XOH-ZLINK001Cardiac Telemetry Device

Page 1 of 6 © Corventis 2010 For US distribution only IFU NUVANT 04-10 P00986-002 Rev A NUVANT™ Mobile Cardiac Telemetry (MCT) System INSTRUCTIONS FOR USE Rx only Indications for Use The NUVANT™ Mobile Cardiac Telemetry (MCT) System is intended to continuously measure, record and periodically transmit physiological data. The System is indicated for those patients who require monitoring for the detection of non-lethal cardiac arrhythmias. The NUVANT System model monitors, derives and displays: • ECG • Heart Rate The System may also monitor, derive and display: • Activity • Posture • Respiration rate (including RR variability) • Body fluid status • Heart rate variability Description of the System The NUVANT System includes: a) PiiX™ - an adherent patient-worn device containing multiple sensors used to track a suite of physiological parameters. The PiiX can also be activated to associate patient symptoms with ECG data using a Patient Trigger Magnet. PiiX can collect approximately 500 ECG episodes. However, PiiX must be replaced after 7.5 days of use or when the end of life indicator appears. An end of life indicator as shown below, will light up when the PiiX needs to be replaced. b) zLink™- a device that receives data from the PiiX and transmits to the Server. c) zLink Charger – a charger for the zLink. d) zLink Holster – a wearable holder for the zLink. e) Prep wipes – wipes used for cleaning the skin prior to applying the PiiX. The NUVANT System enables remote monitoring in ambulatory patients to: a) Detect, store and transmit ECGs and other physiological data. b) Assist physicians/health practitioners in the diagnosis and identification of various clinical conditions/events/trends through web services and patient reports. Based on the indications, the NUVANT System may be used for: a) Patients who require monitoring for known, non-life threatening arrhythmias. b) Patients with symptoms such as chest pain, syncope, lightheadedness or near syncope, vertigo, dizziness, fall, palpitations, transient ischemic episodes, dyspnea (shortness of breath) that might be due to cardiac arrhythmias. c) Patients with cardiac arrhythmia associated with co-morbid conditions. d) Obtaining correlation of rhythm with symptoms when symptoms have unknown etiology. e) Evaluating possible arrhythmias in a) patients recovering from cardiovascular or thoracic surgery; b) survivors of myocardial infarction; c) patients with diagnosed sleep disorder breathing. f) Evaluating benefits after initiating or discontinuation of anti-arrhythmic drug therapy. g) Assessing the results of an ablation procedure for an arrhythmia. Contraindications 1. Patients with known allergies or hypersensitivities to adhesives or hydrogel. 2. Patients with potentially life-threatening arrhythmias, or who require inpatient / hospital monitoring. Precautions 1. PiiX should not be used on patients with implantable devices with active minute ventilation sensors. 2. Patient trigger magnet should not be used in patients who have implanted devices with active magnet features in the vicinity of the PiiX. 3. PiiX should be removed prior to external defibrillation or an MRI scan. 4. PiiX may cause mild discomfort, skin irritation, redness, itching, rash or contact dermatitis in some individuals. The device should be removed if any pain or discomfort occurs. If skin irritation or redness persists after the device has been removed, a topical anti-inflammatory cream may be applied to the area (in consultation with your health care provider). 5. PiiX is intended for single patient use. 6. PiiX should not be applied to broken, damaged or irritated skin. Page 2 of 6 © Corventis 2010 For US distribution only IFU NUVANT 04-10 7. PiiX is water resistant but not waterproof. It should not be submerged in water (showering is acceptable, but swimming and submersion bathing are prohibited). 8. PiiX should not be disassembled. 9. Replace the PiiX if it peels off; do not reapply the PiiX. 10. Replace the PiiX if it appears damaged. 11. No creams or lotions should be applied immediately prior to use of PiiX. 12. Store PiiX in a cool, dry location. The device is designed to withstand environmental temperature fluctuations between 0° to 40°C. The NUVANT System is not intended to replace direct communication with your healthcare provider. The system data should not be used alone, but should be used along with all other clinical data and exams to come to a diagnosis. The system is not intended to alarm or alert physicians, and will not summon emergency response in the event you need help. Talk to your healthcare provider immediately if you have any concerns, or if your condition changes. Step-by-step Operating Instructions – NUVANT MCT System No specific training is needed for the use of this system. The zLink should be set-up first prior to the PiiX application. zLink Set-up 1. Remove the zLink from the box. 2. Connect the charger connector with the zLink 3. Plug the charger into an electrical outlet. zLink will begin charging immediately. If the lights on the zLink do not display, push the round Power button located below the lights to turn on the zLink. The zLink should be kept connected to the charger until the Power light is blue. zLink Lights Power Light: BLUE ON: Full charge confirmed AMBER ON: Low charge warning AMBER Flashing: Battery capacity less than 10%. Full charge may take up to 4 hours Cell Light: BLUE: Adequate cell coverage AMBER: No cell coverage. Move zLink to another location Other lights on zLink are utilized only if troubleshooting is necessary. Refer to these lights only if asked by a Corventis Customer Service representative. zLink may also be turned ON and OFF manually. To turn zLink ON when zLink is not connected to the charger, press the round Power button located below the lights. All lights will come on, confirming zLink is ON. To turn zLink OFF, press the round Power button for several seconds until all the lights turn off. 4. To initiate …

