K Number
K212416
Device Name
WX non-Automated Blood Pressure Meter,MODEL WX02, WX non-Automated Blood Pressure Meter with Stethoscope, MODEL WX0201, WX0202, WX0203
Date Cleared
2022-05-18

(288 days)

Product Code
Regulation Number
870.1120
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
WX non-Automated Blood Pressure Meter is intended to be used by medical professionals or in the home for the measurement of systolic and diastolic pressure on children or adults. The device is intended to a patient and manually inflated along with a manual method for detecting Korotkoff sounds. There are a variety of stethoscopes can be an optioned accessory, depending on the model. The device is applicable to all patients at least 2 years of age.
Device Description
WX non-Automated Blood Pressure Meter is a manual non-invasive aneroid sphygmomanometer which respectively uses an inflation cuff wrapped around the upper arm. The cuff is inflated and deflated by a manual inflation bulb. Besides a manometer (Aneroid gauge), the accessories of MODEL WX02, WX0201, WX0202, WX0203 also includes one selected cuff, one inflation bulb, instruction manual and a vinyl bag. Model WX0201, WX0202, WX0203 include additional stethoscope (Single head, Dual head, and Sprague Rappaport). It is conjunction with Stethoscope when use.
More Information

Not Found

No
The device description explicitly states it is a "manual non-invasive aneroid sphygmomanometer" and relies on "manual inflation" and a "manual method for detecting Korotkoff sounds." There is no mention of automated processes, algorithms, or any terms related to AI/ML.

No
The device is used for measurement and detection, not for therapy or treatment.

Yes

This device is intended for the measurement of systolic and diastolic blood pressure, which is a physiological parameter used to assess the health of an individual and can indicate the presence of certain medical conditions. Diagnostic devices are used to detect or diagnose a disease, condition, or state of health. Measuring blood pressure falls under the umbrella of diagnostic assessment.

No

The device description clearly states it is a manual non-invasive aneroid sphygmomanometer with physical components like an inflation cuff, manual inflation bulb, manometer, and optional stethoscopes. This indicates it is a hardware-based medical device, not software-only.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information about a person's health. This testing is done outside of the body (in vitro).
  • Device Function: The WX non-Automated Blood Pressure Meter measures blood pressure by applying pressure to the upper arm and listening for Korotkoff sounds. This is a non-invasive measurement performed on the patient's body.
  • Lack of Specimen Analysis: The device does not analyze any biological specimens.

The description clearly indicates that this is a manual blood pressure meter used directly on the patient, not for testing samples in a lab setting.

N/A

Intended Use / Indications for Use

WX non-Automated Blood Pressure Meter is intended to be used by medical professionals or in the home for the measurement of systolic and diastolic pressure on children or adults. The device is intended to be manually attached to a patient and manually inflated along with a manual method for detecting Korotkoff sounds. There are a variety of stethoscopes can be an optioned accessory, depending on the model. The device is applicable to all patients at least 2 years of age.

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

DXQ, LDE

Device Description

WX non-Automated Blood Pressure Meter is a manual non-invasive aneroid sphygmomanometer which respectively uses an inflation cuff wrapped around the upper arm. The cuff is inflated and deflated by a manual inflation bulb. Besides a manometer (Aneroid gauge), the accessories of MODEL WX02, WX0201, WX0202, WX0203 also includes one selected cuff, one inflation bulb, instruction manual and a vinyl bag. Model WX0201, WX0202, WX0203 include additional stethoscope (Single head, Dual head, and Sprague Rappaport). It is conjunction with Stethoscope when use.

The PVC or nature latex inflation bulb and optional various size of cuffs which cuffs outside layer is made of Nylon Cloth or Cotton Cloth can be selected according to user's need.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Upper Arm (leg for child)

Indicated Patient Age Range

The device is applicable to all patients at least 2 years of age.
infants, children, young adults, and adults

Intended User / Care Setting

medical professionals or in the home
Home, Hospital, heathcare facility, ambulance etc.

