K Number
K980386
Device Name
HOSPAL MULTIFLOW 100, MULTIFLOW 100 KITS A0 (A0,A0/B AND A0/0), MULTIFLOW 100 KITS B22 (B22,B22/B, & B22/0)
Manufacturer
Date Cleared
1999-02-24

(387 days)

Product Code
Regulation Number
876.5860
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Hospal Multiflow 100 and Multiflow 100 Kits A0 (A0/B A0 and A0/0 ) and Multiflow 100 Kits B22 (B22, B22B, & B22/0) can be used whenever continuous arterio-venous or veno-venous hemofiltration, ultrafiltration or hemodialysis is indicated. This can be used for acute hemodialysis, hemofiltration or continuous ultrafiltration. In these therapies, monitoring of patient vital signs, the therapy delivery system, heparin administration, and clotting times should be performed under the direction of a physician
Device Description
The Hospal Multiflow 100, Multiflow 100 Kit A0, Multiflow 100 Kit B22 are identical in construction in function to other hemofilters currently marketed in the United States. These devices are intended for use in continuous pump assisted veno-venous The membrane used in this device is Acrylonitrile and sodium hemofiltration and. methallyl sulfonate copolymer (AN69) which is identical to the membrane utilized in the Kit Multiflow 60P which have been previously approved for marketing in the United States under a 510K Notification (K884365). Blood enters a blood inlet port where it is distributed to Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) hollow fibers. Each hollow fiber has an inner diameter of approximately 240 microns (wet hollow fiber internal diameter) and a wall thickness of 50 microns. There are 6,000 Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) hollow fibers having an effective length of 27 cm. The effective membrane surface area of the Multiflow 100 hemofilter is 0.90 m2. At either end of the device the hollow fibers are potted in polyurethane to isolate the blood compartment from the filtrate compartment. Each end of the hemofilter is sealed using a silicone O-ring and polycarbonate end cap. The housing of this hemofilter is also made of polycarbonate. The fibers used in this device are identical in design and materials to the previously approved Hospal Kit Multiflow 60P. The patient's blood traverses the inside of the hollow fibers and exits the device via a blood exit port. By means of a hydrostatic pressure or transmembrane pressure which is created by a combination of positive and negative pressures across the Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) membrane, plasma water along with certain lower molecular weight solutes of plasma water pass through the membrane and into the dialysate or filtrate compartment of the device. Removal of uremic toxins and waste products are removed from the patient's blood in this device by means of both diffusion and convection through the Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) membrane and into the counter current flowing dialysis solution during CVVHD. During CVVH, no dialysis solution is perfused through the filtrate compartment in which case removal of plasma water and uremic toxins is accomplished by means of convection alone. The dialysate exits the devices via a dialysate outlet port. Schematic drawings of the Hospal Multiflow 100, Multiflow 100 Kit A0, and Multiflow 100 Kit B22 are included in this Section. - The Multiflow 100 Kit A0 (A0, A0/B and A0/0) and Multiflow 100 Kit B22 (B22, ● B22/B, & B22/0) are an extracorporeal blood circuit with the Multiflow 100 , Hemofilter and are intended to be used with a variety of equipment for pump assisted The Multiflow 100 Kit B22 consists of the Multiflow 100 CVVH, and CVVHD. Hemofilter pre-attached to blood tubing. The Multiflow 100 Kits A0 (A0, A0/B and A0/0) and Multiflow 100 Kits B22 (B22/B22/B/B22/0) can be used for continuous veno-venous hemodialysis (CVVHD), continuous veno-venous hemofiltration (CVVH). These kits are designed to operate with pump-assisted blood circulation. An ultrafiltrate / dialysate collection and measurement set is also included with these kits. - The component parts of the Multiflow Kits 100 B22/B22/0 are: . - A Multiflow 100 Hemofilter 1. - A arterial blood line 2. - 3. A venous blood line - 4. An ultrafiltrate line - 5. A ultrafiltrate/dialysate measuring container (not in the B22/0 Kit) - A 5 liter ultrafiltrate/dialysate collection container (included in only the B22Kit) 6. - 7. A priming adaptor - A reinfusion line 8. - The component parts of the Multiflow Kits 100 A0. A0/B and A0/0 are: - A Multiflow 100 Hemofilter 1. - 2. An ultrafiltrate line - A ultrafiltrate/dialysate measuring container (included in only the A0 Kit) 3. - A 5 liter ultrafiltrate/dialysate collection container (included in only the A0/B Kit) ব: - 5. A priming adaptor
More Information

No
The description focuses on the physical components and function of a hemofilter and associated kits, with no mention of AI or ML.

