K Number
K112961
Device Name
CLO-SURPLUS P.A.D.
Date Cleared
2011-10-31

(27 days)

Product Code
Regulation Number
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Scion Cardio-Vascular Clo-SurPUS P.A.D. is intended for the local management of bleeding wounds and to provide a barrier to bacterial penetration of the dressing in all patients and for the promotion of rapid control (hemostasis) of bleeding in patients following hemodialysis and for those on anticoagulation therapy. The dressing is indicated for the following wounds: lacerations, nose bleeds, surgical debridement sites, skin surface puncture sites, vascular sites, and sites involving percutaneous catheters, tubes and pins.
Device Description
The Scion Cardio-Vascular Clo-SurPLUS PADTM is a soft, nonwoven topical pad that provides an optimal wound healing environment, combining an effective antibacterial barrier activity with exudates management. An optional slit Clo-SurfLUS PAD™ allows for easier placement of the dressing around pins and tubes. Clo-Sur PLUS PADTM has demonstrated in-vitro antibacterial activity for up to 144 hours (6 days) in certain strains shown to be detrimental to wound healing such as: Escherichia Coli, Staphylococcus Aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Bacillus cereus, Enterococcus faecium, Candida Albicans and Asperigillus brasiliensis. Clo-SurPLUS PAD™ is a sterile topical hemostasis pad, packed in a foil pouch and sterilized by E-beam radiation to a 10°6 SAL.
More Information

Not Found

No
The description focuses on the physical properties and antibacterial activity of a topical pad, with no mention of AI or ML.

Yes

Explanation: The device is intended for local management of bleeding wounds and provides a barrier to bacterial penetration, which are therapeutic actions.

No
The device is described as a wound dressing for managing bleeding and providing a barrier against bacteria, which are therapeutic functions, not diagnostic.

No

The device description clearly states it is a "soft, nonwoven topical pad," which is a physical, hardware component, not software.

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

Here's why:

  • Intended Use: The intended use is for the local management of bleeding wounds and to provide a barrier to bacterial penetration. This is a topical application and directly interacts with the wound site.
  • Device Description: The device is described as a "soft, nonwoven topical pad" and a "sterile topical hemostasis pad." This further reinforces its external, wound-dressing nature.
  • Lack of In Vitro Testing: While the device description mentions "in-vitro antibacterial activity," this refers to testing the device's effect on bacteria in a lab setting, not testing a patient's sample to diagnose a condition. IVDs are used to examine specimens (like blood, urine, tissue) from the human body to provide information for diagnosis, monitoring, or screening.
  • No Mention of Patient Samples: The description does not mention collecting or analyzing any samples from the patient.

In summary, the Scion Cardio-Vascular Clo-SurPLUS P.A.D. is a wound dressing and hemostatic device applied externally to the body, not a device used to test patient samples for diagnostic purposes.

N/A

Intended Use / Indications for Use

The Scion Cardio-Vascular Clo-SurPUS P.A.D. is intended for the local management of bleeding wounds and to provide a barrier to bacterial penetration of the dressing in all patients and for the promotion of rapid control (hemostasis) of bleeding in patients following hemodialysis and for those on anticoagulation therapy.

The dressing is indicated for the following wounds: lacerations, nose bleeds, surgical debridement sites, skin surface puncture sites, vascular sites, and sites involving percutaneous catheters, tubes and pins.

Product codes

QSY, LYA, FRO

Device Description

The Scion Cardio-Vascular Clo-SurPLUS PADTM is a soft, nonwoven topical pad that provides an optimal wound healing environment, combining an effective antibacterial barrier activity with exudates management.

An optional slit Clo-SurfLUS PAD™ allows for easier placement of the dressing around pins and tubes.

Clo-SurPLUS PAD™ has demonstrated in-vitro antibacterial activity for up to 144 hours (6 days) in certain strains shown to be detrimental to wound healing such as: Escherichia Coli, Staphylococcus Aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Bacillus cereus, Enterococcus faecium, Candida Albicans and Asperigillus brasiliensis.

Clo-SurPLUS PAD™ is a sterile topical hemostasis pad, packed in a foil pouch and sterilized by E-beam radiation to a 10SAL.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Wounds (lacerations, abrasions, nose bleeds, surgical debridement sites, skin surface puncture sites, vascular procedure sites, and sites involving percutaneous catheters, tubes and pins)

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

K092552

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

N/A

0

Image /page/0/Picture/0 description: The image contains the logos of the Department of Health & Human Services and the Food and Drug Administration (FDA). The Department of Health & Human Services logo is on the left and features a stylized eagle. The FDA logo is on the right and features the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

Scion Cardio-Vascular, Inc. c/o C2C Development, LLC Craig Pagan 1050 W NASA Boulevard, Suite 136 Melbourne, Florida 32901

July 28, 2023

Re: K112961 Trade/Device Name: Clo-SurPLUS P.A.D. Regulatory Class: Unclassified Product Code: QSY, LYA

Dear Craig Pagan:

The Food and Drug Administration (FDA) is sending this letter to notify you of an administrative change related to your previous substantial equivalence (SE) determination letter dated October 31, 2011 and correction letter dated May 1, 2012. Specifically, FDA is updating this SE Letter because FDA has better categorized your device technology under product codes QSY and LYA.

