K Number
K022163
Device Name
WELCH ALLYN SPOT VITAL SIGN MONITOR WITH MP506
Manufacturer
Date Cleared
2002-09-17

(76 days)

Product Code
Regulation Number
870.2700
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Welch Allyn Spot Vital Signs is intended for measurement of blood pressure, pulse rate, temperature and oxygen saturation (SpO2) of adult and pediatric patients. The device is not designed, sold or intended for use except as indicated. * The Welch Allyn Spot Check Device is not designed for use with neonates. To ensure pediatric blood pressure accuracy and safety, note that the Welch Allyn small cuff (5200-03) and the small One Piece cuff (5200-13) are the smallest cuffs approved for use with young children and infants. The circumference of the child's arm must fit within the range markings on the cuff. * The Welch Allyn Spot Check Device should not be used on patients who are linked to heart/lung machines. * The Welch Allyn Spot Check Device is not designed for use of axillary temperature option above three years of age in children. * The Welch Allyn Spot Check Device is not intended to monitor patient's vital signs. * The Welch Allyn Spot Check Device is not defibrillator proof.
Device Description
The Welch Allyn Spot Vital Signs is not a monitor, but a one-time vital signs measurement device. This product will not have continuous monitoring capability with timed cycle intervals, memory, or any various programmable alarm features. The device is intended to provide the physician, physician's assistant, or nurse, facing high patient traffic or multiple tasks, a cost effective method to determine a one-time vital signs reading on the spot. The base unit will have non-invasive blood pressure (BP) measurement. Options will also be offered such as SureTemp® thermometry, Nellcor® pulse oximetry (SpO2), mounting bracket, and rolling stand. The device may be interfaced with an external printer via an infrared port. The Welch Allyn Spot Vital Signs is designed to non-invasively measure systolic and diastolic blood pressure, pulse rate, temperature and oxygen saturation (SpO2) for adult and pediatric patients. The Welch Allyn Spot Vital Signs also calculates Mean Arterial Pressure (MAP). All blood pressure, pulse, temperature and SpO2 values are displayed on a large, easy-to-read LCD display, and may be printed via an external thermal printer, as desired. The rechargeable battery and wide variety of mounting accessories make the Welch Allyn Spot Vital Signs convenient for many locations.
More Information

Not Found

No
The description focuses on standard vital sign measurement technologies (blood pressure, pulse oximetry, thermometry) and explicitly states it is a one-time measurement device without continuous monitoring, memory, or programmable alarm features, which are not indicative of AI/ML capabilities. There is no mention of AI, ML, or related concepts in the provided text.

No.
The device is for measurement and monitoring of vital signs, not for treating a condition or disease.

No.
The device measures vital signs (blood pressure, pulse rate, temperature, SpO2) but is explicitly stated as "not a monitor" and for "one-time vital signs measurement". It does not provide continuous monitoring, memory, or alarm features typically associated with diagnostic devices, nor does its intended use describe diagnosing conditions, but rather providing data points.

No

The device description explicitly details hardware components such as a base unit for blood pressure measurement, options for thermometry and pulse oximetry, an LCD display, a rechargeable battery, and mounting accessories. It is clearly a physical medical device with integrated software, not a software-only device.

Based on the provided text, the Welch Allyn Spot Vital Signs is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • IVD devices are used to examine specimens taken from the human body. The text describes the Welch Allyn Spot Vital Signs as a device that measures vital signs directly from the patient's body (blood pressure, pulse rate, temperature, and oxygen saturation). It does not involve the analysis of biological samples like blood, urine, or tissue.
  • The intended use and device description clearly outline non-invasive measurements. The device measures vital signs externally and directly from the patient.

Therefore, the Welch Allyn Spot Vital Signs falls under the category of a non-invasive medical device used for monitoring and measuring physiological parameters, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Welch Allyn Spot Vital Signs is intended for measurement of blood pressure, pulse rate, temperature and oxygen saturation (SpO2) of adult and pediatric patients. The device is not designed, sold or intended for use except as indicated.

