K Number
K200694
Device Name
Perfect EMS
Manufacturer
Date Cleared
2021-06-04

(444 days)

Product Code
Regulation Number
882.5890
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

TENS: The device is designed to be used for temporary relief of pain associated with sore and aching muscles in the shoulder, waist, back, neck, upper extremities (arm), lower extremities (leg), abdomen and bottom due to strain from exercise or normal household work activities.

EMS: The device is designed to be used for stimulate healthy muscles in order to improve and facilitate muscle performance.

Device Description

Perfect EMS is a hand-held, home-use device designed to relief of pain and improve and facilitate muscle performance. Perfect EMS is intended for over-the-counter use.

The device is battery powered, two channels home use neuromuscular stimulation. The device is supplied with self-adhesive electrodes which connect to the control unit by cable and plug and are placed on patients' intact skin by the end user. Electrical stimulation is delivered via self-adhesive electrodes to nerves and muscles.

The level of electrical stimulation is easily controlled by the end user using manual, pushbutton controls.

The unit is intended for home use by the patient, and is designed with simplicity and ease of use in mind. It has six preset treatment programs and four manually adjustable programmes are available.

Accessories: 2 x 1.25m PVC Lead Wires (L-CPT) 50x50mm hydrogel electrode pads (E-CM5050)

Optional accessories: 50x100mm Large hydrogel electrode pads Pack of 4 (E-CM50100)

AI/ML Overview

The provided text describes a 510(k) submission for the Perfect EMS device, asserting its substantial equivalence to a predicate device (HIVOX OTC Electrical Stimulator Model: EM49-2, K190347). The document focuses on demonstrating that the Perfect EMS meets safety and performance criteria by comparing it to the predicate and through compliance with recognized standards.

Here's an analysis of the acceptance criteria and the study that proves the device meets them, based on the provided text:

1. Table of Acceptance Criteria and Reported Device Performance

The acceptance criteria for the Perfect EMS device are implicitly defined by its substantial equivalence to the predicate device, EM49-2 (K190347), and adherence to a battery of safety and performance standards. The table above the horizontal line below summarizes the performance attributes of the Perfect EMS (Subject Device) and the predicate device, along with the comparison stating "Substantially equivalent" or "Identical."

AttributeAcceptance Criteria (Implicitly from Predicate/Standards)Reported Device Performance (Perfect EMS)Comparison Conclusion
Product CodeNUH, NGXNUH, NGXIdentical; Substantially equivalent
Regulation No.21 CFR 882.5890; 21 CFR 890.585021 CFR 882.5890; 21 CFR 890.5850Identical; Substantially equivalent
Indications for UseSame as predicate (TENS: temporary pain relief for sore/aching muscles; EMS: stimulate healthy muscles for improved performance)Same as predicateSame indications for use; Substantially equivalent
Prescriptive or OTCOTCOTCIdentical; Substantially equivalent
Number of output modesWithin acceptable range compared to predicate (predicate had 70 modes)10Substantially equivalent
Number of output channels22Substantially equivalent
Timer (minutes) RangeAdjustable, comparable to predicate (predicate 5-100 mins)Default 20 mins, Adjustable to 10, 20, 30, 45, 60, 90 minutesBoth are adjustable; Substantially Equivalent
Regulated Current or Regulated Voltage?NoneNoneSubstantially Equivalent.
Software/Firmware/Microprocessor Control?YesYesIdentical control method
Automatic No-Load Trip?YesYesIdentical
Automatic Overload Trip?YesYesIdentical
Automatic Shut Off?YesYesIdentical
User Override Control?YesYesSubstantially Equivalent.
Indicator Display: On/Off statusYesYesIdentical
Indicator Display: Low batteryYesYesIdentical
Indicator Display: Voltage/Current levelYesYesIdentical
Indicator Display: Time to cut-offYesYesIdentical
Frequency (Hz)Within acceptable range compared to predicate (predicate 1-150Hz)1-120HzSubstantially equivalent
Pulse Width (µs)Within acceptable range compared to predicate (predicate 50-450µs)50-350µsSubstantially equivalent
WaveformBi-phasicBi-phasicIdentical
ShapeRectangularRectangularIdentical
Maximum Output Voltage (V)50V@ 500Ω50V@ 500ΩSubstantially equivalent
Maximum Output Current (mA)100mA@ 500Ω100mA@ 500ΩSubstantially equivalent
Maximum Phase Charge (µC)Within acceptable range compared to predicate (predicate 37.6µC@ 500Ω)20.5µC@ 500ΩSubstantially equivalent
Maximum Current Density, (mA/cm²)Safe levels, compared to predicate (predicate 0.07426mA/cm²@ 500Ω)0.01013mA/cm²@ 500Ω (Area=25cm²)Substantially equivalent
Maximum Power Density, (W/cm²)Safe levels, less than 0.25 W/cm² (predicate 0.0066W/cm²@ 500Ω)0.00053W/cm²@ 500Ω (Area=25cm²)Substantially equivalent
Power SourceInternal power supply (predicate used AAA batteries)2 Alkaline AA 1.5V BatteriesBoth are internal power supply source: Substantially equivalent
WeightComparable to predicate (predicate 83g)75 g without batteriesSubstantially Equivalent.
Dimensions (mm) [W x H x D]Comparable to predicate (predicate 132 x 63 x 29.5 mm)120 x 60 x 31mmSubstantially Equivalent.
Housing Materials and ConstructionSafe and effective (predicate ABS plastics)Silicone, ABS plasticsSubstantially Equivalent.
Electrode lead wires and patient cableYes (PVC)Yes (PVC and nylon yarn)Substantially equivalent
Compliance with Voluntary StandardsYesYes (See section 1.3/VII for specific standards)Substantially equivalent