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GSM Module Motorola G24J GEN 1 HOME GATEWAY BLOCK DIAGRAM Bluetooth Module LMX9830 SIM POWER SUPPLY LINEAR USER INTERFACE USB 13.00 MHz Oscillator Undisclosed Oscillator FCC ID: XOH-GSM001 No user tuning range Unspecified IF No user tuning range Unspecified IF Digital Signals @ 115Kbps Digital Signals @ 1 Hz Digital Signals @ 3.25 MHz Digital Signals @ 12 Mbps

5/27/10

Top View Bottom View

Motorola GSM G24 Module Backside with FCC ID IHDT56FV1 visible.

Motorola GSM G24 Module Backside with FCC ID XOH‐GSM001 visible.

Bottom View Gateway opened Main Board Top View Close‐up 1 Main Board Top View Close‐up 2 Main board back side Main board back side close‐up 1 Main board back side close‐up 2

Narrative Description: The Gen1 In‐Home Gateway is part of the NUVANT™ Mobile Cardiac Telemetry System. The NUVANT™ Mobile Cardiac Telemetry (MCT) System continuously measures and records patient physiological data. Periodically, this data is sent to a data collection server. The Gateway is the wireless interface between the patient worn Adhere nt Device and the data collection server. The industry standard “Bluetooth” wireless protocol is used between the Gateway and Adherent Device while “GSM/GPRS” is used between the Gateway and data collection server. The Bluetooth integrated circuit, National Semiconductor LMX9830, is used with a printed circuit board meandered “F” antenna. The GSM module is used with a Jinchang meandered dipole, 2.0dBi, GSM antenna, model JCG059. zLink [GEN1 Gateway] is marketed with another device, PiiX with FCC ID XOH‐PIIX. zLINK and PiiX are part of the NUVANT MCT system, see user manual for more details. The GEN1 Gateway contains an FCC approved tran smitter, FCC ID XOH‐GSM001.

