K Number
K211716
Device Name
DropSafe Safety Pen Needles
Manufacturer
Date Cleared
2022-01-07

(218 days)

Product Code
Regulation Number
880.5570
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs.
Device Description
DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs. DropSafe Safety Pen Needles are OTC devices intended to be used by clinical and non-clinical users. DropSafe Safety Pen Needles are already offered in one gage - 31 G and in two lengths: 6mm and 8 mm. This submission covers the addition of a new length: 5 mm with the same gage - 31G. DropSafe Safety Pen Needles are gamma sterilized, non-toxic single use devices. The device is designed to minimize the risk from accidental needle sticks with a used needle by application of a sharps injury prevention feature. Following use, the needle is locked out preventing reuse. The shield also serves to hide the needle before and after injection. Each DropSafe safety pen needle is individually packaged in a sealed container. The DropSafe safety pen needle is used by removing the seal and attaching it to the pen injector device to administer a drug subcutaneously. While inserting the needle into the skin at a 90° angle, the slider glides into the shield. While the slider glides into the shield, the safety feature is activated. Following injection, the slides back into its initial position, completely covering the needle where it remains locked. The red safety lock indicator tells the safety lock has been activated. Once the safety pen needle is in the locked mode, it cannot be reused. The safety pen needle is detached from the pen injector device and disposed of into a sharps container. The pen needle assembly consists of a double-ended cannula that is assembled into an injection molded hub using an adhesive. The hub has internal threads which allows it to be screwed onto the pen injector device. This allows the cartridge end of the needle to penetrate through the rubber septum of the cartridge. The patient-end and the cartridge end of the cannula are lubricated using a silicone-based lubricant for ease of injection and rubber septum penetration. An injection molded inner shield is assembled over the patient end of the cannula to prevent needle point damage and accidental needle-sticks. This needle assembly is inserted into a protective injection molded container and sealed with a peel away medical grade paper tab which provides a sterility barrier and tamper evident seal.
More Information

Not Found

No
The device description focuses on mechanical features for safety and does not mention any computational or data-driven components.

No.
The device is a safety pen needle designed for drug injection with an emphasis on preventing needle sticks, rather than directly treating a disease or condition.

No
The device is a pen needle intended for drug injection, not for diagnosing conditions or diseases.

No

The device description clearly details physical components like needles, hubs, shields, and packaging, indicating it is a hardware medical device.

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

Here's why:

  • Intended Use: The intended use is "for use with pen injector devices for the injection of drugs." This describes a device used to administer a substance into the body, not to perform tests on samples taken from the body.
  • Device Description: The description details a needle assembly designed for subcutaneous injection and features to prevent needle sticks. This aligns with a drug delivery device, not a diagnostic test.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting analytes, or providing diagnostic information.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The DropSafe Safety Pen Needle's function is solely to facilitate the delivery of medication.

N/A

Intended Use / Indications for Use

The DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs.

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

FMI

Device Description

DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs. DropSafe Safety Pen Needles are OTC devices intended to be used by clinical and non-clinical users. DropSafe Safety Pen Needles are already offered in one gage - 31 G and in two lengths: 6mm and 8 mm. This submission covers the addition of a new length: 5 mm with the same gage - 31G. DropSafe Safety Pen Needles are gamma sterilized, non-toxic single use devices.

The device is designed to minimize the risk from accidental needle sticks with a used needle by application of a sharps injury prevention feature. Following use, the needle is locked out preventing reuse. The shield also serves to hide the needle before and after injection. Each DropSafe safety pen needle is individually packaged in a sealed container. The DropSafe safety pen needle is used by removing the seal and attaching it to the pen injector device to administer a drug subcutaneously. While inserting the needle into the skin at a 90° angle, the slider glides into the shield. While the slider glides into the shield, the safety feature is activated. Following injection, the slides back into its initial position, completely covering the needle where it remains locked. The red safety lock indicator tells the safety lock has been activated. Once the safety pen needle is in the locked mode, it cannot be reused. The safety pen needle is detached from the pen injector device and disposed of into a sharps container.

The pen needle assembly consists of a double-ended cannula that is assembled into an injection molded hub using an adhesive. The hub has internal threads which allows it to be screwed onto the pen injector device. This allows the cartridge end of the needle to penetrate through the rubber septum of the cartridge. The patient-end and the cartridge end of the cannula are lubricated using a silicone-based lubricant for ease of injection and rubber septum penetration.

An injection molded inner shield is assembled over the patient end of the cannula to prevent needle point damage and accidental needle-sticks. This needle assembly is inserted into a protective injection molded container and sealed with a peel away medical grade paper tab which provides a sterility barrier and tamper evident seal.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Body below the surface of the skin (for injection of drugs)

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Clinical and non-clinical users

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)

Verification/Validation testing was conducted in compliance with the requirements of ISO 11608- 2:2012. All testing met the applicable requirements.

