K Number
K020794
Device Name
SALICYLATE ASSAY FOR THE ADVIA INTEGRATED MODULAR SYSTEM
Date Cleared
2002-07-11

(122 days)

Product Code
Regulation Number
862.3830
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Bayer ADVIA IMS Salicylate method is an in vitro diagnostic device intended to measure salicylate levels in human serum or plasma (Lithium heparin). Such measurements are used in the diagnosis of salicylate toxicity and overdose.
Device Description
Not Found
More Information

Not Found

No
The summary describes a standard in vitro diagnostic assay for measuring salicylate levels, with no mention of AI, ML, image processing, or any other indicators of AI/ML technology.

No
The device is described as an "in vitro diagnostic device intended to measure salicylate levels," which is for diagnosis, not for treating a condition.

Yes

The "Intended Use / Indications for Use" section explicitly states, "The Bayer ADVIA IMS Salicylate method is an in vitro diagnostic device..."

No

The device is an in vitro diagnostic device intended to measure salicylate levels in human serum or plasma. This involves a physical assay and analysis of biological samples, which requires hardware components beyond just software.

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

The "Intended Use / Indications for Use" section explicitly states:

"The Bayer ADVIA IMS Salicylate method is an in vitro diagnostic device intended to measure salicylate levels in human serum or plasma (Lithium heparin)."

This statement directly identifies the device as an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

This in-vitro diagnostic method is intended to measure salicylate in human serum and plasma (lithium heparin as the anticoagulant) on ADVIA IMS. Measurements of salicylate are used in the diagnosis, monitoring and treatment of salicylate toxicity and overdose.

The Bayer ADVIA IMS Salicylate method is an in vitro diagnostic device intended to measure salicylate levels in human serum or plasma (Lithium heparin). Such measurements are used in the diagnosis of salicylate toxicity and overdose.

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

DKJ

Device Description

Not Found

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

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

Imprecision (Serum)
ADVIA IMS:
Level (mg/dL): 4.8, Total CV (%): 9.6
Level (mg/dL): 32.1, Total CV (%): 2.7
Level (mg/dL): 64.6, Total CV (%): 2.5

Abbott/TDx:
Level (mg/dL): 7.5, Total CV (%): 4.48
Level (mg/dL): 30, Total CV (%): 2.95
Level (mg/dL): 60, Total CV (%): 2.98

Correlation (Y=ADVIA IMS, X=comparison system)
Specimen type: Serum, Comparison System (X): Abbott/TDx, N: 47, Regression Equation: Y=0.997X - 1.39, Syx (mg dL): 2.88, R: 0.996, Sample Range (mg/dL): 0.5-112.2
Specimen type: Plasma(y), Serum(x), Comparison System (X): ADVIA IMS, N: 49, Regression Equation: Y=0.985X + 0.00, Syx (mg dL): 2.73, R: 0.988, Sample Range (mg/dL): 4.2-75.8

Interfering Substances
Interfering Substance: Bilirubin (unconjugated), Interfering Sub. Conc. (mg/dL): 25, Salicylate Conc (mg/dL): 29.6, Effect (% change): 0.0
Interfering Substance: Bilirubin (conjugated), Interfering Sub. Conc. (mg/dL): 25, Salicylate Conc (mg/dL): 31.9, Effect (% change): 0.0
Interfering Substance: Hemoglobin, Interfering Sub. Conc. (mg/dL): 1000, Salicylate Conc (mg/dL): 29.7, Effect (% change): +6.0
Interfering Substance: Lipids (Triglycerides), Interfering Sub. Conc. (mg/dL): 500, Salicylate Conc (mg/dL): 29.1, Effect (% change): +7.0

Analytical Range: Serum/Plasma: 0 to 120 mg/dL

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.

K844070

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.

Not Found

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

§ 862.3830 Salicylate test system.

(a)
Identification. A salicylate test system is a device intended to measure salicylates, a class of analgesic, antipyretic and anti-inflammatory drugs that includes aspirin, in human specimens. Measurements obtained by this device are used in diagnosis and treatment of salicylate overdose and in monitoring salicylate levels to ensure appropriate therapy.(b)
Classification. Class II.