MET Laboratories, Inc. Safety Certification - EMI - Telecom Environmental Simulation 914 WEST PATAPSCO AVENUE ! BALTIMORE, MARYLAND 21230-3432 ! PHONE (410) 354-3300 ! FAX (410) 354-3313 33439 WESTERN AVENUE ● UNION CITY, CALIFORNIA 94587 ● PHONE (510) 489-6300 ● FAX (510) 489-6372 3162 BELICK STREET ● SANTA CLARA, CALIFORNIA 95054 ● PHONE (408 748-3585 ● FAX (510) 489-6372 The Nation’s First Licensed Nationally Recognized Testing Laboratory Dosimetric Assessment Test Report For the Gen 1 Gateway (zLink TM ) Tested and Evaluated In Accordance With FCC OET 65 Supplement C: 01-01 Prepared for Corventis 1400 Energy Park Drive, Suite 1 St. Paul, MN 55108 Engineering Statement: The measurements shown in this report were made in accordance with the procedures specified in Supplement C to OET Bulletin 65 of the Federal Communications Commission (FCC) Guidelines [FCC 2001] for uncontrolled exposure. I assume full responsibility for the accuracy and completeness of these measurements, and for the qualifications of all persons taking them. It is further stated that upon the basis of the measurements made, the equipment evaluated is capable of compliance for localized specific absorption rate (SAR) for uncontrolled environment/general population exposure limits specified in ANSI/IEEE Std. C95.1-1992. Corventis Gen1 gateway (zLink™) SAR Report MET Report: EMC29453-SAR Rev. 2 © 2010, MET Laboratories, Inc. Page 2 of 29 SAR Evaluation Applicant Name and Address: Corventis 1400 Energy Park Drive, Suite 1 St. Paul, MN 55108 Test Location: MET Laboratories, Inc. 3162 Belick Street Santa Clara, CA 95054 USA EUT: Gen 1 Gateway (zLink TM ) Date of Receipt: 09/28/10 Device Category: Portable RF exposure environment: Uncontrolled Exposure / General Population RF exposure category: Portable Production/prototype: Production Antenna: Internal Modulations Tested: GPRS Duty Cycle: 1:4 GSM/GPRS/Edge Multislot Class: GPRS Multi-slot class 10 (4 Rx, 2 Tx, 5 Sum) TX Range: 824 – 848 MHz 1850 – 1909 MHz Frequency Channel SAR 1g (mW/g) 836.4 MHz 190 0.076 Frequencies Tested: 1880.0 MHz 661 0.122 Shawn McMillen SAR Compliance Manager Corventis Gen1 gateway (zLink™) SAR Report MET Report: EMC29453-SAR Rev. 2 © 2010, MET Laboratories, Inc. Page 3 of 29 Report Status Sheet Revision Report Date Reason for Revision  August 11, 2010 Initial Issue. 1 September 22, 2010 Revised to reflect engineer corrections. 2 September 28, 2010 Revised to reflect customer corrections. Corventis Gen1 gateway (zLink™) SAR Report MET Report: EMC29453-SAR Rev. 2 © 2010, MET Laboratories, Inc. Page 4 of 29 Table of Contents 1 INTRODUCTION ................................................................................................................................................................. 5 2 SAR DEFINITION ................................................................................................................................................................ 5 3 DESCRIPTION OF TEST PLATFORMS ............................................................................................................................. 6 4 SAR MEASUREMENT SYSTEM ........................................................................................................................................ 7 5 MEASUREMENT SUMMARY ............................................................................................................................................ 8 6 DETAILS OF SAR EVALUATION....................................................................................................................................... 9 7 EVALUATION PROCEDURES.......................................................................................................................................... 10 8 DATA EVALUATION PROCEDURES................................................................................................................................11 9 SYSTEM PERFORMANCE CHECK ................................................................................................................................. 13 10 SIMULATED EQUIVALENT TISSUES............................................................................................................................. 14 11 SAR SAFETY LIMITS ....................................................................................................................................................... 14 12 FLOW CHART OF THE RECOMMENDED PRACTICES AND PROCEDURES ........................................................... 15 13 DEFINITION OF REFERENCE POINTS .......................................................................................................................... 16 13.1. EAR Reference Point................................................................................................................................................. 16 13.2. HANDSET REFERENCE POINTS .......................................................................................................................... 16 13.3. POSITIONING FOR CHEEK/TOUCH .................................................................................................................... 17 13.4. POSITIONING FOR EAR/15 DEGREE TILE ......................................................................................................... 17 14 ROBOT SYSTEM SPECIFICATIONS ............................................................................................................................... 18 14.1. SPECIFICATION...................................................................................................................................................... 18 14.2. DATA ACQUISITION ELECTRONIC (DAE) SYSTEM:.......................................................................................18 14.3. PHANTOM(S): .....................................................................................................................................................…

