical Ltd. (“Solus”), a wholly owned subsidiary of the Company based in the United Kingdom, which was acquired in the first quarter of 2019. All intercompany accounts and transactions have been eliminated upon consolidation.
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, fair values of acquired assets and liabilities, including goodwill and intangibles assets, realizability of inventories, allowance for bad debt, accrued expenses and the valuation allowances against deferred income tax assets. Actual results may differ from these estimates.
Unaudited Interim Financial Information	Unaudited Interim Financial Information The accompanying condensed condensed condensed
Recently Adopted and Issued Accounting Pronouncements	Recently Adopted Accounting Pronouncements Statement of Cash Flows (Topic 230): Restricted Cash In November 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash (“ASU 2016-18”). ASU 2016-18 amends Accounting Standards Codification to add or clarify guidance on the classification and presentation of restricted cash in the statement of cash flows. The new standard requires cash and cash equivalents balances on the statement of cash flows to include restricted cash and cash equivalent balances. ASU 2016-18 requires the company to provide appropriate disclosures about its accounting policies pertaining to restricted cash in accordance with U.S. GAAP. Additionally, changes in restricted cash and restricted cash equivalents that result from transfers between cash, cash equivalents, and restricted cash and restricted cash equivalents should not be presented as cash flow activities in the statement of cash flows. A company with a material balance of amounts generally described as restricted cash and restricted cash equivalents must disclose information about the nature of the restrictions. The new standard is effective for interim and annual periods beginning after December 15, 2018. The Company had not previously included restricted cash as a component of cash and cash equivalents as presented on its consolidated statements of cash flows. The Company adopted the new standard in the first quarter of fiscal 2019, under the retrospective adoption method, and the prior year restricted cash presentation has been reclassified to conform to current year presentation. Clarifying the Definition of a Business (Topic 805): In January 2017, the FASB issued ASU No. 2017-01 Clarifying the Definition of a Business (Topic 805) Revenue from Contracts with Customers condensed Recently Issued Accounting Pronouncements Leases (Topic 842): In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) (“ASU 2016-02”). ASU 2016-02 establishes a comprehensive new lease accounting model. The new standard clarifies the definitions of a lease, requires a dual approach to lease classification similar to current lease classifications, and causes lessees to recognize leases on the balance sheet as a lease liability with a corresponding right-of-use asset for leases with a lease term of more than twelve months. In July 2019, the FASB issued a proposed ASU that would defer the effective date for ASU 2016-02 to interim and annual periods beginning after December 15, 2020. The Company is currently evaluating the period in which it intends to adopt the new standard. The new standard originally required a modified retrospective transition for capital or operating leases existing at or entered into after the beginning of the earliest comparative period presented in the financial statements, but it does not require transition accounting for leases that expire prior to the date of the initial application. In July 2018, the FASB issued ASU No. 2018-11 Leases (Topic 842) (“ASU 2018-11”) which provided another transition method in addition to the existing transition method by allowing entities to initially apply the new leases standard at the adoption date and recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption. The Company has not yet determined the effects, if any, that the adoptions of ASU 2016-02 and ASU 2018-11 may have on its financial position, results of operations, cash flows, or disclosures. 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”). This standard 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. In July 2019, the FASB issued a proposed ASU that would defer the effective date for ASU 2016-02 to interim and annual periods beginning after December 15, 2022. The Company has not yet determined the effects, if any, that the adoption of ASU 2016-13 may have on its financial position, results of operations, cash flows, or disclosures.
Foreign Currency	Foreign Currency 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 our non-U.S. subsidiary that transacts 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 our 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’ equity. There were no assets or liabilities of foreign subsidiaries that were translated at period-end exchange rates as of December 31, 2018. See Note 15 “Business Combinations” to these condensed consolidated financial statements for details of the Solus acquisition. The f unctional currency for this entity is its local currency, Pound Sterling (GBP). 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.
Intangible Assets	Intangible Assets Intangible assets related to customer agreements are amortized on a straight-line basis, over their useful lives. Amortization is recorded within sales and marketing expenses in the condensed
Goodwill	Goodwill Goodwill represents the excess of purchase consideration over the fair value of net tangible and identifiable intangible assets acquired in a transaction accounted for using the purchase method of accounting. 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 the reporting unit exceeds the fair value of the reporting unit, the Company would record an impairment loss equal to the difference. As described in Note 14 “Segment Reporting”, the Company operates in one operating segment and has two reporting units, Vapotherm and Solus.
Disaggregated Revenue	Disaggregated Revenue The following table shows the Company’s net revenue disaggregated into categories the Company considers meaningful to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors: Three Months Ended September 30, Nine Months Ended September 30, 2019 2019 US International Total US International Total Net revenue by: Product Revenue Capital $ 1,408 $ 647 $ 2,055 $ 4,517 $ 2,198 $ 6,715 Disposable 5,962 1,865 7,827 20,023 5,353 25,376 Subtotal Product Revenue 7,370 2,512 9,882 24,540 7,551 32,091 Lease Revenue 463 - 463 1,410 - 1,410 Service and Other Revenue 202 262 464 812 781 1,593 Total Revenue $ 8,035 $ 2,774 $ 10,809 $ 26,762 $ 8,332 $ 35,094 Three Months Ended September 30, Nine Months Ended September 30, 2018 2018 US International Total US International Total Net revenue by: Product Revenue Capital $ 1,809 $ 570 $ 2,379 $ 5,317 $ 2,551 $ 7,868 Disposable 5,130 1,167 6,297 16,673 3,808 20,481 Subtotal Product Revenue 6,939 1,737 8,676 21,990 6,359 28,349 Lease Revenue 328 - 328 992 - 992 Service and Other Revenue 270 115 385 996 354 1,350 Total Revenue $ 7,537 $ 1,852 $ 9,389 $ 23,978 $ 6,713 $ 30,691 Service and other revenue includes sales of non-Vapotherm products sold by Solus. Net revenue by U.S. and International 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 revenue.
Product Returns	Product Returns 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 time of sale. The Company provides its customers with the right to return products for a refund of the purchase price or for an account credit, if the return is made within a specified number of days from the original invoice date. The Company records a product return liability based upon an estimate of specific returns and a review of historical returns experienced. Adjustments are made to the product return liability as returns data and historical experience change. The provision for product return estimates is recorded as a reduction of revenue. The product return liability of less than $0.1 million is included in other current liabilities as of September 30, 2019.
Stock Split	Stock Split On November 2, 2018, the Company’s Board of Directors and stockholders approved a 14:1 reverse stock split. The effect of this event has been reflected in all of the share quantities and per share amounts throughout these financial statements. The shares of common stock retained a par value of $0.001.
Business Combinations	Business Combinations The Company uses its best estimates and assumptions to assign fair value to the tangible and intangible assets acquired and liabilities assumed at the acquisition date. The Company’s estimates are inherently uncertain and subject to refinement. During the measurement period, which may be up to one year from the acquisition date, the Company may record adjustments to the fair value of these tangible and intangible assets acquired and liabilities assumed, with the corresponding offset to goodwill. In addition, uncertain tax positions and tax-related valuation allowances are initially recorded in connection with a business combination as of the acquisition date. The Company continues to collect information and re-evaluates these estimates and assumptions quarterly and records any adjustments to the Company’s preliminary estimates to goodwill provided that the Company is within the measurement period. Upon the conclusion of the measurement period or final determination of the fair value of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments will be recorded in the Company’s condensed
Property and Equipment	Property and Equipment Property and equipment are recorded at cost. Depreciation is recognized over the estimated useful lives of the related assets using the straight-line method for consolidated financial statement purposes. The Company uses other depreciation methods (generally, accelerated depreciation methods) for tax purposes, where appropriate. Amortization of leasehold improvements is computed using the straight-line method over the shorter of the remaining lease term or the estimated useful lives of the improvements and is included in depreciation expense. When impairment indicators are present, the Company evaluates the recoverability of its long-lived assets. If the assessment indicates an impairment, the affected assets are written down to fair value. Repairs and maintenance are expensed as incurred. Expenditures that increase the value or productive capacity of assets are capitalized. When property and equipment are retired, sold, or otherwise disposed of, the asset’s carrying amount and related accumulated depreciation are removed from the accounts and any gain or loss is included in operating expenses. The lives used in computing straight-line depreciation for financial reporting purposes are as follows: Number of Years Property and equipment placed in service: Equipment 3 - 7 Furniture 5 - 7 Manufacturing equipment 3 - 10 Software 3 Demonstration, placements and evaluation units 3 - 5 Leasehold improvements Lesser of life of lease or 10 years The Company’s policy is to periodically review the estimated useful life of all property and equipment. This review during fiscal year 2019 indicated that the estimated useful life of all property and equipment is consistent with fiscal year 2018, with the exception of manufacturing equipment. The maximum useful life increased from 7 years to 10 years.
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 September 30, 2019, $0.3 million of our $85.4 million of cash, cash equivalents and restricted cash balance was located outside the U.S. 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: September 30, 2019 December 31, 2018 Cash and cash equivalents $ 83,522 $ 58,223 Restricted cash 1,852 1,799 Total cash, cash equivalents, and restricted cash $ 85,374 $ 60,022

