When people suffer from some types of heart arrhythmias, the result may be that blood flow to various parts of the body is reduced. Some arrhythmias may even result in a Sudden Cardiac Arrest (SCA). SCA can lead to death very quickly, e.g. within 10 minutes, unless treated in the interim.
Some people have an increased risk of SCA. People at a higher risk include individuals who have had a heart attack, or a prior SCA episode. A frequent recommendation is for these people to receive an Implantable Cardioverter Defibrillator (“ICD”). The ICD is surgically implanted in the chest, and continuously monitors the person's electrocardiogram (“ECG”). If certain types of heart arrhythmias are detected, then the ICD delivers an electric shock through the heart.
After being identified as having an increased risk of an SCA, and before receiving an ICD, these people are sometimes given a Wearable Cardiac Defibrillator (“WCD”) system. A WCD system typically includes a harness, vest, or other garment that is configured to be worn by the patient. The WCD system includes a defibrillator and external electrodes, which are attached to the inside of the harness, vest, or other garment. When the patient wears the WCD system, the external electrodes can help monitor the patient's ECG. If a shockable heart arrhythmia is detected, then the defibrillator of the WCD system delivers the appropriate electric shock through the patient's body, and thus through the heart.
A challenge in the prior art remains with the monitoring electrodes. Electrodes may need to make good electrical contact with the patient's skin, without being intrusive or irritating the skin.
The present description gives instances of Wearable Cardiac Defibrillator (WCD) systems and electrode components for such systems, the use of which may help overcome problems and limitations of the prior art.
In embodiments, a wearable cardiac defibrillation (WCD) system includes one or more flexible ECG electrodes. The WCD system may have a support structure that is dimensioned to be worn so as to press the electrodes towards the body of the patient. The electrodes may be made from appropriate material so as to flex in order to match a contour of the body of the patient. An advantage over the prior art is that the flexible electrode may make better electrical contact with the patient's skin, and therefore provide a better ECG signal for the WCD system to perform its diagnosis.
In embodiments, a wearable cardiac defibrillation (WCD) system includes one or more electrode assemblies. The WCD system may have a support structure that is dimensioned to be worn so as to press the electrode assembly towards the body of the patient. The electrode assembly may have an electrode, and a signal terminal electrically coupled to the electrode. The electrode assembly may have a compressible pillow structure. The electrode assembly may have a moisture barrier so as to trap moisture from the patient's skin, for better conduction and lateral shifting of the electrode along the patient's skin. The electrode assembly may have an electrostatic shield between the electrode and the signal terminal so as to shield the electrode from electrical noise.
Embodiments may result in garments that integrate the disclosed electrode, and which can be washed with normal household methods. This allows for simple cleaning of lotions or patient's sweat from the electrodes, which may improve patient hygiene and reduce the chance of skin infections. All of this will add to the patient's overall comfort with the garment, and thus enhance their compliance with wearing the garment.
These and other features and advantages of this description will become more readily apparent from the Detailed Description, which proceeds with reference to the associated drawings in which:
As has been mentioned, the present description is about Wearable Cardiac Defibrillator (WCD) systems and electrode components for such systems. Embodiments are now described in more detail.
Components 100 of a WCD system are now described in more detail. Components 100 include a support structure 110, which is shown partly abstractly in
Support structure 110 can be dimensioned relative to the body of patient 182 to be worn with internal tension 112. This dimensioning may be accomplished by, for example, making a portion be of adjustable length. In other words, in some embodiments at some times support structure 110 does not fit patient 182 everywhere loosely, but is worn with non-zero internal tension 112. Tension 112 is tension of non-zero magnitude that is internal to support structure 110, and which can cause pressure 114 to be exerted onto the body of patient 182 when support structure 110 is worn. Pressure 114 may squeeze the body of patient 182, preferably only gently. Internal tension 112, and its resulting pressure 114, may ensure that any electrodes of the WCD system make good electrical contact with the body of patient 182. Accordingly, support structure 110 can be a continuous band, or have clasps (not shown) that lock together, etc.
Components 100 also include an electronics module 140. Electronics module 140 can be a part of a wearable medical system that performs any one or more of the following functions: monitor physiological signals of patient 182, make determinations from these signals, communicate with the patient or with entities remote from the patient, store electrical energy for defibrillation, defibrillate, and so on.
