K Number
K990899
Device Name
HEMOCHEK-A1C SAMPLE COLLECTION KIT
Manufacturer
Date Cleared
1999-12-21

(278 days)

Product Code
Regulation Number
864.7470
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The HemoChek-A1c Sample Collection Kit is indicated for over-the-counter sale for use in the measurement of HbA1c on blood specimens which can be collected at the patient's home or at a physician's office on filter paper and delivered to the laboratory by mail. The HbA1c test is used in the assessment of the average blood glucose over a 10-12 week period. The results are to be evaluated by the patient and their physician. The product is not indicated for the diagnosis of diabetes mellitus.
Device Description
The HemoChek-A1c Sample Collection Kit is a kit which is purchased by a patient a pharmacy or other retail store. The kit consists of the following: - A Sample Card containing the proprietary filter paper that the blood sample is placed on and a place for the patient to print his/her name, address, social security number and the sample was collected - A pamphlet containing detailed instructions about how to obtain a blood sample and mail it to Osborn -Group, Inc. - A specimen envelope with the words "After blood has dried, insert completed HemoChek test in this envelope. Seal flap and place in envelope" printed on it - A self-adhesive envelope in which the card is inserted and then mailed to Osborn Group, Inc. - - A sterile lancet - - An alcohol swab - - A gauze pad - - An adhesive bandage - - -An outer package containing all of the items listed above After purchasing the HemoChek-A1c Sample Collection Kit, the patient then prints the required information on the Sample Card and collects a blood sample, using a lancet (either the one provided in the kit, one provided by the patient's physician or one supplied by the patient). The blood sample is placed on both circles on the right hand side of the Sample Card, as described in the instructions. The Sample Card is then placed in the specimen envelope which in turn is placed in the mailing envelope provided in the kit and mailed to Osborn Group, Inc. When the blood sample is received by Osborn Group, Inc., the patient's HbA1c level is measured using existing assay methods. The results are then mailed to the patient.
More Information

Not Found

No
The device description details a sample collection kit and the process of mailing the sample to a lab for analysis using existing assay methods. There is no mention of AI or ML in the intended use, device description, or any other section.

No
The device is a sample collection kit used for measuring HbA1c, which is an assessment of blood glucose and not a treatment or therapy.

No

The device is a sample collection kit for measuring HbA1c, which assesses average blood glucose. However, the "Intended Use / Indications for Use" section explicitly states, "The product is not indicated for the diagnosis of diabetes mellitus," meaning it does not provide a diagnosis.

No

The device description clearly lists multiple physical components, including a sample card, pamphlet, envelopes, lancet, alcohol swab, gauze pad, adhesive bandage, and outer packaging. This indicates it is a physical kit, not a software-only device.

Based on the provided text, the HemoChek-A1c Sample Collection Kit is not an IVD itself, but it is a component used for collecting a sample for an IVD test.

Here's why:

  • Intended Use: The kit is used for the "measurement of HbA1c on blood specimens". The actual measurement of HbA1c is the diagnostic test. The kit facilitates the collection and transport of the sample for this test.
  • Device Description: The kit contains items for sample collection (lancet, swab, gauze, bandage, sample card) and mailing. It does not contain the reagents or equipment needed to perform the HbA1c measurement itself. The text explicitly states that "When the blood sample is received by Osborn Group, Inc., the patient's HbA1c level is measured using existing assay methods." This indicates the diagnostic testing happens elsewhere.
  • Predicate Devices: The predicate devices are also described as "Sample Collection Kits," further supporting the idea that the kit is for sample collection, not the diagnostic test itself.

Therefore, the HemoChek-A1c Sample Collection Kit is a sample collection device intended for use with an IVD test (the HbA1c measurement).

N/A

Intended Use / Indications for Use

The HemoChek-A1c Sample Collection Kit is indicated for over-the-counter sale for use in the measurement of HbA1c on blood specimens which can be collected at the patient's home or at a physician's office on filter paper and delivered to the laboratory by mail. The HbA1c test is used in the assessment of the average blood glucose over a 10-12 week period. The results are to be evaluated by the patient and their physician. The product is not indicated for the diagnosis of diabetes mellitus.

