FORTUNE SILICONE VACUUM SUCTION, MODEL #1300

K021193 · Fortune Medical Instrument Corp. · HDB · Feb 12, 2003 · Obstetrics/Gynecology

Device Facts

• Record ID: K021193
• Device Name: FORTUNE SILICONE VACUUM SUCTION, MODEL #1300
• Applicant: Fortune Medical Instrument Corp.
• Product Code: HDB · Obstetrics/Gynecology
• Decision Date: Feb 12, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 884.4340
• Device Class: Class 2
• Attributes: Therapeutic, Pediatric

Intended Use

The Silicone Vacuum Cup is to assist a clinician in delivery of an infant during childbirth.

Device Story

The All Silicone Vacuum Suction device is a fetal vacuum extractor used by clinicians during childbirth to assist in infant delivery. The device consists of a silicone vacuum cup that is applied to the fetal head. By creating a vacuum, the device provides suction to facilitate the extraction of the infant. It is intended for use in a clinical setting by trained medical professionals. The device aids in the delivery process, potentially reducing the need for more invasive interventions.

Technological Characteristics

The device is constructed of silicone. It functions as a fetal vacuum extractor (Product Code: 85 HDB) under 21 CFR 884.4340. It is a manual suction device.

Indications for Use

Indicated for use by clinicians to assist in the delivery of an infant during childbirth.

Regulatory Classification

Identification

A fetal vacuum extractor is a device used to facilitate delivery. The device enables traction to be applied to the fetal head (in the birth canal) by means of a suction cup attached to the scalp and is powered by an external vacuum source. This generic type of device may include the cup, hosing, vacuum source, and vacuum control.

Submission Summary (Full Text)

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## Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

## FEB 1 2 2003

Mr. Tyler Wang CEO/President Fortune Medical Instrument Corp. 12-9, Lin 5, Mao-Chang Village, San-Chih Hsiang, Taipei Hsien 252 TAIWAN

Re: K021193

Trade/Device Name: All Silicone Vacuum Suction Regulation Number: 21 CFR 884.4340 Regulation Name: Fetal vacuum extractor Regulatory Class: II Product Code: 85 HDB Dated: November 4, 2002 Received: November 14, 2002

Dear Mr. Wang:

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.

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); good manufacturing practice requirements 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.

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This letter will allow you to begin marketing your device as described in your Section 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), please contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of the letter:

| 8xx. 1xxx | [phone] |
|----------------------------------|----------------|
| 876.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| 884.2xxx, 3xxx, 4xxx, 5xxx, 6xxx | [phone] |
| 892.2xxx, 3xxx, 4xxx, 5xxx | [phone] |
| Other | [phone] |

Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97) you may obtain. Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Nancy C. Brogdon

Nancy C. Brogdon Director, Division of Reproductive, Abdominal and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Image /page/2/Picture/0 description: The image shows the logo and contact information for Fortune Medical Instrument Corp. The logo is on the left, and the company name is in bold, large font. Below the name is the address, phone number (886-2-28360488), fax number (886-2-28360434), website (www.fortunemed.com), and email addresses ([e-mail] and [e-mail]).

021193 510(k) number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: Vacuum Suction

Indication for Use:

The Silicone Vacuum Cup is to assist a clinician in delivery of an infant during childbirth.

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

| | Concurrence of CDRH, Office of Device Evaluation (ODE) | |
|----------------------|----------------------------------------------------------------------------------------------------------------------|-----------------------|
| Prescription Use | OR | Over-The -Counter Use |
| (Per 21 CDR 801.109) | Orney<br>Inning<br>(Division Sign-Off)<br>Division of Reproductive, Abd<br>and Radiological Devices<br>510(k) Number | 0173 |