K Number
K163091
Device Name
VibraPEP
Date Cleared
2017-02-21

(109 days)

Product Code
Regulation Number
868.5690
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The VibraPEP™ Mucus Clearing Device is a Positive Expiratory Pressure, PEP device. It was designed to exercise patient's lungs and to improve secretion clearance. The device may be connected via a Valved T-adapter for use with a jet nebulizer for aerosol drug delivery. The VibraPEP™ Mucus Clearing Device is not intended to be used while connected to a jet nebulizer which is delivering nebulized steroidal drugs or antibiotics.
Device Description
The proposed device is the identical VibraPEP™ cleared under K153441 but with a Valved T-adapter and mouthpiece that allow the user to connect a general purpose jet nebulizer. The VibraPEP™ is an Oscillatory PEP (OPEP) device that looks like a curved shaped pipe with a plastic mouthpiece at one end. A long hose is attached inside. As the patient blows through the VibraPEP™, the hose pressure increases and buckles at the bending of the tube. When the peak pressure is reached, the hose end opens and is catapulted against the wall releasing its pressure. This process is repeated, providing an oscillation effect with pressure during the exhalation phase. By rotating the therapy selector, pressure and flow can be adjusted to achieve optimal therapy for each patient. The VibraPEP™ facilitates mucus clearing by generating and delivering an oscillation effect that vibrates the airways and lung secretions, causing lung secretions to thin and become expelled.
More Information

No
The device description and performance studies focus on mechanical and physical principles of operation (oscillatory PEP, pressure, flow, frequency) and do not mention any computational or data-driven components indicative of AI/ML. The "Mentions AI, DNN, or ML" field is explicitly marked as "Not Found".

Yes
The device is described as an Oscillatory PEP (OPEP) device designed to "exercise patient's lungs and to improve secretion clearance." It "facilitates mucus clearing by generating and delivering an oscillation effect that vibrates the airways and lung secretions, causing lung secretions to thin and become expelled." These are clear therapeutic effects for a medical condition.

No.
The device is described as a "Mucus Clearing Device" intended to "exercise patient's lungs and to improve secretion clearance," which are therapeutic functions, not diagnostic ones. It facilitates mucus clearing and aerosol drug delivery.

No

The device description clearly outlines a physical, mechanical device (curved pipe, mouthpiece, hose) that generates oscillations through physical means (hose buckling and releasing pressure). The performance studies also focus on physical characteristics and performance of the hardware components.

Based on the provided information, the VibraPEP™ Mucus Clearing Device is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use is to "exercise patient's lungs and to improve secretion clearance." This is a therapeutic purpose, not a diagnostic one.
  • Device Description: The device description details a mechanical device that uses pressure and oscillation to facilitate mucus clearing. It does not describe any components or processes for analyzing biological samples (like blood, urine, or tissue) to diagnose a condition.
  • Performance Studies: The performance studies focus on the mechanical performance of the device (pressure, flow, frequency) and the performance of connected nebulizers in delivering medication. They do not involve the analysis of biological samples or the diagnosis of a disease.
  • Anatomical Site: The anatomical site is the lungs and airways, which are the target of the therapy, not the source of a sample for diagnostic testing.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The VibraPEP™ does not perform this function.

N/A

Intended Use / Indications for Use

The VibraPEP™ Mucus Clearing Device is a Positive Expiratory Pressure, PEP device. It was designed to exercise patient's lungs and to improve secretion clearance. The device may be connected via a Valved T-adapter for use with a jet nebulizer for aerosol drug delivery. The VibraPEP™ Mucus Clearing Device is not intended to be used while connected to a jet nebulizer which is delivering nebulized steroidal drugs or antibiotics.

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

BWF

Device Description

The proposed device is the identical VibraPEP™ cleared under K153441 but with a Valved T-adapter and mouthpiece that allow the user to connect a general purpose jet nebulizer.