0

JUL 1 1 2002

510(k) SUMMARY OF SAFETY AND EFFECTIVENESS Salicylate method for ADVIA® IMSTM

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of the Safe Medical Device Act of 1990 and 21 CFR 807.92.

The assigned 510(k) number is: HO20794

1. Intended Use

This in-vitro diagnostic method is intended to measure salicylate in human serum and plasma (lithium heparin as the anticoagulant) on ADVIA IMS. Measurements of salicylate are used in the diagnosis, monitoring and treatment of salicylate toxicity and overdose.

Predicate Device 2.

Product NameReagent Part #Calibrator Part #
Abbott/TDx Salicylate953369953302

3. Device / Method

Product NameReagent Part #Calibrator Part #
Bayer ADVIA IMS Salicylate0831980204120475

Imprecision (Serum)

ADVIA IMS
Level
(mg/dL)Total
CV(%)
4.89.6
32.12.7
64.62.5
Abbott/TDx
Level
(mg/dL)Total
CV(%)
7.54.48
302.95
602.98

Correlation (Y=ADVIA IMS, X=comparison system)

| Specimen type | Comparison
System (X) | N | Regression Equation | Syx
(mg dL) | R | Sample Range
(mg/dL) |
|---------------------|--------------------------|----|---------------------|----------------|-------|-------------------------|
| Serum | Abbott/TDx | 47 | $Y=0.997X - 1.39$ | 2.88 | 0.996 | 0.5-112.2 |
| Plasma(y), Serum(x) | ADVIA IMS | 49 | $Y=0.985X + 0.00$ | 2.73 | 0.988 | 4.2-75.8 |

Interfering Substances

| Interfering
Substance | Interfering Sub.
Conc. (mg/dL) | Salicylate Conc
(mg/dL) | Effect
(% change) |
|--------------------------|-----------------------------------|----------------------------|----------------------|
| Bilirubin (unconjugated) | 25 | 29.6 | 0.0 |
| Bilirubin (conjugated) | 25 | 31.9 | 0.0 |
| Hemoglobin | 1000 | 29.7 | +6.0 |
| Lipids (Triglycerides) | 500 | 29.1 | +7.0 |

Analytical Range

Serum/Plasma: 0 to 120 mg/dL

1

4. Conclusion

Performance of the ADVIA IMS Salicylate Assay on a Bayer ADVIA® IMS™ is equivalent to the performance of the Salicylate Assay on the predicate device (Abbott TDX, K844070) and is within proposed manufacturing specifications. No safety and effectiveness issues have been raised.

Kuretsch. Charles

2/28/02
Date

Date

Kenneth T. Edds Manager Regulatory Affairs Bayer Corporation 511 Benedict Avenue Tarrytown, New York 10591-5097

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 is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES (USA)" around the perimeter. Inside the circle is a stylized image of an eagle with its wings spread, with three wavy lines below the eagle.

JUL 11 2002

Public Health Service

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Kenneth T. Edds, Ph.D. Regulatory Affairs Manager Bayer Corporation 511 Benedict Avenue Tarrytown. NY 10591-5097

Re: K020794

Trade/Device Name: Salicylate Assay for the ADVIA® IMS™ Regulation Number: 21 CFR 862.3830 Regulation Name: Salicylate test system Regulatory Class: Class II Product Code: DKJ Dated: June 19, 2002 Received: June 20, 2002

Dear Dr. Edds:

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. Iisting 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. 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.

3

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 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 1 additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4588. 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 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/dsmaldsmamain.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

Enclosure

4

510(k) Number: KOZO794

Device Name: Salicylate Assay for the ADVIA® IMSTM

Indications for Use:

The Bayer ADVIA IMS Salicylate method is an in vitro diagnostic device intended to measure salicylate levels in human serum or plasma (Lithium heparin). Such measurements are used in the diagnosis of salicylate toxicity and overdose.

Ican

(Division Sign-Off)

Division of Clinical Laboratory Devices

510(k) Number. K020794

Cooger

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-CounterUse_

(Optional Format 1-2-96)