K Number
K102260
Device Name
FDI GLUCOSE CONTROL SOLUTIONS
Date Cleared
2010-09-24

(45 days)

Product Code
Regulation Number
862.1660
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
For in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of the FreeStyle Lite Blood Glucose Monitor.
Device Description
The FDI Glucose Control Solution consists of a viscosity-adjusted, aqueous liquid control solution containing a known quantity of glucose. The product is packaged in plastic dropper tipped bottles for easy application of the control solutions to the test strips and a red coloration to aid the user to visually confirm application of the control. The product is nonhazardous and contains no human or animal derived materials.
More Information

Not Found

No
The device description and performance studies focus on the chemical composition and stability of a glucose control solution, with no mention of AI or ML algorithms for data analysis or interpretation.

No
The device is a control solution for assessing the performance of a blood glucose monitor, not intended for direct treatment or diagnosis.

No
The device is a control solution used to assess the performance of a blood glucose monitor, not to diagnose a condition itself.

No

The device description clearly states it is an "aqueous liquid control solution" packaged in "plastic dropper tipped bottles," indicating it is a physical product, not software.

Yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The "Intended Use / Indications for Use" section explicitly states "For in vitro diagnostic use".
  • Device Description: The description details a "control solution" used to "assess the performance of the FreeStyle Lite Blood Glucose Monitor." Control solutions for testing the accuracy of diagnostic devices are a common type of IVD.
  • Predicate Device: The mention of a "Predicate Device(s)" with a K number (K083549) and name ("AbT Glucose Control Solution") strongly indicates that this device is being submitted for regulatory clearance as an IVD, as predicate devices are used for comparison in the regulatory process for IVDs.

N/A

Intended Use / Indications for Use

The FDI Glucose Control Solution is intended for in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of FreeStyle Lite Blood Glucose Monitor

For in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of the FreeStyle Lite Blood Glucose Monitor.

Product codes

75 JJX, JJX

Device Description

The FDI Glucose Control Solution consists of a viscosity-adjusted, aqueous liquid control solution containing a known quantity of glucose. The product is packaged in plastic dropper tipped bottles for easy application of the control solutions to the test strips and a red coloration to aid the user to visually confirm application of the control. The product is nonhazardous and contains no human or animal derived materials.

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

healthcare professionals and in the home by people with diabetes mellitus

Professional and home use

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

Tests were performed to verify specific performance . characteristics:

    1. Stability
    1. Open Vial
    1. Mean and Variance Comparison

Key Metrics

Not Found

Predicate Device(s)

K083549

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 862.1660 Quality control material (assayed and unassayed).

(a)
Identification. A quality control material (assayed and unassayed) for clinical chemistry is a device intended for medical purposes for use in a test system to estimate test precision and to detect systematic analytical deviations that may arise from reagent or analytical instrument variation. A quality control material (assayed and unassayed) may be used for proficiency testing in interlaboratory surveys. This generic type of device includes controls (assayed and unassayed) for blood gases, electrolytes, enzymes, multianalytes (all kinds), single (specified) analytes, or urinalysis controls.(b)
Classification. Class I (general controls). Except when intended for use in donor screening tests, quality control materials (assayed and unassayed) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9.

0

102260 EP 2 4 2010

5. 510(k) Summary

Introduction: According to the requirements of 21 CFR 807.92, the following information provides sufficient detail to understand the basis for a determination of substantial equivalence. Submitter: Fujirebio Diagnostics, Inc. (FDI) 940 Crossroads Blvd Seguin, TX 78155 (830) 372-1391 ex. 213 Establishment Registration Number: 1643621 Contact Person: Kent Pruett Device Name: FDI Glucose Control Solution Common Name: Single Analyte Control Solution, All Types (Assayed and Unassayed) Classification Name: Quality Control Material (assayed and unassayed), Classification: Class I per 21 CFR 862.1660 Product Code: 75 JJX Panel: Chemistry Predicate Devices: Name: AbT Glucose Control Solution Manufacturer: Fujirebio Diagnostics, Inc. 510(k) No.: : K083549 Device Description: The FDI Glucose Control Solution consists of a viscosity-adjusted, aqueous liquid control solution containing a known quantity of glucose. The product is packaged in plastic dropper tipped bottles for easy application of the control solutions to the test strips and a red coloration to aid the user to visually confirm application of the control. The product is nonhazardous and contains no human or animal derived materials.

Page 13 of 37

1

Intended Use:

  • The FDI Glucose Control Solution is intended for in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of FreeStyle Lite Blood Glucose Monitor

| Characteristic/

AspectPredicate Device No. 1New Product
NameAbT Glucose Control SolutionFDI Glucose Control Solution
510(k), DateK083549, 12/22/2008
Number of
Levels11
AnalyteGlucoseGlucose
Target (mg/dL)8888
Target Range
(mg/dL)80 – 130(1)75 - 125
ContainerPlastic bottle with dropper-tipPlastic bottle with dropper-tip
Fill Volume3.6 mL3.6 mL
ColorRedRed
MatrixBuffered aqueous solution of D-Glucose, a
viscosity modifier, preservatives, and other
non-reactive ingredientsIdentical to Predicate 1 which is
manufactured by FDI.
Indications for
UseUsed to check the performance of
FreeStyle and FreeStyle Lite Blood
Glucose Systems.Used to check the performance
of FreeStyle Lite Blood Glucose
Systems.
Target
PopulationProfessional and home useProfessional and home use

Comparison to Predicate Device:

(1) FDI's target range for the Liberty Glucose Control.

2

Performance Studies:

Tests were performed to verify specific performance . characteristics:

    1. Stability
    1. Open Vial
    1. Mean and Variance Comparison

Conclusion:

Comparison of the performance characteristics, formulation and intended use support the claim of substantial equivalence.

3

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the Department of Health & Human Services, USA. The logo features a stylized eagle with three swooping lines forming its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES, USA" is arranged in a circular fashion around the eagle.

Public Health Service

Food & Drug Administration 10903 New Hampshire Avenue Building 66 Silver Spring, MD 20993

Fujirebio Diagnostics, Inc. c/o Mr. Kent Pruett Director Quality Assurance & Regulatory Affairs 940 Crossroads Blvd. Seguin, TX 78155

SEP 2 4 2010

K102260 Re:

Trade Name: FDI Glucose Control Solution Regulation Number: 21 CFR §862.1660 Regulation Name: Quality control material (assayed and unassayed). Regulatory Class: Class I, reserved Product Codes: JJX Dated: August 10, 2010 Received: August 10, 2010

Dear Mr. Pruett:

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 Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. 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 Parts 801 and 809); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820).

4

Page 2 -

If you desire specific advice for your device on our labeling regulation (21 CFR Parts 801 and 809), please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 796-5450. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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) 796-7100 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

C.C.

Courtney Harper, Ph.D. Director Division of Chemistry and Toxicology Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

5

Indications for Use Statement 4.

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

K102260

FDI Glucose Control Solution Device Name:

SEP 2 4 2010

Indications for Use:

For in vitro diagnostic use (i.e. for external use only) by healthcare professionals and in the home by people with diabetes mellitus to assess the performance of the FreeStyle Lite Blood Glucose Monitor.

Prescription Use X (21 CFR Part 801 Subpart D) AND/OR

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

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

Dia

Division Sign-Off Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) K10 22-60