K Number
K163511
Device Name
NovaGuard SA Pro Safety System
Date Cleared
2017-02-02

(49 days)

Product Code
Regulation Number
880.5860
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist seff-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.
Device Description
The proposed device, NovaGuard SA Pro Safety System, is a non-sterile, single use anti needlestick accessory for pre-filled ISO standard glass syringes that are 1ml long with a max needle length of 5/8". The NovaGuard SA Pro Safety System consist of three components, syringe holder, sleeve and spring. The proposed device will be assembled along with the pre filled syringe by the pharmaceutical company. Upon completion of the injection, the needle is then covered by the sleeve protecting the user from potential sharps needle stick injury. There is a visual, tactile and audible recognition that the device safety feature has activated.
More Information

Not Found

No
The device description and performance studies focus on mechanical safety features and bench testing, with no mention of AI/ML algorithms or data processing.

No.
The device is an accessory for pre-filled syringes designed to prevent needlestick injuries, not to treat a disease or condition.

No

The device is described as an accessory for syringes, designed to prevent needlestick injuries, not to diagnose medical conditions. Its function is purely mechanical safety.

No

The device description clearly states it consists of three physical components: syringe holder, sleeve, and spring. It is an accessory for physical syringes.

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

Here's why:

  • Intended Use: The intended use clearly states that the device is an "accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist seff-injecting patients, from accidental needlesticks." This describes a device used for safety and injury prevention during the administration of medication, not for diagnosing a condition or examining specimens from the human body.
  • Device Description: The description reinforces this by explaining how the device covers the needle after injection to prevent sharps injury.
  • Lack of IVD Characteristics: There is no mention of the device being used to test or analyze biological samples (blood, urine, tissue, etc.) or to provide information about a patient's health status based on such analysis.

Therefore, the NovaGuard SA Pro Safety System is a medical device, but it falls under the category of a safety accessory for drug delivery, not an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist seff-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.

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

MEG

Device Description

The proposed device, NovaGuard SA Pro Safety System, is a non-sterile, single use anti needlestick accessory for pre-filled ISO standard glass syringes that are 1ml long with a max needle length of 5/8". The NovaGuard SA Pro Safety System consist of three components, syringe holder, sleeve and spring. The proposed device will be assembled along with the pre filled syringe by the pharmaceutical company. Upon completion of the injection, the needle is then covered by the sleeve protecting the user from potential sharps needle stick injury. There is a visual, tactile and audible recognition that the device safety feature has activated.

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

unrestricted and may include children and adults

Intended User / Care Setting

healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist self-injecting patients

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)

Based on the verification and validation activities, along with the risk assessment evaluation, it was determined that the following tests needed to be performed on the proposed device, NovaGuard SA Pro Safety System:

  • Syringe assembly force
  • Pre-activation disassembly force (force applied to RNS)
  • Pre-Activation Disassembly Force Test (force applied to cannula)
  • Clip impact test (Integrated clip feature test)
  • Drop Test Post-activation with PFS
  • Drop Test - Pre-activation with PFS
  • Activation Security
  • RNS replacement

All testing met the required acceptance criteria. The bench testing evaluation of the proposed device, NovaGuard SA Pro Safety System, does not raise any additional concerns regarding safety and effectiveness.
Clinical Testing: The proposed device, NovaGuard SA Pro Safety System, modifications did not affect the device design impacting activation of the safety prevention feature therefore based upon their risk analysis a simulated use study was deemed not necessary.

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.

NovaGuard SA Safety System 510(k) K141464

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

§ 880.5860 Piston syringe.

(a)
Identification. A piston syringe is a device intended for medical purposes that consists of a calibrated hollow barrel and a movable plunger. At one end of the barrel there is a male connector (nozzle) for fitting the female connector (hub) of a hypodermic single lumen needle. The device is used to inject fluids into, or withdraw fluids from, the body.(b)
Classification. Class II (performance standards).

0

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

February 2, 2017

West Pharmaceutical Services, Inc. Ms. Ana Ladino Director of Regulatory Affairs 530 Herman O. West Drive Exton, Pennsylvania 19341-1147

Re: K163511

Trade/Device Name: NovaGuard SA Pro Safety System Regulation Number: 21 CFR 880.5860 Regulation Name: Piston Syringe Regulatory Class: II Product Code: MEG Dated: December 14, 2016 Received: December 15, 2016

Dear Ms. Ladino:

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

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 (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 Industry and Consumer Education 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. 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 Industry and Consumer Education 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,

Tina
Kiang-S

Tina Kiang, Ph.D. Acting 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) K163511

Device Name NovaGuard SA Pro Safety System

Indications for Use (Describe)

Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist seff-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

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FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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510(K) SUMMARY : K163511

NovaGuard SA Pro Safety System Device:

Company Name:

West Pharmaceutical Services, Inc. 530 Herman O. West Drive Exton, PA 19341-1147 Phone: (610) 594-3105

Contact Person:

Ana Ladino Director of Regulatory Affairs West Pharmaceutical Services, Inc. Phone: 610-594-3165 Fax: 610-717-0668 E-mail: ana.ladino@westpharma.com

US Agent:

Kevin Lentz Senior Director of Regulatory Affairs West Pharmaceutical Services, Inc. 530 Herman O. West Drive Exton, PA 19341-1147 Phone: 610-594-4353 Fax: 610-717-0668 E-mail: kevin.lentz@westpharma.com

Preparation date: January 31, 2017

Classification:

Classification Name: Piston Syringe Trade Name: NovaGuard SA Safety System Common/Usual Name: Anti Stick Syringe Product Code: MEG Regulation No.: 21 CFR 880.5860 Class: II Panel Identification: General Hospital Panel

4

Predicate Device:

NovaGuard SA Safety System 510(k) K141464.

