K Number
K223090
Date Cleared
2023-01-27

(119 days)

Product Code
Regulation Number
862.1345
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The GEM Premier ChemSTAT is a portable critical care system for use by health care professionals to rapidly analyze lithium heparinized whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of sodium (Na+), Potassium (K+), Ionized Calcium (Ca++), Chloride (Cl-), Glucose (Glu), Lactate (Lac), Hematocrit (Hct), Creatinine (Crea), Blood Urea Nitrogen (BUN), Total Carbon Dioxide (tCO2), pH, and partial pressure of carbon dioxide (pCO2) from arterial and venous heparinized whole blood. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance.

Electrolytes in the human body have multiple roles. Nearly all metabolic processes depend on or vary with electrolytes:

· Sodium (Na+) measurements are used in the diagnosis and treatment of aldosteronism, diabetes insipidus, adrenal hypertension, Addison's disease, dehydration, inappropriate antidiuretic secretion, or other diseases involving electrolyte imbalance.

· Potassium (K+) measurements are used to monitor electrolyte balance in the diagnosis and treatment of disease conditions characterized by low or high blood potassium levels.

· Ionized calcium (Ca++) measurements are used in the diagnosis and treatment of parathyroid disease, a variety of bone diseases, chronic renal disease and tetany. · Chloride (Cl-) measurements are used in the diagnosis and treatment of electrolyte and metabolic disorders, such as cystic fibrosis and diabetic acidosis.

· Glucose (Glu) measurement is used in the diagnosis, monitoring and treatment of carbohydrate metabolism disturbances including diabetes mellitus, neonatal hypoglycemia, idiopathic hypoglycemia, and of pancreatic islet cell carcinoma.

· Lactate (Lac) measurement is used to evaluate the acid-base status of patients suspected of having lactic acidosis, to monitor tissue hypoxia and strenuous physical exertion, and in the diagnosis of hyperlactatemia.

· Hematocrit (Hct) measurements in whole blood of the packed red cell volume of a blood sample are used to distinguish normal from abnormal states, such as anemia and erythrocytosis (an increase in the number of red cells).

· Creatinine (Crea) measurements are used in the diagnosis and treatment of renal diseases and in monitoring renal dialysis.

· Blood Urea Nitrogen (BUN) or urea measurements are used for the diagnosis, monitoring, and treatment of certain renal and metabolic diseases.

· Total carbon dioxide/tCO2 (also referred to as bicarbonate/HCO3-) is used in the diagnosis, monitoring, and treatment of numerous potentially serious disorders associated with changes in body acid-base balance.

· pH and pCO2 measurements in whole blood are used in the diagnosis and treatment of life-threatening acid-base disturbances.

Device Description

The GEM Premier ChemSTAT system provides fast, accurate, quantitative measurements of Sodium (Na"), Potassium (K*), Ionized Calcium (Ca*), Chloride (Cl·), Glucose (Glu), Lactate (Lac), Hematocrit (Hct), Creatinine (Crea), Blood Urea Nitrogen (BUN), Total Carbon Dioxide (tCO2), pH, and partial pressure of carbon dioxide (pCO2) from arterial and venous lithium heparinized whole blood.

AI/ML Overview

The provided text describes a Special 510(k) submission for an upgrade to the operating system of the GEM Premier ChemSTAT device. The device itself is an in vitro diagnostic (IVD) system for quantitative measurements of various blood parameters. The submission focuses on the software upgrade rather than a change in the device's fundamental function or performance.

Therefore, the "acceptance criteria" and "reported device performance" in this context refer to the successful verification and validation of the software upgrade and the continued adherence to the established performance of the unmodified device, as the indications for use and performance claims remain unchanged. The study proving this essentially consists of the software verification and validation activities.

Here's the information extracted from the document, tailored to the context of a software upgrade:

1. Table of Acceptance Criteria and Reported Device Performance

Since this is a software upgrade with no changes to the performance claims of the device, the general acceptance criteria are that the upgraded software performs as intended without adversely affecting the device's established performance specifications. The reported device performance is that these criteria were met.

