K Number
K170497
Device Name
V10
Manufacturer
Date Cleared
2017-12-15

(301 days)

Product Code
Regulation Number
870.1130
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The V10 is intended to be used to monitor noninvasive blood pressure (NIBP) - systolic, diastolic and mean arterial pressures, functional arterial oxygen saturation (SpO2), pulse rate (PR), temperature (Temp) for adult, pediatric and neonatal patients in all areas of a hospital-type facilities. Monitor users should be skilled at the level of a technician, doctor, nurse or medical specialist. The V10 is suitable for continuous operation.
Device Description
The V10 vital signs monitor non-invasive blood pressure, pulse rate, non-invasive functional oxygen saturation of arterial hemoglobin for adult, pediatric and neonate patients and body temperature for adult and pediatric patients in general hospital and alternate care facilities by medically trained personnel. This monitor is available for sale only upon the order of a physician or licensed health care professional. The Mediana V10 vital signs monitor is a lightweight and compact device (249 x 211 x 154 (mm) (WxHxD) and 3.0 kg) powered by AC mains (100-240VAC, 50Hz/60Hz) and also powered by internal battery. The monitor provides patient data and monitoring status on 7-segment LED displays.
More Information

Not Found

No
The document describes a standard vital signs monitor and does not mention any AI or ML capabilities in its description, intended use, or performance studies.

No.
The device is intended to monitor vital signs (NIBP, SpO2, PR, Temp) and does not provide therapy or treatment.

No

The device is described as a "vital signs monitor" intended to measure and monitor physiological parameters (blood pressure, SpO2, pulse rate, temperature) rather than to diagnose a condition.

No

The device description explicitly states it is a "lightweight and compact device" with physical dimensions and weight, powered by AC mains and an internal battery, and provides data on "7-segment LED displays." This indicates it is a physical hardware device, not software only.

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

Here's why:

  • Intended Use: The intended use clearly states the device is for monitoring noninvasive blood pressure, oxygen saturation, pulse rate, and temperature. These are physiological measurements taken directly from the patient's body.
  • Device Description: The description reinforces that it's a vital signs monitor measuring these same physiological parameters.
  • Lack of IVD Characteristics: There is no mention of analyzing samples (blood, urine, tissue, etc.) in vitro (outside the body) to provide diagnostic information. IVDs are used to examine these samples to detect diseases, conditions, or infections.

The device described is a patient monitoring device used for real-time assessment of vital signs, which is distinct from an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The V10 is intended to be used to monitor noninvasive blood pressure (NIBP) - systolic, diastolic and mean arterial pressures, functional arterial oxygen saturation (SpO2), pulse rate (PR), temperature (Temp) for adult, pediatric and neonatal patients in all areas of a hospital-type facilities. Monitor users should be skilled at the level of a technician, doctor, nurse or medical specialist. The V10 is suitable for continuous operation.

Note: Hospital use typically includes such as general care floors, operating rooms, special procedure areas, intensive and critical care area, within the hospital-type facilities include physician office-based facilities, sleep labs, skilled nursing facilities, surgical centers, and sub acute care centers.

Note: The medically skilled and trained user can be clinicians like doctors and nurses who know how to take and interpret a patient's vital signs. These clinicians must take direct responsibility for the patient's life. This can include care-givers or medically trained interpreters who are authorized under the appropriate clinical facility procedures to support patient care. Any inappropriate setting, especially the alarm notification settings, can lead to a hazardous situation that injures the patient, harms the patient, or threatent's life. This equipment should only be operated by trained users who can adjust the settings of the vital signs monitor.

Product codes

DXN, DOA, FLL

Device Description

The V10 vital signs monitor non-invasive blood pressure, pulse rate, non-invasive functional oxygen saturation of arterial hemoglobin for adult, pediatric and neonate patients and body temperature for adult and pediatric patients in general hospital and alternate care facilities by medically trained personnel. This monitor is available for sale only upon the order of a physician or licensed health care professional.

The Mediana V10 vital signs monitor is a lightweight and compact device (249 x 211 x 154 (mm) (WxHxD) and 3.0 kg) powered by AC mains (100-240VAC, 50Hz/60Hz) and also powered by internal battery. The monitor provides patient data and monitoring status on 7-segment LED displays.

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 patients

Intended User / Care Setting

Monitor users should be skilled at the level of a technician, doctor, nurse or medical specialist.
Hospital-type facilities typically includes such as general care floors, operating rooms, special procedure areas, intensive and critical care area, within the hospital. Hospital-type facilities include physician office-based facilities, sleep labs, skilled nursing facilities, surgical centers, and sub acute care centers.

