K Number
K131990
Device Name
OXYGEN GENERATOR LIQUEFIER - (OGL)
Date Cleared
2014-02-21

(238 days)

Product Code
Regulation Number
868.5440
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The OGL is intended to be used by emergency response personnel in military and commercial applications to produce emergency source of 93% USP liquid oxygen (LOX) which will be transferred into portable LOX systems. The portable LOX systems are used as an emergency source of supplemental oxygen for patient(s) while being transported for a crisis situation to a health care facility. This medical device is for supplemental oxygen and is not intended to sustain or support life.
Device Description
The OGL is a device that generates 93% USP oxygen gaseous, liquefy it into LOX and store up to 40 liters of LOX. It OGL is a single module that weighs approximately 730 LBS empty or 830 full of LOX. The system is 52" long, 33" wide and 48" tall if the wheels are deployed). The system has to forklift pockets to allow the system to be moved by a forklift. The system also has retractable wheels that allows for one or two persons to easily move the device on a flat smooth surface. The OGL requires only 200-240 VAC, 50/60 Hz 30 amp single phase power supply for operation. The system is very simple to operate. The control panel has a mode switch that allows the user to make liquid oxygen (LOX), generate gaseous oxygen for the oxygen gas port or transfer the liquid oxygen to a separate device. The control panel also has fault indicators if there is a problem with the system, emergency stop button, hour meter, Dewar pressure gauge and LOX quantity gauge.
More Information

Not Found

No
The description focuses on the mechanical and electrical components of an oxygen generation and liquefaction system, with no mention of AI or ML technologies for control, analysis, or operation.

Yes
The device produces supplemental oxygen for patients, and its predicate device is a "Portable Therapeutic Oxygen Concentrator System".

No

The OGL is described as a device that generates and stores liquid oxygen for supplemental oxygen. Its purpose is to provide a source of oxygen, not to diagnose a medical condition or disease.

No

The device description clearly outlines a physical hardware system that generates, liquefies, and stores oxygen, including weight, dimensions, power requirements, and a control panel with physical components.

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

Here's why:

  • Intended Use: The intended use is to generate and store liquid oxygen for supplemental oxygen for patients during transport. This is a therapeutic use, providing a substance to the patient.
  • Device Description: The device description details the physical characteristics and operation of an oxygen generation and liquefaction system. It does not describe a device used to examine specimens derived from the human body.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing information about a patient's health status, diagnosis, or treatment monitoring based on sample analysis.
    • Using reagents or assays.

The device is clearly intended to produce a medical gas for patient use, which falls under the category of a therapeutic device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The OGL is intended to be used by emergency response personnel in military and commercial applications to produce emergency source of 93% USP liquid oxygen (LOX) which will be transferred into portable LOX systems. The portable LOX systems are used as an emergency source of supplemental oxygen for patient(s) while being transported for a crisis situation to a health care facility. This medical device is for supplemental oxygen and is not intended to sustain or support life.

Product codes

CAW

Device Description

The OGL is a device that generates 93% USP oxygen gaseous, liquefy it into LOX and store up to 40 liters of LOX. It OGL is a single module that weighs approximately 730 LBS empty or 830 full of LOX. The system is 52" long, 33" wide and 48" tall if the wheels are deployed). The system has to forklift pockets to allow the system to be moved by a forklift. The system also has retractable wheels that allows for one or two persons to easily move the device on a flat smooth surface.

The OGL requires only 200-240 VAC, 50/60 Hz 30 amp single phase power supply for operation. The system is very simple to operate. The control panel has a mode switch that allows the user to make liquid oxygen (LOX), generate gaseous oxygen for the oxygen gas port or transfer the liquid oxygen to a separate device. The control panel also has fault indicators if there is a problem with the system, emergency stop button, hour meter, Dewar pressure gauge and LOX quantity gauge.

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

emergency response personnel in military and commercial applications, military medical personnel
Environments of Use: Locations where LOX oxygen generation is desired, e.g. military, hospital.

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 Testing Summary:
We have performed bench tests and found that the OGL met all requirements specifications and standards requirements and was found to be equivalent in comparison to the predicate.

Testing is documented in the Qualification Test Report (OTR-50C-0103-5 .- 7) in Section 18 - Performance Bench Testing.