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)

Non-Clinical Testing: Non-clinical testing included biocompatibility and bench testing. The tests listed in the ISO10993 and ISO81060-1, were included. Results of testing were acceptable.
Clinical Study: No clinical study is included in this submission.

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

Pressure: +/- 3 mmHg of reading

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.

K190902

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

§ 870.1120 Blood pressure cuff.

(a)
Identification. A blood pressure cuff is a device that has an inflatable bladder in an inelastic sleeve (cuff) with a mechanism for inflating and deflating the bladder. The cuff is used in conjunction with another device to determine a subject's blood pressure.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA acronym and full name on the right. The FDA part of the logo is in blue, with the acronym in a square and the full name, "U.S. Food & Drug Administration," written out next to it.

May 18, 2022

Wenzhou Xikang Medical Instruments Co., Ltd % Sandy Liu, Consultant Jin Services Co. 9F-1, No13, Lane41, Zhangrong Rd, Sec. 5, North District Tainan City, 70447 Taiwan

Re: K212416

Trade/Device Name: WX non-Automated Blood Pressure Meter, MODEL WX02, WX non-Automated Blood Pressure Meter with Stethoscope, MODEL WX0201, WX0202, WX0203 Regulation Number: 21 CFR 870.1120 Regulation Name: Blood Pressure Cuff Regulatory Class: Class II Product Code: DXQ, LDE Dated: April 6, 2022 Received: April 22, 2022

Dear Sandy Liu:

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 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 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, 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-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.

LCDR Stephen Browning Assistant Director Division of Cardiac Electrophysiology, Diagnostics and Monitoring Devices Office of Cardiovascular Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K212416

Device Name

WX non-Automated Blood Pressure Meter, MODEL WX02 and WX non-Automated Blood Pressure Meter with Stethoscope, MODEL WX0201, WX0202, WX0203

Indications for Use (Describe)

WX non-Automated Blood Pressure Meter is intended to be used by medical professionals or in the home for the measurement of systolic and diastolic pressure on children or adults. The device is intended to a patient and manually inflated along with a manual method for detecting Korotkoff sounds. There are a variety of stethoscopes can be an optioned accessory, depending on the model. The device is applicable to all patients at least 2 years of age.

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

Image /page/3/Picture/1 description: The image shows the logo for Wenzhou Xikang Medical Instruments Co., LTD. The logo features the letters "WX" in a stylized font, with a stethoscope wrapped around the letters. The text "WENZHOU XIKANG MEDICAL INSTRUMENTS CO., LTD" is written in bold, black letters to the right of the logo.

510(k) Summary

Company Name:WENZHOU XIKANG MEDICAL INSTRUMENTS CO., LTD
Company Address:NO.1478 Haining Road, Haibin Street, Longwan District, Wenzhou, Zhejiang
325024, China
Telephone:86-577-86876969
Fax:N/A
Contact Person:WANG TIANCE
Summary Preparation Date:May 11, 2022
Device Trade Name:WX non-Automated Blood Pressure Meter, MODEL WX02 and WX non-
Automated Blood Pressure Meter with Stethoscope, MODEL WX0201,
WX0202, WX0203
Classification Name:Blood pressure cuff
Regulation Number:21 CFR 870.1120
Product Code:DXQ
Device Class:Class 2
Panel:Cardiovascular

PREDICATE DEVICE:

RH non-Automated Blood Pressure Meter, MODEL Max02 and RH non-Automated Blood Pressure Meter with Stethoscope, MODEL Max0201, Max0202, Max0203 (K190902)

INDICATIONS FOR USE

WX non-Automated Blood Pressure Meter is intended to be used by medical professionals or in the home for the measurement of systolic and diastolic pressure on children or adults. The device is intended to be manually attached to a patient and manually inflated along with a manual method for detecting Korotkoff sounds. There are a variety of stethoscopes can be an optioned accessory, depending on the model. The device is applicable to all patients at least 2 years of age.