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)

Summary of Performance Testing:
Biocompatibility Testing: The Mediana vital signs monitor, Model V10 does not contain any patient contact material.
Electrical Safety and Electromagnetic Compatibility Testing: The Mediana vital signs monitor, Model V10 substantially has been tested in accordance with the IEC 60601-1, IEC 60601-2-49 standards for safety and the IEC 60601-1-2 standard for EMC.
Verification and Validation Testing: The Mediana vital signs monitor, Model V10 substantially has been tested in accordance with the system V & V plan #MDR-EG161022-02 included with the submission.
Clinical Testing: The Mediana vital signs monitor, Model V10 substantially has been tested in accordance with the NIBP and Temp clinical investigations.
Key Results: The V10 is safe and effective, complies with the appropriate medical device guidance and standards and is substantially equivalent to the predicate device.

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

Not Found

Predicate Device(s)

K152659

Reference Device(s)

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

§ 870.1130 Noninvasive blood pressure measurement system.

(a)
Identification. A noninvasive blood pressure measurement system is a device that provides a signal from which systolic, diastolic, mean, or any combination of the three pressures can be derived through the use of tranducers placed on the surface of the body.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

December 15, 2017

Mediana Co., Ltd. % Charlie Mack President International Regulatory Consultants 7808 Rush Creek Drive Pasco, Washington 99301

Re: K170497

Trade/Device Name: V10 Regulation Number: 21 CFR 870.1130 Regulation Name: Noninvasive Blood Pressure Measurement System Regulatory Class: Class II Product Code: DXN, DOA, FLL Dated: October 24, 2017 Received: November 17, 2017

Dear Charlie Mack:

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 of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820);

1

and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR

1000-1050. 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.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

M.A. Hilleman

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

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known) K170497

Device Name V10

Indications for Use (Describe)

The V10 is intended to be used to monitor noninvasive blood pressure (NIBP) - systolic, diastolic and mean arterial pressures, functional arterial oxygen saturation (SpO2), pulse rate (PR), temperature (Temp) for adult, pediatric and neonatal patients in all areas of a hospital-type facilities. Monitor users should be skilled at the level of a technician, doctor, nurse or medical specialist. The V10 is suitable for continuous operation.

Note: Hospital use typically includes such as general care floors, operating rooms, special procedure areas, intensive and critical care area, within the hospital-type facilities include physician office-based facilities, sleep labs, skilled nursing facilities, surgical centers, and sub acute care centers.

Note: The medically skilled and trained user can be clinicians like doctors and nurses who know how to take and interpret a patient's vital signs. These clinicians must take direct responsibility for the patient's life. This can include care-givers or medically trained interpreters who are authorized under the appropriate clinical facility procedures to support patient care. Any inappropriate setting, especially the alarm notification settings, can lead to a hazardous situation that injures the patient, harms the patient, or threatent's life. This equipment should only be operated by trained users who can adjust the settings of the vital signs monitor.

Type of Use (Select one or both, as applicable)❌ Prescription Use (Part 21 CFR 801 Subpart D) ❍ Over-The-Counter Use (21 CFR 801 Subpart C)❌ Prescription Use (Part 21 CFR 801 Subpart D)❍ Over-The-Counter Use (21 CFR 801 Subpart C)
❌ Prescription Use (Part 21 CFR 801 Subpart D)❍ Over-The-Counter Use (21 CFR 801 Subpart C)

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510(k) Summary of Safety and Effectiveness

Submitter

Mediana Co., Ltd. 132, Donghwagongdan-ro, Munmak-eup, Wonju-si, Gangwon-do, Republic of Korea Tel) +82-33-742-5400 Fax) +82-33-742-5483

Company Contact: Ju-yeon, Song

Date Summary Prepared: October 20, 2017

Device Name

Trade Name:V10
Common Name:Vital Signs Monitor
Classification Name:NIBP measurement system (21CFR870.1130), also contains
non-invasive pulse oximetry, SpO2 (21CFR870.2700) and
clinical electronic thermometer (21CFR880.2910)
Classification:Class II
Product Code:DXN, DQA, FLL

Predicate Devices (Legally Marketed Devices)

The predicate device for the V10 are:

  • Mediana Co., Ltd. Vital Signs Monitors, V10 i Cleared by FDA through 510(k) No. K152659

Device Description

The V10 vital signs monitor non-invasive blood pressure, pulse rate, non-invasive functional oxygen saturation of arterial hemoglobin for adult, pediatric and neonate patients and body temperature for adult and pediatric patients in general hospital and alternate care facilities by medically trained personnel. This monitor is available for sale only upon the order of a physician or licensed health care professional.

