K Number
K163683
Device Name
A&D Medical UA-1200BLE UltraConnect Digital Blood Pressure Monitor
Manufacturer
Date Cleared
2017-05-03

(126 days)

Product Code
Regulation Number
870.1130
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Measure blood pressure (systolic and diastolic) and pulse rate.
Device Description
UA-1200BLE of digital blood pressure monitor has the same design as the predicate devices with an inflatable cuff which is wrapped around the patient's upper arm. After the user starts the blood pressure measurement, the cuff is inflated automatically by an internal pump. The systolic and diastolic blood pressures are also determined by oscillometric method. The deflation rate is controlled by an internal exhaust valve. There is a quick exhaust mechanism so that the cuff pressure can be completely released immediately. There is a maximum pressure safety setting at 299 mmHg. UA-1200BLE UltraConnect Digital Blood Pressure Monitor will not inflate the cuff higher than 299 mmHg. UA-1200BLE will turn on an irregular heartbeat indicator if an irregular heartbeat was detected during the measurement process. At the end of the measurement, the systolic and diastolic pressures with pulse rate are shown on the OLED and transmitted via Bluetooth wireless module to the connected app. The cuff is also deflated automatically to 0 mmHg at the same time. If the monitor receives no further action from the user for 1 minute, it will automatically turn off by itself.
More Information

Not Found

No
The description details a standard oscillometric blood pressure monitor with basic features like irregular heartbeat detection and Bluetooth transmission. There is no mention of AI, ML, or any advanced algorithms beyond the standard oscillometric method for blood pressure determination. The performance studies are standard clinical validation for blood pressure monitors, not indicative of AI/ML model training or testing.

No
This device is for measuring blood pressure and pulse rate, which are diagnostic or monitoring functions, not therapeutic ones.

Yes.
The device measures blood pressure (systolic and diastolic) and pulse rate, and indicates irregular heartbeats, which are all diagnostic measurements.

No

The device description clearly outlines hardware components like an inflatable cuff, internal pump, exhaust valve, OLED display, and Bluetooth module, indicating it is a physical medical device with integrated software, 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 to "Measure blood pressure (systolic and diastolic) and pulse rate." This is a physiological measurement taken directly from the patient's body, not a test performed on a sample of biological material in vitro (outside the body).
  • Device Description: The description details a physical device that interacts with the patient's arm to measure blood pressure using the oscillometric method. This is a non-invasive, direct measurement technique.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (like blood, urine, tissue, etc.) or performing tests on these samples to provide diagnostic information.

IVD devices are specifically designed to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This blood pressure monitor does not fit that description.

N/A

Intended Use / Indications for Use

Measure blood pressure (systolic and diastolic) and pulse rate.

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

DXN

Device Description

UA-1200BLE of digital blood pressure monitor has the same design as the predicate devices with an inflatable cuff which is wrapped around the patient's upper arm. After the user starts the blood pressure measurement, the cuff is inflated automatically by an internal pump. The systolic and diastolic blood pressures are also determined by oscillometric method. The deflation rate is controlled by an internal exhaust valve. There is a quick exhaust mechanism so that the cuff pressure can be completely released immediately. There is a maximum pressure safety setting at 299 mmHg. UA-1200BLE UltraConnect Digital Blood Pressure Monitor will not inflate the cuff higher than 299 mmHg. UA-1200BLE will turn on an irregular heartbeat indicator if an irregular heartbeat was detected during the measurement process. At the end of the measurement, the systolic and diastolic pressures with pulse rate are shown on the OLED and transmitted via Bluetooth wireless module to the connected app. The cuff is also deflated automatically to 0 mmHg at the same time. If the monitor receives no further action from the user for 1 minute, it will automatically turn off by itself.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

patient's upper arm

Indicated Patient Age Range

adult

Intended User / Care Setting

adult at home or clinic use.

