K Number
K031463
Device Name
MARINA MEDICAL SILICONE PESSARY
Date Cleared
2003-11-18

(194 days)

Product Code
Regulation Number
884.3575
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia. It is available with different sizes of the following models: CUBE (with and without drain), OVAL. (with and without support), HODGE (with and without support), SHAATZ , GELLHORN (with and without drains), RING (with and without support), DONUT , GEHRUNG, DISH (with and without support), & MAR-LAND (with and without support). CUBE: indicated for use for the support of a third-degree prolapse. OVAL: indicated for use for the support of a first or mild second-degree prolapse. HODGE: indicated for use for the support of a uterine retroversion. SHAATZ; indicated for use for the support of a first or mild second-degree prolapse. GELLHORN: indicated for use for the support of a third-degree prolapse or procidentia. RING: indicated for use for the support of a first or mild second-degree prolapse. DONUT: indicated for use for the support of a third-degree prolapse. GEHRUNG: indicated for use for the support of cystocele or rectocele. DISH: indicated for use for the control of stress urinary incontinence or a first or mild seconddegree prolapse. It restores continence by applying gentle pressure to the urethra. MAR-LAND: indicated for use for the control of stress urinary incontinence or a first or mild second-degree prolapse. It restores continence by applying gentle pressure to the urethra.
Device Description
This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia. It is available with different sizes of the following models: CUBE (with and without drain), OVAL (with and without support). HODGE (with and without support), SHAATZ , GELLHORN (with and without drains), RING (with and without support), DONUT , GEHRUNG, DISH (with and without support), & MAR-LAND (with and without support). All models with their dimensions are detailed within the labeling section of this submission.
More Information

Not Found

No
The device description and intended use clearly describe a physical, non-electronic medical device (a silicone pessary) with no mention of software, algorithms, or any components that would suggest the use of AI or ML.

Yes
The device is described as treating conditions such as uterine prolapse, uterine retroposition, or gynecologic hernia, which are therapeutic uses.

No
The device description clearly states its purpose is to "support the pelvic organs and is used to treat conditions" like uterine prolapse, indicating a therapeutic rather than diagnostic function.

No

The device description explicitly states it is a physical structure made of silicone, placed in the vagina. This is a hardware device, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In vitro diagnostic devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information for diagnosis, monitoring, or screening.
  • Device Description and Intended Use: The description clearly states that this device is a physical structure placed in the vagina to support pelvic organs and treat conditions like prolapse and retroposition. It is a mechanical device for physical support and treatment.
  • Lack of Specimen Analysis: There is no mention of this device analyzing any biological specimens or providing diagnostic information based on such analysis.

Therefore, this device falls under the category of a medical device used for physical support and treatment, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia. It is available with different sizes of the following models: CUBE (with and without drain), OVAL. (with and without support), HODGE (with and without support), SHAATZ , GELLHORN (with and without drains), RING (with and without support), DONUT , GEHRUNG, DISH (with and without support), & MAR-LAND (with and without support).

CUBE: indicated for use for the support of a third-degree prolapse. OVAL: indicated for use for the support of a first or mild second-degree prolapse. HODGE: indicated for use for the support of a uterine retroversion. SHAATZ; indicated for use for the support of a first or mild second-degree prolapse. GELLHORN: indicated for use for the support of a third-degree prolapse or procidentia. RING: indicated for use for the support of a first or mild second-degree prolapse. DONUT: indicated for use for the support of a third-degree prolapse. GEHRUNG: indicated for use for the support of cystocele or rectocele. DISH: indicated for use for the control of stress urinary incontinence or a first or mild second-degree prolapse. It restores continence by applying gentle pressure to the urethra. MAR-LAND: indicated for use for the control of stress urinary incontinence or a first or mild second-degree prolapse. It restores continence by applying gentle pressure to the urethra.

Product codes

85 HHW

Device Description

This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia. It is available with different sizes of the following models: CUBE (with and without drain), OVAL (with and without support). HODGE (with and without support), SHAATZ , GELLHORN (with and without drains), RING (with and without support), DONUT , GEHRUNG, DISH (with and without support), & MAR-LAND (with and without support).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

vagina

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)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K013289

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 884.3575 Vaginal pessary.

(a)
Identification. A vaginal pessary is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia.(b)
Classification. Class II (performance standards).