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836.4 MHz, Mid Channel 190, Body GSM+GPRS, Toward Body Date/Time: 11/29/2010 4:07:51 PM DUT: Corventis; Type: GEN 1 Gateway Medium Notes: Ambient Temp: 23.4 deg C, Fluid Temp: 23 deg C Communication System: GSM 850; ; Frequency: 836.4 MHz;Duty Cycle: 1:4 Medium: M850 Medium parameters used: f = 836.4 MHz; σ = 0.926 mho/m; ε r = 55.6; ρ = 1000 kg/m 3 Phantom section: Flat Section - Probe: ET3DV6 - SN1793; ConvF(6.06, 6.06, 6.06); Calibrated: 4/27/2010 - Sensor-Surface: 4mm (Mechanical And Optical Surface Detection) - Electronics: DAE3 Sn584; Calibrated: 4/26/2010 - Phantom: SAM with CRP; Type: SAM; Serial: TP 1310 - Measurement SW: DASY4, V4.7 Build 71; Postprocessing SW: SEMCAD, V1.8 Build 184 Area Scan (91x131x1): Measurement grid: dx=10mm, dy=10mm Maximum value of SAR (interpolated) = 0.074 mW/g Zoom Scan (7x7x7)/Cube 0: Measurement grid: dx=5mm, dy=5mm, dz=5mm Reference Value = 2.28 V/m; Power Drift = 0.002 dB Peak SAR (extrapolated) = 0.104 W/kg SAR(1 g) = 0.069 mW/g; SAR(10 g) = 0.046 mW/g Maximum value of SAR (measured) = 0.076 mW/g

835 MHz Body System Check Date/Time: 11/29/2010 2:50:17 PM DUT: Dipole 835 MHz; Type: D835V2 SN: 4d110 Medium Notes: Ambient Temp: 23.4 deg C, Fluid Temp: 23.0 deg C Communication System: CW; ; Frequency: 835 MHz;Duty Cycle: 1:1 Medium: M850 Medium parameters used: f = 835 MHz; σ = 0.93 mho/m; ε r = 55.6; ρ = 1000 kg/m 3 Phantom section: Flat Section - Probe: ET3DV6 - SN1793; ConvF(6.06, 6.06, 6.06); Calibrated: 4/27/2010 - Sensor-Surface: 4mm (Mechanical And Optical Surface Detection) - Electronics: DAE3 Sn584; Calibrated: 4/26/2010 - Phantom: SAM with CRP; Type: SAM; Serial: TP 1310 - Measurement SW: DASY4, V4.7 Build 71; Postprocessing SW: SEMCAD, V1.8 Build 184 Area Scan (81x201x1): Measurement grid: dx=10mm, dy=10mm Maximum value of SAR (interpolated) = 2.73 mW/g Zoom Scan (7x7x7)/Cube 0: Measurement grid: dx=5mm, dy=5mm, dz=5mm Reference Value = 55.6 V/m; Power Drift = -0.147 dB Peak SAR (extrapolated) = 4.00 W/kg SAR(1 g) = 2.59 mW/g; SAR(10 g) = 1.7 mW/g Maximum value of SAR (measured) = 2.82 mW/g

