K Number
K131876
Device Name
M SERIES PATIENT MONITOR
Date Cleared
2014-02-27

(248 days)

Product Code
Regulation Number
870.1025
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
M Series Patient Monitor is intended to be used for monitoring, displaying, storing and alarming of multiple physiological parameters including ECG, Heart Rate (HR). Respiration Rate (RESP), Pulse Oxygen Saturation (SpO2), Pulse Rate (PR), Non-invasive Blood Pressure (NIBP), Invasive Blood Pressure (IBP), carbon dioxide (CO2), and Temperature (TEMP) of adult, pediatric and neonatal patient. The monitor is to be used in healthcare facilities by clinical physicians or appropriate medical staff under the direction of physicians. It is not intended for helicopter transport or hospital ambulance. Note: M7000 does not have functions of Invasive Blood Pressure and Carbon Dioxide.
Device Description
The proposed devices, M Series Patient Monitors, M66, M69, M7000, M8000 and M9000, are modification devices to the existed devices, M Series Patient Monitors, M66, M69, M7000, M8000 and M9000 as cleared in K100046 at 04/08/2010. The proposed devices and the existed devices share same intended use, design principle and technical specifications. The main modification of the proposed devices is adding a SpO2 module, which was designed and manufactured by Masimo Corporation and previously cleared by FDA in K053269 at 12/21/2005. It is an independent module installed within the patient monitor, without any other modifications, and shall be used with the specified accessories, which are listed in following table.
More Information

Not Found

No
The summary describes a standard patient monitor with added SpO2 functionality, and there is no mention of AI or ML in the intended use, device description, or performance studies.

No
The device is a patient monitor, explicitly stating its purpose is "for monitoring, displaying, storing and alarming of multiple physiological parameters." It does not mention any therapeutic action or treatment.

No

This device is a patient monitor that is intended for "monitoring, displaying, storing and alarming of multiple physiological parameters". It does not describe any function related to diagnosing a disease, condition, or injury.

No

The device description explicitly states that the proposed devices are "modification devices" to existing patient monitors and that the main modification is "adding a SpO2 module," which is described as an "independent module installed within the patient monitor." This indicates the device includes hardware components beyond just software.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is for "monitoring, displaying, storing and alarming of multiple physiological parameters including ECG, Heart Rate (HR). Respiration Rate (RESP), Pulse Oxygen Saturation (SpO2), Pulse Rate (PR), Non-invasive Blood Pressure (NIBP), Invasive Blood Pressure (IBP), carbon dioxide (CO2), and Temperature (TEMP)". These are all measurements taken directly from the patient's body, not from samples of bodily fluids or tissues.
  • Device Description: The description focuses on the hardware and the parameters it measures. There is no mention of reagents, calibrators, controls, or any other components typically associated with IVD devices that analyze samples.
  • Lack of IVD Characteristics: The document does not mention any analysis of biological samples (blood, urine, tissue, etc.) or the use of laboratory procedures.

IVD devices are specifically designed to examine specimens derived from the human body (such as blood, urine, or tissue) to provide information for the diagnosis, treatment, or prevention of disease. This patient monitor directly measures physiological signals from the patient.

N/A

Intended Use / Indications for Use

M Series Patient Monitor is intended to be used for monitoring, displaying, storing and alarming of multiple physiological parameters including ECG, Heart Rate (HR). Respiration Rate (RESP), Pulse Oxygen Saturation (SpO2), Pulse Rate (PR), Non-invasive Blood Pressure (NIBP), Invasive Blood Pressure (IBP), carbon dioxide (CO2), and Temperature (TEMP) of adult, pediatric and neonatal patient.

The monitor is to be used in healthcare facilities by clinical physicians or appropriate medical staff under the direction of physicians. It is not intended for helicopter transport or hospital ambulance.

Note: M7000 does not have functions of Invasive Blood Pressure and Carbon Dioxide.

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

MHX, DRT, DXN, DSK, DQA, BZQ, CCK, FLL

Device Description

The proposed devices, M Series Patient Monitors, M66, M69, M7000, M8000 and M9000, are modification devices to the existed devices, M Series Patient Monitors, M66, M69, M7000, M8000 and M9000 as cleared in K100046 at 04/08/2010.

The proposed devices and the existed devices share same intended use, design principle and technical specifications. The main modification of the proposed devices is adding a SpO2 module, which was designed and manufactured by Masimo Corporation and previously cleared by FDA in K053269 at 12/21/2005. It is an independent module installed within the patient monitor, without any other modifications, and shall be used with the specified accessories, which are listed in following table.

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

adult, pediatric and neonatal patient

Intended User / Care Setting

healthcare facilities by clinical physicians or appropriate medical staff under the direction of physicians.

