K Number
K011970
Device Name
BIOSAFE CHOLESTEROL PROFILE BLOOD COLLECTION AND TRANSPORT SYSTEM
Date Cleared
2001-09-26

(93 days)

Product Code
Regulation Number
862.1175
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System is intended for prescription distribution, and is a clinic-use device for collection and transportation of dried capillary blood for in vitro diagnostic quantitative determination of Total Cholesterol, HDL-Cholesterol, Triglycerides and Calculated LDL-Cholesterol in dried blood spots. This kit is not intended for use on neonates. LDL cannot be determined where the triglyceride value is greater than 400 mg/dL.
Device Description
The device is a kit containing the materials necessary to collect a capillary blood sample onto a filter paper card for transport to a certified clinical laboratory for lipid profile testing. The kit is comprised of a blood collection card packaged in a foil pouch, alcohol prep pad, disposable lancets, gauze pad, bandage strip, collection instructions, return prepaid envelope, and a patient test authorization form.
More Information

No
The summary describes a blood collection and transport system, not a device that analyzes data using AI/ML. There are no mentions of AI, ML, or related concepts.

No
This device is for the collection and transport of blood for in vitro diagnostic testing, not for treating a disease or condition.

Yes

Explanation: The "Intended Use / Indications for Use" section explicitly states that the device is for "in vitro diagnostic quantitative determination of Total Cholesterol, HDL-Cholesterol, Triglycerides and Calculated LDL-Cholesterol in dried blood spots." This clearly indicates its purpose is diagnostic.

No

The device description clearly states it is a "kit containing the materials necessary to collect a capillary blood sample onto a filter paper card for transport," listing physical components like a blood collection card, lancets, gauze, etc. This indicates a hardware-based medical device, not a software-only one.

Yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use explicitly states it's for "in vitro diagnostic quantitative determination of Total Cholesterol, HDL-Cholesterol, Triglycerides and Calculated LDL-Cholesterol in dried blood spots." This directly aligns with the definition of an IVD, which are devices used to examine specimens derived from the human body to provide information for diagnostic purposes.
  • Device Description: The device is a kit designed to collect a biological sample (capillary blood) for subsequent analysis in a laboratory. This is a common characteristic of IVD devices.
  • Performance Studies: The performance studies compare the results obtained from the device's collected samples to a reference method (venous blood samples analyzed by a certified laboratory). This type of validation is typical for IVD devices to demonstrate their accuracy and reliability for diagnostic purposes.
  • Predicate and Reference Devices: The listing of predicate and reference devices, which are also IVD reagents and systems for lipid testing, further confirms the device's classification as an IVD.

In summary, the primary purpose of this device is to facilitate the collection and transport of a biological sample for in vitro diagnostic testing of lipid levels, making it clearly an IVD.

N/A

Intended Use / Indications for Use

The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System is intended for prescription distribution, and is a clinic-use device for collection and transportation of dried capillary blood for in vitro diagnostic quantitative determination of Total Cholesterol, HDL-Cholesterol, Triglycerides and Calculated LDL-Cholesterol in dried blood spots. This kit is not intended for use on neonates. LDL cannot be determined where the triglyceride value is greater than 400 mg/dL.

Product codes (comma separated list FDA assigned to the subject device)

JKA, CHH, LBS, CDT

Device Description

The device is a kit containing the materials necessary to collect a capillary blood sample onto a filter paper card for transport to a certified clinical laboratory for lipid profile testing. The kit is comprised of a blood collection card packaged in a foil pouch, alcohol prep pad, disposable lancets, gauze pad, bandage strip, collection instructions, return prepaid envelope, and a patient test authorization form.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found (Excludes neonates)

Intended User / Care Setting

clinic-use device

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

Performance studies were conducted on professionally collected blood samples from volunteer study subjects at three different geographical sites. A corresponding venous blood sample was collected by the health care professional in order to compare serum lipid results to those obtained from capillary blood samples collected onto the BIOSAFE Blood Collection Card. Venous samples were express shipped, and dried capillary samples were mailed directly to BIOSAFE Laboratories for lipid profile analysis by their respective methods.

