K Number
K011784
Device Name
MODIFICATION TO ENVOY PATIENT MONITOR
Date Cleared
2001-08-16

(69 days)

Product Code
Regulation Number
870.1025
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
ENVOY is intended for use as a multiparameter physiological patient monitoring system. The ENVOY can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the ENVOY to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital. Functions include display of multiparameter waveforms, vital signs, alarm & status messages. The Mennen Medical ENVOY is intended for sale as a system for monitoring and recording patient information or any in-hospital application requiring patient monitoring. The following are examples of intended clinical applications: - · Critical Care Patients - · Cardiac Step-down/Telemetry Units - Emergency Departments - · Intra-operative (Anesthesia) Monitoring - · Post Anesthesia Care
Device Description
The Envoy is a multiparameter physiological patient monitor, capable of monitoring: - · ECG/Heart Rate - · invasive blood pressure - · non-invasive blood pressure - · respiration - · pulse oximetry - · two temperature channels - · cardiac output - · eTCO2 The Envoy bedside patient monitor consists of a main processing unit, a mountable color monitor, and a module rack housing the various Mennen Medical plug-in vital signs modules. The modules monitor the patient's vital signs. Up to six internal modules can be plugged into a module rack. The Envoy can accommodate two module racks. The vital sign data derived from the modules by the Envoy are presented on the monitor as waveform and numeric displays. ENVOY vital signs modules acquire vital signs data from the patient, and display their waveforms and alarms indications on the ENVOY display unit. Vital signs and waveform information are displayed simultaneously on the ENVOY Display Unit. Up to 8 traces can be displayed at any one time. The vital signs modules interface with readily available physiologic transducers through electrically isolated patient input connections. After amplification, the signals are digitized, analyzed and displayed. All processing and alarm determination for ECG, Respiration and Invasive Blood Pressure is made using proprietary algorithms and software based on previously marketed Mennen Medical monitoring devices tested against well known and accepted data bases that present representative examples of waveform artifact to be encountered in real case conditions. The SpO2, Non-Invasive Blood Pressure and EtCO2 Modules incorporate software and/or hardware technology developed by vendors whose products are marketed in the USA. Information from each vital sign is presented in a separate portion of the display. Each vital sign is labeled for identification and numeric value. Displayed Vital sign information can include: Primary Vital Sign Name, Waveform, Vital Sign Numeric Value, Alarm Status Message. Operation of the ENVOY is accomplished by interaction with front panel controls on the main processor unit. A quick-knob control allows direct interaction with displayed menus for direct parameter selection and setup. Where manual entry of alphanumeric information is required, a menu keyboard menu is display. ENVOY is a reusable, software driven, patient monitor, intended for use as part of a physiological monitoring system in a hospital environment. As such it is not a life supporting, nor life sustaining device; nor is it implantable and therefore sterility is not a consideration. ENVOY complies with IEC 601-1 Medical Electrical Equipment, IEC 601-2-2-27 Safety of Electrocardiographic monitoring, IEC 601-2-30 Requirements for Automatic Cycling Indirect Blood Pressure monitoring, AAMI/ANSI SP-10/A1 Electronic or Automated Sphygmomanometers, IEC 601-2-34 Requirements for Invasive Blood Pressure monitoring, AAMI/ANSI ES1 Safe Current Limits for Electromedical Apparatus, and AAMVANSI EC13, Cardiac Monitors, Heart Rate Meters and Alarms. ENVOY is not a kit, does not contain any drug or biological products and is not for prescription use. The ECG/Resp. module is the source of all ECG data in the Envoy bedside monitor. ECG is measured using a multi-lead cable via electrodes attached to the patient's chest. Monitoring the ECG produces a continuous waveform of cardiac electrical activity to enable an accurate assessment of a patient's current physiological condition. With the ECG module, you can use a 3, 5 6 or 10 lead electrode ECG cable set to display up to 12 selectable ECG leads in up to three channels. The 12 Lead ECG/Resp. module is housed in the Envoy module rack, where it occupies a single slot. It includes ECG and respiration monitoring.
More Information

No
The document describes the use of "proprietary algorithms and software" for signal processing and alarm determination, but does not mention or imply the use of AI or ML technologies. The focus is on traditional signal processing and analysis based on established data bases.

