K Number

Device Name

JMS APHERESIS NEEDLE SET WINGEATER(R) V2

Manufacturer

JMS NORTH AMERICA CORPORATION

Date Cleared

2011-10-27

(91 days)

Product Code

FIE FOZ

Regulation Number

876.5540

Intended Use

Use for providing access to a donor's blood for apheresis. This device is intended to single use only and is for temporary catheterization less than 30 days. The safety feature (foldable wing and WingEater) aids in prevention of needlestick injuries when removing and discarding needle after blood collection.

Device Description

JMS Apheresis Needle Set "WingEater" V2 is a device whereby an antineedlestick feature (WingEater guard) is assembled with predicate device under 510(k), K00845. Needlestick injury can be prevented by pulling the PVC tube to retract the needle and wing into WingEater guard when removing needle so as to encapsulate the whole needle within the WingEater guard. Modifications to JMS Apheresis Needle Set "WingEater®" V2 in this special 510(k) are: - Additional new polypropylene (PP) materials used for WingEater a) guard, needle cover, luer lock cover and clamp (non fluid pathway) There are other non-significant changes which were made to 510(k) -K010410 in the past. These changes are listed under Attachment 004 List of Past Changes of this special 510(k). Evaluation of the new packaging configuration was performed accordingly to stimulated conditions experienced during transportation. New design and material used for the WingEater guard was evaluated accordingly with folded wing in order to realize the actual device usage. Reviews of the modifications were documented within this special 510(k) submission.

More Information

Contact

Type

Center

Panel

Date Received

Product Code

Subsequent Product Codes

Applicant Name (Manufacturer)

Device Name

Decision

Street 1

Street 2

City

State

Country Code

ZIP

Postal Code

Class Advise Committee

SSP Indicator

Third Party Reviewed

Expedited Review

Predicate Devices

K00845, K010410

Reference Devices

K00845

AI/ML (Artificial Intelligence / Machine Learning)

No
The device description and performance studies focus on mechanical design, material changes, and standard biological and physical testing, with no mention of AI or ML.

Therapeutic

No.
The device is used for providing access to a donor's blood for apheresis, which is a blood collection process, not a therapeutic treatment. The safety feature prevents needlestick injuries, which is a safety mechanism rather than a therapeutic function.

Diagnostic

Explanation: The device is intended for providing access to a donor's blood for apheresis, which is a therapeutic or collection procedure, not a diagnostic one. Its purpose is to facilitate blood collection, not to diagnose a medical condition.

SaMD (Software as a Medical Device)

The device description clearly indicates it is a physical needle set with an anti-needlestick feature made of polypropylene and other materials. It is a hardware device for accessing blood.

IVD (In Vitro Diagnostic)

Based on the provided text, this device is not an IVD (In Vitro Diagnostic).

Here's why:

Intended Use: The intended use is "for providing access to a donor's blood for apheresis." This describes a procedure performed on a patient (or donor in this case) to collect blood, not a test performed on a sample of blood or other biological material in vitro (outside the body).
Device Description: The description focuses on the physical components of a needle set used for blood collection and a safety feature to prevent needlestick injuries. It does not mention any reagents, assays, or analytical processes typically associated with IVD devices.
Performance Studies: The listed performance studies are related to the biological safety of the materials, the physical integrity of the device (luer taper, transfusion sets, packaging), sterilization, and risk management. These are standard tests for medical devices that come into contact with the body, not specific performance characteristics of an IVD (like sensitivity, specificity, etc.).

IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. This device is used to obtain the specimen, not to test it.

PCCP (Predetermined Change Control Plan) Authorized

N/A

Overview

Intended Use / Indications for Use

Product codes

FIE, FOZ

Device Description

Additional new polypropylene (PP) materials used for WingEater a) guard, needle cover, luer lock cover and clamp (non fluid pathway)
There are other non-significant changes which were made to 510(k) -K010410 in the past. These changes are listed under Attachment 004 List of Past Changes of this special 510(k).
Evaluation of the new packaging configuration was performed accordingly to stimulated conditions experienced during transportation. New design and material used for the WingEater guard was evaluated accordingly with folded wing in order to realize the actual device usage. Reviews of the modifications were documented within this special 510(k) submission.

