Adhesive Electrodes

K171381 · Shenzhen Quality Medical Technology Co.,Ltd · GXY · Dec 13, 2017 · Neurology

Device Facts

• Record ID: K171381
• Device Name: Adhesive Electrodes
• Applicant: Shenzhen Quality Medical Technology Co.,Ltd
• Product Code: GXY · Neurology
• Decision Date: Dec 13, 2017
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 882.1320
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Adhesive Electrodes are intended to transmit electrical current to patient skin for TENS (Transcutaneous Electrical Nerve Stimulation) and EMS (Electrical Muscular Stimulation) applications. It is for OTC (Over-The -Counter) or Prescription use and is to be used for adults only.

Device Story

Adhesive electrodes; multi-layer flexible structure; transmit electrical current from stimulator to patient skin. Input: electrical current via snap button; transformation: current passes through conductive carbon film to biocompatible self-adhesive conductive hydrogel; output: electrical stimulation to skin. Used in clinical or home settings; operated by patients or healthcare providers. Device acts as interface between stimulator and patient; facilitates TENS/EMS therapy for pain management or muscle stimulation. Benefits: reusable, conductive interface for electrical therapy.

Clinical Evidence

Bench testing only. No clinical data included. Performance evaluated via electrical impedance, adhesive performance, current dispersion, peel force, and reuse testing. Biocompatibility verified per ISO 10993-5 (cytotoxicity) and ISO 10993-10 (sensitization). Shelf life validated per ASTM F1980-16.

Technological Characteristics

Multi-layer flexible structure: EVA foam backing, carbon film conductor, biocompatible self-adhesive conductive hydrogel, PET protective liner. Dimensions: 40mm x 70mm x 3mm. Electrical connection via snap button. Non-sterile. A.C. Impedance <300 ohms. Biocompatible per ISO 10993-5/10.

Indications for Use

Indicated for adults requiring TENS or EMS therapy via transcutaneous electrical current transmission. No specific contraindications listed.

Regulatory Classification

Identification

A cutaneous electrode is an electrode that is applied directly to a patient's skin either to record physiological signals (e.g., the electroencephalogram) or to apply electrical stimulation.

Predicate Devices

• Wandy Self-adhesive Electrodes (K132998)
• Adhesive Electrodes (K160138)

Submission Summary (Full Text)

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December 13, 2017

ShenZhen Quality Medical Technology Co.,Ltd % Jet Li Regulation Manager Guangzhou LETA Testing Technology Co., Ltd 6F, No.1 TianTai road, Science City, LuoGang District Guangzhou. Guangdong, CN

Re: K171381

Trade/Device Name: Adhesive Electrodes Regulation Number: 21 CFR 882.1320 Regulation Name: Cutaneous Electrode Regulatory Class: Class II Product Code: GXY Dated: October 28, 2017 Received: November 6, 2017

Dear Jet Li:

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

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801); medical device reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements 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.

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.

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 ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely.

Vivek J. Pinto -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) K171381

Device Name Adhesive Electrodes

Indications for Use (Describe)

The Adhesive Electrodes are intended to transmit electrical current to patient skin for TENS (Transcutaneous Electrical Nerve Stimulation) and EMS (Electrical Muscular Stimulations. It is for OTC (Over-The -Counter) or Prescription use and is to be used for adults only.

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

|X | Prescription Use (Part 21 CFR 801 Subpart D)

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

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# 510(k) Summary

This summary of 510(K) safety and effectiveness information is being submitted in accordance with the requirement of 21 CFR 807.92.