FDA GUIDANCE Medical Devices with Sharps Injury Prevention Features (issued on August 9, 2005). Testing was performed to evaluate the function of the safety feature in a simulated clinical environment with the participation of both clinical and non-clinical users. The Simulated Use Study was performed to validate the Instructions For Use (IFU) with the participation of clinical and non-clinical users. As evidenced in the study, the use of this device does not affect the injection technique or the functionality of the pen injector and is safe and effective when used as per the Instructions for 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.

K170988

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

§ 880.5570 Hypodermic single lumen needle.

(a)
Identification. A hypodermic single lumen needle is a device intended to inject fluids into, or withdraw fluids from, parts of the body below the surface of the skin. The device consists of a metal tube that is sharpened at one end and at the other end joined to a female connector (hub) designed to mate with a male connector (nozzle) of a piston syringe or an intravascular administration set.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" followed by the words "U.S. FOOD & DRUG ADMINISTRATION" stacked on top of each other.

January 7, 2022

Htl Strefa Sa Justyna Zemigala RA Manager ul. Adamówek 7 Ozorków. 95-035 Poland

Re: K211716

Trade/Device Name: DropSafe Safety Pen Needles Regulation Number: 21 CFR 880.5570 Regulation Name: Hypodermic Single Lumen Needle Regulatory Class: Class II Product Code: FMI Dated: November 30, 2021 Received: December 6, 2021

Dear Justyna Zemigala:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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) for

1

devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

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/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

CAPT Alan Stevens Assistant Director DHT3C: Division of Drug Delivery and General Hospital Devices, and Human Factors OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known)

Device Name

Indications for Use (Describe)

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)

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3

510(k) Summary

As required by the Safe Medical Devices Act of 1990 and in accordance with 21 CFR ട്ല807.92(a).

[807.92 (a)(1,2)]

| Date Summary

Prepared:May 26th, 2021
Submitted By:HTL-STREFA S.A.
ul. Adamówek 7
95-035 Ozorków
POLAND
Phone: +48 42 270 00 10
Fax: +48 42 270 00 20
Primary Contact:Justyna Żemigała
RA Manager
justyna.zemigala@htl-strefa.pl
Secondary Contact:Izabela Banaś
Senior RA Specialist
izabela.banas@htl-strefa.pl
Trade Name:DropSafe Safety Pen Needles
Models:31G x 5 mm
Common Name:Insulin Pen Needle
Regulation Number:21 CFR § 880.5570
Product Code:FMI
Device Classification:II
Review Panel:80 General Hospital

4

Predicate Device [807.92(a)(3)]

The legally marketed devices to which substantial equivalence is claimed is:

Predicate Device:

ManufacturerTrade Name510(k) Number
HTL-Strefa S.A.DropSafe Safety Pen NeedleK170988

Description of Device: [807.92(a)(4)]

Device description

DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs. DropSafe Safety Pen Needles are OTC devices intended to be used by clinical and non-clinical users. DropSafe Safety Pen Needles are already offered in one gage - 31 G and in two lengths: 6mm and 8 mm. This submission covers the addition of a new length: 5 mm with the same gage - 31G. DropSafe Safety Pen Needles are gamma sterilized, non-toxic single use devices.

The device is designed to minimize the risk from accidental needle sticks with a used needle by application of a sharps injury prevention feature. Following use, the needle is locked out preventing reuse. The shield also serves to hide the needle before and after injection. Each DropSafe safety pen needle is individually packaged in a sealed container. The DropSafe safety pen needle is used by removing the seal and attaching it to the pen injector device to administer a drug subcutaneously. While inserting the needle into the skin at a 90° angle, the slider glides into the shield. While the slider glides into the shield, the safety feature is activated. Following injection, the slides back into its initial position, completely covering the needle where it remains locked. The red safety lock indicator tells the safety lock has been activated. Once the safety pen needle is in the locked mode, it cannot be reused. The safety pen needle is detached from the pen injector device and disposed of into a sharps container.

The pen needle assembly consists of a double-ended cannula that is assembled into an injection molded hub using an adhesive. The hub has internal threads which allows it to be screwed onto the pen injector device. This allows the cartridge end of the needle to penetrate through the rubber septum of the cartridge. The patient-end and the cartridge end of the cannula are lubricated using a silicone-based lubricant for ease of injection and rubber septum penetration.

An injection molded inner shield is assembled over the patient end of the cannula to prevent needle point damage and accidental needle-sticks. This needle assembly is inserted into a protective injection molded container and sealed with a peel away medical grade paper tab which provides a sterility barrier and tamper evident seal.

5

Indications for Use: [807.92(a)(5)]

The DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs.