The VibraPEP™ is an Oscillatory PEP (OPEP) device that looks like a curved shaped pipe with a plastic mouthpiece at one end. A long hose is attached inside. As the patient blows through the VibraPEP™, the hose pressure increases and buckles at the bending of the tube. When the peak pressure is reached, the hose end opens and is catapulted against the wall releasing its pressure. This process is repeated, providing an oscillation effect with pressure during the exhalation phase. By rotating the therapy selector, pressure and flow can be adjusted to achieve optimal therapy for each patient. The VibraPEP™ facilitates mucus clearing by generating and delivering an oscillation effect that vibrates the airways and lung secretions, causing lung secretions to thin and become expelled.

The VibraPEP™ is similar to the predicate RC-Cornet device, cleared on K983308. It has been demonstrated to be functionally equivalent and with the same intended use to the predicate.

The primary device is comprised of several components:

  • Curved tube
  • Cap for end of Tube
  • Mouthpiece with selector
  • Valve tube
  • Drying tool
  • Valved T-adapter for use to connect a general purpose nebulizer

The VibraPEP can allow the patient to connect a standard jet nebulizer via a "tee" adapter and during inhalation receive an aerosol treatment, but with a one-way valve, upon exhalation the user exhales through the VibraPEP™ device to PEP therapy.

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

Patient - Patients who have been prescribed PEP Therapy
Environment - Hospital, clinics, physician offices, home setting

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 Testing - Non-clinical:
Biocompatibility and Materials - The new materials (other components are the same as the predicate) in the gas pathway are only the T-adapter and mouthpiece which have been evaluated per ISO 10993-1. They are characterized as:

  • External Communicating (Indirect gas pathway)
  • Tissue / Bone / Dentin communicating
  • Duration of Use - permanent (> 30 days)
    And
  • Surface Contact
  • Mucosal membrane
  • Duration of Use permanent (> 30 days)

Comparative Performance:
A series of tests were performed comparing the predicate, reference and subject device Across flow rates of 10, 20, and 40 lpm:

  • Average Pressure
  • Average Pressure Amplitude
  • Frequency
  • Average Flow Rate
    Key results: It was demonstrated that the addition of the Valved T-adapter and mouthpiece do not alter the performance of the VibraPEP™ with the Valved T-adapter as compared to the predicate – K983308 - RC Cornet.

Nebulizer performance – Samples of cleared small volume jet nebulizers were tested with 3 drugs with and without connection to the VibraPEP.
Key results: The results show that there were no statistically significant differences between the performances in all configurations. It was demonstrated that the addition of the T-adapter and mouthpiece do not alter the performance of the nebulizer and thus can be used simultaneously with the VibraPEP as indicated with the predicate - K983308 - RC Cornet, which can be used with its specified nebulizer in the same manner.

PEP performance - Samples of the VibraPEP™ with the T-adapter were tested and compared to the VibraPEP without T-adapter, as well as comparing the predicate RC Cornet and its T-adapter for PEP performance.
Key results: The results show that there no differences between performance. It was demonstrated that the addition of the T-adapter and mouthpiece do not alter the PEP performance.

Effects of Aging, Cleaning, and Drop testing - Testing related to aging and cleaning that included mechanical drop testing of the new components, Valved T-adapter and mouthpiece, was performed.
Key results: The components continued to meet their performance specifications.

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.

Pari / Medica Holdings - RC-Cornet – K983308

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.

Medica Holdings – VibraPEP™ - K153441

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

§ 868.5690 Incentive spirometer.

(a)
Identification. An incentive spirometer is a device that indicates a patient's breathing volume or flow and that provides an incentive to the patient to improve his or her ventilation.(b)
Classification. Class II (performance standards).

0

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

February 21, 2017

Medica Holdings, LLC % Paul Dryden Consultant Promedic, LLC 24301 Woodsage Dr. Bonita Springs, Florida 34134

Re: K163091

Trade/Device Name: VibraPEPTM Regulation Number: 21 CFR 868.5690 Regulation Name: Incentive Spirometer Regulatory Class: II Product Code: BWF Dated: January 15, 2017 Received: January 17, 2017

Dear Paul Dryden:

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.

