K Number
K221176
Date Cleared
2022-07-01

(67 days)

Product Code
Regulation Number
880.5570
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Insulin Pen Needle (Ordinary Type) is intended for use with pen injector devices for the subcutaneous injection of insulin.

The Insulin Pen Needle (Safety Type) is sterile, single-use safety needle intended for use with pen iniector devices for the injection of insulin.

Device Description

The proposed devices, Insulin Pen Needle (Ordinary Type) and Insulin Pen Needle (Safety Type) are single use device, which is designed for used with a pen injector for the subcutaneous injection of insulin. For the safety type, it is designed with a sharp injury prevention feature to minimize the risk from accidental needles sticks. The proposed device is available in 29G, 30G, 31G, 32G and 33G five different specifications with the needle length available in 4mm, 5mm, 6mm, 10mm and 12mm for Insulin Pen Needle (Ordinary Type) and 4mm, 5mm, and 8mm for Insulin Pen Needle (Safety Type). The product is for single use and provided sterile (Irradiation). The shelf-life of the product is five-years.

AI/ML Overview

The provided text describes the acceptance criteria and study for an Insulin Pen Needle (Ordinary Type, Safety Type), not an AI/algorithm-based device. Therefore, many of the requested points, such as MRMC studies, training set details, or expert ground truth establishment for AI, are not applicable.

However, I can extract the information relevant to the medical device's performance and testing as described in the 510(k) summary.

Here's a breakdown based on the provided document:

Device Type: Insulin Pen Needle (Ordinary Type, Safety Type) - This is a physical medical device, not a software/AI device.

1. A table of acceptance criteria and the reported device performance:

The document refers to adherence to various ISO standards and specific test results, but does not present a single consolidated table of "acceptance criteria" vs. "reported performance" in a quantitative manner for all aspects. Instead, it states that the device "met all design specifications" and "complies with the following standards."

Here's an attempt to extract the closest information, primarily by listing the standards the device claims to conform with for performance characteristics:

Feature/TestAcceptance Criteria (as per standards/claims)Reported Performance
General Performance:
Bond between hub and needle tube (Ordinary Type)Clause 4.4 of ISO 11608-2:2012; Clause 4.12 of ISO 7864:2016Complies with standards (Stated implicitly by "met all design specifications")
Needle tip configuration (Ordinary Type)Conform with ISO 7864 standardsComplies with standards
Bond between hub and needle tube (Safety Type)Drawing force ≥ 22N (29G); Drawing force ≥ 11N (30G-33G); Clause 4.4 of ISO 11608-2:2012; Clause 4.12 of ISO 7864:2016Complies with standards and specified drawing forces (Stated implicitly by "met all design specifications")
Needle tip configuration (Safety Type)Conform with ISO 7864 standardsComplies with standards
Biocompatibility:
CytotoxicityNo CytotoxicityMet (Stated "No Cytotoxicity")
Intracutaneous reactivity / IrritationNo Irritation to SkinMet (Stated "No Irritation to Skin")
Skin SensitizationNo skin sensitizationMet (Stated "No skin sensitization")
Acute Systemic ToxicityNo Systemic ToxicityMet (Stated "No Systemic Toxicity")
PyrogenNo pyrogenMet (Stated "No pyrogen")
HemolysisNo hemolysisMet (Stated "No hemolysis")
Subacute Systemic ToxicityNo Subacute Systemic ToxicityMet (Stated "No Subacute Systemic Toxicity")
Sterility:
Sterility Assurance Level (SAL)10⁻⁶Achieved 10⁻⁶
Endotoxin Limit20 EU per deviceMet (Stated "20 EU per device")
Shelf-life:
Shelf life5 yearsValidated for 5 years
Sharps Injury Protection (Safety Type):
Sharps injury prevention featureMeet pre-established criteria per ISO 23908:2011 and FDA GuidanceMet pre-established criteria (Tested in simulated clinical use)
General Quality:
Particulate matterUSP <788> acceptance criteriaMet USP acceptance criteria
Package integrityAcceptable for protection and sterility maintenanceAll packaging deemed acceptable