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)

Bench testing had been conducted to verify performance of JMS Apheresis Needle Set "WingEater®" V2 and it was found to be safe and effective. The following data and reports were enclosed within this submission document.

ISO 10993-4:2002 Biological Evaluation of Medical Devices Part 4 . – Selection of Tests for Interactions with Blood
ISO 10993-5:2009 Biological Evaluation of Medical Devices Part 5 . - Tests for In Vitro Cytotoxicity
ISO 10993-10 Biological Evaluation of Medical Devices Part 10 . Tests for Irritation and Delayed-Type Hypersensitivity
ISO 10993-11 Biological Evaluation of Medical Devices Part 11 . Tests for Systemic Toxicity
ISO 594-1: 1986 Conical Fittings with 6% (Luer) Taper for Syringes, . Needles and Certain Other Medical Equipment - Part 1 - General Requirements
ISO 594-2: 1998 Conical Fittings with 6% (Luer) Taper for Syringes, . Needles and Certain Other Medical Equipment - Part 2 - General Requirements
ISO 1135-4 4th Edition 2010-04-15, Transfusion Equipment for . Medical Use _ Part 4 - Transfusion Sets for Single Use
ISO 11135-1:2007 Sterilization of Health Care Products Ethylene . Oxide - Part 1 - Requirements for Development, Validation and routine control of a sterilization process for medical devices. (Sterility)
ISO 11137-1 Sterilization of Health Care Products Radiation Part . 1 - Requirements for Development, Validation, and Routine Control of a Sterilization Process for Medical Devices. (Sterility)
ISO 11137-2:2006 Sterilization of Health Care Products Radiation . Part 2 – Establishing the Sterilization Dose
ISO 11137-3:2006 2010 Sterilization of Health Care Products -. Radiation - Part 3 - Guidance on Dosimetric Aspects
ISO 11607-1:2007 Packaging for Terminally Sterilized Medical . Devices – Part 1: Requirements for Materials
ISO 11607-2: 2006 Packaging for Terminally Sterilized Medical . Devices - Part 2: Validation Requirements for Forming, Sealing and Assembly Processes
ISO 14644-1: 1999 Clean rooms and associated controlled . environments- Part 1: Classification of air cleanliness
ISO 14644-2: 2000 Clean rooms and associated controlled . environments -- Part 2: Specifications for testing and monitoring to prove continued compliance with ISO 14644-1
ISO 9626: 1991 + (Amd1:2001) Stainless Steel Needle Tubing for . the Manufacture of Medical Devices
USP 32:2009 Sterility Tests .
USP 33:2010 Bacterial Endotoxins .
ISO 14971:2007 Medical Devices Application of Risk Management . to Medical Devices

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K010410

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

Regulation Number and Section

§ 876.5540 Blood access device and accessories.

