K Number
K110390
Device Name
ETG 255 COMBO STIMUALTOR, TEN 260 STIMUALTOR
Date Cleared
2011-07-29

(168 days)

Product Code
Regulation Number
882.5890
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
ETG 255 Combo Stimulator, For TENS mode Symptomatic relief of chronic intractable pain, relief of acute post-surgical and posttraumatic pain. For EMS mode 1. Relaxation of muscle spasm. 2. Increase of local blood flow circulation 3. Prevention or retardation of disuse atrophy 4. Muscle re-education 5. Maintaining or increasing range of motion. 6. Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis TEN 260 Stimulator Symptomatic relief of chronic intractable pain, relief of acute post-surgical and posttraumatic pain.
Device Description
ETG 255 Combo Stimulator, TEN 260 Combo Stimulator are non-invasive devices. The devices contain the following main parts: TENS stimulation unit, Support Belt, electrode, and snap cable. The electrode is permanently sewn up in the support belt. Each belt is flexible, and is available in range of sizes to ensure good patient contact. A male snap connector is placed within the electrode and is connected via the female snap connector to a short lead wire. The lead wire has a female pin connection at the distal end which accepts the lead wire connection from the stimulator. The device can be worn on the low back part of user so as to place the electrode on the treatment location of low back.
More Information

Not Found

No
The document describes a standard electrical stimulator with no mention of AI or ML capabilities. The device description focuses on hardware components and basic functionality.

Yes

The device description, intended use, and indications for use clearly state that it is designed to provide symptomatic relief of pain, muscle relaxation, improve circulation, and other therapeutic effects for various conditions.

No

The device is a stimulator designed for symptomatic relief, muscle relaxation, and prevention of muscle atrophy, not for identifying or diagnosing a condition.

No

The device description explicitly lists hardware components such as a stimulation unit, support belt, electrode, and snap cable, indicating it is not software-only.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information for diagnosis, monitoring, or screening.
  • Device Description: The description clearly states that the ETG 255 Combo Stimulator and TEN 260 Stimulator are non-invasive devices. They apply electrical stimulation externally to the body.
  • Intended Use: The intended uses listed are for pain relief (TENS mode) and muscle stimulation (EMS mode). These are therapeutic applications, not diagnostic tests performed on specimens.

The device is a therapeutic electrical stimulator, not a diagnostic device that analyzes samples.

N/A

Intended Use / Indications for Use

Symptomatic relief of chronic intractable pain, relief of acute post-surgical and posttraumatic pain.
For EMS mode

    1. Relaxation of muscle spasm.
  • Increase of local blood flow circulation 2.
  • Prevention or retardation of disuse atrophy 3.
  • Muscle re-education 4.
  • Maintaining or increasing range of motion. 5.
  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis 6.
    TEN 260 Stimulator
    Symptomatic relief of chronic intractable pain, relief of acute post-surgical and posttraumatic pain.

Product codes (comma separated list FDA assigned to the subject device)

NUH, GZJ, IPF

Device Description

Care back pain relief stimulator, which includes models TENS 7000 and LT3074 are non-invasive devices which are tented for over the counter use in temporary relief of pain associated with sore and aching muscles in the lower back due to strain form exercise or normal household and working activities.

The devices contain the following main parts: TENS stimulation unit, Support Belt, electrode, and snap cable.

The electrode is permanently sewn up in the support belt. Each belt is flexible, and is available in range of sizes to ensure good patient contact. A male snap connector is placed within the electrode and is connected via the female snap connector to a short lead wire. The lead wire has a female pin connection at the distal end which accepts the lead wire connection from the stimulator.

The device can be worn on the low back part of user so as to place the electrode on the treatment location of low back.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

lower back, calf muscles

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Over-The-Counter Use

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Non-Clinical Tests Performed:
Care back pain relief stimulator did not conduct, nor rely upon, clinical tests to determine substantial equivalence. Care back pain relief stimulator has received test reports certifying that the Care back pain relief stimulator was tested and found to be in conformity with voluntary standards includes IEC60601, IEC60601-1-2, IEC60601-2-10, ISO 10993 and ISO14971. The software verification has been carried out according to the FDA Guidance of the content of Premarket submissions for the software contained in Medical Devices. This test reports have provided as part of this premarket notification.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K060222

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 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).

0

K110390

File No: WMI-04-OTCT -FDA-05 Version: 1.3

JUL 2 9 2011

)

510(k) SUMMARY

Care back pain relief stimulator, K (

07/27/2011 Date of Submission: Shenzhen Dongdixin Technology Co., Ltd. 510(k) Submitter's Name: No.3bldg. xiliyangguang industrial Estae xilixiaobaimang Nanshan district Shenzhen, China Address: 518108 +86(755) 27652471 Telephone: Fax: +86(755) 27652674 510(k) Correspondent Kang Jian Ping contact: microcong@gmail.com E-mail:

1

1. Proposed Device:

Trade Name:Care back pain relief stimulator
Model:TENS 7000,LT3074
Classification Name:Stimulator, Nerve, Transcutaneous.
Over-The-Counter
Regulation Number:21CRF 882.5890
Product Code:NUH
Device Class:II

2. Predicate Device:

Predicate Device:Low Back Pain Relief System
510(k) Number:K060222
Manufacturer:Gemore Technology Co.,Ltd

3. Description of Proposed Device:

Care back pain relief stimulator, which includes models TENS 7000 and LT3074 are non-invasive devices which are tented for over the counter use in temporary relief of pain associated with sore and aching muscles in the lower back due to strain form exercise or normal household and working activities.

