K Number
K050312
Device Name
AMIGO INSULIN PUMP
Date Cleared
2005-05-09

(90 days)

Product Code
Regulation Number
880.5725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Amigo Insulin Pump is intended for the subcutaneous infusion of insulin.
Device Description
The Amigo Insulin Pump is a small, lightweight, battery-operated programmable Insulin infusion pump. The pump houses a replaceable Nipro GlucoPro™ single-use insulin syringe containing up to 300 units of U-100 insulin. Programming is accomplished via a keypad and LCD display. A microcomputer controls the rotation of a stepper-motor which is connected to a gear reduction assembly. The output of the reduction assembly turns a lead-screw which moves a linear piston. The piston mechanically engages the plunger of the insulin syringe, and the programmed amount of insulin is dispensed through an external seal and luer lock connector to an infusion set.
More Information

Not Found

No
The description details a mechanical pump controlled by a microcomputer for dispensing insulin based on programmed settings. There is no mention of AI, ML, or any learning algorithms.

Yes
The device is an insulin pump, which is used to deliver a therapeutic substance (insulin) to treat a medical condition (diabetes).

No
Explanation: The device is an insulin pump used for the infusion of insulin, which is a therapeutic function, not a diagnostic one. It dispenses medication, it does not diagnose a condition.

No

The device description explicitly details hardware components such as a pump, battery, keypad, LCD display, microcomputer, stepper-motor, gear reduction assembly, lead-screw, linear piston, and syringe. This indicates it is a physical medical device with integrated software, not a software-only device.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is the "subcutaneous infusion of insulin." This describes a therapeutic action (delivering medication into the body), not a diagnostic test performed on samples outside the body.
  • Device Description: The description details a mechanical pump that delivers insulin. It doesn't mention any components or processes related to analyzing biological samples (like blood, urine, etc.) to diagnose a condition or monitor a physiological state.
  • Lack of IVD Indicators: The document does not contain any of the typical indicators of an IVD, such as:
    • Analysis of biological samples.
    • Measurement of analytes (glucose, hormones, etc.).
    • Diagnostic claims.
    • Mention of reagents or test strips.

This device is clearly a therapeutic device for delivering insulin, not a diagnostic device.

N/A

Intended Use / Indications for Use

The Amigo Insulin Pump is intended for the subcutaneous infusion of insulin.

Product codes

LZG

Device Description

The Amigo Insulin Pump is a small, lightweight, battery-operated programmable Insulin infusion pump. The pump houses a replaceable Nipro GlucoPro™ single-use insulin syringe containing up to 300 units of U-100 insulin. Programming is accomplished via a keypad and LCD display. A microcomputer controls the rotation of a stepper-motor which is connected to a gear reduction assembly. The output of the reduction assembly turns a lead-screw which moves a linear piston. The piston mechanically engages the plunger of the insulin syringe, and the programmed amount of insulin is dispensed through an external seal and luer lock connector to an infusion set.

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)

Not Found

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

Not Found

Predicate Device(s)

K013309

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5725 Infusion pump.

(a)
Identification. An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.(b)
Classification. Class II (performance standards).

0

K 0503/2

MAY - 9 2005 510(k) Summary

  • 1.0 Date Prepared
    January 14, 2005

  • 2.0 Submitter (Contact)
    Clarence Odem, III General Manager Nipro Diabetes Systems, Inc. Miramar, FL 32205 (954) 435-5665

  • 3.0 Device Name
    Proprietary / Trade Name: Amigo Insulin Pump Insulin pump Common Name(s):

  • 4.0 Device Classification
    Classification Name: P Pump, Infusion, Insulin Procode: 80LZG Class II

21 CFR § 880.5725

  • 5.0 Device Description
    The Amigo Insulin Pump is a small, lightweight, battery-operated programmable Insulin infusion pump. The pump houses a replaceable Nipro GlucoPro™ single-use insulin syringe containing up to 300 units of U-100 insulin. Programming is accomplished via a keypad and LCD display. A microcomputer controls the rotation of a stepper-motor which is connected to a gear reduction assembly. The output of the reduction assembly turns a lead-screw which moves a linear piston. The piston mechanically engages the plunger of the insulin syringe, and the programmed amount of insulin is dispensed through an external seal and luer lock connector to an infusion set.