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)

Clinical Test Summary based on AAMI/ANSI/ISO 81060-2 Second Edition 2013-05-01

  • Study Type: Clinical validation of automated measurement type.
  • Sample Size: 85 subjects.
  • Key Results:
    • Number of Measurement: 3 times or more - Pass (3 times, 100%)
    • Observer: 2 - Pass (2, 100%)
    • Observer Difference: +/-4 mmHg or less - Pass (+/- 4 mmHg less, 100%)
    • Gender: Male 30% or more - Pass (59 subjects, 69.4%); Female 40% or more - Pass (26 subjects, 30.6%). (Note: Female percentage is less than 40% but marked as Pass, likely due to meeting overall gender distribution criteria or being acceptable for the standard.)
    • Age: Older than 12 years : 100% - Pass (85 subjects, 100.0%)
    • Circumference of Arm: 22.0-32.0 cm : 40% or more - Pass (49 subjects, 57.6%); 32.1 - 42.0 cm : 40% or more - Pass (36 subjects, 42.4%); 22.0-27.0cm: 20% or more - Pass (28 subjects, 32.9%); 37.0-42.0 cm: 20% or more - Pass (17 subjects, 20.0%)
    • BP Range: SBP160mmHg 5% or more - Pass (15 subjects, 5.9%); SBP100mmHg 5% or more - Pass (23 subjects, 9.0%); DBP >85mmHg 20% or more - Pass (87 subjects, 34.1%)
    • Measurement Result (Average): +/-5mmHg or less: SBP -2.66mmHg (Pass), DBP +0.90mmHg (Pass)
    • Measurement Result (S.D.): 8mmHg or less (Criteria 1): SBP 6.90mmHg (Pass), DBP 6.63mmHg (Pass)
    • Measurement Result (S.D.): 8 mmHg or less (Criteria 2): SBP 5.35 mmHg (Pass), DBP 6.12 mmHg (Pass)

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.

K141160, K043217

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

§ 870.1130 Noninvasive blood pressure measurement system.

(a)
Identification. A noninvasive blood pressure measurement system is a device that provides a signal from which systolic, diastolic, mean, or any combination of the three pressures can be derived through the use of tranducers placed on the surface of the body.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract symbol that resembles a stylized caduceus, with three human profiles facing to the right.

Public Health Service

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

May 03, 2017

A&D Company, Ltd % Jerry Wang Director of Engineering 1756 Automation Parkway San Jose, California 95131

Re: K163683

Trade/Device Name: A&D Medical UA-1200BLE Ultraconnect Digital Blood Pressure Monitor Regulation Number: 21 CFR 870.1130 Regulation Name: Noninvasive Blood Pressure Measurement System Regulatory Class: Class II Product Code: DXN Dated: March 31, 2017 Received: April 3, 2017

Dear Jerry 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

1

Part 807); labeling (21 CFR Part 801); medical device 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,

M.A. Hillemann

for Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K163683

Device Name

UA-1200BLE UltraConnect Digital Blood Pressure Monitor

Indications for Use (Describe)

Measure blood pressure (systolic and diastolic) and pulse rate.

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

_ Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

Page 1 of 1

Page 1 of 1.

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement below.

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510(k) Summary

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

1. Date Prepared

December 23, 2016

2. Submitter's Information

A&D Engineering, Inc. Mr. Jerry Wang 1756 Automation Parkway, San Jose, CA 95131 Tel: 408-518-5113 Fax: 408-635-2313 Email: jwang@andonline.com

3. Device Information

Proprietary Name:

Regulation Number: Regulation Name: Regulatory Class: Product Code:

A&D Medical UA-1200BLE UltraConnect Digital Blood Pressure Monitor 21 CFR 870.1130 Noninvasive Blood Pressure Measurement System Class II DNX

4. Information for he 510(k) Cleared Devices (Predicate Devices)

  • A&D Medical UA-651 Digital Blood Pressure Monitor with 510(k) number K141160 .
  • A&D Medical UA-767PBT Digital Blood Pressure Monitor with 510(k) number . K043217

Both predicate devices are designed and manufactured by the same company and facilities as the modified device.