  • The Welch Allyn Spot Check Device is not designed for use with neonates. To ensure pediatric blood pressure accuracy and safety, note that the Welch Allyn small cuff (5200-03) and the small One Piece cuff (5200-13) are the smallest cuffs approved for use with young children and infants. The circumference of the child's arm must fit within the range markings on the cuff.
  • The Welch Allyn Spot Check Device should not be used on patients who are linked to heart/lung machines.
  • The Welch Allyn Spot Check Device is not designed for use of axillary temperature option above three years of age in children.
  • The Welch Allyn Spot Check Device is not intended to monitor patient's vital signs.
  • The Welch Allyn Spot Check Device is not defibrillator proof.

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

DQA

Device Description

The Welch Allyn Spot Vital Signs is not a monitor, but a one-time vital signs measurement device. This product will not have continuous monitoring capability with timed cycle intervals, memory, or any various programmable alarm features. The device is intended to provide the physician, physician's assistant, or nurse, facing high patient traffic or multiple tasks, a cost effective method to determine a one-time vital signs reading on the spot. The base unit will have non-invasive blood pressure (BP) measurement. Options will also be offered such as SureTemp® thermometry, Nellcor® pulse oximetry (SpO2), mounting bracket, and rolling stand. The device may be interfaced with an external printer via an infrared port.

The Welch Allyn Spot Vital Signs is designed to non-invasively measure systolic and diastolic blood pressure, pulse rate, temperature and oxygen saturation (SpO2) for adult and pediatric patients. The Welch Allyn Spot Vital Signs also calculates Mean Arterial Pressure (MAP). All blood pressure, pulse, temperature and SpO2 values are displayed on a large, easy-to-read LCD display, and may be printed via an external thermal printer, as desired. The rechargeable battery and wide variety of mounting accessories make the Welch Allyn Spot Vital Signs convenient for many locations.

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

adult and pediatric patients.
not designed for use with neonates.
not designed for use of axillary temperature option above three years of age in children.
The Welch Allyn small cuff (5200-03) and the small One Piece Cuff (5200-13) are the smallest cuffs approved for use with young children and infants.

Intended User / Care Setting

physician, physician's assistant, or nurse

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)

Not Found

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.

K002530, K012891

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

§ 870.2700 Oximeter.

(a)
Identification. An oximeter is a device used to transmit radiation at a known wavelength(s) through blood and to measure the blood oxygen saturation based on the amount of reflected or scattered radiation. It may be used alone or in conjunction with a fiberoptic oximeter catheter.(b)
Classification. Class II (performance standards).

0

K 022163

SEP 1 7 2002

V. 510(k) Summary

[As described in CFR 807.92]

| Submitted by: | Welch Allyn Inc.
4341 State Street Road
Skaneateles Falls, NY 13153 |
|----------------------|----------------------------------------------------------------------------------------------|
| Contact Person: | David Klementowski
Corporate Regulatory Affairs Manager |
| Date Prepared: | 20 May 2002 |
| Proprietary Name: | Welch Allyn Spot Vital Sign Monitor with MP506 |
| Common Name: | Vital Signs measurement device |
| Classification Name: | Class II 870.1130 Noninvasive Blood Pressure
Measurement System |
| Predicate Devices: | Welch Allyn Spot Vital Signs
Welch Allyn, Inc.
510(k) Document Control Number K002530 |
| | OxiMax Pulse Oximetry System w/N-595 Pulse Oximeter
Nellcor Puritan Bennett, Incorporated |

Noneor Parkan Delhott, Incorporator
510(k) Document Control Number K012891

1

Description of the Device:

The Welch Allyn Spot Vital Signs is not a monitor, but a one-time vital signs measurement device. This product will not have continuous monitoring capability with timed cycle intervals, memory, or any various programmable alarm features. The device is intended to provide the physician, physician's assistant, or nurse, facing high patient traffic or multiple tasks, a cost effective method to determine a one-time vital signs reading on the spot. The base unit will have non-invasive blood pressure (BP) measurement. Options will also be offered such as SureTemp® thermometry, Nellcor® pulse oximetry (SpO2), mounting bracket, and rolling stand. The device may be interfaced with an external printer via an infrared port.

