K Number
K143737
Manufacturer
Date Cleared
2015-07-27

(209 days)

Product Code
Regulation Number
890.5850
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The EM25 - glute toning device is intended for use by healthy persons to apply transcutaneous electrical muscle stimulation (EMS) through skin contact electrodes for the purpose of improvement of muscle tone of the buttocks muscles.

Device Description

The proposed device, EM25 - glute toning device is a self-adhesive EMS device for muscle training. The device can be applied with accuracy thanks to the use of EMS technology. Made from medical-quality silicone rubber, the elegantly designed EMS pad is extremely slim and flexible and adapts perfectly to the area to be treated. The high-tech circuit provides energy-efficient treatments of 20 minutes each.

Electrical muscle stimulation (EMS) is a widespread and generally recognized method and has been used in sports medicine and rehabilitation for years. In sports and fitness, EMS is used to complement conventional muscle training, to increase the performance of muscle groups and to adjust physical proportions to achieve the desired aesthetic results.

EMS devices work by passing electrical currents over the skin. The gel pad is used as a transfer medium and is subject to natural wear and tear. The gel pad must be replaced if it stops providing sufficient contact, as this will prevent the EMS pad from sticking to the skin. If it is not replaced, the partially increased current density could irritate the skin.

The proposed device, EM25 - glute toning device is assembled with the PCBA and electrode, and the LR03 (AAA) battery supplies the safe low-frequency current. The electrode stuck on the human skin purposes to train the deep muscle. There are 0-15 intensity levels for EM25 - glute toning device. The maximum voltage is divided by 15 (levels) and accumulated for each voltage. But the each increased amperage cannot be over 2%. The intensity level will be minimum when turning on. The user can adjust it from 0 to 15 and gradually increase the intensity level. The whole treatment time is 20 minutes, and then the device switches off automatically.

AI/ML Overview

The EM25 - glute toning device is a powered muscle stimulator intended to improve muscle tone of the buttocks muscles in healthy persons through transcutaneous electrical muscle stimulation (EMS).

Here's an analysis of the acceptance criteria and study information provided:

1. Table of Acceptance Criteria and Reported Device Performance

The document does not explicitly state quantitative "acceptance criteria" in terms of clinical performance metrics (e.g., a specific percentage improvement in muscle tone measured by a defined metric). Instead, the acceptance criteria are implicitly defined by compliance with a series of recognized safety and performance standards. The "reported device performance" is essentially that the device met these standards, and is deemed substantially equivalent to a predicate device.

Acceptance Criteria (Implicit)Reported Device Performance
Biocompatibility: Compliance with ISO 10993 seriesAll tests demonstrate compliance with ISO 10993 series.
Software: Compliance with IEC 62304 and ISO 14971All tests demonstrate compliance with IEC 62304 and ISO 14971.
Electromagnetic Compatibility & Electrical Safety: Compliance with IEC 60601 seriesAll tests demonstrate compliance with IEC 60601 series.
Risk Management: Compliance with ISO 14971All tests demonstrate compliance with ISO 14971.
Functional Performance (Implicit, compared to predicate)Device output specifications (voltage, current, frequency, etc.) are comparable to the predicate device, with some differences that were determined not to raise new safety/effectiveness issues.

2. Sample Size Used for the Test Set and Data Provenance

No test set related to clinical performance or human efficacy is mentioned. The primary "test set" for this submission refers to the physical device itself and its components undergoing engineering and biocompatibility testing. The data provenance for these tests is implicitly from the manufacturer's testing (Hivox Biotek, Inc., Taiwan). The document confirms that no clinical test data was used to support the decision of safety and effectiveness (Section 5.9).

3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of those Experts

Not applicable. No clinical test set with human data and expert ground truth was established for this submission. The "ground truth" for the non-clinical tests was adherence to the specified international standards.

4. Adjudication Method for the Test Set

Not applicable. No clinical adjudication method was used, as no clinical studies were performed.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

Not applicable. This device is a muscle stimulator, not an AI-assisted diagnostic or imaging device, and does not involve "human readers" or AI assistance in that context.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done

Not applicable. See point 5. This device is a physical therapeutic device, not an algorithm, and does not have a "standalone" algorithmic performance in the typical sense of AI/software as a medical device.

