K Number
K113275
Device Name
COMPRESSIBLE LIMB THERAPY SYSTEM
Date Cleared
2012-02-27

(115 days)

Product Code
Regulation Number
890.5650
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The device is indicated for use by medical professionals and patients at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injures, Postimmobilization edema, Venous insufficiencies, Lymphedema.
Device Description
Power Q1000 Premium is used with four chamber garments for full leg, and period has its own variable duration pressure, cycle time and gradient setting. Power unit features visual operation statusand fault indicators. Power Q1000 Premium is a pneumatic pressure treatment system that repeats expansion of sleeves to help blood circulation and prevent blood clots or clogs.
More Information

Not Found

No
The description focuses on pneumatic pressure and cycle settings, with no mention of AI/ML terms or capabilities.

Yes
The device is indicated for treating various medical conditions such as lymphedema, edema, and venous insufficiencies, which directly relates to its therapeutic purpose. It is also designed to help blood circulation and prevent blood clots, indicating a direct health benefit.

No

The device description indicates that the Power Q1000 Premium is a "pneumatic pressure treatment system that repeats expansion of sleeves to help blood circulation and prevent blood clots or clogs." This describes a therapeutic function, not a diagnostic one. Its intended use also focuses on "treating many conditions," further supporting its therapeutic nature.

No

The device description explicitly states "Power Q1000 Premium is a pneumatic pressure treatment system" and mentions a "Power unit" and "four chamber garments," indicating it is a hardware-based system that uses pneumatic pressure for treatment.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to diagnose, monitor, or screen for various health issues.
  • Device Function: The description clearly states that the Power Q1000 Premium is a "pneumatic pressure treatment system that repeats expansion of sleeves to help blood circulation and prevent blood clots or clogs." This is a physical therapy or medical device that applies external pressure to the body.
  • Intended Use: The intended use is for treating conditions like lymphedema, edema, and venous insufficiencies by applying pressure. This is a therapeutic application, not a diagnostic test performed on a sample.
  • Lack of IVD Characteristics: The description does not mention any analysis of biological samples, reagents, or diagnostic measurements.

Therefore, the Power Q1000 Premium falls under the category of a therapeutic medical device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The device is indicated for use by medical professionals and patients at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injures, Postimmobilization edema, Venous insufficiencies, Lymphedema.

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

IRP

Device Description

Power Q1000 Premium is used with four chamber garments for full leg, and period has its own variable duration pressure, cycle time and gradient setting. Power unit features visual operation statusand fault indicators.

  • Pressure (mmHg): 0~240mmHg
  • Mode: A, B, C, D(D1, D2, D3, D4), E selection. (The initial set : Mode A)
  • Interval: Interval : 0, 5, 10, 15, 20, 25, 30 sec, selection. (The initial set : 0sec)
  • Time(min): Time(min) : 5~99min, selection. (The initial set : 15min)
  • Pressure Time: Pressure : 0240mmHg, selection (The initial set : 200mmHg) 0240 : A, B, D(D1, D2, D3, D4) Mode 0~130 : C, E Mode

Power Q1000 Premium is a pneumatic pressure treatment system that repeats expansion of sleeves to help blood circulation and prevent blood clots or clogs.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Full leg

Indicated Patient Age Range

Not Found

Intended User / Care Setting

medical professionals and patients at home, who are under medical supervision

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)

The Model Power-Q1000 Premium has tested and meets the requirements of the following standard.
-EN60601-1, Medical electrical equipment - Part 1: General requirements for safety (IEC 60601-1:1988/A1:91/A2:9s)
-EN60601-2-10, Medical electrical equipment - Part 2-10: Particular requirements for the safety of nerve and muscle stimulators
-EN60601-1-2, Medical electrical equipment - Part 1: General requirements for safety -Collateral standard: Electromagnetic compatibility

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.

K100656

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

§ 890.5650 Powered inflatable tube massager.

(a)
Identification. A powered inflatable tube massager is a powered device intended for medical purposes, such as to relieve minor muscle aches and pains and to increase circulation. It simulates kneading and stroking of tissues with the hands by use of an inflatable pressure cuff.(b)
Classification. Class II (performance standards).

0

FEB 2 7 2012

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510(k) Summary [As required by 807.92(c)]

Date of issue: Jan 25, 2012

A. 510k Number

  • B. Applicant/Applicant Company Name: BSR KOREA Corp. Company Name: DSR ROREA Corp:
    Address: Migun Techno World 2 C-dong, 524, #533-1 Yongsan-dong, Yuseong-gu, Daejeon, KOREA. Tel: 82-42-476-2977 Fax:82-42-476-2978 Contact person: Eileen Yang
  • C. Proprietary and Established Names: WONJIN MULSAN Co., Ltd. Address: 10B-7L 623-6 Namchon-dong, Namdong-gu Incheon, Korea
  • D. Regulatory information
      1. Classification Name: Massager, Powered Inflatable Tube
      1. Common/Usual Name: Powered inflatable Tube Massager
      1. Proprietary Name: Compressible Limb Therapy System (Power-Q1000 Premium)
      1. Classification /Product Code: Class 2, IRP(21 CFR 890.5650)
  • E. Intended Use

Power-Q1000 Premium is intended for use by medical professionals and patients at home, Fower-Q1000 Trennant is meeting many conditions, such as: Primary lymphedema, Edema following trauma and sport injuries, Postimmobilization edema, Venous insufficiencies, Lymphedema.

F. Device Description

Device Deseription
Power Q1000 Premium is used with four chamber garments for full leg, and period has its own variable duration pressure, cycle time and gradient setting. Power unit features visual operation statusand fault indicators.