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2019
Accounting Policies [Abstract]
Net Revenue Disaggregated into Categories	The following table shows the Company’s net revenue disaggregated into categories the Company considers meaningful to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors: Three Months Ended September 30, Nine Months Ended September 30, 2019 2019 US International Total US International Total Net revenue by: Product Revenue Capital $ 1,408 $ 647 $ 2,055 $ 4,517 $ 2,198 $ 6,715 Disposable 5,962 1,865 7,827 20,023 5,353 25,376 Subtotal Product Revenue 7,370 2,512 9,882 24,540 7,551 32,091 Lease Revenue 463 - 463 1,410 - 1,410 Service and Other Revenue 202 262 464 812 781 1,593 Total Revenue $ 8,035 $ 2,774 $ 10,809 $ 26,762 $ 8,332 $ 35,094 Three Months Ended September 30, Nine Months Ended September 30, 2018 2018 US International Total US International Total Net revenue by: Product Revenue Capital $ 1,809 $ 570 $ 2,379 $ 5,317 $ 2,551 $ 7,868 Disposable 5,130 1,167 6,297 16,673 3,808 20,481 Subtotal Product Revenue 6,939 1,737 8,676 21,990 6,359 28,349 Lease Revenue 328 - 328 992 - 992 Service and Other Revenue 270 115 385 996 354 1,350 Total Revenue $ 7,537 $ 1,852 $ 9,389 $ 23,978 $ 6,713 $ 30,691
Lives Used in Computing Straight-Line Depreciation	The lives used in computing straight-line depreciation for financial reporting purposes are as follows: Number of Years Property and equipment placed in service: Equipment 3 - 7 Furniture 5 - 7 Manufacturing equipment 3 - 10 Software 3 Demonstration, placements and evaluation units 3 - 5 Leasehold improvements Lesser of life of lease or 10 years
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: September 30, 2019 December 31, 2018 Cash and cash equivalents $ 83,522 $ 58,223 Restricted cash 1,852 1,799 Total cash, cash equivalents, and restricted cash $ 85,374 $ 60,022