2. Sample size used for the test set and the data provenance:

  • Simulated Clinical Use Study (Safety Type only): 600 device samples.
  • Data Provenance: Not specified in terms of country of origin for testing data. The manufacturer is in Tianjin, China. The testing appears to be non-clinical, laboratory-based performance testing rather than human clinical study data. It is a non-clinical study, not a retrospective or prospective human data study.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts:

  • Not Applicable. This is a physical medical device. "Ground truth" in the context of AI/machine learning data is not relevant here. Performance is assessed against engineering standards (e.g., ISO, USP) and physical properties.

4. Adjudication method (e.g. 2+1, 3+1, none) for the test set:

  • Not Applicable. As this is not a study requiring human interpretation or labeling of data (like medical imaging), there's no adjudication method in the described testing.

5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance:

  • Not Applicable. This is not an AI/software device. No human-in-the-loop studies or MRMC studies were conducted.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done:

  • Not Applicable. This is not an AI/software device. "Standalone performance" in this context would refer to the device's adherence to its design specifications and relevant standards, which was evaluated through non-clinical testing.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.):

  • Not Applicable. For a physical device, "ground truth" is defined by established engineering and biological standards (e.g., ISO, USP), material specifications, and physical measurements. The "truth" is whether the device physically meets these specifications and passes the required tests.

8. The sample size for the training set:

  • Not Applicable. There is no "training set" as this is not an AI/machine learning model.

9. How the ground truth for the training set was established:

  • Not Applicable. There is no "training set." The performance of the device is assessed against pre-defined engineering standards and test methods.

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Image /page/0/Picture/0 description: The image contains 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 FDA logo is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

Tianjin Huahong Technology Co., Ltd. Yuan Ying Quality Manager A01, Plant B, No. 278, Hangkong Road, Tianjin Pilot Free Trade Zone(Air Port Industrial Park) Tianiin. 300308 China

Re: K221176

Trade/Device Name: Insulin Pen Needle (Ordinary Type, Safety Type) Regulation Number: 21 CFR 880.5570 Regulation Name: Hypodermic Single Lumen Needle Regulatory Class: Class II Product Code: FMI Dated: June 16, 2022 Received: June 16, 2022

Dear Yuan Ying:

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

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801); medical device reporting of medical device-related adverse events) (21 CFR 803) for 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 mediation-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,

For CAPT Alan M. 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

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Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2023 See PRA Statement below.

Submission Number (if known)

K221176

Device Name

Insulin Pen Needle (Ordinary Type, Safety Type)

Indications for Use (Describe)

The Insulin Pen Needle (Ordinary Type) is intended for use with pen injector devices for the subcutaneous injection of insulin.

The Insulin Pen Needle (Safety Type) is sterile, single-use safety needle intended for use with pen iniector devices for the injection of insulin.

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

Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

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"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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510(k) Summary - K221176

l Submitter

Tianjin Huahong Technology Co., Ltd.

A01, Plant B, No.278, Hangkong Road, Tianjin Pilot Free Trade Zone (Air Port Industrial Park), 300308 Tianjin, China

Establishment Registration Number: 3009498536

Contact person: Ms. Ying Yuan Quality Manager Tel.: +86-18622179097 E-mail: ying.yuan@hh-technology.com

Preparation date: July 1, 2022

II Proposed Device

Trade Name of Device:Insulin Pen Needle (Ordinary Type, Safety Type)
Classification name:Hypodermic, Single Lumen
Regulation Number:21 CFR 880.5570
Regulatory Class:Class II
Product code:FMI
Review PanelGeneral Hospital

III Predicate Devices

510(k) Number:K181069
Trade name:Disposable Insulin Pen Needle
Classification:Class II
Product Code:FMI
ManufacturerZhejiang Kindly Medical Devices Co. Ltd
510(k) Number:K170988
Trade name:DropSafe Safety Pen Needle
Classification:Class II
Product Code:FMI
ManufacturerHTL-Strefa S.A.