Functional testing, e.g. pressure, delivery rate, normal evaporation rate and environmental testing, e.g. vibration testing, of the OGL was acceptable and proves that the device functions as intended and functions safely. Functional testing, e.g. display readout accuracy and fault indicator testing, and environmental testing, e.g. high and low temperature operation and storage testing, was acceptable and proves that the device functions as intended and functions safely. Testing includes:

  • Visual Examination .
  • . Oxygen Purity
  • Liquefaction Rate and Capacity .
  • Liquid Transfer .
  • Dimensional Examination .
  • Weight .
  • Power .
  • . Normal Evaporative Rate (NER)
  • Component Bonding .
  • High Temperature Operation .
  • Low Temperature Operation .
  • High Temperature Storage .
  • . Humidity
  • Rain
  • Salt Fog
  • Shipping Vibration ●
  • ISO 8359:1996 Oxygen concentrators for medical use Safety requirements .

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

Oxygen Purity: 93% USP
LOX Storage Capacity: 40 Liters of LOX
Oxygen Gas Outlet: Flow Rate = 11 LPM, Pressure = 7 PSI

Predicate Device(s)

Portable Therapeutic Oxygen Concentrator System (PTOCS) - K022684

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 868.5440 Portable oxygen generator.

(a)
Identification. A portable oxygen generator is a device that is intended to release oxygen for respiratory therapy by means of either a chemical reaction or physical means (e.g., a molecular sieve).(b)
Classification. Class II (performance standards).

0

Premarket Notification 510(k) Section 5-510(k) Summary

FEB 2 1 2014 Essex Industries OGL

510(k) Summary
Page 1 of 7
6/27/2013

| Essex Industries, Inc. d/b/a
Essex Cryogenics of MO

8007 Chivvis Drive
St. Louis, Missouri 63123Tel: (314) 338-8533
Fax: (314)832-8208
Official Contact:Kenneth L. Seise - Quality Assurance/Regulatory
Compliance Manager
Proprietary or Trade Name:OGL
Common/Usual Name:Portable Oxygen Generator
Classification Name/Code:CAW- Portable Oxygen Generator
21CFR 868.5440
Class II
Device:Oxygen Generator Liquefier- (OGL)
Predicate Device:Portable Therapeutic Oxygen Concentrator System
(PTOCS) - K022684

Device Description:

The OGL is a device that generates 93% USP oxygen gaseous, liquefy it into LOX and store up to 40 liters of LOX. It OGL is a single module that weighs approximately 730 LBS empty or 830 full of LOX. The system is 52" long, 33" wide and 48" tall if the wheels are deployed). The system has to forklift pockets to allow the system to be moved by a forklift. The system also has retractable wheels that allows for one or two persons to easily move the device on a flat smooth surface.

The OGL requires only 200-240 VAC, 50/60 Hz 30 amp single phase power supply for operation. The system is very simple to operate. The control panel has a mode switch that allows the user to make liquid oxygen (LOX), generate gaseous oxygen for the oxygen gas port or transfer the liquid oxygen to a separate device. The control panel also has fault indicators if there is a problem with the system, emergency stop button, hour meter, Dewar pressure gauge and LOX quantity gauge.

Intended User

Healthcare providers

1

510(k) Summary Page 2 of 7 6/27/2013

Patient Population

This device generates liquid oxygen to be transferred into portable LOX systems, so a patient population is not indicated.

Indications for Use:

The OGL is intended to be used by emergency response personnel in military and commercial applications to produce emergency source of 93% USP liquid oxygen (LOX) which will be transferred into portable LOX systems. The portable LOX systems are used as an emergency source of supplemental oxygen for patient(s) while being transported for a crisis situation to a health care facility. This medical device is for supplemental oxygen and is not intended to sustain or support life.

Environment of Use:

Environments of Use: Locations where LOX oxygen generation is desired, e.g. military, hospital.

Contraindications:

There are no known contraindications.

Predicate Device Comparison:

The OGLwas compared to the predicate PTOCS (K022684) in the device comparison table below.

