K Number
K121527
Device Name
WI-FI BODY SCALE
Date Cleared
2012-06-28

(36 days)

Product Code
Regulation Number
870.2770
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Wi-Fi body scale, model HS5 is indicated to measure body weight, estimate body fat, body water percentage, body muscle mass, bones mass, visceral fat rating and daily calorie intake (DCI) using BIA (bioelectrical impedance analysis). This product is for use by generally healthy adults,,who are not ill, feverish, have a chronic or acute disease, or a condition that affect the level of hydration such as pregnancy.
Device Description
The patient steps on the scale device, where four electrodes are located. The patient must step on the electrodes with bare feet, with normal moisture. Through harmless current stimulation of 500 uA, at 50 kHz, the Wi-Fi body scale calculates the body fat percentage. This calculation is done via the Bioelectrical Impedance Method. The current is passed through the body and the impedance of the body determines the body fat. The calculation is based upon electrical impedance, height, weight, age, and gender. The calculation is performed via internal software, which uses the variables programmed in by the user. Wi-Fi body scale, model HS5 can be used with an iPod Touch, iPhone or iPad.
More Information

Not Found

No
The description details calculations based on Bioelectrical Impedance Analysis (BIA) using programmed variables (electrical impedance, height, weight, age, and gender). There is no mention of AI, ML, or any learning algorithms. The calculation method is explicitly stated as the Bioelectrical Impedance Method, which is a standard physiological measurement technique.

No
The device is a body scale that measures various body composition metrics. It does not claim to treat, diagnose, cure, or prevent any disease or condition.

No

Explanation: A diagnostic device is used to detect, diagnose, or monitor a disease, condition, or health status. This device measures body composition parameters (weight, fat, water, muscle, bone, visceral fat, DCI) for generally healthy adults, which are indicators of overall health but not for diagnosing medical conditions.

No

The device description explicitly states it is a "Wi-Fi body scale" and describes physical components like electrodes and the process of stepping on the scale, indicating it is a hardware device with internal software.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices intended for use in vitro for the examination of specimens, including blood, tissue, and urine, derived from the human body, in order to provide information concerning a physiological or pathological state, or a congenital abnormality, or to monitor therapeutic measures.
  • Device Function: The Wi-Fi body scale, model HS5, measures body composition (weight, fat, water, muscle, bone, visceral fat, DCI) by passing a small electrical current through the body and analyzing the impedance. This is an in vivo measurement (within the living body), not an in vitro examination of a specimen outside the body.
  • Intended Use: The intended use is to measure body composition in generally healthy adults, not to diagnose a disease or condition based on the analysis of a biological specimen.

Therefore, while it is a medical device, it falls under the category of devices that perform measurements directly on the body, rather than analyzing samples taken from the body.

N/A

Intended Use / Indications for Use

Wi-Fi body scale, model HS5 is indicated to measure body weight, estimate body fat, body water percentage, body muscle mass, bones mass, visceral fat rating and daily calorie intake (DCI) using BIA (bioelectrical impedance analysis). This product is for use by generally healthy adults,,who are not ill, feverish, have a chronic or acute disease, or a condition that affect the level of hydration such as pregnancy.

Product codes

MNW

Device Description

The patient steps on the scale device, where four electrodes are located. The patient must step on the electrodes with bare feet, with normal moisture. Through harmless current stimulation of 500 uA, at 50 kHz, the Wi-Fi body scale calculates the body fat percentage. This calculation is done via the Bioelectrical Impedance Method. The current is passed through the body and the impedance of the body determines the body fat. The calculation is based upon electrical impedance, height, weight, age, and gender. The calculation is performed via internal software, which uses the variables programmed in by the user. Wi-Fi body scale, model HS5 can be used with an iPod Touch, iPhone or iPad.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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)

Electrical, mechanical, environmental safety and performance testing according to standard EN/IEC 60601-1 and EN/IEC 60601-1-2. Clinical testing was used to validate the effectiveness and accuracy of the device. All test results were satisfactory.

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

Not Found

Predicate Device(s)

K110928

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2770 Impedance plethysmograph.

(a)
Identification. An impedance plethysmograph is a device used to estimate peripheral blood flow by measuring electrical impedance changes in a region of the body such as the arms and legs.(b)
Classification. Class II (special controls). The device, when it is a body composition analyzer which is not intended to diagnose or treat any medical condition, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

0

510(k) Summary Jun 2 8 2012

K121527

PAGE 1 OF 4

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirement of SMDA and 21 CFR 807.92.

