K Number
K020362
Device Name
P.O.G.S. 3.3 PORTABLE OXYGEN GENERATOR SYSTEM
Date Cleared
2002-02-12

(8 days)

Product Code
Regulation Number
868.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The POGS is intended to provide supplemental oxygen. Device is to be operated by trained medical personnel only for military use only.
Device Description
The On Site Gas Systems portable oxygen generator is a prescription device designed to provide an inexpensive supply of supplemental oxygen in a military environment without a continuous source of The feed air compressor creates a vacuum to draw air into a oxvaen. holding talk. The air is then flushed through two tanks in series to provide continuous oxygen. The molecular sieve material adsorbs nitrogen, which comprises approximately 78% of the makeup of air. The resulting gas is approximately 93% oxygen. The variations of the device are to allow for greater total flow, to accommodate more cannulas per device. The variations are designed and tested for same indication of use, safety and effectiveness; variations are substantially equivalent to predicate devices.
More Information

K 014078, K 011844, K 955549

Not Found

No
The device description focuses on a physical process of oxygen generation using molecular sieves and does not mention any computational or algorithmic components that would suggest AI/ML. The performance studies reference a standard for oxygen concentrators, not AI/ML performance metrics.

Yes
Explanation: The device is intended to provide supplemental oxygen, which is a therapeutic intervention for military personnel.

No
The device is intended to provide supplemental oxygen, not to diagnose a condition.

No

The device description clearly outlines hardware components like a compressor, holding tank, and tanks with molecular sieve material, indicating it is a physical medical device, not software-only.

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

Here's why:

  • Intended Use: The intended use is to "provide supplemental oxygen." This is a therapeutic purpose, delivering a substance to the patient's body.
  • Device Description: The device generates oxygen from air and delivers it for breathing. This is a medical device used for treatment or support of a physiological function.
  • Lack of IVD Characteristics: IVD devices are used to examine specimens (like blood, urine, tissue) taken from the human body to provide information about a physiological state, health, disease, or congenital abnormality. The POGS does not perform any such analysis of specimens.

Therefore, the POGS falls under the category of a therapeutic medical device, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The POGS is intended to provide supplemental oxygen. Device is to be operated by trained medical personnel for military use only.

Product codes

73 CAW

Device Description

The On Site Gas Systems portable oxygen generator is a prescription device designed to provide an inexpensive supply of supplemental oxygen in a military environment without a continuous source of The feed air compressor creates a vacuum to draw air into a oxvaen. holding talk. The air is then flushed through two tanks in series to provide continuous oxygen. The molecular sieve material adsorbs nitrogen, which comprises approximately 78% of the makeup of air. The resulting gas is approximately 93% oxygen.

The variations of the device are to allow for greater total flow, to accommodate more cannulas per device. The variations are designed and tested for same indication of use, safety and effectiveness; variations are substantially equivalent to predicate devices.

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

Trained medical personnel, military use only.

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 device meets the requirements of the FDA recognized standard covering Oxygen Concentrators, ASTM F 1464-93, and is substantially equivalent to the predicate devices.

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

Not Found

Predicate Device(s)

K 014078, K 011844, K 955549

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 868.5440 Portable oxygen generator.

(a)
Identification. A portable oxygen generator is a device that is intended to release oxygen for respiratory therapy by means of either a chemical reaction or physical means (e.g., a molecular sieve).(b)
Classification. Class II (performance standards).

0

K020362

FEB 1 2 2002

10.0 510 (k) SUMMARY

Submitter's Name 10.1

Francis X. Hursey, President

Address 10.2

On Site Gas Systems. Inc. 35 Budney Road Budney Industrial Park Newington, CT 06111

10.3 Phone

888-748-3429 (Toll-free) 860-667-8888

10.4 Fax

860-667-2222

Contact Person 10.5

C. Barton ("Bart") Gullong, Vice President, Marketing and Technical Services

10.6 Date of Preparation

January 28, 2002

10.7 Device Name

Portable Oxygen Generator

Trade Name 10.8

On Site Gas Systems Portable Oxygen Generation System

Common Name 10.9

Oxygen Concentrator

  • Proprietary Name 10.10 P.O.G.S. - 3.3

Classification Name 10.11 Portable Oxygen Generator

10-1

1

Legally Marketed Device Claiming Substantial 10.12 Equivalency To:

On Site Gas Systems Portable Oxygen Generation System K 014078 Merits Health Products Oxygen Concentrators K 011844

Oxlife Oxygen Concentrators K 955549

10.13 Description of the Device

The On Site Gas Systems portable oxygen generator is a prescription device designed to provide an inexpensive supply of supplemental oxygen in a military environment without a continuous source of The feed air compressor creates a vacuum to draw air into a oxvaen. holding talk. The air is then flushed through two tanks in series to provide continuous oxygen. The molecular sieve material adsorbs nitrogen, which comprises approximately 78% of the makeup of air. The resulting gas is approximately 93% oxygen.

The variations of the device are to allow for greater total flow, to accommodate more cannulas per device. The variations are designed and tested for same indication of use, safety and effectiveness; variations are substantially equivalent to predicate devices.

10.14 Intended Use of Device

The POGS is intended to provide supplemental oxygen. Device is to be operated by trained medical personnel for military use only.

Summary of Technological Characteristics of Device 10.15 Compared to Predicates

The oxygen generator operates by using molecular sieve material to adsorb the nitrogen from filtered air. The resulting gas has an increased concentration of oxygen. This technology is well established, and has been used in the predicate device as well as other legally marketed products.

2

Discussion of Non-clinical Test to Support Determination 10.16 of Substantial Equivalency

10.17 Performance Data

The device meets the requirements of the FDA recognized standard covering Oxygen Concentrators, ASTM F 1464-93, and is substantially equivalent to the predicate devices.

10.18 Conclusions

Based on the design, performance specifications, and intended use, the Oxygen Concentrators are substantially equivalent to the currently marketed devices.

3

Image /page/3/Picture/1 description: The image is a logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle or bird-like symbol with three curved lines representing its wings or body. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the bird symbol. The logo is presented in black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

FEB 1 2 2002

Mr. C. Barton Gullong On Site Gas Systems Inc. 35 Budney Road Budney Park Industrial Newington, CT 06111

Re: K020362

P.O.G.S. 3.3 Portable Oxygen Generator System Regulation Number: 868.5440 Regulation Name: Generator, Oxygen, Portable Regulatory Class: Class II (two) Product Code: 73 CAW Dated: January 28, 2002 Received: February 4, 2002

Dear Mr. Gullong:

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.

4

Page 2 - Mr. C. Barton Gullong

Please be advised that FDA's issuance of a substantial equivalence determination does not mean i hat FDA has made a determination that your device complies with other requirements of the Act that I Dr Hab Intato a assoc regulations administered by other Federal agencies. You must or any 1 outlar statutes and states and the mot limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set Of It Fart 607); adoming (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) I mo letter with and wy of substantial equivalence of your device of your device to a legally promance notifications of 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) 594-4646. 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 Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Oiner general internation turers, 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,

Deaky Till

am D. uckerman, M.D. Acting Director Division of Cardiovascular and Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Image /page/5/Picture/0 description: The image shows the logo for "O2 N2 SITE On Site Gas Systems, Inc." The logo is in black and white, with the text "O2 N2 SITE" in large, bold letters. The text "On Site Gas Systems, Inc." is in smaller letters below the main logo. A line separates the two parts of the logo.

8.10 Statement of Indications for Use

  • 510 (k) File Number 8.10.1
    Kozozio 222222

8.10.2 Device Name

On Site Gas Systems Portable Oxygen Generation System - 3.3

8.10.3 Indications for Use

The POGS is intended to provide supplemental oxygen. Device is to be operated by trained medical personnel only for military use only.

Prescription Use
(Per 21 CFR 801.109)

Tek
Division of Cardiovascular & Respiratory Devices
510(k) Number K620362

8-8

On Site Gas Systems, Inc.

35 Budney Road, Budney Industrial Park, Newington, CT 06111 U.S.A. Telephone: 860.667.8888 · Fax: 860.667.2222 Website: www.onsitegas.com · Email: info@onsitegas.com A BUSINESS INCORPORATED IN THE STATE OF CONNECTICUT, U S A