NamePower-Q1000 Premium
Pressure (mmHg)0~240mmHg
ModeA, B, C, D(D1, D2, D3, D4), E selection. (The initial set : Mode A)
IntervalInterval : 0, 5, 10, 15, 20, 25, 30 sec, selection. (The initial set :
0sec)
Time(min)Time(min) : 5~99min, selection. (The initial set : 15min)
Pressure TimePressure : 0~240mmHg, selection (The initial set : 200mmHg)
0~240 : A, B, D(D1, D2, D3, D4) Mode
0~130 : C, E Mode

Technological characteristics

1

K113275

Pg 2 of 3

  • H. Substantial Equivalence Information
    • l. Predicate Device
      • -510(k) Number: 100656

-510(R) Namber: 100050
-Name: Compressible Limb Therapy system(WHF-324 POWER-Q1000 PLUS) -Classification: 2

    1. Comparison with predicate _________________________________________________________________________________________________________________________________________________
Model NamePower Q1000 PremiumWHF-324 (POWER-Q1000) (predicate device)
510(k) numberNone yetK100656
ClassificationClass II Device/ IRP (21 CFR 890. 5650)Class II Device/ IRP (21 CFR 890. 5650)
Intended useThe device is indicated for use by medical professionals and patients at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injures, Postimmobilization edema, Venous insufficiencies, Lymphedema.The device is indicated for use by medical professionals and patients at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injures, Postimmobilization edema, Venous insufficiencies, Lymphedema.
DescriptionPower Q1000 Premium is a pneumatic pressure treatment system that repeats expansion of sleeves to help blood circulation and prevent blood clots or clogs.Power Q1000 PLUS is a pneumatic pressure treatment system that repeats expansion of sleeves to help blood circulation and prevent blood clots or clogs
StandardEN ISO14971
EN60601-1
EN60601-2-10
EN60601-1-2EN ISO14971
EN60601-1
EN60601-2-10
EN60601-1-2
IndicationsPrimary lymphedema, Edema following trauma and sport injuires, postimmobilization edema, Venous insufficiencies, Lymphedema.Primary lymphedema, Edema following trauma and sport injuires, postimmobilization edema, Venous insufficiencies, Lymphedema.
ContraindicationsAcute pulmonary edema
Acute throubophlebitis
Acute congestive cardiac failure
Acute infections, Deep vein thrombosis
Episodes of pulmonary embolism Wounds, lesions, or turmors at or in the vicinity of applicationAcute pulmonary edema
Acute throubophlebitis
Acute congestive cardiac failure
Acute infections, Deep vein thrombosis
Episodes of pulmonary embolism Wounds, lesions, or turmors at or in the vicinity of application
Where increased venous and
lymphatic return is undesirable,
Bone fractures or dislocation at
or in the vicinity of applicationWhere increased venous and
lymphatic return is undesirable,
Bone fractures or dislocation at
or in the vicinity of application
Mode of CompressionSequentialSequential
Power sourceElectricity Supply: 220-240V
50/60HZ
Therapy Time0~99 minutes0-30 minutes
Maximum and
Minimum Pressure0-240mm Hg0-300mm Hg
Number of Chambers4 Chambers for each unit4 Chambers for each unit
Compression
Applicator GarmentsNylonNylon

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J. Performance characteristics

The Model Power-Q1000 Premium has tested and meets the requirements of the following standard.

-EN60601-1, Medical electrical equipment - Part 1: General requirements for safety (IEC 60601-1:1988/A1:91/A2:9s)

-EN60601-2-10, Medical electrical equipment - Part 2-10: Particular requirements for the safety of nerve and muscle stimulators

-EN60601-1-2, Medical electrical equipment - Part 1: General requirements for safety -Collateral standard: Electromagnetic compatibility

K. Conclusion

Compressible Limb Therapy System WHF-324 (POWER-Q1000 PLUS)) has substantial equivalent intended use as the-market-cleared WHF-314(POWER-Q1000) and has substantial equivalent technological and performance characteristics. After analyzing Substantial equivately "connerogen" it is the conclusion of WONJIN MULSAN Co., Idol that Compressible Limb Therapy System (WHF-324 (POWER-Q10 PLUS)) is as safe and effective as the predicate devices, has few technological differences, but there are no new and chective as the productions any new safety and/or effectiveness concerns. mentations for about that it substantially equivalent to the predicate devices

3

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 consists of a stylized eagle with three tail feathers, representing the department's commitment to health, services, and people. The eagle is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" in a circular arrangement.

Public Health Service

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

FEB 2 7 2012

Wonjinmulsan Co., Ltd. % BSR Korea Ms. Eileen Yang D-524 Migun Techno World 2 533-1 Yongsan-Dongyuseong-Gu Daejeon Republic of Korea KS

Re: K113275

Trade/Device Name: Compressible Limb Therapy System Regulation Number: 21 CFR 890.5650 Regulation Name: Powered Inflatable Tube Massager Regulatory Class: Class II Product Code: IRP Dated: February 14, 2012 Received: February 14, 2012

Dear Ms. Yang:

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 I ou may , arons 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.

4

Page 2 - Ms. Eileen Yang

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.

Mark N. Melkerson Director Division of Surgical, Orthopedic' and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

all

Enclosure

5

K113275


PJ 1.of1

INDICATIONS FOR USE

510(k) Number (if known):

Model No. POWER-Q1000 Premium Device Name: Compressible Limb Therapy System

Indications for Use:

The device is indicated for use by medical professionals and patients at home, who are under medical supervision, in treating many conditions, such as: Primary lymphedema, edema following trauma and sport injures, Postimmobilization edema, Venous insufficiencies, Lymphedema.

Prescription Use _ x (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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

(Division Sign-Off)
Division of Surgical, Orthopedic,
and Restorative Devices

Page 1 of 1

510(k) Number. K113275