Electronics module 140 can be configured to be coupled to support structure 110. Coupling can be permanent, such as attaching. In some embodiments, however, electronics module 140 can be coupled to and uncoupled from support structure 110, by the manufacturer, by patient 182, and so on. For example, electronics module 140 can be thus coupled by being inserted in a special pocket 111, and so on.
Components 100 additionally include an electrode 159, which can be an ECG electrode. Electrode 159 can be stand-alone, or it may be attached to an additional component 149 of an electrode assembly. Electrode assemblies are described in more detail later in this document, and may have even more components. While only one electrode 159 is shown, of course more may be used.
Whether part of an electrode assembly or not, electrode 159 can be configured to be coupled to support structure 110, so that electrode 159 remains pressed against the body of patient 182 due to nonzero pressure 114, when support structure 110 is worn by patient 182 as designed. As will be seen, a number of configurations of components 100 may accomplish this. For example, electrode 159 could be physically attached to support structure 110, for example by being constructed permanently into it, be received into a suitable pocket 115, etc. Moreover, electrode 159 could be coupled to support structure 110 but not be permanently physically attached to it. Electrode 159 can be coupled to the skin of patient 182 by contacting the skin directly, or indirectly over clothing, depending on whether the electrode is dry or not, etc. Even when physically coupled to the skin over clothing, some electrodes can achieve electrical coupling with the patient's skin through the clothing.
Electrode 159 is of course conductive. This is written explicitly in this document, because electrode 159 can be made according to embodiments from materials that are unusual for electrodes.
Electrode 159 may also be flexible. For example, it may bend under pressure 114. As can be seen in
In addition, as can be seen in
The flexibility of electrode 159 can be such that it transitions from the first shape to the second shape and vice versa immediately, or after some time. This time is preferably less than 1 hour, and preferably less than 10 min. Accordingly, hard materials like large pieces of metal may not serve well.
The views of
In some embodiments, electrode 159 may be 2 cm on the side. The amount of curvature shown in
The views of electrode 159 in
Electrode 159 may be made in a number of ways. For example, it can include a metal foil, such as aluminum or copper foil. Such a foil could be attached to a side of a piece of foam. Alternately, electrode 159 can include a material that includes polyurethane, or conductive polyurethane that contains one of carbon, carbon nanotubes, particles of a metal, and metal nanoparticles. Alternately, electrode 159 can include silicone, a conductive silicone rubber, and so on. The conductive silicone rubber may be enriched with conductive elements such as carbon, carbon nanotubes, particles of a metal, metal nanoparticles, and so on. Electrode 159 may also include a material that includes polydimethylsiloxane (PDMS) silicone rubber, perhaps enriched with conductive elements such as mentioned above. Electrodes formed from silicone rubber with added conductive fillers can be more resistive than capacitive in nature. This resistive component allows for various features to be added that cannot be implemented with capacitive electrodes. First, the amplifier can generate a dc coupled driven lead which is used to reduce common mode on the patient. This is often referred to as a Right Leg Drive though the electrode can be placed in various places. Some capacitive electrodes cannot be used for driven leads at frequencies that compensate for patient movement and power line interference. Using electrodes made from a silicone rubber greatly increases signal quality using driven leads. The resistive component also allows the use of a “dc leads off” method for detecting when an electrode is not in good contact with the patient. This is both a simpler and more robust leads off method than the “ac leads off” required by capacitive electrodes. Embodiments of a silicone electrode can thus be made without any electronics supporting the electrode itself. In addition, electrodes thus formed from silicone rubber might not be affected much by commonly available lotions, and so the patient is free to use these both for general use or to minimize any effects of using the electrodes if the patient has very sensitive skin.
In choosing a material, care should be taken so that the material contacting the patient is biocompatible with the skin of the patient. Accordingly, if electrode 159 is worn over a garment, the material may not matter very much. If, however, electrode 159 is configured to contact the skin directly so it can make ohmic contact with it, then a material like aluminum may not be preferred. Ohmic contact makes for excellent signal quality. The electrode could be made capacitive, if need be.
Returning to
Components 300 additionally include an electrode assembly 350. Electrode assembly 350 can be configured to be coupled to support structure 310 so that electrode assembly 350 remains pressed against the body of patient 382 due to nonzero pressure 314, when support structure 310 is worn by patient 382. A number of configurations of components 300 may accomplish this. For example, electrode assembly 350 could be physically attached to support structure 310, for example by being constructed permanently into it, be received into a suitable pocket 315, etc. Moreover, electrode assembly 350 could be coupled to support structure 310 but not be permanently physically attached to it.
