K Number
K110182
Device Name
CANNABINOIDS URINE TEST
Date Cleared
2011-05-20

(119 days)

Product Code
Regulation Number
862.3870
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Wondfo Cannabinoids Urine Test is an immunochromatographic assay for the qualitative determination of Cannabinoids in human urine. The test is available in a cassette format. The test has a cutoff of 50ng/mL of Cannabinoids. It is intended for prescription use and over the counter use. The test provides only preliminary test results. A more specific alternative chemical must be used in order to obtain a conformed analytical result. GCMS is the preferred confirmatory method. Clinical consideration and professional judgment should be exercised with any drug of abuse test result, particularly when the preliminary result is positive.
Device Description
Immunochromatographic assay for Cannabinoids urine test using a lateral flow system for the qualitative detection of Cannabinoids in human urine. Each assay uses a monoclonal antibody-dye congugate from mouse against drug with gold chloride and fixed drug-protein conjugate and anti-mouse lgG polyclonal antibody in membrane.
More Information

Not Found

No
The device description details a standard immunochromatographic assay (lateral flow test) which relies on chemical reactions and antibody binding, not AI/ML. There are no mentions of AI, ML, image processing, or data sets typically associated with AI/ML devices.

No
The device is described as an immunochromatographic assay for the qualitative determination of Cannabinoids in human urine, which is a diagnostic (detection) purpose, not a therapeutic (treatment) purpose.

Yes
The device is intended for the qualitative determination of Cannabinoids in human urine, which provides preliminary test results. This function of identifying specific substances in a biological sample to indicate a condition (presence of Cannabinoids) falls within the definition of a diagnostic device, even though confirmatory tests are required.

No

The device description clearly states it is an "Immunochromatographic assay" using a "lateral flow system" and includes physical components like "monoclonal antibody-dye congugate," "gold chloride," and "membrane." This indicates a physical test kit, not a software-only device.

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

Here's why:

  • Intended Use: The intended use explicitly states it's for the "qualitative determination of Cannabinoids in human urine." This involves testing a sample taken from the human body (urine) outside the body (in vitro) to gain information about a physiological state (presence of cannabinoids).
  • Device Description: The description details an "Immunochromatographic assay for Cannabinoids urine test." This is a common type of in vitro diagnostic test.
  • Anatomical Site: The anatomical site is "human urine," which is a biological sample tested in vitro.

The definition of an IVD generally includes devices intended for use in the collection, preparation, and examination of specimens taken from the human body for the purpose of providing information for the diagnosis, treatment, or prevention of disease or for the determination of the state of health. This device fits that description by providing information about the presence of cannabinoids in a human sample.

N/A

Intended Use / Indications for Use

The Cannabinoids Urine Test is intended for the qualitative determination of Cannabinoids in human i he Cannabilioius Unite Test is intended for the qualities and over the counter use.

Wondfo Cannabinoids Urine Test is an immunochromatographic assay for the qualitative determination of Cannabinoids in human urine. The test is available in a cassette format. The test has a cutoff of 50ng/mL of Cannabinoids. It is intended for prescription use and over the counter use.

The test provides only preliminary test results. A more specific alternative chemical must be used in order to obtain a conformed analytical result. GCMS is the preferred confirmatory method. Clinical consideration and professional judgment should be exercised with any drug of abuse test result, particularly when the preliminary result is positive.

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

LDJ

Device Description

Assay Principle: Immunochromatographic assay for Cannabinoids urine test using a lateral Assay Principle: Immunochromation of Cannabinoids in human urine. Each assay uses a
flow system for the qualitative detection of Cannabinoids in human note ableside and fixed flow system for the qualitative detection of ourinament thrug with gold chloride and fixed monoclonal antibody-dye congugate from medio against any
drug-protein conjugate and anti-mouse lgG polyclonal antibody in membrane.

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

prescription use and over the counter 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 (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.

K020771

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

§ 862.3870 Cannabinoid test system.