2. Sample size used for the test set and the data provenance

The document does not specify a "test set" in the context of clinical data or patient outcomes. The performance evaluation is based on engineering and safety testing against recognized standards. Therefore, information regarding sample size and data provenance for a test set in the traditional sense (e.g., patient data) is not applicable here. The provenance for the device is the manufacturing facility in China (EasyMed Instruments Co Ltd).

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not applicable. The evaluation framework is based on compliance with established engineering and safety standards, and a comparison to a predicate device. There is no mention of human expert-established "ground truth" for the performance tests conducted on the device's technical specifications.

4. Adjudication method for the test set

This information is not applicable. As there is no clinical "test set" requiring human interpretation or decision-making, an adjudication method for such a set is not relevant.

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

An MRMC study is relevant for evaluating the performance of AI-assisted diagnostic or decision-making systems. The Perfect EMS is an electrical stimulator for pain relief and muscle performance, not an AI diagnostic tool. Therefore, an MRMC comparative effectiveness study is not applicable and was not reported.

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

The Perfect EMS is a physical medical device, not a software algorithm. Therefore, "standalone (algorithm only without human-in-the-loop performance)" is not applicable. Performance was assessed by measuring the device's electrical output and adherence to safety standards.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

The "ground truth" in this context is the pre-defined acceptance criteria set by recognized safety and performance standards (e.g., ANSI AAMI ES60601-1, IEC 60601-1-2, IEC 60601-1-11, IEC 60601-2-10, IEC 62304, ISO 10993-1) and the technical specifications of the legally marketed predicate device (EM49-2 K190347). The device's performance was measured against these established quantitative parameters and qualitative design characteristics.

8. The sample size for the training set

This information is not applicable. The Perfect EMS is a hardware device; it does not explicitly mention any machine learning or AI components that would require a "training set" for an algorithm.

9. How the ground truth for the training set was established

This information is not applicable for the same reason as point 8. There is no mention of a training set or AI algorithm in this context.

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

June 4, 2021

TensCare Ltd. Andrew Brown Quality Manager 9 Blenheim Road, Longmead Business Park Epsom, Surrey KT19 9BE United Kingdom

Re: K200694

Trade/Device Name: Perfect EMS Regulation Number: 21 CFR 882.5890 Regulation Name: Transcutaneous Electrical Nerve Stimulator for Pain Relief Regulatory Class: Class II Product Code: NUH, NGX Dated: May 1, 2021 Received: May 17, 2021

Dear Andrew Brown:

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. 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 con tract 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

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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/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); 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, Sub part 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Heather Dean, PhD Assistant Director. Acute Injurv Devices Team DHT5B: Division of Neuromodulation and Physical Medicine Devices OHT5: Office of Neurological and Physical Medicine Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K200694

Device Name Perfect EMS

Indications for Use (Describe)

TENS: The device is designed to be used for temporary relief of pain associated with sore and aching muscles in the shoulder, waist, back, neck, upper extremities (arm), lower extremities (leg), abdomen and bottom due to strain from exercise or normal household work activities.