Accounts Receivable (Tables)

Accounts Receivable (Tables)	9 Months Ended
	Sep. 30, 2019
Receivables [Abstract]
Summary of Accounts Receivable Owned to Company by Customers and Distributors	Accounts receivable owed to the Company by its customers and distributors consists of the following: September 30, 2019 December 31, 2018 United States $ 4,743 $ 4,948 International 2,364 2,493 Total accounts receivable 7,107 7,441 Less: Allowance for doubtful accounts (259 ) (334 ) Accounts receivable, net of allowance for doubtful accounts $ 6,848 $ 7,107

Financial Instruments (Tables)

Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2019
Warrants
Schedule of Assumptions Used in Black-Scholes Options Pricing Model at the Date of Grant	The assumptions used in the Black-Scholes pricing model were as follows at the date of grant: Expected dividend yield 0.0 % Risk free interest rate 2.4 % Expected stock price volatility 60.9 % Expected term (years) 10.0

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2019
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories as of September 30, 2019 and December 31, 2018 consist of the following: September 30, 2019 December 31, 2018 Component parts $ 5,838 $ 5,601 Finished goods 5,006 8,109 Total inventory $ 10,844 $ 13,710

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2019
Debt Disclosure [Abstract]
Schedule of Annual Principal Maturities of Amended Credit Agreement and Guaranty	The annual principal maturities of the Amended Credit Agreement and Guaranty as of September 30, 2019 are as follows: 2019 $ - 2020 - 2021 - 2022 - 2023 42,560 Less: Discount on loans payable (844 ) Long-term loans payable $ 41,716

Income Taxes (Tables)

Income Taxes (Tables)	9 Months Ended
	Sep. 30, 2019
Income Tax Disclosure [Abstract]
Schedule of Reconciliation of Income Tax Expense (Benefit)	Error extracting Word content
Significant Components of Net Deferred Tax Asset	Error extracting Word content

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
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: Nine Months Ended September 30, 2019 2018 Expected dividend yield 0.0 % 0.0 % Risk free interest rate 2.1 % 2.6 % Expected stock price volatility 63.5 % 58.9 % Expected term (years) 6.2 5.8
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 September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Cost of goods sold $ 9 $ 5 $ 147 $ 23 Research and development 11 11 266 39 Sales and marketing (102 ) 60 657 134 General and administrative 222 57 1,685 171 Total $ 140 $ 133 $ 2,755 $ 367
Summary of Restricted Stock Activity	Restricted Stock A summary of restricted stock activity for the nine months ended September 30, 2019 is as follows: Weighted Average Grant Date Shares Fair Value Unvested at December 31, 2018 399,485 $ 1.68 Granted/purchased 78,476 17.54 Vested (210,395 ) 3.31 Canceled - - Unvested at September 30, 2019 267,566 $ 4.02

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 2019
Earnings Per Share [Abstract]
Schedule of Computation of Diluted Net Loss Per Share Attributable to Common Stockholders	The Company excluded the following potential common shares, based on amounts outstanding at each period end, from the computation of diluted net loss per share attributable to common stockholders for the periods indicated because including them would have had an anti-dilutive effect: As of September 30, 2019 2018 Options to purchase common stock 1,407,448 757,635 Warrants to purchase redeemable convertible preferred stock (as converted to common stock) 182,076 230,296 Unvested restricted stock 267,566 604,455 Redeemable convertible preferred stock (as converted to common stock) - 11,143,571 1,857,090 12,735,957

Warrants (Tables)

Warrants (Tables)	9 Months Ended
	Sep. 30, 2019
Warrants And Rights Note Disclosure [Abstract]
Summary of Warrants	Common Stock Warrants Number of Shares Weighted Average Exercise Price Outstanding at December 31, 2018 230,295 $ 14.50 Warrants granted 19,790 15.92 Warrants exercised (68,009 ) (14.00 ) Outstanding at September 30, 2019 182,076 $ 14.84

