K Number
K183491
Device Name
Arm Blood Pressure Monitor
Date Cleared
2019-03-24

(97 days)

Product Code
Regulation Number
870.1130
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Arm blood pressure monitor is used for measuring blood pressure and pulse rate. The monitor can be used in hospitals, families, schools and medical centers. It is suitable for adult, not for neonate or pregnancy.
Device Description
The proposed device, Arm Blood Pressure Monitor, is an automatic non-invasive Blood Pressure Monitor which can be driven both battery and AC power supply. It uses an inflatable cuff which is wrapped around the patient's upper arm to measure the systolic and diastolic blood pressure as well as the pulse rate of adult, not for neonate or pregnancy. The measuring method for the Arm Blood Pressure Monitor is oscillation mensuration. And all values can be read out in one LCD panel. User can set different user ID for data storage, which can be set as two independent groups of measured blood pressure data.The blood pressure storing 2x99 set memory value, each measurement it will automatically stored. When it stored 2x99 set memory value, the old value will be covered by the new one. It can show the latest 3 times average value. User can set the time as year, month, day, hour and minute; User can enable or disable the function of voice broadcast about measurement result: User can select the unit of the measurement: mmHg or KPa; The device has the data storage function for data reviewing, including the data of systolic pressure, diastolic pressure, pulse rate and measurement time. The device has low power indicator to indicate the states of low batteries power.
More Information

Not Found

No
The document describes a standard oscillometric blood pressure monitor with basic data storage and display features. There is no mention of AI, ML, or any advanced data processing that would suggest the use of these technologies. The clinical validation follows a standard protocol for non-invasive sphygmomanometers.

No.
The device is used for measuring blood pressure and pulse rate, which supports diagnosis but does not provide a therapeutic function or treatment.

No

Explanation: The device 'measures blood pressure and pulse rate,' which are physiological parameters. While these measurements can be used by a healthcare professional in conjunction with other information to form a diagnosis, the device itself simply provides measurements and does not interpret those measurements to 'establish or confirm a diagnosis'.

No

The device description explicitly states it is an "automatic non-invasive Blood Pressure Monitor which can be driven both battery and AC power supply" and "uses an inflatable cuff". These are hardware components, indicating it is not a software-only device.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. These tests are performed outside of the living body (in vitro).
  • Device Function: The described device is an Arm Blood Pressure Monitor. It measures blood pressure and pulse rate by applying a cuff to the patient's upper arm and using oscillation mensuration. This is a non-invasive measurement performed on the living body.
  • Lack of Sample Analysis: The device does not analyze any biological samples taken from the patient.

Therefore, based on the provided information, the Arm Blood Pressure Monitor is a non-invasive medical device used for physiological measurement, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Arm blood pressure monitor is used for measuring blood pressure and pulse rate. The monitor can be used in hospitals, families, schools and medical centers. It is suitable for adult, not for neonate or pregnancy.

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

DXN

Device Description

The proposed device, Arm Blood Pressure Monitor, is an automatic non-invasive Blood Pressure Monitor which can be driven both battery and AC power supply. It uses an inflatable cuff which is wrapped around the patient's upper arm to measure the systolic and diastolic blood pressure as well as the pulse rate of adult, not for neonate or pregnancy.

The measuring method for the Arm Blood Pressure Monitor is oscillation mensuration. And all values can be read out in one LCD panel.

User can set different user ID for data storage, which can be set as two independent groups of measured blood pressure data.The blood pressure storing 2x99 set memory value, each measurement it will automatically stored. When it stored 2x99 set memory value, the old value will be covered by the new one. It can show the latest 3 times average value.

User can set the time as year, month, day, hour and minute;

User can enable or disable the function of voice broadcast about measurement result:

User can select the unit of the measurement: mmHg or KPa;

The device has the data storage function for data reviewing, including the data of systolic pressure, diastolic pressure, pulse rate and measurement time.

The device has low power indicator to indicate the states of low batteries power.