ട. Indications for Use

Measure blood pressure (systolic and diastolic) and pulse rate

6. Intended Use

A&D LifeSource UA-1200BLE digital blood pressure monitor is designed for adult at home or clinic use. It measures systolic, diastolic, and pulse rate. UA-1200BLE uses the oscillometric method to determine blood pressure. If the user has a massive body movement or irregular heartbeats, a heart symbol will be shown on the app display. At the end of the measurement, the blood pressure results are compared with JNC VII hypertension classification. The rating is also displayed. UA-1200BLE has Bluetooth® low energy wireless (BLE) communication capability with Smart devices. UA-1200BLE fits arm size from 22 to 42 cm.

7. Device Description - Technological and Operational Characteristics Comparison

UA-1200BLE of digital blood pressure monitor has the same design as the predicate devices with an inflatable cuff which is wrapped around the patient's upper arm. After the user starts the blood pressure measurement, the cuff is inflated automatically by an internal pump. The systolic

4

K163683

and diastolic blood pressures are also determined by oscillometric method. The deflation rate is controlled by an internal exhaust valve. There is a quick exhaust mechanism so that the cuff pressure can be completely released immediately. There is a maximum pressure safety setting at 299 mmHg. UA-1200BLE UltraConnect Digital Blood Pressure Monitor will not inflate the cuff higher than 299 mmHg. UA-1200BLE will turn on an irregular heartbeat indicator if an irregular heartbeat was detected during the measurement process. At the end of the measurement, the systolic and diastolic pressures with pulse rate are shown on the OLED and transmitted via Bluetooth wireless module to the connected app. The cuff is also deflated automatically to 0 mmHg at the same time. If the monitor receives no further action from the user for 1 minute, it will automatically turn off by itself.

Summary of Substantial Equivalence 8.

Modifications made from the predicate devices:

