K Number
K020749
Date Cleared
2002-10-31

(238 days)

Product Code
Regulation Number
882.5890
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

EV-803 Digital TENS is an electrical nerve stimulator intended for use for pain relief by applying an electrical current to electrodes on a patient's skin to treat pain.
In particular, this device is indicated for use for:

  • Symptomatic relief and management of chronic (long term) intractable pain
  • Adjunctive treatment in the management of post surgical and post traumatic acute pain problems.
Device Description

EV-803 Digital Tens is a battery operated pulse generator that sends electrical impulses through electrodes to the body and reach the nerves causing pain. The device is provided with two controllable output channels, each independent of each other. An electrode pair can be connected to each output channel.
The electronics of the EVERYWAY EV-803 DIGITAL TENS create electrical impulses whose intensity, duration, number per second and modulation may be altered with the controls/switches. Press buttons are very easy to use and the large liquid crystal display showing the exact mode and values of parameters are very convenient for patients.

AI/ML Overview

Here's an analysis of the provided text regarding the EV-803 Digital TENS device, structured according to your requested information.

It's important to note that the provided document is a 510(k) summary for a Transcutaneous Electrical Nerve Stimulator (TENS) device. For TENS devices, the regulatory pathway generally focuses on demonstrating substantial equivalence to a predicate device, rather than requiring extensive clinical trials to prove efficacy from scratch. This means the "study that proves the device meets the acceptance criteria" in this context refers to the demonstration of equivalence and compliance with relevant standards, rather than a traditional clinical outcome study.


Acceptance Criteria and Device Performance

1. A table of acceptance criteria and the reported device performance

For a 510(k) submission, especially for a device like a TENS unit, the "acceptance criteria" are typically met by demonstrating that the new device is substantially equivalent to a legally marketed predicate device in terms of indications for use, technological characteristics, and safety and effectiveness. The performance is then judged against this equivalence.

Criteria (as implied by Substantial Equivalence)Reported Device Performance (EV-803 Digital TENS)
Indications for UseIdentical to predicate device (Transamerica Digital EMS, 510k #K010782)
Target PopulationIdentical to predicate device
DesignIdentical to predicate device
MaterialsIdentical to predicate device
PerformanceIdentical to predicate device
SterilityIdentical to predicate device
BiocompatibilityIdentical to predicate device
Mechanical SafetyIdentical to predicate device
Chemical SafetyIdentical to predicate device
Anatomical SitesIdentical to predicate device
Human FactorsIdentical to predicate device
Energy used and/or deliveredIdentical to predicate device
Compatibility with environment and other devicesIdentical to predicate device
Where used (intended environment)Identical to predicate device
Standards metIdentical to predicate device (and listed specific standards: EN 60601-1, EN60601-1-2, ISO 9002, EN 46002, ISO 13488)
Electrical SafetyIdentical to predicate device
Thermal SafetyIdentical to predicate device
Radiation SafetyIdentical to predicate device
Overall Safety and EffectivenessClaimed to be safe and effective as the predicate device because it is identical.

2. Sample size used for the test set and the data provenance

The document does not describe a specific "test set" in the sense of a clinical trial or a dataset of patients/images. The demonstration of safety and effectiveness relies on the declaration of conformity to standards and the assertion of identical technological characteristics to the predicate device. Therefore, no explicit sample size or data provenance (country, retrospective/prospective) related to a test set for performance comparison is provided, as the study type isn't a direct comparative performance study against a ground truth.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

Not applicable. There was no "test set" requiring ground truth established by experts in the context of this 510(k) submission.

4. Adjudication method for the test set

Not applicable, as there was no test set requiring expert ground truth adjudication.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This is a TENS device, not an AI-assisted diagnostic or imaging device. No MRMC study was performed.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

Not applicable. This is a TENS device, not an algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)

Not applicable. The "ground truth" for regulatory clearance in this case is effectively the established safety and effectiveness of the legally marketed predicate device and the compliance with recognized electrical and medical device standards.

8. The sample size for the training set

Not applicable. This is not an AI/machine learning device that requires a training set.