(a)
Identification. A blood access device and accessories is a device intended to provide access to a patient's blood for hemodialysis or other chronic uses. When used in hemodialysis, it is part of an artificial kidney system for the treatment of patients with renal failure or toxemic conditions and provides access to a patient's blood for hemodialysis. The device includes implanted blood access devices, nonimplanted blood access devices, and accessories for both the implanted and nonimplanted blood access devices.(1) The implanted blood access device is a prescription device and consists of various flexible or rigid tubes, such as catheters, or cannulae, which are surgically implanted in appropriate blood vessels, may come through the skin, and are intended to remain in the body for 30 days or more. This generic type of device includes various catheters, shunts, and connectors specifically designed to provide access to blood. Examples include single and double lumen catheters with cuff(s), fully subcutaneous port-catheter systems, and A-V shunt cannulae (with vessel tips). The implanted blood access device may also contain coatings or additives which may provide additional functionality to the device.
(2) The nonimplanted blood access device consists of various flexible or rigid tubes, such as catheters, cannulae or hollow needles, which are inserted into appropriate blood vessels or a vascular graft prosthesis (§§ 870.3450 and 870.3460), and are intended to remain in the body for less than 30 days. This generic type of device includes fistula needles, the single needle dialysis set (coaxial flow needle), and the single needle dialysis set (alternating flow needle).
(3) Accessories common to either type include the shunt adaptor, cannula clamp, shunt connector, shunt stabilizer, vessel dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor, and declotting tray (including contents).
(b)
Classification. (1) Class II (special controls) for the implanted blood access device. The special controls for this device are:(i) Components of the device that come into human contact must be demonstrated to be biocompatible. Material names and specific designation numbers must be provided.
(ii) Performance data must demonstrate that the device performs as intended under anticipated conditions of use. The following performance characteristics must be tested:
(A) Pressure versus flow rates for both arterial and venous lumens, from the minimum flow rate to the maximum flow rate in 100 milliliter per minute increments, must be established. The fluid and its viscosity used during testing must be stated.
(B) Recirculation rates for both forward and reverse flow configurations must be established, along with the protocol used to perform the assay, which must be provided.
(C) Priming volumes must be established.
(D) Tensile testing of joints and materials must be conducted. The minimum acceptance criteria must be adequate for its intended use.
(E) Air leakage testing and liquid leakage testing must be conducted.
(F) Testing of the repeated clamping of the extensions of the catheter that simulates use over the life of the device must be conducted, and retested for leakage.
(G) Mechanical hemolysis testing must be conducted for new or altered device designs that affect the blood flow pattern.
(H) Chemical tolerance of the device to repeated exposure to commonly used disinfection agents must be established.
(iii) Performance data must demonstrate the sterility of the device.
(iv) Performance data must support the shelf life of the device for continued sterility, package integrity, and functionality over the requested shelf life that must include tensile, repeated clamping, and leakage testing.
(v) Labeling of implanted blood access devices for hemodialysis must include the following:
(A) Labeling must provide arterial and venous pressure versus flow rates, either in tabular or graphical format. The fluid and its viscosity used during testing must be stated.
(B) Labeling must specify the forward and reverse recirculation rates.
(C) Labeling must provide the arterial and venous priming volumes.
(D) Labeling must specify an expiration date.
(E) Labeling must identify any disinfecting agents that cannot be used to clean any components of the device.
(F) Any contraindicated disinfecting agents due to material incompatibility must be identified by printing a warning on the catheter. Alternatively, contraindicated disinfecting agents must be identified by a label affixed to the patient's medical record and with written instructions provided directly to the patient.
(G) Labeling must include a patient implant card.
(H) The labeling must contain comprehensive instructions for the following:
(
1 ) Preparation and insertion of the device, including recommended site of insertion, method of insertion, and a reference on the proper location for tip placement;(
2 ) Proper care and maintenance of the device and device exit site;(
3 ) Removal of the device;(
4 ) Anticoagulation;(
5 ) Management of obstruction and thrombus formation; and(
6 ) Qualifications for clinical providers performing the insertion, maintenance, and removal of the devices.(vi) In addition to Special Controls in paragraphs (b)(1)(i) through (v) of this section, implanted blood access devices that include subcutaneous ports must include the following:
(A) Labeling must include the recommended type of needle for access as well as detailed instructions for care and maintenance of the port, subcutaneous pocket, and skin overlying the port.
(B) Performance testing must include results on repeated use of the ports that simulates use over the intended life of the device.
(C) Clinical performance testing must demonstrate safe and effective use and capture any adverse events observed during clinical use.
(vii) In addition to Special Controls in paragraphs (b)(1)(i) through (v) of this section, implanted blood access devices with coatings or additives must include the following:
(A) A description and material characterization of the coating or additive material, the purpose of the coating or additive, duration of effectiveness, and how and where the coating is applied.
(B) An identification in the labeling of any coatings or additives and a summary of the results of performance testing for any coating or material with special characteristics, such as decreased thrombus formation or antimicrobial properties.
(C) A Warning Statement in the labeling for potential allergic reactions including anaphylaxis if the coating or additive contains known allergens.
(D) Performance data must demonstrate efficacy of the coating or additive and the duration of effectiveness.
(viii) The following must be included for A-V shunt cannulae (with vessel tips):
(A) The device must comply with Special Controls in paragraphs (b)(1)(i) through (v) of this section with the exception of paragraphs (b)(1)(ii)(B), (b)(1)(ii)(C), (b)(1)(v)(B), and (b)(1)(v)(C), which do not apply.
(B) Labeling must include Warning Statements to address the potential for vascular access steal syndrome, arterial stenosis, arterial thrombosis, and hemorrhage including exsanguination given that the device accesses the arterial circulation.
(C) Clinical performance testing must demonstrate safe and effective use and capture any adverse events observed during clinical use.
(2) Class II (performance standards) for the nonimplanted blood access device.
(3) Class II (performance standards) for accessories for both the implanted and the nonimplanted blood access devices not listed in paragraph (b)(4) of this section.
(4) Class I for the cannula clamp, disconnect forceps, crimp plier, tube plier, crimp ring, and joint ring, accessories for both the implanted and nonimplanted blood access device. The devices subject to this paragraph (b)(4) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