The Mediana V10 vital signs monitor is a lightweight and compact device (249 x 211 x 154 (mm) (WxHxD) and 3.0 kg) powered by AC mains (100-240VAC, 50Hz/60Hz) and also powered by internal battery. The monitor provides patient data and monitoring status on 7-segment LED displays.

4

Intended Use

The V10 is intended to be used to monitor noninvasive blood pressure (NIBP) - systolic, diastolic and mean arterial pressures, functional arterial oxygen saturation (SpO2), pulse rate (PR), temperature (Temp) for adult, pediatric and neonatal patients in all areas of a hospital and hospital-type facilities. Monitor users should be skilled at the level of a technician, doctor, nurse or medical specialist. The V10 is suitable for continuous operation.

  • Note: Hospital use typically includes such as general care floors, operating rooms, special procedure areas, intensive and critical care area, within the hospital. Hospital-type facilities include physician office-based facilities, sleep labs, skilled nursing facilities, surqical centers, and sub acute care centers.
  • Note: The medically skilled and trained user can be clinicians like doctors and nurses who know how to take and interpret a patient's vital signs. These clinicians must take direct responsibility for the patient's life. This can include care-givers or medically trained interpreters who are authorized under the appropriate clinical facility procedures to support patient care. Any inappropriate setting, especially the alarm limit or alarm notification settings, can lead to a hazardous situation that injures the patient, harms the patient, or threatens the patient's life. This equipment should only be operated by trained users who can adjust the settings of the vital signs monitor.

Summary of Technical Characteristics of the Device Compared to the Predicate Devices (Legally Marketed Devices)

The subject device (Mediana vital signs monitor, Model V10) is substantially equivalent to the predicate device (current Mediana vital signs monitor, Model V10). They have the same technological characteristics and material, and they are comparable in key safety and effectiveness features and software design and have the same intended uses and basic operation modes as the predicate device.

  • The Non-Invasive Blood Pressure (NIBP) measurement specifications and performance are equivalent to the predicate device. The subject device is partially modified to display mean arterial pressure (MAP) value. The subject device uses the oscillometric technique to measure non-invasive blood pressure. This measurement technique of blood pressure is not changed and the mean arterial pressure is additionally displayed on LED displays. To verify the accuracy of measuring, the clinical evaluation was performed on adult, pediatric and neonate. The V10 vital signs monitor complies with the testing validations defined in ISO 81060-2 standard so that it is substantially equivalent to predicate devices as Mediana model V10 vital signs monitor.
  • . The Pulse rate specifications and performance derived from either Non-Invasive Blood Pressure (NIBP) or Pulse Oximetry (SpO2) are equivalent to the predicate device.
  • . The Pulse Oximetry (SpO2) specifications and performance are equivalent to the predicate device.
  • i The Temperature specifications and performance are equivalent to the predicate device.

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Summary of Performance Testing

. Biocompatibility Testing

The Mediana vital signs monitor, Model V10 does not contain any patient contact material. See Section 16 "Biocompatibility" of this submission for biocompatibility testing of patient contact accessories.

. Electrical Safety and Electromagnetic Compatibility Testing

The Mediana vital signs monitor, Model V10 substantially has been tested in accordance with the IEC 60601-1, IEC 60601-2-49 standards for safety and the IEC 60601-1-2 standard for EMC.

ı Verification and Validation Testing

The Mediana vital signs monitor, Model V10 substantially has been tested in accordance with the system V & V plan #MDR-EG161022-02 included with the submission.

י Clinical Testing

The Mediana vital signs monitor, Model V10 substantially has been tested in accordance with the NIBP and Temp clinical investigations. See Section 20 "Performance testing -Clinical" of this submission.

A risk analysis identifying potential hazards and documenting mitigation of the hazards has been developed and applied as part of Mediana design control procedure. Mediana's quality system confirms to 21CFR820, ISO13485 and CMDCAS ISO 13485 certified by DNV (Det Norske Veritas).

Conclusions

As stated above, the V10 is safe and effective, complies with the appropriate medical device guidance and standards and is substantially equivalent to the predicate device.