K Number
K112936
Device Name
SAFE'SOUND LUER LOCK PASSIVE DEVLIVERY SYSTEM
Date Cleared
2012-01-20

(109 days)

Product Code
Regulation Number
880.5860
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Single use devices that are indicated for use as an accessory with BD Hypak Sterile Clean Fill (SCF) glass Prefilled Syringes 1 mL long to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications, and individuals that assist self-injecting patients, from accidental needlesticks. The devices can be used on a wide range of patients including children and adults.
Device Description
The Safe'n'Sound® Luer Lock Passive Delivery System is an anti-needlestick accessory for use with BD Hypak SCF glass Prefilled Syringes. It fits with needles 1" long maximum, and consists of a body assembly and a loose plunger rod.
More Information

No
The summary describes a mechanical anti-needlestick accessory and does not mention any AI or ML components or functionalities.

No
The device is described as an "anti-needlestick accessory" that aids in the protection from accidental needlesticks. It does not directly diagnose, cure, mitigate, treat, or prevent disease, which are characteristics of a therapeutic device.

No

The device is described as an "anti-needlestick accessory" for prefilled syringes, designed to protect users from accidental needlesticks. Its intended use and description focus on safety and delivery of medication, not on diagnosis of medical conditions.

No

The device description clearly states it is a physical accessory consisting of a body assembly and a loose plunger rod, designed to be used with prefilled syringes. It is a hardware device, not software.

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

Here's why:

  • Intended Use: The intended use clearly states the device is an accessory for prefilled syringes to prevent accidental needlesticks. This is a physical safety mechanism for drug delivery, not a test performed on biological samples to diagnose or monitor a condition.
  • Device Description: The description details a physical anti-needlestick accessory that fits onto a syringe. This aligns with a medical device used for administering substances, not for in vitro testing.
  • Lack of IVD Characteristics: The text does not mention any of the typical characteristics of an IVD, such as:
    • Testing of biological samples (blood, urine, tissue, etc.)
    • Detection or measurement of analytes
    • Diagnosis, monitoring, or screening of diseases or conditions
    • Use of reagents or assays

The device's function is purely mechanical and related to the safe handling and disposal of a syringe after medication delivery.

N/A

Intended Use / Indications for Use

Single use devices that are indicated for use as an accessory with BD Hypak Sterile Clean Fill (SCF) glass Prefilled Syringes 1 mL long to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications, and individuals that assist self-injecting patients, from accidental needlesticks. The devices can be used on a wide range of patients including children and adults.

Product codes

MEG

Device Description

The Safe'n'Sound® Luer Lock Passive Delivery System is an anti-needlestick accessory for use with BD Hypak SCF glass Prefilled Syringes. It fits with needles 1" long maximum, and consists of a body assembly and a loose plunger rod.

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

children and adults

Intended User / Care Setting

healthcare professionals, patients who self-inject doctor prescribed medications, and individuals that assist self-injecting patients

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

Bench testing has been performed on the Safe'n'Sound® Luer Lock Passive Delivery System. It confirmed the product functions as intended and is substantially equivalent to the predicate device. Biocompatibility testing performed demonstrates that the product meets ISO 10993-5 and ISO 10993-10 requirements.
Simulated clinical use testing has been performed. It confirmed that the Safe'n'Sound® Luer Lock Passive Delivery System could be used safely and effectively to shield needles inside the protection device after use.

Key Metrics

Not Found

Predicate Device(s)

K060743 UltraSafe® Passive Delivery System by Safety Syringes, Inc.; K101233 Safe'n'Sound® Passive Delivery System by Rexam Pharma

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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).