7. The Type of Ground Truth Used

The "ground truth" for this submission is based on adherence to recognized international technical standards for safety, biocompatibility, software lifecycle, and electrical safety (e.g., ISO 10993 series, IEC 62304, IEC 60601 series, ISO 14971). The claim of "effectiveness" is supported by substantial equivalence to an existing predicate device, rather than direct clinical evidence for efficacy.

8. The Sample Size for the Training Set

Not applicable. No training set for an algorithm was used, as this is not an AI/software device that requires machine learning.

9. How the Ground Truth for the Training Set Was Established

Not applicable. See point 8.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract image of an eagle with three heads, all facing to the right.

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

July 27, 2015

Hivox Biotek, Inc. Clytie Chiou Product Manager 5 F., NO. 123, Shingde Road, San-Chong District New Taipei City 24158, Taiwan

Re: K143737 Trade/Device Name: EM25-glute toning device Regulation Number: 21 CFR 890.5850 Regulation Name: Powered Muscle Stimulator Regulatory Class: Class II Product Code: NGX Dated: June 24, 2015 Received: June 26, 2015

Dear Clytie Chiou,

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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

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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 Industry and Consumer Education 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. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 Industry and Consumer Education 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,

Carlos L. Pena -5D/Δ

Carlos L. Peña, PhD, MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K143737

Device Name

EM25 - glute toning device

Indications for Use (Describe)

The EM25 - glute toning device is intended for use by healthy persons to apply transcutaneous electrical muscle stimulation (EMS) through skin contact electrodes for the purpose of improvement of muscle tone of the buttocks muscles.

Type of Use (Select one or both, as applicable) Prescription Use (Part 801 Subpart D) Over-The-Counter Use (801 CFR 801 Subpart C) Prescription Use (Part 801 Subpart D) Over-The-Counter Use (801 CFR 801 Subpart C)
Prescription Use (Part 801 Subpart D)
Over-The-Counter Use (801 CFR 801 Subpart C)

_ | Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary

5.1Type of Submission:Traditional
5.2Preparation Date:July 22, 2015
5.3Submitter:Hivox Biotek, Inc.
Address:5F., No. 123, Shingde Road, San-ChongDistrict, New Taipei City 24158, Taiwan(R.O.C.)
Phone:+886-2-8511-2668
Fax:+886-2-8511-2669
Contact:Clytie Chiou(clytie.chiou@hivox-biotek.com)
Registration number:9611558

5.4 Identification of the Device:

Proprietary/Trade name:EM25 - glute toning device
Classification Name:Stimulator, Muscle, Powered, For MuscleConditioning
Device Classification:II
Regulation Number:890.5850
Panel:Physical Medicine
Product Code:NGX

5.5 Identification of the Predicate Device:

Predicate Device Name:Buttock Muscle Stimulator, model:WL-2413E
Manufacturer:Well-Life Healthcare Limited.
Regulation number:890.5850
Product Code:NGX
510(k) Number:K123075

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5.6 Intended Use and Indications for Use of the subject device.

The EM25 - glute toning device is intended for use by healthy persons to apply transcutaneous electrical muscle stimulation (EMS) through skin contact electrodes for the purpose of improvement of muscle tone of the buttocks muscles.

5.7 Device Description

The proposed device, EM25 - glute toning device is a self-adhesive EMS device for muscle training. The device can be applied with accuracy thanks to the use of EMS technology. Made from medical-quality silicone rubber, the elegantly designed EMS pad is extremely slim and flexible and adapts perfectly to the area to be treated. The high-tech circuit provides energy-efficient treatments of 20 minutes each.

Electrical muscle stimulation (EMS) is a widespread and generally recognized method and has been used in sports medicine and rehabilitation for years. In sports and fitness, EMS is used to complement conventional muscle training, to increase the performance of muscle groups and to adjust physical proportions to achieve the desired aesthetic results.