No.
The device is a physiological patient monitoring system, which monitors vital signs and patient information, rather than providing therapy.

Yes

The device monitors multiple physiological parameters (ECG, blood pressure, temperature, etc.) to assess a patient's current physiological condition. While it doesn't provide a diagnosis itself, the data it collects is used by clinicians to make diagnostic decisions. The intended use for "monitoring and recording patient information" to "assess a patient's current physiological condition" indicates its role in providing data for diagnosis.

No

The device description explicitly states that the Envoy consists of a main processing unit, a mountable color monitor, and a module rack housing various plug-in vital signs modules, indicating significant hardware components beyond just software.

Based on the provided information, the ENVOY device is not an In Vitro Diagnostic (IVD).

Here's why:

  • IVDs are used to examine specimens derived from the human body. The ENVOY monitors physiological parameters directly from the patient (ECG, blood pressure, temperature, etc.) using sensors and transducers attached to the body. It does not analyze samples like blood, urine, or tissue.
  • The intended use and device description clearly state it's a patient monitoring system. Its purpose is to display and record real-time physiological data from a living patient.
  • The device description mentions "electrically isolated patient input connections" and "physiologic transducers," which are characteristic of devices that interface directly with the body, not with in vitro samples.

Therefore, the ENVOY falls under the category of a physiological patient monitor, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

ENVOY is intended for use as a multiparameter physiological patient monitoring system.

The ENVOY can monitor ECG/heart rate, two invasive blood pressure channels, two The ENVOT our monitor oximetry, respiration, non-invasive blood pressure and temporature offectively allows the ENVOY to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages.

The Mennen Medical ENVOY is intended for sale as a system for monitoring and recording patient information or any in-hospital application requiring patient monitoring.

The following are examples of intended clinical applications:

  • · Critical Care Patients
  • · Cardiac Step-down/Telemetry Units
  • Emergency Departments
  • · Intra-operative (Anesthesia) Monitoring
  • · Post Anesthesia Care

Product codes

74 DSI

Device Description

The Envoy is a multiparameter physiological patient monitor, capable of monitoring:

  • · ECG/Heart Rate
  • · invasive blood pressure
  • · non-invasive blood pressure
  • · respiration
  • · pulse oximetry
  • · two temperature channels
  • · cardiac output
  • · eTCO2

The Envoy bedside patient monitor consists of a main processing unit, a mountable color monitor, and a module rack housing the various Mennen Medical plug-in vital signs modules. The modules monitor the patient's vital signs. Up to six internal modules can be plugged into a module rack. The Envoy can accommodate two module racks. The vital sign data derived from the modules by the Envoy are presented on the monitor as waveform and numeric displays.

ENVOY vital signs modules acquire vital signs data from the patient, and display their waveforms and alarms indications on the ENVOY display unit. Vital signs and waveform information are displayed simultaneously on the ENVOY Display Unit. Up to 8 traces can be displayed at any one time.

The vital signs modules interface with readily available physiologic transducers through electrically isolated patient input connections. After amplification, the signals are digitized, analyzed and displayed. All processing and alarm determination for ECG, Respiration and Invasive Blood Pressure is made using proprietary algorithms and software based on previously marketed Mennen Medical monitoring devices tested against well known and accepted data bases that present representative examples of waveform artifact to be encountered in real case conditions. The SpO2, Non-Invasive Blood Pressure and EtCO2 Modules incorporate software and/or hardware technology developed by vendors whose products are marketed in the USA.

Information from each vital sign is presented in a separate portion of the display. Each vital sign is labeled for identification and numeric value. Displayed Vital sign information can include: Primary Vital Sign Name, Waveform, Vital Sign Numeric Value, Alarm Status Message.