Electrode assembly 350 can be constructed in many different ways. It can have components selected from many possible components. Examples are now described.
Referring to
Components 450 additionally include a signal terminal 451. In embodiments where electrode assembly 350 is removable from support structure 310, signal terminal 451 can advantageously be part of an electro-mechanical connector. An electro-mechanical connector can be implemented in many ways according to embodiments as is known in the art, for example with connector components that make a mechanical connection, and also complete an electrical connection upon making a mechanical connection. These electro-mechanical connectors include elements such as hooks, buttons, etc. Another example of an electro-mechanical connector is a snap mechanical contact, which is also known as a snap fastener. This snap mechanical contact may match matingly with another snap mechanical contact of support structure 310 for coupling and uncoupling. For example, one can be male and the other can be female.
Signal terminal 451 can be electrically coupled to electrode 459, which is a feature not shown in
Returning to
Returning to
Pillow structure 456 can be flexible, and pressure 314 can maintain good electrical contact. The reduced pressure can thus help improve patient compliance with wearing the WCD system. So, pillow structure 456 can be flexible enough so as to acquire a first shape due to the electrode assembly being subjected to nonzero pressure 314 when support structure 310 is worn. As seen in
Pillow structure 456 may be made in a number of ways. For example, it can include a piece of an open-celled foam, or a pouch filled with a fluid, such as air, a liquid, etc. Foam works well when it is resilient enough, since it is a single material. In some embodiments, the pillow structure includes a pouch that has a spring.
As mentioned above, an electrode assembly according to embodiments may further include a flexible inner conductor. The signal terminal can be electrically coupled to the electrode via the flexible inner conductor. For example, the flexible inner conductor can be electrically coupled to the signal terminal, to the electrode, or to both. The flexible inner conductor may flex when pillow structure 456 transitions from the first shape, e.g. of
Referring to
Components 550 moreover include a flexible inner conductor 553, which is a wire. Flexible inner conductor 553 is electrically coupled to both signal terminal 551 and to electrode 559.
Referring to
Components 650 moreover include a flexible inner conductor 653, which includes a fabric. The fabric can operate as a flexible substrate, and be advantageously coated with a metal, such as silver. Flexible inner conductor 653 is electrically coupled directly to signal terminal 651, and indirectly to electrode 659. In particular, flexible inner conductor 653 is coupled to electrode 659 via a conductive adhesive 658. Alternately, a conductive double-sided pressure sensitive adhesive tape could be used, etc. Or, electrode 659 could also be intrinsically molded through or around the flexible conductor. Or, flexible inner conductor 653 can include a conductive fabric that is overmolded with the electrode.
Flexible inner conductor 653 can be planar.
Referring to
Components 750 moreover include a moisture barrier 757. Moisture barrier 757 is between electrode 759 and signal terminal 751. In this case where pillow structure 756 is provided, moisture barrier 757 is between electrode 759 and pillow structure 756.
In some embodiments, electrode 759 has a main surface that has holes. This feature is not shown in
Moisture barrier 757 of
Accordingly, moisture barrier 757 is made from a material that is substantially impermeable to water vapor so as to slow down the evaporation from the skin. This means that, if moisture barrier 757 is made from a material that has pores, these pores are not large enough to permit the skin to dry out in the usual conditions that the patient is expected to wear the WCD system. Candidates are any continuous-surface material, even metal foil or a continuously coated water-resistant fabric material, such as the material that is sometimes used to make raincoats. Other materials can be a thin polymer membrane, such as a urethane or silicone based material.
Referring to
Components 850 moreover include an electrostatic shield 855. Electrostatic shield 855 is between signal terminal 851 and electrode 859. In this particular embodiment, electrostatic shield 855 is between signal terminal 851 and pillow structure 856. Electrostatic shield 855 is intended to shield electrode 859 from any signals that may be traveling along any other signal conductors of the WCD system, and which are physically close to the electrode assembly. Electrostatic shield 855 may shield electrode 859 from varying electric fields that are external to the patient. Such could be formed by clothing that has a static charge moving relative to electrode 859 or from another person who has a static charge moving in close proximity to the patient. There are other sources of varying electric fields as well.
