K Number
K131142
Device Name
GENESIS LED WANDS
Date Cleared
2013-11-27

(218 days)

Product Code
Regulation Number
878.4810
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Red: Generally indicated for use in dermatology for the treatment of superficial, benign vascular and pigmented legions. Blue: Generally indicated to treat dermatological conditions and specifically indicated to treat moderate inflammatory acne vulgaris.
Device Description
The Genesis LED Device uses high-end Light Emitting Diodes (LED's) to distribute the specific wavelengths of light it uses. This technology is commonly referred to as Photobiostimulation, Light Emitting Diode Therapy (LEDT), or LED's. The application of LED's to tissue is non-invasive. The Genesis LED Wands emit light at the following wavelengths: Genesis LED Wand RED at 627 nm and Genesis LED Wand BLUE at 415 nm.
More Information

Not Found

No
The device description focuses on LED technology and photobiostimulation, with no mention of AI or ML. The "Mentions AI, DNN, or ML" section explicitly states "Not Found".

Yes
The device is described as treating "superficial, benign vascular and pigmented lesions" and "moderate inflammatory acne vulgaris," indicating a therapeutic purpose to alleviate or cure medical conditions.

No

The device description and intended use clearly state that it is used for treatment of dermatological conditions (vascular and pigmented legions, and acne vulgaris) using LED light, not for diagnosis.

No

The device description explicitly states the use of "high-end Light Emitting Diodes (LED's)" and "Genesis LED Wands" which are hardware components emitting light. This is not a software-only device.

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 treatment of dermatological conditions (vascular and pigmented lesions, inflammatory acne vulgaris). This is a therapeutic use, not a diagnostic one.
  • Device Description: The device uses LED light therapy applied directly to tissue. This is a physical treatment method, not a method for examining specimens from the body.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information based on in vitro testing.

IVD devices are used to examine specimens taken from the human body to provide information for diagnosis, monitoring, or screening. This device's function is to treat conditions by applying light to the skin.

N/A

Intended Use / Indications for Use

LED ColorWavelengthIndication:
Red627nmGenerally indicated for use in dermatology for the treatment of superficial, benign vascular and pigmented legions
Blue415nmGenerally indicated to treat dermatological conditions and specifically indicated to treat moderate inflammatory acne vulgaris

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

GEX

Device Description

The Genesis LED Device uses high-end Light Emitting Diodes (LED's) to distribute the specific wavelengths of light it uses. This technology is commonly referred to as Photobiostimulation, Light Emitting Diode Therapy (LEDT), or LED's. The application of LED's to tissue is non-invasive. The Genesis LED Wands emit light at the following wavelengths:

Device:Wavelength:Output:
Genesis LED Wand RED627 nm135mW/cm², pulsed 50% duty cycle
Genesis LED Wand BLUE415 nm135mW/cm², pulsed 50% duty cycle

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)

Performance data in the form of clinical trials were not necessary as the device uses the same technology and intended use as the predicate devices.
Testing information demonstrating safety and effectiveness of the Genesis LED wands in the intended environment of use are supported by testing that was conducted in accordance with the following standard(s): ISO 14971: 2009
Biocompatibility testing was not performed as the Genesis LED Wands do not make contact with the skin at any time before or during treatments.
Testing to demonstrate compliance to the recognized electrical safety and EMC requirements of IEC 60601-1 and IEC 60601-1-2 have been performed by an independent, accredited laboratory.
Testing to determine laser classification according to IEC 60825-1 was performed by an independent, accredited laboratory.

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.

K042630, K082586

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

§ 878.4810 Laser surgical instrument for use in general and plastic surgery and in dermatology.

(a)
Identification. (1) A carbon dioxide laser for use in general surgery and in dermatology is a laser device intended to cut, destroy, or remove tissue by light energy emitted by carbon dioxide.(2) An argon laser for use in dermatology is a laser device intended to destroy or coagulate tissue by light energy emitted by argon.
(b)
Classification. (1) Class II.(2) Class I for special laser gas mixtures used as a lasing medium for this class of lasers. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 878.9.

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2 7 2013 NOV

510(K) Summary

This summary of 510(k) information is being submitted in accordance with the requirements of 21 CFR 1040.10 & 1040.11

1. General Information
Submitter:Genesis Biosystems, Inc.
1500 Eagle Court
Lewisville, TX 75057
972-315-7888 (direct)
972-315-7818 (fax)
Contact Person:Jim Lafferty
President
Genesis Biosystems, Inc.
1500 Eagle Court Lewisville, TX 75057
jgroves@genesisbiosystems.com
Manufacturing Facility:Genesis Biosystems, Inc.
1500 Eagle Court
Lewisville, TX 75057
Summary Preparation Date:15-April-2013
2. Names
Device Name:Genesis LED Device
Common Name:Laser instrument, surgical, powered
Regulation:878.4810
Product Code:GEX