DEVICE DESCRIPTION

WX non-Automated Blood Pressure Meter is a manual non-invasive aneroid sphygmomanometer which respectively uses an inflation cuff wrapped around the upper arm. The cuff is inflated and deflated by a manual inflation bulb. Besides a manometer (Aneroid gauge), the accessories of MODEL WX02, WX0201, WX0202, WX0203 also includes one selected cuff, one inflation bulb, instruction manual and a vinyl bag. Model WX0201, WX0202, WX0203 include additional stethoscope (Single head, Dual head, and Sprague Rappaport). It is conjunction with Stethoscope when use.

4

Image /page/4/Picture/1 description: The image shows a logo with the letters "WX" in a stylized, three-dimensional font. To the right of the letters is a stethoscope, a medical instrument used for listening to internal sounds in the body. The stethoscope is positioned so that its earpieces are above the "X" and its diaphragm is below, suggesting a connection to healthcare or medical services. The overall design is simple and clean, with a focus on the letters and the medical symbol.

The PVC or nature latex inflation bulb and optional various size of cuffs which cuffs outside layer is made of Nylon Cloth or Cotton Cloth can be selected according to user's need.

Substantial Equivalence Comparison

It is substantially equivalent to the predicate device (K190902), RH non-Automated Blood Pressure Meter, MODEL Max02 and RH non-Automated Blood Pressure Meter with Stethoscope, MODEL Max0201, Max0202, Max0203 with respect to indications for use, device description, and technical characteristics.

All comparison table for applied devices are as following, and the substantial equivalence determination is based on the 510(k) Substantial Equivalence Decision-Making Process Flowchart which includes the comparison and discussion of indications for use, technology, and performance specifications.