Technological Characteristics: [807.92(a)(6)]

A comparison of characteristics of DropSafe Safety Pen Needles and the predicate device is shown in the table below:

Device NameNew DevicePredicate Device
ManufacturerHTL-STREFA S.A.HTL-STREFA S.A.
510(k) NumberK211716K170988
Brand nameDropSafe Safety Pen NeedleDropSafe Safety Pen Needle
Intended useIntended for use with pen injector
devices for the injection of drugsIntended for use with pen injector
devices for the injection of drugs
Operation principleManualManual
DesignNeedle assembly -
cannula, hub, primary container,
seal, needle shield, slider, plug,
spring- operatedNeedle assembly -
cannula, hub, primary container,
seal, needle shield, slider, plug, spring-
operated
Product CodeFMIFMI
Length5 mm6mm, 8 mm
Gage31G31G
BiocompatibilityConforms to
ISO 10993-1 & USP Method 1Conforms to ISO
10993-1
SterilizationGamma radiationGamma radiation
Needle tubeMedical Grade Stainless SteelMedical Grade Stainless Steel
Hub, Primary
Container,
Shield, PlugPlastic resinPlastic resin
SpringStainless steel wireStainless steel wire

6

The new device and the predicate device are classified under 21 CFR 880.5570, which states: "A hypodermic single lumen needle is a device intended to inject fluids into, or withdraw fluids from, parts of the body below the surface of the skin." The indications for use of the new device and the predicate and devices is identical (intended for use with pen injector devices for the injection of drugs).

The only difference between the new device and the predicate device is the needle length on patient end. The new device is 5 mm, whereas the already cleared versions are 6mm and 8mm.

The production process, sterilization process, production facilities and conditions, operation principle, biocompatibility and shelf life aspects are identical for the new and predicate device.

The difference in needle length on patient end between the new device and the predicate device does not raise any new or different questions of safety or effectiveness.

7

Non-Clinical Performance Data:

[(807.92(b)(1)]

Verification/Validation testing was conducted in compliance with the requirements of ISO 11608- 2:2012 as summarized below. All testing met the applicable requirements.

| Parameters and clause

from ISO 11608-2:2012RequirementsResult
4.1 MaterialsThe needle shall be made of tubing
materials specified in ISO 9626Meets standard
4.2.2 DimensionsNeedles shall fit the test apparatus
specified in item 7.3 of ISO 11608-2.
Dimensions shall be in accordance withMeets standard
4.3 Determination of
flow rate through the
needleThe flow rate is at the border: min 2,14
ml/minMeets standard
4.4 Bond between hub
and needle tubeClause 9 of ISO 11608-2 and clause 13.1.
The union of the hub and needle tube
shall not break for at least 5 sec. while a
force of at least 11 N is appliedMeets standard
4.5 Needle pointsVisually under a magnification of x2,5,
needle points shall appear sharp and free
from feather edges, burrs and hooksMeets standard
4.6 Freedom from defectsVisually inspected by normal or
corrected-to-normal vision without
magnification under an illuminance of
300 lx to 700 lx, the outer surface of the
tubing shall be smooth and free fromMeets standard
4.7 LubricationNo visible droplets on the outside surface
of theMeets standard
4.8 Dislocation of
measuring point at
patient endClause 8 of ISO 11608-2:2012 maximum
allowable dislocation acc. Clause 4.8,
Table 2 for 5mm: 0.65mMeets standard
4.9 Determination of
functional compatibility
with needle-basedClause 11 of ISO 11608-2:2012
Needle assembly torque: 0.07 +/- 0.01
Nm Needle hub removal: less than 0.100Meets standard
4.10 Ease of assembly
and disassemblyNm Dose accuracy: for doses ≤ 20 ml the
calculated values were within ± 0.01 ml
of the targeted dose; for doses > 20 ml the
calculated values were within ± 5 % of
the targeted doseMeets standard
4.11 SterilityThe needle in its unit packaging has
undergone an approved sterilization
process. Sterilization method: Gamma
irradiation. Sterilization conditions 17,5-
40kGy.Meets standard
6. Pre-conditioning of
needlesAll pen safety needles to in tested were
preconditioned atmosphere in: a dry-heat,
a cold-storage, a cyclical atmosphere.
Prepared in accordance with the
requirements specified in clauses 6.1, 6.2,
6.3 of ISO 11608-2: 2012Meets standard
12.2.1 Marking on the
unit packagingAny marking on the unit packaging that is
essential for the safe use of the NIS shall
be visible and easily legibleMeets standard
12.2.2 Marking on the
unit packagingThe marking on the unit packaging shall
comprise at least the particulars listed in
ISO 11608-2:2012 item 12.2.2Meets standard
12.2.3 Marking on the
user packagingThe marking on the user packaging shall
comprise at least the particulars listed in
ISO 11608-2:2012 item 12.2.3Meets standard

8

9

Clinical Performance Data:

[(807.92(b)(2)]

FDA GUIDANCE Medical Devices with Sharps Injury Prevention Features (issued on August 9, 2005).

Testing was performed to evaluate the function of the safety feature in a simulated clinical environment with the participation of both clinical and non-clinical users. The Simulated Use Study was performed to validate the Instructions For Use (IFU) with the participation of clinical and non-clinical users. As evidenced in the study, the use of this device does not affect the injection technique or the functionality of the pen injector and is safe and effective when used as per the Instructions for Use.

Conclusion:

[(807.92(b)(3)]

DropSafe Safety Pen Needle 5mm is substantially equivalent in the intended use, technology/principle of operation, materials and performance to the predicate device and does not raise any new questions of safety and effectiveness.