K Number
K042560
Device Name
STELLAR 404 MONITORING SYSTEM
Date Cleared
2004-10-06

(15 days)

Product Code
Regulation Number
870.2300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The STELLAR 404 two parameter Patient Monitoring System is intended to monitor a single adult, pediatric or neonatal patient's vital signs at the bedside or during hospital transport along with the appropriate accessories mentioned/ supplied with the unit. Vital signs parameter includes Plethysmograph. It can also display the digital values of PR, SpO2 Non-Invasive Blood Pressure (Systolic, Diastolic and Mean) readings. The user, responsible to interpret the monitored data made available, will be a professional health-care provider. The device, which can also be used as a portable device, permits patient monitoring with adjustable alarm limits as well as visible and audible alarm signals. The monitor is not intended for home use.
Device Description
This STELLAR 404 unit is a 2 parameter Patient monitor System (TFT color monitor) with NIBP and Pulse oximetry with an optional inbuilt two channel thermal array recorder for printing of Tabular trends & waveforms. STELLAR 404 has waveform display capability for Plethysmograph. It also displays the digital values of PR, SpO2 and Non-Invasive Blood Pressure (Cystolic, Diastolic and Mean) readings. It has graded and color coded alarms It has 2 hours and 12 hours tabular and graphical trends for SpO2. It has special tabular trend for NIBP to store the last 100 readings. Alarm recall feature offers last 16 alarm conditions.
More Information

Not Found

No
The summary describes a standard vital signs monitor with basic data display, trending, and alarm features, with no mention of AI or ML.

No
The device is intended for monitoring vital signs and displaying them, not for treating any medical condition.

No

A diagnostic device is used to identify or determine the nature of a disease or condition. This device is described as a "Patient Monitoring System" that displays vital signs. Its function is to monitor existing conditions, not to diagnose new ones.

No

The device description explicitly states it is a "2 parameter Patient monitor System (TFT color monitor)" and mentions an "optional inbuilt two channel thermal array recorder," indicating it includes hardware components beyond just software.

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

Here's why:

  • IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.
  • The STELLAR 404 Patient Monitoring System directly monitors physiological parameters of a living patient (SpO2, NIBP, Pulse Rate). It does not analyze samples taken from the patient.

The description clearly states its purpose is to monitor a patient's vital signs at the bedside or during transport, using non-invasive methods. This falls under the category of patient monitoring devices, not in vitro diagnostics.

N/A

Intended Use / Indications for Use

The STELLAR 404 two parameter Patient Monitoring System is intended to monitor a single adult, pediatric or neonatal patient's vital signs at the bedside or during hospital transport along with the appropriate accessories mentioned/ supplied with the unit. Vital signs parameter includes Plethysmograph. It can also display the digital values of PR, SpO2 Non-Invasive Blood Pressure (Systolic, Diastolic and Mean) readings.

The user, responsible to interpret the monitored data made available, will be a professional health-care provider. The device, which can also be used as a portable device, permits patient monitoring with adjustable alarm limits as well as visible and audible alarm signals. The monitor is not intended for home use.

Product codes

MWI

Device Description

This STELLAR 404 unit is a 2 parameter Patient monitor System (TFT color monitor) with NIBP and Pulse oximetry with an optional inbuilt two channel thermal array recorder for printing of Tabular trends & waveforms.

STELLAR 404 has waveform display capability for Plethysmograph. It also displays the digital values of PR, SpO2 and Non-Invasive Blood Pressure (Cystolic, Diastolic and Mean) readings. It has graded and color coded alarms It has 2 hours and 12 hours tabular and graphical trends for SpO2. It has special tabular trend for NIBP to store the last 100 readings. Alarm recall feature offers last 16 alarm conditions.

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, pediatric or neonatal

Intended User / Care Setting

professional health-care provider / bedside or during intrahospital transport

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

K032871

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.2300 Cardiac monitor (including cardiotachometer and rate alarm).

(a)
Identification. A cardiac monitor (including cardiotachometer and rate alarm) is a device used to measure the heart rate from an analog signal produced by an electrocardiograph, vectorcardiograph, or blood pressure monitor. This device may sound an alarm when the heart rate falls outside preset upper and lower limits.(b)
Classification. Class II (performance standards).

0

OCT 2004

K042560
P 1/4-

Image /page/0/Picture/2 description: The image shows the logo for Larsen & Toubro Limited. The logo consists of the letters L and T inside of a circle. Below the logo, the words "LARSEN & TOUBRO LIMITED" are written in all caps. The text is bolded and in a sans-serif font.