Business Combinations (Tables)

Business Combinations (Tables)	9 Months Ended
	Sep. 30, 2019
Business Combinations [Abstract]
Summary of Preliminary Purchase Price Allocation	The following table summarizes the preliminary purchase price allocation that includes the fair values of the separately identifiable assets acquired and liabilities assumed as of February 28, 2019: Cash $ 466 Accounts receivable 411 Inventory 492 Prepaids and other assets 11 Property and equipment 1 Goodwill 584 Intangible assets 455 Total assets acquired 2,420 Accounts payable and accrued expenses (222 ) Contract liabilities (75 ) Deferred taxes (97 ) Total liabilities assumed (394 ) Total purchase price $ 2,026
Summary of Business Acquisition Pro Forma Information	The following unaudited pro forma information for the three and nine months ended September 30, 2019 and 2018, respectively, presents consolidated information as if the Solus acquisition occurred on January 1, 2018, which is the first day of the Company’s fiscal year 2018: Three Months Ended September 30, Nine Months Ended September 30, 2019 2018 2019 2018 Net revenue $ 10,809 $ 9,985 $ 35,331 $ 32,826 Net loss $ (12,765 ) $ (9,840 ) $ (38,895 ) $ (30,416 ) Net loss per share, basic $ (0.65 ) $ (11.24 ) $ (2.18 ) $ (36.48 )

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Schedule of Changes in Carrying Amount of Goodwill and Intangible Assets	The changes in the carrying amount of goodwill and intangible assets during 2019 are as follows: Goodwill Intangible Assets Balance at December 31, 2018 $ - $ - Acquired during the period 584 455 Amortization - (69 ) Foreign currency exchange rate changes (45 ) (35 ) Balance at September 30, 2019 $ 539 $ 351
Summary of Acquired Intangible Assets	The following table presents a summary of acquired intangible assets: As of September 30, 2019 Period of amortization Gross Carrying Amount Accumulated Amortization Customer agreements 3.83 $ 420 $ 69 Total identifiable intangible assets $ 420 $ 69
Schedule of Estimated Amortization Expense for Intangible Assets	The estimated amortization expense for intangible assets for each of the five succeeding fiscal years is as follows: Estimated Amortization Expense: Remainder of 2019 $ 27 2020 108 2021 108 2022 108 Total $ 351

Description of Business - Addit

Description of Business - Additional Information (Details) - Common Stock - USD ($) $ / shares in Units, $ in Millions	Nov. 16, 2018	Aug. 31, 2019	Sep. 30, 2019	Sep. 30, 2019
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Number of shares issued			3,570,750	3,570,750
Initial Public Offering
Organization Consolidation And Presentation Of Financial Statements [Line Items]
Number of shares issued	4,600,000	3,570,750
Public offering price of common stock	$ 14	$ 14.50
Proceeds from initial offering net of underwriting discounts and offering costs	$ 57.4	$ 48.3
Underwriting discount	4.5	3.1
Offering expenses	$ 2.5	$ 0.4
Exercise of underwriters option to purchase shares		465,750

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details)	Nov. 02, 2018$ / shares	Sep. 30, 2019USD ($)Segment$ / shares	Dec. 31, 2018USD ($)$ / shares	Sep. 30, 2018USD ($)	Dec. 31, 2017USD ($)
Summary Of Significant Accounting Policies [Line Items]
Number of operating segment | Segment		1
Number of reporting units | Segment		2
Standard product warranty period		1 year
Reverse stock split	14
Common stock, par value | $ / shares	$ 0.001	$ 0.001	$ 0.001
Cash, cash equivalents and restricted cash balance		$ 85,374,000	$ 60,022,000	$ 15,052,000	$ 28,360,000
Outside U.S.
Summary Of Significant Accounting Policies [Line Items]
Cash, cash equivalents and restricted cash balance		300,000
Maximum
Summary Of Significant Accounting Policies [Line Items]
Product return liability		$ 100,000
Maximum | Manufacturing Equipment
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of property and equipment		10 years	7 years
Minimum | Manufacturing Equipment
Summary Of Significant Accounting Policies [Line Items]
Estimated useful life of property and equipment		3 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Net Revenue Disaggregated into Categories (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Disaggregation Of Revenue [Line Items]
Total Revenue	$ 10,809	$ 9,389	$ 35,094	$ 30,691
US
Disaggregation Of Revenue [Line Items]
Total Revenue	8,035	7,537	26,762	23,978
International
Disaggregation Of Revenue [Line Items]
Total Revenue	2,774	1,852	8,332	6,713
Product Revenue, Capital
Disaggregation Of Revenue [Line Items]
Total Revenue	2,055	2,379	6,715	7,868
Product Revenue, Capital | US
Disaggregation Of Revenue [Line Items]
Total Revenue	1,408	1,809	4,517	5,317
Product Revenue, Capital | International
Disaggregation Of Revenue [Line Items]
Total Revenue	647	570	2,198	2,551
Product Revenue, Disposable
Disaggregation Of Revenue [Line Items]
Total Revenue	7,827	6,297	25,376	20,481
Product Revenue, Disposable | US
Disaggregation Of Revenue [Line Items]
Total Revenue	5,962	5,130	20,023	16,673
Product Revenue, Disposable | International
Disaggregation Of Revenue [Line Items]
Total Revenue	1,865	1,167	5,353	3,808
Subtotal Product Revenue
Disaggregation Of Revenue [Line Items]
Total Revenue	9,882	8,676	32,091	28,349
Subtotal Product Revenue | US
Disaggregation Of Revenue [Line Items]
Total Revenue	7,370	6,939	24,540	21,990
Subtotal Product Revenue | International
Disaggregation Of Revenue [Line Items]
Total Revenue	2,512	1,737	7,551	6,359
Lease Revenue
Disaggregation Of Revenue [Line Items]
Total Revenue	463	328	1,410	992
Lease Revenue | US
Disaggregation Of Revenue [Line Items]
Total Revenue	463	328	1,410	992
Service and Other Revenue
Disaggregation Of Revenue [Line Items]
Total Revenue	464	385	1,593	1,350
Service and Other Revenue | US
Disaggregation Of Revenue [Line Items]
Total Revenue	202	270	812	996
Service and Other Revenue | International
Disaggregation Of Revenue [Line Items]
Total Revenue	$ 262	$ 115	$ 781	$ 354