0

Abbreviated 510(k)
Safe'n'Sound® Luer Lock Passive Delivery System Page 1 of 2

JAN 2 0 2012

ﺐ،، ﺍﻟﺘﺎﺭﻳﺦ

Section 5: 510(k) Summary

Assigned 510(k) number:K112936
Company:Rexam Healthcare
800 Corporate Grove Drive
Buffalo Grove, IL 60089
Phone: 847-325-3016
Fax: 847-325-3911
Contact:Sandra Anderson, M.J., RAC
Date Prepared:December 21, 2011
Proprietary Names:Safe'n'Sound® Luer Lock Passive Delivery System
Classification Name:Piston syringe accessory
Classification:21 CFR 880.5860, Class II, Product Code MEG
Predicate Devices:K060743 UltraSafe® Passive Delivery System by Safety
Syringes, Inc.; K101233 Safe'n'Sound® Passive Delivery
System by Rexam Pharma
Device Description:The Safe'n'Sound® Luer Lock Passive Delivery System is
an anti-needlestick accessory for use with BD Hypak SCF
glass Prefilled Syringes. It fits with needles 1" long
maximum, and consists of a body assembly and a loose
plunger rod.
Intended Use:Single use devices that are indicated for use as an accessory
with BD Hypak Sterile Clean Fill (SCF) glass Prefilled
Syringes 1 mL long to aid in the protection of healthcare
professionals, patients who self-inject doctor prescribed
medications, and individuals that assist self-injecting
patients, from accidental needlesticks. The devices can be
used on a wide range of patients including children and
adults.
Technological
Characteristic Comparison
Summary to Predicate Devices

Summary to Predicate Device:

The Safe'n'Sound® Luer Lock Passive Delivery System is similar to predicate devices in general technological features and principle of operation. All are molded plastic

1

Abbreviated 510(k) K112936 Safe'n'Sound® Luer Lock Passive Delivery System Page 2 of 2

assemblies consisting of a body, sleeve, plunger rod, and spring that activates upon injection completion to fully contain the needle. Minor differences with the predicates in technological features and performance have been demonstrated to be insignificant based upon bench testing and simulated clinical use studies performed.

Performance Testing:

Bench testing has been performed on the Safe'n'Sound® Luer Lock Passive Delivery System. It confirmed the product functions as intended and is substantially equivalent to the predicate device. Biocompatibility testing performed demonstrates that the product meets ISO 10993-5 and ISO 10993-10 requirements.

Simulated clinical use testing has been performed. It confirmed that the Safe'n'Sound® Luer Lock Passive Delivery System could be used safely and effectively to shield needles inside the protection device after use.

the design, technology, performance, Based upon functional testing, and intended use, the Safe'n'Sound® Luer Lock Passive Delivery System is substantially equivalent to predicate devices currently marketed under the Food, Drug and Cosmetic Act. The Safe'n'Sound® Luer Lock Passive Delivery System raises no new issues of safety or effectiveness.

Clinical Testing:

Conclusion:

12

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. Inside the circle is a stylized eagle-like symbol with three curved lines representing the body and wings.

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

JAN 2 0 2012

Ms. Sandra Anderson Regulatory Compliance Manager Rexam Consumer Plastics Incorporated d/b/a Rexam Pharma 800 Corporate Grove Drive Buffalo Grove, Illinois 60089

Re: K112936

Trade/Device Name: Safe'n'Sound® Luer Lock Passive Delivery System Regulation Number: 21 CFR 880.5860 Regulation Name: Piston Syringe Regulatory Class: II Product Code: MEG Dated: December 21, 2011 Received: December 22, 2011

Dear Ms. Anderson:

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.

3

Page 2 - Ms. Anderson

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 vours.

Ciprian D.avat

nthony D. Watson, B.S., M.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

4

Indications for Use

510(k) Number (if known): K112936

Device Name: Safe'n'Sound® Luer Lock Passive Delivery System

Indications for Use:

Single use devices that are indicated for use as an accessory with BD Hypak Sterile Clean Fill (SCF) glass Prefilled Syringes 1 mL long to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications, and individuals that assist self-injecting patients, from accidental needlesticks. The devices can be used on a wide range of patients including children and adults.

Prescription Use X (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 IF NEEDED)

Rell C. 1/12/12

(Division Suppor CDRH, Office of Device Evaluation (ODE) Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: K112936

Page 1 of