K Number
K012013
Device Name
LIFESOURCE MODELS UA-787, UA 787PC, UA-787T
Date Cleared
2001-07-13

(15 days)

Product Code
Regulation Number
870.1130
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Measuring systolic and diastolic blood pressure and pulse rate in adult patients (18 years Mcasuring Systeme and Charlerse office. The arm circumference should be between 5.1" and 17.7" (13 cm to 45 cm).
Device Description
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More Information

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Not Found

No
The provided text does not contain any keywords or descriptions related to AI or ML technology.

Yes.
The device measures systolic and diastolic blood pressure and pulse rate, which are physiological parameters used for monitoring and managing health conditions, aligning with the definition of a therapeutic device.

Yes
The device measures systolic and diastolic blood pressure and pulse rate, which are physiological parameters used to assess a patient's health status and aid in diagnosing conditions like hypertension.

No

The summary describes a device that measures blood pressure and pulse rate using an arm cuff, which is a hardware component. The lack of a device description makes it impossible to definitively rule out hardware.

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

Here's why:

  • Intended Use: The intended use is to measure systolic and diastolic blood pressure and pulse rate. These are physiological measurements taken directly from the patient's body.
  • IVD Definition: In Vitro Diagnostics are devices used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information about a physiological state, health, or disease.

This device operates on the patient's arm to measure vital signs, not on a specimen taken from the patient. Therefore, it falls outside the scope of IVD devices.

N/A

Intended Use / Indications for Use

Measuring systolic and diastolic blood pressure and pulse rate in adult patients (18 years Mcasuring Systeme and Charlerse office. The arm circumference should be between 5.1" and 17.7" (13 cm to 45 cm).

Product codes

DXN

Device Description

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Mentions image processing

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Mentions AI, DNN, or ML

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Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

adult patients (18 years

Intended User / Care Setting

Not Found

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.1130 Noninvasive blood pressure measurement system.

(a)
Identification. A noninvasive blood pressure measurement system is a device that provides a signal from which systolic, diastolic, mean, or any combination of the three pressures can be derived through the use of tranducers placed on the surface of the body.(b)
Classification. Class II (performance standards).

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized caduceus, which is a symbol often associated with medicine and healthcare. The caduceus is depicted with three lines forming the shape of a bird or wing-like structure. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the caduceus.

Public Health Service

JUL 1 3 2001

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

A & D Engineering, Inc. c/o Mr. Robert Mosenkis Citech 5200 Butler Pike Plymouth meeting, PA 19462

Re: K012013

Trade Name: LifeSource Models UA-787, UA-787PC, and UA-787T Regulation Number: 21 CFR 870.1130 Regulatory Class: Class II (two) Product Code: DXN Dated: June 27, 2001 Received: June 28, 2001

Dear Mr. Mosenkis:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we 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 stired in the 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified 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 provisions of the Act. The general controls provisions of the Act include requirements for annual provision, listing of devices, 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 ( reading your device can be found in the 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 comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this

1

Page 2 - Mr. Robert Mosenkis

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 nothloated. THE I Drive 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 11 you active specific and 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 mornation on your respect 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,

toello

James E. Dillard III Director Division of Cardiovascular and Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: A&D Medical LifeSource UA-787, UA-787PC, & UA-787T Digital Blood Pressure Monitors

Indications for Use:

Measuring systolic and diastolic blood pressure and pulse rate in adult patients (18 years Mcasuring Systeme and Charlerse office. The arm circumference should be between 5.1" and 17.7" (13 cm to 45 cm).

(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division of Cardiovascular & Respiratory Devices
510(k) NumberK012013

Or

Prescription Use __________

Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)