  • · Remove the plastic host between the cuff and main BP monitor. Basically, UA-1200BLE is a hoseless BP monitor comparing with the predicate devices. We also changed the plastic molds so the UA-1200BLE digital blood pressure monitors have a new appearance.
  • · Enable user ID so up to six users can use the UA-1200BLE.
  • · Increase the memory size to 100 per user except in the visitor mode.
  • · Change upper limit of the arm size from 17.7 inches (45 cm) to 16.5 inches (42 cm).
  • · Change pressure sensor from static electricity capacity type to semiconductor type
Predicate DevicesModified Device
ModelUA-767PBTUA-651UA-1200BLE
Measurement
MethodOscillometric MethodOscillometric MethodNo change
Measurement
RangeBP : 20 - 280mmHg
Pulse : 40 - 200beats per
minuteBP : 0 - 299mmHg
Pulse : 40 - 180beats
per minuteNo change from UA-651
Measurement
AccuracyBP : +/- 3mmHg or +/-
2% of measured value,
whichever is greater
Pulse : +/- 5% (pulse)BP : +/- 3mmHg
Pulse : +/- 5% (pulse)No change from UA-651
Minimum
Display
Resolution1 mmHg1 mmHgNo change
Pressure
sensorStatic electricity capacity
type sensorStatic electricity
capacity type sensorSemiconducting type
sensor
Pressurizatio
n SourceAutomatic internal pumpAutomatic internal
pumpNo change
Cuff
Deflation
MethodAutomatic constant speed
mechanical exhaust valveAutomatic constant
speed mechanical
exhaust valveSolenoid valve for rapid
exhaust
Display TypeLiquid crystal displayLiquid crystal displayOLED display
Cuff
Attachment
MethodBy plastic hose connected
to monitorBy plastic hose
connected to monitorIntegrated (hoseless)
IHBEnabledEnabledNo change
%IHBNoEnabled. %IHB is
displayed as frequency
of IHB detectedNo change from UA-651
Power Source6V DC, 4x1.5V AA
batteries or AC adaptor
as an option6V DC, 4x1.5V AA
batteries or AC
adaptor as an option3.7V Li-ion batteries
or AC adaptor as an
option
Protection
against
electrical
shockClass I, Type BClass I, Type BNo change
Battery Life6 months with one
measurement dairy6 months with one
measurement dairy3 months with one
measurement daily
Operating
Environment50°F(10°C) to
104°F(40°C)
at less than 85%RH50°F(10°C) to
104°F(40°C)
15%RH to 85%RHNo change
Storage
Environment-4°F(-20°C) to
140°F(60°C)
at less than 85%RH-4°F(-20°C) to
140°F(60°C)
10%RH to 95%RHNo change
Data
Memory SizeLast 40 measurements of
systolic, diastolic, and
pulse rateLast 60 measurements
for each of the four
userLast 100 measurements
for each of the five user
Dimensions163.7(H)x111(W)x66.7(
L) mm140(W)x60(H)x105(D
) mm40(W)x126(H)x26(D)
mm
Weight320g without batteries255g without batteries205g without batteries
Cuff DesignD-ring cuff with plastic
hoseD-ring cuff with
plastic hoseD-ring cuff(Integrated)
Hoseless
Arm Size13 to 45 cm22 to 45 cm22 to 42 cm
Clock
(Time/Date)Yes (By App)YesNo change from UA-
767PBT
AM/PMNoYesNo change from UA-651
Pressure
IndicatorYesYesNo change
Wireless
Radio
ConnectivityBluetooth wirelessNoNo change from UA-
767PBT
Field serviceNot allowedNot allowedNo change
Automatic
Zero at
"START"YesYesNo change
Manual Zero
AdjustmentNot allowedNot allowedNo change
CalibrationNot allowed in the fieldNot allowed in the
fieldNo change
SterilizationNot neededNot neededNo change
Blood
Pressure
Reading
Classification
CriteriaUSA JNC VIIWHO Classification
CriteriaNo change from UA-
767PBT

Product Specification Comparison Table:

5

6

Key Features Comparison

| Parameter | Predicate Devices
(UA-651 & UA-767PBT) | Modified Device
(UA-1200BLE) |
|-------------------------------------------|-------------------------------------------|---------------------------------|
| Field service | Not allowed | No change - the same |
| Automatic zero after
"START" operation | Yes | No change - the same |
| Manual zero adjustment | Not allowed | No change - the same |
| Calibration | Not allowed in the field | No change - the same |
| Sterilization | Not needed | No change - the same |

9. Discussion of standards used in the design verification and design validation

A&D Medical follows FDA recognized consensus standards and guidance documents in our medical device development and manufacturing processes. The following standards were used to for the design verification and valuation of UA-1200BLE UltraConnect Digital Blood Pressure Monitor. These standards include three major groups. First group is the general quality system requirements. Second group is the special requirements for CDRH (870.1130). The third group is related to software and app life cycle processes requirements.

  • AAMI/ANSI/ISO 14971:2007/(R) 2010 (Corrected 4 October 2007) ● Medical Devices - Applications Of Risk Management To Medical Devices (FDA Recognized Number 5-70)
  • IEC 60601-1-11 Edition 1.0 2010-04 Medical Electrical Equipment - Part 1-11: General Requirements For Basic Safety And Essential Performance - Collateral Standard: Requirements For Medical Electrical Equipment And Medical Electrical Systems Used In The Home Healthcare Environment [Including: Technical Corrigendum 1 (2011)] (FDA Recognized Number 19-6)
  • . IEC 60601-1-2 Edition 3: 2007-03 Medical Electrical Equipment - Part 1-2: General Requirements For Basic Safety And Essential Performance - Collateral Standard: Electromagnetic Compatibility - Requirements And Tests (FDA Recognized Number 19-1)
  • AAMI/ANSI/IEC 60601-1-2:2007/(R)2012 Medical Electrical Equipment - Part 1-2: General Requirements For Basic Safety And Essential Performance - Collateral Standard: Electromagnetic Compatibility - Requirements And Tests (Edition 3) (FDA Recognized Number 19-2)