2

510(k) Summary Page 3 of 7

6/27/2013

Device Comparison Table 5.1

| Performance/
Characteristics | OGL | PTOCS K022684
(PREDICATE DEVICE) |
|---------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for Use | The OGL is intended to be used by
emergency response personnel in
military and commercial
applications to produce emergency
source of 93% USP liquid oxygen
(LOX) which will be transferred
into portable LOX systems. The
portable LOX systems are used as
an emergency source of
supplemental oxygen for patient(s)
while being transported for a crisis
situation to a health care facility.
This medical device is for
supplemental oxygen and is not
intended to sustain or support life. | Provides supplemental therapeutic
oxygen to a patient in a military field
hospital setting. |
| Environment of use | Used by emergency response
personnel in military and
commercial applications and by
military medical personnel. | Used by emergency response personne
in military and commercial
applications and by military medical
personnel. |
| Energy Used | 200-240, 50/60 Hz | 110, 60 Hz & 208-220, 60 Hz |
| Technology | Oxygen is concentrated by the use
of molecular sieve beds / Pressure
Swing Adsorption (PSA) | Oxygen is concentrated by the use of
molecular sieve beds and Pressure
Swing Adsorption (PSA) |
| Portability/Human
Factors | Forklift portable or can be move by
one person with the wheels
deployed on a level surface. | Compressor Module "A"
4 man portable
Compressor Module "B"
4 man portable
Oxygen Concentrator Module
4 man portable
High Pressure Fill Module
4 man portable |
| Standards Met | IEC 60601-1, IEC 60601-1-2 | IEC60601-1 |
| Sterility / Shelf Life | N/A | N/A |
| Electrical Safety | Tested IA W MIL-STD-810, &
IEC60601-1 | Tested IA W MIL-STD-810, &
IEC60601-1 |
| Operating Temperature | 0°F to 120°F | 32°F to 90°F |
| Storage Temperature | 0°F to 130°F | -40°F to 158°F |
| Humidity | Up to 95% | Up to 95% |
| Storage Humidity | Up to 100% | Up to 100% |
| Performance/
Characteristics | OGL | PTOCS K022684
(PREDICATE DEVICE) |
| Dimensional Envelope | OGL
Height (Wheels Retracted) = 48.0"
Height (Wheels Deployed) = 54.5"
Width = 33.0"
Depth = 52.0"
See Figure 12-7 | Compressor Module "A"
Height = 28"
Width = 27"
Depth = 44"
See Figure 12-8
Compressor Module "B"
Height = 27"
Width = 24"
Depth = 44"
See Figure 12-8
Oxygen Concentrator Module
Height = 42"
Width = 22"
Depth = 31"
See Figure 12-8
High Pressure Fill Module
Height = 27.5"
Width = 23.5"
Depth = 34.5"
See Figure 12-8 |
| System Weight | OGL
Empty = 730 LBS
Full (with LOX) = 830 LBS | Compressor Module "A" = 298.8 LBS
Compressor Module "B" = 149.6 LBS
Oxygen Concentrator Module = 283.3 LBS
High Pressure Fill Module = 153.0 LBS |
| Power Requirements | OGL
Power = 200-240 VAC
Supply Frequency = 50/60 Hz
Phase = Single Phase
Watts = 6.3 kW MAX | Compressor Module "A" & "B"
Power = 208-220 VAC
Supply Frequency = 60 Hz
Phase = Three Phase
Watts = 6.93 kW MAX
Oxygen Concentrator Module
Power = 110 VAC
Supply Frequency = 50/60 Hz
Watts = 100 W
High Pressure Fill Module
Power = 110 VAC
Supply Frequency = 60 Hz
Watts = 600 W |
| Oxygen Purity | 93% USP | 93% USP |

3

.

Premarket Notification 510(k) Section 5 - 510(k) Summary

510(k) Summary

Page 4 of 7

4

Premarket Notification 510(k) Section 5 - 510(k) Summary

| 510(k) Summary
Page 5 of 7

6/27/2013
Performance/
CharacteristicsOGLPTOCS K022684
(PREDICATE DEVICE)
Oxygen Gas Outlet# of Ports = 1
Port Type = Male DISS 1240
Flow Rate = 11 LPM
Pressure = 7 PSI# of Ports = 3
Port Type = Female Schrader Quick
Disconnect
Flow Rate = 45 LPM
Pressure = 50 PSIG
Medical Devices
CompatibilityHigh Pressure Cylinder FillCommercial Mask
Commercial Cannula
Flow Control Valve (0.5-15 LPM, with
12 settings)
LOX Quantity IndicatorMechanical GaugeNone
Fill ConnectionStandard Military CRU-59/E
connection which connects with the
military standard CRU-50/A
connector on all the portable LOX
storage systemsNone
LOX Storage Capacity40 Liters of LOXNone
Alarms/IndicatorsThree Fault Indicators. (If any
problem occurs with system, the
system will shut down and it will
light the appropriate fault
indicators.)Compressor Module "A" & "B"
Low Pressure Indicator
Power Out of Phase Indicator
Oxygen Concentrator Module
Low Pressure Indicator
High Pressure Indicator
Low Oxygen Purity Indicator
Oxygen Sensor Fault Indicator
High Pressure Fill Module
Low Pressure Indicator
Back up Activated Indicator
SoftwareHas software with a microprocessor
that controls the entire system.