Acceptance Criteria (Software Upgrade)Reported Device Performance (Software Upgrade)
All identified risks associated with the design changes for the modified device are mitigated.Risk assessments were performed in compliance with ISO 14971:2019, and identified risks were mitigated.
All software verification and validation activities are completed according to established plans and protocols.All verification and validation activities were performed in accordance with established plans and protocols and Design Control procedures.
All acceptance criteria for software verification and validation are met.Testing verified all acceptance criteria were met.
Cybersecurity vulnerabilities are identified, assessed, and compensating controls are implemented.Cybersecurity assessments were performed, vulnerabilities identified and assessed, and compensating controls implemented to mitigate threats and safeguard data.
No changes to indications for use or intended use.No changes to indications for use or intended use.
No changes to the fundamental scientific technology.No changes to the fundamental scientific technology.
No changes to operating principle.No changes to operating principle.
No changes to labeled performance claims.No changes to labeled performance claims.

2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)

The document does not specify a "test set sample size" or "data provenance" in the traditional sense for evaluating diagnostic performance. The focus is on software verification and validation. Therefore, the "sample" for testing the software functionality would be the various test cases and scenarios designed to validate the operating system upgrade and its interaction with the GEM Premier ChemSTAT application software.

The document states: "Performance data is limited to Software Verification and Validation as the scope of this Special 510(k) is specific to an operating system upgrade from Fedora 17 Linux to WindRiver LTS 18 Linux."

Further details on the specific number of test cases, the nature of the data (e.g., simulated, actual runs on the device), or its origin are not provided in this summary.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)

This information is not applicable to a software operating system upgrade as described. "Ground truth" in the context of expert consensus is typically relevant for diagnostic performance studies where human interpretation or a gold standard reference is needed (e.g., pathology for an imaging device). Here, the "ground truth" is the proper functioning of the software and its integration with the hardware, which is evaluated through engineering and software testing.

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

This information is not applicable for a software operating system upgrade. Adjudication methods like 2+1 or 3+1 are used in clinical studies to resolve discrepancies in expert interpretation of diagnostic results. Software verification and validation typically rely on predefined test outcomes and engineering assessments.

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

This information is not applicable. An MRMC comparative effectiveness study is used to evaluate the impact of an AI algorithm on human reader performance, usually for diagnostic tasks. This submission is for a software operating system upgrade for an existing IVD device, not for a new AI algorithm.

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

The concept of "standalone performance" in the context of an algorithm's diagnostic capability (like an AI algorithm) is not directly applicable here. The device itself (GEM Premier ChemSTAT) operates to provide quantitative measurements. The software upgrade ensures the continued, correct operation of the device. The verification and validation activities demonstrate that the upgraded software performs its functions correctly as part of the overall device system.

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

For this software upgrade, the "ground truth" is the expected behavior and functionality of the software and the device. This is established through:

  • Functional specifications: The software is expected to perform according to its design specifications.
  • Risk analysis: The software should not introduce new risks or fail to mitigate existing ones.
  • Cybersecurity standards: The software should meet cybersecurity requirements.
  • Established device performance: The software upgrade should not negatively impact the established analytical and clinical performance of the GEM Premier ChemSTAT device (which relies on the physical and chemical principles of its measurements).

The document explicitly states that the changes "do not introduce...changes to labeled performance claims." This implies that the performance of the device (e.g., accuracy, precision of Na+, K+, Glu measurements) remains the same as previously cleared, and the software upgrade was validated not to alter these.

8. The sample size for the training set

This information is not applicable. Training sets are used for machine learning models. This submission describes a conventional software operating system upgrade (Fedora 17 Linux to WindRiver LTS 18 Linux) for an existing IVD device, not the development or retraining of a machine learning algorithm.

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

This information is not applicable, as there is no training set for a machine learning model; it is a software operating system upgrade.

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January 27, 2023

Instrumentation Laboratory Co. Gabriella Erdosy Director of Regulatory Affairs 180 Hartwell Road Bedford, MA 01730

Re: K223090

Trade/Device Name: GEM Premier ChemSTAT Regulation Number: 862.1345 Regulation Name: Glucose Test System Regulatory Class: Class II Product Code: CGA, JGS, CEM, CGZ, JFP, CHL, KHP, GKF, JFY, CDQ, KHS Dated: September 29, 2022 Received: September 30, 2022

Dear Gabriella Erdosy:

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/cfpmp/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 and Part 809); 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

{1}------------------------------------------------

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.