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Lives Used in Computing Straight-Line Depreciation (Details)	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Dec. 31, 2018
Equipment | Minimum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	3 years
Equipment | Maximum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	7 years
Furniture | Minimum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	5 years
Furniture | Maximum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	7 years
Manufacturing Equipment | Minimum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	3 years
Manufacturing Equipment | Maximum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	10 years	7 years
Software | Minimum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	3 years
Demonstration, Placements and Evaluation Units | Minimum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	3 years
Demonstration, Placements and Evaluation Units | Maximum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	5 years
Leasehold Improvements
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Term	Lesser of life of lease or 10 years
Leasehold Improvements | Maximum
Property Plant And Equipment [Line Items]
Property and equipment placed in service, Number of years	10 years

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Components of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018	Sep. 30, 2018	Dec. 31, 2017
Accounting Policies [Abstract]
Cash and cash equivalents	$ 83,522	$ 58,223
Restricted cash	1,852	1,799
Total cash, cash equivalents, and restricted cash	$ 85,374	$ 60,022	$ 15,052	$ 28,360

Accounts Receivable - Summary o

Accounts Receivable - Summary of Accounts Receivable Owned to Company by Customers and Distributors (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Accounts Notes And Loans Receivable [Line Items]
Total accounts receivable	$ 7,107	$ 7,441
Less: Allowance for doubtful accounts	(259)	(334)
Accounts receivable, net of allowance for doubtful accounts	6,848	7,107
US
Accounts Notes And Loans Receivable [Line Items]
Total accounts receivable	4,743	4,948
International
Accounts Notes And Loans Receivable [Line Items]
Total accounts receivable	$ 2,364	$ 2,493

Accounts Receivable - Additiona

Accounts Receivable - Additional Information (Details) - Customer Concentration Risk - Customer	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Revenue
Accounts Notes And Loans Receivable [Line Items]
Number of customer accounted more than 10%	0	0	0	0
Percentage of concentration risk	10.00%	10.00%	10.00%	10.00%
Accounts Receivable
Accounts Notes And Loans Receivable [Line Items]
Number of customer accounted more than 10%			0		0
Percentage of concentration risk			10.00%		10.00%

Financial Instruments - Additio

Financial Instruments - Additional Information (Details) - USD ($) $ in Millions	Sep. 30, 2019	Mar. 22, 2019
Amendment To Financing Arrangement | Common Stock Warrants
Class Of Warrant Or Right [Line Items]
Granted warrants to purchase shares		19,790
Level 1 | Money Market Deposits
Class Of Warrant Or Right [Line Items]
Cash equivalents	$ 80.6

Financial Instruments - Schedul

Financial Instruments - Schedule of Assumptions Used in Black-Scholes Options Pricing Model at the Date of Grant (Details)	Sep. 30, 2019
Class Of Warrant Or Right [Line Items]
Expected term (years)	10 years
Expected Dividend Yield
Class Of Warrant Or Right [Line Items]
Key inputs used in valuation	0
Risk Free Interest Rate
Class Of Warrant Or Right [Line Items]
Key inputs used in valuation	0.024
Expected Stock Price Volatility
Class Of Warrant Or Right [Line Items]
Key inputs used in valuation	0.609

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Component parts	$ 5,838	$ 5,601
Finished goods	5,006	8,109
Total inventory	$ 10,844	$ 13,710

Debt - Additional Information (

Debt - Additional Information (Details)

Mar. 22, 2019USD ($)$ / sharesshares

Dec. 31, 2018USD ($)

Sep. 27, 2018USD ($)$ / sharesshares

Jul. 20, 2018USD ($)$ / sharesshares

Apr. 06, 2018USD ($)Tranche$ / sharesshares

Nov. 16, 2016USD ($)Tranche

Apr. 30, 2018USD ($)

