K Number
K021024
Device Name
HEMOSIL HIGH ABNORMAL CONTROL ASSAYED
Date Cleared
2002-05-16

(48 days)

Product Code
Regulation Number
864.5425
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
HemosIL High Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the high abnormal range on IL Coagulation and ELECTRA™ Systems. The High Abnormal Control is prepared using 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 high abnormal range.
Device Description
Available as an assayed high abnormal control (HemosIL High Abnormal Control) or unassayed high abnormal control (HemosIL High Abnormal Control 3), the product is intended for the quality control of coagulation assays in the high abnormal range on IL Coagulation and ELECTRATM Systems. The High Abnormal Control is prepared using human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified, by means of a dedicated process, to simulate an abnormal coagulation sample.
More Information

Not Found

No
The document describes a quality control material for coagulation assays and its performance characteristics. There is no mention of AI or ML technology in the intended use, device description, or performance studies.

No
This device is a quality control material for diagnostic assays, not a treatment for a disease or condition.

No

This device is a quality control material intended for use in coagulation assays, not a device that makes a diagnosis.

No

The device description clearly states it is a "product" prepared using "human citrated plasma" and modified through a "dedicated process," indicating it is a physical control material, not software.

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 device is "intended for the quality control of coagulation assays". Coagulation assays are performed in vitro (outside the body) on biological samples (plasma).
  • Device Description: The "Device Description" further clarifies that the product is used for "quality control of coagulation assays".
  • Nature of the Device: The device itself is a control material prepared from human plasma, designed to be used in laboratory tests.

These points clearly align with the definition of an In Vitro Diagnostic device, which is used to examine specimens derived from the human body to provide information for diagnostic purposes. In this case, the information is about the performance of the coagulation assays themselves.

N/A

Intended Use / Indications for Use

HemosIL High Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the high abnormal range on IL Coagulation and ELECTRA™ Systems. The High Abnormal Control is prepared using 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 high abnormal range.

Product codes

81GGN

Device Description

Available as an assayed high abnormal control (HemosIL High Abnormal Control) or unassayed high abnormal control (HemosIL High Abnormal Control 3), the product is intended for the quality control of coagulation assays in the high abnormal range on IL Coagulation and ELECTRA™ Systems. The High Abnormal Control is prepared using human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified, by means of a dedicated process, 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 High Abnormal Control over multiple days with multiple runs using specific lots of reagents and control:

Analyten=MeanWithin-Run %CV
Activated Partial Thromboplastin (APTT) (Seconds)8064.42.62
Antithrombin (% Activity)8022.89.90
Protein C (% Activity)8014.46.11
Protein S (% Activity)4029.52.75
Prothrombin Time (PT) (Seconds)8043.61.61

Key Metrics

Not Found

Predicate Device(s)

K931118, K864271, K912711, K930327

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

K021024

Section 3

HemosIL High 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 High Abnormal Control ASSAYED HemosIL High Abnormal Control 3 UNASSAYED

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
K931118Assess™ High Abnormal ControlProthrombin Time (PT)
Activated Partial
Thromboplastin (APTT)
K864271IL Test™ Abnormal Chromogenic Control Plasma
Level 2Antithrombin
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

Description of the Device/Intended Use(s):

Available as an assayed high abnormal control (HemosIL High Abnormal Control) or unassayed high abnormal control (HemosIL High Abnormal Control 3), the product is intended for the quality control of coagulation assays in the high abnormal range on IL Coagulation and ELECTRATM Systems. The High Abnormal Control is prepared using human citrated plasma from healthy donors (not heparinized plasma or plasma samples under oral anticoagulant therapy) and modified, by means of a dedicated process, to simulate an abnormal coagulation sample.

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

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

1

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

Summary of Performance Data:

A precision study was performed with HemosIL High 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 | 64.4 | 2.62 |
| Antithrombin
(% Activity) | 80 | 22.8 | 9.90 |
| Protein C
(% Activity) | 80 | 14.4 | 6.11 |
| Protein S
(% Activity) | 40 | 29.5 | 2.75 |
| Prothrombin Time (PT)
(Seconds) | 80 | 43.6 | 1.61 |

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, with flowing lines connecting them.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

MAY 1 6 2002

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

Re: K021024

Trade/Device Name: HemosIL High Abnormal Control ASSAYED HemosIL High Abnormal Control 3 UNASSAYED 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 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 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

8021024 510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Names: HemosIL High Abnormal Control ASSAYED

Indications for Use:

HemosIL High Abnormal Control ASSAYED is intended for the quality control of coagulation assays in the high abnormal range on IL Coagulation and ELECTRA™ Systems. The High Abnormal Control is prepared using 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 high 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) NumberK021024

| Prescription Use

(Per 21 CFR 801.019)OROver-The-Counter Use
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HemosIL High Abnormal Control 510(k)