Cuff supporting the use of Xuzhou Yongkang electronic sphygmomanometer:

M5303(small adult)/M5304(adult)/ M5305(big adult) provided by Xuzhou Maikang Science and Technology Ltd., and cleared by the CE(Declaration of Conformity for Class I)/ISO and FDA(K151290).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Upper Arm

Indicated Patient Age Range

adult, not for neonate or pregnancy

Intended User / Care Setting

hospitals, families, schools and medical centers.

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

The clinical trials for YK-BPA1 were performed according the standard of ISO 81060-2:2013, Non-Invasive Sphygmomanometers - Part 2: Clinical Validation of Automated Measurement Type, and relevant volunteers were collected to conduct actual clinical trial of blood pressure measurement.

There were 150 subjects been selected to participate in the trial, and Auscultation was applied as gold standard with the qualified calibrated mercurial sphygmomanometer used as control group for comparison with the proposed device.

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Clinical Trial: The clinical trials for YK-BPA1 were performed according the standard of ISO 81060-2:2013, Non-Invasive Sphygmomanometers - Part 2: Clinical Validation of Automated Measurement Type. 150 subjects were selected. Auscultation was applied as gold standard with the qualified calibrated mercurial sphygmomanometer used as control group for comparison with the proposed device. The results shown that the accuracy of proposed device meet the requirements of ISO 81060-2:2013 within the +/- 5mmHg. And the proposed device comply with the standard requirements and the accuracy the manufacture declared.

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

Accuracy +/- 5mmHg

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.

K170605

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 contains the logos of the Department of Health & Human Services and the Food and Drug Administration (FDA). The Department of Health & Human Services logo is on the left, and the FDA logo is on the right. The FDA logo includes the text "U.S. Food & Drug Administration" in blue.

March 24, 2019

Xuzhou Yongkang Electronic Science Technology Co., Ltd % Boyle Wang Official Correspondent Shanghai Truthful Information Technology Co., Ltd. RM. 608. No. 738. Shangcheng Rd., Pudong Shanghai, 200120 Cn

Re: K183491

Trade/Device Name: Arm Blood Pressure Monitor Regulation Number: 21 CFR 870.1130 Regulation Name: Noninvasive Blood Pressure Measurement System Regulatory Class: Class II Product Code: DXN Dated: December 17, 2018 Received: December 17, 2018

Dear Boyle Wang:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Shawn W. Forrest -S 2019.03.24 22:04:34 -04'00'

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

Enclosure

2

Indications for Use

510(k) Number (if known) K183491

Device Name Arm Blood Pressure Monitor

Indications for Use (Describe)

The Arm blood pressure monitor is used for measuring blood pressure and pulse rate. The monitor can be used in hospitals, families, schools and medical centers. It is suitable for adult, not for neonate or pregnancy.

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

Prescription Use (Part 21 CFR 801 Subpart D)

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

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3

Tab #06 510(k) Summary

This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of SMDA 1990 and 21 CFR 807.92.

1.0 submitter's information

Name: Xuzhou Yongkang Electronic Science Technology Co., Ltd Address: 4F Building C8, 40 Jingshan Road, Economic and Technological Development Zone, Xuzhou, Jiangsu,221000,China Tel: 86-516- 87892766-601 Fax: 86- 516-87892766 -606 Contact: Kai Li Date of Preparation: Mar.24.2019

Designated Submission Correspondent

Mr. Boyle Wang Shanghai Truthful Information Technology Co., Ltd. Room 608, No. 738 Shangcheng Rd., Pudong Shanghai, 200120 China Tel: +86-21-50313932 Email: Info@truthful.com.cn

2.0 Device information

Trade name: Arm Blood Pressure Monitor Common name: Noninvasive Blood Pressure Measurement System Classification name: Noninvasive Blood Pressure Measurement System Model(s): YK-BPA1

3.0 Classification

Production code: DXN Regulation number: 21 CFR 870.1130 Class II Classification: Panel: Cardiovascular