Operation of the ENVOY is accomplished by interaction with front panel controls on the main processor unit. A quick-knob control allows direct interaction with displayed menus for direct parameter selection and setup. Where manual entry of alphanumeric information is required, a menu keyboard menu is display.

ENVOY is a reusable, software driven, patient monitor, intended for use as part of a physiological monitoring system in a hospital environment. As such it is not a life supporting, nor life sustaining device; nor is it implantable and therefore sterility is not a consideration.

ENVOY complies with IEC 601-1 Medical Electrical Equipment, IEC 601-2-27 Safety of Electrocardiographic monitoring, IEC 601-2-30 Requirements for Automatic Cycling Indirect Blood Pressure monitoring, AAMI/ANSI SP-10/A1 Electronic or Automated Sphygmomanometers, IEC 601-2-34 Requirements for Invasive Blood Pressure monitoring, AAMI/ANSI ES1 Safe Current Limits for Electromedical Apparatus, and AAMVANSI EC13, Cardiac Monitors, Heart Rate Meters and Alarms. ENVOY is not a kit, does not contain any drug or biological products and is not for prescription use.

The ECG/Resp. module is the source of all ECG data in the Envoy bedside monitor. ECG is measured using a multi-lead cable via electrodes attached to the patient's chest.

Monitoring the ECG produces a continuous waveform of cardiac electrical activity to enable an accurate assessment of a patient's current physiological condition. With the ECG module, you can use a 3, 5 6 or 10 lead electrode ECG cable set to display up to 12 selectable ECG leads in up to three channels.

The 12 Lead ECG/Resp. module is housed in the Envoy module rack, where it occupies a single slot. It includes ECG and respiration monitoring.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

patient's chest

Indicated Patient Age Range

adult, pediatric and neonatal patient

Intended User / Care Setting

hospital environment

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

The 12 Lead ECG/Resp. module of the Envoy patient monitor has been subject to extensive safety and performance testing. Final testing for the system included various performance tests designed to ensure that the device meets all functional requirements and performance specifications. Safety testing and EMC testing were performed by an independent testing laboratory to ensure that the device complies to applicable industry and safety standards. The 12 Lead ECG/Resp. module of the Envoy patient monitor has also been clinically tested and evaluated in a local hospital.

Key Metrics

Not Found

Predicate Device(s)

MENNEN MEDICAL ENVOY PATIENT MONITOR (K001120).

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

We consider the 12 Lead ECG/Resp. module to be substantially equivalent to the 3/5/6 Lead ECG/Resp. module and we submit that any differences between the two modules:
*fall within the scope of a Special 510(k) Device Modification *do not raise any new issues of safety and effectiveness

§ 870.1025 Arrhythmia detector and alarm (including ST-segment measurement and alarm).

(a)
Identification. The arrhythmia detector and alarm device monitors an electrocardiogram and is designed to produce a visible or audible signal or alarm when atrial or ventricular arrhythmia, such as premature contraction or ventricular fibrillation, occurs.(b)
Classification. Class II (special controls). The guidance document entitled “Class II Special Controls Guidance Document: Arrhythmia Detector and Alarm” will serve as the special control. See § 870.1 for the availability of this guidance document.

0

Food and Drug Administration

K011784

17 July, 2001

Food and Eagle
ENVOY Patient Monitor - Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

AUG 1 6 2001

MENNEN MEDICAL LTD.