Product codes

LCP

Device Description

The HemoChek-A1c Sample Collection Kit is a kit which is purchased by a patient a pharmacy or other retail store. The kit consists of the following:

  • A Sample Card containing the proprietary filter paper that the blood sample is placed on and a place for the patient to print his/her name, address, social security number and the sample was collected
  • A pamphlet containing detailed instructions about how to obtain a blood sample and mail it to Osborn -Group, Inc.
  • A specimen envelope with the words "After blood has dried, insert completed HemoChek test in this envelope. Seal flap and place in envelope" printed on it
  • A self-adhesive envelope in which the card is inserted and then mailed to Osborn Group, Inc. - A sterile lancet - An alcohol swab - A gauze pad - An adhesive bandage - -An outer package containing all of the items listed above
    After purchasing the HemoChek-A1c Sample Collection Kit, the patient then prints the required information on the Sample Card and collects a blood sample, using a lancet (either the one provided in the kit, one provided by the patient's physician or one supplied by the patient). The blood sample is placed on both circles on the right hand side of the Sample Card, as described in the instructions. The Sample Card is then placed in the specimen envelope which in turn is placed in the mailing envelope provided in the kit and mailed to Osborn Group, Inc. When the blood sample is received by Osborn Group, Inc., the patient's HbA1c level is measured using existing assay methods. The results are then mailed to the patient.

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

patient's home or at a physician's office

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

Not Found

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

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Information contained in this submission demonstrates that the HemoChek-Atc performs in the same manner as the HemoChek predicate device.

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

Not Found

Predicate Device(s)

K971919, K984529

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 864.7470 Glycosylated hemoglobin assay.

(a)
Identification. A glycosylated hemoglobin assay is a device used to measure the glycosylated hemoglobins (A1a , A1b , and A1c ) in a patient's blood by a column chromatographic procedure. Measurement of glycosylated hemoglobin is used to assess the level of control of a patient's diabetes and to determine the proper insulin dosage for a patient. Elevated levels of glycosylated hemoglobin indicate uncontrolled diabetes in a patient.(b)
Classification. Class II (performance standards).

0

1990899

DEC 2 1 1999

Image /page/0/Picture/2 description: The image shows the logo for Osborn Group, INC. The logo is in black and white and features a curved line above the word "OSBORN". Below the company name is the text "A ChoicePoint Company" in a smaller font. The logo is simple and professional.

510(k) SUMMARY

Osborn Group, Inc.

HemoChek-A1c Sample Collection Kit

March 17, 1999

Submitter Information:

Osborn Group, Inc. 19401 West 117th Street Olathe, Kansas 66062

Submitter's Name: Phone:

Gilbert P. Bourk III (913) 390-7146

Device Name:

HemoChek-A1c Sample Collection Kit

Common Name: Hemoglobin A1c blood sample collection kit

Classification Name: Glycosvlated Hemoglobin Assay

Predicate Device Equivalence:

Substantial equivalence is claimed to the EZCHEK™/HbA1c Sample Collection Kit, and to the HemoChek Sample Collection Kit, cleared for commercial distribution per K971919 and K984529, respectively.

Device Description:

The HemoChek-A1c Sample Collection Kit is a kit which is purchased by a patient a pharmacy or other retail store. The kit consists of the following:

  • A Sample Card containing the proprietary filter paper that the blood sample is placed on and a place for the patient to print his/her name, address, social security number and the sample was collected
  • A pamphlet containing detailed instructions about how to obtain a blood sample and mail it to Osborn -Group, Inc.
  • A specimen envelope with the words "After blood has dried, insert completed HemoChek test in this envelope. Seal flap and place in envelope" printed on it
  • A self-adhesive envelope in which the card is inserted and then mailed to Osborn Group, Inc. -

Image /page/0/Picture/23 description: The image shows the logo for Osborn Laboratories, a ChoicePoint company. The logo features a stylized letter "L" formed by a grid pattern within a circle. To the right of the circular element, the words "OSBORN LABORATORIES" are printed in a simple, sans-serif font, with the tagline "A ChoicePoint Company" appearing in a smaller font size below.

Image /page/0/Picture/24 description: The image shows the logo for Intellisys, an Osborn Company. The word "INTELLISYS" is written in a bold, sans-serif font, with a curved line above it. Below the word "INTELLISYS" is the phrase "AN OSBORN COMPANY" in a smaller, sans-serif font. The logo is simple and modern, and it is likely used to represent the company's brand.