Yes
The device is used for hemodialysis, hemofiltration, and continuous ultrafiltration to remove uremic toxins and waste products from the patient's blood, which are therapeutic interventions.

No
Explanation: The device is described as a hemofilter used for continuous arterio-venous or veno-venous hemofiltration, ultrafiltration, or hemodialysis, which are therapeutic procedures to remove waste products from the blood. It does not perform diagnostic functions.

No

The device description clearly details physical components such as hollow fibers, polyurethane potting, silicone O-rings, polycarbonate end caps and housing, blood lines, and collection containers, indicating it is a hardware device.

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

Here's why:

  • Intended Use: The intended use is for "continuous arterio-venous or veno-venous hemofiltration, ultrafiltration or hemodialysis." These are procedures performed directly on the patient's blood outside the body to filter waste products.
  • Device Description: The description details a hemofilter and associated tubing designed to process blood extracorporeally. It describes the physical components and how they interact with blood flow and dialysate/filtrate.
  • Lack of IVD Characteristics: An IVD device is typically used to examine specimens (like blood, urine, tissue) in vitro (in a lab setting) to provide information for diagnosis, monitoring, or screening. This device does not perform such analysis. It is a therapeutic device for blood purification.

The device is a therapeutic device used for extracorporeal blood treatment, not an IVD.

N/A

Intended Use / Indications for Use

The Hospal Multiflow 100 and Multiflow 100 Kits A0 (A0/B A0 and A0/0 ) and Multiflow 100 Kits B22 (B22, B22B, & B22/0) can be used whenever continuous arterio-venous or veno-venous hemofiltration, ultrafiltration or hemodialysis is indicated. This can be used for acute hemodialysis, hemofiltration or continuous ultrafiltration. In these therapies, monitoring of patient vital signs, the therapy delivery system, heparin administration, and clotting times should be performed under the direction of a physician.

Product codes

78 KDI

Device Description

The Hospal Multiflow 100, Multiflow 100 Kit A0, Multiflow 100 Kit B22 are identical in construction in function to other hemofilters currently marketed in the United States. These devices are intended for use in continuous pump assisted veno-venous hemofiltration. The membrane used in this device is Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) which is identical to the membrane utilized in the Kit Multiflow 60P which have been previously approved for marketing in the United States under a 510K Notification (K884365).

Blood enters a blood inlet port where it is distributed to Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) hollow fibers. Each hollow fiber has an inner diameter of approximately 240 microns (wet hollow fiber internal diameter) and a wall thickness of 50 microns. There are 6,000 Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) hollow fibers having an effective length of 27 cm. The effective membrane surface area of the Multiflow 100 hemofilter is 0.90 m2. At either end of the device the hollow fibers are potted in polyurethane to isolate the blood compartment from the filtrate compartment. Each end of the hemofilter is sealed using a silicone O-ring and polycarbonate end cap. The housing of this hemofilter is also made of polycarbonate. The fibers used in this device are identical in design and materials to the previously approved Hospal Kit Multiflow 60P. The patient's blood traverses the inside of the hollow fibers and exits the device via a blood exit port.

By means of a hydrostatic pressure or transmembrane pressure which is created by a combination of positive and negative pressures across the Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) membrane, plasma water along with certain lower molecular weight solutes of plasma water pass through the membrane and into the dialysate or filtrate compartment of the device. Removal of uremic toxins and waste products are removed from the patient's blood in this device by means of both diffusion and convection through the Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) membrane and into the counter current flowing dialysis solution during CVVHD. During CVVH, no dialysis solution is perfused through the filtrate compartment in which case removal of plasma water and uremic toxins is accomplished by means of convection alone. The dialysate exits the devices via a dialysate outlet port. Schematic drawings of the Hospal Multiflow 100, Multiflow 100 Kit A0, and Multiflow 100 Kit B22 are included in this Section.

