K Number
K110716
Device Name
EVERYWAY LOW BACK PAIN RELIEF SYSTEM
Date Cleared
2011-10-18

(217 days)

Product Code
Regulation Number
882.5890
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Everyway Low Back Pain Relief System, model EV-820 is indicated for over the counter use in the temporary relief of pain associated with sore and aching muscles in the low back due to strain from exercise or normal household and work activities.
Device Description
The Everyway Low Back Pain Relief System, models EV-820 is a non-invasive devices which are intended for over the counter use in temporary relief of pain associated with sore and aching muscles in the lower back due to stain from exercise or normal household and work activities. The devices contain the following main parts: TENS stimulation unit which was designed to generate 8 preprogram modes of output stimulation pulse, Support Belt, Self-adhesive pads, and Snap Cable. With the combination of the main device parts, the device can be worn on the low back part of user so as to place the stimulation pads on the treatment location of low back for over the counter use without prescription in temporary relief of pain associated with sore and aching muscles in the lower back.
More Information

Not Found

No
The device description and performance studies do not mention any AI or ML components or capabilities. The device is described as a TENS unit with pre-programmed modes.

Yes
The device is indicated for the temporary relief of pain associated with sore and aching muscles, which is a therapeutic purpose. It uses TENS stimulation, a recognized therapeutic modality.

No

The device is indicated for temporary pain relief and does not mention any diagnostic capabilities or functions.

No

The device description explicitly lists hardware components: TENS stimulation unit, Support Belt, Self-adhesive pads, and Snap Cable. Performance studies also include electrical and biocompatibility testing, which are relevant to hardware.

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

Here's why:

  • Intended Use: The intended use is for the temporary relief of pain associated with sore and aching muscles in the low back. This is a therapeutic purpose, not a diagnostic one.
  • Device Description: The device is a TENS (Transcutaneous Electrical Nerve Stimulation) unit with a support belt and pads. TENS devices are used for pain management by applying electrical stimulation to the body. This is a physical intervention, not a test performed on a sample from the body.
  • No mention of in vitro testing: The description does not mention any testing of samples (like blood, urine, tissue, etc.) outside of the body. IVD devices are specifically designed for such testing.

Therefore, the Everyway Low Back Pain Relief System is a therapeutic device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Everyway Low Back Pain Relief System, model EV-820 is indicated for over the counter use in the temporary relief of pain associated with sore and aching muscles in the low back due to strain from exercise or normal household and work activities.

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

NUH

Device Description

The Everyway Low Back Pain Relief System, models EV-820 is a non-invasive devices which are intended for over the counter use in temporary relief of pain associated with sore and aching muscles in the lower back due to stain from exercise or normal household and work activities.

The devices contain the following main parts: TENS stimulation unit which was designed to generate 8 preprogram modes of output stimulation pulse, Support Belt, Self-adhesive pads, and Snap Cable.

With the combination of the main device parts, the device can be worn on the low back part of user so as to place the stimulation pads on the treatment location of low back for over the counter use without prescription in temporary relief of pain associated with sore and aching muscles in the lower back.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

low back

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:
1> Performance Compliance Test according to ANSI/AAMI NS4 conducted by manufacturer
2> Usability Study Report according to IEC 60601-1-6 conducted by manufacturer.
3> Electrical Compliance Test according to IEC 60601-1 by accredited laboratory.
4> EMC Compliance Test according to IEC 60601-1-2 by accredited laboratory.
5> Biocompatibility Test for the support belt and stimulation electrode according to ISO 10993-5 & ISO 10993-10 by accredited laboratory.

Clinical Test:
No particular Clinical Test was conducted for Everyway Low Back Pain Relief System, model EV-820.

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

K UD716

EVERYWAY MEDICAL INSTRUMENTS CO.,LTD.

3F1., No. 5, Lane 155, Sec. 3,Peishen Rd, Shen Keng Hsiang, Taipei Hsien, Taiwan,

OCT 1 8 2011

510(K) SUMMARY

This summary of 510(k) safety and effectiveness information is being prepared in accordance with the requirements of SMDA 1990 and 21 CFR 807.92 at February 28, 2011.

The assigned 510(k) number is:

    1. Submitter's Identifications:
      ごいで

r

Establishment:EVERYWAY MEDICAL INSTRUMENT CO., LTD. Address: 3Fl., No. 5, Lane 155, Sec. 3, Peishen Rd., Shenkeng Hsiang, Taipei Hsien 222. Taiwan Registration Number: 9616877 Operations: Manufacturer

Owner/Operator:EVERYWAY MEDICAL INSTRUMENT CO., LTD. Address : 3Fl., No. 5, Lane 155, Sec. 3, Peishen Rd., Shenkeng Hsiang, Taipei Hsien 222, Taiwan Contact Person: Robert Tu Phone : 886-2-2662-0038 Fax No: 886-2-2664-5566 e-mail : tu922@ms35.hinet.net

    1. Name of the Device: Everyway Low Back Pain Relief System, model EV-820.
    1. Information of the 5.10(k) Cleared Device (Predicate Device): Gemore Low Back Pain Relief System, model GM310PP(K060222).
    1. Classification Information: Trade/Device Name: Everyway Low Back Pain Relief System, model EV-820, Regulation Number: 21 CFR 882.5890 Regulation Name: Transcutaneous Nerve Stimulator Regulatory Class: II Product Code: NUH
    1. Device Description:

The Everyway Low Back Pain Relief System, models EV-820 is a non-invasive devices which are intended for over the counter use in temporary relief of pain associated with sore and aching muscles in the lower back due to stain from exercise or normal household and work activities.