Digitally signed by Paula Paula Caposino -S Caposino -S Date: 2023.01.27
18:12:23 -05'00'

Paula V. Caposino, Ph.D. Acting Deputy Director Division of Chemistry and Toxicology Devices OHT7: Office of In Vitro Diagnostics Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K223090

Device Name

GEM Premier ChemSTAT

Indications for Use (Describe)

The GEM Premier ChemSTAT is a portable critical care system for use by health care professionals to rapidly analyze lithium heparinized whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of sodium (Na+), Potassium (K+), Ionized Calcium (Ca++), Chloride (Cl-), Glucose (Glu), Lactate (Lac), Hematocrit (Hct), Creatinine (Crea), Blood Urea Nitrogen (BUN), Total Carbon Dioxide (tCO2), pH, and partial pressure of carbon dioxide (pCO2) from arterial and venous heparinized whole blood. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance.

Electrolytes in the human body have multiple roles. Nearly all metabolic processes depend on or vary with electrolytes:

· Sodium (Na+) measurements are used in the diagnosis and treatment of aldosteronism, diabetes insipidus, adrenal hypertension, Addison's disease, dehydration, inappropriate antidiuretic secretion, or other diseases involving electrolyte imbalance.

· Potassium (K+) measurements are used to monitor electrolyte balance in the diagnosis and treatment of disease conditions characterized by low or high blood potassium levels.

· Ionized calcium (Ca++) measurements are used in the diagnosis and treatment of parathyroid disease, a variety of bone diseases, chronic renal disease and tetany. · Chloride (Cl-) measurements are used in the diagnosis and treatment of electrolyte and metabolic disorders, such as cystic fibrosis and diabetic acidosis.

· Glucose (Glu) measurement is used in the diagnosis, monitoring and treatment of carbohydrate metabolism disturbances including diabetes mellitus, neonatal hypoglycemia, idiopathic hypoglycemia, and of pancreatic islet cell carcinoma.

· Lactate (Lac) measurement is used to evaluate the acid-base status of patients suspected of having lactic acidosis, to monitor tissue hypoxia and strenuous physical exertion, and in the diagnosis of hyperlactatemia.

· Hematocrit (Hct) measurements in whole blood of the packed red cell volume of a blood sample are used to distinguish normal from abnormal states, such as anemia and erythrocytosis (an increase in the number of red cells).

· Creatinine (Crea) measurements are used in the diagnosis and treatment of renal diseases and in monitoring renal dialysis.

· Blood Urea Nitrogen (BUN) or urea measurements are used for the diagnosis, monitoring, and treatment of certain renal and metabolic diseases.

· Total carbon dioxide/tCO2 (also referred to as bicarbonate/HCO3-) is used in the diagnosis, monitoring, and treatment of numerous potentially serious disorders associated with changes in body acid-base balance.

· pH and pCO2 measurements in whole blood are used in the diagnosis and treatment of life-threatening acid-base disturbances.

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

X Prescription Use (Part 21 CFR 801 Subpart D)

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510(k) Summary

This 510(k) Summary of Safety and Effectiveness is being submitted in accordance with the requirements of the Safe Medical Device Act of 1990 and 21 CFR 807.92.

Submitter's InformationInstrumentation Laboratory (IL) Co.180 Hartwell RoadBedford, MA 01730, USA
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Contact PersonGabriella ErdosyDirector of Regulatory AffairsPhone: 781-861-4571Fax: 781-861-4207Email: gerdosy@werfen.com
---------------------------------------------------------------------------------------------------------------------------------------------
Preparation DateSeptember 29, 2022
--------------------------------------
510(k) NumberK223090
------------------------
Device Trade NameGEM Premier ChemSTAT
-----------------------------------------
Predicate DeviceGEM Premier ChemSTATK183549, K183546, K183555
-------------------------------------------------------------------
Regulatory Information
GEM Premier ChemSTAT
AnalyteRegulationSectionRegulatory DescriptionClassProductCodePanel
pH, pCO2862.1120Blood Gases (pCO2, pO2) and BloodpH systemIICHL
Sodium862.1665Sodium test systemIIJGS
Potassium862.1600Potassium test systemIICEM
Chloride862.1170Chloride test systemIICGZ75