The Multiflow 100 Kit A0 (A0, A0/B and A0/0) and Multiflow 100 Kit B22 (B22, B22/B, & B22/0) are an extracorporeal blood circuit with the Multiflow 100, Hemofilter and are intended to be used with a variety of equipment for pump assisted CVVH, and CVVHD. The Multiflow 100 Kit B22 consists of the Multiflow 100 Hemofilter pre-attached to blood tubing. The Multiflow 100 Kits A0 (A0, A0/B and A0/0) and Multiflow 100 Kits B22 (B22/B22/B/B22/0) can be used for continuous veno-venous hemodialysis (CVVHD), continuous veno-venous hemofiltration (CVVH). These kits are designed to operate with pump-assisted blood circulation. An ultrafiltrate / dialysate collection and measurement set is also included with these kits.
The component parts of the Multiflow Kits 100 B22/B22/0 are:

  1. A Multiflow 100 Hemofilter
  2. A arterial blood line
  3. A venous blood line
  4. An ultrafiltrate line
  5. A ultrafiltrate/dialysate measuring container (not in the B22/0 Kit)
  6. A 5 liter ultrafiltrate/dialysate collection container (included in only the B22Kit)
  7. A priming adaptor
  8. A reinfusion line
    The component parts of the Multiflow Kits 100 A0. A0/B and A0/0 are:
  9. A Multiflow 100 Hemofilter
  10. An ultrafiltrate line
  11. A ultrafiltrate/dialysate measuring container (included in only the A0 Kit)
  12. A 5 liter ultrafiltrate/dialysate collection container (included in only the A0/B Kit)
  13. A priming adaptor

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

Not Found

Intended User / Care Setting

Not Found

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

Non-Clinical Tests: In vitro testing was performed on the Multiflow 100 to determine the following: blood side priming volume, dialysate side priming volume, dialysate and blood flow resistance, ultrafiltration coefficient, urea, creatinine, phosphate and vitamin B12, inulin, myoglobin, and albumin sieving coefficients. The results of these tests confirmed that the proposed device is substantially equivalent to the proposed device for these parameters.
Clinical Test Results: Clinical testing was not performed.

Key Metrics

Not Found

Predicate Device(s)

Hospal Kit Multiflow 60P (K924437)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5860 High permeability hemodialysis system.

(a)
Identification. A high permeability hemodialysis system is a device intended for use as an artificial kidney system for the treatment of patients with renal failure, fluid overload, or toxemic conditions by performing such therapies as hemodialysis, hemofiltration, hemoconcentration, and hemodiafiltration. Using a hemodialyzer with a semipermeable membrane that is more permeable to water than the semipermeable membrane of the conventional hemodialysis system (§ 876.5820), the high permeability hemodialysis system removes toxins or excess fluid from the patient's blood using the principles of convection (via a high ultrafiltration rate) and/or diffusion (via a concentration gradient in dialysate). During treatment, blood is circulated from the patient through the hemodialyzer's blood compartment, while the dialysate solution flows countercurrent through the dialysate compartment. In this process, toxins and/or fluid are transferred across the membrane from the blood to the dialysate compartment. The hemodialysis delivery machine controls and monitors the parameters related to this processing, including the rate at which blood and dialysate are pumped through the system, and the rate at which fluid is removed from the patient. The high permeability hemodialysis system consists of the following devices:(1) The hemodialyzer consists of a semipermeable membrane with an in vitro ultrafiltration coefficient (K
uf ) greater than 8 milliliters per hour per conventional millimeter of mercury, as measured with bovine or expired human blood, and is used with either an automated ultrafiltration controller or anther method of ultrafiltration control to prevent fluid imbalance.(2) The hemodialysis delivery machine is similar to the extracorporeal blood system and dialysate delivery system of the hemodialysis system and accessories (§ 876.5820), with the addition of an ultrafiltration controller and mechanisms that monitor and/or control such parameters as fluid balance, dialysate composition, and patient treatment parameters (e.g., blood pressure, hematocrit, urea, etc.).
(3) The high permeability hemodialysis system accessories include, but are not limited to, tubing lines and various treatment related monitors (e.g., dialysate pH, blood pressure, hematocrit, and blood recirculation monitors).
(b)
Classification. Class II. The special controls for this device are FDA's:(1) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical Device—Part I: Evaluation and Testing,’ ”
(2) “Guidance for the Content of 510(k)s for Conventional and High Permeability Hemodialyzers,”
(3) “Guidance for Industry and CDRH Reviewers on the Content of Premarket Notifications for Hemodialysis Delivery Systems,”
(4) “Guidance for the Content of Premarket Notifications for Water Purification Components and Systems for Hemodialysis,” and
(5) “Guidance for Hemodialyzer Reuse Labeling.”

