K Number
K061979
Device Name
MODIFICATION TO MYALLERGY TEST
Date Cleared
2006-09-22

(71 days)

Product Code
Regulation Number
862.1675
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MyAllergyTest® is for the collection and transport of a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The MyAllergyTest® is intended for use with the MyAllergyTest® system. The MyAllergyTest® is intended for home use.
Device Description
MyAllergyTest ® is a Sample Collection Kit containing the materials necessary to collect and mail a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The device modification is to revise the limitations statement to allow testing of the whole blood sample for up to 30 days following collection. Currently the limitations states 10 days. No changes to the kit components.
More Information

No
The document describes a sample collection kit and its intended use for transporting blood samples. There is no mention of any software, algorithms, or data processing that would suggest the use of AI or ML. The modification is related to sample stability, not analytical methods.

No
The device is a collection kit for a blood sample for diagnostic testing, not for treating any condition.

No

The device is a sample collection kit. It collects and transports a blood sample for testing, but the testing itself (the diagnostic part) is performed by a clinical laboratory, not the device itself.

No

The device description explicitly states it is a "Sample Collection Kit containing the materials necessary to collect and mail a capillary blood sample," indicating it includes physical components, not just software.

Based on the provided information, the MyAllergyTest® is an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The device is specifically designed for the "collection and transport of a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing." This testing is performed in vitro (outside the body) on a biological sample to provide information about a person's health status (in this case, their allergic sensitivities).
  • Device Description: It's a "Sample Collection Kit containing the materials necessary to collect and mail a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing." This further reinforces its role in the diagnostic process.
  • Performance Studies: The mention of "Blood Sample Stability Studies" to ensure the accuracy of the "assessment of allergen specific IgE" directly relates to the performance of a diagnostic test.
  • Predicate Device: The predicate device is the "MyAllergyTest ® system (K020387)". Looking up this K number would likely confirm it's also an IVD system.

While the device itself is a sample collection kit, its intended use is inextricably linked to an in vitro diagnostic test performed in a laboratory. Therefore, it falls under the definition of an IVD device.

N/A

Intended Use / Indications for Use

The MyAllergyTest® is for the collection and transport of a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The The MyAllergyTest ® is intended for use with the MyAllergyTest ® system (K020387). The MyAllergyTest ® is intended for home use by the lay consumer.

Product codes

JKA

Device Description

MyAllergyTest ® is a Sample Collection Kit containing the materials necessary to collect and mail a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The device modification is to revise the limitations statement to allow testing of the whole blood sample for up to 30 days following collection. Currently the limitations states 10 days. No changes to the kit components.

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

home use by the lay consumer.

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)

Blood Sample Stability Studies were performed to obtain assurance that the whole blood sample would still provide an accurate assessment of allergen specific IgE for the entire transport time indicated in the labeling (30 days). The results from these studies (Initial testing and validation results) confirmed that the sample would be stable during the indicated transport time.

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

Not Found

Predicate Device(s)

K020387

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 862.1675 Blood specimen collection device.

(a)
Identification. A blood specimen collection device is a device intended for medical purposes to collect and to handle blood specimens and to separate serum from nonserum (cellular) components prior to further testing. This generic type device may include blood collection tubes, vials, systems, serum separators, blood collection trays, or vacuum sample tubes.(b)
Classification. Class II.

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6/21/06MyAllergyTest®Page 2 of 5
Special 510K Device Modification
510K Number:K061979
Submitter:ImmuneTech Corporation
Nancy Benson
888 Oak Grove Ave.
Suite 4
Menlo Park, CA 94025
nancylbenson@earthlink.net
650-233-0653 (home)
650-274-5884 (cell)SEP 2 2 2006
Manufacturing Site:ImmuneTech Corporation
888 Oak Grove Ave.
Suite 4
Menlo Park, CA 94025
650-470-7420
650-470-7423 (FAX)

Device Product Code: JKA

Description of the modified device:

MyAllergyTest ® is a Sample Collection Kit containing the materials necessary to collect and mail a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The device modification is to revise the limitations statement to allow testing of the whole blood sample for up to 30 days following collection. Currently the limitations states 10 days. No changes to the kit components.

Intended Use:

The MyAllergyTest ® is for the collection and transport of a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The The MyAllergyTest ® is intended for use with the MyAllergyTest ® system (K020387). The MyAllergyTest ® is intended for home use by the lay consumer.

Proposed Labeling:

See attachment A

Summary of Device Testing:

Blood Sample Stability Studies were performed to obtain assurance that the whole blood sample would still provide an accurate assessment of allergen

1

6/21/06MyAllergyTest®Page 3 of 5
Special 510K Device Modification

specific IgE for the entire transport time indicated in the labeling (30 days). The results from these studies (Initial testing and validation results) confirmed that the sample would be stable during the indicated transport time. See attachment (s) B and C.

Summary of Design Control Activities:

  • Risk Analysis- see attachment C .
  • Validation PROD-0011 .
  • . Declaration of conformity
  • Project History file, not included in submission .

Attachments:

Proposed Labeling, Attachment A (4 pages) Initial Results, Attachment B (7 pages) Validation Results, Attachment C (8 pages) Risk Analysis, Attachment D (3 pages) Completed Corrective Action Letter to the 483, Attachment E (1 page)

Image /page/1/Picture/9 description: The image shows the word "COPY" in large, bold, black letters. The word is slightly rotated counter-clockwise. The letters are spaced closely together, and the overall impression is that the word is stamped or printed onto a document. The background is plain and white.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with its head turned to the left and three stripes extending from its back. The eagle is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES . USA".

Public Health Service

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

SEP 2 2 2006

ImmuneTech Corporation c/o Ms. Nancy Benson VP Quality Systems 888 Oak Grove, Suite 4 Menlo Park, CA 94025

Re: K061979

Trade/Device Name: My Allergy Test® Regulation Number: 21 CFR 862.1675 Regulation Name: Blood specimen collection device Regulatory Class: Class II Product Code: JKA Dated: June 21, 2006 Received: July 13, 2006

Dear Ms. Nancy Benson:

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.

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.

3

Page 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 (240) 276-0484. 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 + Manniacturers; International Consumer Assistance at its toll-free-number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Robert G. Beckerf

Robert L. Becker, Jr., M.D., Ph.D. Director Division of Immunology and Hematology Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: MyAllergyTest®

Indications For Use:

The MyAllergyTest® is for the collection and transport of a capillary blood sample to a clinical laboratory for allergen specific IgE profile testing. The MyAllergyTest® is intended for use with the MyAllergyTest® system. The MyAllergyTest® is intended for home use.

Prescription Use _____________________________________________________________________________________________________________________________________________________________

AND/OR

Over-The-Counter Use

(Part 21 CFR 801 Subpart D)

(21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of CDRH, Diagnostic Devices (OIVD)

Office of In Vitro Diag Device Evaluation and S

510(k) K5 61979