Please note that the 510(k) submission was not re-reviewed. For questions regarding this letter please contact Julie Morabito, OHT4: Office of Surgical and Infection Control Devices, 240-402-3839, Julie.Morabito@fda.hhs.gov.

Sincerely.

Julie A. Morabito -S

Julie Morabito, Ph.D. Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

1

Image /page/1/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized image of a human figure in profile, with three overlapping faces. The figure is positioned to the right of the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA", which is arranged in a circular pattern around the figure.

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

Scion Cardio-Vascular, Inc. % C2C Development, LLC Mr. Craig Pagan 1050 W NASA Boulevard, Suite 136 Melbourne, Florida 32901

Re: K112961 Trade/Device Name: Clo-Sur-LUS P.A.D. Regulatory Class: Unclassified Product Code: FRO Dated: September 29, 2011

Received: October 4, 2011

MAY 1 2012

Dear Mr. Pagan:

This letter corrects our substantially equivalent letter of October 31, 2011.

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

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

2

Page 2 - Mr. Craig Pagan

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/ResourcesforYou/Industry/default.htm.

Sincerely yours,
Mada M Millan

Mark N. Melkerson Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

3

SECTION 5 - INDICATIONS FOR USE STATEMENT

112961 510(k) Number:

Clo-Surplus P.A.D. Device Name:

INDICATIONS:

The Scion Cardio-Vascular Clo-SurPUS P.A.D. is intended for the local management of bleeding wounds and to provide a barrier to bacterial penetration of the dressing in all patients and for the promotion of rapid control (hemostasis) of bleeding in patients following hemodialysis and for those on anticoagulation therapy.

The dressing is indicated for the following wounds: lacerations, nose bleeds, surgical debridement sites, skin surface puncture sites, vascular sites, and sites involving percutaneous catheters, tubes and pins.

Prescription Use _ > (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)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Danill Ksomefu MXM
(Division Sign Off)

(Division Sign-Division of Surgical, Orthopedic. and Restorative Devices

510(k) Number K112961

Page 1 of 1

Scion Cardio-Vascular, Inc. Special 510(k) Submission - Modified Clo-Sur PLUS PAD

Page 18 of 47

4

K112961
page 1 of 2

OCT 3 1 2011

SECTION 6 - 510(k) SUMMARY

Submitted by:

Scion Cardio-Vascular, Inc. 14256 S.W. 119th Avenue Miami, FL 33186 Phone: (305) 259-8880 Fax: (305) 259-8878

Contact Person:

Lou Rose 14256 S.W. 119th Avenue Miami, FL 33186 Phone: (305) 259-8880 Ext 103 Fax: (305) 259-8878

Date Prepared:

September 14, 2011 Clo-Surpl.us PAD™

Proprietary Name:

Common Name:

Classification:

Classification Name:

Predicate Device:

Device Description:

Intended Use:

Topical Hemostasis Pad

Unclassified

Topical Wound Dressing Pad

Scion Cardio-Vascular, Inc, K092552, CLO-SURPLUS P.A.D.,

The Scion Cardio-Vascular Clo-SurPLUS PADTM is a soft, nonwoven topical pad that provides an optimal wound healing environment, combining an effective antibacterial barrier activity with exudates management.

An optional slit Clo-SurfLUS PAD™ allows for easier placement of the dressing around pins and tubes.

Clo-Sur PLUS PADTM has demonstrated in-vitro antibacterial activity for up to 144 hours (6 days) in certain strains shown to be detrimental to wound healing such as: Escherichia Coli, Staphylococcus Aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Bacillus cereus, Enterococcus faecium, Candida Albicans and Asperigillus brasiliensis.

Clo-SurPLUS PAD™ is a sterile topical hemostasis pad, packed in a foil pouch and sterilized by E-beam radiation to a 10°6 SAL.

The Scion Cardio-Vascular Clo-Sur-Lus P.A.D. is intended for the local management of bleeding wounds and to provide a barrier to bacterial penetration of the dressing in all patients and for the promotion of rapid control (hemostasis) of bleeding

5

K112961
page 2 of 2

in patients following hemodialysis and for those on anticoagulation therapy.

The dressing is indicated for the following wounds: lacerations, abrasions, nose bleeds, surgical debridement sites, skin surface puncture sites, vascular procedure sites, and sites involving percutaneous catheters, tubes and pins.

Technological Characteristics

The Scion Cardio-Vascular Clo-SurPLUS PADTM is a soft, nonwoven pad made of a proprietary formulation of poly-Dglucosamine and poly-N-acetylglucosamine derived from chitosan. The natural biological properties of this material gives the Clo-Sur-LUS PADTM an advantage as an effective bacterial barrier while providing for an optimal wound healing environment.

Several biomedical applications of poly-D-glucosamine and poly-N-acetyglucosamine have been reported. The studies represent research on the safety and use of these materials, which have been published over a period of decades by scientists from around the world. The scientific literature satisfies the requirement that a general recognition of safety requires common knowledge about the substance throughout the scientific community. This formulation has many useful and advantageous properties in their application as a wound dressing, namely biocompatibility, biodegradability, hemostatic activity, anti-infectional activity.

The technological characteristics of the modified Clo-SurPLus PAD™ are the same as the predicate device. The Scion Cardio-Vascular modified Clo-SuPLUS PAD™ works in the same manner as the approved predicate device.

Scion Cardio-Vascular, Inc. Special 510(k) Submission - Modified Clo-Sur PLUS PAD