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)

Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

ISO 14971:2007 Medical devices -- Application of risk management to medical devices; IEC 60601-1, Medical Electrical Equipment - Part 1: General Requirements for Safety, 1988; Amendment 1, 1991-11, Amendment 2, 1995;

IEC 60601-1-2, (Edition 2:2001 with Amendment 1:2004), Medical Electrical Equipment - Part 1-2:

General Requirements for Safety - Collateral Standard: Electromagnetic Compatibility -- Requirements and Tests:

ISO 9919:2005: Medical electrical equipment - Particular requirements for the basic safety and essential performance of pulse oximeter equipment for medical use.

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.

K100046, K053269

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

§ 870.1025 Arrhythmia detector and alarm (including ST-segment measurement and alarm).

(a)
Identification. The arrhythmia detector and alarm device monitors an electrocardiogram and is designed to produce a visible or audible signal or alarm when atrial or ventricular arrhythmia, such as premature contraction or ventricular fibrillation, occurs.(b)
Classification. Class II (special controls). The guidance document entitled “Class II Special Controls Guidance Document: Arrhythmia Detector and Alarm” will serve as the special control. See § 870.1 for the availability of this guidance document.

0

510(k) Summary

This 510(k) Summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of SMDA 1990 and Title 21, CFR Section 807.92.

The assigned 510(k) Number: K131876

l. Date of Submission: 06/08/2013

  1. Sponsor Identification

Guangdong Biolight Meditech Co., Ltd. No.2 Innovation First Road, Technical Innovation Coast, Hi-tech Zone, Zhuhai, P.R. China

Establishment Registration Number: 3007305624

Contact Person: Jin Liang Position: R&D Director Tel: +86-756-3399967 Fax: +86-756-3399989 Email: liang j@blt.com.cn

Submission Correspondent 3.

Ms. Diana Hong & Mr. Lee Fu Mid-Link Consulting Co., Ltd P.O. Box 120-119 Shanghai, 200120, China Tel: +86-21-22815850 Fax: 240-238-7587 Email: info@mid-link.net

1

4. Proposed Device Identification

Proposed Device Name: M Series Patient Monitor Proposed Device Model: M66, M69, M7000. M8000 and M9000 Proposed Device Common Name: Patient Monitor

Regulatory Information:

Classification Name: Monitor, Physiological, Patient;

Classification: II:

Product Code: MHX:

Regulation Number: 21 CFR 870.1025;

Review Panel: Cardiovascular;

Subsequent Product Code:

| Product
Code | Regulation
Number | Classification Name | Panel |
|-----------------|----------------------|--------------------------------------------------------|------------------|
| DRT | 870.2300 | Monitor, Cardiac (incl. cardiotachometer & rate alarm) | Cardiovascular |
| DXN | 870.1130 | System, Measurement, Blood-pressure, Non-invasive | Cardiovascular |
| DSK | 870.1110 | Computer, Blood-pressure | Cardiovascular |
| DQA | 870.2700 | Oximeter | Anesthesiology |
| BZQ | 868.2375 | Monitor, Breathing Frequency | Anesthesiology |
| CCK | 868.1400 | Analyzer, Gas, Carbon-Dioxide, Gaseous-phase | Anesthesiology |
| FLL | 880.2910 | Thermometer, Electronic, Clinical | General Hospital |

Intended Use Statement:

M Series Patient Monitor is intended to be used for monitoring, displaying, storing and alarming of multiple physiological parameters including ECG, Heart Rate (HR). Respiration Rate (RESP), Pulse Oxygen Saturation (SpO2), Pulse Rate (PR), Non-invasive Blood Pressure (NIBP), Invasive Blood Pressure (IBP), carbon dioxide (CO2), and Temperature (TEMP) of adult, pediatric and neonatal patient.

The monitor is to be used in healthcare facilities by clinical physicians or appropriate medical staff under the direction of physicians. It is not intended for helicopter transport or hospital ambulance.

Note: M7000 does not have functions of Invasive Blood Pressure and Carbon Dioxide.

2

  • Predicate Device Identification 5.
    510(k) Number: K100046 Product Name: M Series Patient Monitor Manufacturer: Guangdong Biolight Meditech Co., Ltd.

510(k) Number: K053269 Product Name: MASIMO SET RAD-8 PULSE OXIMETER Manufacturer: Masimo Corporation

    1. Device Description
      The proposed devices, M Series Patient Monitors, M66, M69, M7000, M8000 and M9000, are modification devices to the existed devices, M Series Patient Monitors, M66, M69, M7000, M8000 and M9000 as cleared in K100046 at 04/08/2010.

