K Number
K123198
Device Name
LIQUICHEK ETHANOL/AMMONIA CONTROL LEVEL 1 MODEL 271, LIQUICHEK ETHANOL/AMMONIA CONTROL LEVEL 2 MODEL 272, LIQUICHEK ETHA
Date Cleared
2012-11-20

(40 days)

Product Code
Regulation Number
862.1660
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Liquichek Ethanol/Ammonia Control is intended for use as an assayed quality control serum to monitor the precision of laboratory testing procedures for the analytes listed in the package insert.
Device Description
Liquichek Ethanol/Ammonia Control is prepared from bovine serum albumin with chemicals, stabilizers and preservatives added. This control is provided in liquid form for convenience.
More Information

Not Found

No
The summary describes a quality control serum for laboratory testing and does not mention any AI or ML components or functionalities.

No.
The device is described as an "assayed quality control serum to monitor the precision of laboratory testing procedures," indicating it is used for quality control in laboratory settings rather than for treating a disease or condition in a patient.

No
Explanation: The device is a quality control serum used to monitor the precision of laboratory testing procedures, not to diagnose a patient's condition.

No

The device is a quality control serum, which is a physical substance used to monitor laboratory testing procedures. It is not software.

Based on the provided information, the device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use explicitly states it's for "monitoring the precision of laboratory testing procedures for the analytes listed in the package insert." This is a classic function of an IVD control material used in a laboratory setting to assess the performance of diagnostic tests.
  • Analytes: The analytes listed (Ethanol and Ammonia) are substances measured in biological samples for diagnostic purposes.
  • Device Description: It's a "quality control serum" used in "laboratory testing procedures."
  • Intended User / Care Setting: "laboratory testing procedures" further reinforces its use in a diagnostic laboratory environment.

While the document doesn't explicitly use the term "In Vitro Diagnostic," the intended use and context clearly align with the definition of an IVD device, which is used to examine specimens derived from the human body to provide information for diagnostic purposes. In this case, the control material helps ensure the accuracy of the tests that are performing those diagnostic examinations.

N/A

Intended Use / Indications for Use

Liquichek Ethanol/Ammonia Control is intended for use as an assayed quality control serum to monitor the precision of laboratory testing procedures for the analytes listed in the package insert.

The following analytes are included in the package insert:

  1. Ethanol
  2. Ammonia

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

JJY

Device Description

Liquichek Ethanol/Ammonia Control is prepared from bovine serum albumin with chemicals, stabilizers and preservatives added. This control is provided in liquid form for convenience.

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)

Stability studies have been performed and met the acceptance criteria for Liquichek Ethanol/Ammonia Control (New Device) to determine the open vial and shelf life claims.

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.

K955024

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

§ 862.1660 Quality control material (assayed and unassayed).

(a)
Identification. A quality control material (assayed and unassayed) for clinical chemistry is a device intended for medical purposes for use in a test system to estimate test precision and to detect systematic analytical deviations that may arise from reagent or analytical instrument variation. A quality control material (assayed and unassayed) may be used for proficiency testing in interlaboratory surveys. This generic type of device includes controls (assayed and unassayed) for blood gases, electrolytes, enzymes, multianalytes (all kinds), single (specified) analytes, or urinalysis controls.(b)
Classification. Class I (general controls). Except when intended for use in donor screening tests, quality control materials (assayed and unassayed) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9.

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K1231'98

Bio-Rad Laboratories Premarket Notification Section 510 (k) Liquichek Ethanol/Ammonia Control

Page 1 of 3

Summary of Safety and Effectiveness Liquichek Ethanol/Ammonia Control

1.0 Submitter

Bio-Rad Laboratories 9500 Jeronimo Road, Irvine, California 92618-2017 Telephone: (949) 598-1200 Fax: (949) 598-1557

Contact Person

Suzanne Parsons Regulatory Affairs Manager Telephone: (949) 598-1467

Date of Summary Preparation

November 15, 2012

2.0 Device Identification

Product Trade Name:Liquichek Ethanol/Ammonia Control
Common Name:Multi-Analyte Controls, All Kinds (Assayed)
Classifications:Class I, Reserved
Product Code:JJY
Regulation Number:21 CFR 862.1660

3.0 Device to Which Substantial Equivalence is Claimed

Predicate Device Information
Device Name:Liquichek Ethanol/Ammonia Control
Applicant:Bio-Rad Laboratories
510(k) Number:K955024
Product Code:JJY
Regulation #:862.1660
Device Classification Name:Multi-analyte Controls. All Kinds(Assayed)

4.0 Description of Device

Liquichek Ethanol/Ammonia Control is prepared from bovine serum albumin with chemicals, stabilizers and preservatives added. This control is provided in liquid form for convenience.