(a)
Identification. A cannabinoid test system is a device intended to measure any of the cannabinoids, hallucinogenic compounds endogenous to marihuana, in serum, plasma, saliva, and urine. Cannabinoid compounds includedelta -9-tetrahydrocannabinol, cannabidiol, cannabinol, and cannabichromene. Measurements obtained by this device are used in the diagnosis and treatment of cannabinoid use or abuse and in monitoring levels of cannabinoids during clinical investigational use.(b)
Classification. Class II (special controls). A cannabinoid test system is not exempt if it is intended for any use other than employment or insurance testing or is intended for Federal drug testing programs. The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9, provided the test system is intended for employment and insurance testing and includes a statement in the labeling that the device is intended solely for use in employment and insurance testing, and does not include devices intended for Federal drug testing programs (e.g., programs run by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Transportation (DOT), and the U.S. military).

0

Premarket Notification - Guangzhou Wond

Co. Ltd. K110182

TABLE 4

Submitter's name: Address:

Phone:

SUMMARY

December 13, 2010

Guangzhou Wondfo Biotech Co., Ltd. South China University of Technology Guangzhou, P.R. China 510641 012-86-20-32296069

MAY 2 0 2011

Joe Shia LSI International Inc. 504 East Diamond Ave., Suite F Gaithersburg, MD 20878 Telephone: 240-505-7880 Fax: 301-916-6231

Date the summary was prepared:

Name of the device: Trade or proprietary name: Common or usual name:

Cannabinoids Urine Test Cannabinoids Urine Test lmmunochromatographic test for the qualitative detection of Cannabinoids

Classification: Class II medical device with the product codes with Code of Federal Regulation references:

CFR # Product Code 862.3870 LDJ

The legally marketed device to which we are claiming equivalence [807.92((3)]: illy marketed device to which Step Drug Screen Test Card, K020771.

Description of the device:

Assay Principle: Immunochromatographic assay for Cannabinoids urine test using a lateral Assay Principle: Immunochromation of Cannabinoids in human urine. Each assay uses a
flow system for the qualitative detection of Cannabinoids in human note ableside and fixed flow system for the qualitative detection of ourinament thrug with gold chloride and fixed monoclonal antibody-dye congugate from medio against any
drug-protein conjugate and anti-mouse lgG polyclonal antibody in membrane.

Intended use of the device:

The Cannabinoids Urine Test is intended for the qualitative determination of Cannabinoids in human i he Cannabilioius Unite Test is intended for the qualities and over the counter use.

Summary of the technological characteristics of our device compared to the predicate device:

The Wondfo Biotech Co., Ltd. Cannabinoids have similar technological characteristics and performance to the predicate and are equivalent.

1

Image /page/1/Picture/12 description: The image shows a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - GSA" arranged around the perimeter. Inside the circle is a stylized eagle emblem with outstretched wings. The eagle's body is formed by three curved lines, giving it a modern and abstract appearance. The seal is black and white.

Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993

MAY 20 2011

Guangzhou Wondfo Biotech Co., LTD. c/o Joe Shia, LSI International Inc. 504 East Diamond Ave. Suite F Gaithersburg, MD 20877

Re: K110182

Trade Name: Wondfo Cannabinoids Urine Test Regulation Number: 21 CFR §862.3870 Regulation Name: Cannabinoid Test System Regulatory Class: Class II Product Codes: LDJ Dated: May 16, 2011 Received: May 19, 2011

Dear Mr. Shia:

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).

2

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.

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

: Vijs

Enclosure

3

INDICATIONS FOR USE FORM

510(k) Number (if known): K110182

Device Name: Wondfo Cannabinoids Urine Test

Indications for Use:

Wondfo Cannabinoids Urine Test is an immunochromatographic assay for the qualitative determination of Cannabinoids in human urine. The test is available in a cassette format. The test has a cutoff of 50ng/mL of Cannabinoids. It is intended for prescription use and over the counter use.

The test provides only preliminary test results. A more specific alternative chemical must be used in order to obtain a conformed analytical result. GCMS is the preferred confirmatory method. Clinical consideration and professional judgment should be exercised with any drug of abuse test result, particularly when the preliminary result is positive.

Prescription Use __ X (21 CFR Part 801 Subpart D) And/Or

Over the Counter Use _ X (21 CFR Part 801 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

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

510(k) K110182