Kiryat Weizmann Science Park P.O.B. 102 Rehovot 76100 Israel Tel: 972-8-9383030 Fax: 972-8-9406519

Date prepared: 17th July, 2001

Topic: 510(k) Safety and Effectiveness Summary as per 21 CFR Section 807.92 Special 510k Device Modification (K011784): Envoy Patient Monitor - 12Lead ECG/Resp. Module

Establishment Name, Registration Number and Address

Name:Mennen Medical Ltd.
Registration Number:9611022
Operator Number:9011766
Address:Kiryat Weizmann Science Park
Rehovot 76100 Israel
Tel: 972-8-938-3030
Fax: 972-8-940-6519

Contact person:

Asher Kassel, Director of Regulatory Affairs

Food and Drug Administration To: Center for Devices and Radiological Health Document Mail Center (HFZ-401) 9200 Corporate Boulevard Rockville MD, 20850

Document Control Clerk Attn.: Asher Kassel, Director of Regulatory Affairs From:

Product Name

ENVOY Proprietary: Physiological Patient Monitor Common: 550-010-000 (full system) Mennen Medical Part Number: 554-000-010 (CPU only)

FDA Classification

Classification Name:Arrhtymia Detector and Alarm
Classification Number:21 CFR 870.1025
Classification:Class III
Product Code:74 DSI

1

KO11784

Food and Drug Administration

17 July, 2001

ENVOY Patient Monitor - Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

Performance Standards

None promulgated

Voluntary Standards

UL 2601-1, IEC 60601-1 for electrical safety for medical equipment AAMI/ EC 11 - Diagnostic electrocardiograph devices (1991) AAMI/ EC 13 - Cardiac monitors, heart-rate meters, alarms (1992) AAMI/ ES 1 - Safe current limits for electromedical apparatus (1993) IEC 60601-1: General Requirement for Safety for Medical Electrical Systems - part 1, (1988); Amendment 1 - 1991-11 Amendment 2 - 1995-03 IEC 60602-2-27: Medical electrical equipment, Part 2, (1994) Requirements for safety of electrocardiograph monitoring equipment.

Predicate Device

MENNEN MEDICAL ENVOY PATIENT MONITOR (K001120).

Device Description: Envoy Patient Monitor

The Envoy is a multiparameter physiological patient monitor, capable of monitoring:

  • · ECG/Heart Rate
  • · invasive blood pressure
  • · non-invasive blood pressure
  • · respiration
  • · pulse oximetry
  • · two temperature channels
  • · cardiac output
  • · eTCO2

The Envoy bedside patient monitor consists of a main processing unit, a mountable color monitor, and a module rack housing the various Mennen Medical plug-in vital signs modules. The modules monitor the patient's vital signs. Up to six internal modules can be plugged into a module rack. The Envoy can accommodate two module racks. The vital sign data derived from the modules by the Envoy are presented on the monitor as waveform and numeric displays.

2

ENVOY Patient Monitor - Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

ENVOY vital signs modules acquire vital signs data from the patient, and display their waveforms and alarms indications on the ENVOY display unit. Vital signs and waveform information are displayed simultaneously on the ENVOY Display Unit. Up to 8 traces can be displayed at any one time.

The vital signs modules interface with readily available physiologic transducers through electrically isolated patient input connections. After amplification, the signals are digitized, analyzed and displayed. All processing and alarm determination for ECG, Respiration and Invasive Blood Pressure is made using proprietary algorithms and software based on previously marketed Mennen Medical monitoring devices tested against well known and accepted data bases that present representative examples of waveform artifact to be encountered in real case conditions. The SpO2, Non-Invasive Blood Pressure and EtCO2 Modules incorporate software and/or hardware technology developed by vendors whose products are marketed in the USA.

Information from each vital sign is presented in a separate portion of the display. Each vital sign is labeled for identification and numeric value. Displayed Vital sign information can include: Primary Vital Sign Name, Waveform, Vital Sign Numeric Value, Alarm Status Message.

Operation of the ENVOY is accomplished by interaction with front panel controls on the main processor unit. A quick-knob control allows direct interaction with displayed menus for direct parameter selection and setup. Where manual entry of alphanumeric information is required, a menu keyboard menu is display.

ENVOY is a reusable, software driven, patient monitor, intended for use as part of a physiological monitoring system in a hospital environment. As such it is not a life supporting, nor life sustaining device; nor is it implantable and therefore sterility is not a consideration.