#### 1. Date of the summary prepared: December 11, 2017

#### 2. Submitter's Information

#### Sponsor:

510(k) Owner's Name: ShenZhen Quality Medical Technology Co.,Ltd

Establishment Registration Number: N/A

Address: 5/F, Plant C3, No.1, Nuclear Power Industrial Zone, Guanlan Shijing

Community,

Guanlan Street, Longhua New Area, Shenzhen, Guangdong

Phone: [phone]

Fax: [phone]

Contact Person: Grace Zhao

E-mail: [e-mail]

#### Application Correspondent:

Guangzhou LETA Testing Technology Co., Ltd. Address: 6F, No.1 TianTai road, Science City, LuoGang District, GuangZhou

#### City.China

Contact Person: Mr. Jet Li Tile: Regulation Manager Tel: [phone] Email: [e-mail]

#### 3. Subject Device Information

- Adhesive Electrodes Trade Name: �
- Cutaneous electrode Common Name: �

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- Classification name: Electrode, Cutaneous �
- � Review Panel: Neurology
- Product Code: GXY �
- Regulation Class: ll �
- Regulation Number: 882.1320 �

# 4. Predicate Device Information

#### Predicate Device 1

| Sponsor | Wandy Rubber Industrial Co., Ltd |
|-------------------|----------------------------------|
| Device Name | Wandy Self-adhesive Electrodes |
| 510(k) Number | K132998 |
| Product Code | GXY |
| Regulation Number | 882.1320 |
| Regulation Class | 2 |

# Predicate Device 2

| Sponsor | GMDASZ Manufacturing Co., Ltd |
|-------------------|-------------------------------|
| Device Name | Adhesive Electrodes |
| 510(k) Number | K160138 |
| Product Code | GXY |
| Regulation Number | 882.1320 |
| Regulation Class | 2 |

# 5. Device Description

The Adhesive Electrodes transmit electrical current to patient skin, the electrical current is first transmitted via the snap button then transmitted to the conductive gel which is adhered to patient skin.

Adhesive Electrodes are multi-layer reusable, flexible structures, composed of laminated materials commonly used in this application:

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EVA foam First layer: Insulating backing material: Second layer: Conductive film: Carbon film Third layer: Biocompatible self-adhesive conductive hydrogel Protective liner: PET

The dimension of the adhesive electrode is 40 mm (L) × 70 mm (W) ×3mm (H).

# 6. Intended Use / Indications for Use

The Adhesive Electrodes are intended to transmit electrical current to patient skin for TENS (Transcutaneous Electrical Nerve Stimulation) and EMS (Electrical Muscular Stimulation) applications. It is for OTC (Over-The -Counter) or Prescription use and is to be used for adults only.

# 7. Bench Testing (Non-clinical)

Compare to primary predicate devices specified in K132998 and K160138, our device and the predicate devices are same in, raw materials, physical features, and same manufacturing processes. The biocompatibility performance equivalence evidence of proposed electrode can be demonstrated according to ISO10993-1, ISO10993-5 and ISO10993-10.

The proposed Electrode evaluated through Electrode Performance testing (Electrical Impedance Performance, Adhesive Performance, Current dispersion and Peel force ), Biocompatibility testing and Reuse testing.

The non-clinical tests demonstrated that the subject device is as safe, as effective, and performs as well as the legally marketed predicate devices.

# 8. Clinical Test Conclusion

No clinical study is needed to be included in this submission.

# 9. Test Summary

Sensitivity testing criteria as specified in ISO 10993-10 and cytotoxicity testing criteria as specified in ISO 10993-5.

ISO 14971:2007 Medical Device, Harm Control Application to Medical Device Shelf life testing according to FDA recognized standard ASTM F1980 - 16 (Standard Guide for Accelerated Aging of Sterile Barrier Systems for Medical Devices)

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# 10. Comparison to predicate device and conclusion

The technological characteristics, features, specifications, materials, mode of operation, and intended use of Electrode piece is substantially equivalent to the predicate devices quoted above.

