N9+

K223785 · Nonagon , Ltd. · DQD · Apr 14, 2023 · Cardiovascular

Device Facts

• Record ID: K223785
• Device Name: N9+
• Applicant: Nonagon , Ltd.
• Product Code: DQD · Cardiovascular
• Decision Date: Apr 14, 2023
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 870.1875
• Device Class: Class 2

Intended Use

The N9+ (OTC) device, combined with a smartphone application, is a multiple-sensor device that is intended to measure, record, and transmit the recorded data of auscultation sound of human body temperature, oxygen saturation (SpO2) and pulse rate, and images of an examined body part. N9+ (OTC) device is intended for use by adult lay users in a non-clinical environment. Nonagon application enables counseling with the physician and transmission of the information over an IP network. The oxygen saturation (SpO2) sensor of the device is for Rx only.

Device Story

Handheld multi-sensor unit interfaces with smartphone; includes wireless otoscope kit (camera, tongue depressor, ear specula). Captures auscultation sounds, body temperature, SpO2, pulse rate, and images of skin/body parts. Smartphone app controls hardware, processes/displays data, and transmits information over IP network to remote physician for counseling. Used by adult lay users in home environments. Provides raw data for physician review; no automated interpretation of data. Benefits include remote patient monitoring and clinical guidance without in-person visits.

Clinical Evidence

Bench testing only. Includes biocompatibility (ISO 10993), electrical safety (IEC 60601-1), EMC (IEC 60601-1-2), wireless coexistence (ANSI C63.27-2017), and software validation. Self-selection study (n=31) confirmed adult lay users correctly identified device suitability based on packaging.

Technological Characteristics

Handheld unit with wireless otoscope; reusable specula/tongue depressor. Sensors for auscultation, temperature, SpO2, pulse, and imaging. Connectivity via smartphone app over IP network. Standards: IEC 60601-1, IEC 60601-1-2, IEC 60601-1-11, IEC 62471, IEC 60601-2-18. Software level of concern: moderate.

Indications for Use

Indicated for adult lay users in non-clinical environments to measure, record, and transmit auscultation sounds, body temperature, SpO2, pulse rate, and images of body parts. SpO2 sensor is Rx only.

Regulatory Classification

Identification

Manual stethoscope: A mechanical device used to project the sounds associated with the heart, arteries, and veins and other internal organs. Electronic stethoscope: An electrically amplified device used to project the sounds associated with the heart, arteries, and veins and other internal organs.

Special Controls

*Classification.* Class II (special controls). The device, when it is a lung sound monitor, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.

Predicate Devices

• MyHomeDoc device (K202483)
• Tyto Thermometer (OTC) (K190242)
• Tyto Stethoscope (OTC) (K181612)

Submission Summary (Full Text)

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April 14, 2023

Nonagon Ltd. % Jonathan Kahan Partner Hogan Lovells US LPP 555 Thirteenth Street NW Washington, District of Columbia 20004

Re: K223785

Trade/Device Name: N9+ Regulation Number: 21 CFR 870.1875 Regulation Name: Stethoscope Regulatory Class: Class II Product Code: DQD, FLL, DQA, ERA, Dated: March 23, 2023 Received: March 23, 2023

Dear Jonathan Kahan:

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.

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

> Sincerely. Robert T. Kazmierski -S

for

LCDR Stephen Browning Assistant Director Division of Cardiac Electrophysiology, Diagnostics, and Monitoring Devices Office of Cardiovascular 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) K223785

Device Name

N9+ (OTC) device

Indications for Use (Describe)

The N9+ (OTC) device, combined with a smartphone application, is a multiple-sensor device that is intended to measure, record, and transmit the recorded data of auscultation sound of human body temperature, oxygen saturation (SpO2) and pulse rate, and images of an examined body part.

N9+ (OTC) device is intended for use by adult lay users in a non-clinical environment. Nonagon application enables counseling with the physician and transmission of the information over an IP network.

