K Number
K103450
Device Name
FDI GLUCOSE CONTROL SOLUTION FOR FREESTYLE
Date Cleared
2011-01-25

(62 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 Blood Glucose Monitor
Device Description
The FDI Glucose Control Solution for FreeStyle 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 non-hazardous and contains no human or animal derived materials.
More Information

Not Found

No
The device is a glucose control solution, a liquid used to verify the performance of a blood glucose monitor. The description focuses on its chemical composition and packaging, with no mention of software, algorithms, or AI/ML capabilities.

No.
The device is a control solution for testing the performance of a blood glucose monitor, not for treating a medical condition.

No
This device is a control solution used to assess the performance of a blood glucose monitor, not to diagnose a medical condition in a patient.

No

The device description clearly states it is a liquid control solution packaged in plastic 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" explicitly states "For in vitro diagnostic use".
  • Device Description: The description details a "control solution containing a known quantity of glucose" used to "assess the performance of the FreeStyle Blood Glucose Monitor". This is a classic example of an IVD used to verify the accuracy of another IVD (the blood glucose monitor).
  • User: It is intended for use by "healthcare professionals and in the home by people with diabetes mellitus", which aligns with the typical users of IVDs related to diabetes management.

The information provided clearly indicates that this product is designed to be used outside of the body to test a sample (in this case, the control solution itself) to assess the performance of a diagnostic device.

N/A

Intended Use / 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 Blood Glucose Monitor

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

75 JJX, JJX

Device Description

The FDI Glucose Control Solution for FreeStyle 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 non-hazardous 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

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)

Tests were performed to verify specific performance characteristics:

  1. Stability
  2. Open Vial
  3. Mean and Variance Comparison
    Conclusion: Comparison of the performance characteristics, formulation and intended use support the claim of substantial equivalence.

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.

K102260

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

§ 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

K103450

510(k) Premarket Notification: FDI Glucose Control Solution For FreeStyle
Fujirebio Diagnostics, Inc.

JAN 2 5 2011

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 for FreeStyle | |
| 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:
Manufacturer:
510(k) No.: | FDI Glucose Control Solution
Fujirebio Diagnostics, Inc.
K102260 |
| Device Description: | The FDI Glucose Control Solution for FreeStyle
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 non-hazardous and contains no human
or animal derived materials. | |

1

510(k) Premarket Notification: FDI Glucose Control Solution For FreeStyle Fujirebio Diagnostics, Inc.

The FDI Glucose Control Solution for FreeStyle Intended Use: 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 Blood Glucose Monitor

| Characteristic/

AspectPredicate Device No. 1New Product
NameFDI Glucose Control SolutionFDI Glucose Control Solution
for FreeStyle
510(k), DateK102260, 09/24/2010
Number of
Levels11
AnalyteGlucoseGlucose
Target (mg/dL)8888
Target Range
(mg/dL)75 – 125(1)70-120
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
Lite Blood Glucose Systems.Used to check the
performance of FreeStyle
Blood Glucose Systems.
Target
PopulationProfessional and home useProfessional and home use

Comparison to Predicate Device:

TFFDI's target range for the Freestyle Glucose Control.

2

510(k) Premarket Notification: FDI Glucose Control Solution For FreeStyle Fujirebio Diagnostics, Inc.

.

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/10 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle. The logo is black and white.

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

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

· JAN 2 5 201

K103450 Trade Name: FDI Glucose Control Solution for FreeStyle Regulation Number: 21 CFR 862.1660 Regulation Name: Quality Control Material (assayed and unassayed) Regulatory Class: Class I, reserved Product Codes: JJX Dated: November 1, 2010 Received: November 24, 2010

Dear Mr. Pruett:

Re:

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).

LANY

4

Page 2 -

If you desire specific advice for your device on our labeling regulation (21 CFR Parts 80) 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 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,

CJC.

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

510(k) Premarket Notification: FDI Glucose Control Solution Fujirebio Diagnostics, Inc.

4. Indications for Use Statement

510(k) Number (if known): K103450

FDI Glucose Control Solution for FreeStyle Device Name:

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 Blood Glucose Monitor

Prescription Use × (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)

Signature of Owner or Officer

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

510(k) 1/103452