Title SubTitle November 29, 2010 11:51 AM Frequency 800.000000 MHz 802.000000 MHz 804.000000 MHz 806.000000 MHz 808.000000 MHz 810.000000 MHz 812.000000 MHz 814.000000 MHz 816.000000 MHz 818.000000 MHz 820.000000 MHz 822.000000 MHz 824.000000 MHz 826.000000 MHz 828.000000 MHz 830.000000 MHz 832.000000 MHz 834.000000 MHz 836.000000 MHz 838.000000 MHz 840.000000 MHz 842.000000 MHz 844.000000 MHz 846.000000 MHz 848.000000 MHz 850.000000 MHz 852.000000 MHz 854.000000 MHz 856.000000 MHz 858.000000 MHz 860.000000 MHz 862.000000 MHz 864.000000 MHz 866.000000 MHz 868.000000 MHz e'e'' 55.928020.1879 55.901020.1783 55.874120.1687 55.872720.1549 55.828320.1456 55.830920.1388 55.805320.1469 55.764620.1089 55.771920.1267 55.746020.0991 55.745420.0760 55.731420.0782 55.698620.0366 55.674520.0443 55.692020.0205 55.663819.9948 55.633819.9656 55.594619.9683 55.616019.9426 55.574719.9244 55.566319.8928 55.527719.8868 55.525919.8827 55.496019.8676 55.462319.8370 55.429519.8238 55.386419.8076 55.358219.8096 55.302219.8009 55.301219.7879 55.253919.7703 55.228319.7362 55.182319.7356 55.152619.6780 55.129219.6781 870.000000 MHz 872.000000 MHz 874.000000 MHz 876.000000 MHz 878.000000 MHz 880.000000 MHz 882.000000 MHz 884.000000 MHz 886.000000 MHz 888.000000 MHz 890.000000 MHz 892.000000 MHz 894.000000 MHz 896.000000 MHz 898.000000 MHz 900.000000 MHz 55.080019.6319 55.097419.6265 55.072019.5759 55.086719.5806 55.050219.5712 55.056319.5678 55.056919.5243 55.057119.5027 55.063119.5209 55.068219.5223 55.060619.5310 55.039219.5304 55.066119.5534 55.066319.5745 55.032719.5811 55.049819.6009

9/14/10 10/14/10

SAR Evaluation

Applicant Name and Address: Corventis

1400
Energy
Park
Drive,
Suite
1

St.
Paul,
MN
55108

Test Location: MET Laboratories, Inc.

3162
Belick
Street

Santa
Clara,
CA
95054

USA


EUT: Gen
1
Gateway
(zLink
TM )
Device Category: Portable
RF exposure environment: Uncontrolled
Exposure
/
General
Population
RF exposure category: Portable
Production/prototype: Production
Antenna: Internal
Modulations Tested: GPRS
Duty Cycle: 1:4
TX Range: 824
–
848
MHz
Frequency
Channel
SAR 1g (mW/g) Frequencies Tested: 836.4
MHz
190
0.069


Shawn
McMillen
SAR
Compliance
Manager




Gen 1 Gateway (zLink TM )
BODY4WORN SAR MEASUREMENT RESULTS (850MHz) Band Freq (MHz) Chan Mode Test ed Cond. Pwr. Before (dBm) Battery Type Body4Worn Accessories Antenna Position EUT Test Position Phantom Section Host Sep. Dist. (cm) Measured SAR 1g (W/kg) 836.4
Mid
GSM/
GPRS
33.19
Li;Ion
Holster
Internal
Front
Side
Front
Face
Planar
1.5
0.069
ANSI/IEEE C95.1 1992 – SAFETY LIMITBODY: 1.6 W/kg (averaged over 1 gram) Spatial Peak – Uncontrolled Exposure / General Population Measured Mixture Type 835
MHz
Body
Date Tested November
29 th ,
2010
IEEE Target Measured Duty Cycle 1:4
Dielectric Constant εr 55.2
55.6
Ambient Temperature (C) 23.4
IEEE Target Measured Fluid Temperature (C) 23.0
Conductivity σ (mho/m) 0.97
0.926
Fluid Depth ≥15cm

SYSTEM
PERFORMANCE
CHECK
Prior
to
the
SAR
evaluation
a
system
check
was
performed
in
the
planar
section
of
the
SAM
phantom
with
an
835MHz.
The
dielectric
parameters
of
the
simulated
body
fluids
were
measured
prior
to
the
system
performance
check
using
an
85070D
Dielectric
Probe
Kit
and
an
8722D
Network
Analyzer.

A
forward
power
of
250mW
was
applied
to
the
dipole
and
the
system
was
verified
to
a
tolerance
of
±5%.