4.0 Predicate device information

Manufacturer: Jiangsu Yuyue Medical Equipment & Supply Co., Ltd Device: Upper Arm Type Electronic Blood Pressure Monitor Series, Electronic Blood Pressure Monitor: YE650A, YE650D, YE660B, YE670A and YE670D

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510(k) number: K170605

5.0 Indication for Use Statement

The Arm Blood Pressure Monitor is used for measuring blood pressure and pulse rate. The monitor can be used in hospitals, families, schools and medical centers. It is suitable for adult, not for neonate or pregnancy.

6.0 Device description

The proposed device, Arm Blood Pressure Monitor, is an automatic non-invasive Blood Pressure Monitor which can be driven both battery and AC power supply. It uses an inflatable cuff which is wrapped around the patient's upper arm to measure the systolic and diastolic blood pressure as well as the pulse rate of adult, not for neonate or pregnancy.

The measuring method for the Arm Blood Pressure Monitor is oscillation mensuration. And all values can be read out in one LCD panel.

User can set different user ID for data storage, which can be set as two independent groups of measured blood pressure data.The blood pressure storing 2x99 set memory value, each measurement it will automatically stored. When it stored 2x99 set memory value, the old value will be covered by the new one. It can show the latest 3 times average value.

User can set the time as year, month, day, hour and minute;

User can enable or disable the function of voice broadcast about measurement result:

User can select the unit of the measurement: mmHg or KPa;

The device has the data storage function for data reviewing, including the data of systolic pressure, diastolic pressure, pulse rate and measurement time.

The device has low power indicator to indicate the states of low batteries power.

Cuff supporting the use of Xuzhou Yongkang electronic sphygmomanometer:

M5303(small adult)/M5304(adult)/ M5305(big adult) provided by Xuzhou Maikang Science and Technology Ltd., and cleared by the CE(Declaration of Conformity for Class I)/ISO and FDA(K151290).

7.0 Non-Clinical Test Conclusion

Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

IEC 60601-1:2012, Medical electrical equipment-Part 1: General requirements for basic safety, and essential performance.

IEC 60601-1-2:2007, Medical electrical equipment - Part 1-2: General

5

requirements for basic safety and essential performance - Collateral standard: Electromagnetic compatibility - Requirements and tests.

IEC 80601-2-30:2013, Medical Electrical Equipment - Part 2-30: Particular Requirements For The Basic Safety And Essential Performance Of Automated Non-Invasive Sphygmomanometers.

IEC 62304:2015 standard and FDA Guidance for the Content of Pre-Market Submission for Software Contained in Medical Devices standard.

8.0 Clinical Test Conclusion

Performance testing has been carried out to demonstrate that this device meets the performance specifications for its intend use.

The clinical trials for YK-BPA1 were performed according the standard of ISO 81060-2:2013, Non-Invasive Sphygmomanometers - Part 2: Clinical Validation of Automated Measurement Type, and relevant volunteers were collected to conduct actual clinical trial of blood pressure measurement.

There were 150 subjects been selected to participate in the trial, and Auscultation was applied as gold standard with the qualified calibrated mercurial sphygmomanometer used as control group for comparison with the proposed device.

The results shown that the accuracy of proposed device meet the requirements of ISO 81060-2:2013 within the ±5mmHg.And the proposed device comply with the standard requirements and the accuracy the manufacture declared.

