K Number
K021022
Device Name
HEMOSIL LOW ABNORMAL CONTROLLED (ASSAYED); HEMOSIL LOW ABNORMAL CONTROL 2 (UNASSAYED)
Date Cleared
2002-05-14

(46 days)

Product Code
Regulation Number
864.5425
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
HemosIL Low Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the low abnormal range on IL Coagulation and ELECTRA™ Systems. The Low Abnormal Control is prepared from human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified to simulate an abnormal coagulation sample. Values for all analytes are in the low abnormal range.
Device Description
HemosIL Low Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the low abnormal range on IL Coagulation and ELECTRA™ Systems. The Low Abnormal Control is prepared from human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified to simulate an abnormal coagulation sample.
More Information

Not Found

No
The document describes a quality control material for coagulation assays, not a device that processes data or makes decisions using AI/ML. The "Mentions AI, DNN, or ML" field is explicitly "Not Found".

No
This device is a quality control material for coagulation assays, used to ensure the accuracy of diagnostic tests, not to treat a condition.

No

This device is a quality control material used to assess the performance of coagulation assays, not to diagnose a patient's condition.

No

The device description clearly states it is a "Low Abnormal Control" prepared from human plasma, indicating it is a biological material, not software.

Based on the provided information, yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use explicitly states it's for "quality control of coagulation assays". Coagulation assays are laboratory tests performed in vitro (outside the body) on biological samples (plasma) to assess blood clotting function.
  • Device Description: The description confirms it's a "control" prepared from human plasma, designed to simulate an abnormal sample for testing purposes.
  • Performance Studies: The performance studies describe testing the control with specific analytes (APTT, Antithrombin, etc.) which are measured in laboratory settings.
  • Predicate Devices: The listed predicate devices are also controls used in laboratory coagulation testing, further supporting its classification as an IVD.

The device is used in vitro to evaluate the performance of other diagnostic tests (coagulation assays) on biological samples. This aligns perfectly with the definition of an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

HemosIL Low Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the low abnormal range on IL Coagulation and ELECTRA™ Systems. The Low Abnormal Control is prepared from human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified to simulate an abnormal coagulation sample.

Values for all analytes are in the low abnormal range.

Product codes

81GGN

Device Description

HemosIL Low Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the low abnormal range on IL Coagulation and ELECTRA™ Systems. The Low Abnormal Control is prepared from human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified to simulate an abnormal coagulation sample.

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

A precision study was performed with HemosIL Low Abnormal Control over multiple days with multiple runs using specific lots of reagents and control:

Analyten=MeanWithin-Run %CV
Activated Partial Thromboplastin (APTT) (Seconds)8042.41.84
Antithrombin (% Activity)8035.45.60
Protein C (% Activity)8028.75.96
Protein S (% Activity)4040.22.31
Prothrombin Time (PT)* (Seconds)8023.51.15
Thrombin Time (Seconds)8020.04.00

Key Metrics

Not Found

Predicate Device(s)

K931117, K864271, K912711, K930327, K000679

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 864.5425 Multipurpose system for in vitro coagulation studies.

(a)
Identification. A multipurpose system for in vitro coagulation studies is a device consisting of one automated or semiautomated instrument and its associated reagents and controls. The system is used to perform a series of coagulation studies and coagulation factor assays.(b)
Classification. Class II (special controls). A control intended for use with a multipurpose system for in vitro coagulation studies is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 864.9.

0

MAY 1 4 2002

K021022

Section 3 HemosIL Low Abnormal Control - 510(k) Summary (Summary of Safety and Effectiveness)

Submitted by:

Instrumentation Laboratory Company 113 Hartwell Avenue Lexington, MA 02421 Phone: 781-861-4467 781-861-4207 Fax:

Contact Person:

Carol Marble, Regulatory Affairs Manager Phone: 781-861-4467 / Fax: 781-861-4207

Summary Prepared:

March 28, 2002

Name of the Device(s):

HemosIL Low Abnormal Control ASSAYED

Classification Name(s):

Common Name:Plasma Coagulation Control
Product Code:81GGN
Regulation Number:21 CFR 864.5425
Classification:Class II

Identification of Predicate Device(s):

510(k) No.Predicate Device(s)Analytes
K931117Assess™ Low Abnormal ControlProthrombin Time (PT)
Activated Partial
Thromboplastin (APTT)
K864271IL Test™ Abnormal Chromogenic Control Plasma
Level 1Antithrombin
K912711IL Test™ Protein C Control Plasma
(component of IL Test™ ProClot kit)Protein C
K930327IL Test™ Protein S Control Plasma
(component of IL Test™ Protein S kit)Protein S
K000679ThromboScreen Abnormal Thrombin Time ControlThrombin Time

Description of the Device/Intended Use(s):

HemosIL Low Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the low abnormal range on IL Coagulation and ELECTRA™ Systems. The Low Abnormal Control is prepared from human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified to simulate an abnormal coagulation sample.

Statement of Technological Characteristics of the Device Compared to Predicate Device:

HemosIL Low Abnormal Control is substantially equivalent to the predicate devices in performance, intended use and safety and effectiveness for the specific claimed analyte.

Section 3

HemosIL Low Abnormal Control 510(k)

1

Section 3 (Cont.) HemosIL Low Abnormal Control - 510(k) Summary (Summary of Safety and Effectiveness)

Summary of Performance Data:

A precision study was performed with HemosIL Low Abnormal Control over multiple days with multiple runs using specific lots of reagents and control:

| Analyte | n= | Mean | Within-Run
%CV |
|------------------------------------------------------|----|------|-------------------|
| Activated Partial Thromboplastin (APTT)
(Seconds) | 80 | 42.4 | 1.84 |
| Antithrombin
(% Activity) | 80 | 35.4 | 5.60 |
| Protein C
(% Activity) | 80 | 28.7 | 5.96 |
| Protein S
(% Activity) | 40 | 40.2 | 2.31 |
| Prothrombin Time (PT)*
(Seconds) | 80 | 23.5 | 1.15 |
| Thrombin Time
(Seconds) | 80 | 20.0 | 4.00 |

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the Department of Health & Human Services - USA. The logo consists of a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of an eagle with three human profiles incorporated into its design. The eagle's head is facing left, and its wings are represented by curved lines.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

MAY 1 4 2002

Ms. Carol Marble Regulatory Affairs Manager Instrumentation Laboratory Company 101 Hartwell Avenue Lexington, Massachusetts 02421-3125

Re: K021022

Trade/Device Name: HemosIL Low Abnormal Control ASSAYED Regulation Number: 21 CFR § 864.5425 Regulation Name: Plasma, Coagulation Control Regulatory Class: II Product Code: GGN Dated: March 28, 2002 Received: March 29, 2002

Dear Ms. Marble:

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. 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 nredicate 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 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/dsma/dsmamain.html".

Sincerely yours,

Steven Sutman

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

Indications for Use Statement

621022 510(k) Number (if known):

HemosIL Low Abnormal Control ASSAYED Device Names:

Indications for Use:

HemosIL Low Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the low abnormal range on IL Coagulation and ELECTRA™ Systems. The Low Abnormal Control is prepared from human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified to simulate an abnormal coagulation sample.

Values for all analytes are in the low abnormal range.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)
(Division Sign-Off)
Division of Clinical Laboratory Devices
510(k) NumberK021022
Prescription Use (Per 21 CFR 801.019)OR Over-The-Counter Use

HemosIL Low Abnormal Control 510(k)