The differences between the subject device and predicate devices do not raise new issues of safety or effectiveness.

| Elements<br>of<br>Comparison | Subject Device | Predicate Device 1 | Predicate Device 2 | Remark |
|--------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------|
| Characteristics | | | | |
| Device Name and<br>Model | Adhesive Electrodes | Wandy Self-adhesive<br>Electrodes | Adhesive<br>Electrodes | -- |
| 510 (K) Number | Applying | K132998 | K160138 | -- |
| Intended Use | The Adhesive<br>Electrodes are<br>intended to transmit<br>electrical current to<br>patient skin for TENS<br>(Transcutaneous<br>Electrical Nerve<br>Stimulation) and<br>EMS (Electrical<br>Muscular Stimulation)<br>applications. It is for<br>OTC (Over-The<br>-Counter) or<br>Prescription use and<br>is to be used for<br>adults only. | Wandy Self-adhesive<br>Electrode is intended to<br>transmit electrical current<br>to patient skin for<br>TENS (Transcutaneous<br>Electrical Nerve<br>Stimulation) and EMS<br>(Electrical Muscular<br>Stimulation) applications,<br>for OTC (Over-The<br>-Counter) or Prescription<br>use. The Electrode<br>are used for adults only. | The adhesive<br>electrodes<br>are intended for as a<br>reusable, conductive<br>adhesive interface<br>between<br>the patient's skin and<br>the<br>marketed electrical<br>stimulators (i.e.<br>TENS<br>(Transcutaneous<br>Electrical<br>Nerve Stimulation),<br>EMS<br>(Electrical Muscular<br>Stimulation), IF<br>(Interferential) or<br>PGF<br>(Pulsed Galvanic<br>Stimulation) for<br>transmitting electrical<br>current. The<br>electrode is<br>for OTC (Over-The-<br>Counter) or | SE |
| Elements<br>of<br>Comparison | Subject Device | Predicate Device 1 | Predicate Device 2 | Remark |
| Product Code | GXY | GXY | GXY<br>Prescription use. | SE |
| Regulation<br>Number | 882.1320 | 882.1320 | 882.1320 | SE |
| OTC or<br>Prescription | OTC and Prescription | OTC and Prescription | OTC and<br>Prescription | SE |
| Intended patient<br>population | adults | adults | -- | SE |
| Single Patient Use | Single Patient Use | Single Patient Use | Single Patient Use | SE |
| Reusable | Reusable | Reusable | Reusable | SE |
| Design Feature | Three layers:<br>1. Insulation backing<br>material: EVA foam<br>2. Conductive film:<br>Carbon film<br>3.Conductive<br>hydrogel | Three layers:<br>1. Insulating backing<br>material: Woven<br>Fabric/Foam<br>2. Conductor:<br>Aluminum/Carbon<br>3. Conductive hydrogel | Three layers:<br>1. Insulation backing<br>material:<br>Fabric/Foam/Tan<br>fabric<br>2. Conductive film:<br>Carbon film/Carbon<br>film coated with<br>silver/Aluminum foil<br>film<br>3. Conductive<br>hydrogel | SE |
| Protective Liner | PET | PET | PET | SE |
| Electrical<br>Connection | Snap button | Snap button or lead wire | Snap button or lead<br>wire | SE |
| Non-sterile | Non-sterile | Non-sterile | Non-sterile | SE |
| Reusable | Reusable | Reusable | Reusable | SE |
| A.C. Impedance | <300 ohms | <300 ohms | <300 ohms | SE |
| Biocompatibility | All user directly<br>contacting materials<br>are compliance with | All user directly<br>contacting materials are<br>compliance<br>with | Has passed the<br>required skin<br>sensitivity testing | SE |
| Elements of<br>Comparison | Subject Device | Predicate Device 1 | Predicate Device 2 | Remark |
| | ISO10993-5 and<br>ISO10993-10<br>requirements. | ISO10993-5 and<br>ISO10993-10<br>requirements. | criteria as<br>specified in the<br>Tripartite<br>Biocompatibility<br>Guidance for Medical<br>Devices and ISO<br>10993-1<br>requirements for skin<br>contact. These tests<br>include Cytotoxicity,<br>Sensitization and<br>Primary Skin Irritation<br>Tests. | |

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# Finial Conclusion:

Based on the indication for use, technology characteristics, and performance testing, the proposed device has been shown to be appropriate for its indication for use and is considered to be substantially equivalent to the primary predicate device and reference device.