3. Predicate Devices

Revitalight Skincare System (K042630) Lightwave Deluxe (K082586)

4. Device Description

The Genesis LED Device uses high-end Light Emitting Diodes (LED's) to distribute the specific wavelengths of light it uses. This technology is commonly referred to as Photobiostimulation, Light Emitting Diode Therapy (LEDT), or LED's. The application of LED's to tissue is non-invasive. The Genesis LED Wands emit light at the following wavelengths:

Device:Wavelength:Output:
Genesis LED Wand RED627 nm135mW/cm², pulsed 50% duty cycle
Genesis LED Wand BLUE415 nm135mW/cm², pulsed 50% duty cycle

5. Indications for Use

LED ColorWavelengthIndication:
Red627nmGenerally indicated for use in dermatology for the treatment of superficial,
benign vascular and pigmented legions
Blue415nmGenerally indicated to treat dermatological conditions and specifically
indicated to treat moderate inflammatory acne vulgaris

1

6. Performance Data

Based upon an analysis of the overall performance characteristics for the device, Genesis Biosystems, Inc. believes that no significant differences exist between the Genesis LED Wands and the predicate devices referenced in this document.

7. Comparison to Predicate Devices

Decision ProcessDecisionK042630K082586
Does new device have same
Indication Statement (as marketed
device?Yes. The Genesis LED
Wand device has the
same intended use as
predicate devices noted.The RevitaLight
Skin Care System
generally
indicated to treat
dermatological
conditions and
specifically
indicated to treat
moderate
inflammatory
acne vulgaris (Blue
Pulsars)The LightWave Deluxe Red light is indicated
for use in dermatology for treatment of
superficial, benign vascular, and pigmented
legions. (Red Pulsars)
Does new device have same
technological characteristics, e.g.,
design, materials, etc?Yes. The Genesis LED
Wand device has the
same technological
characteristics utilizing
light emitting diodes, a
power source and means
of controlling both.Base unit contains
power supplies
and control unit.
Pulsator
attachments
contain the light
emitting diodes
and connect to
the base unit.The base unit contains the power supplies and
the control unit. The LED panel is attached to
the end of the arms and then positioned for
patient treatment.
Are the descriptive characteristics
precise enough to ensure
equivalence ?Yes. The devices are
sufficiently characterized
to ensure equivalence.Operates as blue
(420nm), yellow
(590nm), and red
(625nm) LED
source at
80mW/cm². LED
array panel hand
held device.Operates as red (630nm to 830nm) LED
source at 4.73J/cm².
Performance data demonstrate
equivalence?Yes. The device
performance
demonstrates
equivalence.Operates
equivalently as
yellow (590nm)
and red (625 nm)
LED source.Operates equivalently as a red (630nm-
645nm) LED source.

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8. Testing

Performance data in the form of clinical trials were not necessary as the device uses the same technology and intended use as the predicate devices.

Testing information demonstrating safety and effectiveness of the Genesis LED wands in the intended environment of use are supported by testing that was conducted in accordance with the following standard(s): ISO 14971: 2009

Biocompatibility testing was not performed as the Genesis LED Wands do not make contact with the skin at any time before or during treatments.

Testing to demonstrate compliance to the recognized electrical safety and EMC requirements of IEC 60601-1 and IEC 60601-1-2 have been performed by an independent, accredited laboratory.

Testing to determine laser classification according to IEC 60825-1 was performed by an independent, accredited laboratory.

9. Conclusion

Based upon an analysis of the overall characteristics for the device in comparison to the predicates, Genesis Biosystems, Inc. concludes that the Genesis LED Wands are substantially equi

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-00002

Genesis Biosystems, Incorporated Mr. Jim Lafferty President 1500 Eagle Court Lewisville, Texas 75057

November 27, 2013

Re: K131142

Trade/Device Name: Genesis LED Wands Regulation Number: 21 CFR 878.4810 Regulation Name: Laser surgical instrument for use in general and plastic surgery and in dermatology Regulatory Class: Class II Product Code: GEX Dated: October 16, 2013 Received: October 17, 2013

Dear Mr. Lafferty:

We have reviewed vour 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. Ilsting 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 device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

4

Page 2 - Mr. Jim Lafferty

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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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,

Joshua C. Nipper -S

Binita S. Ashar, M.D., M.B.A., F.A.C.S. Acting Director Division of Surgical Devices Office of Device Evaluation

For

Center for Devices and Radiological Health

Enclosure

5

Indications for Use

510(k) Number (if known): K131142

Device Name: Genesis LED Wands

Indications For Use:

Led ColorWavelengthIndication:
Red627nmGenerally indicated for use in dermatology for treatment of superficial, benign vascular and pigmented lesions
Blue415nmGenerally indicated to treat dermatological conditions and specifically indicated to treat moderate inflammatory acne vulgaris.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

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

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

Concurrence of Center for Devices and Radiological Health (CDRH)

Joshua C. - C

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