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IV Device description

The proposed devices, Insulin Pen Needle (Ordinary Type) and Insulin Pen Needle (Safety Type) are single use device, which is designed for used with a pen injector for the subcutaneous injection of insulin. For the safety type, it is designed with a sharp injury prevention feature to minimize the risk from accidental needles sticks. The proposed device is available in 29G, 30G, 31G, 32G and 33G five different specifications with the needle length available in 4mm, 5mm, 6mm, 10mm and 12mm for Insulin Pen Needle (Ordinary Type) and 4mm, 5mm, and 8mm for Insulin Pen Needle (Safety Type). The product is for single use and provided sterile (Irradiation). The shelf-life of the product is five-years.

V Indication for use

The Insulin Pen Needle (Ordinary Type) is intended for use with pen injector devices for the subcutaneous injection of insulin.

The Insulin Pen Needle (Safety Type) is sterile, single-use safety needle intended for use with pen injector devices for the injection of insulin.

Table 1 General Comparison for Insulin Pen Needle (Ordinary Type)
ITEMProposed DeviceK202319Predicate Device 1K181069
Proprietary/ trade nameInsulin Pen Needle (Ordinary Type)Disposable Insulin Pen Needle
Regulation No.880.5570880.5570
Product CodeFMIFMI
ClassIIII
Intended UseThe Insulin Pen Needle (Ordinary Type) is intended for use with pen injector devices for the subcutaneous injection of insulin.The Disposable Insulin Pen Needle is intended for use with pen injector devices for the subcutaneous injection of insulin.
Environment of useIn hospital or in the home environment.In hospital or in the home environment.
Type-of-useDisposableDisposable
Configuration and materials of construction for all componentsNeedle Tube Stainless SteelNeedle Tube Stainless Steel
Needle Hub PolypropyleneHub Polypropylene
Outer Sheath PolypropyleneCup Polyethylene
Inner Sheath PolypropyleneInner Sheath Polypropylene
Sealed PaperPaperSealed PaperPaper

VI Comparison of technological characteristics with the predicate devices

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Operation ModeFor Manual Use OnlyFor Manual Use Only
Methodofattachment to peninjectorThrough threaded connectionThrough threaded connection
Table 2 Safety and Performance Comparison for Insulin Pen Needle (Ordinary Type)
Proposed DevicePredicate
ITEMK202319Device 1K181069
Needle Gauge29G, 30G, 31G, 32G, 33G28G, 29G, 30G,31G, 32G, 33G
Needle Length4mm, 5mm, 6mm, 8mm, 10mm, 12mm4mm, 6mm,8mm, 12mm
Patient-contact materials
Needle TubeStainless Steel (SUS304)Stainless Steel
LubricantMDX4-4159Unknown
adhesiveUV glueUnknown
Bond between hub andneedle tubeClause 4.4 of ISO 11608-2:2012;Clause 4.12 of ISO 7864:2016Clause 4.4 of ISO 11608-2:2012;Clause 4.12 of ISO 7864:2016
Design specification of theinner sheath (dimensions,color, materials andstrength)14.35.85.8mm;Transparent color; Polypropylene;Tensile stress at yield>20MPa; Flexuralmodulus: >800MPa; Charpy NotchedImpact Strength (23°C ) >2.8kJ/m².Unknown
Design specification of theouter sheath (dimensions,color, materials andstrength)30.313.413.4mm;Transparent color; Polypropylene;Tensile stress at yield>20MPa; Flexuralmodulus: >800MPa; Charpy NotchedImpact Strength (23°C ) >2.8kJ/m².Unknown
Needle tip configurationConform with ISO 7864 standardsConform withISO 7864standards
CytotoxicityNo CytoxicityNo Cytoxicity
Intracutaneous reactivityNo Irritation to SkinNo Irritation to Skin
Skin SensitizationNo skin sensitizationNo skin sensitization
Acute Systemic ToxicityNo Systemic ToxicityNo Systemic Toxicity
PyrogenNo pyrogenNo pyrogen