Summary

KII2178

OCT 2 7 2011

510(k) Summary

Preparation Date: October 24, 2011

Manufacturer and contact Information

| Manufacturer: | JMS Singapore Pte Ltd
440, Ang Mo Kio Industrial Park 1
Singapore 569620 |
|----------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Sponsor: | JMS North America Corporation
22320 Foothill Blvd., Suite 350
Hayward, CA 94541
USA |
| Contact Information for Sponsor: | Mr Sho Hosoki
Coordinator of Product Management
and Regulatory Affairs
JMS North America Corporation
22320 Foothill Blvd., Suite 350
Hayward, CA 94541
Email: SHosoki@jmsna.net
Telephone: (510) 888-9090
Fax: (510) 888-9099 |

Trade Name: 1.

JMS Apheresis Needle Set "WingEater®"

JMS North America Corp will continue to name the new modified device as "JMS Apheresis Needle Set "WingEater®". For the purpose

of this submission, we will refer our predicate and new modified device as:

Predicate device	JMS Apheresis Needle Set "WingEater®" V1
New modified device	JMS Apheresis Needle Set "WingEater®" V2

Device Classification Name 2.

Gastroenterology Devices Panel has classified modified device of JMS Apheresis Needle Set "WingEater®" V2 (21 CFR 876.5540) as Class II.

Predicate Device Name 3.

Predicate device used in this submission is JMS Apheresis Needle Set "Wing Eater®" V1, (510(k) number - K010410, cleared on 20 June 2001).

Device Intended use 4.

Device Description ક.

JMS Apheresis Needle Set "WingEater" V2 is a device whereby an antineedlestick feature (WingEater guard) is assembled with predicate device under 510(k), K00845.

Needlestick injury can be prevented by pulling the PVC tube to retract the needle and wing into WingEater guard when removing needle so as to encapsulate the whole needle within the WingEater guard.

Modifications to JMS Apheresis Needle Set "WingEater®" V2 in this special 510(k) are:

Additional new polypropylene (PP) materials used for WingEater a) guard, needle cover, luer lock cover and clamp (non fluid pathway)
There are other non-significant changes which were made to 510(k) -K010410 in the past. These changes are listed under Attachment 004 List of Past Changes of this special 510(k).

Evaluation of the new packaging configuration was performed accordingly to stimulated conditions experienced during transportation. New design and material used for the WingEater guard was evaluated accordingly with folded wing in order to realize the actual device usage. Reviews of the modifications were documented within this special 510(k) submission.

Technological Characteristics and Substantial Equivalence 6.

JMS Apheresis Needle Set "WingEater®" V2 has same intended use and identical fundamental scientific technology as JMS Apheresis Needle Set "WingEater®" V1. Bench testing had been conducted to verify performance of JMS Apheresis Needle Set "WingEater®" V2 and it was found to be safe and effective. The following data and reports were enclosed within this submission document.