0

2/24/99

510K Notification Hospal Multiflow 100, Multiflow 100 Kit A0, Multiflow 100 Kit B22 January 27th, , 1998

510K(k) SUMMARY

SUBMITTER:

Gambro Healthcare Formerly: Cobe Renal Care, Inc. 1185 Oak Street Lakewood, CO 80215 (303) 231-4436

DATE PREPARED:October 15th, 1997
DEVICE NAME:Hospal Multiflow 100, Multiflow 100 Kits A0, Multiflow 100 Kits B22
CLASSIFICATION NAMES:High Permeability Hemodialyzer
PREDICATE DEVICE:Hospal Kit Multiflow 60P

Device Description:

The Hospal Multiflow 100, Multiflow 100 Kit A0, Multiflow 100 Kit B22 are identical in construction in function to other hemofilters currently marketed in the United States. These devices are intended for use in continuous pump assisted veno-venous The membrane used in this device is Acrylonitrile and sodium hemofiltration and. methallyl sulfonate copolymer (AN69) which is identical to the membrane utilized in the Kit Multiflow 60P which have been previously approved for marketing in the United States under a 510K Notification (K884365).

Blood enters a blood inlet port where it is distributed to Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) hollow fibers. Each hollow fiber has an inner diameter of approximately 240 microns (wet hollow fiber internal diameter) and a wall thickness of 50 microns. There are 6,000 Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) hollow fibers having an effective length of 27 cm. The effective membrane surface area of the Multiflow 100 hemofilter is 0.90 m2. At either end of the device the hollow fibers are potted in polyurethane to isolate the blood compartment from the filtrate compartment. Each end of the hemofilter is sealed using a silicone O-ring and polycarbonate end cap. The housing of this hemofilter is also made of polycarbonate. The fibers used in this device are identical in design and materials to the previously approved Hospal Kit Multiflow 60P. The patient's blood traverses the inside of the hollow fibers and exits the device via a blood exit port.

By means of a hydrostatic pressure or transmembrane pressure which is created by a combination of positive and negative pressures across the Acrylonitrile and sodium methallyl sulfonate copolymer (AN69) membrane, plasma water along with certain lower molecular weight solutes of plasma water pass through the membrane and into the dialysate or filtrate compartment of the device. Removal of uremic toxins and waste products are removed from the patient's blood in this device by means of both diffusion and convection through the Acrylonitrile and sodium methallyl sulfonate copolymer

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(AN69) membrane and into the counter current flowing dialysis solution during CVVHD. During CVVH, no dialysis solution is perfused through the filtrate compartment in which case removal of plasma water and uremic toxins is accomplished by means of convection alone. The dialysate exits the devices via a dialysate outlet port. Schematic drawings of the Hospal Multiflow 100, Multiflow 100 Kit A0, and Multiflow 100 Kit B22 are included in this Section.

2

p. 3/4

MULTIFLOW 100 KIT A0, MULTIFLOW 100 KIT B22

  • The Multiflow 100 Kit A0 (A0, A0/B and A0/0) and Multiflow 100 Kit B22 (B22, ● B22/B, & B22/0) are an extracorporeal blood circuit with the Multiflow 100 , Hemofilter and are intended to be used with a variety of equipment for pump assisted The Multiflow 100 Kit B22 consists of the Multiflow 100 CVVH, and CVVHD. Hemofilter pre-attached to blood tubing. The Multiflow 100 Kits A0 (A0, A0/B and A0/0) and Multiflow 100 Kits B22 (B22/B22/B/B22/0) can be used for continuous veno-venous hemodialysis (CVVHD), continuous veno-venous hemofiltration (CVVH). These kits are designed to operate with pump-assisted blood circulation. An ultrafiltrate / dialysate collection and measurement set is also included with these kits.
  • The component parts of the Multiflow Kits 100 B22/B22/0 are: .
  • A Multiflow 100 Hemofilter 1.
  • A arterial blood line 2.
    1. A venous blood line
    1. An ultrafiltrate line
    1. A ultrafiltrate/dialysate measuring container (not in the B22/0 Kit)
  • A 5 liter ultrafiltrate/dialysate collection container (included in only the B22Kit) 6.
    1. A priming adaptor
  • A reinfusion line 8.
  • The component parts of the Multiflow Kits 100 A0. A0/B and A0/0 are:
  • A Multiflow 100 Hemofilter 1.
    1. An ultrafiltrate line
  • A ultrafiltrate/dialysate measuring container (included in only the A0 Kit) 3.
  • A 5 liter ultrafiltrate/dialysate collection container (included in only the A0/B Kit) ব:
    1. A priming adaptor

Predicate Devices:

The Hospal Multiflow 100 and Multiflow 100 Kits A0 and Multiflow 100 Kits B22 are substantially equivalent in construction, design, intended use, function and materials to other hemofilter kits currently marketed in the United States. The Hospal Multiflow 100 and Multiflow 100 Kits A0 and Multiflow 100 Kits B22 are substantially equivalent in function, design, composition, materials, and operation, to the Hospal Kit Multiflow 60P Kit (K924437) which is currently in commercial distribution in the United States.