Electrostatic shield 855 can be made in a number of ways. In embodiments, it can be made from a metal foil, such as copper. Electrostatic shield 855 is preferably protected from contacting the flexible conductor, and insulating is one way to do this. Accordingly, electrostatic shield 855 is sometimes a foil covered by an insulating tape.
Referring to
Components 950 moreover include a cover 961. Cover 961 may surround pillow structure 956 at least in part. In some embodiments cover 961 is flexible, and flexes when pillow structure 956 transitions from the first shape to the second shape. Cover 961 may be made from any suitable material, such as fabric, plastic, etc.
In some embodiments, cover 961 surrounds pillow structure 956 completely. In other embodiments, the electrode assembly further includes a backing which, together with cover 961, completely surround pillow structure 956. An example is now described.
Referring to
Electrode assembly 1050 includes an electrode 1059 that can be as described for electrode 459, a signal terminal 1051 that can be as described for signal terminal 451, and a flexible inner conductor 1053 that can be as described for flexible inner conductor 653. In this particular example, signal terminal 1051 can be part of a snap mechanical contact. Flexible inner conductor 1053 is electrically coupled directly to signal terminal 1051, and indirectly to electrode 1059 via a conductive adhesive 1058.
Electrode assembly 1050 also includes a pillow structure 1056 that can be as described for pillow structure 456, a moisture barrier 1057 that can be as described for moisture barrier 757, and an electrostatic shield 1055 that can be as described for electrostatic shield 855.
Electrode assembly 1050 additionally includes a reference terminal 1052. Reference terminal 1052 is coupled to electrostatic shield 1055, and can serve as electrical ground. In this embodiment, reference terminal 1052 can be part of a snap mechanical contact, similarly with signal terminal 1051. In such embodiments, the WCD system may also include a reference conductor 372, which can be seen in
Electrode assembly 1050 moreover includes a backing 1054, on which signal terminal 1051 and reference terminal 1052 are provided. Backing 1054 can be made from a hard plastic, or other suitable material. The snap mechanical contacts of signal terminal 1051 and reference terminal 1052 are on backing 1054. These snap mechanical contacts permit electrode assembly 1050 to be removable from the support structure. Signal terminal 1051 and reference terminal 1052 are electrically connected with wire stubs 1091, 1092 that go through suitable openings in backing 1054.
Electrode assembly 1050 further includes a cover 1061 that can be as described for cover 961. Backing 1054, together with cover 1061, completely surround pillow structure 1056.
In
Referring to
Unlike with
Referring to
Unlike with
A person skilled in the art will be able to practice the present invention in view of this description, which is to be taken as a whole. Details have been included to provide a thorough understanding. In other instances, well-known aspects have not been described, in order to not obscure unnecessarily this description. Plus, any reference to any prior art in this description is not, and should not be taken as, an acknowledgement or any form of suggestion that such prior art forms parts of the common general knowledge in any country or any art.
This description includes one or more examples, but this fact does not limit how the invention may be practiced. Indeed, examples, instances, versions or embodiments of the invention may be practiced according to what is described, or yet differently, and also in conjunction with other present or future technologies. Other such embodiments include combinations and sub-combinations of features described herein, including for example, embodiments that are equivalent to the following: providing or applying a feature in a different order than in a described embodiment; extracting an individual feature from one embodiment and inserting such feature into another embodiment; removing one or more features from an embodiment; or both removing a feature from an embodiment and adding a feature extracted from another embodiment, while providing the features incorporated in such combinations and sub-combinations.
In this document, the phrases “constructed to” and/or “configured to” denote one or more actual states of construction and/or configuration that is fundamentally tied to physical characteristics of the element or feature preceding these phrases and, as such, reach well beyond merely describing an intended use. Any such elements or features can be implemented in a number of ways, as will be apparent to a person skilled in the art after reviewing the present disclosure, beyond any examples shown in this document.
Any and all parent, grandparent, great-grandparent, etc. patent applications, whether mentioned in this document or in an Application Data Sheet (ADS) of this patent application, are hereby incorporated by reference herein, including any priority claims made in those applications and any material incorporated by reference, to the extent such subject matter is not inconsistent herewith.