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HemolysisNo hemolysis
Subacute Systemic ToxicityNo Subacute Systemic ToxicityUnknown
MethodIrradiation SterilizedEO Sterilized
SAL10-610-6
Endotoxin Limit20 EU per device20 EU per device
Shelf life5 yearsUnknown
Label/ LabelingComplied with 21 CFR part 801Complied with 21 CFR part 801

Table 3 General Comparison for Insulin Pen Needle (Safety Type)

ITEMProposed DevicePredicate Device 2
K202319K170988
Regulation No.880.5570880.5570
Product CodeFMIFMI
ClassIIII
Intended UseThe Insulin Pen Needle (Safety Type) is sterile, single-use safety needle intended for use with pen injector devices for the injection of insulin.The DropSafe Safety Pen Needles are sterile, single-use safety needles intended for use with pen injector devices for the injection of drugs.
Environment of useIn hospital or in the home environment.In hospital or in the home environment.
Proprietary/ trade nameInsulin Pen Needle (Safety Type)DropSafe Safety Pen Needles
Type-of-useDisposableDisposable
Configuration and materials of construction for all componentsNeedle Tube Stainless Steel (SUS304)Cannula Medical grade stainless steel
Needle Hub PolypropyleneHub Plastic resin
Outer Sheath PolypropylenePrimary container Plastic resin
Inner Sheath PolypropyleneSlider Unknown
Sealed Paper PaperSeal Unknown
Spring Stainless Steel (SUS304)Spring- operated Stainless steel wire
Upper Cover PolypropyleneNeedle shield Plastic resin

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Operation ModeFor Manual Use OnlyFor Manual Use Only
Method ofattachment to peninjectorThreaded connection method.Threaded connection method.
Safety FeaturePrevent from needlestickPrevent from needlestick
Method ofactivationTrigger shieldTrigger shield
ITEMProposed DeviceK202319Predicate Device 2K170988
Needle Gauge29G, 30G, 31G, 32G, 33G31G
Needle Length4mm, 5mm, 6mm, 8mm6mm and 8mm
Patient-contact material
Needle TubeStainless Steel (SUS304)Medical grade stainless steel
LubricantMDX4-4159Unknown
adhesiveUV glueUnknown
Bond between hub andneedle tubeDrawing force≥22N (29G) ;Drawing force≥ 11N (30G-33G);Clause 4.4 of ISO11608-2:2012;Clause 4.12 of ISO 7864:2016Clause 4.4 of ISO 11608-2:2012;Clause 4.12 of ISO 7864:2016
Design specification of theinner sheath (dimensions,color, materials andstrength)21.510.79.8mm;Transparent color;Polypropylene.Tensile stress atyield>20MPa; Flexuralmodulus: >800MPa;Charpy Notched ImpactStrength (23°C ) >2.8kJ/m² .Unknown
Design specification of theouter sheath (dimensions,color, materials andstrength)43.818.618.6mm;Transparent color;Polypropylene.Tensile stress atyield>20MPa; Flexuralmodulus: >800MPa;Charpy Notched ImpactStrength (23°C ) >2.8kJ/m².Unknown
Design specification of theupper cover (dimensions,30.214.614.6mm;White:Unknown
color, materials andstrength)Polypropylene.Tensile stress atyield>20MPa; Flexuralmodulus: >800MPa;Charpy Notched ImpactStrength (23°C) >2.8kJ/m².
Needle tip configurationConform with ISO 7864 standardsConform with ISO 7864 standards
Biocompatibility
CytotoxicityNo Cytoxicity
Intracutaneous reactivityNo Irritation to Skin
Skin SensitizationNo skin sensitizationConform with ISO 10993 standards
Acute Systemic ToxicityNo Systemic Toxicity
PyrogenNo pyrogen
HemolysisNo hemolysis
Subacute Systemic ToxicityNo Subacute SystemicToxicityUnknown
Sterilization
MethodIrradiation SterilizedIrradiation Sterilized
SAL10-610-6
Endotoxin Limit20 EU per device20 EU per device
Shelf life5 yearsUnknown
Label/ LabelingComplied with 21 CFR part 801Complied with 21 CFR part 801