Table1-General Comparison
ItemProposed devicePredicated device
K170605Remark
Product CodeDXNDXNSE
Regulation No.21 CFR 870.113021 CFR 870.1130SE
ClassIIIISE
Intended UseThe Arm blood pressure
monitor is used for
measuring blood
pressure and pulse rate.
The monitor can be used
in hospitals, families,
schools and medical
centers. It is suitable for
adult, not for neonate or
pregnancy.Electronic blood pressure
monitor is intended to
measure the blood
pressure and pulse rate
of adult at household or
medical center. (Not
suitable for neonate,
pregnancy or
pre-eclampsia).SE
ApplicationUpper ArmUpper ArmSE

Table1-General Comparison

9.0 Technological Characteristic Comparison Table

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Site
Patients
Contacting
MaterialsPatient contact materials
of the cuff supporting the
use of Xuzhou Yongkang
electronic
sphygmomanometer:
M5303(small
adult)/M5304(adult)/
M5305(big adult)
provided by Xuzhou
Maikang Science and
Technology Ltd., and
cleared by the
CE(Declaration of
Conformity for Class
I)/ISO and
FDA(K151290).Patient contact materials
of the cuff have been
tested in accordance with
ISO10993 and FDA
guidance.SE
Patient
PopulationAdultAdultSE
Measurements
ItemSYS,DYS,PulseSYS,DYS,PulseSE
DisplayLCD Digital DisplayLCD Digital DisplaySE
Design
MethodOscillometric
MethodOscillometric
MethodSE
Main
ComponentLCD / Key / Cuff / MCU /
Pump / Batteries
(optional) / AC
Adapter(optional)LCD / Key / Cuff / MCU /
Pump / Batteries
(optional) / AC
Adapter(optional)SE

Table2 Performance Comparison

| Item | Proposed Device | Predicate Device
K170605 | Remark |
|------------------------|---------------------------------------|---------------------------------------------|----------|
| BP Range | 20-280 mmHg | 0-280 mmHg | Analysis |
| BP Accuracy | $\pm$ 5mmHg | $\pm$ 3 mmHg | Analysis |
| PR Range | 40-199 beats/min | 40 ~ 200 beats/min | Analysis |
| Pulse
Accuracy | $\pm$ 5% of reading
value | $\pm$ 5% of reading
value | SE |
| Operation
Condition | 5-40 °C
15%-80% RH
86kPa~105kPa | 10-40 °C
15%-90% RH (no
condensation) | Analysis |
| Storage
Condition | -20-55 °C
$\le$ 95% RH | -20-55 °C
15%-90% RH (no | Analysis |

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50kPa $\sim$ 105kPacondensation)
Data StorageSYS, DIA, PR,
Measurement Time, No.SYS, DIA, PR,
Measurement Time, No.SE
Performance
StandardComply with IEC
80601-2-30Comply with IEC
80601-2-30SE
Cuff
Circumference220mm $\sim$ 320mm220mm $\sim$ 320mmAnalysis
Power Supply4 AA batteries or
AC Adapter4 AA batteriesSE

Analysis

The proposed device is substantially equivalent to the predicate device. The differences between both devices are insignificant in terms of safety and effectiveness. Based on the nonclinical and clinical tests performed, the subject device is as safe, as effective, and performs as well as the legally marketed predicate device.

| Item | Proposed Device | Predicate Device
K170605 | Remark |
|----------------------------------------|-----------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------|--------|
| Electrical Safety | Comply with IEC
60601-1 | Comply with IEC 60601-1 | SE |
| Home Use | Comply with IEC
60601-1-11 | Comply with IEC
60601-1-11 | SE |
| EMC | Comply with IEC
60601-1-2 | Comply with IEC
60601-1-2 | SE |
| Biocompatibility | Comply with ISO
10993-1, FDA
Guidance | Comply with ISO
10993-1, FDA Guidance,
Tests included
Cytotoxicity, Sensitization
and Intracutaneous
Reactivity | SE |
| Label and
Labeling | Conforms to FDA
Regulatory
Requirements | Conforms to FDA
Regulatory Requirements | SE |
| Level of
Concern of the
Software | Moderate | Moderate | SE |

Table3 Safety Comparison

10.0 Conclusion

The conclusions drawn from the comparison and analysis above demonstrate that the proposed device is as safe, as effective, and performs as well as the legally marketed predicated device and raises no new questions of safety

8

or effectiveness.The differences between both devices are insignificant in terms of safety and effectiveness.