ENVOY complies with IEC 601-1 Medical Electrical Equipment, IEC 601-2-27 Safety of Electrocardiographic monitoring, IEC 601-2-30 Requirements for Automatic Cycling Indirect Blood Pressure monitoring, AAMI/ANSI SP-10/A1 Electronic or Automated Sphygmomanometers, IEC 601-2-34 Requirements for Invasive Blood Pressure monitoring, AAMI/ANSI ES1 Safe Current Limits for Electromedical Apparatus, and AAMVANSI EC13, Cardiac Monitors, Heart Rate Meters and Alarms. ENVOY is not a kit, does not contain any drug or biological products and is not for prescription use.

Functional Description of the Envoy 12Lead ECG/Resp. module

The ECG/Resp. module is the source of all ECG data in the Envoy bedside monitor. ECG is measured using a multi-lead cable via electrodes attached to the patient's chest.

Monitoring the ECG produces a continuous waveform of cardiac electrical activity to enable an accurate assessment of a patient's current physiological condition. With the ECG module, you can use a 3, 5 6 or 10 lead electrode ECG cable set to display up to 12 selectable ECG leads in up to three channels.

The 12 Lead ECG/Resp. module is housed in the Envoy module rack, where it occupies a single slot. It includes ECG and respiration monitoring.

3

ENVOY Patient Monitor - Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

ENVOY Intended Use:

ENVOY is intended for use as a multiparameter physiological patient monitoring system.

The ENVOY can monitor ECG/heart rate, two invasive blood pressure channels, two temperature channels, pulse oximetry, respiration, non-invasive blood pressure and EtCO2. This effectively allows the ENVOY to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages.

The Mennen Medical ENVOY is intended for sale as a system for monitoring and recording patient information or any in-hospital application requiring patient monitoring.

The following are examples of intended clinical applications:

  • · Critical Care Patients
  • · Cardiac Step-down/Telemetry Units
  • · Emergency Departments
  • · Intra-operative (Anesthesia) Monitoring
  • Post Anesthesia Care

4

ENVOY Patient Monitor -- Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

Substantial Equivalency Information:

The following tables summarize and compare data on the Mennen Medical ENVOY 3/5/6 Lead ECG/Resp. module (predicate device - K001120) to the subject of this Special 510(k) submittal, the ENVOY 12 Lead ECG/Resp. module (modified device). We submit that the ENVOY 12 Lead ECG/Resp. module (modified device) is substantially equivalent to the Mennen Medical ENVOY 3/5/6 Lead ECG/Resp. module (predicate device - K001120), available in the U.S. market.

SE Comparison: 12 Lead ECG/Resp. module vs 3/5/6 Lead ECG/Resp. module

The following tables summarize and compare data on the Mennen Medical ENVOY 3/5/6 Lead ECG/Resp. module (predicate device - K001120) to the subject of this Special 510(k) submittal, the ENVOY 12 Lead ECG/Resp. module (modified device).

