K Number
K022027
Device Name
CALIBRATING MATERIAL, BUFFERS, STANDARD
Date Cleared
2002-07-22

(31 days)

Product Code
Regulation Number
862.1150
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The products encompassed by this request are intended for in-vitro diagnostics use and are intended for use in calibrating the electrodes and flushing the sample flow path of the equivalent OEM Analyzers.
Device Description
The Calibrators for the OEM Instruments are aqueous reagents with salts added to obtain desired analyte levels to provide calibration of the electrodes and rinse the sample path. Mission uses a similar composition, description and packaging as that used by the OEM in its products.
More Information

Not Found

Not Found

No
The document describes a simple aqueous reagent for calibrating electrodes and flushing sample paths, with no mention of AI/ML terms or functionalities.

No
The device is described as an in-vitro diagnostic product used for calibrating electrodes and flushing sample flow paths of OEM Analyzers, indicating it is for diagnostic rather than therapeutic purposes.

Yes
The "Intended Use / Indications for Use" section explicitly states that the products are "intended for in-vitro diagnostics use."

No

The device description explicitly states it is an "aqueous reagent with salts added," indicating a physical, chemical substance, not software.

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

Here's why:

  • Intended Use / Indications for Use: The very first sentence explicitly states, "The products encompassed by this request are intended for in-vitro diagnostics use..." This is the most direct indicator.
  • Function: The device is used for "calibrating the electrodes and flushing the sample flow path of the equivalent OEM Analyzers." These analyzers are used to test samples in vitro (outside the body). The calibrators are essential for ensuring the accuracy of these in vitro tests.
  • Device Description: The description mentions "aqueous reagents with salts added to obtain desired analyte levels." These are typical components of reagents used in in vitro diagnostic testing.

The information provided strongly supports the classification of this device as an IVD.

N/A

Intended Use / Indications for Use

The products encompassed by this request are intended for in-vitro diagnostics use and are intended for use in calibrating the electrodes and flushing the sample flow path of the equivalent OEM Analyzers.

Product codes

JIT

Device Description

  • The Calibrators for the OEM Instruments are aqueous reagents with salts added to obtain desired analyte levels to provide calibration of the electrodes and rinse the sample path.
  • Mission manufactures calibrators intended to serve as direct replacements to like named . products manufactured by Original Equipment Manufactures (OEM)
  • Mission reagents are intended to serve as direct replacements to like named products manufactured by the OEM.
  • The products encompassed are to be handled using normal laboratory precautions.
  • Sodium Azide is NOT added to any of the formulations

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

Precision and correlation data are collected per:

  • SOP23-01-02 Performance Study Protocol for 510(k) Submission 0
  • Data for each instrument and each run are recorded on SOP23-03F Performance Study O Record Sheet. (See Attachment Section for Copy of Procedure and Data Record Sheet)

Key Metrics

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 862.1150 Calibrator.

(a)
Identification. A calibrator is a device intended for medical purposes for use in a test system to establish points of reference that are used in the determination of values in the measurement of substances in human specimens. (See also § 862.2 in this part.)(b)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9.

0

K022027
Page 48 of 60

JUL 2 2 2002

Abbreviated 510(k) Submission for Mission Diagnostic Reagents on pH/Blood Gas &/or Electrolyte Analyzers

Submitter's Name & Address 1.

Mission Diagnostics 331 Fiske St Holliston MA 01746 FAX: 508-429-0452

Contact Person: Linda M Stundtner QA/RA Manager 508-429-0450

Establishment Registration Number: 300-36-56-721

Date of Preparation:

June 19, 2002

2. Identification of the Device:

Proprietary/Trade name:Calibrating Material, Buffers, Standards
Common or usual name:Calibrators for ISE and/or pH/Blood Gas automated systems
Classification name:Calibrator, secondary
Device Classification:II
Regulation Number:21 CFR § 862.1150
Panel:Chemistry (75)
Product Code:JIT
  • Mission manufactures calibrators intended to serve as direct replacements to like named . products manufactured by Original Equipment Manufactures (OEM)

1

3. Predicate Device:

Mission ProductOEM Equivalent
DA-D100DISE Standard CDade Dimension® ISE Standard C D100
DA-D102DISE Standard ADade Dimension® ISE Standard A D102
DA-D103ADISE Standard BDade Dimension® ISE Standard B D103A
DA-D200DISE Standard CDade Dimension® ISE Standard C D200
DA-D202DISE Standard ADade Dimension® ISE Standard A D202
DA-S540DIMT Standard ADade MultiPLY® IMT Standard A S540
DA-S550DIMT Standard BDade MultiPLY® IMT Standard B S550
DA-S560DIMT Standard CDade MultiPLY® IMT Standard C S560
RO-46997DISE Standard 1Roche Standard 1 for Cobas® ISE Module 46997
RO-46998DISE Standard 2Roche Standard 2 for Cobas® ISE Module 46998
RD-943118DRed Cal S1556S1556 Code No. 943-118 Red Calibrating Solution (High pH)
RD-943117DGreen Cal S1546S1546 Code No. 943-117 Green Calibrating Solution (Low pH)
RD-943791DCal. Sol. 7.4; 3 S1565S1565 Code No. 943-791 Calibrating Solution 1, Red 3
RD-943792DCal. Sol. 6.8; 4 S1575S1575 Code No. 943-792 Calibrating Solution 2, Red 4
RD-943831DCal. Sol. 1; 3 S1585S1585 Code No. 943-831 Calibrating Solution 1, Blue 3
RD-943832DCal. Sol. 2; 4 S1595S1595 Code No. 943-832 Calibrating Solution 2, Blue 4
RD-943837DCal 1; S1545S1545 Code No. 943-837 Calibrating Solution 1, red
RD-943839DCal 2; S1555S1555 Code No. 943-839 Calibrating Solution 2, green
RD-943959DCal 1; 9 S1580S1580 Code No. 943-959 Calibrating Solution 1, Red 9
RD-943960DCal 2; 10 S1590S1590 Code No. 943-960 Calibrating Solution 2, Red 10
IL-03336004D7.384 pH Buffer33360 IL Test™ 7.384 pH Reference Buffer
IL-03106004D6.840 pH Buffer31060 IL Test™ 6.840 pH Reference Buffer
IL-09831804DCal 109831800 IL Test™ Cal 1
IL-09831904DCal 209831900 IL Test™ Cal 2