1.0 submitter's information

Name: Shenzhen Healthcare Electronic Technology Co., Ltd. Address: 2/F, Block B, Tsinghua Information Termi North Zone Of Hi-Tech Industrial Park,Na Shenzhen, CHINA 518057 Phone number: 86-755-27179235 Fax number: 86-755-27179236 Contact: Mrs. SHELLY SHI Date of Application: 05/10/2012

2.0 Device information

Trade name:Wi-Fi body scale, model HS5
Common name:Body Analysis scale/ Electronic Body Fat Scale
Classification name:Impedance plethysmograph

3.0 Classification

Production code: MNW- Body Fat Analyzer. Regulation number: 870.2770 Classification: II Panel: Cardiovascular

4.0 Predict device information

Shenzhen Healthcare Electronic Technology Co., Ltd Manufacturer: Body Analysis Scale, Model BG 17 Device: 510(k) number: K110928

5.0 Device description

The patient steps on the scale device, where four electrodes are located. The patient must step on the electrodes with bare feet, with normal moisture. Through harmless current stimulation of 500 uA, at 50 kHz, the Wi-Fi body scale calculates the body fat percentage. This calculation is done via the Bioelectrical Impedance Method. The current is passed through the body and the impedance of the body

1

determines the body fat. The calculation is based upon electrical impedance, height, weight, age, and gender. The calculation is performed via internal software, which uses the variables programmed in by the user. Wi-Fi body scale, model HS5 can be used with an iPod Touch, iPhone or iPad.

6.0 Intended use

Wi-Fi body scale, model HS5 is indicated to measure body weight, estimate body fat, body water percentage, body muscle mass, bones mass, visceral fat rating and daily calorie intake (DCI) using BIA (bioelectrical impedance analysis). This product is for use by generally healthy adults,,who are not ill, feverish, have a chronic or acute disease, or a condition that affect the level of hydration such as pregnancy.

7.0 Summary comparing technological characteristics with predicate device

Wi-Fi body scale, model HS5Body Analysis Scale, Model BG 17(K110928)Same or not?
Intended useWi-Fi body scale, model HS5 is indicated to measure body weight, estimate body fat, body water percentage, body muscle mass, bones mass, visceral fat rating and daily calorie intake (DCI) using BIA (bioelectrical impedance analysis). This product is for use by generally healthy adults,,who are not ill, feverish, have a chronic or acute disease, or a condition that affect the level of hydration such as pregnancy.Body Analysis Scale, Model BG 17 is indicated to measure body weight, estimate body fat, body water percentage, body muscle mass, bones mass, visceral fat rating and daily calorie intake (DCI) using BIA (bioelectrical impedance analysis). This product is for use by generally healthy adults,,who are not ill, feverish, have a chronic or acute disease, or a condition that affect the level of hydrationSame

2

:

:

:

:

:

such as pregnancy.
Product
DescriptionWi-Fi body scale, model
HS5 is indicated to
measure body weight,
estimate body fat,
body water
percentage, body
muscle mass, bones
mass, visceral fat
rating and daily calorie
intake (DCI) using BIA
(bioelectrical
impedance analysis).Body Analysis Scale,
Model BG 17 is
indicated to measure
body weight,
estimate body fat,
body water
percentage, body
muscle mass, bones
mass, visceral fat
rating and daily
calorie intake (DCI)
using
BIA
(bioelectrical
impedance analysis).Same
Analytical
methodBIA
(bioelectrical
impedance analysis)BIA (bioelectrical
impedance analysis)Same

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

.

:

and the comments of the comments of

3

8.0 Performance summary

Electrical, mechanical, environmental safety and performance testing according to standard EN/IEC 60601-1 and EN/IEC 60601-1-2. Clinical testing was used to validate the effectiveness and accuracy of the device. All test results were satisfactory.

9.0 Comparison to the predict device and the conclusion

Our device Wi-Fi body scale, model HS5 is substantially equivalent to the ody Analysis Scale, Model BG 17 whose 510(k) number is K110928.

The two devices are very similar in the intended use, the design principle, the material, the energy source and the applicable standards. Wi-Fi body scale, model HS5 can be used with an iPod Touch, iPhone or iPad.

However, the test in this submission provides demonstration that these small differences do not raise any new questions of safety and effectiveness.

4

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/4/Picture/1 description: The image shows the logo for the Department of Health & Human Services USA. The logo is circular, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. In the center of the circle is an abstract symbol that resembles an eagle or other bird in flight. The symbol is composed of three stylized lines that suggest the bird's head, body, and tail.

Public Health Service

JUN 28 2012

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

Shenzhen Healthcare Electronic Technology Co., Ltd. % Ms. Yang Wang Andon Health Co., Ltd. No 3. Jinping Road Ya'an Street, Nankai District TIANJIN 300190 CHINA

Re: K121527

Trade/Device Name: Wi-Fi body scale, model HS5 Regulation Number: 21 CFR& 870.2770 Regulation Name: Impedance plethysmograph Regulatory Class: II Product Code: MNW Dated: May 23, 2012 . Received: May 30, 2012

Dear Ms. Wang:

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.

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

5

device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) 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,

Benjamin K. twho

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

Statement of Indications for Use

510(k) Number :

121527

Device name:

Wi-Fi body scale, model HS5

Indications for use:

Wi-Fi body scale, model HS5 is indicated to measure body weight, estimate body fat, body water percentage, body muscle mass, bones mass, visceral fat rating and daily calorie intake (DCI) using BIA (bioelectrical impedance analysis). This product is for use by generally healthy adults,,who are not ill, feverish, have a chronic or acute disease, or a condition that affect the level of hydration such as pregnancy.

Prescription use Part 21 CFR 801 Subpart D)

Over-The-Counter Use AND/OR YES (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Huber Steur

ductive, Gastro-Renal, and

Page 1 of 1