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Intended Use:

The Hospal Multiflow 100 and Multiflow 100 Kits A0 and Multiflow 100 Kits B22 can be used whenever continuous veno-venous hemofiltration or hemodialysis is indicated. This can be used for acute hemodialysis, hemofiltration. In these therapies, monitoring of patient vital signs, the therapy delivery system, heparin administration, and clotting times should be performed under the direction of a physician.

This indication statement is essentially the same as the indication statement for the predicate device.

Technological Characteristics:

Comparing the proposed device to the predicate device, some similarities and differences are noted in the design employed to accomplish the same intended use. Both the proposed and predicate devices utilize the same AN69, hollow fiber membrane manufactured by Hospal Industrie. Both the proposed and predicate devices utilize polycarbonate for the housing and header material and polyurethane for the membrane potting material. The predicate device is different from the proposed device in that it utilizes a larger membrane surface area and has a slightly larger blood side priming volume.

Summary of Non-Clinical Tests:

In vitro testing was performed on the Multiflow 100 to determine the following: blood side priming volume, dialysate side priming volume, dialysate and blood flow resistance, ultrafiltration coefficient, urea, creatinine, phosphate and vitamin B12, inulin, myoglobin, and albumin sieving coefficients. The results of these tests confirmed that the proposed device is substantially equivalent to the proposed device for these parameters.

Clinical Test Results:

Clinical testing was not performed

Conclusions:

Testing performed on the Multiflow 100 and Multiflow 100 A0 and Multiflow 100 B22 Kits indicates that they are safe, effective, and perform as well as the predicate device, when used in accordance with the instructions for use.

4

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Re: K980386 Hospal Multiflow 100, Multiflow 100 Kits A0. and Multiflow 100 Kits B22 Dated: June 8, 1998 Received: June 9, 1998 Regulatory Class: III 21 CFR 876.5860/Procode: 78 KDI

Dear Dr. Shideman:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to 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). 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.

If your device is classified (see above) into either class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Fective in the clarions, Title 21. Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (OS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification i submission does not affect any obligation you might have under sections 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitto diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address "http://www.fda.gov/cdr/dsmadsmam.html".

Sincerely your

Lillian Yin, Ph.D.

Director. Division of Reproducti Abdominal. Far. Nose and Throat and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

Image /page/4/Picture/13 description: The image shows a partial view of a logo, specifically the emblem of the U.S. Department of Health and Human Services (HHS). The emblem features a stylized depiction of a human figure in profile, with three overlapping heads suggesting a sense of community or interconnectedness. The word "DEPARTMENT" is partially visible along the left edge of the image, indicating the organizational affiliation of the logo.

FEB 2 4 1999

Jeffrey R. Shideman, Ph.D. GAMBRO Healthcare 1185 Oak Street Lakewood, CO 80215

Re: K98
II

5

Page_1 of 1

1.980386 510(k) Number (if known): ________________

Device Name: H _ Hospal Multiflow 100 and Multiflow 100 Kits A0 and B22 ﺩ ﺩ Indications For Use:

The Hospal Multiflow 100 and Multiflow 100 Kits A0 (A0/B A0 and A0/0 ) and Multiflow 100 Kits B22 (B22, B22B, & B22/0) can be used whenever continuous arterio-venous or veno-venous hemofiltration, ultrafiltration or hemodialysis is indicated. This can be used for acute hemodialysis, hemofiltration or continuous ultrafiltration. In these therapies, monitoring of patient vital signs, the therapy delivery system, heparin administration, and clotting times should be performed under the direction of a physician

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Robert R. Nathing/

(Division Sign-Off) Division of Reproductive, Abdominal, ENT, and Radiological Devices 11980386 510(k) Number

Prescription Use
(Per 21 CFR 801.109)

OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)