| comparison item | New device
WX non-Automated Blood
Pressure Meter, MODEL
WX02 and WX non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL WX0201, WX0202,
WX0203 | Predicate device
RH non-Automated Blood
Pressure Meter, MODEL
Max02 and RH non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL Max0201,
Max0202, Max0203
(K190902) | Result of
Comparison |
|-----------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------|
| Applicant | WENZHOU XIKANG
MEDICAL
INSTRUMENTS CO., LTD | Wenzhou Renhua
Instruments Co., Ltd | Different |
| Classification | Class II | Class II | SAME |
| Regulation
number | 21CFR 870.1120 | 21CFR 870.1120 | SAME |
| Product code | DXQ | DXQ | SAME |
| Indications for | The device is intended to be | The device is intended to be | SAME |
| comparison item | New device | Predicate device | Result of
Comparison |
| | WX non-Automated Blood
Pressure Meter, MODEL
WX02 and WX non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL WX0201, WX0202,
WX0203 | RH non-Automated Blood
Pressure Meter, MODEL
Max02 and RH non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL Max0201,
Max0202, Max0203
(K190902) | |
| use | used by medical
professionals or at home for
the measurement of systonic
and diastonic pressure by
detecting Korotkoff sounds. | used by medical
professionals or at home for
the measurement of systonic
and diastonic pressure by
detecting Korotkoff sounds. | |
| Over-The-
Counter Use | Yes | Yes | SAME |
| Where used | Home, Hospital, heathcare
facility, ambulance etc. | Home, Hospital, heathcare
facility, ambulance etc. | SAME |
| Target population | infants, children, young
adults, and adults | infants, children, young
adults, and adults | SAME |
| Anatomical sites | Upper Arm (leg for child) | Upper Arm (leg for child) | SAME |
| Measurement
Method | Auscultatory Korotkoff
sounds Method | Auscultatory Korotkoff
sounds Method | SAME |
| Inflation | Manual by inflation bulb | Manual by inflation bulb | SAME |
| Deflation | Manual deflation via valve | Manual deflation via valve | SAME |
| Display | Aneroid Manometer | Aneroid Manometer | SAME |
| The monitor scale | From 0 to 300 mmHg with a | From 0 to 300 mmHg with a | SAME |
| comparison item | New device | Predicate device | Result of Comparison |
| | WX non-Automated Blood
Pressure Meter, MODEL
WX02 and WX non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL WX0201, WX0202,
WX0203 | RH non-Automated Blood
Pressure Meter, MODEL
Max02 and RH non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL Max0201,
Max0202, Max0203
(K190902) | |
| | minimum interval of 2
mmHg. | minimum interval of 2
mmHg. | |
| Design of blood
pressure meter | The device comprises
tubing attached to a soft
inelastic cuff with an
integrated inflatable bladder
that is wrapped around the
patient's limb and secured
by hook and loop closure. | The device comprises
tubing attached to a soft
inelastic cuff with an
integrated inflatable bladder
that is wrapped around the
patient's limb and secured
by hook and loop closure. | SAME |
| Design of
Stethoscope | Three types of option:
Single head
Dual head
Sprague Rappaport | Three types of option:
Single head
Dual head
Sprague Rappaport | SAME |
| Materials | The manometer: Zinc Alloy
or Aluminum materials. The
tubing, inflation bulb: PVC
or nature latex.
Cuff: Nylon cloth or cotton | The manometer: Zinc Alloy
or Aluminum materials. The
tubing, inflation bulb: PVC
or nature latex.
Cuff: Nylon cloth or cotton | SAME |
| comparison item | New device | Predicate device | Result of
Comparison |
| | WX non-Automated Blood
Pressure Meter, MODEL
WX02 and WX non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL WX0201, WX0202,
WX0203 | RH non-Automated Blood
Pressure Meter, MODEL
Max02 and RH non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL Max0201,
Max0202, Max0203
(K190902) | |
| | cloth for outside layer.
Cuff bladder: PVC or nature
latex | cloth for outside layer.
Cuff bladder: PVC or nature
latex | |
| Accuracy | Pressure: +/- 3 mmHg of
reading | Pressure: +/- 3 mmHg of
reading | SAME |
| Compatibility
with environment | It can be used from 50°F to
104°F (10°C to 40°C ) and
15%~85%RH humidity. | It can be used from 50°F to
104°F (10°C to 40°C ) and
15% ~ 85%RH humidity. | SAME |
| Cuff Size | 20"x 5.5" (510mm140mm)
21.7" x 6.3"
(550mm
160mm)
24.4" x 6.9"
(620mm175mm)
28.3" x 8.3"
(720mm
210mm)
13.4" x 4.15"
(340mm105mm) | 20"x 5.5" (510mm140mm)
21.7" x 6.3"
(550mm160mm)
24.4" x 6.9"
(620mm
175mm)
28.3" x 8.3"
(720mm210mm)
13.4" x 4.15"
(340mm
105mm) | SAME |
| Cuff
Circumference | Fits arm circumferences
8.7" to 17.3" (220mm to
440 mm), The standard cuff
should be available for use | Fits arm circumferences
8.7" to 17.3" (220mm to
440 mm), The standard cuff
should be available for use | SAME |
| comparison item | New device | Predicate device | Result of Comparison |
| | WX non-Automated Blood
Pressure Meter, MODEL
WX02 and WX non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL WX0201, WX0202,
WX0203 | RH non-Automated Blood
Pressure Meter, MODEL
Max02 and RH non-
Automated Blood Pressure
Meter with Stethoscope,
MODEL Max0201,
Max0202, Max0203
(K190902) | |
| | in measuring a child's leg
blood pressure and for
children with larger arms. | in measuring a child's leg
blood pressure and for
children with larger arms. | |
| Cuff bladder Size | 8.7"x 4.7"(220mm120mm)
11.8"x
5.9"(300mm
150mm)
13.4"x
6.7"(340mm170mm)
6.9"x 3.3"(175mm
85mm) | 8.7"x 4.7"(220mm120mm)
11.8"x
5.9"(300mm
150mm)
13.4"x
6.7"(340mm170mm)
6.9"x 3.3"(175mm
85mm) | SAME |
| Cuff Color | Blue, Pink, Black | Blue, Pink, Black | Same |
| Contents (with
accessories) | Aneroid gauge, Arm Cuff,
Inflation Bulb, Vinyl storage
pouch and Instruction
Manual, Stethoscope
(option) | Aneroid gauge, Arm Cuff,
Inflation Bulb, Vinyl storage
pouch and Instruction
Manual, Stethoscope
(option) | Same |
| Biocompatibility | biocompatible as
requirement of ISO 10993-1 | biocompatible as
requirement of ISO 10993-1 | Same |
| | ISO 10993-5 | ISO 10993-5 | |
| | ISO 10993-10 | ISO 10993-10 | |
| Performance | compatible as requirement
of ISO 81060-1 | compatible as requirement
of ISO 81060-1 | Same |

