K Number
K110697
Date Cleared
2011-07-14

(122 days)

Product Code
Regulation Number
880.5860
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Syringe with or without needle is intended for dispensing/administering fluids, and collecting/ sampling of fluid in medical practice.
The insulin syringe (U-100) with fixed needle is a device intended for medical purposes for the manual aspiration of U-100 insulin, and for the injection of U-100 insulin into parts of the body below the surface skin.
The Hypodermic Needle for single use is intended for use with syringes and injection devices for general purpose fluid injection/aspiration.

Device Description
Device NameIntended UseNozzelNominal Capacity / GaugeMaterialRemark
SyringeSyringe is intended for dispensing/ administering fluids, and collecting/ sampling of fluid in medical practice.Luer Slip1ml、2ml、3ml、5ml、10ml、20ml、30ml、50mlPP/PEWith or Without Needle
Insulin SyringeInsulin syringe (U-100) with fixed needle is a device intended for medical purposes for the manual aspiration of U-100 insulin, and for the injection of U-100 insulin into parts of the body below the surface skin.Fixed0.3ml、0.5ml、1mlPP/PEWith Fixed Needle
Hypodermic NeedleHypodermic Needle is intended for use with syringes and injection devices for general purpose fluid injection/aspiration.Female 6% Luer Conical Socket16G, 18G, 19G, 20G, 21G, 22G, 23G, 24G, 25G, 26G, 27G, 28G, 29G, 30GSUS 304 Stainless Steel / PP-
AI/ML Overview

This is a 510(k) premarket notification for general hospital devices (syringes and needles), not an AI/ML medical device. Therefore, many of the requested categories for AI/ML device evaluation are not applicable.

Here's the information that can be extracted relevant to acceptance criteria and device performance:

Acceptance Criteria and Device Performance for Syringes and Needles

This document describes a 510(k) submission for conventional medical devices (syringes and needles), not an AI/ML medical device. As such, the acceptance criteria are based on compliance with established international standards for these types of devices, rather than performance metrics like sensitivity, specificity, or AUC typically used for AI/ML.

1. Table of Acceptance Criteria and the Reported Device Performance:

DeviceAcceptance Criteria (Standard Compliance)Reported Device Performance
Syringe (with/without needle)Performance: Conforms to ISO 7886-1 and ISO 7864 Biocompatibility: Conforms to ISO 10993 Sterility: EtO Sterilization Nozzle: Luer Slip Gradations Legibility: Legible Barrel Transparency: Transparent and clear Labeling: Meet FDA requirementsPerformance: "Conforms to ISO 7886-1 and ISO 7864" Biocompatibility: "Conforms to ISO 10993" Sterility: "EtO Sterilization" (All reported to be equivalent to predicate device)
Insulin Syringe (U-100) with fixed needlePerformance: Conforms to ISO 8537 Biocompatibility: Conforms to ISO 10993 Sterility: EtO Sterilization Nozzle: Fixed Gradations Legibility: Legible Barrel Transparency: Transparent and clear Labeling: Meet FDA requirementsPerformance: "Conforms to ISO 8537" Biocompatibility: "Conforms to ISO 10993" Sterility: "EtO Sterilization" (All reported to be equivalent to predicate device)
Hypodermic Needle for single usePerformance: Conforms to ISO 7864 Biocompatibility: Conforms to ISO 10993 Sterility: EtO Sterilization Nozzle: Female 6% luer conical socket Labeling: Meet FDA requirementsPerformance: "Conforms to ISO 7864" Biocompatibility: "Conforms to ISO 10993" Sterility: "EtO Sterilization" (All reported to be equivalent to predicate device)
General Acceptance (all devices)Physical properties: Meet design specifications (e.g., nominal capacity, needle gauge, material properties)Bench tests conducted to verify compliance with design specifications and standards. (Results state "the proposed devices comply with the following standards...")

Study Proving Device Meets Acceptance Criteria:

The study proving the device meets the acceptance criteria is a non-clinical bench testing summary.