EMS: The device is designed to be used for stimulate healthy muscles in order to improve and facilitate muscle performance.

Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)X

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510(k) Summary

K200694

Date of Subimission prepared: March 5, 2020

Submitter :Tenscare Ltd
Address:9 Blenheim Road, Longmead Business Park, Epsom,Surrey, KT19 9BE, United Kingdom
Tel :+44(0)1372 723 434
Fax :+44(0)1372 745 434
E-Mail :andrew@tenscare.co.uk
FDA EstablishmentRegistration No:3003446042
Contact person:Andrew Brown

Address of the manufacturing facility:

EasyMed Instruments Co Ltd 3/F, 5F/6F, Block A, Gupo Gongmao Building, Fengxin Road, Fengxiang Industrial District, Daliang, 528300 Shunde, Foshan, Guangdong, China,

FDA Establishment Registration No: 3004049909

Address of American Representative:

Contact First Name;SCOTT A
Contact Last Name:BEDNAR
Title:MR
Business Name:QA/RA CONSULTING GROUP, INC.
Full Address:3335 TUSCARAWAS ROADBEAVER, PENNSYLVANIA, 15009, UNITED STATES
E-mail:sbednar@qaraconsultinggroup.com
Phone Number:412-4188066

ll Submitted Device:

Trade name:Perfect EMS
Common name:Transcutaneous Electrical Nerve Stimulator (TENS) /Electrical Muscle Stimulator (EMS)
Classification Number:21 CFR 882.5890;21 CFR 890.5850
Classification name:Transcutaneous electrical nerve stimulator for pain relief;Powered muscle stimulator
Product Code:NUH (Stimulator, Nerve, Transcutaneous, Over-The-Counter);NGX (Stimulator, Muscle, Powered, For Muscle Conditioning)
Classification Panel:Neurology; Physical Medicine
Regulatory Class:Class II

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��� Predicate Device:

Predicate Device:HIVOX OTC Electrical Stimulator
Trade/Device Name:EM49-2
Model Number:HIVOX BIOTEK INC.
Manufacturer:K190347
510(k) Number:NUH, NGX
Product Code:Over-The-Counter Use (OTC Use
Type of Use:Class II
Regulatory Class:

Device Description: IV

Perfect EMS is a hand-held, home-use device designed to relief of pain and improve and facilitate muscle performance. Perfect EMS is intended for over-the-counter use.

The device is battery powered, two channels home use neuromuscular stimulation. The device is supplied with self-adhesive electrodes which connect to the control unit by cable and plug and are placed on patients' intact skin by the end user. Electrical stimulation is delivered via self-adhesive electrodes to nerves and muscles.

The level of electrical stimulation is easily controlled by the end user using manual, pushbutton controls.

The unit is intended for home use by the patient, and is designed with simplicity and ease of use in mind. It has six preset treatment programs and four manually adjustable programmes are available.

Accessories: 2 x 1.25m PVC Lead Wires (L-CPT) 50x50mm hydrogel electrode pads (E-CM5050)

Optional accessories: 50x100mm Large hydrogel electrode pads Pack of 4 (E-CM50100)

ENVIRONMENT OF USE: Clinics, hospital and home environments

Indications for Use of the device: >

TENS: The device is designed to be used for temporary relief of pain associated with sore and aching muscles in the shoulder, waist, back, neck, upper extremities (arm), lower extremities (leg), abdomen and bottom due to strain from exercise or normal household work activities.

EMS: The device is designed to be used for stimulate healthy muscles in order to improve and facilitate muscle performance.

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The Perfect EMS is intended for OTC use.

The indications for use of the Perfect EMS are the same as those of the predicate device HIVOX OTC Electrical Stimulator Model: EM49-2 (K190347).