EMS devices work by passing electrical currents over the skin. The gel pad is used as a transfer medium and is subject to natural wear and tear. The gel pad must be replaced if it stops providing sufficient contact, as this will prevent the EMS pad from sticking to the skin. If it is not replaced, the partially increased current density could irritate the skin.

The proposed device, EM25 - glute toning device is assembled with the PCBA and electrode, and the LR03 (AAA) battery supplies the safe low-frequency current. The electrode stuck on the human skin purposes to train the deep muscle. There are 0-15 intensity levels for EM25 - glute toning device. The maximum voltage is divided by 15 (levels) and accumulated for each voltage. But the each increased amperage cannot be over 2%. The intensity level will be minimum when turning on. The user can adjust it from 0 to 15 and gradually increase the intensity level. The whole treatment time is 20 minutes, and then the device switches off automatically.

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EM25 - glute toning device

Hivox Biotek, Inc. 510(k) Notification, K143737

5.8 Non-clinical Testing

A series of safety tests were performed to assess the safety and effectiveness of the EM25 - glute toning device.

Testing ItemStandard and regulations applied
BiocompatibilityISO 10993-1 Biological evaluation of medical devices – Part 1:Evaluation and testing with a risk management process.
EN ISO 10993-2:2006, Biological evaluation of medical devices –Part 2: Animal welfare requirements.
EN ISO 10993-5:2009, Biological evaluation of medical devices -Part 5: Tests for In Vitro Cytotoxicity.
EN ISO 10993-10:2010, Biological evaluation of medical devices -Part 10: Tests for irritation and skin sensitization.
EN ISO 10993-12:2009, Biological evaluation of medical devices -Part 12: Sample preparation and reference materials.
SoftwareIEC 62304: 2006 Medical device software - Software life cycleprocesses.
ISO 14971:2007 Medical devices - Application of risk managementto medical devices.
ElectromagneticCompatibility &Electrical SafetyIEC 60601-1, Medical Electrical Equipment - Part 1: GeneralRequirements For Basic Safety And Essential Performance
IEC 60601-1-11, Medical Electrical Equipment - Part 1-11: GeneralRequirements For Basic Safety And Essential Performance -Collateral Standard: Requirements For Medical ElectricalEquipment And Medical Electrical Systems Used In The HomeHealthcare Environment.
IEC 60601-2-10, Medical Electrical Equipment - Part 2-10:Particular Requirements For The Basic Safety And EssentialPerformance Of Nerve And Muscle Stimulators.
Risk ManagementISO 14971:2007 Medical devices - Application of risk managementto medical devices

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All the test results demonstrate that EM25 - glute toning device meet the requirements of its pre-defined acceptance criteria and intended uses.

5.9 Clinical Testing

No clinical test data was used to support the decision of safety and effectiveness.

5.10 Substantial Equivalence Determination

The EM25 - glute toning device is substantially equivalent in intended use, design, technology/principles of operation and performance to the cleared Buttock Muscle Stimulator, model: WL-2413E (K123075). Differences between the devices cited in this section do not raise any new issues of safety or effectiveness.

Proposed DevicePredicate Device
ItemEM25 - glute toning deviceButtock Muscle Stimulator
ModelEM25WL-2413E
ManufacturerHivox Biotek, Inc.Well-Life Healthcare Limited.
Intended UseThe EM25 - glute toning deviceis intended for use by healthypersons to apply transcutaneouselectrical muscle stimulation(EMS) through skin contactelectrodes for the purpose ofimprovement of muscle tone ofthe buttocks muscles.The Bullock Muscle Stimulator,model WL-2413E, is intendedfor use by healthy persons toapply transcutaneous electricalmuscle stimulation (EMS)through skin contact electrodefor the purpose of improvementof muscle tone of the buttocksmuscles.
Prescription or OTCOTCOTC
Regulation Number890.5850890.5850
Product CodeNGXNGX
Electrode UsedK131720, HIVOX self-adhesiveelectrode gel padsK082065, SiliconPad Electrode(7.0cm diameter)
Comparison of Significant device features:
Proposed DevicePredicate Device
510(k) NumberK143737K123075
ItemEM25 - glute toning deviceButtock Muscle Stimulator
ModelEM25WL-2413E
ManufacturerHivox Biotek, Inc.Well-Life HealthcareLimited.
Power Sources1.5V x2 (AAA side)(Alkaline type ONLY)1.5V x3 (AAA Size)
-Method of Line currentIsolationType BFType BF
-Patient Leakage Current
Average DC current throughelectrodes when device is onbut no pulses are beingapplied (µA)N/AN/A
Number of Output Modes14
Number of outputChannels:Synchronousor Alternating?Not applicable (onechannel)Synchronous
Method ofChannelIsolation?Not applicable (onechannel)Output Coil
Regulated Current orRegulated Voltage?VoltageVoltage
Software/Firmware/Microprocessor control?YesYes
Automatic Overload Trip?NoNo
Automatic No-Load Trip?NoYes
Automatic Shut Off?YesYes
User Override control?YesNo
Indicator On/Off Status?No. alerted by soundYes