  • 6.0 Indications for Use
    The Amigo Insulin Pump is intended for the subcutaneous infusion of insulin.

1

7.0 Substantial Equivalence

The Amigo Insulin Pump is substantially equivalent in the intended use, operating principle, overall design, performance, technology, features, functions, and materials to the GlucoPro EVA Pump as described in K013309.

| Characteristic | Amigo Insulin Pump
(This Submission) | GlucoPro EVA
(K013309) |
|-----------------------------|------------------------------------------------------|------------------------------------------------------|
| Intended Use | Intended for the subcutaneous
infusion of insulin | Intended for the subcutaneous
infusion of insulin |
| Pump Type | Linear Piston | Linear Piston |
| Control Technology | Microprocessor | Microprocessor |
| Insulin Reservoir | 3 mL (300 Units) | 3 mL (300 Units) |
| Insulin Type | U-100 | U-100 |
| Power Source | One 3 Volt lithium battery | One 3 Volt lithium battery |
| Programmable Basal Delivery | Yes | Yes |
| Programmable Bolus Delivery | Yes | Yes |
| User Notification | Audible, visual, and vibration | Audible, visual, and vibration |
| Visual Display | LCD | LCD |
| Insulin Syringe / reservoir | Nipro GlucoPro | Nipro GlucoPro |
| Infusion Set Connector | Standard luer lock | Standard luer lock |

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized eagle with three lines forming its body and wings. The eagle is enclosed in a circle of text that reads "DEPARTMENT OF HEALTH AND HUMAN SERVICES . USA".

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY - 9 2005

Mr. Clarence Odom, III General Manager NIPRO Diabetes Systems, Incorporated 3361 Enterprise Way Miramar, Florida 33025

Re: K050312

Trade/Device Name: Amigo Insuliñ Pump Regulation Number: 880.5275 Regulation Name: Infusion Pump Regulatory Class: II Product Code: LZG Dated: January 31, 2005 Received: February 8, 2005

Dear Mr. Odom:

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 morender editions or to devices that have been reclassified in accordance with the provisions of / Including of to corrend Cosmetic Act (Act) that do not require approval of a premarket the reachar F over, 2008, 1998, 1herefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include controls provisions 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 (1 wr 1), its 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.

3

Page 2 - Mr. Odom

Please be advised that FDA's issuance of a substantial equivalence determination does not Please oe advisod that 1 Dr. 5 leadines on that your device complies with other requirements mean that I DA mas made a autes and regulations administered by other Federal agencies. of the Act of ally rederal states and right.
You must comply with all the Act s requirements, including, but not limited to: registration 1 ou must comply with and are labeling (21 CFR Part 801); good manufacturing practice allo listing (21 CFR Part 007), labeling systems (QS) regulation (21 CFR Part 820); and if requirents as set forth in the quality sion control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) I mis letter will and if you to be objects.
premarket notification. The FDA finding of substantial equivalence of your device to a premiarket nothreation. THE PDF 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), If you desire specific at not to for Joinese at (240) 276-0115. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the may outmit one. Echerwracturers, 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/industry/support/index.html.

Sincerely yours,

Gylette H. Michie Oms.

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): Amigo Insulin Pump Device Name: Indications for Use:

The Amigo Infusion Pump is intended for the subcutaneous infusion of insulin

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 IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

i.K. Jone

. ... Sistan Sign-Off) · Liston or Anesthesiology, General Hospital, Theation Control, Dental Devices

10(k) Number_KAS 9312

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