SAR 1g (W/kg) Permittivity Constant εr Conductivity σ (mho/m) Test Date 835MHz Equivalent Tissue Calibrated Target Measured IEEE Target Measured IEEE Target Measured Ambient Temp. (C) Fluid Temp. (C) Fluid Depth (cm) 11/29/10
Body
2.53±5%
2.59
55.2
±5%
55.6
0.97±10%
0.93
23.4
23.0
≥15


TEST EQUIPMENT LIST
Test Equipment Serial Number Calibration Date DASY4
System
Robot
ET3DV6
DAE3
835MHz
Dipole
SAM
Phantom
V4.0C
EUT
Planar
Phantom
Validation
Phantom



FO3/SX19A1/A/01
1793
584
4d110
N/A
N/A
N/A




N/A
April
2010
April
2010
November
2010
N/A
N/A
N/A


85070D
Dielectric
Probe
Kt

N/A
N/A

Agilent
N9310A
Signal
Generator

CN0115000737
April
2010
HP
E4418B
Power
Meter
GB40205140
October
2010

HP
8482A
Power
Sensor

2607A11286
May
2010

HP
8722D
Vector
Network
Analyzer

3S36140188
July
2010

HP
EPM;442A
Power
Meter

GB37480766
June
2010

Agilent
Power
Sensor

MY41496163
December
2009
Mini;Circuits
Power
Amplifier

D111903#8

N/A

TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 TEST RESULT SUMMARY FCC Part 15 Subpart C Section 15.247 Industry Canada RSS-210 Issue 7 COMPANY Corventis Inc 1410 Energy Park Dr # 1 St Paul MN 55108-5249 DESCRIPTION OF EQUIPMENT Communications device for patient monitoring system NAME OF EQUIPMENT Gen1 Gateway MODEL NUMBER(S) TESTED MCT-ZD-001 SERIAL NUMBER(S) TESTED n/a TEST REPORT NUMBER WC1003209 Rev A TEST DATE(S) 26 April – 27 May 2010 TÜV SÜD America Inc, as an independent testing laboratory, declares that the equipment tested as specified above conforms to the applicable EMC requirements of FCC Part 15 Subpart C Section 15.247 “Operation within the bands 902–928 MHz, 2400–2483.5 MHz, and 5725–5850 MHz; General requirements.” and IC RSS-210 Issue 7 “Low-power License-exempt Radiocommunication Devices (All Frequency Bands): Category I Equipment”. It is the manufacturer's responsibility to assure that additional production units of this model are manufactured with identical electrical and mechanical characteristics. Any modifications necessary for compliance made during testing on the above mentioned date(s) must be implemented in all production units for compliance to be maintained. Date: 27 May 2010 Location: Taylors Falls MN Greg S Jakubowski Joel T Schneider USA Senior EMC Technician Senior EMC Engineer Not Transferable TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 EMC TEST REPORT Test Report No. WC1003209 Rev A Date of issue: 27 May 2010 Manufacturer Corventis Inc Address 1410 Energy Park Drive #1 St Paul MN 55108-5249 Description of Equipment Communications device for patient monitoring system Name of Equipment Gen1 Gateway Model No(s) Tested MCT-ZD-001 Serial No(s) Tested n/a Test Result „ Compliant † Non-compliant TÜV SÜD America Inc reports apply only to the specific samples tested under stated test conditions. It is the manufacturer's responsibility to assure that additional production units of this model are manufactured with identical electrical and mechanical components. TÜV SÜD America Inc shall have no liability for any deductions, inferences or generalizations drawn by the client or others from TÜV SÜD America Inc issued reports. This report is the confidential property of the client. As a mutual protection to our clients, the public and ourselves, extracts from the test report shall not be reproduced except in full without our written approval. This report shall not be used by the client to claim product endorsement by NVLAP, NIST, or any agency of the US government. TÜV SÜD America Inc and its professional staff hold government and Professional organization certifications and are members of AAMI, ACIL, AEA, ANSI, IEEE, NARTE, and VCCI.. Test Report WC1003209 Rev A1 of 43 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 REVISION RECORD REVISION TOTAL NUMBER OF PAGES DATE DESCRIPTION 