The proposed devices and the existed devices share same intended use, design principle and technical specifications. The main modification of the proposed devices is adding a SpO2 module, which was designed and manufactured by Masimo Corporation and previously cleared by FDA in K053269 at 12/21/2005. It is an independent module installed within the patient monitor, without any other modifications, and shall be used with the specified accessories, which are listed in following table.

ITEMAccessoryReusable/DisposablePopulationType
DCI / 2501SpO2 SensorReusableAdultClip
DCIP / 2502SpO2 SensorReusablePediatricClip
Neo / 2514SpO2 SensorDisposableInfantWrap
M-LNC1 / 2523Extension CableN.A.N.A.N.A.

Table 3-1 Accessories of Masimo SpO2 Module

7. Non-Clinical Test Conclusion

Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

ISO 14971:2007 Medical devices -- Application of risk management to medical devices; IEC 60601-1, Medical Electrical Equipment - Part 1: General Requirements for Safety, 1988; Amendment 1, 1991-11, Amendment 2, 1995;

IEC 60601-1-2, (Edition 2:2001 with Amendment 1:2004), Medical Electrical Equipment - Part 1-2:

3

General Requirements for Safety - Collateral Standard: Electromagnetic Compatibility -- Requirements and Tests:

ISO 9919:2005: Medical electrical equipment - Particular requirements for the basic safety and essential performance of pulse oximeter equipment for medical use.

Substantially Equivalent (SE) Conclusion 8.

·

The following table compares the DEVICE to the predicate device with respect to intended use. technological characteristics and principles of operation, etc.

4

ItemProposed DevicesPredicate Device
Product CodeM Series Patient MonitorK100046
MHXSame
Regulation No.21 CFR 870.1025Same
ClassClass IISame
Intended UseM Series Patient Monitor is intended to be used for
monitoring, displaying, reviewing, storing and
alarming of multiple physiological parameters
including ECG. Heart Rate (HR). Respiration Rate
(RESP). Pulse Oxygen Saturation (SpO2), Pulse Rate
(PR), Non-invasive Blood Pressure (NIBP), Invasive
Blood Pressure (IBP), carbon dioxide (CO2), and
Temperature (TEMP) of adult, pediatric and neonatal
patient.
The monitor is to be used in healthcare facilities by
clinical physicians or appropriate medical staff under
the direction of physicians. It is not intended for
helicopter transport or hospital ambulance.
Note: M7000 does not have functions of Invasive
Blood Pressure and Carbon DioxideSame
FeatureDisplayColour TFTSame
AlarmVisual and audio alarmingSame
Electrical SafetyThe proposed devices were tested to demonstrate to
comply with IEC 60601-1.Same
EMCThe proposed devices were tested to demonstrate to
comply with IEC 60601-1-2Same
Patient-contact
MaterialECG Electrode: Conductive adhesive
SpO2 Sensor: Silicone
NIBP Cuff: Polyester fibre
EtCO2 Sensor: PVC
Temperature Probe: PVCSame
Level of Concern of
the SoftwareMajorSame
Label and LabelingConforms to FDA Regulatory RequirementsSame
ItemProposed DevicesPredicate Devices
M Series Patient MonitorK100046
ECG Lead Mode5-leads ECG input / 3-leads ECG inputSame
ECG CMRRMON ≥105dB / OPS ≥105dBSame
ECG Sweep speed12.5mm/s. 25mm/s. 50mm/sSame
HR Range10~350 bpmSame
HR Accuracy±1% or ±1 bpm, whichever is greaterSame
NIBP MethodOscillometricSame
NIBP Measurement UnitmmHg / kPaSame
NIBPAdult 10-270 mmHgSame
MeasurementPediatric 10-235 mmHgSame
RangeNeonatal 10-135 mmHgSame
(Static) ±2% or ±3 mmHg. whichever is greaterSame
NIBP Accuracy(Clinical) ±5 mmHg average error
≤ 8 mmHg standard deviation
TEMP Range0.0~50.0°CSame
TEMP AccuracyAt 45.1°C~50.0°C, ±0.2°C (exclusive of probe)
At 25.0°C~45.0°C, ±0.1°C (exclusive of probe)
At 0.0°C~24.9°C, ±0.2°C (exclusive of probe)Same
RESP MethodImpedance variation between RA-LL (R-F)Same
RESP Measurement Range0~150 rpmSame
RESP Accuracy±2 rpmSame
BLT SpO2 Module
SpO2 Range0~100%Same
SpO2 AccuracyAt 70~100%, ±2%
At 0~69%, unspecifiedSame
PR Range25~250 bpmSame
PR Accuracy±1% or ±1 bpm,
whichever is greaterSame
Necllor SpO2 Module
SpO2 Range1~100%Same
SpO2 AccuracyAt 70~100%, ±2 digits (Adult)
At 70~100%, ±3 digits (Neonate)
At 70~100%, ±2 digits (Low Perfusion)
At 0~69%, unspecifiedSame
PR Range20~250 bpmSame
PR Accuracy±3 digitsSame