In this description a single reference numeral may be used consistently to denote a single aspect, component, or process. Moreover, a further effort may have been made in the drafting of this description to choose similar though not identical reference numerals to denote versions or embodiments of an aspect, component or process that are the same or possibly different. Where made, such a further effort was not required, but was nevertheless made gratuitously to accelerate comprehension by the reader. Even where made in this document, such an effort might not have been made completely consistently throughout the many versions or embodiments that are made possible by this description. Accordingly, the description controls. Any similarity in reference numerals may be used to confirm a similarity in the text, or even possibly a similarity where express text is absent, but not to confuse aspects where the text or the context indicates otherwise.
The claims of this document define certain combinations and subcombinations of elements, features and steps or operations, which are regarded as novel and non-obvious. Additional claims for other such combinations and subcombinations may be presented in this or a related document. These claims are intended to encompass within their scope all changes and modifications that are within the true spirit and scope of the subject matter described herein. The terms used herein, including in the claims, are generally intended as “open” terms. For example, the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” etc. If a specific number is ascribed to a claim recitation, this number is a minimum but not a maximum unless stated otherwise. For example, where a claim recites “a” component or “an” item, it means that it can have one or more of this component or item.
This patent application claims priority from U.S. Provisional Patent Application Ser. No. 62/072,818, filed on Oct. 30, 2014, the disclosure of which is hereby incorporated by reference.
Number | Name | Date | Kind |
---|---|---|---|
3724355 | Unger | Apr 1973 | A |
4583524 | Hutchins | Apr 1986 | A |
4619265 | Morgan et al. | Oct 1986 | A |
4928690 | Heilman et al. | May 1990 | A |
4955381 | Way et al. | Sep 1990 | A |
5078134 | Heilman et al. | Jan 1992 | A |
5228449 | Christ et al. | Jul 1993 | A |
5353793 | Bomn | Oct 1994 | A |
RE34800 | Hutchins | Nov 1994 | E |
5394892 | Kenny | Mar 1995 | A |
5405362 | Kramer et al. | Apr 1995 | A |
5474574 | Payne et al. | Dec 1995 | A |
5662690 | Cole et al. | Sep 1997 | A |
5782878 | Morgan et al. | Jul 1998 | A |
5792204 | Snell | Aug 1998 | A |
5902249 | Lysler | May 1999 | A |
5913685 | Hutchins | Jun 1999 | A |
6047203 | Sackner et al. | Apr 2000 | A |
6065154 | Hulings et al. | May 2000 | A |
6108197 | Janik | Aug 2000 | A |
6148233 | Owen et al. | Nov 2000 | A |
6201992 | Freeman | Mar 2001 | B1 |
6263238 | Brewer et al. | Jul 2001 | B1 |
6287328 | Snyder et al. | Sep 2001 | B1 |
6304780 | Owen et al. | Oct 2001 | B1 |
6319011 | Motti et al. | Nov 2001 | B1 |
6334070 | Nova et al. | Dec 2001 | B1 |
6356785 | Snyder | Mar 2002 | B1 |
6437083 | Owen et al. | Jul 2002 | B1 |
6529875 | Nakajima | Mar 2003 | B1 |
6546285 | Owen et al. | Apr 2003 | B1 |
6681003 | Linder et al. | Jan 2004 | B2 |
6762917 | Verbiest et al. | Jul 2004 | B1 |
7065401 | Worden | Jun 2006 | B2 |
7559902 | Ting et al. | Jul 2009 | B2 |
7865238 | Brink | Jan 2011 | B2 |
7870761 | Valentine et al. | Jan 2011 | B2 |
7974689 | Volpe et al. | Jul 2011 | B2 |
8140154 | Donnelly et al. | Oct 2012 | B2 |