9. How the ground truth for the training set was established

Not applicable, as there is no training set for this device.


Summary of the "Study" and Regulatory Pathway:

The "study" described in the 510(k) submission is a demonstration of substantial equivalence to a predicate device (Transamerica Digital EMS, K010782) and conformance to recognized consensus standards. The manufacturer, Everyway Medical Instruments Co., Ltd., is stating that their EV-803 Digital TENS device is identical to the predicate device, which had previously received 510(k) clearance.

The evidence for meeting "acceptance criteria" is primarily:

  • Performance Comparison Table (Paragraph 19): This table asserts "Identical" across all listed technological characteristics when compared to the predicate device.
  • Declaration of Conformity: The device explicitly conforms to international and European standards for medical electrical equipment, quality management systems, and electro-magnetic compatibility (e.g., EN 60601-1, EN60601-1-2, DIN EN ISO 9002, DIN EN 46002, ISO 13488). This compliance is assessed by TUV Rheinland Product Safety GmbH.
  • Predicate Device Clearance: The regulatory clearance relies on the fact that an identical device (manufactured by Everyway but previously marketed by another distributor) has already been cleared by the FDA.

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OCT 31 2002

510(k) Summary

16020749 As Required by 21 section 807.92 ( c )

1-Submitter Name: Everyway Medical Instruments Co., Ltd

2-Address: 3FL.. No. 5, Lane 155, Sec. 3, PeiShen Rd., Shen Keng Hsiang

Taipei Hsien Taiwan, R.O.C.

886-2-2662-0038

3-Phone:

4-Fax: 886-2664-5566

5-Contact Person: Mr Robert Tu (General Manager)

6-Date summary prepared: February 27th, 2002

7- Official Correspondent: Mansour Consulting

8- Address:

1308 Morningside Park Dr Alpharetta, GA 30022 USA

9- Phone: 10- Fax:

  • (678) 908-8180 (425) 795-9341
    Jay Mansour, president 11- Contact person:

12-Device Trade or Proprietary Name: EV-803 Digital TENS

13-Device Common or usual name: Stimulator, Nerve, Transcutaneous, for pain relief

  • 14-Device Classification Name: Stimulator, Nerve, Transcutaneous, for pain relief
    15-Substantial Equivalency is claimed against the following device:

TransAmerica Medical Systems, 510k #K010782 (refer to Appendix 2 for FDA website printout)

This notification for EV-803 is of the ABBREVIATED type as per the declaration of conformitv included in this summary

16-Description of the Device: EV-803 Digital Tens is a battery operated pulse generator that sends electrical impulses through electrodes to the body and reach the nerves causing pain. The device is provided with two controllable output channels, each independent of each other. An electrode pair can be connected to each output channel.

The electronics of the EVERYWAY EV-803 DIGITAL TENS create electrical impulses whose intensity, duration, number per second and modulation may be altered with the controls/switches. Press buttons are very easy to use and the large liquid crystal display showing the exact mode and values of parameters are very convenient for patients.

17-Intended use of the device: (Indications for use typed on a separate FDA form)

EV-803 Digital TENS is an electrical nerve stimulator intended for use for pain relief by applying an electrical current to electrodes on a patient's skin to treat pain

18-Safety and effectiveness of the device:

This device is safe and effective as the predicate device Transamerica Digital EMS. Indeed, it is identical. The same device which was cleared by 510k #K010782 for the distributor TransAmerica Medical Systems is submitted here for the original manufacturer in Taiwan EVERYWAY MEDICAL INSTRUMENTS CO., LTD.