Table 4 Safety and Performance Comparison for Insulin Pen Needle (Safety Type)

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VII Compatible injectors

The Insulin Pen Needle can be used in combination with following pen injector available and cleared in the USA:

  • Autopen ® K983974 Owen Mumford, Inc.
  • Novopen Echo ® K162602 Novo Nordisk Inc.
  • Humapen and Humapen Ergo K982842 Eli Lilly and Company -
  • Humapen Luxura K142518 Eli Lilly and Company -
  • -Humapen Memoir K053563 Eli Lilly and Company

VIII Non-Clinical Testing

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

Performance Testing:

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  • ISO 7864: 2016 Sterile hypodemic needles for single use

  • ISO 9626: 2016 Stainless steel needle tubing for the manufacture of medical devices

  • ISO 11608-2: 2012 Needle-based injection systems for medical use- Requirements and test methods- Part 2: Needles

  • ハ ISO 23908 :2011 Sharps injury protection - Requirements and test methods -Sharps protection features for single-use hypodermic needles, introducers for catheters and needles used for blood sampling

Biocompatibility Testing:

In accordance with ISO 10993-1, the Insulin Pen Needles are classified as: Externally communicating, indirect blood path with prolonged contact duration (>24 h to 30 d). The direct and indirect patient-contact component(s) along with the material(s) for the proposed devices are identified as follows:

ComponentsMaterialContact LevelContact Duration
Needle TubeStainless Steel(SUS304)Indirect, blood pathprolonged (>24hrs to 30 days)
AdhesiveUV glueIndirect, blood pathprolonged (>24hrs to 30 days)
LubricantMDX4-4159Indirect, blood pathprolonged (>24hrs to 30 days)
Needle hubPolypropyleneDirect contact with intact skinLimited (≤24 h)
Outer sheathPolypropyleneDirect contact with intact skinLimited (≤24 h)

Table 5 Patient Contact Material Identification

The following testing was conducted:

  • . Cytotoxicity
  • . Sensitization
  • Irritation ●
  • . Acute Systemic Toxicity
  • Material-Mediated Pyrogenicity .
  • Subacute Toxicity .
  • . Hemocompatibility

Particulate matter testing was conducted in accordance with USP <788> Particulate Matter in Injections and met the USP acceptance criteria.

Sterility, Shipping and Shelf-Life

The Insulin Pen Needles were sterilized by irradiation to achieve a SAL of 10 °. The radiation source

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was Electron beam, and the radiation dose was 25kGy, which was established according to VDmax method per ISO11137-2, Sterilization of healthcare products-Radiation establishing the sterilization dose. The sterilization was validated according to ISO 11137-2. The Insulin Pen Needles were evaluated for bacterial endotoxin utilizing the USP <85> Limulus Amebocyte Lysate (LAL) method.

  • . Package integrity testing, after environmental conditioning and simulated transportation was conducted on the final, packaged, and sterile devices. All packaging deemed acceptable for protection of product and sterility maintenance.
  • Sterile Barrier Packaging Testing performed on the proposed device: .
    • Seal strength ASTM F88/F88-15 o
    • o Dye penetration ASTM F1929-15

Shelf life of 5 years is validated using the FDA recognized standard ASTM F1980-16 Standard Guide for Accelerated Aging of Sterile Barrier Systems for Medical Devices

Simulated Clinical Use

A simulated clinical use study was performed on 600 device samples for the Insulin Pen Needle (Safety Type) according to FDA Guidance (Guidance for Industry and FDA Staff: Medical Device with Sharps Injury Prevention Feature) and ISO 23908:2011 to evaluate the safety mechanism of the proposed device. The results demonstrated that the proposed device met the pre-established criteria.

VIII Clinical Testing

No clinical study is included in this submission.

IX Conclusion

The clinical and non-clinical performance testing demonstrate that the subject device is as safe and effective as the predicate. Therefore, the subject device is substantially equivalent to the predicate device.

§ 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).