2. Sample size used for the test set and the data provenance:

  • Sample Size: Not explicitly stated in the provided document. The document mentions "Bench tests were conducted," implying laboratory testing on a sample of devices, but the exact number of units tested is not provided.
  • Data Provenance: The tests were "Bench tests" which typically means laboratory-controlled testing. There is no mention of country of origin for the data or whether it was retrospective or prospective in the context of clinical data, as this is a non-clinical submission.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

  • Not applicable. For this type of device (syringes and needles), "ground truth" is established by adherence to engineering performance standards (ISO standards) and material specifications, verified through objective bench testing. It does not involve expert interpretation or clinical ground truth as would be relevant for an AI/ML diagnostic device.

4. Adjudication method for the test set:

  • Not applicable. No adjudication method is described because there is no subjective interpretation or clinical assessment involved in establishing ground truth for these physical devices. Compliance is determined by objective measurements against established standard parameters.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, if so, what was the effect size of how much human readers improve with AI vs without AI assistance:

  • Not applicable. This submission is for physical medical devices (syringes and needles), not an AI/ML diagnostic or assistive device. Therefore, no MRMC study or assessment of human reader improvement with AI assistance was performed.

6. If a standalone (i.e., algorithm only without human-in-the-loop performance) was done:

  • Not applicable. This is not an AI/ML device.

7. The type of ground truth used:

  • The "ground truth" for these devices is defined by international consensus standards (ISO 8537, ISO 7886-1, ISO 594-1, ISO 594-2, ISO 7864, ISO 10993) and the design specifications of the device (e.g., nominal capacity, material composition, transparency, legibility of gradations). These are objective, measurable criteria.

8. The sample size for the training set:

  • Not applicable. This submission is for physical medical devices, not an AI/ML device that requires a training set.

9. How the ground truth for the training set was established:

  • Not applicable. See point 8.

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510(k) Summary

As Required by 21 CFR 807.92

JUL 1 4 2011

The assigned 510(k) Number is : ______________________________________________________________________________________________________________________________________________

  1. Date Prepared: Dec, 17, 2010

2. Sponsor Infromation:

Tiger Medical Products Ltd. Liulin Tower, Suit 1910, 1 Huaihai Zhong Road Shanghai 200021, China

Contact Person:

David Wang RA Manager Fiona Fu Regulatory Assistant Tiger Medical Products Ltd. Phone Number: 86-21-6386 6300 Fax Number: 86-21-6386 5086 E-mail: davidwang@tigermedicalgroup.com

3. Submission Correspondent

David Wang RA Manager Fiona Fu Regulatory Assistant Tiger Medical Products Ltd. Phone Number: 86-21-6386 6300 Fax Number: 86-21-6386 5086 E-mail: davidwang@tigermedicalgroup.com

4. Device Name and Classification:

1) Syringe (with/without needle)

a. Classification Name: Syringe,Piston

b. Regulation Number: 880.5860

c. Product code: FMF

d. Class: Il

e. Review Panel: General Hospital

2) Insulin syringe (U-100) with fixed needle

f. Classification Name: Syringe,Piston

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g. Regulation Number: 880.5860 h. Product Code: FMF i. Class: II j. Review Panel: General Hospital

3) Hypodermic Needle for single use

k. Classification Name: Needle, Hypodermic, Single Lumen

  1. Regulation Number: 880.5570

m. Product code: FMI

n. Class: II

o. Review Panel: General Hospital

5. Predicate Device Identification:

a. K number: K980987 Trade Name: Becton Dickinson Single Use Hypodermic Syringes

b. K number: K090929

Trade Name: Sterile Insulin Syringe for single use, with fixed needle

c. K number: K070440

Trade Name: BD Hypoint

6. Device Description

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Premarked Notification 510(k) Submisssion- 510(K) Summar

:

Device NameIntended UseNozzelNominal Capacity / GaugeMaterialRemark
SyringeSyringe is intended for dispensing/ administering fluids, and collecting/ sampling of fluid in medical practice.Luer Slip1ml、2ml、3ml、5ml、10ml、20ml、30ml、50mlPP/PEWith or Without Needle
Insulin SyringeInsulin syringe (U-100) with fixed needle is a device intended for medical purposes for the manual aspiration of U-100 insulin, and for the injection of U-100 insulin into parts of the body below the surface skin.Fixed0.3ml、0.5ml、1mlPP/PEWith Fixed Needle
Hypodermic NeedleHypodermic Needle is intended for use with syringes and injection devices for general purpose fluid injection/aspiration.Female 6% Luer Conical Socket16G, 18G, 19G, 20G, 21G, 22G, 23G, 24G, 25G, 26G, 27G, 28G, 29G, 30GSUS 304 Stainless Steel / PP-

.

