K Number
K041667
Device Name
SAN-MAR LABS LUBRICATING JELLY
Date Cleared
2005-01-13

(209 days)

Product Code
Regulation Number
884.5300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended 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.
Device Description
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.
More Information

K-Y® Lubricating Jelly

Not Found

No
The device description and performance studies focus on the chemical composition and stability of a lubricating jelly, with no mention of AI or ML technologies.

No.
The device is described as a personal lubricant used for comfort during activities like intercourse and insertion of medical devices, which aligns more with a general wellness or convenience product rather than treating or preventing a specific disease or condition. While it eases discomfort, it does not claim therapeutic action.

No
Explanation: The intended use of the device is for lubrication, not for diagnosis of any condition. It facilitates the use of other devices like condoms, rectal thermometers, enemas, and tampons, and addresses discomfort from vaginal dryness, but it does not perform any diagnostic function itself.

No

The device description clearly states it is a water-based personal lubricant with chemical components, indicating it is a physical product, not software.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is for lubrication purposes (condoms, personal lubrication, insertion of medical devices). This is a topical application and does not involve testing samples taken from the human body to diagnose or monitor a medical condition.
  • Device Description: The description lists the ingredients of a lubricant. There is no mention of reagents, test strips, or any components typically associated with in vitro diagnostic tests.
  • Lack of IVD Characteristics: The document does not mention any of the key characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring specific substances in those samples
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions.

Therefore, this device falls under the category of a medical device, but not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for 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.
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.

Product codes

85 HIS

Device Description

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.

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

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 .

Key Metrics

Not Found

Predicate Device(s)

K-Y® Lubricating Jelly

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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.

0

510(k) Summary

K041667

I. General Information on Submitter

Name:San-Mar Laboratories, Inc.
Address:4 Warehouse Lane
Elmsford, 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 .

1

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.

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 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
Other240-276-0100

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

3

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 _

Page 1 of 1