Powai Works, Saki Vihar Road, P. O. Box 8901, Mumbai-400 072 • Tel. : 858 1401 / 11

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510(K) SUMMARY

(Per section 807.92 ©)

CONTACT DATA
Submitter's NameLarsen & Toubro Limited
AddressKIADB Industrial Area, Hebbal Hootagalli,
Mysore – 570018, Karnataka, INDIA
Telephone91-821-2402561Fax91-821-2402468
Contact PersonA.B.DeshpandeTitleHead - Quality Assurance
E-Mail addressDeshpandeAB@myw.ltindia.com
Date the summary was preparedApril 25th,2004

Regd. Off. : L&T House, Ballard Estate, P.O. Box 278, Mumbai 400 001 • Tel.: 261 8181/82 • Fax : 91-22-262 0223

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Image /page/1/Picture/0 description: The image shows the logo for Larsen & Toubro Limited. The logo consists of the letters 'L' and 'T' intertwined within a circle. Below the logo, the text 'LARSEN & TOUBRO LIMITED' is written in bold, uppercase letters.

Powai Works, Saki Vihar Road, P. O. Box 8901, Mumbai-400 072 • Tel. : 858 1401 / 11

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25th April, 2004 Page : 02 of 04

DEVICE
Trade nameSTELLAR 404
Common namePatient Monitoring System
Classification nameVital Signs Monitor
PREDICATE DEVICE IDENTIFICATION
CFR21 Section870.2300Product code (optional)
Classification panelCardiovascularMWI
Device ClassClass II
Legally marketed Comparison Device / K#PLANET patient Monitoring System (L&T Medical Equipments & systems) / K032871

Regd. Off. : L&T House, Ballard Estate, P.O. Box 278, Mumbai 400 001 • Tel.: 261 8181/82 • Fax : 91-22-262 0223

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Image /page/2/Picture/1 description: The image shows the logo for Larsen & Toubro Limited. The logo consists of a stylized "LT" inside of a circle. Below the logo, the text "LARSEN & TOUBRO LIMITED" is written in all caps.

Powai Works, Saki Vihar Road, P. O. Box 8901, Mumbal-400 072 • Tel. : 858 1401 / 11

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E-mail :

25th April, 2004 Page : 03 of 04

DEVICE DESCRIPTION

This STELLAR 404 unit is a 2 parameter Patient monitor System (TFT color monitor) with NIBP and Pulse oximetry with an optional inbuilt two channel thermal array recorder for printing of Tabular trends & waveforms.

STELLAR 404 has waveform display capability for Plethysmograph. It also displays the digital values of PR, SpO2 and Non-Invasive Blood Pressure (Cystolic, Diastolic and Mean) readings. It has graded and color coded alarms It has 2 hours and 12 hours tabular and graphical trends for SpO2. It has special tabular trend for NIBP to store the last 100 readings. Alarm recall feature offers last 16 alarm conditions.

INTENDED USE OF THE DEVICE

The STELLAR 404 2 parameter Patient Monitoring system is intended to monitor a single adult, pediatric or neonatal patient's vital signs at the bedside or during intrahospital transport along with the appropriate accessories mentioned / supplied with the unit. Vital signs parameter includes Piethysmograph. It can also display the digital values of PR, SpO2, Non-Invasive Blood Pressure (Systolic, Diastolic and Mean) readings. The user, responsible to interpret the monitored data made available, will be a professional health care provider. The device, which can also be used as a portable device, permits patient monitoring with adjustable alarm limits as well as visible and audible alarm signals. The monitor is not intended for home use,

Regd. Off. : 1.&T House, Ballard Estate, P.O. Box 278, Mumbai 400 001 · Tel.: 261 8181/82 · Fax : 91-22-262 0223

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Image /page/3/Picture/1 description: The image shows the logo for Larsen & Toubro Limited. The logo consists of a circle with the letters "L" and "T" inside. Below the circle, the words "LARSEN & TOUBRO LIMITED" are written in all caps. The text is bolded and in a sans-serif font.

Powai Works, Saki Vihar Road, P. O. Box 8901, Mumbai-400 072 · Tel. : 858 1401 / 11

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25th April, 2004 Page : 04 Of 04

TECHNOLOGICAL CHARACTERISTICS OF THE DEVICE COMPARED TO THE PREDICATE DEVICE

Device : Larsen & Toubro limited make STELLAR 404 Patient Monitoring System. Predicate device:

PLANET patient Monitoring System (Make: L&T Medical Equipments & systems) / K032871

The parameters available with the Larsen & Toubro Limited make STELLAR 404 Patient monitoring system (NIBP and Pulse oximetry) are also available with the predicate device. The range and accuracy of the parameters & method of sensing are similar to the predicate devices. In STELLAR 404 monitor audible & visual alarms are provided similar to that in the Predicate device.