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7. Summary of Comparison in Technological Charateristics

Through comparions between the applicant devices with the predicate devices (see comparison chart in Executive Summary), we belive the applicant devices are substantially equivalent with the predicate devices.

Technology Comparison to Predicate Device:

ItemSyringe (with/without needle)Becton Dickinson Single Use Hypodermic Syringes510(K) #: (K980987)
Intended UseThe Syringe is intended for dispensing/ administering fluids, and collecting/ sampling of fluid in medical practice.The Becton Dickinson Syringes product line consists of single use disposable syringes intended for dispensing/ administering fluids, and collecting/ sampling of fluid in medical practice. Their function is mechanical.
Syringe VolumeNominal capacity: 1,2,3,5,10,20,30,50ml (Luer Slip);2,3,5,10,20,30,50ml (Luer Lock)Various sizes
Needle GaugeVarious sizesVarious sizes
Needle Hub TypeFemale 6% LuerFemale 6% Luer
Gradations LegibilityLegibleLegible
Lubricant CompositionDowcorning 360 silicone (barrelinternal surface)Dowcorning 4159 silicone (needle tip)Unknown
Barrel TransparencyTransparent and clearTransparent and clear
Labeling and LabelsMeet FDA requirementsMeet FDA requirements
Plunger MaterialPP/PESame
Barrel MaterialPPSame
Piston MaterialKraton IR-307 polyisopreneThis component is not made with natural rubber latex.Unknown
lubricant for the syringe MaterialDowcorning 360 (barrel internal surface)Dowcorning 4159 (needle tip)Unknown
Ink on the Barrel MaterialTeikuko PPE 911Unknown
PerformanceConforms to ISO 7886-1 and ISO 7864Conforms to ISO 7886-1 and ISO 7864
BiocompatibilityConforms to ISO 10993Conforms to ISO 10993
SterilityEtO SterilizationEtO Sterilization
ItemInsulin syringe with fixed needleSterile Insulin Syringe for single use, withfixed needle510(K) #: K090929
Intended UseInsulin syringe (U-100) with fixedneedle is a device intended formedical purposes for the manualaspiration of U-100 insulin, and forthe injection of U-100 insulin intoparts of the body below the surfaceskin.Sterile Insulin Syringe for single use, withfixed needle is a device intended for medicalpurpose for the manual injection of insulin.
Specific Drug UseU-100 InsulinInsulin
Nominal Capacity0.3ml、0.5ml、1ml0.3ml、0.5ml、1ml
Needle Hub TypeFixedFixed
Gradations LegibilityLegibleLegible
LubricantCompositionDowcorning 360 (used on internalsurface of barrel)Dowcorning 4159 (used on needletip)Dowcorning 360 (used on internal surface ofbarrel)Dowcorning 4159 (used on needle tip)
Barrel TransparencyTransparent and clearTransparent and clear
Labeling and LabelsMeets the FDA requirementsMeets the FDA requirements
NeedleSUS 304 stainless steel304 Stainless Steel
PlungerPE/PPMedical Grade Polypropylene
BarrelPPMedical Grade Polypropylene
PistonKraton IR-307 polyisopreneThis compoment is not made withnatural rubber latex.Santoprene TPE (Natural color)
LubricantDowcorning 360 (barrel internalsurface)Dowcorning 4159 (needle tip)Polydimethylsioxane (12500 cp)
Ink on the BarrelTeikuko PPE 91150% SSPPNK-911
50% PPE-911
PerformanceConforms to ISO 8537Conforms to ISO 8537
BiocompatibilityConforms to ISO 10993Conforms to ISO 10993
SterilityEtO SterilizationEtO Sterilization
ItemHypodermic Needle for single useBD Hypoint510(K) #: K070440
Intended UseThe Hypodermic Needle for single use is intended for use with syringes and injection devices for general purpose fluid injection/aspirationThe BD HypointTM Needle is intended for use with syringes and injection devices for general purpose fluid injection/aspiration.
Needle GaugeVarious sizesVarious sizes
Needle Hub TypeFemale 6% luer conical socketFemale 6% luer conical socket
Labeling and LabelsMeet FDA requirementsMeet FDA requirements
Needle MaterialSUS 304 stainless steelUnknown
Needle Hub MaterialPPSame
Needle Sheath MaterialPPSame
Lubricant MaterialDowcorning 4159Unknown
PerformanceConforms to ISO 7864Conforms to ISO 7864
BiocompatibilityConforms to ISO 10993Conforms to ISO 10993
SterilityEtO SterilizationEtO Sterilization

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8. Non-Clinical Test Summary

Bench tests were conducted to verify that the proposed devices meet all design specifications as are Substantially Equivalent (SE) to the predicate devices. The test results demonstrated that the proposed devices comply with the following standards: ISO 8537:2007 Sterile single-use syringes, with or without needle, for insulin.

