K Number
K033631
Device Name
MODIFICATION TO COATEST FACTOR VIII
Date Cleared
2003-12-15

(26 days)

Product Code
Regulation Number
864.7290
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Coatest Factor VIII was modified to substitute the natural porcine phospholipids in the Phospholipid reagent with synthetic phospholipids. This modification does not alter the fundamental scientific technology of the device or its intended use for the photometric determination of Factor VIII activity in citrated plasma. For in vitro diagnostic use.
Device Description
Coatest Factor VIII (K833892) was modified to substitute the natural porcine phospholipids in the Phospholipid reagent with synthetic phospholipids. This modification does not alter the fundamental scientific technology of the device or its intended use for the photometric determination of Factor VIII activity in citrated plasma.
More Information

Not Found

No
The summary describes a modification to a reagent in a photometric assay and does not mention any computational or algorithmic components indicative of AI/ML.

No.
The device is for "in vitro diagnostic use" to determine Factor VIII activity in plasma, which is a diagnostic function, not a therapeutic one.

Yes

The "Intended Use / Indications for Use" states, "For in vitro diagnostic use."

No

The device description explicitly states it is a modification of a reagent kit used for photometric determination of Factor VIII activity, indicating it is a physical in vitro diagnostic device, not software.

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

The "Intended Use / Indications for Use" section explicitly states: "For in vitro diagnostic use." This is the primary indicator that the device is intended for use outside of a living organism to diagnose diseases or other conditions.

N/A

Intended Use / Indications for Use

Coatest Factor VIII was modified to substitute the natural porcine phospholipids in the Phospholipid reagent with synthetic phospholipids. This modification does not alter the fundamental scientific technology of the device or its intended use for the photometric determination of Factor VIII activity in citrated plasma.
For in vitro diagnostic use.

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

GGP

Device Description

Coatest Factor VIII (K833892) was modified to substitute the natural porcine phospholipids in the Phospholipid reagent with synthetic phospholipids. This modification does not alter the fundamental scientific technology of the device or its intended use for the photometric determination of Factor VIII activity in citrated plasma.

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Within run and between run precision assessed over multiple runs in the low and high ranges using two levels of control plasma gave the results below:

RangeControl LevelnMean % FVIIIWithin Run %CVBetween Run %CV
LowLow9014.41.52.3
HighNormal8981.81.42.4

The following results were obtained in a method comparing the current legally marketed Coatest Factor VIII to the modified Coated Factor VIII:

1.002
0.365
0 085
100 000
. 47 % EVET

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.

K833892

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

§ 864.7290 Factor deficiency test.

(a)
Identification. A factor deficiency test is a device used to diagnose specific coagulation defects, to monitor certain types of therapy, to detect coagulation inhibitors, and to detect a carrier state (a person carrying both a recessive gene for a coagulation factor deficiency such as hemophilia and the corresponding normal gene).(b)
Classification. Class II (performance standards).

0

K033631

(5

DEC 1 5 2003

Section 3 Coatest Factor VIII 510(k) Summary (Summary of Safety and Effectiveness)

Submitted by:

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

Contact Person:

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

Summary Prepared:

November 18, 2003

Name of the Device:

Coatest Factor VIII (Modified)

Classification Name:

864.7290Factor Deficiency TestClass II
81GGPTest, Qualitative and Quantitative Factor Deficiency

Identification of predicate device:

K833892 Coatest Factor VII

Description of the modified device:

Coatest Factor VIII (K833892) was modified to substitute the natural porcine phospholipids in the Phospholipid reagent with synthetic phospholipids. This modification does not alter the fundamental scientific technology of the device or its intended use for the photometric determination of Factor VIII activity in citrated plasma.

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

The modified Coatest Factor VIII is substantially equivalent in performance, intended use, safety and effectiveness to the currently marketed Coatest Factor VIII.

Summary of Performance Data:

Within run and between run precision assessed over multiple runs in the low and high ranges using two levels of control plasma gave the results below:

| Range | Control Level | n | Mean
% FVIII | Within Run
%CV | Between Run
%CV |
|-------|---------------|----|-----------------|-------------------|--------------------|
| Low | Low | 90 | 14.4 | 1.5 | 2.3 |
| High | Normal | 89 | 81.8 | 1.4 | 2.4 |

The following results were obtained in a method comparing the current legally marketed Coatest Factor VIII to the modified Coated Factor VIII:

| ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | الموال
| CALL CLASS COLLECT A
Intercept | | As all all of the store and the first the first the figure of the film to the collection of the film of the collection and the comments of the results of the second the secon
Sample Range |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------|-----------------------------------|------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1. 20
Special and the first and the company of the company of the company of the company of the company of the company of the company of the company of the company of the company o | 1.002 | 0.365 | 0 085
100 000 | Californial
. 47 % EVET
1 |

1

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/1/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 words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" around the perimeter. Inside the circle is an abstract image of an eagle with its wings spread.

Public Health Service

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

DEC 1 5 2003

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

Re: K033631

Trade/Device Name: Coatest Factor VIII (Modified) Regulation Number: 21 CFR 864.7290 Regulation Name: Factor Deficiency Test Regulatory Class: Class II Product Code: GGP Dated: November 18, 2003 Received: November 19, 2003

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 Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. 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 Parts 801 and 809); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820).

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 and thus, permits your device to proceed to the market.

If you desire specific information about the application of labeling requirements to your device, or questions on the promotion and advertising of your device, please contact the Office of In, Vitro Diagnostic Device Evaluation and Safety at (301) 594-3084. 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,

Steven Sutman

Steven I. Gutman, M.D., M.B.A. Director Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

3

Indications for Use Statement

510(k) Number (if known): K033631

Device Name: Coatest Factor VIII (Modified)

Indications for Use:

Coatest Factor VIII was modified to substitute the natural porcine phospholipids in the Phospholipid reagent with synthetic phospholipids. This modification does not alter the fundamental scientific technology of the device or its intended use for the photometric determination of Factor VIII activity in citrated plasma.

For in vitro diagnostic use.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)
Division Sign-Off
Office of In Vitro Diagnostic Device

Evaluation and Salety

510(k) K033631

Prescription Use
(Per 21 CFR 801.019)

Over-The-Counter Use

Section 2

Special 510(k): Coatest Factor VIII

OR

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