1

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 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,

Tina
Kiang-S

Tina Kiang, Ph.D. Acting Director Division of Anesthesiology. General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known)

K163091

Device Name

VibraPEP™

Indications for Use (Describe)

The VibraPEP™ Mucus Clearing Device is a Positive Expiratory Pressure, PEP device. It was designed to exercise patient's lungs and to improve secretion clearance. The device may be connected via a Valved Tadapter for use with a jet nebulizer for aerosol drug delivery. The VibraPEP™ Mucus Clearing Device is not intended to be used while connected to a jet nebulizer which is delivering nebulized steroidal drugs or antibiotics.

Patient - Patients who have been prescribed PEP Therapy

Environment - Hospital, clinics, physician offices, home setting

Type of Use (Select one or both, as applicable)
---------------------------------------------------

XX Prescription Use (Part 21 CFR 801 Subpart D)

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

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3

510(k) Summary February 21, 2017

Page 1 of 8

Date PreparedFebruary 21, 2017
Official Contact:George Reed
Medica Holdings, LLC
5200 Meadows Road, Suite 150
Lake Oswego, OR 97035
Tel - 503-223-5360
Proprietary or Trade Name:VibraPEP™
Common/Usual Name:Spirometer, Therapeutic (Incentive)
Classification Name:BWF - 21CFR868.5690, Class II
Predicate Device:Pari / Medica Holdings - RC-Cornet – K983308
Reference Device:Medica Holdings – VibraPEP™ - K153441

Device Description:

The proposed device is the identical VibraPEP™ cleared under K153441 but with a Valved T-adapter and mouthpiece that allow the user to connect a general purpose jet nebulizer.

The VibraPEP™ is an Oscillatory PEP (OPEP) device that looks like a curved shaped pipe with a plastic mouthpiece at one end. A long hose is attached inside. As the patient blows through the VibraPEP™, the hose pressure increases and buckles at the bending of the tube. When the peak pressure is reached, the hose end opens and is catapulted against the wall releasing its pressure. This process is repeated, providing an oscillation effect with pressure during the exhalation phase. By rotating the therapy selector, pressure and flow can be adjusted to achieve optimal therapy for each patient. The VibraPEP™ facilitates mucus clearing by generating and delivering an oscillation effect that vibrates the airways and lung secretions, causing lung secretions to thin and become expelled.

Device Description:

The VibraPEP™ is similar to the predicate RC-Cornet device, cleared on K983308. It has been demonstrated to be functionally equivalent and with the same intended use to the predicate.

The primary device is comprised of several components:

  • Curved tube
  • Cap for end of Tube ●
  • Mouthpiece with selector ●
  • Valve tube
  • Drying tool
  • . Valved T-adapter for use to connect a general purpose nebulizer

The VibraPEP can allow the patient to connect a standard jet nebulizer via a "tee" adapter and during inhalation receive an aerosol treatment, but with a one-way valve, upon exhalation the user exhales through the VibraPEP™ device to PEP therapy.

4

510(k) Summary

February 21, 2017 Page 2 of 8

Principle of Operation

The VibraPEP™ is a curved tube in which a long valve is inserted. As the patient blows through the VibraPEP, the hose pressure increases and buckles at the bending of the tube. When the peak pressure is reached, the hose end opens and is catapulted against the wall releasing its pressure. This process is repeated, providing an oscillation effect during the entire exhalation phase. By rotating the therapy selector, pressure and flow can be adjusted to increase or decrease the pressure and frequency of PEP therapy.

The modification in this submission is the addition of a Valved T-adapter which allows one to connect a general purpose nebulizer and the VibraPEP™ together. Due to the directional valve in the Valved Tadapter, a patient during inhalation would inhale the aerosolized medications from the nebulizer and during exhalation the valve prevent flow back to the nebulizer and the patient then exhaled through the VibraPEP™. It is the same as if the patient used the 2 devices separately.

Compatibility with aerosolized medications:

Medications which open your airways or help to thin mucus would be good choices to use with your VibraPEPTM Oscillating PEP because they would help remove or thin the mucus in your lungs.

Medications you want to stay in your lungs, like antibiotics and steroids, should be taken after you have completed your VibraPEP™ Oscillating PEP treatment.

Indications for Use:

The VibraPEP™ Mucus Clearing Device is a Positive Expiratory Pressure, PEP device. It was designed to exercise patient's lungs and to improve secretion clearance. The device may be connected via a Valved T-adapter for use with a jet nebulizer for aerosol drug delivery. The VibraPEPIM Mucus Clearing Device is not intended to be used while connected to a jet nebulizer which is delivering nebulized steroidal drugs or antibiotics.