Mar. 31, 2017USD ($)

Jan. 31, 2017USD ($)

Sep. 30, 2019USD ($)

Sep. 30, 2018USD ($)

Mar. 21, 2019USD ($)

Debt Instrument [Line Items]

Proceeds from term loan

$ 10,500,000

$ 30,374,000

Repayment of term loan balance

$ 20,000,000

Western Alliance Bank | Revolving Credit Line | Revolver Agreement

Debt Instrument [Line Items]

Line of credit made available under agreement

$ 7,000,000

$ 7,500,000

Percentage of eligible receivables used as base to calculate line of credit availability

80.00%

Line of credit, maturity date

Sep. 30, 2018

Sep. 30, 2020

Line of credit, interest rate

7.30%

Outstanding balance under line of credit

$ 3,200,000

Line of credit, remaining availability under agreement

1,000,000

Western Alliance Bank | Revolving Credit Line | Revolver Agreement | Credit Card Program

Debt Instrument [Line Items]

Line of credit made available under agreement

$ 300,000

Western Alliance Bank | Revolving Credit Line | Amended Revolver Agreement

Debt Instrument [Line Items]

Line of credit, interest rate

6.75%

Outstanding balance under line of credit

$ 2,900,000

Line of credit, remaining availability under agreement

300,000

Western Alliance Bank | Revolving Credit Line | Amended Revolver Agreement | Credit Card Program

Debt Instrument [Line Items]

Line of credit made available under agreement

$ 500,000

Solar Capital Ltd. | Term Loan

Debt Instrument [Line Items]

Repayment of term loan balance

$ 6,000,000

Solar Capital Ltd. | Loan and Security Agreement | Term Loan

Debt Instrument [Line Items]

Term loan, face amount

$ 20,000,000

Number of tranches available under agreement | Tranche

3

Minimum revenue threshold required to draw down second tranche and to obtain singed term sheet for equity financing

$ 10,000,000

Solar Capital Ltd. | Loan and Security Agreement | First Tranche | Term Loan

Debt Instrument [Line Items]

Proceeds from term loan

$ 10,000,000

Solar Capital Ltd. | Loan and Security Agreement | Second Tranche | Term Loan

Debt Instrument [Line Items]

Proceeds from term loan

$ 5,000,000

Solar Capital Ltd. | Loan and Security Agreement | Third and Final Tranche | Term Loan

Debt Instrument [Line Items]

Proceeds from term loan

$ 5,000,000

Perceptive Credit Holdings II, LP | Credit Agreement and Guaranty | Term Loan

Debt Instrument [Line Items]

Term loan, face amount

$ 42,500,000

$ 42,600,000

Number of tranches available under agreement | Tranche

3

Proceeds from term loan

$ 10,500,000

$ 32,000,000

Granted warrants to purchase shares | shares

19,790

37,693

Warrants exercise price | $ / shares

$ 15.92

$ 15.92

Warrants expiration, month and year

2029-03

2028-04

Term loan, interest rate

9.06%

11.19%

Debt instrument rate

1.75%

Debt instrument, description

one-month LIBOR

Term loan, remaining availability under agreement

$ 0

Line of credit, covenant compliance description

The Amended Credit Agreement and Guaranty requires the Company to comply with a minimum liquidity covenant at all times and a minimum revenue covenant measured at the end of each fiscal quarter. As of September 30, 2019, the Company was in compliance with all covenants.

Line of credit facility percentage of amount borrowed

0.50%

Perceptive Credit Holdings II, LP | Credit Agreement and Guaranty | First Tranche | Term Loan

Debt Instrument [Line Items]

Proceeds from term loan

$ 20,000,000

Perceptive Credit Holdings II, LP | Credit Agreement and Guaranty | Second Tranche | Term Loan

Debt Instrument [Line Items]

Proceeds from term loan

$ 10,000,000

Granted warrants to purchase shares | shares

18,846

Warrants exercise price | $ / shares

$ 15.92

Warrants expiration, month and year

2028-07

Perceptive Credit Holdings II, LP | First Amendment to Credit Agreement and Guaranty | Term Loan

Debt Instrument [Line Items]

Term loan available to be drawn

$ 12,500,000

Minimum revenue requirement to draw final tranche

43,200,000

Perceptive Credit Holdings II, LP | First Amendment to Credit Agreement and Guaranty | Credit Card Program | Term Loan

Debt Instrument [Line Items]

Line of credit made available under agreement

$ 300,000

Perceptive Credit Holdings II, LP | First Amendment to Credit Agreement and Guaranty | Third and Final Tranche | Term Loan

Debt Instrument [Line Items]

Proceeds from term loan

$ 2,000,000

Granted warrants to purchase shares | shares

3,769

Warrants exercise price | $ / shares

$ 15.92

Warrants expiration, month and year

2028-09

Perceptive Credit Holdings II, LP | Second Amendment to Credit Agreement and Guaranty | Credit Card Program | Term Loan

Debt Instrument [Line Items]