The devices contain the following main parts: TENS stimulation unit, Support Belt, electrode, and snap cable.

The electrode is permanently sewn up in the support belt. Each belt is flexible, and is available in range of sizes to ensure good patient contact. A male snap connector is placed within the electrode and is connected via the female snap connector to a short lead wire. The lead wire has a female pin connection at the distal end which accepts the lead wire connection from the stimulator.

The device can be worn on the low back part of user so as to place the electrode on the treatment location of low back.

4. Proposed Device Intended Use Statement:

Care back pain relief stimulator is intended for temporary relief of pain associated with sore and aching muscles in the lower back due to strain form exercise or

2

normal household and working activities.

Technological Characteristics: 5.

Both the stimulator and the Predicate device stimulator have the same intended use and fundamental technology. A side-by-side comparison of the technological characteristics of the care back pain relief and the cited predicate devices is included in the 510(k) submission.

| Parameter | Care back pain relief stimulator
Model: TENS7000,LT3074 | Low Back Pain Relief
System, model
GM320PP |
|------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for use | Care back pain relief stimulator is
intended for temporary relief of
pain associated with sore and
aching muscles in the lower back
due to strain form exercise or
normal household and working
activities. | The model GM320PP is
intended for temporary
relief of pain associated
with sore and aching
muscles in the lower back
due to strain from exercise
or normal household and
work activities. |
| Power Source | 9V Battery for TENS7000
4.5V Battery for LT3074 | 9V Battery |
| Max Output Voltage (V)
±20% | 40.0V@500Ω for TENS 7000 | 40.0V@500Ω |
| | 45.0V@500Ω for LT3074 | |
| | 100.0V@2kΩ for TENS 7000 | 120.0V@2kΩ |
| | 50.0V@2kΩ for LT3074 | |
| | 110.0V@10kΩ for TENS 7000 | 150.0V@10kΩ |
| | 60.0V@10kΩ for LT3074 | |
| Max Output Current (mA)
±20% | 80.0mA @500Ω for TENS 7000 | 80.0 mA @500Ω |
| | 90.0mA @500Ω for LT3074 | |
| | 50.0mA @2kΩ for TENS 7000 | 60.0 mA @2kΩ |
| | 25.0mA @2kΩ for LT3074 | |
| | 11.0mA @10kΩfor TENS 7000 | 15.0 mA @10kΩ |
| | 6.0mA @2kΩ for LT3074 | |
| Pulse Width Range | 50-300us for TENS 7000
50-250us for LT3074 | 150-260 us |
| Frequency | 2-150Hz for TENS 7000
2-110Hz for LT3074 | 2-120Hz |
| Timer Range (minutes) | 5 - 60 minutes or Continuous fo
TENS7000
30 minutes for LT3074 | 15min, 30min, 60min
and continuous |
| Maximum Average Current
(average absolute value),
mA (refer to the remark 1) | 3.6mA,500Ω, for TENS 7000
2.5mA,500Ω, for LT3074 | 2.5mA,500Ω |
| RMS current (refer to the remark 1) | 17.0 mA.r.m.s for TENS 7000 | 20.0 mA.r.m.s |
| | 14.2 mA.r.m.s for LT3074 | |
| | | |
| Maximum Current Density
(refer to the remark 1) | $0.56mArms/cm^2,500Ω$ for TENS
7000
$0.14mArms/cm^2,500Ω$ for LT3074 | $0.56mArms/cm^2,500Ω$ |
| Maximum Power Density
(refer to the remark 1) | $4.8mWrms/cm^2,500Ω$ for TENS
7000
$1.0mWrms/cm2,500Ω$ for LT3074 | $3.3mWrms/cm^2,500Ω$ |
| Compliance with Voluntar
Standards? | IEC60601-1, IEC60601-1-2
IEC60601-2-10 | IEC60601-1, IEC60601-1-2
IEC60601-2-10 |
| Compliance with 21 CFR
898? | Yes | Yes |
| Weight (grams.) | 150 grams with battery for
TENS7000
80 grams with battery for LT3074 | 140 grams with battery |
| Dimensions (mm.) H x W x T | 1016124.5cm for TENS7000
857230cm for LT3074 | 10861.525 |
| Housing Materials &
Construction | Enclosure: ABS,94V-1,80°C,UL
Approved | Enclosure:
ABS,94V-1,80°C,UL
Approved |
| Materials of electrodes: | Rubber or fabric | Gel |

3

File No: WMI-04-OTCT -FDA-05 Version: 1.3

Non-Clinical Tests Performed: 6.