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IonizedCalcium862.1145Calcium test systemIIJFP
Glucose862.1345Glucose test systemIICGA
Lactate862.1450Lactic acid test systemIKHP
Regulatory Information
GEM Premier ChemSTAT
Regulation
AnalyteSectionRegulatory DescriptionClassProductCodePanel
Hematocrit864.5600Automated hematocrit instrumentIIGKF81
Creatinine862.1225Creatinine Test SystemIIJFY
Blood UreaNitrogen(BUN)862.1770Urea Nitrogen Test SystemIICDQ75

Device Description

The GEM Premier ChemSTAT system provides fast, accurate, quantitative measurements of Sodium (Na"), Potassium (K*), Ionized Calcium (Ca*), Chloride (Cl·), Glucose (Glu), Lactate (Lac), Hematocrit (Hct), Creatinine (Crea), Blood Urea Nitrogen (BUN), Total Carbon Dioxide (tCO2), pH, and partial pressure of carbon dioxide (pCO2) from arterial and venous lithium heparinized whole blood.

Risk Management

The Risk Management was performed in compliance with ISO 14971:2019 Medical Devices - Application of Risk Management to Medical Devices. A series of risk assessments were performed in order to identify and mitigate any potential risks associated to the design changes for the modified device.

Verification and Validation Summary

All verification and validation activities were performed in accordance to established plans and protocols and Design Control procedures. Testing verified all acceptance criteria were met.

Cybersecurity Information

Cybersecurity assessments for the GEM Premier ChemSTAT were performed as part of the Quality Management procedures for software validation and risk analysis activities. Vulnerabilities were identified, assessed and compensating controls were implemented within the software/system, to mitigate potential security threats, system vulnerabilities, viral attacks and safeguard against unauthorized access to patient data.

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Reason for Submission

This Special 510(k) is being submitted to upgrade the operating system from Fedora 17 Linux to WindRiver LTS 18 Linux for the GEM Premier ChemSTAT Instrument. The operating system is being upgraded to accommodate long-term support of resolutions for common vulnerability exposures. The software changes are limited to those required as part of Linux Wind River LTS 18 operating system (OS) and associated changes for the GEM Premier ChemSTAT application software to support the OS change, strengthen cybersecurity, and overall system improvements and reliability.

The submission meets the criteria for a Special 510(k) based on the following:

  • The proposed change is submitted by the manufacturer legally authorized to market the existing device. .
  • Performance data is limited to Software Verification and Validation as the scope of this Special 510(k) is . specific to an operating system upgrade from Fedora 17 Linux to WindRiver LTS 18 Linux.
  • There is a well-established method to evaluate the change: ●
    • General Principles of Software Validation; Final Guidance for Industry and FDA Staff, January O 11,2002
    • Guidance for the Content of Premarket Submissions for Software Contained in Medical O Devices, May 11, 2005
    • Content of Premarket Submissions for Management of Cybersecurity in Medical Devices O Guidance for Industry and Food and Drug Administration Staff, October 2, 2014
    • Off-The-Shelf Software Use in Medical Devices, Guidance for Industry and Food and Drug o Administration Staff, September 2019
  • The data can be reviewed in a summary or risk analysis format.

In addition, the changes in this submission do not introduce:

  • Changes to indications for use or intended use .
  • Changes to the fundamental scientific technology .
  • Changes to operating principle ●
  • Changes to labeled performance claims ●

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Indications for Use / Intended Use

The GEM Premier ChemSTAT is a portable critical care system for use by health care professionals to rapidly analyze lithium heparinized whole blood samples at the point of health care delivery in a clinical setting and in a central laboratory. The instrument provides quantitative measurements of Sodium (Na ), Potassium (K*), Ionized Calcium (Ca*), Chloride (Cl*), Glucose (Glu), Lactate (Lac), Hematocrit (Hct), Creatinine (Crea), Blood Urea Nitrogen (BUN), Total Carbon Dioxide (tCO2), pH, and partial pressure of carbon dioxide (pCO2) from arterial and venous heparinized whole blood. These parameters, along with derived parameters, aid in the diagnosis of a patient's acid/base status, electrolyte and metabolite balance. Electrolytes in the human body have multiple roles. Nearly all metabolic processes depend on or vary