The oxygen saturation (SpO2) sensor of the device is for Rx only.

| Type of Use (Select one or both, as applicable) | |
|----------------------------------------------------------------------------------|---------------------------------------------------------------------------------|
| <input checked="" type="checkbox"/> Prescription Use (Part 21 CFR 801 Subpart D) | <input checked="" type="checkbox"/> Over-The-Counter Use (21 CFR 801 Subpart C) |

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## Traditional Premarket Notification Submission - 510(k) N9+ (OTC) device 510(k) Number K223785

Date Prepared: April 13, 2023

#### l. SUBMITTER

Nonagon Ltd. 1 HaEshel St., Caesarea 3079830, Israel Tel: [phone]

### Contact Persons

Jonathan Kahan, Partner Hogan Lovells US LLP 555 Thirteenth Street, NW Washington, DC 20004 Tel:[phone] [e-mail] Lina Kontos, Partner Hogan Lovells US LLP 555 Thirteenth Street, NW Washington, DC 20004 Tel:[phone] [e-mail]

## Back-up Company Contact:

Orly Maor 25 Sirkin Street Kfar Saba 44421 Israel Tel: [phone] [e-mail]

#### DEVICE ll.

Name of Device: Common or Usual Name: Classification Name: Requlatory Class: Product Code:

N9+ (OTC) device Patient Monitor Oximeter, Clinical Electronic Thermometer, and Otoscope Class II DQD, FLL, DQA, ERA

#### PREDICATE DEVICE lll.

Primary predicate:

MyHomeDoc device (K202483), Requlation Number: 870.1875 Classification Product Code: DQD Subsequent Product Codes: DQA, ERA, FLL

Secondary predicates:

Tyto Care Ltd. Tyto Thermometer (OTC) cleared under K190242 Regulation Number: 21 CFR 880.2910 Product Code: FLL

TytoCare Ltd. Tyto Stethoscope (OTC) cleared under K181612 Regulation Number: 21 CFR 870.1875 Product Code: DQD

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#### IV. DEVICE DESCRIPTION

The N9+ (OTC) (except for the oxygen saturation function), is a home use device. The device is comprised of a handheld unit that interfaces with a smartphone, a wireless otoscope kit comprised of the otoscope camera, a reusable tongue depressor and 2 reusable ear specula (adult and toddlers) and a dedicated smartphone software application that runs on the user's personal smartphone.

The system uses the smartphone's camera to record images of the patient's skin.

An API is defined to enable healthcare providers to communicate with the device. The pulse oximeter will be a prescription device in the US market.

The Device enables user's examination at home with or without the quidance of a remote physician. It also enables guidance and data examination by a remote physician over an IP network. The Smartphone Application controls the Handheld Unit and wireless otoscope functionality (besides recording images of the patient's skin) and processes and displays the collected data.

#### V. INDICATIONS FOR USE

The N9+ (OTC) device, combined with a smartphone application, is a multiple-sensor device that is intended to measure, record, and transmit the recorded data of auscultation sound of human body. human body temperature, oxygen saturation (SpO2) and pulse rate, and images of an examined body part.

N9+ (OTC) device is intended for use by adult lay users in a non-clinical environment. Nonagon application enables counseling with the physician and transmission of the information over an IP network.

The oxygen saturation (SpO2) sensor of the device is for Rx only.

#### VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE AND REFERENCE DEVICE

The N9+ (OTC) have the same intended use as the previously cleared device, with a modification to the indications for use to allow for OTC use (except for the pulse oximeter which remains under prescription use). The N9+ (OTC) device has substantially similar technology as the cleared N9+ and the secondary predicate devices and the minor differences do not raise new or different questions of safety or effectiveness.