Substantial Equivalence Table of Product PN's & Trade Names

4. Device Description:

  • The Calibrators for the OEM Instruments are aqueous reagents with salts added to obtain . desired analyte levels to provide calibration of the electrodes and rinse the sample path.
  • Intended Use:
    • . The reagents are intended for use on equivalent OEM Instruments.
    • . The OEM is the original equipment manufacturer of the instruments and the predicate reagents, which are necessary for the continued operation and use of the instruments.
    • . Mission uses a similar composition, description and packaging as that used by the OEM in its products, as shown in the packaging section of this submission.

5. Performance Characteristics:

Precision and correlation data are collected per:

  • SOP23-01-02 Performance Study Protocol for 510(k) Submission 0
  • Data for each instrument and each run are recorded on SOP23-03F Performance Study O Record Sheet. (See Attachment Section for Copy of Procedure and Data Record Sheet)

510(k) Submission for Mission Diagnostics Reagents on pH/BG &/or Electrolyte Analyzers

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 circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. Inside the circle is a stylized symbol resembling an abstract eagle or bird in flight, composed of several curved lines.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

'JUL 2 2 2002

Ms. Linda Stundtner OA/RA Manager Diamond Diagnostics Inc. Mission Diagnostics 333 Fiske Street Holliston, MA 01746

Re: K022027

Trade/Device Name: Mission Diagnostic Calibrating Reagents for pH/BG &/or Electrolyte Analyzers

Regulation Number: 21 CFR 862.1150 Regulation Name: Calibrator Regulatory Class: Class II Product Code: JIT Dated: June 19, 2002 Received: June 21, 2002

Dear Ms. Stundtner:

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 vour 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/cdrb/dsmaldsmamain.html".

Sincerely yours,

Steven Putman

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 _

K022027

Device Name: Mission Diagnostic Calibrating Reagents for pH/BG &/or Electrolyte Analyzers

Indication For Use:

The products encompassed by this request are intended for in-vitro diagnostics use and are intended for use in calibrating the electrodes and flushing the sample flow path of the equivalent OEM Analyzers.

Substantial Equivalence Table of Product PN's & Trade Names

Mission ProductOEM Equivalent
DA-D100DISE Standard CDade Dimension® ISE Standard C D100
DA-D102DISE Standard ADade Dimension® ISE Standard A D102
DA-D103ADISE Standard BDade Dimension® ISE Standard B D103A
DA-D200DISE Standard CDade Dimension® ISE Standard C D200
DA-D202DISE Standard ADade Dimension® ISE Standard A D202
DA-S540DIMT Standard ADade MultiPLY® IMT Standard A S540
DA-S550DIMT Standard BDade MultiPLY® IMT Standard B S550
DA-S560DIMT Standard CDade MultiPLY® IMT Standard C S560
RO-46997DISE Standard 1Roche Standard 1 for Cobas® ISE Module 46997
RO-46998DISE Standard 2Roche Standard 2 for Cobas® ISE Module 46998
RD-943118DRed Cal S1556S1556 Code No. 943-118 Red Calibrating Solution (High pH)
RD-943117DGreen Cal S1546S1546 Code No. 943-117 Green Calibrating Solution (Low pH)
RD-943791DCal. Sol. 7.4; 3 S1565S1565 Code No. 943-791 Calibrating Solution 1, Red 3
RD-943792DCal. Sol. 6.8; 4 S1575S1575 Code No. 943-792 Calibrating Solution 2, Red 4
RD-943831DCal. Sol. 1; 3 S1585S1585 Code No. 943-831 Calibrating Solution 1, Blue 3
RD-943832DCal. Sol. 2; 4 S1595S1595 Code No. 943-832 Calibrating Solution 2, Blue 4
RD-943837DCal 1; S1545S1545 Code No. 943-837 Calibrating Solution 1, red
RD-943839DCal 2; S1555S1555 Code No. 943-839 Calibrating Solution 2, green
RD-943959DCal 1; 9 S1580S1580 Code No. 943-959 Calibrating Solution 1, Red 9
RD-943960DCal 2; 10 S1590S1590 Code No. 943-960 Calibrating Solution 2, Red 10
IL-03336004D7.384 pH Buffer33360 IL Test™ 7.384 pH Reference Buffer
IL-03106004D6.840 pH Buffer31060 IL Test™ 6.840 pH Reference Buffer
IL-09831804DCal 109831800 IL Test™ Cal 1
IL-09831904DCal 209831900 IL Test™ Cal 2

. Mission reagents are intended to serve as direct replacements to like named products manufactured by the OEM.

  • . The products encompassed are to be handled using normal laboratory precautions.
  • . Sodium Azide is NOT added to any of the formulations

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

Concurrance of CDRH, Office of the Device Evaluation (ODE)

Ruth Chelton for Jean Cooper
(Division Sign-Off)
Division of Clinical Laboratory Devices
510(k) NumberK022027

(Optional format 3-10-98)

510(k) Submission for Mission Diagnostics Reagents on pH/BG &/or Electrolyte Analyzers