  • with electrolytes:
    • . Sodium (Na) measurements are used in the diagnosis and treatment of aldosteronism, diabetes insipidus, adrenal hypertension, Addison's disease, dehydration, inappropriate antidiuretic secretion, or other diseases involving electrolyte imbalance.
    • Potassium (K) measurements are used to monitor electrolyte balance in the diagnosis and ● treatment of disease conditions characterized by low or high blood potassium levels.
    • . Ionized calcium (Ca") measurements are used in the diagnosis and treatment of parathyroid disease, a variety of bone diseases, chronic renal disease and tetany.
    • . Chloride (Cl') measurements are used in the diagnosis and treatment of electrolyte and metabolic disorders, such as, cystic fibrosis and diabetic acidosis.
  • . Glucose (Glu) measurement is used in the diagnosis, monitoring and treatment of carbohydrate metabolism disturbances including diabetes mellitus, neonatal hypoglycemia, idiopathic hypoglycemia, and of pancreatic islet cell carcinoma.
  • . Lactate (Lac) measurement is used to evaluate the acid-base status of patients suspected of having lactic acidosis, to monitor tissue hypoxia and strenuous physical exertion, and in the diagnosis of hyperlactatemia.
  • Hematocrit (Hct) measurements in whole blood of the packed red cell volume of a blood sample are used to distinguish normal from abnormal states, such as anemia and erythrocytosis (an increase in the number of red cells).
  • . Creatinine (Crea) measurements are used in the diagnosis and treatment of renal diseases and in monitoring renal dialysis.
  • Blood Urea Nitrogen (BUN) or urea measurements are used for the diagnosis, monitoring, and treatment of certain renal and metabolic diseases.
  • Total carbon dioxide/tCO2 (also referred to as bicarbonate/HCO3 ) is used in the diagnosis, ●

monitoring, and treatment of numerous potentially serious disorders associated with changes in body acid-base balance.

  • pH and pCO2 measurements in whole blood are used in the diagnosis and treatment of life-threatening . acid-base disturbances.

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Comparison to Predicate
ItemPredicate(K183549, K183546 and K183555)Updated DeviceSubject of thisSubmission
Similarities
Trade NameGEM Premier ChemSTATSame
Indications for UseSee aboveSame
Intended UserCentral Laboratory and Point-of-CareSame
Blood Gas MeasurementPotentiometry: pH and pCO2Same
Electrolyte MeasurementPotentiometry: Na+, K+, Cl-, Ca++Same
Metabolite MeasurementAmperometry: Glucose and LactatePotentiometry: tCO2Same
Hematocrit MeasurementConductivitySame
BUNEnzymatic PotentiometrySame
CreatinineEnzymatic AmperometrySame
Sample IntroductionAspirationSame
Sampling ModesAnd Sample Volumes• Normal Mode150 μLSame
Test Principle• Potentiometry: pH, pCO2, tCO2, Na+, K+, Cl-, Ca++• Amperometry: Glucose and Lactate• Conductivity: Hematocrit• Enzymatic Potentiometry : BUN• Enzymatic Amperometry: CreatinineSame
Sample TypeLithium Heparinized whole blood (arterial andvenous)Same
Dimensions• Height: 18.5 inches• Width: 13.1 inches• Depth: 16.3 inchesSame
Weight• 42.1 poundsSame
System Operating Temperature• 12-32°C (53.6°F to 89.6°F)Same
User InterfaceMenu Driven Touch ScreenSame
Sample IntroductionAspirationSame
Differences
Operating System SoftwareFedora 17 LinuxWind River LTS 18 Linux

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ConclusionThe GEM Premier ChemSTAT, with the change in its operating system fromFedora 17 Linux to WindRiver LTS 18 Linux is substantially equivalent to thelegally marketed predicate device last FDA cleared under K183549, K183546and K183555.
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§ 862.1345 Glucose test system.

(a)
Identification. A glucose test system is a device intended to measure glucose quantitatively in blood and other body fluids. Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolism disorders including diabetes mellitus, neonatal hypoglycemia, and idiopathic hypoglycemia, and of pancreatic islet cell carcinoma.(b)
Classification. Class II (special controls). The device, when it is solely intended for use as a drink to test glucose tolerance, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9.