Device Description:

The proposed device, NovaGuard SA Pro Safety System, is a non-sterile, single use anti needlestick accessory for pre-filled ISO standard glass syringes that are 1ml long with a max needle length of 5/8". The NovaGuard SA Pro Safety System consist of three components, syringe holder, sleeve and spring. The proposed device will be assembled along with the pre filled syringe by the pharmaceutical company. Upon completion of the injection, the needle is then covered by the sleeve protecting the user from potential sharps needle stick injury. There is a visual, tactile and audible recognition that the device safety feature has activated.

Indications for use:

Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist self-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.

Substantial equivalence:

Based on the indications for use, technology, materials of construction and principle of operation the proposed device, NovaGuard SA Pro Safety System, is substantially equivalent to the predicate device, NovaGuard SA Safety System 510(k) K141464.

The following modifications have been made to the predicate device, NovaGuard SA Safety System 510(k) K14146:

  • . Syringe holder modifications to implement integrated clip features instead of a separate clip component.
  • . Syringe holder modifications to aid in the molding and assembly process and to smooth the syringe holder fingers profile.

The predicate device. NovaGuard SA Safety System (K141464) includes a separate clip component. The proposed device, NovaGuard SA Pro Safety System includes an integrated clip feature on the syringe holder instead of a separate clip component. This change was implemented to facilitate the pharmaceutical manufacturer assembly process of the proposed device, NovaGuard SA Pro Safety System, with their prefilled syringe. This device modification eliminates the need to assemble a clip component as a separate operation.

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| Areas for
Comparison | Predicate Device:
NovaGuard SA Safety
System (K141464) | Proposed Device:
NovaGuard SA Pro
Safety System | Comparison |
|------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------|
| Indications for
Use | Single use device that is
indicated for use as an
accessory with pre-
filled ISO Standard
glass syringes to aid in
the protection of
healthcare
professionals, patients
who self-inject doctor
prescribed medications
and individuals that
assist self-injecting
patients from accidental
needle sticks. The
intended patient
population is
unrestricted and may
include children and
adults and parenteral
methods of
administration. | Single use device that is
indicated for use as an
accessory with pre-
filled ISO Standard
glass syringes to aid in
the protection of
healthcare
professionals, patients
who self-inject doctor
prescribed medications
and individuals that
assist self-injecting
patients from accidental
needle sticks. The
intended patient
population is
unrestricted and may
include children and
adults and parenteral
methods of
administration. | Identical |
| Use | Single Use | Single Use | Identical |
| Prescription Use | Yes | Yes | Identical |
| Contraindication | None | None | Identical |
| Components | Syringe holder, sleeve,
spring and clip | Syringe holder, sleeve
and spring | Modified
Integrated clip
replaces the clip
component |
| Compatible
Syringes | Pre-filled ISO Standard
glass syringes | Pre-filled ISO Standard
glass syringes | Identical |
| Syringe size | 1mL Long | 1mL Long | Identical |
| Needle Length | Max 5/8" length | Max 5/8" length | Identical |
| Needle shield
requirement | Rigid | Rigid | Identical |
| Syringe holder
material of | Polycarbonate | Polycarbonate | Identical |
| Areas for
Comparison | Predicate Device:
NovaGuard SA Safety
System (K141464) | Proposed Device:
NovaGuard SA Pro
Safety System | Comparison |
| construction | | | |
| Sleeve material of
construction | Polycarbonate | Polycarbonate | Identical |
| Spring material of
construction | Stainless Steel | Stainless Steel | Identical |
| Clip material of
construction | Polycarbonate | N/A | Modified
The NovaGuard SA
Pro Safety System
does not have a
separate clip
component |
| Biocompatible | Yes
Per ISO 10993-1 | Yes
Per ISO 10993-1 | Identical |
| Sterilization | Non- sterile | Non- sterile | Identical |

6

Performance Testing:

Based on the verification and validation activities, along with the risk assessment evaluation, it was determined that the following tests needed to be performed on the proposed device, NovaGuard SA Pro Safety System.

  • Syringe assembly force
  • Pre-activation disassembly force (force applied to RNS) ●
  • . Pre-Activation Disassembly Force Test (force applied to cannula)
  • Clip impact test (Integrated clip feature test) ●
  • Drop Test Post-activation with PFS ●
  • Drop Test - Pre-activation with PFS
  • Activation Security
  • . RNS replacement

All testing met the required acceptance criteria.

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Performance Testing Summary
Test NameTesting Standard
Syringe assembly forceTested to internal performance standards
Pre-activation disassembly force (force applied to RNS)Tested to internal performance standards
Pre-Activation Disassembly Force Test (force applied to cannula)Tested to internal performance standards
Clip impact test (Integrated clip feature test)Tested to internal performance standards
Drop Test - Post-activation with PFSTested to internal performance standards
Drop Test - Pre-activation with PFSTested to internal performance standards
Activation SecurityTested to internal performance standards
RNS replacementTested to internal performance standards

The bench testing evaluation of the proposed device, NovaGuard SA Pro Safety System, does not raise any additional concerns regarding safety and effectiveness and may therefore be considered substantially equivalent to the predicate device.

Clinical Testing:

The proposed device, NovaGuard SA Pro Safety System, modifications did not affect the device design impacting activation of the safety prevention feature therefore based upon their risk analysis a simulated use study was deemed not necessary.

Conclusion:

Based on the indications for use, technology, materials of construction and principle of operation the proposed device NovaGuard SA Pro Safety System, is substantially equivalent to the predicate device, NovaGuard SA Safety System (K141464).