Patient - Patients who have been prescribed PEP Therapy

Environment - Hospital, clinics, physician offices, home setting

Contraindications:

Although no absolute contraindications to the use of PEP Therapy have been reported, the following should be carefully evaluated before a decision is made to initiate therapy:

  • Inability to tolerate increased work of breathing ●
  • Patients unable to tolerate the increased work of breathing (acute asthma. COPD) ●
  • Intracranial pressure (ICP) > 20 mm Hg .
  • Hemodynamic instability .
  • Recent facial, oral, or skull surgery or trauma .
  • Acute sinusitis
  • . Epistaxis
  • . Esophageal surgery
  • . Active hemoptysis
  • Nausea
  • Known or suspected tympanic membrane rupture or other middle . ear pathology
  • . Untreated pneumothorax

Substantial Equivalence

The following tables present the comparison and then we discuss the differences.

5

510(k) Summary February 21, 2017 Page 3 of 8

Table 1 - Comparison Predicate and Reference to Proposed Device

| Features | Predicate
RC-Cornet
K983308 | Reference
VibraPEP™
K153441 | Proposed
VibraPEP™
with Valved T-adapter |
|------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for use | The PARI RC Cornet Mucus Clearing
Device is a Positive Expiratory Pressure PEP
Device and it was designed to exercise
patient's lungs and to improve secretion
clearance.

The device was designed to work with PARI
LC Nebulizers. | The VibraPEPT™ Mucus Clearing Device is
a Positive Expiratory Pressure, PEP device.
It was designed to exercise patient's lungs
and to improve secretion clearance. | The VibraPEPTM Mucus Clearing Device
is a Positive Expiratory Pressure, PEP
device. It was designed to exercise
patient's lungs and to improve secretion
clearance. The device may be connected
via a Valved T-adapter for use with a jet
nebulizer for aerosol drug delivery. |
| Environment of Use | Hospital, clinics, physician offices, home
setting | Hospital, clinics, physician offices, home
setting | Hospital, clinics, physician offices, home
setting |
| Patient Population | Children 4 years and older to adults | Patients who have been prescribed PEP
Therapy | Patients who have been prescribed PEP
Therapy |
| Contraindications | - Intracranial pressure (IPC) > 20 mm Hg

  • Hemodynamic instability
  • Recent facial, oral or skull surgery or
    trauma
  • Acute sinusitis
  • Epistaxis
  • Esophageal surgery
  • Active hemoptysis
  • Untreated pneumothorax
  • Nausea
  • Known or suspected tympanic membrane
    rupture or other middle ear pathology | - Intracranial pressure (IPC) > 20 mm Hg
  • Hemodynamic instability
  • Recent facial, oral or skull surgery or
    trauma
  • Acute sinusitis
  • Epistaxis
  • Esophageal surgery
  • Active hemoptysis
  • Untreated pneumothorax
  • Nausea
  • Known or suspected tympanic membrane
    rupture or other middle ear pathology
  • Patients unable to tolerate the increased
    work of breathing (acute asthma, COPD) | - Intracranial pressure (IPC) > 20 mm Hg
  • Hemodynamic instability
  • Recent facial, oral or skull surgery or
    trauma
  • Acute sinusitis
  • Epistaxis
  • Esophageal surgery
  • Active hemoptysis
  • Untreated pneumothorax
  • Nausea
  • Known or suspected tympanic membrane
    rupture or other middle ear pathology
  • Patients unable to tolerate the increased
    work of breathing (acute asthma, COPD) |
    | Principle of
    Operation (PEP) | Tube valve that upon patient exhalation
    will create PEP and oscillation

Adjustable to create different frequencies | Tube valve that upon patient exhalation will
create PEP and oscillation

Adjustable to create different frequencies | Tube valve that upon patient exhalation
will create PEP and oscillation