8369944 | Macho et al. | Feb 2013 | B2 |
8644925 | Volpe et al. | Feb 2014 | B2 |
8676313 | Volpe et al. | Mar 2014 | B2 |
8965500 | Macho et al. | Feb 2015 | B2 |
9008801 | Kaib et al. | Apr 2015 | B2 |
9119547 | Cazares et al. | Sep 2015 | B2 |
9131901 | Volpe et al. | Sep 2015 | B2 |
9132267 | Kaib | Sep 2015 | B2 |
9265432 | Warren et al. | Feb 2016 | B2 |
9345898 | Piha et al. | May 2016 | B2 |
9878171 | Kaib | Jan 2018 | B2 |
9901741 | Chapman et al. | Feb 2018 | B2 |
10016613 | Kavounas | Jul 2018 | B2 |
20020181680 | Linder et al. | Dec 2002 | A1 |
20030158593 | Heilman et al. | Aug 2003 | A1 |
20050107833 | Freeman et al. | May 2005 | A1 |
20050107834 | Freeman et al. | May 2005 | A1 |
20060173499 | Hampton et al. | Aug 2006 | A1 |
20080312709 | Volpe et al. | Dec 2008 | A1 |
20090005827 | Weintraub et al. | Jan 2009 | A1 |
20100007413 | Herleikson | Jan 2010 | A1 |
20100298899 | Donnelly et al. | Nov 2010 | A1 |
20110022105 | Owen et al. | Jan 2011 | A9 |
20110288604 | Kaib et al. | Nov 2011 | A1 |
20110288605 | Kaib et al. | Nov 2011 | A1 |
20120112903 | Kaib et al. | May 2012 | A1 |
20120144551 | Guldalian | Jun 2012 | A1 |
20120150008 | Kaib et al. | Jun 2012 | A1 |
20120158075 | Kaib et al. | Jun 2012 | A1 |
20120191476 | Reid et al. | Jul 2012 | A1 |
20120265265 | Razavi et al. | Oct 2012 | A1 |
20120283794 | Kaib et al. | Nov 2012 | A1 |
20120302860 | Volpe et al. | Nov 2012 | A1 |
20130085538 | Volpe et al. | Apr 2013 | A1 |
20130144355 | Macho et al. | Jun 2013 | A1 |
20130231711 | Kaib | Sep 2013 | A1 |
20130245388 | Rafferty et al. | Sep 2013 | A1 |
20130274565 | Langer et al. | Oct 2013 | A1 |
20130325078 | Whiting et al. | Dec 2013 | A1 |
20140012144 | Crone | Jan 2014 | A1 |
20140025131 | Sullivan et al. | Jan 2014 | A1 |
20140046391 | Cowan et al. | Feb 2014 | A1 |
20140070957 | Longinotti-Buritonil et al. | Mar 2014 | A1 |
20140324112 | Macho et al. | Oct 2014 | A1 |
20140378812 | Saroka et al. | Dec 2014 | A1 |
20150039053 | Kaib et al. | Feb 2015 | A1 |
20160004831 | Carlson et al. | Jan 2016 | A1 |
20160283900 | Johnson et al. | Sep 2016 | A1 |
20170319862 | Foshee, Jr. et al. | Nov 2017 | A1 |
20170367591 | Jorgenseon | Dec 2017 | A1 |
20180116537 | Sullivan et al. | May 2018 | A1 |
20180184933 | Sullivan et al. | Jul 2018 | A1 |
20180185662 | Foshee, Jr. et al. | Jul 2018 | A1 |
20180243578 | Volosin | Aug 2018 | A1 |
20190030352 | Sullivan et al. | Jan 2019 | A1 |
20190076666 | Medema | Mar 2019 | A1 |
Number | Date | Country |
---|---|---|
1998039061 | Sep 1998 | WO |
2012064604 | May 2012 | WO |
Entry |
---|
Klein, H. U., Goldenberg I., & Moss, A. J., Risk Stratification for Implantable Cardioverter Defibrillator Therapy: The Role of the Wearable Cardioverter-Defibrillator, Clinical update, European Heart Jounal, May 31, 2013, pp. 1-14, doi:10.1093/eurheartj/eht167, European Society of Cardiology. |
Lifecor LifeVest System Model WCD 3100 Operator's Manual, 2006, PN 20B0040 Rev FI, Zoll Lifecor Corporation, Pittsburgh, PA. |
Heartstart MRx and XL AED Algorithm—Application Note, Jul. 2001, Edition 2 Phillips Healthcare, USA. |
Zoll LifeVest Model 4000 Patient Manual PN 20B0047 Rev B, (C) 2009-2012. |
Number | Date | Country | |
---|---|---|---|
20200360682 A1 | Nov 2020 | US |
Number | Date | Country | |
---|---|---|---|
62072818 | Oct 2014 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 16107854 | Aug 2018 | US |
Child | 16859921 | US | |
Parent | 15800027 | Oct 2017 | US |
Child | 16107854 | US | |
Parent | 14710799 | May 2015 | US |
Child | 15800027 | US |