| Monitored
Parameters
ECG/HEART RATE | ENVOY
3/5/6 Lead ECG/Resp. module | ENVOY
12 Lead ECG/Resp. module |
|---------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------|
| Part/Option Number | 551-104-000 | C51-112-000 |
| Monitored Leads | Multi-lead ECG Module
(3 /5/6-leads) | Multi-lead ECG Module
(3/5/6/12 leads) -
No Substantial Difference |
| Sampling Rate and
Resolution | 641 Hz sampling rate
22 bit resolution | the same |
| Frequency Response -
analog output | Diagnostic: 0.05 to 150 Hz
Monitor: 0.5 to 40 Hz
Exercise: 1.0 to 25 Hz
According to ANSI/AAMI EC11(10)
para.3.2.7.2 | the same |
| Input Impedance | 20M ohm: typical
5M ohm: differential, dc to 10Hz
2.5M ohm: differential 10 to 100 Hz
as per ANSI/AAMI EC13(9)
para.3.2.9.2 | the same |
| Common Mode
Rejection (CMR) | 120 dB, minimum
Lead Fault Detection based on
impedance | the same |
| Baseline Recovery | within 3 sec,
1 sec after lead switch | the same |
| Monitored
Parameters
ECG/HEART RATE | ENVOY
3/5/6 Lead ECG/Resp. module | ENVOY
12 Lead ECG/Resp. module |
| Gain Levels | 250 - 8000 | the same |
| Pacemaker Detection
and Rejection | Amplitude: 2 mV to 700 mV
Width: 0.1 ms to 2.0 ms as per
ANSI/AAMI EC13(9) para.3.1.4
Pacemaker flag inserted into
displayed waveform | the same |
| Patient Isolation | Meets ANSI/AAMI ESI-1985
standard for Safe Current Limits for
Electromedical Apparatus
(5kV dc, 2.5kV AC | the same |
| Heart Rate (HR)
Counting | 20 to 300 BPM | the same |
| HR Accuracy | $\pm$ 2 BPM. Values below 20 are
recorded as zero | the same |
| QRS Detection Range | 0.25 to 5.0 millivolt height
70 to 120 milliseconds width | the same |
| Leads analyzed for: | Heart Rate and Arrhythmia
Configuration
Top two displayed | the same |
| HR Alarm Settings | 20 (low) to 250 (high),
non-overlapping | the same |
| Lead Fault Sense | when ECG electrode is interrupted
or becomes marginal | the same |
| Defib. Pulse Protection | 5KV as per ANSI/AAMI EC13 (9),
clause 3.2.2.2 and per IEC 601-2-27
(12), clause 17,101 and 102 | the same |
| Degree of protection
against electrical shock | Type CF | the same |
| Monitored
Parameters
ECG/HEART RATE | ENVOY
3/5/6 Lead ECG/Resp. module | ENVOY
12 Lead ECG/Resp. module |
| Electrosurgical
Interference
Suppression Provided | Yes | the same |

5

K011784

Food and Drug Administration

ENVOY ENVOY Monitored 12 Lead ECG/Resp. module 3/5/6 Lead ECG/Resp. module Parameters ECG/HEART RATE the same differential voltage of up to ± 5mv at Dynamic Range a rate up to ±320 mV/sec as per ANSI/AAMI EC13(9), para. 3.2.9.1 3K ohm | the same |
| Manual threshold mode | 0.2 ohm/1000 ohm (0.02%) to 5
ohm/1000 ohm (0.5%) at 20 BPM | 0.2 ohm/1500 ohm (0.013%) to 5
ohm/1000 ohm (0.33%) at 20 BPM |
| Automatic Threshold | 0.35 ohm/1000 ohm (0.035%) to 5
ohm/1000 ohm (0.5%) at 20 BPM | the same |
| Alarm Settings | Low rate: 0 - 150 BPM
High: rate: 8 - 150 BPM | Low rate: 0 - 120 BPM
High: rate: 8 - 120 BPM -
No Substantial Difference |
| Apnea Alarm Delay | 10 - 90 sec, selectable
(default 10 sec.) | 10 - 90 sec, selectable
(default 10 sec.) -
the same |
| Apnea Alarm Reset | Automatic as defined by System
administrator (default 3 breaths) | the same |

7

Food and Drug Administration

ENVOY Patient Monitor – Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

| Displayed
Parameters | ENVOY
3/5/6 Lead ECG/Resp. module | ENVOY
12 Lead ECG/Resp. module |
|-------------------------|--------------------------------------|-----------------------------------|
| ECG | Yes | Yes |
| Heart Rate | Yes | Yes |
| Respiration | Yes | Yes |

| Alarm Indications: | ENVOY
3/5/6 Lead ECG/Resp. module | ENVOY
12 Lead ECG/Resp. module |
|--------------------|--------------------------------------|-----------------------------------|
| ECG | Visual & Sound | Visual & Sound |
| Heart Rate | Visual & Sound | Visual & Sound |
| Respiration | Visual & Sound | Visual & Sound |

| Display
Functions | ENVOY
3/5/6 Lead ECG/Resp. module | ENVOY
12 Lead ECG/Resp. module |
|--------------------------------------|--------------------------------------|-----------------------------------|
| Change ECG Lead
Selection | YES | YES |
| Display of Arrhythmia
Information | YES | YES |
| Data Review: Trends | YES | YES |
| Data Review: Tabular | YES | YES |
| User defined
Configuration Setup | YES | YES |
| User defined Default
Settings | YES | YES |