The Welch Allyn Spot Vital Signs is designed to non-invasively measure systolic and diastolic blood pressure, pulse rate, temperature and oxygen saturation (SpO2) for adult and pediatric patients. The Welch Allyn Spot Vital Signs also calculates Mean Arterial Pressure (MAP). All blood pressure, pulse, temperature and SpO2 values are displayed on a large, easy-to-read LCD display, and may be printed via an external thermal printer, as desired. The rechargeable battery and wide variety of mounting accessories make the Welch Allyn Spot Vital Signs convenient for many locations.

Intended Use

The Welch Allyn Spot Check Device Check Device is intended for measurement of blood pressure, pulse rate, temperature and oxygen saturation (SpO2) of adult and pediatric patients. The device is not designed, sold or intended for use except as indicated.

The Welch Allyn Spot Check Device is not designed for use with neonates. To ensure pediatric blood pressure accuracy and safety, note that the Welch Allyn small cuff (5200-03) and the small One Piece Cuff (5200-13) are the smallest cuffs approved for use with young children and infants. The circumference of the child's arm must fit within the range markings on the cuff.

The Welch Allyn Spot Check Device should not be used on patients who are linked to heart/lung machines.

The Welch Allyn Spot Check Device is not designed for use of axillary temperature option above three years of age in children.

The Welch Allyn Spot Check Device is not intended to monitor patient's vital signs.

The Welch Allyn Spot Check Device is not defibrillator proof.

2

Action Taken to Comply with Section 514 of the Act

The agency has recognized the following standards:

  • a) EN60601-1
  • b) EN60601-1-1
  • c) EN60601-1-2
  • d) EN60601-1-4
  • e) AAMI SP10
  • f) ASTM 1112-86
  • g) EN 865

The Welch Allyn Spot Vital Sign with MP506 Pulse Oximeter OEM module meets the requirements called out in these standards. Evidence of compliance is on file at Welch Allyn and is available for review upon demand.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle, there is a stylized symbol that resembles three overlapping human profiles or abstract shapes, possibly representing people or services provided by the department.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. David Klementowski Corporate Regulatory Affairs Manager Welch Allyn, Incorporated 4341 State Street Road Skaneateles Falls, New York 13153-0220

Re: K022163

Trade/Device Name: Welch Allyn Spot Vital Sign Monitor with MP506 Regulation Number: 870.2700 Regulation Name: Oximeter Regulatory Class: II Product Code: DQA Dated: August 13, 2002 Received: August 20, 2002

Dear Mr. Klementowski:

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 vour 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.

4

Page 2 - Mr. Klementowski

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.

This letter will allow you to begin marketing your device as described in your Section 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 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 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,

Timothy A. Ulatowski

Timothy Ulatowski Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

III. Indications for Use Statement

11 11 11 11

.

510(k) Number:Unknown K022163
Device Name:Welch Allyn Spot Vital Signs
Indications for use:The Welch Allyn Spot Vital Signs is intended for
measurement of blood pressure, pulse rate, temperature and
oxygen saturation (SpO2) of adult and pediatric patients.
The device is not designed, sold or intended for use except
as indicated.
  • The Welch Allyn Spot Check Device is not designed for
    use with neonates. To ensure pediatric blood pressure
    accuracy and safety, note that the Welch Allyn small cuff
    (5200-03) and the small One Piece cuff (5200-13) are the
    smallest cuffs approved for use with young children and
    infants. The circumference of the child's arm must fit
    within the range markings on the cuff.
  • The Welch Allyn Spot Check Device should not be used
    on patients who are linked to heart/lung machines.
  • The Welch Allyn Spot Check Device is not designed for
    use of axillary temperature option above three years of age
    in children.
  • The Welch Allyn Spot Check Device is not intended to
    monitor patient's vital signs.
  • The Welch Allyn Spot Check Device is not defibrillator
    proof. |

(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-Counter Use

(Division Sign-Off)

Division of Anesthesiology, General Hospital,

Infection Control, Dental Devices

510(k) Number: IL022163