K Number
K013087
Device Name
SINGLE DOSE DISPENSING PIN, MODEL 2201
Date Cleared
2001-11-13

(57 days)

Product Code
Regulation Number
880.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Single Dose Dispensing Pin is a stand-alone, single use, disposable access device which permits syringe access to a medication vial without the use of a needle. The device is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies. The Single Dose Dispensing Pin is indicated for use with standard medication vials and needleless syringes for withdrawal and/or injection of fluid.
Device Description
The Single Dose Dispensing Pin (Dispensing Pin) is a stand-alone, single use, disposable syringe access device which permits access to a medication vial without the use of a needle. The Dispensing Pin is connected to a needleless syringe and is inserted into the rubber stopper of a medication vial. The healthcare provider uses the Dispensing Pin to inject or withdraw fluid from a vial.
More Information

Not Found

No
The summary describes a mechanical device for accessing medication vials and does not mention any computational or data-driven features indicative of AI/ML.

No
The device is described as an access device for medication vials, facilitating the withdrawal or injection of fluids. It does not provide any therapeutic benefit to a patient.

No
Explanation: The device is described as an "access device which permits syringe access to a medication vial without the use of a needle" for "withdrawal and/or injection of fluid," making it a dispensing tool rather than a diagnostic one. It does not analyze patient data or provide medical insights.

No

The device description clearly states it is a "stand-alone, single use, disposable access device" and a "physical device" that is "inserted into the rubber stopper of a medication vial," indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is for accessing medication vials to withdraw or inject fluids. This is a direct interaction with a medication container, not a biological sample from the human body.
  • Device Description: The description reinforces its function as a syringe access device for medication vials.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting diseases, conditions, or states of health, or providing information for diagnosis, monitoring, or treatment decisions based on such analysis.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information about a person's health. This device's function is purely related to the handling of medication within a vial.

N/A

Intended Use / Indications for Use

The Single Dose Dispensing Pin is a stand-alone, single use, disposable access device which permits syringe access to a medication vial without the use of a needle. The device is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies.

The Single Dose Dispensing Pin is indicated for use with standard medication vials and needleless syringes for withdrawal and/or injection of fluid.

Product codes

LHI

Device Description

The Single Dose Dispensing Pin (Dispensing Pin) is a stand-alone, single use, disposable syringe access device which permits access to a medication vial without the use of a needle. The Dispensing Pin is connected to a needleless syringe and is inserted into the rubber stopper of a medication vial. The healthcare provider uses the Dispensing Pin to inject or withdraw fluid from a vial.

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

Intended User / Care Setting

healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies.

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)

The performance data supplied in this submission indicate that the Single Dose Dispensing Pin meets all specified requirements, and is substantially equivalent to the predicate devices.

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

Not Found

Predicate Device(s)

K790472, K934561

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5440 Intravascular administration set.

(a)
Identification. An intravascular administration set is a device used to administer fluids from a container to a patient's vascular system through a needle or catheter inserted into a vein. The device may include the needle or catheter, tubing, a flow regulator, a drip chamber, an infusion line filter, an I.V. set stopcock, fluid delivery tubing, connectors between parts of the set, a side tube with a cap to serve as an injection site, and a hollow spike to penetrate and connect the tubing to an I.V. bag or other infusion fluid container.(b)
Classification. Class II (special controls). The special control for pharmacy compounding systems within this classification is the FDA guidance document entitled “Class II Special Controls Guidance Document: Pharmacy Compounding Systems; Final Guidance for Industry and FDA Reviewers.” Pharmacy compounding systems classified within the intravascular administration set are exempt from the premarket notification procedures in subpart E of this part and subject to the limitations in § 880.9.