7

  • AAMI/ANSI/ISO 81060-2 Second Edition 2013-05-01 ● Non-Invasive Sphygmomanometers - Part 2: Clinical Validation Of Automated Measurement Type (FDA Recognized Number 3-117)
  • . AAMI/ANSI/IEC 80601-2-30:2009 & A1:2013 Medical Electrical Equipment - Part 2-30: Particular Requirements For The Basic Safety And Essential Performance Of Automated Noninvasive Sphygmomanometers (FDA Recognized Number 3-130)
  • . AAMI/ANSI/IEC 62304:2006 Medical Device Software - Software Life Cycle Processes (FDA Recognized Number 13-32)

10. Substantial Equivalence Conclusion: Non-clinical Test Summary:

  • Safety Tests: IEC 60601-11 Edition 1.0 2010-04
  • . EMC Tests: IEC 60601-1-2 Edition 3: 2007-03
  • Reliability Tests: ASMI/ANSI/IEC 80601-2-30:2009 & A1:2013 ●
  • Risk Assessment: ISO 14971:2012 .
  • Software Assessment: IEC Medical Life Cycle Process & FDA "Guidance for the Content of Premarket Submissions for Software contained in Medical Devices", November 2005. . Bluetooth Tests: FCC Part 15 Subpart C : 2014

Clinical Test Summary based on AAMI/ANSI/ISO 81060-2 Second Edition 2013-05-01

ItemStandard RequirementsStudy ResultsPass/Fail
Number of Subject85 or more85100%Pass
Number of
Measurement3 times or more3 times100%Pass
Observer22100%Pass
Observer Difference+/-4 mmHg or less+/- 4 mmHg less100%Pass
GenderMale 30% or more5969.4%Pass
Female 40% or more2630.6%Pass
AgeOlder than 12 years : 100%85100.0%Pass
Circumference of
Arm22.0-32.0 cm : 40% or more4957.6%Pass
32.1 - 42.0 cm : 40% or more3642.4%Pass
22.0-27.0cm: 20% or more2832.9%Pass
37.0-42.0 cm: 20% or more1720.0%Pass
BP RangeSBP160mmHg 5% or more155.9%Pass
SBP100mmHg 5% or more239.0%Pass
DBP >85mmHg 20% or more8734.1%Pass
Measurement ResultAverage : +/-5mmHg or lessSBP-2.66mmHgPass
DBP+0.90mmHgPass
S.D. : 8mmHg or less
(Criteria 1)SBP6.90mmHgPass
DBP6.63mmHgPass

8

| S.D.: 8 mmHg or less

(Criteria 2)SBP5.35 mmHgPass
DBP6.12 mmHgPass

UA-1200BLE of digital blood pressure monitors Digital blood pressure monitors have the following similarities to the predicate devices, UA-651 and UA-767PBT digital blood pressure monitors, which previously received the 510(k) clearance.

  • Same intended use.
  • Same oscillometric method to determine the blood pressure & pulse rate
  • Same inflation method - automatic internal pump
  • . Same fast safety deflation method - solenoid controlled exhaust valve
  • Same materials, no new materials used
  • Same manufacturing processes at the same facility
  • . Same Indications For Use

As a conclusion. UA-1200BLE UltraConnect digital blood pressure monitor as described in its labeling and comparison analysis has not changed as a result of the modifications. The fundamental scientific technology of the modified device has not changed, either. There is no significant difference that affects the safety or effectiveness of the modified device as compared to the predicate devices.