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Comparison to Predicate Device: The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System has technological characteristics and an intended use that are substantially equivalent to that of the predicate devices listed above. The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System provides components that permit collection, storage, and transportation of a dried capillary blood sample to a certified clinical laboratory for analysis using FDA-Cleared laboratory reagent and analysis systems. All predicate and current kits are intended for the in vitro diagnostic laboratory determination of lipid profile analytes. The laboratory analyses used in conjunction with the BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System, utilize the Synermed Cholesterol Reagent Kit (K903015), Sigma Diagnostics Infinity Triglyceride Reagents (K844032), and Sigma Diagnostics EZ-HDL Cholesterol Reagents (K972041).
Clinical Trials: Results of clinical trials show that professionally collected capillary samples onto the BIOSAFE Blood Collection Card provide results that are substantially equivalent to venous (serum) results for Total Cholesterol, HDL Cholesterol and Triglycerides when analyzed using BIOSAFE Laboratories modified analytical methods.
Performance Studies: Determination of professionally collected capillary blood Total Cholesterol, HDL Cholesterol and Triglycerides using the BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System is substantially equivalent to venous (serum) samples for lipid profile testing BIOSAFE Laboratories modified analytical methods. Performance studies were conducted on professionally collected blood samples from volunteer study subjects at three different geographical sites. A corresponding venous blood sample was collected by the health care professional in order to compare serum lipid results to those obtained from capillary blood samples collected onto the BIOSAFE Blood Collection Card.
Performance characteristics studied included precision, linearity and correlation.
Test Summary: The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System was evaluated for sample stability when exposed to abusive storage and transportation conditions.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K974046, K972041, K781939

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

K903015, K844032, K972041

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 862.1175 Cholesterol (total) test system.

(a)
Identification. A cholesterol (total) test system is a device intended to measure cholesterol in plasma and serum. Cholesterol measurements are used in the diagnosis and treatment of disorders involving excess cholesterol in the blood and lipid and lipoprotein metabolism disorders.(b)
Classification. Class I (general controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 862.9.

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510(k) SummaryK011970
1)Submitter's Name
Address, contactBIOSAFE Laboratories, Inc.
100 Field Drive, Suite 240
Lake Forest, IL 60045
Phone: (847) 234-8111
FAX: (847) 234-8222
Contact Person:Jack A. Maggiore, PhD
BIOSAFE Laboratories, Inc.
(773) 693-0400, x253
Date Prepared:August 22, 2001
2) Device NameProprietary Name:BIOSAFE CHOLESTEROL PROFILE
Blood Collection and Transport System
Common Name:Capillary blood self-collection and
transportation system for Total Cholesterol,
HDL Cholesterol, Triglycerides and Calculated
LDL Cholesterol
Classification Names: Cholesterol (21 CFR 862.1175)
HDL Cholesterol (21 CFR 862.1475)
Triglycerides (21 CFR 862.1705)
LDL Cholesterol (21 CFR 862.1475)
3) Predicate DevicesTotal CholesterolBeckman Synchron Synchron CX Systems
Cholesterol (CHOL) Reagent (K974046)
HDL CholesterolSigma EZ HDLTM Cholesterol Reagent
(K972041)
TriglyceridesBeckman Triglycerides Reagent Kit (K781939)
4) Device DescriptionThe device is a kit containing the materials necessary to collect a
capillary blood sample onto a filter paper card for transport to a
certified clinical laboratory for lipid profile testing. The kit is
comprised of a blood collection card packaged in a foil pouch, alcohol
prep pad, disposable lancets, gauze pad, bandage strip, collection
instructions, return prepaid envelope, and a patient test authorization
form.
5) Intended UseThe BIOSAFE CHOLESTEROL PROFILE Blood Collection and
Transport System is intended for prescription distribution, and is a
clinic-use device for collection and transportation of dried capillary
blood for in vitro diagnostic quantitative determination of Total
Cholesterol, HDL-Cholesterol, Triglycerides and Calculated LDL-
Cholesterol in dried blood spots. This kit is not intended for use on
Continued on next pageneonates. LDL cannot be determined where the triglyceride value is
greater than 400 mg/dL