Refer to the tabulated comparison (Paragraph 19 below)

19-Summary comparing technological characteristics with other predicate device:

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FDA file reference number510k #K010782
Attachments inside notification submission file510k summary print out
TECHNOLOGICAL CHARACTERISTICSComparison result
Indications for useIdentical
Target populationIdentical
DesignIdentical
MaterialsIdentical
PerformanceIdentical
SterilityIdentical
BiocompatibilityIdentical
Mechanical safetyIdentical
Chemical safetyIdentical
Anatomical sitesIdentical
Human factorsIdentical
Energy used and/or deliveredIdentical
Compatibility with environment and other devicesIdentical
Where usedIdentical
Standards metIdentical
Electrical safetyIdentical
Thermal safetyIdentical
Radiation safetyIdentical

:

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3FL., No.5, Lane 155, Sec. 3, PeiShen Rd., Shen Keng Hsiang, Taipei Hsien, Taiwan, R.O.C.
Tel: 886-2-2662-0038 Fax: 886-2-2664-5566 E-mail: everywy@ms2.hinet.net

DECLARATION OF CONFORMITY

This is to declare and confirm that Everyway Medical Instruments Co., Ltd. conforms in its manufacturing of Transcutaneous Electrical
Nerve Stimulators EV-803 Digital TENS to the following recognized standards:

Standards met and standards tested against

Inapplicable requirements or deviationsName and address of any test laboratory or certification body involved in determining the conformance of the device with the standard and reference to any accreditations of those organizations
Identification of any way(s) in which the standard was adapted for the application of the device, i.e., identification of an alternative series of tests that were performed
Specification of any deviations from each applicable standard
Specification of the differences that may exist between the tested device and the device to be marketed and justification of the test results
Supervision of product and design:
QSR (FDA's Quality System Requirements)For QSR: Not applicable
DIN EN ISO 9002/08.1994For ISO 9002: 1994, EN 46002, ISO 13488 and CE Mark: TUV Rheinland Product Safety GmbH- Am Grauen Stein -D-51105 Koln. TUV Rheinland Product Safety GmbH- Am Grauen Stein-D-51105 Koln.
DIN EN 46002/09.1996 EE Directive 93/42 (CE Mark)
ISO 13488/12.1996
Technical standards:N/A.
EN 60601-1:1990+A1:1993+A2:1995
EN60601-1-2:1993
Name, Signature and positionRobert Tu/ General Manager
Date02/27/2002

011,00 STREMUATSNI JAOIG3M YAWYA3V3 2458333

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of a human figure, represented by three curved lines forming a profile. The figure is positioned to the right of the department's name, which is arranged in a circular pattern around the logo.

Public Health Service

Food and Drug Administration
9200 Corporate Boulevard
Rockville MD 20850

OCT 3 1 2002

Mr. Jay Mansour Representing Everyway Medical Instruments Co., Ltd. Mansour Consulting, L.L.C. 1308 Morningside Park Drive Alpharetta, Georgia 30022

K020749 Re:

Trade/Device Name: EV-803 Digital TENS Regulation Number: 21 CFR 882.5890 Regulation Name: TENS Device for Pain Relief Regulatory Class: Class II Product Code: GZJ Dated: July 26, 2002 Received: August 1, 2002

Dear Mr. Mansour:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If vour device is classified (see above) into either class II (Special Controls) or class III (PMA). it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice

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Page 2 - Mr. Jay. Mansour

requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4648. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.qov/cdrh/dsma/dsmamain.html

Sincerely yours.

K. Mark-N-Millican

Celia M. Witten. Ph.D., M.D. Director Division of General, Restorative, and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Page 1 of

KO20749 510 (k) NUMBER (IF KNOWN)

DEVICE NAME: Digital Transcutaneous Electrical Nerve Stimulator (EV-803 Digital TENS) INDICATIONS FOR USE:

EV-803 Digital TENS is an electrical nerve stimulator indicated for use for pain relief by applying an electrical current to electrodes on a patient's skin to treat pain.

In particular, this device is indicated for use for:

  • Symptomatic relief and management of chronic (long term) intractable pain
  • Adjunctive treatment in the management of post surgical and post traumatic acute pain problems.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED.)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 001.109) ાર

Over-The-Counter-Use (Optional Format 1-2-9

0.03

for Mark n Millican

(Division Sign-Off) Division of General. Restorative and Neurological Devices

510(k) Number K020749

§ 882.5890 Transcutaneous electrical nerve stimulator for pain relief.

(a)
Identification. A transcutaneous electrical nerve stimulator for pain relief is a device used to apply an electrical current to electrodes on a patient's skin to treat pain.(b)
Classification. Class II (performance standards).