8

K011784

Food and Drug Administration

17 July, 2001

ENVOY Patient Monitor -- Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

Conclusion of comparison of Technological characteristics:

We consider the 12 Lead ECG/Resp. module to be substantially equivalent to the 3/5/6 Lead ECG/Resp. module and we submit that any differences between the two modules:

*fall within the scope of a Special 510(k) Device Modification *do not raise any new issues of safety and effectiveness

Testing

The 12 Lead ECG/Resp. module of the Envoy patient monitor has been subject to extensive safety and performance testing. Final testing for the system included various performance tests designed to ensure that the device meets all functional requirements and performance specifications. Safety testing and EMC testing were performed by an independent testing laboratory to ensure that the device complies to applicable industry and safety standards. The 12 Lead ECG/Resp. module of the Envoy patient monitor has also been clinically tested and evaluated in a local hospital.

Signature:

A. Kassel

Asher Kassel Director of Regulatory Affairs MENNEN MEDICAL LTD.

972-8-9383011 Tel: 972-8-9406519, or Fax: E-mail: asher@mmi.co.il

9

Image /page/9/Picture/2 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is an abstract image of an eagle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 1 6 2001

Mr. Asher Kassel Mennen Medical Ltd. Kiryat Weizmann Science Park P.O.B. 102 Rehovot 76100 ISRAEL

Re: K011784

Trade Name: Envoy Patient Monitor, 12 Lead ECG/Resp. Module Regulatory Number: 21 CFR 870.1025 Regulatory Class: III (three) Product Code: 74 DSI Dated: July 17, 2001 Received: July 19, 2001

Dear Mr. Kassel:

We have reviewed your Section 510(k) notification of intent to market the device referenced we nave 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 stated in the onerosare, to regarry ent date of the Medical Device Amendments, or to devices that provision in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, market the device, subject to the general controls Cosment Act (100). Tot may) attresses, sontols provisions of the Act include requirements for annual provisions of the Frea - 11tes, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations (1 remarket rippt of ally wills) will be code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to mspottonist the GMP regulation may result in regulatory action. In addition, FDA may publish

10

Page 2 - Mr. Asher Kassel

further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4646. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrh/dsma/dsmamain.html".

Sincerely yours,

James E. Dillard III

Director Division of Cardiovascular and Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

11

Food and Drug Administration

K011784

7 June, 2001

ENVOY Patient Monitor – Device Modification: Special 510 (k) for 12 Lead ECG/Resp. module

INDICATIONS FOR USE

ENVOY is intended for use as a multiparameter physiological patient monitoring system.

The ENVOY can monitor ECG/heart rate, two invasive blood pressure channels, two The ENVOT our monitor oximetry, respiration, non-invasive blood pressure and temporature offectively allows the ENVOY to monitor a wide-range of adult, pediatric and neonatal patient conditions, in many different areas of the hospital.

Functions include display of multiparameter waveforms, vital signs, alarm & status messages.

The Mennen Medical ENVOY is intended for sale as a system for monitoring and recording patient information or any in-hospital application requiring patient monitoring.

The following are examples of intended clinical applications:

  • · Critical Care Patients
  • · Cardiac Step-down/Telemetry Units
  • Emergency Departments
  • · Intra-operative (Anesthesia) Monitoring
  • · Post Anesthesia Care

Dale Till
Division of Cardiovascular & Respiratory Devices
510(k) Number K011784

Prescription Use - $\checkmark$