0

510(k) Summary As Required by 21 section 807.92 ( c )

1-Submitter Name: Mansour Consulting LLC

  • 1308 Morningside Park Dr 2-Address: Alpharetta, GA 30022 USA 3-Phone: (770) 777- 4146 (678) 623- 3765 4-Fax: 5-Contact Person: Jay Mansour 6-Date summary prepared: May 5th, 2003
  • 7 Device Trade or Proprietary Name: MARINA MEDICAL SILICONE PESSARY
  • 8-Device Common or usual name: PESSARY

9-Device Classification Name: VAGINAL PESSARY

10-Substantial Equivalency is claimed against the following device:

  • Bioteque Vaginal pessary from BIOTEQUE AMERICA, INC., 510k # K013289 .

11-Description of the Device:

This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia. It is available with different sizes of the following models: CUBE (with and without drain), OVAL (with and without support). HODGE (with and without support), SHAATZ , GELLHORN (with and without drains), RING (with and without support), DONUT , GEHRUNG, DISH (with and without support), & MAR-LAND (with and without support).

All models with their dimensions are detailed within the labeling section of this submission.

12-Intended use of the device:

This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia.

CUBE: indicated for use for the support of a third-degree prolabse.

OVAL: indicated for use for the support of a first or mild second-degree prolabse.

HODGE: indicated for use for the support of a uterine retroversion.

SHAATZ: indicated for use for the support of a first or mild second-degree prolapse.

GELLHORN: indicated for use for the support of a third-degree profapse or procidentia.

RING: indicated for use for the support of a first or mild second-degree prolapse.

DONUT: indicated for use for the support of a third-degree prolapse.

GEHRUNG: indicated for use for the support of cystocele or rectocele.

DISH: indicated for use for the control of stress urinary incontinence or a first or mild second-degree prolapse. It restores continence by applying gentle pressure to the urethra. MAR-LAND: indicated for use for the control of stress urinary incontinence or a first or mild second-degree prolapse. It restores continence by applying gentle pressure to the urethra.

13-Safety and Effectiveness of the device;

This device is safe and effective as the other predicate device cited above. This is better expressed in the tabulated comparison (Paragraph 14 below)

1

Image /page/1/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS) of the United States. The seal features a stylized caduceus-like symbol, with three abstract human profiles facing right. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is arranged in a circular fashion around the symbol.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 1 8 2003

Marina Medical Instruments, Inc. % Mr. Jay Mansour Managing Member Mansour Consulting, LLC 1308 Morningside Park Dr. ALPHARETTA GA 30022

Re: K031463

Trade/Device Name: Marina Medical Pessaries Regulation Number: 21 CFR 884.3575 Regulation Name: Vaginal pessary Regulatory Class: II Product Code: 85 HHW Dated: September 29, 2003 Received: September 6, 2003

Dear Mr. Mansour:

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 indivations 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, Dry, 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, itstion cof 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 devive 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 1,000-2050.

2

Page 2

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 to regary to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of the letter:

8xx.1xxx(301) 594-4591
876.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4616
884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx(301) 594-4616
892.2xxx, 3xxx, 4xxx, 5xxx(301) 594-4654
Other(301) 594-4692

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, "Microsiding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtain. Other golleral 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/cdch/dsma/dsmamovin's.html.

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

Sincerely yours.

3

510(k) Number (if known): K 03146 3

Device Name: MARINA MEDICAL PESSARIES

Indications for Use:

This device is made out of silicone, and it is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia. It is available with different sizes of the following models: CUBE (with and without drain), OVAL. (with and without support), HODGE (with and without support), SHAATZ , GELLHORN (with and without drains), RING (with and without support), DONUT , GEHRUNG, DISH (with and without support), & MAR-LAND (with and without support).

CUBE: indicated for use for the support of a third-degree prolapse. OVAL: indicated for use for the support of a first or mild second-degree prolapse. HODGE: indicated for use for the support of a uterine retroversion. SHAATZ; indicated for use for the support of a first or mild second-degree prolapse. GELLHORN: indicated for use for the support of a third-degree prolapse or procidentia. RING: indicated for use for the support of a first or mild second-degree prolapse. DONUT: indicated for use for the support of a third-degree prolapse. GEHRUNG: indicated for use for the support of cystocele or rectocele. DISH: indicated for use for the control of stress urinary incontinence or a first or mild seconddegree prolapse. It restores continence by applying gentle pressure to the urethra. MAR-LAND: indicated for use for the control of stress urinary incontinence or a first or mild second-degree prolapse. It restores continence by applying gentle pressure to the urethra.

Prescription Use

Nancy Burgdon


(Division Sign-Off)

Division of Reproductive, Abd and Radiological Devices 510(k) Number

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

Concurence of CDRH, Office of Device Evaulation (ODE)

(Optional Formal 3-10-98)