(209 days)
Use Lubricating Jelly to lubricate condoms and for personal lubrication when vaginal dryness causes discomfort. It also eases insertion of rectal thermometers, enemas, and tampons.
The device is a water-based personal lubricant containing chlorhexidine gluconate and methylparaben as preservatives in a vehicle for glucono delta lactone. glycerin, hydroxyethylcellulose, sodium hydroxide, and purified water.
Here's a breakdown of the acceptance criteria and study information for the San-Mar Laboratories Lubricating Jelly, based on the provided document:
This device (San-Mar Laboratories Lubricating Jelly) is a Class II medical device, and the documentation focuses on demonstrating substantial equivalence to a predicate device rather than presenting a performance study with detailed acceptance criteria for a novel device. Therefore, many of the requested fields related to a clinical or AI-driven performance study are not applicable or cannot be extracted from this 510(k) summary.
1. Table of Acceptance Criteria and Reported Device Performance
| Acceptance Criteria Category | Specific Criteria | Reported Device Performance |
|---|---|---|
| Stability | Labeled shelf life (36 months) maintained. | Demonstrated stability throughout the 36-month labeled shelf life. |
| Preservative Effectiveness | Compliance with USP method <51>. | Demonstrated compliance with USP method <51>. |
| Technological Characteristics | Identical to K-Y® Lubricating Jelly (predicate). | Stated as "identical to those of the predicate device." |
2. Sample size used for the test set and the data provenance
- Not Applicable. This 510(k) summary does not describe a test set or data provenance for a performance study in the way it would for a diagnostic or AI-driven device. The "study" mentioned is a long-term stability study and a preservative effectiveness test, not a clinical performance trial with a test set of patient data.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
- Not Applicable. This document does not pertain to a study involving expert-established ground truth for a test set.
4. Adjudication method for the test set
- Not Applicable. No test set or adjudication method is described.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
- Not Applicable. This device is a personal lubricant, not an AI-driven diagnostic or image analysis tool, so an MRMC study is irrelevant here.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
- Not Applicable. This is not an algorithm-based device.
7. The type of ground truth used
- Not Applicable in the traditional sense. For the stability and preservative effectiveness tests, the "ground truth" would be the pre-defined specifications for stability over time and the microbial kill rates/preservation efficacy against specific challenge organisms as per USP <51>. These are objective chemical and microbiological measurements, not expert consensus or pathology.
8. The sample size for the training set
- Not Applicable. This document does not describe a training set as it would for a machine learning or AI device. The "study" focused on product samples for stability and preservative testing.
9. How the ground truth for the training set was established
- Not Applicable. No training set is described.
Summary of the Study:
The primary study mentioned in this 510(k) summary is a 36-month long-term stability study and a preservative effectiveness test (in accordance with USP method <51>). These studies were conducted to confirm the labeled shelf life and the efficacy of the preservatives in the San-Mar Labs Lubricating Jelly. The results confirmed the stability throughout the 36-month shelf life and compliance with USP method <51>. The core evidence for this 510(k) relies on demonstrating that the device's technological characteristics are identical to the predicate device (K-Y® Lubricating Jelly) and that it meets basic quality and shelf-life requirements.
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510(k) Summary
I. General Information on Submitter
| Name: | San-Mar Laboratories, Inc. |
|---|---|
| Address: | 4 Warehouse LaneElmsford, NY 10523 |
| Telephone: | 914.592.3130 |
| Fax: | 914.592.5373 |
| Contact Person: | Simon Sanders |
| Date Prepared: | June 15, 2004 |
II. General Information on Device
Name: San-Mar Laboratories Lubricating Jelly
Classification Name: Patient Lubricant
III. Predicate Device
K-Y® Lubricating Jelly
IV. Description of Device
The device is a water-based personal lubricant containing chlorhexidine gluconate and methylparaben as preservatives in a vehicle for glucono delta lactone. glycerin, hydroxyethylcellulose, sodium hydroxide, and purified water.
V. Intended Use
The San-Mar Labs Lubricating Jelly is intended for personal lubrication when vaginal dryness causes discomfort and as a lubricant for insertion of rectal thermometers, enemas, douches, and similar types of nozzles.
VI. Technological Characteristics of Device Compared to Predicate Device
The technological characteristics of the San-Mar Labs Lubricating Jelly are identical to those of the predicate device.
VII. Summary of Performance Data
Stability of the San-Mar Labs Lubricating Jelly was confirmed throughout its labeled shelf life (36 months) by a 36 month long-term stability study and a preservative effectiveness test in accordance with USP method <51>.
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Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of a human figure with outstretched arms, symbolizing care and protection. The figure is positioned within a circle, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is arranged around the circle's perimeter. The logo is rendered in black and white.
Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850
Mr. Simon Sanders Director of Quality San-Mar Labs, Inc. 4 Warehouse Lane ELMSFORD NY 10523
Re: K041667
JAN 1 3 2005
Trade/Device Name: San-Mar Laboratories Lubricating Jelly Regulation Number: 21 CFR 884.5300 Regulation Name: Condom Regulatory Class: II ---Product Code: 85 HIS Dated: October 22, 2004 Received: October 28, 2004
Dear Mr. Sanders:
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 (Premarket Approval), 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.
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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), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter:
| 21 CFR 876.xxxx | (Gastroenterology/Renal/Urology) | 240-276-0115 |
|---|---|---|
| 21 CFR 884.xxxx | (Obstetrics/Gynecology) | 240-276-0115 |
| 21 CFR 892.xxxx | (Radiology) | 240-276-0120 |
| Other | 240-276-0100 |
Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). You may obtain other general information on your responsibilities under the Act 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.
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
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Indications for Use
510 (k) Number (if known): Kort 1667
KY Type Lubricating Jelly Device Name:
Indications for Use:
Use Lubricating Jelly to lubricate condoms and for personal lubrication when vaginal dryness causes discomfort. It also eases insertion of rectal thermometers, enemas, and tampons.
Prescription Use (Part 21 CFR 801 Subpart D)
AND/OR
Over-The-Counter Use > (21 CFR 801 subpart C)
(PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)
Tancyc Brogdon
(Division Sign-Off)
Division of Reproductive, Abdominal, nd Radiological Device 510(k) Number _
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§ 884.5300 Condom.
(a)
Identification. A condom is a sheath which completely covers the penis with a closely fitting membrane. The condom is used for contraceptive and for prophylactic purposes (preventing transmission of sexually transmitted infections). The device may also be used to collect semen to aid in the diagnosis of infertility.(b)
Classification. (1) Class II (special controls) for condoms made of materials other than natural rubber latex, including natural membrane (skin) or synthetic.(2) Class II (special controls) for natural rubber latex condoms. The guidance document entitled “Class II Special Controls Guidance Document: Labeling for Natural Rubber Latex Condoms Classified Under 21 CFR 884.5300” will serve as the special control. See § 884.1(e) for the availability of this guidance document.