1

  • The BIOSAFE CHOLESTEROL PROFILE Blood Collection and 6) Comparison to Transport System has technological characteristics and an intended predicate device use that are substantially equivalent to that of the predicate devices listed above. The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System provides components that permit collection, storage, and transportation of a dried capillary blood sample to a certified clinical laboratory for analysis using FDA-Cleared laboratory reagent and analysis systems. All predicate and current kits are intended for the in vitro diagnostic laboratory determination of lipid profile analytes. The laboratory analyses used in conjunction with the BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System, utilize the Synermed Cholesterol Reagent Kit (K903015), Sigma Diagnostics Infinity Triglyceride Reagents (K844032), and Sigma Diagnostics EZ-HDL Cholesterol Results of clinical trials show that Reagents (K972041). professionally collected capillary samples onto the BIOSAFE Blood Collection Card provide results that are substantially equivalent to venous (serum) results for Total Cholesterol, HDL Cholesterol and Triglycerides when analyzed using BIOSAFE Laboratories modified analytical methods.
    Determination of professionally collected capillary blood Total 7) Performance Studies Cholesterol, HDL Cholesterol and Triglycerides using the BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System is substantially equivalent to venous (serum) samples for lipid profile BIOSAFE Laboratories modified analytical methods. testing Performance studies were conducted on professionally collected blood samples from volunteer study subjects at three different geographical sites. A corresponding venous blood sample was collected by the health care professional in order to compare serum lipid results to those obtained from capillary blood samples collected onto the BIOSAFE Blood Collection Card. Venous samples were express shipped, and dried capillary samples were mailed directly to BIOSAFE Laboratories for lipid profile analysis by their respective methods.

Performance characteristics studied included precision, linearity and correlation. In addition, the BIOSAFE CHOLESTEROL PROFILE 8) Test Summary Blood Collection and Transport System was evaluated for sample stability when exposed to abusive storage and transportation conditions.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, stacked on top of each other.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Jack A. Maggiore, Ph.D. Director, Clinical Trials BIOSAFE Laboratories, Inc. 100 Field Drive - Suite 240 Lake Forest, IL 60045

SEP 2 6 2001

K011970 Re:

Trade/Device Name: BIOSAFE Cholesterol Profile Blood Collectionand Transport System Regulation Number: 21 CFR 862.1675 Regulation Name: Blood specimen collection device Regulatory Class: Class II Product Code: JKA Regulatory Class: Class I, reserved Product Code: CHH, LBS, CDT Dated: August 23, 2001 Received: September 4, 2001

Dear Dr. Maggiore:

We have reviewed your Section 510(k) premarket notification of intent to market the device wt nave reviewed your becamed the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for use surfed in the encreations of the enactment date of the Medical Device Amendments, or to conninered processified in accordance with the provisions of the Federal Food, Drug, de rices that have been require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The r ou may, atere, mains of the Act include requirements for annual registration, listing of general voltared pro resuring practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it If your device is classified (600 wor ols. Existing major regulations affecting your device can may be subject to back as a saccrations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean i loast be advisou that I Dri bristian that your device complies with other requirements of the Act that I Dri has made a word regulations administered by other Federal agencies. You must or uny I cacal batales and strequirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set CFR Part 607); adoning (21 CFR Part 820); and if applicable, the electronic forul in the quality by seaths (Sections 531-542 of the Act); 21 CFR 1000-1050.

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Page 2 -

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 nourication. The I Dri Imaling of succion 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 CFF Part 801 and 1 IT you desire specific daily of the diagnostic devices), please contact the Office of Compliance at additionally 607.10 for in The clagitestions on the promotion and advertising of your device, (301) 594-4566. Runnenally, spiliance 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 Information on your responsibilities and er Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its internet address "http://www.fda.gov/cdrb/dsma/dsmamain.html".

Sincerely yours,

Steven Sutman

Steven I. Gutman, M.D., M.B.A. Director Division of Clinical Laboratory-Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K011970

C - 1

C. Indications for Use Statement

The BIOSAFE CHOLESTEROL PROFILE Blood Collection and Transport System is intended for prescription distribution, and is a clinic-use device for Dystem is mended for pion of dried capillary blood for in vitro diagnostic concetion and "thisportation" of Total Cholesterol, HDL-Cholesterol, Triglycerides and Calculated LDL-Cholesterol in dried blood spots. This kit is not intended for use on Caromates. LDL Cholosteror in aired where the triglyceride value is greater than 400 mg/dL.

\checkmark prescription use

Kesia Alexander for Sean Cooper
(Division Sign-Off)

Division of Clinical Laboratory Devices 510(k) Number.