VPT METER

K030829 · Xilas Medical, Inc. · LLN · Dec 5, 2003 · Neurology

Device Facts

• Record ID: K030829
• Device Name: VPT METER
• Applicant: Xilas Medical, Inc.
• Product Code: LLN · Neurology
• Decision Date: Dec 5, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 882.1200
• Device Class: Class 1

Intended Use

The VPT Meter is an instrument designed to measure simply and accurately the threshold of appreciation of vibration in human subjects.

Device Story

VPT Meter identifies sensory neuropathy in patients with loss of sensation; measures vibration perception threshold (VPT). Device consists of control box and handheld vibration apparatus; clinician-operated in clinical settings. Device ramps power to handheld tip to change vibration amplitude; patient acknowledges when vibration is felt. Output is quantitative measurement in volts; user manual provides conversion graph to microns. Clinicians use output to establish baseline sensation loss and monitor progression of pathology. Benefits include non-invasive, quantitative assessment of peripheral sensory neuropathy.

Clinical Evidence

Bench testing only. No clinical data provided.

Technological Characteristics

Standalone digital device; control box with handheld vibration apparatus. Operates by ramping power to the handheld tip to adjust vibration amplitude. Non-invasive. No computer interface required. Digital display for output.

Indications for Use

Indicated for human subjects to measure vibration perception threshold for the evaluation of peripheral sensory neuropathy in upper and lower extremities.

Regulatory Classification

Identification

A two-point discriminator is a device with points used for testing a patient's touch discrimination.

Predicate Devices

• Vibrameter, Somedic AB (K843486)

Submission Summary (Full Text)

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DEPARTMENT OF HEALTH & HUMAN SERVICES

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#### Public Health Service

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

Mr. Ruben G. Zamorano President Xilas Medical, Inc. 12665 Silicon Drive San Antonio, Texas 78249

11 2017 MAY

Re: K030829

Trade/Device Name: Vibration threshold measurement device Regulation Number: 21 CFR 882.1200 Regulation Name: Two-point discriminator Regulatory Class: Class I Product Code: LLN Dated: September 30, 2003 Received: October 2, 2003

Dear Mr. Zamorano:

This letter corrects our substantially equivalent letter of December 5, 2003.

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 Part 807); labeling (21 CFR Parts 801 and 809 ); medical device reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements

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Page 2 - Mr. Ruben G. Zamorano

as set forth in the quality systems (QS) 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 Parts 801 and 809), please contact the Division of Industry and Consumer Education at its toll-free number [phone] or [phone] 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" (21CFR 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 [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

# Michael J. Hoffmann -S

for

Carlos L. Peña. PhD. MS Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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### Indications for Use

510(k) Number (if known): K030829

Device Name: _VPT Meter

Indications For Use:

The VPT Meter is an instrument designed to measure simply and accurately the threshold of appreciation of vibration in human subjects.

Presctiption Use XX (Part 2) CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

| Concurrence of CDRH, Office of Device Evaluation (ODE) | |
|-----------------------------------------------------------|--------------------------------------------|
| Division Sign-Off) | <img alt="signature" src="signature.png"/> |
| Division of General, Restorative and Neurological Devices | |
| K(k) Number | 1030829 |
| Page | 1 of 1 |

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September 30, 2003

### 510(k) Summary

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

The assigned 510(k) number is K030829.

- 1. Submitter:
Xilas Medical Inc. (formerly Salix Medical, Inc.) 12665 Silicon Drive San Antonio, Texas 78249

#### Name of Device: 2.

Vibration Perception Threshold (VPT) Meter

#### 3. Predicate Device Information:

The VPT Meter is similar to the following predicate device: 1) Vibrameter, Somedic AB, Stockholm, Sweden (510(k) number K843486).

#### 4. Device Description:

The Xilas Medical VPT Meter is designed to identify patients with sensory neuropathy. These patients have lost sensation and the "gift of pain" from their extremities or elsewhere. The instrument provides a quantitative measurement of vibration perception threshold (VPT). The digital device allows the clinician to quantify the loss of sensation, initially to establish a baseline loss of sensation and subsequently monitor the progression of established pathology.

#### 5. Intended Use:

The VPT Meter is an instrument designed to measure simply and accurately the threshold of appreciation of vibration in human subjects.

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## K030829 2/2

#### Substantial Equivalence: 6.

The Xilas Medical VPT Meter is substantially equivalent to the Vibrameter, a product produced by Somedic AB, Stockholm, Sweden.

- Both devices consist of a control box and a handheld vibration apparatus. The ● handheld apparatus on both devices is similar in size, shape and weight and both use a tip to transfer vibrations to the patients skin.
- Both devices have a digital display and easy access to the control mechanism on ● the face of the box.
- Both devices are free standing and independent and do not require a computer ● interface to achieve the desired output.
- Both devices vibrate at a similar frequency and vibration displacement. ●
- Both devices ramp up power to the handheld vibration apparatus, which changes ● the amplitude of the vibration displacement at the tip.
- Both devices are dependent on patient acknowledgement of the level where ● vibration is being felt.
- The Vibrameter measures in microns and the VPT Meter measures in volts, . however in the VPT Meter User's Manual a conversion graph is provided that represents the relationship between microns and volts.
- Both devices are easy-to-use and non-invasive. .
- Both devices are designed to be used as a clinical assessment tool by health care . professionals to evaluate peripheral sensory neuropathy on the upper and lower extremities.

#### 7. Conclusions:

The Xilas Medical VPT Meter has the same intended use and similar characteristics to the Somedic AB Vibrameter. Testing of the device (included with this submission) demonstrates the VPT Meter to be both safe and efficacious. Therefore, the VPT Meter is substantially equivalent to the predicate product, the Vibrameter.