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Natures Pillows, Inc. and Top Dog Direct, LLC were cited for illegally marketing the Clean Zone CPAP Sanitizer, a medical device intended to disinfect CPAP therapy equipment, without required FDA premarket approval or an approved Investigational Device Exemption (IDE). The company violated the Federal Food, Drug, and Cosmetic Act by failing to obtain either a Premarket Approval (PMA) application or submit a premarket notification (510(k)) before distributing the device in interstate commerce. The device was found to be both adulterated and misbranded under FDA regulations due to the absence of these required regulatory submissions.