STELLAR 404 has got TFT color display like PLANET. STELLAR 404 has got thermal array recorder similar to that available in PLANET. Weight of the STELLAR 404 (4Kg maximum) is less than that of the predicate device. Battery provided in STELLAR 404 is Lithium ion, where as it is Lead acid battery in case of predicate device PLANET.

Comparison of all the parameters of STELLAR 404 to that of the predicate devices is given in the "Substantial Equivalence Equipment comparison" document.

Compliance to standards:

The following international standards are referred. IEC 60601-1 Medical Electrical safety IEC 60601-1-2 EMC compliance

Conclusion:

Based on the Technological characteristics of STELLAR 404 and its comparison with that of predicate device PLANET, Larsen & Toubro Limited believes that their device is substantially equivalent to this predicate Monitor and doesn't pose any additional risk on safetx & effectiveness of the device.

(Mohan G:R)
Head - Design & Development

Regd. Off. : L&T House, Ballard Estate, P.O. Box 278, Mumbai 400 001 • Tel.: 261 8181/82 • Fax : 91-22-262 0223

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Image /page/4/Picture/11 description: The image is a seal for the Department of Health & Human Services - USA. The seal is circular and contains text around the perimeter. In the center of the seal is an abstract image of an eagle.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

OCT 6 - 2004

Larsen & Toubro Ltd. c/o Mr. Ned Devine Entela, Inc. 3033 Madison Ave. SE Grand Rapids, MI 49548

Re: K042560

Trade Name: STELLAR 404 Patient Monitoring System Regulation Number: 21 CFR 870.2300 Regulation Name: Cardiac Monitor (including cardiotachometer and rate alarm) Regulatory Class: Class II (two) Product Code: MWI Dated: September 21, 2004 Received: September 21, 2004

Dear Mr. Devine:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed your bector. 310(x) premained is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate 101 use stated in the encreate) to togally to togal Device Amendments, or to commerce prior to May 20, 1978, the examine
devices that have been reclassified in accordance with the provisions of the Federal Food, DNAA de vices may been results in a mot require approval of a premarket approval application (PMA). allu Cosmetic Act (71ct) that do not requent to the general controls provisions of the Act. The I ou may, dicroro, market are act include requirements for annual registration, listing of general controls provisions of as tice, 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 If your device to such additional controls. Existing major regulations affecting your device can may be subject to such additions, Title 21, Parts 800 to 898. In addition, FDA may be found in ther announcements concerning your device in the Federal Register.

5

Page 2 – Mr. Ned Devine

Please be advised that FDA's issuance of a substantial equivalence determination does not mean Please be advised that I Dri 3 issuation of a bevice complies with other requirements of the Act that I DA has made a decommanding administered by other Federal agencies. You must or any I oderal statutes and registements, including, but not limited to: registration and listing (21 Comply with an the Act 31equirements, 01); good manufacturing practice requirements as set CTN in the quality systems (QS) of Art 807), go critical (21), and if applicable, the electronic (200 forth in the quality systems (Sections 531-542 of the Act); 21 CFR 1000-1050. product radiation of to begin marketing your device as described in your Section 510(k) I his letter will anow you to oegin mainer of substantial equivalence of your device to a legally prematics notification: "The PDF intentigestication 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 If you desire specific arrestiance at (301) 594-4646. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Whoording of reference to your responsibilities under the Act may be obtained from the Other general informational 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,

B. Ziminor for
B. Ziminor, MD

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

6

Indications for Use

510(k) Number (if known): K042560

Device Name: STELLAR 404

Indications for Use:

The STELLAR 404 two parameter Patient Monitoring System is intended to monitor a single adult, pediatric or neonatal patient's vital signs at the bedside or during hospital transport along with the appropriate accessories mentioned/ supplied with the unit. Vital signs parameter includes Plethysmograph. It can also display the digital values of PR, SpO2 Non-Invasive Blood Pressure (Systolic, Diastolic and Mean) readings.

The user, responsible to interpret the monitored data made available, will be a professional health-care provider. The device, which can also be used as a portable device, permits patient monitoring with adjustable alarm limits as well as visible and audible alarm signals. The monitor is not intended for home use.

Blumiman
(Division Sign Off)

(Division Sign-Off) Division of Cardiovascular Devices 510(k) Number KOUNS

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)