VI Equivalence Comparison to the Predicate Devices:

Electrical nerve and muscle stimulation is the technological principle for both the Perfect EMS and the predicate device EM49-2 (K190347).

The technical characteristics of Perfect EMS are similar to those of the predicate device in design, intended use and function. The predicate device EM49-2 (K190347) and the Perfect EMS are devices apply an electrical current via electrodes to a patient's nerves and muscles.

The stimulation parameters of Perfect EMS are similar to those of predicate device EM49-2 (K190347). Perfect EMS totally has 10 programs, the parameter of Perfect EMS are all in the same range of those of predicate device EM49-2 (K190347).

Table 1 below summarizes the shared and unique technological elements between the Perfect EMS and EM49-2 (K190347). The technology, engineering, and performance for Perfect EMS are substantially equivalent to the predicate device.

From the view of safety and effectiveness, the output characteristics of Perfect EMS are similar to those of predicate device EM49-2 (K190347), see Table 1. The Perfect EMS is designed to comply with relevant safety applicable recognized consensus standards: the output energy is controlled well within the safety and effectiveness ranges specified by relevant FDA guidance. Detailed and strictly controlled testing has been carried out. The maximum power density of Perfect EMS is less than 0.25 watts per square centimeter of electrode conductive surface area to reduce the risk of thermal burns. Furthermore, Test results, Risk Analysis, and FMEA analysis show that the Perfect EMS is safe with no hazard.

As such:

  1. the Perfect EMS has similar technological characteristics and intended uses as the predicate EM49-2 (K190347): and

  2. the information submitted to the FDA for the Perfect EMS does not raise new questions about safety or effectiveness and demonstrates with reasonable assurance based on established controls that the device is at least as safe and effective as a legally marketed device.

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Table 1 Substantial Equivalence Comparison Table

AttributeSubject DevicePredicate DeviceComparison
Product NamePerfect EMSEM49-2
510(K) numberK200694K190347
Product CodeNUH, NGXNUH, NGXIdentical codes;Substantiallyequivalent
Regulation No.21 CFR 882.5890;21 CFR 890.585021 CFR 882.5890;21 CFR 890.5850Identical;Substantiallyequivalent
ManufacturerTensCare LtdHIVOX BIOTEK INC.
Indicationsfor UseTENS: The device isdesigned to be used fortemporary relief of painassociated with sore andaching muscles in theshoulder, waist, back, neck,upper extremities (arm),lower extremities (leg),abdomen and bottom due tostrain from exercise or normalhousehold work activities.EMS: The device is designedto be used for stimulatehealthy muscles in order toimprove and facilitate muscleperformance.TENS: The device isdesigned to be used fortemporary relief of painassociated with sore andaching muscles in theshoulder, waist, back, neck,upper extremities (arm),lower extremities (leg),abdomen and bottom due tostrain from exercise ornormal household workactivities.EMS: The device is designedto be used for stimulatehealthy muscles in order toimprove and facilitate muscleperformance.Same indicationsfor use;Substantiallyequivalent
Prescriptive or OTCOTCOTCIdentical;Substantiallyequivalent
Numberofoutputmodes1070*Substantiallyequivalent
Numberofoutputchannels22*Substantiallyequivalent
Timer(minutes)RangeDefault 20 minutes.Adjustable to 10, 20, 30, 45,60, 90 minutesDefault 30 minutes.Adjustable from 5 to 100minutes*Both areadjustable;SubstantiallyEquivalent
Regulated Current orRegulated Voltage?NoneNone*SubstantiallyEquivalent.
AttributeSubject DevicePredicate DeviceComparison
Software/Firmware/MicroprocessorControl?YesYes *Identical controlmethod
AutomaticNo-LoadTrip?YesYes*Identical
AutomaticOverloadTrip?YesYes*Identical
Automatic Shut Off?YesYes*Identical
User OverrideControl?YesYes*SubstantiallyEquivalent.
Indicator Display:-On/Off statusYesYes*Identical
-Low batteryYesYes*
-Voltage/Current levelYesYes*
-Time to cut-offYesYes*
Frequency (Hz)1-120Hz1-150Hz*Substantiallyequivalent
Pulse Width (μs)50-350μs50-450μs*Substantiallyequivalent
WaveformBi-phasicBi-phasic*Identical
ShapeRectangularRectangular*Identical
Maximum OutputVoltage (V)50V@ 500Ω50V@ 500Ω*Substantiallyequivalent
Maximum OutputCurrent (mA)100mA@ 500Ω100mA@ 500Ω*Substantiallyequivalent
Maximum PhaseCharge (μC)20.5μC@ 500Ω37.6μC@ 500Ω*Substantiallyequivalent
Maximum CurrentDensity, (mA/cm²)0.01013mA/cm²@ 500Ω(Area=25cm²)0.07426mA/cm²@ 500Ω*(Area=20.25cm²)Substantiallyequivalent
Maximum PowerDensity, (W/cm²)0.00053W/cm²@ 500Ω(Area=25cm²)0.0066W/cm²@ 500Ω*(Area=20.25cm²)Substantiallyequivalent
Power Source2 Alkaline AA 1.5V Batteries3 Alkaline AAA 1.5VBatteriesBoth are internal power supplysource:Substantiallyequivalent
Weight120 x 60 x 31mm132 x 63 x 29.5 mm*SubstantiallyEquivalent.
Dimensions (mm) [Wx H x D]75 g without batteries83 g without batteries*SubstantiallyEquivalent.
Housing Materialsand ConstructionSilicone, ABS plasticsABS plastics *SubstantiallyEquivalent.
Electrode lead wiresand patient cableYes(PVC and nylon yarn)Yes*PVCSubstantiallyequivalent
AttributeSubject DevicePredicate DeviceComparison
compliance with 21CFR 898
CompliancewithVoluntary StandardsYesSee section 1.3Yes*See section 1.3Substantiallyequivalent