Adjustable to create different frequencies |
| Features | Predicate
RC-Cornet
K983308 | Reference
VibraPEPTM
K153441 | Proposed
VibraPEPTM
with Valved T-adapter |
| Use with a nebulizer | Use of a Valved T-adapter to connect the
outlet of the nebulizer | No | Use of a Valved T-adapter to connect the
outlet of the nebulizer |
| Specified Nebulizer | Pari LC | None | General Purpose small volume nebulizers |
| Duration of Use | Single patient, multi-use | Single patient, multi-use | Single patient, multi-use |
| Cleaning method | Soap / water
Boiling water | Soap / water
Boiling water | Soap / water
Boiling water |
| Accessories | Valved – T-adapter to be inserted between
nebulizer and mouthpiece | None | Valved T- adapter to be inserted between
nebulizer and mouthpiece |
| | Pari LC nebulizers | | User supplied cleared jet nebulizer |
| Components | Curved tube
Mouthpiece / selector
Tube Valve
Cap
Drying device
T-adapter | Curved tube
Mouthpiece / selector
Tube Valve
Cap
Drying device | Curved tube
Mouthpiece / selector
Tube Valve
Cap
Drying device
Valved T-adapter |
| Biocompatibility
ISO 10993-1 | Surface Contact
Mucosal membrane
Externally Communicating
Tissue
Duration of Use – permanent (> 30 days) | Surface Contact
Mucosal membrane
Duration of Use – permanent (> 30 days) | Surface Contact
Mucosal membrane
Externally Communicating
Tissue
Duration of Use – permanent (> 30 days)
Cytotoxicity
Sensitization
Irritation
Leachable / Extractable 2 solvents
Risk Based Assessment |
| Performance Testing – Non-clinical | | | |
| Shelf-life | Not specified | 1 year | 1 year |

6

510(k) Summary

February 21, 2017

7

510(k) Summary

February 21, 2017 Page 5 of 8

| Features | Predicate
RC-Cornet
K983308 | Reference
VibraPEPTM
K153441 | Proposed
VibraPEPTM
with Valved T-adapter | | | | | | |
|----------------------------------------------------------------------------------------|-----------------------------------|----------------------------------------------------|-------------------------------------------------|-----------|---------|---------|----------------|----------------------------------------------------|----------------|
| Performance without the Valved T-adapter Data from K153441 Across Settings 1, 3, and 5 | | | | | | | | | |
| | Flow Rate | | | Flow Rate | | | Flow Rate | | |
| | 10 lpm | 20 lpm | 40 lpm | 10 lpm | 20 lpm | 40 lpm | 10 lpm | 20 lpm | 40 lpm |
| Ave. Pressure
(cmH2O)
across full range | 11 - 14 | 17 - 21 | 23 - 44 | 10 - 13 | 18 - 21 | 27 - 41 | 10 - 13 | 18 - 21 | 27 - 41 |
| Ave. Pressure
Amplitude (cmH2O)
across full range | 6 - 19 | 21 - 27 | 46 - 80 | 7 - 17 | 22 - 28 | 51 - 76 | 7 - 17 | 22 - 28 | 51 - 76 |
| Ave. Flow Rate
(lpm) across full
range | 6 - 16 | 12 - 18 | 15 - 21 | 8 - 16 | 12 - 17 | 19 - 22 | 8 - 16 | 12 - 17 | 19 - 22 |
| Performance with Valves T-adapter Across Settings 1, 3, and 5 | | | | | | | | | |
| Ave. Pressure
(cmH2O)
across full range | 10
13
15 | Setting 1 - 22
Setting 3 - 19
Setting 5 - 19 | 41
39
30 | N/A | N/A | N/A | 9
12
13 | Setting 1 - 21
Setting 3 - 18
Setting 5 - 18 | 40
38
29 |
| Ave. Pressure
Amplitude (cmH2O)
across full range | 5
6
18 | Setting 1 - 20
Setting 3 - 21
Setting 5 - 26 | 60
54
50 | N/A | N/A | N/A | 5
6
13 | Setting 1 - 19
Setting 3 - 19
Setting 5 - 24 | 58
52
46 |
| Frequency (Hz) | 16
15
9 | Setting 1 - 17
Setting 3 - 16
Setting 5 - 13 | 20
21
17 | | | | 15
15
8 | Setting 1 - 17
Setting 3 - 16
Setting 5 - 13 | 20
21
18 |
| Ave. Flow Rate
(lpm) across full
range | 10
10
10 | 20 | 40
40
40 | N/A | N/A | N/A | 10
10
10 | 20 | 40
40
40 |