0

K013087

SUMMARY OF SAFETY AND EFFECTIVENESS Single Dose Dispensing Pin

SUBMITTER INFORMATION

A.Company Name:ALARIS Medical Systems, Inc.
B.Company Address:10221 Wateridge Circle
San Diego, CA 92121-2772
C.Company Phone:
Company Fax:(858) 458-7563
(858) 458-6223
D.Contact Person:Renée L. Fluet
Principal Regulatory Affairs Specialist
ALARIS Medical Systems, Inc.
E.Date Summary Prepared:September 14, 2001

DEVICE IDENTIFICATION

A.Generic Device Name:Set, Intravascular Administration
B.Trade/Proprietary Name:Single Dose Dispensing Pin
C.Classification:21 CFR 880.5440, Class II
D.Product Code:LHI, I.V. Fluid Transfer Set

DEVICE DESCRIPTION

The Single Dose Dispensing Pin (Dispensing Pin) is a stand-alone, single use, disposable syringe access device which permits access to a medication vial without the use of a needle. The Dispensing Pin is connected to a needleless syringe and is inserted into the rubber stopper of a medication vial. The healthcare provider uses the Dispensing Pin to inject or withdraw fluid from a vial.

SUBSTANTIAL EQUIVALENCE

The Single Dose Dispensing Pin as manufactured is of comparable type and is substantially equivalent to the following predicate devices:

1

SUMMARY OF SAFETY AND EFFECTIVENESS, Continued Single Dose Dispensing Pin

Predicate DeviceManufacturer510(k) No.Date Cleared
Micro Pin, MP-1000B. Braun of America, Inc.K79047203/26/1979
One Time Vial Access
SpikeICU Medical, Inc.K93456102/10/1994

INTENDED USE

The Single Dose Dispensing Pin is a stand-alone, single use, disposable access device which permits syringe access to a medication vial without the use of a needle. The device is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies.

The Single Dose Dispensing Pin is indicated for use with standard medication vials and needleless syringes for withdrawal and/or injection of fluid.

TECHNOLOGICAL CHARACTERISTICS

The Single Dose Dispensing Pin has the same technological characteristics as the predicate devices; the B. Braun Micro Pin (K790472) and the ICU Medical One Time Vial Access Spike (K934561). The devices consist of similar components made of the same type of materials using the same method of manufacture. The associated applications and intended use of the devices are the same. Since there are no technological differences, there are no new questions of safety and effectiveness.

PERFORMANCE DATA

The performance data supplied in this submission indicate that the Single Dose Dispensing Pin meets all specified requirements, and is substantially equivalent to the predicate devices.

2

Image /page/2/Picture/1 description: The image shows a black and white logo. The logo is a circular seal with text around the perimeter. Inside the circle is a stylized image of an eagle or other bird with outstretched wings. The logo appears to be a symbol of a government agency or organization.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 1 3 2001

Ms. Renee L. Fluet Principal Regulatory Affairs Specialist Alaris Medical Systems, Incorporated 10221 Wateridge Circle San Diego, California 92121-2733

Re: K013087

Trade/Device Name: Single Dose Dispensing Pin, Model 2201 Regulation Number: 880.5440 Regulation Name: Set, Intravascular Administration (I.V.) Fluid Transfer Set Regulatory Class: II Product Code: LHI Dated: September 12, 2001 Received: September 17, 2001

Dear Ms. Fluet:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and 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 prior to May 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) that do not require approval of a premarket approval application (PMA). 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 registration, 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 (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, 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 that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies.

3

You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 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 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4618. 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 Part 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/cdrh/dsma/dsmamain.html

Sincerely yours,

Timothy A. Ulatowski

Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

:

INDICATIONS FOR USE NOV 1 3 2001

510(k) Number: Device Trade Name: KO1 3087 ______________ (To Be Assigned By FDA)

Single Dose Dispensing Pin

Indications For Use:

The Single Dose Dispensing Pin is a stand-alone, single use, disposable access device which permits syringe access to a medication vial without the use of a needle. The device is intended for use by healthcare professionals in a wide variety of healthcare environments including hospitals, healthcare facilities, and pharmacies.

The Single Dose Dispensing Pin is indicated for use with standard medication vials and needleless syringes for withdrawal and/or injection of fluid.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use _

OR

Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________

(Per 21 CFR 801.109)

falticien Cueraitz

·vision of Dental, Infection Control, C General Hospital Devi 110(k) Number _

9/14/01 0027

Confidential