Table 3-2 Comparison of General and Safety Characteristics

·

:

5

Table 3-3 Comparison of ECG, NIBP, TEMP, RESP and SpO2 Characteristics

6

| Item | Proposed Devices | Predicate
Devices
K053269 | Predicate
Devices
K100046 |
|------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------|---------------------------------|
| SpO2 Module | MASIMO Module | Same | Similar |
| SpO2 Range | 1100% | Same | Same |
| SpO2
Accuracy | At 70
100%: $\pm$ 2% (adult/pediatric, non-motion
conditions)
At 70 ~ 100%: $\pm$ 3% (neonate, non-motion
conditions)
At 70100%: $\pm$ 3% (motion conditions)
At 0
69%, unspecified | Same | Similar |
| PR Range | 25~240 bpm | Same | Similar |
| PR Accuracy | $\pm$ 3 bpm (non-motion conditions)
$\pm$ 5 bpm (motion conditions) | Same | Similar |
| PI Range | 0.02 ~ 20.0% | Same | NA |

Table 3-4 Comparison of Masimo SpO2 Characteristics

Table 3-5 Comparison of IBP and EtCO2 Characteristics (Inapplicable to M7000)

ItemProposed DevicesPredicate Devices
M Series Patient MonitorK100046
IBP Measurement Range-50 ~ +300 mmHgSame
IBP Sensitivity of transducer5uV/V/mmHg, 2%Same
IBP Accuracy$\pm$ 4mmHg or 4%, whichever is greaterSame
EtCO2 MethodInfrared AbsorptionSame
EtCO2 ModeMain Stream / Side StreamSame
EtCO₂ Measurement Range019.7 %(0150 mmHg)Same
EtCO2 Accuracy0 ~ 40 mmHg, $\pm$ 2 mmHg
41 ~ 70 mmHg, $\pm$ 5% of reading
71 ~100 mmHg, $\pm$ 8% of reading
101 ~ 150 mmHg, $\pm$ 10% of readingSame

The proposed device has a Masimo SpO2 Module, while the predicate device M Series Patient Monitor (K100046) docsn't have. The Masimo SpO2 Module was designed and manufactured by Masimo Corporation and previously cleared by FDA in K053269. And Sp02 and pulse rate accuracy of the proposed device with Masimo SpO2 Module has been verified comply with the declaration of specification. Therefore, the difference will not affectiveness of the proposed device.

The proposed devices, M Series Patient Monitors, are determined to be Substantially Equivalent (SE) to the predicate devices, M Series Patient Monitors (K 100046), in respect of safety and effectiveness.

7

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/7/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three stripes representing the department's mission of providing health and human services to the nation. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the eagle.

February 27, 2014

Public Health Service

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

Guangdong Biolight Meditech Co. % Diana Hong General Manager Mid-Link Consulting Co., Ltd P.O. Box 120-119 Shanghai, 200120 CHINA

Re: K131876

Trade/Device Name: M Series Patient Monitor models M66, M69, M7000, M8000, and M9000 Regulation Number: 21 CFR 870.1025 Regulation Name: Patient Monitor Regulatory Class: Class II Product Code: MHX Dated: January 29, 2014 Received: January 30, 2014

Dear Ms. Diana Hong:

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 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical

8

Page 2 - Ms. Diana Hong

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Sincerely yours,

Bram D. Zuckerman -S

Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

9

Indications for Use

510(k) Number: K131876 Device Name: M Series Patient Monitor

Indications for Use:

M Series Patient Monitor is intended to be used for monitoring, reviewing, storing and alarming of multiple physiological parameters of adult, pediatric and neonatal patient as listed below:

ParametersM66M69M7000M8000M9000
ECGxxxxx
Heart Ratexxxxx
Respiration Rate (RESP)xxxxx
Pulse Oxygen Saturation (SpO2)xxxxx
Non-Invasive Blood Pressure (NIBP)xxxxx
Invasive Blood Pressure (IBP)xx--xx
Carbon Dioxide (CO2)xx--xx
Temperature (TEMP)xxxxx

The monitor is to be used in healthcare facilities by clinical physicians or appropriate medical staff under the direction of physicians.

It is not intended for helicopter transport or hospital ambulance.

OPRESCRIPTION USE (Part 21 CFR 801 Subpart D)

OR

OOVER-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)

am D. Zuckerman - S Page 1 of 1
2014.02.27 08:40:56 -05'00' 2-1

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