5

Image /page/5/Picture/1 description: The image shows a logo with the letters "WX" in a stylized, three-dimensional font. To the right of the "X", there is a stethoscope graphic. The stethoscope is positioned so that its earpieces are above the "X" and its chest piece is below the "X", creating a visual connection between the letters and the medical symbol. The overall design suggests a connection to healthcare or medical services.

6

Image /page/6/Picture/1 description: The image shows the letters 'WX' in a stylized font, with a stethoscope wrapped around the right side of the 'X'. The letters appear to be made of a textured material, possibly stone or concrete, giving them a three-dimensional look. The stethoscope is drawn in a simple, outlined style, adding a medical or healthcare-related theme to the image. The overall design is clean and modern, suggesting a logo or branding element for a company or organization.

7

Image /page/7/Picture/1 description: The image shows a logo with the letters 'WX' in a stylized, three-dimensional font. To the right of the 'X', there is a stethoscope graphic. The stethoscope is positioned so that its tubing curves around the 'X', adding a medical or healthcare-related theme to the logo. The overall design is simple and clean, with a focus on the letters and the medical symbol.

8

Image /page/8/Picture/1 description: The image shows a logo with the letters 'WX' in a stylized font. A stethoscope is draped around the 'X', with the earpieces at the top right and the chest piece at the bottom right. The letters and stethoscope are in grayscale.

Discussion

9

Image /page/9/Picture/1 description: The image shows the letters 'WX' in a stylized font, with a stethoscope draped over them. The letters appear to be made of a textured material, possibly foam or stone, giving them a three-dimensional look. The stethoscope is drawn in a simple line art style, adding a medical or health-related theme to the image.

Comparing with the predicate device, RH non-Automated Blood Pressure Meter, MODEL Max02 and RH non-Automated Blood Pressure Meter with Stethoscope, MODEL Max0201, Max0203 (K190902), WX non-Automated Blood Pressure Meter, MODEL WX02 and WX non-Automated Blood Pressure Meter with Stethoscope, MODEL WX0202, WX0203 have same product name, classification and product code, product physical design and operation, same Aneroid gauge, packaging materials, performance parameter ranges, physical properties, mechanical properties, biocompatibility. The differences between those two devices are as following,

  • Package brand name, layout design, trade name and model name.

Non-Clinical Testing

Non-clinical testing included biocompatibility and bench testing. The tests listed in the ISO10993 and ISO81060-1, were included. Results of testing were acceptable.

Clinical Study

No clinical study is included in this submission.

CONCLUSION

WX non-Automated Blood Pressure Meter, MODEL WX02 and WX non-Automated Blood Pressure Meter with Stethoscope, MODEL WX0201, WX0202, WX0203 have the same intended use and same technological characteristics as the above predicate devices. Thus, WX non-Automated Blood Pressure Meter, MODEL WX02 and WX non-Automated Blood Pressure Meter with Stethoscope, MODEL WX0201, WX0202, WX0203 are substantially equivalent to the predicate devices.