K Number
K052551
Device Name
DEVON STANDARD SYRINGE, HYPODERMIC NEEDLE AND INSULIN SYRINGE
Date Cleared
2005-09-30

(14 days)

Product Code
Regulation Number
880.5860
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
This device is intended for injection of fluids into, or withdrawing fluids from, parts of the body below the surface of the skin. Syringe with plunger for general medical uses. The Insulin syringes are intended for insulin injection.
Device Description
The Devon Standard Syringe is a sterile, single use, disposable syringe with attachable hypodermic needle. The Devon Standard Syringe consists of a syringe barrel, a plunger rod, piston, nozzle cap and a single lumen hypodermic needle. The Insulin syringes are used for the injection of U100 insulin only and have scale lines in insulin units.
More Information

Not Found

No
The document describes a standard syringe and needle, with no mention of AI or ML capabilities or related performance metrics.

No
This device is intended for the injection or withdrawal of fluids, which is a diagnostic or procedural function, not a therapeutic one that treats or cures a condition.

No
The device is described as a syringe for injection or withdrawal of fluids, and its intended use is for general medical uses, specifically for administering insulin or other fluids. This function is therapeutic or for sample collection, not for diagnosing a condition.

No

The device description clearly outlines physical components like a syringe barrel, plunger rod, piston, nozzle cap, and hypodermic needle, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is for "injection of fluids into, or withdrawing fluids from, parts of the body below the surface of the skin." This describes a procedure performed on the body, not a test performed on a sample taken from the body.
  • Device Description: The description details a syringe and needle, which are tools for administering or withdrawing substances directly from the body. It doesn't mention any components or processes related to analyzing biological samples.
  • Lack of IVD Indicators: There is no mention of analyzing blood, urine, tissue, or any other biological sample. There is no mention of diagnostic purposes or providing information about a patient's health status based on sample analysis.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for diagnostic, monitoring, or screening purposes. This syringe fits the description of a general medical device used for direct patient care procedures.

N/A

Intended Use / Indications for Use

The Devon Standard Syringe is intended for injection of fluids into, or withdrawing fluids from, parts of the body below the surface of the skin.
Syringe with plunger for general medical uses.
The Insulin syringes are intended for insulin injection.

Product codes

FMF, FMI

Device Description

The Devon Standard Syringe is a sterile, single use, disposable syringe with attachable hypodermic needle. The Devon Standard Syringe consists of a syringe barrel, a plunger rod, piston, nozzle cap and a single lumen hypodermic needle.
The Insulin syringes are used for the injection of U100 insulin only and have scale lines in insulin units.

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

The Devon Standard Syringe has been shown to meet internationally recognized standards for syringe performance and labeling characteristics.

Key Metrics

Not Found

Predicate Device(s)

K980181, K941657, K021993, K013293

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5860 Piston syringe.

(a)
Identification. A piston syringe is a device intended for medical purposes that consists of a calibrated hollow barrel and a movable plunger. At one end of the barrel there is a male connector (nozzle) for fitting the female connector (hub) of a hypodermic single lumen needle. The device is used to inject fluids into, or withdraw fluids from, the body.(b)
Classification. Class II (performance standards).

0

SEP 3 0 2005

K452551 (Pior2)

510(k) Summary

Submitted on behalf of:

Devon Safety Products DBA Devon Medical Supplies 1100 First Avenue, Suite 100 King Of Prussia, PA 19406

Telephone:1-800-431-2273
Fax:610-768-4509

| By: | Barry Berler
Chief Operating Officer
1100 First Avenue, Suite 100
King of Prussia, PA 19406 |
|------------|------------------------------------------------------------------------------------------------------|
| Telephone: | 1-800-431-2273 x 4102 |
| Fax: | 610-768-4509 |

CONTACT PERSON: Barry Berler

DATE PREPARED: July 10, 2005

TRADE NAME: Devon Standard Syringe and as sold under various trade names COMMON NAME: Piston Syringe and Hypodermic Needle

SUBSTANTIALLY EQUIVALENT TO:

The Devon Standard Syringe is substantially equivalent to:

K980181: Terumo, Disposable Hypodermic Syringe K941657: Becton Dickinson, Insulin Syringes. K021993: Shandong Zibo Shanchuan Medical Instrument, Co., Ltd., Piston Syringe, Hypodermic Needle: Insulin Syringe K013293: Nipro Medical Corp., Hypodermic Needle.

DESCRIPTION of the DEVICE:

The Devon Standard Syringe is a sterile, single use, disposable syringe with attachable hypodermic needle. The Devon Standard Syringe consists of a syringe barrel, a plunger rod, piston, nozzle cap and a single lumen hypodermic needle.

The Insulin syringes are used for the injection of U100 insulin only and have scale lines in insulin units.

1

K452551 (P.2 of 2)

INDICATIONS FOR USE:

The Devon Standard Syringe is intended for injection of fluids into, or withdrawing fluids from, parts of the body below the surface of the skin.

Syringe with plunger for general medical uses.

The Insulin syringes are intended for insulin injection.

SUMMARY of TESTING:

The Devon Standard Syringe has been shown to meet internationally recognized standards for syringe performance and labeling characteristics.

2

Image /page/2/Picture/1 description: The image is a black and white logo for the Department of Health and Human Services - USA. The logo features a stylized image of an eagle with three lines representing its wings. The text "DEPARTMENT OF HEALTH AND HUMAN SERVICES - USA" is arranged in a circular pattern around the eagle image. The logo is simple and recognizable, representing the department's mission to protect the health of all Americans.

SEP 3 0 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Devon Safety products, Incorporated C/O Mr. Mark Job Reviewer Regulatory Technology Services, LLC 1394 25th Street, NW Buffalo, Minnesota, 55313

Re: K052551

Trade/Device Name: DEVON STANDARD SYRINGE, HYPODERMIC NEEDLE AND INSULIN SYRINGE Regulation Number: 21 CFR 880.5860 Regulation Name: PISTON SYRINGE Regulatory Class: II Product Code: FMF and FMI Dated: September 13, 2005 Received: September 16, 2005

Dear Mr. Job:

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 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. Job

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. 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 (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 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/industry/support/index.html.

Sincerely yours,

Sujata y. 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

K4222221 510(k) Number (if known):

Device Name: Devon Standard Syringe

Indications For Use:

This device is intended for injection of fluids into, or withdrawing fluids from, parts of the body below the surface of the skin.

Syringe with plunger for general medical uses.

The Insulin syringes are intended for insulin injection.

Prescription Use X (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)

Cim Un

Page 1 of ____________________________________________________________________________________________________________________________________________________________________

(Division Sign-Off) (Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number ________________________________________________________________________________________________________________________________________________________________