Line of credit made available under agreement

$ 500,000

Debt - Schedule of Annual Princ

Debt - Schedule of Annual Principal Maturities of Amended Credit Agreement and Guaranty (Details) - Loans Payable $ in Thousands	Sep. 30, 2019USD ($)
Debt Instrument [Line Items]
2019	$ 0
2020	0
2021	0
2022	0
2023	42,560
Less: Discount on loans payable	(844)
Long-term loans payable	$ 41,716

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($)	Jun. 15, 2018	Jun. 12, 2018
Minimum
Loss Contingencies [Line Items]
Breach of contract and other causes of action and seeking damages	$ 2,100,000	$ 800,000

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($)	3 Months Ended		7 Months Ended	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2019	Sep. 30, 2018
Income Tax Contingency [Line Items]
Provision for income taxes	$ 0	$ 0		$ 0	$ 0
Book loss	(12,765,000)	(9,459,000)		(38,609,000)	(29,591,000)
Revenue	$ 10,809,000	$ 9,389,000		$ 35,094,000	$ 30,691,000
Solus
Income Tax Contingency [Line Items]
Book loss			$ 500,000
Revenue			$ 1,700,000

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Weighted Average Assumptions Used in Black-Scholes Options Pricing Model (Details)	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Expected dividend yield	0.00%	0.00%
Risk free interest rate	2.10%	2.60%
Expected stock price volatility	63.50%	58.90%
Expected term (years)	6 years 2 months 12 days	5 years 9 months 18 days

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Allocated Stock Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	$ 140	$ 133	$ 2,755	$ 367
Cost of goods sold
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	9	5	147	23
Research and development
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	11	11	266	39
Sales and marketing
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	(102)	60	657	134
General and administrative
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Allocated stock based compensation expense	$ 222	$ 57	$ 1,685	$ 171

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - $ / shares	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock options, granted	871,346	345,948
Exercise price range, lower range limit	$ 13.35	$ 1.68
Exercise price range, upper range limit	19.40	3.78
Weighted average exercise price	17.36	2.27
Weighted average fair value of stock options granted	$ 10.88	$ 1.27

Stock-Based Compensation - Su_2

Stock-Based Compensation - Summary of Restricted Stock Activity (Details) - Restricted Stock	9 Months Ended
	Sep. 30, 2019$ / sharesshares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares, Unvested, Beginning balance | shares	399,485
Shares, Granted/purchased | shares	78,476
Shares, Vested | shares	(210,395)
Shares, Canceled | shares	0
Shares, Unvested Ending balance | shares	267,566
Weighted Average Grant Date Fair Value, Unvested, Beginning balance | $ / shares	$ 1.68
Weighted Average Grant Date Fair Value, Granted/purchased | $ / shares	17.54
Weighted Average Grant Date Fair Value, Vested | $ / shares	3.31
Weighted Average Grant Date Fair Value, Canceled | $ / shares	0
Weighted Average Grant Date Fair Value, Unvested Ending balance | $ / shares	$ 4.02

Earnings Per Share - Schedule o

Earnings Per Share - Schedule of Computation of Diluted Net Loss Per Share Attributable to Common Stockholders (Details) - shares	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	1,857,090	12,735,957
Redeemable Convertible Preferred Stock (as Converted to Common Stock)
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount		11,143,571
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	1,407,448	757,635
Warrants to Purchase Redeemable Convertible Preferred Stock (as Converted to Common Stock)
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	182,076	230,296
Unvested Restricted Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount	267,566	604,455

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details)	Nov. 16, 2018USD ($)	Nov. 30, 2018	Sep. 30, 2019USD ($)	Sep. 30, 2018USD ($)	Sep. 30, 2019USD ($)Stockholder	Sep. 30, 2018USD ($)	Dec. 31, 2018USD ($)
Related Party Transaction [Line Items]
Preferred stock purchased by related party			$ 48,308,000		$ 48,308,000
Number of stockholders that are vendors | Stockholder					2
Total amount billed from related parties						$ 1,200,000
Accounts payable to vendors			500,000		$ 500,000		$ 500,000
Revenue from related party			300,000	$ 500,000	1,000,000	$ 1,600,000
Accounts receivable from customer			100,000		100,000		$ 100,000
Maximum
Related Party Transaction [Line Items]
Total amount billed from related parties			$ 100,000	$ 100,000	$ 100,000
Redeemable Convertible Preferred Stock
Related Party Transaction [Line Items]
Preferred stock purchased by related party	$ 33,200,000
Temporary equity to permanent equity conversion basis					one-to-one basis
Temporary to permanent equity conversion ratio		100.00%

Warrants - Summary of Warrants

Warrants - Summary of Warrants (Details) - Common Stock Warrants	9 Months Ended
	Sep. 30, 2019$ / sharesshares
Class Of Warrant Or Right [Line Items]
Number of shares, beginning balance | shares	230,295
Number of shares, warrants granted | shares	19,790
Number of shares, warrants exercised | shares	(68,009)
Number of shares, ending balance | shares	182,076
Weighted Average
Class Of Warrant Or Right [Line Items]
Weighted average exercise price, beginning balance | $ / shares	$ 14.50
Weighted average exercise price, warrants granted | $ / shares	15.92
Weighted average exercise price, warrants exercised | $ / shares	(14)
Weighted average exercise price, ending balance | $ / shares	$ 14.84