8

510(k) Summary

February 21, 2017

Page 6 of 8

Table 2 - Comparison of General Purpose Nebulizer as Standalone vs. Attached to VibraPEP™

| Measurement
(Mean) | Standalone
configuration | With
VibraPEP | Standalone
Configuration | With
VibraPEP | Standalone
configuration | With
VibraPEP |
|----------------------------------------------------|-----------------------------|------------------|-----------------------------|------------------|-----------------------------|------------------|
| Westmed - VixOne (K800562) | | | | | | |
| | Albuterol | | Cromoly Sodium | | Ipratropium Bromide | |
| MMAD (um) | 1.7 | 1.37 | 1.67 | 1.43 | 1.53 | 1.37 |
| GSD | 2.24 | 2.21 | 2.04 | 1.75 | 2.11 | 2.09 |
| Total Dose (ug) | 1256 | 1050 | 6295 | 5212 | 262 | 252 |
| Total Respirable
Dose (0.5-5) | 896 | 790 | 4939 | 4106 | 174 | 147 |
| Coarse Particle > 4.7 | 266 | 154 | 881 | 555 | 72 | 83 |
| Fine particle ( 4.7 | 277 | 193 | 782 | 564 | 52 | 44 |
| Fine particle ( 30 days)

And

  • Surface Contact
  • Mucosal membrane
  • Duration of Use permanent (> 30 days) ●

Discussion - We tested the all components of the VibraPEP including the new components. Testing was performed with final, finished product and was found to be non-reactive. We do not supply the nebulizer, but any nebulizer used has been cleared under 510(k) and use with the VibraPEP does not change its intended use.

Differences - Testing has demonstrated that the proposed VibraPEP meets the ISO 10993 requirements and the proposed materials have not raise different questions of safety and effectiveness.

Comparative Performance

  • · A series of tests were performed comparing the predicate, reference and subject device

10

510(k) Summary February 21, 2017 Page 8 of 8

Across flow rates of 10, 20, and 40 lpm

  • o Average Pressure
  • o Average Pressure Amplitude
  • Frequency o

  • 0 Average Flow Rate
    Discussion – We demonstrated that the addition of the Valved T-adapter and mouthpiece do not alter the performance of the VibraPEP™ with the Valved T-adapter as compared to the predicate – K983308 - RC Cornet.

Nebulizer performance – We tested samples of cleared small volume jet nebulizers with 3 drugs with and without connection to the VibraPEP. The results show that there were no statistically significant differences between the performances in all configurations.

Discussion - We have demonstrated that the addition of the T-adapter and mouthpiece do not alter the performance of the nebulizer and thus can be used simultaneously with the VibraPEP as indicated with the predicate - K983308 - RC Cornet, which can be used with its specified nebulizer in the same manner.

PEP performance - We tested samples of the VibraPEP™ with the T-adapter and compared performed to the VibraPEP without T-adapter as well as we compared the predicate RC Cornet and its T-adapter for PEP performance. The results show that there no differences between performance. Discussion - We have demonstrated that the addition of the T-adapter and mouthpiece do not alter the PEP performance.

Effects of Aging, Cleaning, and Drop testing - We performed testing related to aging and cleaning that included mechanical drop testing of the new components, Valved T-adapter and mouthpiece, and found that they continued to meet their performance specifications.

Differences - Testing has demonstrated when a nebulizer is connected to the proposed VibraPEP the performance of the nebulizer is not significantly changed, thus we can stated that there are no different questions of safety and effectiveness.

Discussion of Differences and Substantial Equivalence Conclusion

As detailed above, the indications for use, patient population, environment of use, technology or principle of operation, and performance are substantially equivalent to the predicate.

There are no differences between the proposed VibraPEP™ and the predicate - K983308 - RC-Cornet and reference - K153441 - VibraPEP based upon the comparative performance testing which raise different questions of safety and effectiveness.