The devices contain the following main parts: TENS stimulation unit which was designed to generate 8 preprogram modes of output stimulation pulse, Support Belt, Self-adhesive pads,

... . 4 r

1

EVERYWAY MEDICAL INSTRUMENTS CO.,LTD.

3F1., No. 5, Lane 155, Sec. 3,Peishen Rd, Shen Keng Hsiang, Taipei Hsien, Taiwan,

and Snap Cable.

: -

With the combination of the main device parts, the device can be worn on the low back part of user so as to place the stimulation pads on the treatment location of low back for over the counter use without prescription in temporary relief of pain associated with sore and aching muscles in the lower back.

6. Intended Use:

The Everyway Low Back Pain Relief System, model EV-820 is indicated for over the counter use in the temporary relief of pain associated with sore and aching muscles in the low back due to stain from exercise or normal household and work activities.

7. Comparison to the 510(k) Cleared Device (Predicate Device):

The Everyway Low Back Pain Relief System, model EV-820 is substantially equivalent to the Gemore Low Back Pain Relief System, model GM310PP(K060222) without any significant difference in main technological and operational feature.

    1. Discussion of Non-Clinical Tests Verification Activities Performed to Determine the Safety and Performance of EV-820 are as the followings:
    • 1> Performance Compliance Test according to ANSI/AAMI NS4 conducted by manufacturer
    • 2> Usability Study Report according to IEC 60601-1-6 conducted by manufacturer.
    • 3> Electrical Compliance Test according to IEC 60601-1 by accredited laboratory.
    • 4> EMC Compliance Test according to IEC 60601-1-2 by accredited laboratory.
    • 5> Biocompatibility Test for the support belt and stimulation electrode according to ISO 10993-5 & ISO 10993-10 by accredited laboratory.
    1. Discussion of Clinical Test Validation Activities Performed to Determine the Effectiveness of Device are as the followings:

No particular Clinical Test was conducted for Everyway Low Back Pain Relief System, model EV-820.

    1. Conclusions
      The Everyway Low Back Pain Relief System, model EV-820, has the same intended use and technological characteristics as the cleared device of Gemore Low Back Rain Relief System, model GM310PP(K060222). Moreover, verification and validation tests contained this submission demonstrate that the difference in the submitted model could maintain it he same safety and effectiveness as that of cleared device.

In the other words, Everyway Low Back Pain Relief System, model EV-820 is substantial equivalent with the Gemore Low Back Pain Relief System, model GM310PP(K600222).

2

Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services. The logo consists of a stylized eagle with three curved lines representing its wings. The words "DEPARTMENT OF HEALTH & HU" are arranged in an arc above the eagle, and the words "& HU" are arranged in an arc below the eagle.

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

OCT 1 8 2011

Everyway Medical Instruments Co., Ltd. c/o Mr. Robert Tu President and Operator Owner 3 Fl., No. 5, Lane 155, Sec. 3 Peishen Rd., Shenkeng Hsiang Taipei Hsien 222 Taiwan

Re: K110716

Trade/Device Name: Everyway Low Back Pain Relief System (Model EV-820) Regulation Number: 21 CFR 882,5890 Regulation Name: Transcutaneous Electrical Nerve Stimulator for Pain Relief Regulatory Class: Class II Product Code: NUH Dated: October 4, 2011 Received: October 5, 2011

Dear Mr. Tu:

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.

3

Page 2 - Mr. Robert Tu

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice 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.

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/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Kesia Alexander

Malvina B. Eydelman, M.D. Director Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

EVERYWAY MEDICAL INSTRUMENTS CO.,LTD.

3F1., No. 5, Lane 155, Sec. 3,Peishen Rd, Shen Keng Hsiang, Taipei Hsien, Taiwan,

Indications For Use

510(k) Number (if known):___K110716

Device Name: Everyway Low Back Pain Relief System, model EV-820.

Indications For Use:

The Everyway Low Back Pain Relief System, model EV-820 is indicated for over the counter use in the temporary relief of pain associated with sore and aching muscles in the low back due to strain from exercise or normal household and work activities

Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 807 Subpart C)

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

OR

Concurrence of CDRH, Office of Device Evaluation (ODE)

Daryl Ellis
(Division Size 08)

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

510(k) Number K110716

Page 1 of