Warrants - Additional Informati

Warrants - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Mar. 22, 2019	Sep. 30, 2019
Common Stock Warrants
Class Of Warrant Or Right [Line Items]
Estimated fair value of warrants at the time of issuance	$ 0.3
Warrants to purchase of common stock shares, net exercised		68,009
Issuance of stock upon exercise of warrants, shares		12,164
Amended Credit Agreement and Guaranty
Class Of Warrant Or Right [Line Items]
Granted warrants to purchase shares	19,790
Warrants exercise price	$ 15.92
Warrants expire date	2029-03

Stockholders' Equity - Addition

Stockholders' Equity - Additional Information (Details)	1 Months Ended	9 Months Ended
	Nov. 30, 2018	Sep. 30, 2019Vote$ / sharesshares	Dec. 31, 2018$ / sharesshares	Nov. 02, 2018$ / shares
Stockholders Equity [Line Items]
Preferred stock, shares authorized		25,000,000	25,000,000
Preferred stock, par value | $ / shares		$ 0.001	$ 0.001
Preferred stock, shares outstanding		0	0
Common stock, shares authorized		175,000,000	175,000,000
Common stock, par value | $ / shares		$ 0.001	$ 0.001	$ 0.001
Common stock voting rights		Each share of common stock is entitled to one vote.
Number of vote each share of common stock entitled | Vote		1
Redeemable Convertible Preferred Stock
Stockholders Equity [Line Items]
Temporary equity to permanent equity conversion basis		one-to-one basis
Temporary to permanent equity conversion ratio	100.00%

Segment Reporting - Additional

Segment Reporting - Additional Information (Details)	9 Months Ended
	Sep. 30, 2019Segment
Segment Reporting [Abstract]
Number of reporting segment	1
Number of reporting units	2

Business Combinations - Additio

Business Combinations - Additional Information (Details) - USD ($) $ in Thousands	Feb. 28, 2019	Sep. 30, 2019
Business Acquisition [Line Items]
Purchase price, net of cash acquired		$ 1,560
Solus
Business Acquisition [Line Items]
Acquisition date		Feb. 28, 2019
Purchase price, net of cash acquired	$ 2,000
Initial cash payment	1,600
Loss on settlement of preexisting relationship	400
Business combination estimate of contingent payments as compensation to be recognized	$ 2,400
Weighted average amortization period for intangible assets		3 years 9 months 29 days
Solus | General and administrative
Business Acquisition [Line Items]
Transaction costs associated with acquisition		$ 200

Business Combinations - Summary

Business Combinations - Summary of Preliminary Purchase Price Allocation (Details) - USD ($) $ in Thousands	Sep. 30, 2019	Feb. 28, 2019
Business Acquisition [Line Items]
Goodwill	$ 539
Solus
Business Acquisition [Line Items]
Cash		$ 466
Accounts receivable		411
Inventory		492
Prepaids and other assets		11
Property and equipment		1
Goodwill		584
Intangible assets		455
Total assets acquired		2,420
Accounts payable and accrued expenses		(222)
Contract liabilities		(75)
Deferred taxes		(97)
Total liabilities assumed		(394)
Total purchase price		$ 2,026

Business Combinations - Summa_2

Business Combinations - Summary of Business Acquisition Pro Forma Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Business Combinations [Abstract]
Net revenue	$ 10,809	$ 9,985	$ 35,331	$ 32,826
Net loss	$ (12,765)	$ (9,840)	$ (38,895)	$ (30,416)
Net loss per share, basic	$ (0.65)	$ (11.24)	$ (2.18)	$ (36.48)

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Schedule of Changes in Carrying Amount of Goodwill and Intangible Assets (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Goodwill
Acquired during the period		$ 584,000
Foreign currency exchange rate changes		(45,000)
Balance at September 30, 2019		539,000
Intangible Assets
Acquired during the period		455,000
Amortization	$ 0	(69,000)	$ 0
Foreign currency exchange rate changes		(35,000)
Balance at September 30, 2019		$ 351,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Summary of Acquired Intangible Assets (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2019USD ($)
Acquired Finite Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 420
Accumulated Amortization	$ 69
Customer Agreements
Acquired Finite Lived Intangible Assets [Line Items]
Period of amortization	3 years 9 months 29 days
Gross Carrying Amount	$ 420
Accumulated Amortization	$ 69

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Acquired Finite Lived Intangible Assets [Line Items]
Amortization expense of intangible assets		$ 0	$ 69,000	$ 0
Sales and marketing | Maximum
Acquired Finite Lived Intangible Assets [Line Items]
Amortization expense of intangible assets	$ 100,000		$ 100,000

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense for Intangible Assets (Details) $ in Thousands	Sep. 30, 2019USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
Remainder of 2019	$ 27
2020	108
2021	108
2022	108
Total	$ 351