1

  • A sterile lancet -
  • An alcohol swab -
  • A gauze pad -
  • An adhesive bandage -
  • -An outer package containing all of the items listed above

After purchasing the HemoChek-A1c Sample Collection Kit, the patient then prints the required information on the Sample Card and collects a blood sample, using a lancet (either the one provided in the kit, one provided by the patient's physician or one supplied by the patient). The blood sample is placed on both circles on the right hand side of the Sample Card, as described in the instructions. The Sample Card is then placed in the specimen envelope which in turn is placed in the mailing envelope provided in the kit and mailed to Osborn Group, Inc. When the blood sample is received by Osborn Group, Inc., the patient's HbA1c level is measured using existing assay methods. The results are then mailed to the patient.

Intended Use:

The HemoChek-A1c Sample Collection Kit is indicated for over-the-counter sale for use in the measurement of HbA1c on blood specimens which can be collected at the patient's home or at a physician's office on filter paper and delivered to the laboratory by mail. The HbA1c test is used in the assessment of the average blood glucose over a 10-12 week period. The results are to be evaluated by the patient and their physician. The product is not indicated for the diagnosis of diabetes mellitus.

Comparison of Technological Characteristics:

Essentially, the devices use the same basic technology, i.e., collecting a blood sample and analyzing it using an existing assay methodology. However, the physical size of the device is different than the EZCHEK predicate device. Also, the existing assay methodologies used are different for the device and the EZCHEK predicate device, but are the same as for the HemoChek predicate device.

Summary of Performance Testing:

Information contained in this submission demonstrates that the HemoChek-Atc performs in the same manner as the HemoChek predicate device.

Conclusions:

Based on the above, we concluded that the HemoChek-A1c Sample Collection Kit is substantially equivalent to legally marketed predicate devices and iffective for its intended use.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. Inside the circle is a stylized symbol that resembles an abstract human figure or a bird in flight, composed of three curved lines.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

DEC 21 1999

Mr. Gilbert P. Bourk III Vice President and General Counsel Osborn Group, Inc. 14901 West 117th Street Olathe, Kansas 66062

K990899 Re:

Trade Name: HemoChek-A1c™ Sample Collection Kit Regulatory Class: II Product Code: LCP Dated: October 29, 1999 Received: November 1, 1999

Dear Mr. Bourk:

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 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). 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 II (Special Controls) or 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 Federal Regulations, 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 (QS) 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 submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or regulations.

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Page 2

Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88), this device may require a CLIA complexity categorization. To determine if it does, you should contact the Centers for Disease Control and Prevention (CDC) at (770) 488-7655.

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 vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4588. 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/cdrh/dsma/dsmamain.html".

Sincerely yours,

Steven Putman

Steven I. Gutman, M.D. M.B.A. Director Division of Clinical Laboratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Image /page/4/Picture/0 description: The image shows the logo for Osborn Group, Inc. The logo is in black and white and features the company name in a bold, sans-serif font. Below the company name is the text "A ChoicePoint Company" in a smaller font. A curved line extends from the top of the "O" in Osborn to the bottom of the "N".

Device Name:

HemoChek-A1c™ Sample Collection Kit

Indications for Use:

The HemoChek-A1c Sample Collection Kit is indicated for over-the-counter sale for use in the measurement of HbA1c on blood specimens which can be collected at the patient's home or at a physician's office on filter paper and delivered to the laboratory by mail. The HbA1c test is used in the assessment of the average blood glucose over a 10-12 week period. The results are to be evaluated by the patient and their physician. The product is not indicated for the diagnosis of diabetes mellitus.

Peter E. Makris

(Division Sign-Off)
Division of Clinical Laboratory Devices Ka90899
510(k) Number

ver the counter.

Image /page/4/Picture/11 description: The image shows the logo for Osborn Laboratories. The logo consists of a circular design on the left, made up of small squares, with a larger square in the center. To the right of the circular design, the text "OSBORN LABORATORIES" is displayed in a simple, sans-serif font. Below this, the text "A ChoicePoint Company" is written in a smaller font size.

Image /page/4/Picture/9 description: The image shows the logo for Intellisys, an Osborn Company. The word "INTELLISYS" is in large, bold, sans-serif font, with a line underneath. Below the line, in a smaller font, it says "AN OSBORN COMPANY". There is a curved line above and to the right of the word "INTELLISYS".