K Number
K963136
Device Name
PACER MODEL 100 INFUSION CONTROLLER
Manufacturer
Date Cleared
1997-10-10

(423 days)

Product Code
Regulation Number
880.5725
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Pacer Model 100 Infusion Controller is indicated for use in: - 1. The delivery if Intravenous (parenteral) fluids where positive pressure (above 36" of water) is not required. - 2. The delivery of intravenous drugs where positive pressure (above 36" of water) is not required.
Device Description
Not Found
More Information

Not Found

Not Found

No
The provided 510(k) summary focuses on the basic function of an infusion controller and contains no mention of AI, ML, image processing, or any other indicators of advanced computational techniques.

No
The device is an infusion controller used for delivering fluids and drugs, which are therapeutic agents, but the device itself is not a therapeutic agent. It is a control device for therapeutic delivery.

No
The "Intended Use / Indications for Use" section states that the device is for the "delivery" of intravenous fluids and drugs, indicating it is a therapeutic device, not a diagnostic one. There is no mention of measurement, analysis, or detection for diagnostic purposes.

No

The provided text describes an "Infusion Controller," which is inherently a hardware device used for controlling the flow of fluids. There is no mention of this being a software application that controls a separate hardware infusion pump. The description focuses on the function of delivering fluids and drugs, which is a hardware function.

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

Here's why:

  • Intended Use: The intended use clearly states the device is for the delivery of intravenous fluids and drugs. This is a therapeutic function, not a diagnostic one. IVDs are used to examine specimens from the human body to provide information for diagnosis, monitoring, or screening.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing diagnostic information
    • Using reagents or assays

The Pacer Model 100 Infusion Controller is a medical device used for administering substances into a patient's bloodstream, which falls under the category of therapeutic devices, not diagnostic ones.

N/A

Intended Use / Indications for Use

The Pacer Model 100 Infusion Controller is indicated for use in:

    1. The delivery if Intravenous (parenteral) fluids where positive pressure (above 36" of water) is not required.
    1. The delivery of intravenous drugs where positive pressure (above 36" of water) is not required.

Product codes

LDR

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

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Indicated Patient Age Range

Not Found

Intended User / Care Setting

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Description of the training set, sample size, data source, and annotation protocol

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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)

Not Found

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

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

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Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 880.5725 Infusion pump.

(a)
Identification. An infusion pump is a device used in a health care facility to pump fluids into a patient in a controlled manner. The device may use a piston pump, a roller pump, or a peristaltic pump and may be powered electrically or mechanically. The device may also operate using a constant force to propel the fluid through a narrow tube which determines the flow rate. The device may include means to detect a fault condition, such as air in, or blockage of, the infusion line and to activate an alarm.(b)
Classification. Class II (performance standards).

0

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/0/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal features the department's name encircling a stylized emblem. The emblem consists of a symbol that resembles a stylized caduceus, with three parallel lines curving upwards and to the right, ending in a flourish.

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

JAN 1 0 2017

Health Watch Incorporated C/O John D. Greenbaum 20310 SW 4 8th Street Ft. Lauderdale, Florida 33332

Re: K963136

Trade/Device Name: Pacer Model 100 Infusion Controller Regulation Number: 21 CFR 880.5725 Regulation Name: Infusion Pump Regulatory Class: Class II Product Code: LDR Dated: July 6, 1997 Received: July 18, 1997

Dear: Dear Mr. Greenbaum

This letter corrects our substantially equivalent letter of October 10, 1997.

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 Parts 801 and 809 ); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements

1

Page 2 – Mr. John Greenbaum

as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Parts 801 and 809] ), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Erin I. Keith -S

Erin I. Keith, M.S. Director Division of Anesthesiology. General Hospital, Respiratory, Infection Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

510(k) Number: K963136 Device Name: Pacer Model 100 Infusion Controller

Indications For Use:

The Pacer Model 100 Infusion Controller is indicated for use in:

    1. The delivery if Intravenous (parenteral) fluids where positive pressure (above 36" of water) is not required.
    1. The delivery of intravenous drugs where positive pressure (above 36" of water) is not required.

(PLEASE DONOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation

(Division Sign-Off) 1-8 Division of Dental, I and General Hospi 510(k) Number

Prescription Use (Per 21 CFR 801.109)

OR

Over-The-Counter Use (Optional Format 1-2-96)