ISO 10993-4:2002 Biological Evaluation of Medical Devices Part 4 . – Selection of Tests for Interactions with Blood
ISO 10993-5:2009 Biological Evaluation of Medical Devices Part 5 . - Tests for In Vitro Cytotoxicity
ISO 10993-10 Biological Evaluation of Medical Devices Part 10 . Tests for Irritation and Delayed-Type Hypersensitivity

ISO 10993-11 Biological Evaluation of Medical Devices Part 11 . Tests for Systemic Toxicity
ISO 594-1: 1986 Conical Fittings with 6% (Luer) Taper for Syringes, . Needles and Certain Other Medical Equipment - Part 1 - General Requirements
ISO 594-2: 1998 Conical Fittings with 6% (Luer) Taper for Syringes, . Needles and Certain Other Medical Equipment - Part 2 - General Requirements
ISO 1135-4 4th Edition 2010-04-15, Transfusion Equipment for . Medical Use _ Part 4 - Transfusion Sets for Single Use
ISO 11135-1:2007 Sterilization of Health Care Products Ethylene . Oxide - Part 1 - Requirements for Development, Validation and routine control of a sterilization process for medical devices. (Sterility)
ISO 11137-1 Sterilization of Health Care Products Radiation Part . 1 - Requirements for Development, Validation, and Routine Control of a Sterilization Process for Medical Devices. (Sterility)
ISO 11137-2:2006 Sterilization of Health Care Products Radiation . Part 2 – Establishing the Sterilization Dose
ISO 11137-3:2006 2010 Sterilization of Health Care Products -. Radiation - Part 3 - Guidance on Dosimetric Aspects
ISO 11607-1:2007 Packaging for Terminally Sterilized Medical . Devices – Part 1: Requirements for Materials
ISO 11607-2: 2006 Packaging for Terminally Sterilized Medical . Devices - Part 2: Validation Requirements for Forming, Sealing and Assembly Processes
ISO 14644-1: 1999 Clean rooms and associated controlled . environments- Part 1: Classification of air cleanliness
ISO 14644-2: 2000 Clean rooms and associated controlled . environments -- Part 2: Specifications for testing and monitoring to prove continued compliance with ISO 14644-1

ISO 9626: 1991 + (Amd1:2001) Stainless Steel Needle Tubing for . the Manufacture of Medical Devices
USP 32:2009 Sterility Tests .
USP 33:2010 Bacterial Endotoxins .
ISO 14971:2007 Medical Devices Application of Risk Management . to Medical Devices

Thus, the information provided in this submission clearly demonstrated Substantial Equivalence of JMS Apheresis Needle Set "WingEater®" V2 to the predicate device JMS Apheresis Needle Set "WingEater®" V1.

Image /page/5/Picture/0 description: The image shows the text "DEPARTMENT OF HEALTH & HUMAN SERVICES". The text is in all caps and is in a sans-serif font. The text is black and the background is white. The text is centered in the image.

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

OCT 2 7 2011

Mr. E.J. Smith Consultant JMS North America Corporation 1468 Harwell Avenue Crofton, Maryland 21114

Re: K112178

Trade/Device Name: JMS Apheresis Needle Set "WingEater®" Regulation Number: 21 CFR 876.5540 Regulation Name: Blood Access Device and Accessories Regulatory Class: II Product Code: FIE, FOZ Dated: September 29, 2011 Received: September 30, 2011

Dear Mr. Smith:

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.

Page 2 - Mr. Smith

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/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/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours.

hnfor

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

Indications for Use

510(K) Number:

KII2178

Device Name:

Needle, Fistula

Indications For Use:

Prescription Use V (Part 21 CFR 801 Subpart D)

AND/OR

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

ACRNG FOR
RICHARD CHAPMAN.
(Division Sign-Off)

Division of Anesthesiology, General Hospital Infection Control, Dental Devices

1/12/78 510(k) Number:

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