510/11 €

Differences Between Other Legally Marketed Predicate Devices:

The OGL is viewed as substantially equivalent to the predicate device because: The OGL uses the exact same technology and has similar indications for use. The differences that exist between the devices are insignificant in the terms of safety or effectiveness.

Indications -

The OGL is intended to be used by emergency response personnel in military and commercial applications to produce emergency source of 93% USP liquid oxygen (LOX) which will be transferred into portable LOX systems. The portable LOX systems are used as an emergency source of supplemental oxygen for patient(s) while being

5

510(k) Summary Page 6 of 7 6/27/2013

transported for a crisis situation to a health care facility. This medical device is for supplemental oxygen and is not intended to sustain or support life.

Discussion - These indications are similar to the predicate PTOCS (K022684).

Prescriptive - The OGL and predicate are both prescriptive.

Design and Technology - The OGL has equivalent design and features as the predicate and has the identical technology to the predicate.

Performance and Specifications - The OGL has equivalent specifications of performance as the predicate.

Compliance with standards - The OGL and predicate device declare compliance with IEC 60601-1 and IEC 60601-1-2.

Materials -

The air contacting materials have been cleared in prior 510(k)s as described in Section 15

Patient Population -

Neither the OGL or predicate have a define patient population.

Non-Clinical Testing Summary:

We have performed bench tests and found that the OGL met all requirements specifications and standards requirements and was found to be equivalent in comparison to the predicate.

Testing is documented in the Qualification Test Report (OTR-50C-0103-5 .- 7) in Section 18 - Performance Bench Testing.

Functional testing, e.g. pressure, delivery rate, normal evaporation rate and environmental testing, e.g. vibration testing, of the OGL was acceptable and proves that the device functions as intended and functions safely. Functional testing, e.g. display readout accuracy and fault indicator testing, and environmental testing, e.g. high and low temperature operation and storage testing, was acceptable and proves that the device functions as intended and functions safely. Testing includes:

  • Visual Examination .
  • . Oxygen Purity
  • Liquefaction Rate and Capacity .

6

510(k) Summary Page 7 of 7 6/27/2013 ·

  • Liquid Transfer .
  • Dimensional Examination .
  • Weight .
  • Power .
  • . Normal Evaporative Rate (NER)
  • Component Bonding .
  • High Temperature Operation .
  • Low Temperature Operation .
  • High Temperature Storage .
  • . Humidity
  • � Rain
  • Salt Fog
  • Shipping Vibration ●
  • ISO 8359:1996 Oxygen concentrators for medical use Safety requirements .

Clinical Testing Summary:

No clinical testing

Substantial Equivalence Conclusion

Essex maintains that the OGL is substantially equivalent to the predicate PTOCS (K022684) in indications for use, patient population, and environment for use, technology characteristics, specifications / performance and compliance with international standards

7

Image /page/7/Picture/0 description: The image shows the text "DEPARTMENT OF HEALTH & HUMAN SERVICES" in all capital letters. The text is written in a bold, sans-serif font. The text is centered horizontally and vertically in the image. The background of the image is white.

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Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G60 Silver Spring, MD 20993-0002

February 21, 2014

Essex Industries, Incorporated Mr. Paul Dryden Regulatory Consultant 8007 Chivvis Drive St. Louis. MO 63123

Re: K131990

Trade/Device Name: Oxygen generator Liquefier (OGL) Regulation Number: 21 CFR 868.5440 Regulation Name: Portable Oxygen Generator Regulatory Class: II Product Code: CAW Dated: February 18, 2014 Received: February 19, 2014

Dear Mr. Dryden:

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 10 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.

8

Page 2 - Mr. Dryden

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.

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" (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.

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Sincerely vours.

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

Enclosure

9

4 Indications for Use Statement

As required, we have prepared the Indications for Use statement on a separate page.

10

Indications for Use Statement

Page 1 of 1

510(k) Number:

K131990 (To be assigned)

Device Name:

Essex Industries Oxygen Generator/Liquefier (OGL)

Indications for Use:

Device Name: Oxygen Generator/Liquefier

The OGL is intended to be used by emergency response personnel in military and commercial applications to produce emergency source of 93% USP liquid oxygen (LOX) which will be transferred into portable LOX systems. The portable LOX systems are used as an emergency source of supplemental oxygen for patient(s) while being transported for a crisis situation to a health care facility. This medical device is for supplemental oxygen and is not intended to sustain or support life.

Environments of Use: Locations where LOX oxygen generation is desired, e.g. military, hospital.

Prescription Use XX (Part 2) CFR 801 Subpart D)

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)

K131990

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Anya C. Harry -S 2014.02.21 14:27:30 -05'00'