K Number
K012163
Device Name
POLYTITER SYSTEM
Manufacturer
Date Cleared
2001-08-20

(40 days)

Product Code
Regulation Number
866.5100
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The PolyTiter Immunofluorescent Titration System including the calibrator solutions is designed to assist in the semiquantitative determination (titer/pattern) of the and no Te-aDiscRips System may be in the in vitro microscopic immuno-fluorescent assay. The PolyTiter System may be used as an aid in the diagnosis and management of autoimmune diseases.
Device Description
Not Found
More Information

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Not Found

No
The summary does not mention AI, ML, or any related terms, nor does it describe functionalities typically associated with AI/ML in image analysis (like automated pattern recognition or classification beyond simple titration).

No
The device is an in vitro diagnostic (IVD) system used to assist in the diagnosis and management of autoimmune diseases, not to directly treat or prevent a disease.

Yes
The "Intended Use" section states that the system "may be used as an aid in the diagnosis and management of autoimmune diseases."

No

The description explicitly mentions "including the calibrator solutions," which are physical components, indicating it is not a software-only device.

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

Here's why:

  • Intended Use: The "Intended Use / Indications for Use" section explicitly states that the system is designed to assist in the "in vitro microscopic immuno-fluorescent assay" and is used as an "aid in the diagnosis and management of autoimmune diseases." This clearly indicates that the device is intended for use on samples taken from the human body (in vitro) to provide information for diagnostic purposes.

The definition of an IVD generally includes devices used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device fits that description.

N/A

Intended Use / Indications for Use

The PolyTiter Immunofluorescent Titration System including the calibrator solutions is designed to assist in the semiquantitative determination (titer/pattern) of the and no Te-aDiscRips System may be in the in vitro microscopic immuno-fluorescent assay. The PolyTiter System may be used as an aid in the diagnosis and management of autoimmune diseases.

Product codes

DHN

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

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Intended User / Care Setting

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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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

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

Not Found

Predicate Device(s)

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Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 866.5100 Antinuclear antibody immunological test system.

(a)
Identification. An antinuclear antibody immunological test system is a device that consists of the reagents used to measure by immunochemical techniques the autoimmune antibodies in serum, other body fluids, and tissues that react with cellular nuclear constituents (molecules present in the nucleus of a cell, such as ribonucleic acid, deoxyribonucleic acid, or nuclear proteins). The measurements aid in the diagnosis of systemic lupus erythematosus (a multisystem autoimmune disease in which antibodies attack the victim's own tissues), hepatitis (a liver disease), rheumatoid arthritis, Sjögren's syndrome (arthritis with inflammation of the eye, eyelid, and salivary glands), and systemic sclerosis (chronic hardening and shrinking of many body tissues).(b)
Classification. Class II (performance standards).

0

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the logo is an abstract symbol that resembles an eagle or bird in flight.

AUG 2 0 2001

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Ms. Helen Landicho, RAC Polymedco, Inc. 510 Furnace Dock Road, Cortlandt Manor, New York 10567

K012163 Re:

Trade Name: PolyTiter Immunofluorescent Titration System Regulation Number: 21 CFR § 866.5100 Regulatory Class: II Product Code: DHN Dated: July 6, 2001 Received: July 11, 2001

Dear Ms. Landicho:

We have reviewed your Section 510(k) notification of intent to market the device referenced we have reviewed your booms of substantially equivalent (for the indications for use above and we nave decommod the actected predicate devices marketed in interstate commerce stated in the encrosure) to regarly and date of the Medical Device Amendments, or to devices that provision in the roll be recordance 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 (Act. The general controls provisions of the Act include requirements for annual provisions of the rec. "The general smanufacturing 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 (Frediation Applovary, it may be oubject Code of Federal Regulations, Title 21, Parts 800 to 895. alloomig your ac 1100 vient determination assumes compliance with the Current Good A subscliming 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 mspoonoms, the Food and may result in regulatory action. In addition, FDA may publish 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.

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Page 2

This letter will allow you to begin marketing your device as described in your 510(k) premarket I site lotter will and in your ding 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 11 you desire spooline arin vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4588. Additionally, for questions on the promotion and advertising of your device, (Joase 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 International and Consumer 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 Butman

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

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Enclosure

2

510(k) submission

PolyTiter Immunofluorescent System

SECTION 12.0 INDICATIONS FOR USE STATEMENT

510(k) NumberKO12163

Device Name: PolyTiter Immunofluorescent Titration System

Indications For Use:

The PolyTiter Immunofluorescent

Titration System including the calibrator solutions is designed to assist in the semiquantitative determination (titer/pattern) of the and no Te-aDiscRips System may be in the in vitro microscopic immuno-fluorescent assay. The PolyTiter System may be used as an aid in the diagnosis and management of autoimmune diseases. en al

C Donson

(Division Sign-Off)
Division of Clinical Laboratory Devices

510(k) Number K012163

(PLEASE NO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

V Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use

Polymedco, Inc.