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EM25 - glute toning device

Comparison of Basic Unit Characteristics:

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EM25 - glute toning device

Display:Low Battery?No, alerted by soundYes
Voltage /Current Level?No, alerted by soundYes
Timer Range (Minutes)2020-40
Compliance with Voluntary Standards?IEC60601-2-10IEC60601-2-10
Compliance with 21 CFR 898?YESYes
Weight (g) including battery13380
Dimensions [W x H x D] (mm)429 X 125 X 2164 X 90 X 20
Housing Materials and constructionSilicone & ABSABS

Comparison of Output Specifications:

Proposed DevicePredicate Device
ItemEM25 - glute toning deviceButtock Muscle Stimulator
ModelEM25WL-2413E
Waveform (e.g., pulsedmonophasic, biphasic)Symmetrical BiphasicBiphasic
ShapeButterfly shapedRetangular
Maximum Output Voltage(volts) - (+/- 20%)64.8V @ 500Ω120V @ 2kΩ132V @ 10kΩ40.8V @ 500Ω70.0V @ 2kΩ106.0V @ 10kΩ
Maximum Output Current(mA) - (+/-20%)129.6mA @ 500Ω60mA @ 2kΩ13.2mA @ 10kΩ81.6mA @ 500Ω35.0mA @ 2kΩ10.6mA @ 10kΩ
Duration of primary phase(µsec)400 fixed300 Max
Pulse Duration (usec)400 fixed720 Max
Pulse length400 μsunknown

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Pulse Frequency (Hz)4-5070 Max
Atmospheric pressure operation700-1060 hPaunknown
For multiphasic waveforms only:Symmetrical phases?YesYes
Phase DurationN/AN/A
Net charge (µC)00
Method of achieving zero net charge for net charge/pulseBiphasic symmetric wave for each pulseBiphasic symmetric wave for each pulse
Max. phase charge50 µC24 µC
Max. current Density1.1549mA/cm²/500Ω0.0997 mA/ cm²
Max. Power Density0.0748Watts/cm²/500Ω0.00399 Watts/ cm²
Max. Average current(RMSA)500Ω129.6mA38.644mA
2ΚΩ60mA16.907 mA
10Ω13.2mA5.120 mA
Burst ModeYESYes
Pulse per burst50Same for each program
Burst per second18Same for each program
Burst duration400µsSame for each program
Duty Cycle7200Same for each program

5.11 Summary for the comparison

The EM25 - glute toning device is substantially equivalent in intended use, design, technology/principles of operation and performance to the predicate device, Buttock Muscle Stimulator, model: WL-2413E (K123075). The proposed device has tested on safety and performance tests and the results were complied with the test requests. Although there are some differences in the output parameters between proposed device and predicate device, the differences did not raise any problems of safety or effectiveness.

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5.12 Conclusion

After analyzing bench tests, safety testing data, it can be concluded that the EM25 glute toning device is substantially equivalent to the predicate device.

§ 890.5850 Powered muscle stimulator.

(a)
Identification. A powered muscle stimulator is an electrically powered device intended for medical purposes that repeatedly contracts muscles by passing electrical currents through electrodes contacting the affected body area.(b)
Classification. Class II (performance standards).