ISO 7886 Sterile hypodermic syringes for single use -- Part 1: Syringes for manual use

ISO 594-1:1986 Conical fittings with a 6 % (Luer) taper for syringes, needles and certain other medical equipment -- Part 1: General requirement

ISO 594-2: 1998 Conical fittings with 6 % (Luer) taper for syringes, needles and certain other medical equipment -- Part 2: Lock fittings

ISO 7864:1993 Sterile hypodermic needles for single use.

9. Substantially Equivalent Conclusion

The subject device and predicate device have the same classification information, intended use, sterilization specifications, performance, biocompatibility, chemical specifications, physical and mechanical specifications. Both devices meet requirements of ISO 10993, ISO 7886-1, ISO 7864 and ISO 8537. Even if there is some difference in component material (lubricant, ink, piston), we believe such difference has no adverse effect on safety and efficacy of the subject device, and we can be sure of substantial equivalence between subject device and predicate device.

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Image /page/6/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular, with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. In the center of the seal is an abstract symbol that resembles a stylized bird or eagle, composed of three curved lines.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Mr. David Wang Tiger Medical Products, Limited 1 Huaihai Zhong Road Liu Lin Tower, Suite 1910 Shanghai, China 200021

JUL 1 4 2011

Re: K110697

Trade/Device Name: Syringe (With or Without Needles), Insulin Syringe (U-100) With Fixed Needles, Hypodermic Needle for Single Use Regulation Number: 21 CFR 880.5860 Regulation Name: Piston Syringe Regulatory Class: II Product Code: FMF, FMF, FMI Dated: June 28, 2011 Received: June 28, 2011

Dear Mr. Wang:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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.

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Page 2 -- Mr. Wang

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 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/Reporta Problem/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/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely vours.

Anthony D. Norton

Anthony D. Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital. Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known): _ K (10697

Syringe (with or without needle) Device Name: __

Indications for Use:

The Syringe with or without needle is intended for dispensing/administering fluids, and collecting/ sampling of fluid in medical practice.

Prescription Use (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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Division Sign-Off)

Jivision of Anesthesiology, General Hospital nfection Control, Dental Devices

් 10 (k) Number:

Page 1 of 3

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Indications for Use

K110697 510(k) Number (if known):

Device Name: Insulin syringe (U-100) with fixed needle

Indications for Use:

The insulin syringe (U-100) with fixed needle is a device intended for medical purposes for the manual aspiration of U-100 insulin, and for the injection of U-100 insulin into parts of the body below the surface skin.

The proposed device of Insulin Syringe (U-100) with fixed needle is available in 0.3ml, 0.5ml, and 1ml in volume.

Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use V AND/OR (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

7/1/14

Division Sign-Off) Division of Anesthesiology, General Hospital nfection Control, Dental Devices

:10(k) Number: K110697

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Page 2 of 3

Indications for Use

510(k) Number (if known): _ |< | | 0 6 9 7

Device Name: Hypodermic Needle for single use

Indications for Use:

The Hypodermic Needle for single use is intended for use with syringes and injection devices for general purpose fluid injection/aspiration.

Prescription Use V (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 OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Rild C. Chy 7/13/14
(Division Sign-Off)

് vision of Anesthesiology, General Hospital .fection Control, Dental Devices

510(k) Number: K110697

Page 3 of 3

§ 880.5860 Piston syringe.

(a)
Identification. A piston syringe is a device intended for medical purposes that consists of a calibrated hollow barrel and a movable plunger. At one end of the barrel there is a male connector (nozzle) for fitting the female connector (hub) of a hypodermic single lumen needle. The device is used to inject fluids into, or withdraw fluids from, the body.(b)
Classification. Class II (performance standards).