K Number
K131496
Device Name
BELLAVAR / CUSTOM SEAMLESS SOFT (A.K.A. COMTESSE)
Manufacturer
Date Cleared
2013-07-10

(48 days)

Product Code
Regulation Number
880.5780
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Compression Class I Mild swelling, tired aching legs, thrombosis prophylaxis, minor varices, post surgery Compression Class II Primary varices, varices with edema, varices with pregnancy; post-sclerotherapy; post venous ulceration Compression class III Secondary varices; severe varices with edema; post-phlebitic syndrome; chronic venous insufficiency; phiebitis; thrombophlebitis and edema
Device Description
Not Found
More Information

Not Found

Not Found

No
The summary provides no information about the device's technology, and specifically states "Not Found" for mentions of AI, DNN, or ML.

Yes
The Indications for Use section describes several medical conditions like mild swelling, varices, thrombosis, chronic venous insufficiency, and post-phlebitic syndrome, for which the device is intended to provide compression therapy. This aligns with the definition of a therapeutic device designed to treat or alleviate a medical condition.

No

Explanation: The provided text describes different compression classes and their uses for various venous conditions. These uses relate to treatment or prevention (prophylaxis) of conditions and do not involve identifying or diagnosing a disease.

No

The provided text only describes the intended use/indications for use of a device related to compression classes. It does not contain any information about the device's description, technology, or components, making it impossible to determine if it is software-only.

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

Here's why:

  • Intended Use/Indications for Use: The listed indications (swelling, varices, thrombosis prophylaxis, etc.) describe conditions related to the circulatory system and are treated with physical compression. IVDs are used to examine specimens (like blood, urine, or tissue) from the body to provide information for diagnosis, monitoring, or screening.
  • Device Description: While "Not Found" is listed, the intended uses strongly suggest a physical device like compression stockings or garments.
  • Lack of IVD-related information: There is no mention of analyzing biological samples, diagnostic testing, or any of the typical characteristics of an IVD.

Therefore, based on the provided text, this device is a therapeutic device used for physical compression, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

Compression Class I Mild swelling, tired aching legs, thrombosis prophylaxis, minor varices, post surgery

Compression Class II Primary varices, varices with edema, varices with pregnancy; post-sclerotherapy; post venous ulceration

Compression class III Secondary varices; severe varices with edema; post-phlebitic syndrome; chronic venous insufficiency; phiebitis; thrombophlebitis and edema

Product codes

DWL

Device Description

Not Found

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)

Not Found

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

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5780 Medical support stocking.

(a)
Medical support stocking to prevent the pooling of blood in the legs —(1)Identification. A medical support stocking to prevent the pooling of blood in the legs is a device that is constructed of elastic material and designed to apply controlled pressure to the leg and that is intended for use in the prevention of pooling of blood in the leg.(2)
Classification. Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 880.9.(b)
Medical support stocking for general medical purposes —(1)Identification. A medical support stocking for general medical purposes is a device that is constructed of elastic material and designed to apply controlled pressure to the leg and that is intended for medical purposes other than the prevention of pooling of blood in the leg.(2)
Classification. Class I. The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter, subject to the limitations in § 880.9. The device is also exempt from the current good manufacturing practice requirements of the quality system regulation in part 820 of this chapter, with the exception of § 820.180, with respect to general requirements concerning records, and § 820.198, with respect to complaint files.

0

Image /page/0/Picture/0 description: The image shows the logo for the Department of Health & Human Services - USA. 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 emblem featuring an abstract design of an eagle or bird-like figure, rendered in black.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

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

July 10, 2013

BSN Medical, Incorporated C/O Mr. Carroll D. Hoyle Global Regulatory Affairs 100 Beiersdorf Drive RUTHERFORD COLLEGE NC 28671

Re: K131496

Trade/Device Name: Bellavar, Custom Seamless Soft Regulation Number: 21 CFR 880.5780 Regulation Name: Medical Support Stocking Regulatory Class: II Product Code: DWL Dated: May 13, 2013 Received: June 11, 2013

Dear Mr. Hoyle:

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.

1

Page 2 - Мг. Hoyle

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 devicerelated 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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. 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.

Mary S. Runne 2013.07.10 12:36:4

Kwame Ulmer, M.S. Acting Division Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known): K131496

Device Name: Bellavar, Custom Seamless Soft

Indications for Use:

Compression Class I

Mild swelling, tired aching legs, thrombosis prophylaxis, minor varices, post surgery

Compression Class II Primary varices, varices with edema, varices with pregnancy; post-sclerotherapy; post venous ulceration

Compression class III Secondary varices; severe varices with edema; post-phlebitic syndrome; chronic venous insufficiency; phiebitis; thrombophlebitis and edema

Prescription Use X (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)

.. . . . !

Richard C. Chapman 2013.07.10 10:27:16 -04'00'

... .

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

Page _ l_ of _l

510(k) Number: K131476