5.0 Intended Use

Liquichek Ethanol/Ammonia Control is intended for use as an assayed quality control serum to monitor the precision of laboratory testing procedures for the analytes listed in this package insert.

NOV 2 0 2012

1

6.0 Value Assignment

The mean values and the corresponding ±3SD ranges printed in this insert were derived from replicate analyses and are specific for this lot of product. The tests listed were performed by the manufacturer and/or independent laboratories using manufacturer supported reagents and a representative sampling of this lot of product. It is recommended that each laboratory establish its own acceptable ranges and use those provided only as quides. Laboratory established ranges may vary from those listed during the life of this control. Variations over time and between laboratories may be caused by differences in laboratory technique, instrumentation and reagents, or by manufacturer test method modifications

7.0 Comparison of the new device with the Predicate Device

Liquichek Ethanol/Ammonia Control claims substantial equivalence to the Liquichek Ethanol/Ammonia Control currently in commercial distribution under 510(k)K95024. Table 1 (below) contains comparison information of similarities and differences between the new and predicate device to which substantial equivalence is claimed.

| Characteristics | Liquichek Ethanol/Ammonia Control
(New Device) | Liquichek Ethanol/Ammonia Control
(Predicate Device under K955024) |
|----------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Similarities | | |
| Intended Use | Liquichek Ethanol/Ammonia Control is
intended for use as an assayed quality
control serum to monitor the precision of
laboratory testing procedures for the
analytes listed in this package insert. | Liquichek Ethanol/Ammonia Control is
intended for use as an assayed quality
control serum to monitor the precision of
laboratory testing procedures for the
analytes listed in this package insert. |
| Matrix | This product is prepared from bovine
serum albumin with added chemicals,
stabilizers and preservatives. | This product is prepared from bovine
serum albumin with added chemicals,
stabilizers and preservatives. |
| Form | Liquid | Liquid |
| Storage unopened
(Shelf life) | Until the expiration date when stored at
2 to 8°C | Until the expiration date when stored at
2 to 8°C |
| Analytes | Ethanol
Ammonia | Ethanol
Ammonia |
| Differences | | |
| Fill Size | 2.5 mL | 3 mL |
| Open Vial Stability | 20 days at 2 to 8°C on board Siemens
Dimension Vista instrument | 20 days at 2 to 8°C |

Table 1. Similarities and Differences between new and predicate device.

8.0 Statement of Supporting Data

Stability studies have been performed and met the acceptance criteria for Liquichek Ethanol/Ammonia Control (New Device) to determine the open vial and shelf life claims. Product claims are as follows:

Open Vial Stability:

2

Sheif Life Stability

24 Months at 2 to 8°C

9.0 Conclusion

Liquichek Ethanol/Ammonia Control (New Device) is intended to be used for the same intended use as the predicate. It has bovine serum albumin matrix and performs similarly as the predicate device

All supporting data is retained on file at Bio-Rad Laboratories.

3

DEPARTMENT OF HEALTH & HUM AN SERVICES

Image /page/3/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 an abstract symbol that resembles an eagle or bird in flight, composed of three curved lines.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

November 20, 2012

Bio-Rad Laboratories c/o Suzanne Parsons 9500 Jeronimo Road Irvine, CA 92618-2017

Re: K123198

Trade/Device Name: Liquichek Ethanol/Ammonia Control Regulation Number: 21 CFR 862.1660 Regulation Name: Quality control material Regulatory Class: Class I, reserved Product Code: JJY Dated: October 8, 201-2 Received: October 25, 2012

Dear Ms. Suzanne Parsons:

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 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 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 (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

4

Page 2 - Suzanne Parsons

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 Diagnostics and Radiological Health 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,

Carol C. Benson

for

Courtney H. Lias, Ph.D. Director Division of Chemistry and Toxicology Office of In Vitro Diagnostics and Radiological Health Center for Devices and Radiological Health

Enclosure

5

Indications for Use Form

123198 510(k) Number (if known):

Liquichek Ethanol/Ammonia Control Device Name:

Indications for Use:

Liquichek Ethanol/Ammonia Control is intended for use as an assayed quality control serum to monitor the precision of laboratory testing procedures for the analytes listed in the package insert.

The following analytes are included in the package insert:

  1. Ethanol 2. Ammonia

X Over-The-Counter Use Prescription Use Prescription Ose
(Part 21 CFR 801 Subpart D) 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 In Vitro Diagnostics and Radiological Health (OIR)

Yung. Chan

Division/Sign-Office of In Vitro Diagnostics and Radiological Health

510(k) k123i98