Revitive Medic; Revitive MV; Revitive LV

K152480 · Actegy , Ltd. · NGX · Mar 31, 2016 · Physical Medicine

Device Facts

• Record ID: K152480
• Device Name: Revitive Medic; Revitive MV; Revitive LV
• Applicant: Actegy , Ltd.
• Product Code: NGX · Physical Medicine
• Decision Date: Mar 31, 2016
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.5850
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

To temporarily increase local blood circulation in healthy leg muscles. To stimulate healthy muscles in order to improve and facilitate muscle performance. For temporary relief of pain associated with sore and aching muscles in the shoulder, waist, back, upper extremities (arms) and lower extremities (legs) due to strain from exercise or normal household duties.

Device Story

Revitive Medic, Revitive MV, and Revitive LV are powered muscle stimulators designed for over-the-counter use. The device delivers electrical stimulation to muscles via electrodes or foot pads to induce muscle contraction. This process facilitates local blood circulation and provides temporary relief from muscle aches and pains caused by strain. The device is intended for home use by the patient. It functions as a non-invasive therapeutic tool to improve muscle performance and manage minor musculoskeletal discomfort without requiring physician intervention.

Clinical Evidence

No clinical data provided; substantial equivalence is based on technological characteristics and intended use compared to legally marketed predicate devices.

Technological Characteristics

Powered muscle stimulator; electrical stimulation output; intended for OTC use; Class II device; product codes NGX and NUH.

Indications for Use

Indicated for healthy individuals seeking temporary increase in local blood circulation in leg muscles, improvement of muscle performance, and temporary relief of muscle pain in the shoulder, waist, back, arms, and legs resulting from exercise or household strain.

Regulatory Classification

Identification

A powered muscle stimulator is an electrically powered device intended for medical purposes that repeatedly contracts muscles by passing electrical currents through electrodes contacting the affected body area.

Submission Summary (Full Text)

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

March 31, 2016

Actegy, Ltd. % Deanna Hughes Assistant Director, Regulatory Affairs Dohmen Life Science Services, LLC 11925 W I-70 Frontage Rd. North, Suite 900 Wheat Ridge. Colorado 80033

Re: K152480

Trade/Device Name: Revitive Medic; Revitive MV; Revitive LV Regulation Number: 21 CFR 890.5850 Regulation Name: Powered Muscle Stimulator Regulatory Class: Class II Product Code: NGX, NUH Dated: February 23, 2016 Received: February 24, 2016

Dear Ms. Hughes:

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 Part 801); medical device reporting (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

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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 [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" (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 [phone] or [phone] or at its Internet address

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

Sincerely yours,

## Michael J.Hoffmann -A

Carlos L. Peña, PhD, MS for 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) K152480

Device Name Revitive Medic, Revitive MV, Revitive LV

Indications for Use (Describe)

· To temporarily increase local blood circulation in healthy leg muscles

· To stimulate healthy muscles in order to improve and facilitate muscle performance.

· For temporary relief of pain associated with sore and aching muscles in the shoulder, waist, back, upper extremities (arms) and lower extremities (legs) due to strain from exercise or normal household duties.

| Type of Use (Select one or both, as applicable) |
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| <input type="checkbox"/> Research Use (Part 21 CFR 601.3, Subpart D) | <input checked="" type="checkbox"/> Gene Therapy Studies (21 CFR 601.2, Subpart C) |
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_ | Prescription Use (Part 21 CFR 801 Subpart D)

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

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