44 06 May 2010 Initial Release A 43 27 May 2010 Revision Include: ƒ Additional testing per TCB application review. Test Report WC1003209 Rev A2 of 43 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 TEST REPORT CONTENTS Page(s) Revision Record 2 Directory 3 Test Regulations, Environmental conditions, Power supply 4 Test Results: FCC IC Carrier frequency separation 15.247(a)1) RSS-210 A8.1(b) 5 Number of Hopping Frequencies 15.247(a)1)iii) RSS-210 A8.1(d) 6 - 7 Time of Occupancy 15.247(a)1)iii) RSS-210 A8.1(d) 8 - 9 20 dB Bandwidth 15.247(a)1) RSS-210 A8.1 10 - 11 Peak output power 15.247(b)1) RSS-210 A8.4(2) 12 - 13 Spurious Emissions 15.247(d) RSS-210 A8.5 14 - 21 AC power line conducted emissions 15.207 RSS-GEN 22 - 27 Test area diagram(s) 28 Test setup photo(s) 29 - 31 Test Operation Mode, Configuration of the device under test 32 Deviations From Standard, General Remarks, Summary 33 Appendix A Constructional Data Form 34 - 40 Appendix B Measurement Protocol 41 - 43 Sign Explanations: † - not applicable „ - applicable Test Report WC1003209 Rev A3 of 43 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 EMC TEST REGULATIONS The tests were performed according to the following regulations: FCC Part 15 Subpart C Section 15.247 IC RSS-210 Issue 7 ENVIRONMENTAL CONDITIONS IN THE LAB Actual Temperature: : 22-24°C Atmospheric pressure : 96-98 kPa Relative Humidity : 29-32 % POWER SUPPLY UTILIZED Power supply system : 60 Hz 110 VAC Test Report WC1003209 Rev A4 of 43 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 Carrier Frequency Separation FCC 15.247(a)(1), IC RSS-210 A8.1(b) Test summary The requirements are: „ - MET † - NOT MET Test was performed in accordance with the test procedure of FCC Public Notice DA 00-705 Carrier Frequency Separation = 1.005 MHz Test location † - Wild River Lab Large Test Site (Open Area Test Site) „ - Wild River Lab Large Test Site - Tech area † - Wild River Lab Small Test Site (Open Area Test Site) Test equipment TUV ID Model Number Manufacturer Description Serial Number Cal Due WRLE10435 E4440A Agilent Spectrum Analyzer MY42510439 28 Jul 10 Test Limit 682.6 kHz (> 2/3 of the 20 dB bandwidth – 1.024 MHz - for Bluetooth 2.0 and later) minimum Test data Test Report WC1003209 Rev A5 of 43 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 Number of Hopping Frequencies FCC 15.247(a)(1)(iii), IC RSS-210 A8.1(d) Test summary The requirements are: „ - MET † - NOT MET Number of hopping frequencies = 79 Test was performed in accordance with the test procedure of FCC Public Notice DA 00-705 Test location † - Wild River Lab Large Test Site (Open Area Test Site) „ - Wild River Lab Larg…

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TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 TEST SETUP FOR EMISSIONS TESTING WILD RIVER LAB Large Test Site Notes: 1. Items shown in dotted lines are located on the floor below the test area. It is 5 meters vertically from the ground floor to the test area. 2. 50 Hz and 60 Hz are power panels for alternating current. 3. The antenna may be positioned horizontally 3 and 10 meters from the center of the turntable. 4. The circle is either a 6.7 meter or 1.2 meter diameter turntable. 5. A ground plane is in the plane of this sheet. 6. The test sample is shown in the azimuthal position representing zero degrees. ANTENNA EUT 0 927 18 60 50 Shielded Enclosure Test Report WC100320929 of 44 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 Test-setup photo(s): Radiated emissions Test Report WC100320930 of 44 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 Test Report WC100320931 of 44 TÜV SUD AMERICA INC 19333 Wild Mountain Road Taylors Falls MN 55084 Tel: (651) 638-0297 Fax: (651) 638-0298 Rev. 012907 Test-setup photo(s): Conducted emissions Test Report WC100320932 of 44