| N9+ (OTC) device<br>K223785 | MyHomeDoc device<br>(N9+)<br>K202483 | Tyco Care Tyto<br>Stethoscope (OTC)<br>K181612 | Tyto Care Tyto<br>Thermometer (OTC)<br>K190242 |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| The N9+ (OTC) device, combined with a<br>smartphone application, is a<br>multiple-sensor device that<br>is intended to measure,<br>record, and transmit the<br>recorded data of<br>auscultation sound of<br>human body, human body | The MyHomeDoc device, combined with a<br>smartphone application,<br>is a multiple-sensor<br>device that is intended to<br>measure, record, and<br>transmit the recorded<br>data of auscultation<br>sound of human body. | The Tyto<br>Stethoscope is an<br>electronic<br>stethoscope that<br>enables transmission<br>of auscultation sound<br>data, whereby a<br>clinician at one<br>location on an IP | The Tyto<br>Thermometer is a<br>non - contact clinical<br>infrared thermometer<br>intended for<br>intermittent<br>determination of<br>human body<br>temperature from the |

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| N9+ (OTC) device<br>K223785 | MyHomeDoc device<br>(N9+)<br>K202483 | Tyco Care Tyto<br>Stethoscope (OTC)<br>K181612 | Tyto Care Tyto<br>Thermometer (OTC)<br>K190242 |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| temperature, oxygen<br>saturation (SpO2) and pulse<br>rate, and images of an<br>examined body part.<br>N9+ (OTC) device is<br>intended for use by adult lay<br>users in a non-clinical<br>environment. Nonagon<br>application enables<br>counseling with the<br>physician and transmission<br>of the information over an IP<br>network.<br>The oxygen saturation<br>(SpO2) sensor of the device<br>is for Rx only. | human body<br>temperature, oxygen<br>saturation (SpO2) and<br>pulse rate, and images of<br>an examined body part.<br>MyHomeDoc device is<br>intended for use by adult<br>lay users in a non-clinical<br>environment.<br>MyHomeDoc application<br>enables counseling with<br>the physician and<br>transmission of the<br>information over an IP<br>network. | network can listen to<br>the auscultation<br>sounds of a patient<br>on site or at a<br>different location on<br>the IP network with<br>the signal carried on<br>an IP connection<br>between the two<br>locations. The Tyto<br>Stethoscope is<br>intended to be used<br>by professional users<br>in a clinical<br>environment or by lay<br>users in a nonclinical<br>environment. The<br>device is for medical<br>diagnostics purposes<br>only. The device is<br>not intended for self-<br>diagnosis. | center of the<br>forehead on people of<br>all ages. The Tyto<br>Thermometer is<br>intended for use by<br>both adult lay users<br>and clinicians. It can<br>be used both at home<br>and in clinic<br>environments. |

No significant changes to the technological characteristics of the device have been implemented since clearance except for a modification to the otoscope due to a change in supplier.

The N9+ (OTC) device has similar technological characteristics as the predicate device in that it is provides the same exams, used at home by the patient directly to record and wirelessly transmit the patient's data to the healthcare provider at a different location in either an online or offline mode. The secondary predicate devices provide similar functionalities as the N9+ (OTC) device and also allows for OTC use. With the subject and predicate devices, none of the systems provide any interpretation of the data.

#### PERFORMANCE DATA VII.

The following performance data were provided in support of the substantial equivalence determination:

- Biocompatibility testing in compliance with ISO 10993. -
#### Software Validation -

The N9+ (OTC) software level of concern is moderate. Software verification and validation testing were conducted, and documentation was provided as recommended by FDA's Guidance for Industry and FDA Staff, "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices".

#### Electrical Safely and EMC -

Electrical Safety per IEC 60601-1 and Electromagnetic compatibility (EMC) per IEC 60601-1-2 were conducted on the N9+ (OTC) device. In addition, the system complies with IEC 60601-1-11, IEC 62471, and IEC 60601-2-18.

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## Wireless quality of service and coexistence testing

Testing was performed to address testing of the device in the presence of the relevant potential emitters in the intended use environment in accordance with ANSI C63.27-2017: Evaluation of wireless coexistence and FDA's Guidance "Radio frequency wireless technology in medical devices."

#### -Self-Selection testing

The study enrolled 31 men and women of different ages and literacy levels. All the participants made a correct purchasing decision. The results of this self-selection study show that consumers are able to decide whether the N9+ (OTC) is right for them based on the information communicated on the outer package (box).

## VIII. CONCLUSIONS

The N9+ (OTC) device was determined to be substantially equivalent to the predicate devices.