K Number
K103314
Device Name
CLOTRAC HEPARINASE TEST CARTIDGE (HTC) COAGULATION CONTROL
Manufacturer
Date Cleared
2010-12-03

(23 days)

Product Code
Regulation Number
864.5425
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control is used to verify the performance of the ACT instrument and the Heparinase (HR-HTC) cartridges. For In Vitro Diagnostic Use.
Device Description
The modification to the current control is to replace old USP heparin with revised USP heparin. The source of the heparin remains porcine.
More Information

Not Found

No
The summary describes a control solution for a coagulation test and explicitly states that AI, DNN, or ML were not found in the description. The modification is a change in the source of heparin.

No
This device is a control for an in vitro diagnostic test, used to verify the performance of an instrument and its cartridges, not to directly treat a patient.

No
The device is a control used to verify the performance of an instrument and test cartridges, as stated in the "Intended Use / Indications for Use" section ("The CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control is used to verify the performance of the ACT instrument and the Heparinase (HR-HTC) cartridges."). It is not intended to diagnose a medical condition directly.

No

The device is a test cartridge, which is a physical component used in an in vitro diagnostic test, not a software-only device.

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

The "Intended Use / Indications for Use" section explicitly states: "For In Vitro Diagnostic Use." This is the primary indicator that the device is intended for use in the diagnosis of disease or other conditions, including a determination of the state of health, in order to cure, mitigate, treat, or prevent disease or its sequelae.

N/A

Intended Use / Indications for Use

The CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control is used to verify the performance of the ACT instrument and the Heparinase (HR-HTC) cartridges. For In Vitro Diagnostic Use.

Product codes (comma separated list FDA assigned to the subject device)

JBP, GGN

Device Description

Not Found

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): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K042175

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

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

§ 864.5425 Multipurpose system for in vitro coagulation studies.

(a)
Identification. A multipurpose system for in vitro coagulation studies is a device consisting of one automated or semiautomated instrument and its associated reagents and controls. The system is used to perform a series of coagulation studies and coagulation factor assays.(b)
Classification. Class II (special controls). A control intended for use with a multipurpose system for in vitro coagulation studies is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 864.9.

0

K103314

Image /page/0/Picture/1 description: The image shows the Medtronic logo. The logo consists of a circular graphic on the left and the word "Medtronic" on the right. The graphic shows three figures in motion inside of a circle. The word "Medtronic" is in a bold, sans-serif font.

DEC2 2010

510(k) Summary

Date Prepared

October 1, 2010

Submitter

Medtronic, Inc. Medtronic Perfusion Systems 7611 Northland Drive Minneapolis, MN 55428 Establish Registration Number: 2184009

Contact Person

Jeffrey L. Koll Senior Regulatory Affairs Specialist Phone: (763) 514-9842 (763) 367-8360 Fax: Email: jeffrey.l.koll(@medtronic.com

Device Name and Classification .

Trade Name: CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control Common Name: Activated Whole Blood Clotting Time Regulation Number: 21 CFR 864.7140 Product Code: JBP Classification: Class II

Predicate Device

CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control (K042175) cleared on October 18, 2004.

Comparison to Predicate Device

A comparison of the modified device and the currently marketed CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control show the following similarities:

  • Same intended use. .
  • Same operating principle. .
  • Same technological characteristics. ●
  • Same performance claims. �

Alleviating Pain · Restoring Health · Extending Life

CLOTtrac Heparinase Test Cartridge (HTC) Coagulation Control Special 510k

Medtronic, Inc. CONFIDENTIAL

1

Description of Device Modification

Heparin

  • The modification to the current control is to replace old USP heparin with revised . USP heparin. The source of the heparin remains porcine.

Intended Use

The intended use is unchanged.

Labeling

The current labels are unchanged by this device modification. The current Instructions for Use (IFU) has been updated for style, grammar and readability.

  • Appendix A contains the current IFU. .
  • . Appendix B contains the draft IFU.
  • Appendix C contains the current labels ●

Conclusion

The modifications to the CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control described in this submission result in a substantially equivalent device because the fundamental scientific technology and the intended use are unchanged.

Medtronic, Inc. CONFIDENTIAL

2

Image /page/2/Picture/0 description: The image shows the text "DEPARTMENT OF HEALTH & HUMAN SERVICES" in all caps. The text is in a bold, sans-serif font. The text is likely part of a document or presentation from the U.S. Department of Health and Human Services.

Image /page/2/Picture/1 description: The image is a black and white logo for the Department of Health & Human Services USA. The logo features a stylized eagle with its wings spread, symbolizing strength and freedom. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" are arranged in a circular pattern around the eagle, indicating the organization's name and location.

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-0609 Silver Spring, MD 20993-0002

Medtronic, Inc. c/o Mr. Jeffrey L. Koll Senior Regulatory Affairs Specialist 8200 Coral Sea Street NE Mounds View, MN 55112

DEC 0 2 2010

Re: K103314

Trade/Device Name: CLOTtrac®Heparinase Test Cartridge (HTC) Coagulation Control Regulation Number: 21 CFR 864.7140 Regulation Name: Activated whole blood clotting time tests Regulatory Class: Class II Product Code: GGN Dated: October 1, 2010 Received: November 10, 2010

Dear Mr. Koll:

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 class II (Special Controls), 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). This letter will allow you to begin marketing your device as described in your Section 510(k) premarket

3

Page 2 - Mr. Jeffrey L. Koll

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 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,

Reena Philip

1192

Maria M. Chan, 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): . K / 0 33 / 4

K/03314

Device Name: CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control

Indications for Use:

The CLOTtrac® Heparinase Test Cartridge (HTC) Coagulation Control is used to verify the performance of the ACT instrument and the Heparinase (HR-HTC) cartridges.

For In Vitro Diagnostic Use.

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)

Division Sign-Off

Office of In Vitro Diagnostic
Device Evaluation and Safety

510(k) K103314