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Remark: The information marks with * means the information is not publicly available

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VII Performance Tests:

A series of safety and performance tests were conducted on the subject device Perfect EMS See below:

FDA recognition No.Standard Title
19-4ANSI AAMI ES60601-1:2005/(R)2012 and A1:2012,C1:2009/(R)2012 and A2:2010/(R)2012 (Consolidated Text)Medical electrical equipment - Part 1: General requirements forbasic safety and essential performance (IEC 60601-1:2005, MOD)
19-8IEC 60601-1-2 Edition 4.0 2014-02Medical electrical equipment - Part 1-2: General requirements forbasic safety and essential performance - Collateral Standard:Electromagnetic disturbances - Requirements and tests
19-14IEC 60601-1-11 Edition 2.0 2015-01Medical electrical equipment - Part 1-11: General requirements forbasic safety and essential performance - Collateral Standard:Requirements for medical electrical equipment and medicalelectrical systems used in the home healthcare environment.
17-16IEC 60601-2-10 Edition 2.1 2016-04Medical electrical equipment - Part 2-10: Particular requirements forthe basic safety and essential performance of nerve and musclestimulators
13-79IEC 62304 Edition 1.1 2015-06 CONSOLIDATEDVERSION Medical device software - Software life cycle processes
2-220ANSI AAMI ISO 10993-1:2009/(R)2013Biological evaluation of medical devices - Part 1: Evaluation andtesting within a risk management processThree biocompatibility tests conducted:Cytotoxicity (per ISO 10993-5)-Sensitization (per ISO 10993-10)-Irritation (per ISO 10993-10)-

All the test results demonstrate Perfect EMS meets the requirements of its pre-defined acceptance criteria and intended use, and is substantially equivalent to the predicate device.

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VII Conclusion:

  • � The Perfect EMS has the same technological characteristics and intended uses as the predicateEM49-2 (K190347); and
  • � The labelling of the Perfect EMS is concordant with the predicate device and FDA requirements; and
  • � The information submitted to the FDA for the Perfect EMS does not raise new questions about safety or effectiveness and demonstrates with reasonable assurance based on established controls that the device is at least as safe and effective as a legally marketed device.

Therefore, the Perfect EMS is substantially equivalent to the predicate device.

§ 882.5890 Transcutaneous electrical nerve stimulator for pain relief.

(a)
Identification. A transcutaneous electrical nerve stimulator for pain relief is a device used to apply an electrical current to electrodes on a patient's skin to treat pain.(b)
Classification. Class II (performance standards).