Care back pain relief stimulator did not conduct, nor rely upon, clinical tests to determine substantial equivalence. Care back pain relief stimulator has received test reports certifying that the Care back pain relief stimulator was tested and found to be in conformity with voluntary standards includes IEC60601, IEC60601-1-2, IEC60601-2-10, ISO 10993 and ISO14971. The software verification has been carried out according to the FDA Guidance of the content of Premarket submissions for the software contained in Medical Devices. This test reports have provided as part of this premarket notification.

7. Conclusions:

The Care back pain relief Stimulator, which includes models TENS 7000 and LT3074, has the same intended use and technological characteristics as the cited predicate device. Moreover, bench testing, safety report and Risk Analysis Report documentation supplied in this submission demonstrates that the difference in the submitted models could maintain the same safety and effectiveness as that of the cited predicate device. In the other words, those engineering difference do not affect the intended use or alter the fundamental scientific technology of the device. Thus, the care back pain relief stimulator is substantially equivalent to the predicate device.

4

File No: WMI-04-OTCT -FDA-05 Version: 1.3

Remark 1

TENS 7000 sample calculations:

Maximum Average Current=I maxpulse ratepulse width=80mA150Hz300us*$10^{-6}$=3.6mA

300us * 80mA = 17.0mA.r.m.s Ir.m.s = 150 Hz * 1000000 17.0mArm.s Ir.m.s Maximum Current Density = = 0.56mA.r.m.s/$cm^2$ 30cm2 S 300us Vr.m.s * 40V = 8.5V r.m.s 150Hz 10000000 8.5Vr.m.s Vr.m.s Maximum Voltage Density = = 0.28V r.m.s/$cm^2$ 30cm2 S Vr.m.s * Ir.m.s 8.5Vr.m.s * 17mAr.m.s Maximum Power Density = = 4.8mW r.m.s / cm2 S 30cm2

LT3074 sample calculations:

Maximum Average Current=I maxpulse ratepulse width=90mA100Hz250us*10-6=2.5mA

$$Ir.m.s = \sqrt{\frac{5}{5} * 100 Hz * \frac{250us}{1000000}} * 90mA = 14.2mAr.m.s$$

$$Maximum Current Density = \frac{Ir.m.s}{S} = \frac{14.2mAr.m.s}{100cm^{2}} = 0.14mAr.m.s/cm^{2}$$

$$Vr.m.s = \sqrt{\frac{5}{5} * 100Hz * \frac{250us}{1000000}} * 45V = 7.1Vr.m.s$$

$$Maximum Voltage Density = \frac{Vr.m.s}{S} = \frac{7.1Vr.m.s}{100cm^{2}} = 0.07Vr.m.s/cm^{2}$$

$$Maximum Power Density = \frac{Vr.m.s * Ir.m.s}{S} = \frac{7.1Vr.m.s * 14.2mAr.m.s}{100cm^{2}} = 1.0mWr.m.s/cm^{2}$$

5

Image /page/5/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three stripes forming its wing and body. The eagle is positioned to the right of a circular text element that reads "DEPARTMENT OF HEALTH & HUMAN SERVICES USA".

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Handelhaus Dittman GMBH Shenzen Dongdixin Technology Co. LTD. c/o Mr. Kang Jiang Ping R.A. Director No. 3 Building Xiliyiangguang Industrial Estate Xillixaobaim Shenzen China 518108

JUL 2 9 2011

Re: K110390

Trade/Device Name: ETG 255 Combo Stimulator, TEN 260 Stimulator Regulation Number: 21 CFR 882.5890 Regulation Name: Transcutaneous electrical nerve stimulator for pain relief Regulatory Class: Class II Product Codes: GZJ, IPF Dated: November 30, 2011 Received: February 11, 2011

Dear Mr. Jiang Ping:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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.

6

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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Keria Alexander

Malvina B. Eydelman, M.D. Director

Division of Ophthalmic, Neurological, Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

Indications for Use

510(k) Number ( ):

Device Name:

ETG 255 Combo Stimulator, TEN 260 Combo Stimulator

Indications for Use:

ETG 255 Combo Stimulator,

For TENS mode

Symptomatic relief of chronic intractable pain, relief of acute post-surgical and posttraumatic pain.

For EMS mode

    1. Relaxation of muscle spasm.
  • Increase of local blood flow circulation 2.
  • Prevention or retardation of disuse atrophy 3.
  • Muscle re-education 4.
  • Maintaining or increasing range of motion. 5.
  • Immediate post-surgical stimulation of calf muscles to prevent venous thrombosis 6.

TEN 260 Stimulator

Symptomatic relief of chronic intractable pain, relief of acute post-surgical and posttraumatic pain.

Prescription Use V V (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division Sign Off

(Division Sign-Off) Division of Ophthalmic, Neurological and Ear, Nose and Throat Devices

510(k) Number K110390