STORZ RANEY SCALP CLIP, MODEL 1-20-004-05

K033660 · Rudolf Storz GmbH · HBO · Jan 7, 2004 · Neurology

Device Facts

• Record ID: K033660
• Device Name: STORZ RANEY SCALP CLIP, MODEL 1-20-004-05
• Applicant: Rudolf Storz GmbH
• Product Code: HBO · Neurology
• Decision Date: Jan 7, 2004
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 882.4150
• Device Class: Class 2
• Attributes: Therapeutic

Indications for Use

The STORZ Raney Scalp Clip is a device designed to stop bleeding during surgery on the scalp.

Device Story

The STORZ Raney Scalp Clip is a surgical instrument used to provide hemostasis by compressing scalp tissue during surgical procedures. It is intended for use by surgeons in an operating room environment. The device functions as a mechanical clamp to stop bleeding from the scalp edges. It is a manual, non-powered surgical accessory.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Mechanical scalp clip; manual application; non-powered; metallic construction.

Indications for Use

Indicated for use in patients undergoing scalp surgery to achieve hemostasis.

Regulatory Classification

Identification

A scalp clip is a plastic or metal clip used to stop bleeding during surgery on the scalp.

Submission Summary (Full Text)

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Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JAN - 7 2004

Rudolf Storz GmbH c/o Ms. Angelika Scherp Business Support International Amstel 320-1 Amsterdam, Netherlands 1017AP

Re: K033660

Trade/Device Name: Scalp Clips Regulation Number: 21 CFR 882.4150 Regulation Name: Scalp clip Regulatory Class: II Product Code: HBO Dated: November 21, 2003 Received: November 24, 2003

Dear Ms. Scherp:

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 (o devices that have been rcclassified 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 mistranding and adultcration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can he 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 sct forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the clectronic product radiation control provisions (Scctions 531-542 of the Act); 21 CFR 1000-1050.

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Page 2 - Ms. Angelika Scherp

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 [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 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,

Miriam C. Provost

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K033660

## Indications for Use

| 510(k) Number (if known): | K033660 |
|---------------------------|--------------------------------------------------------------------------------------------------|
| Device Name: | Scalp Clips |
| Indications For Use: | The STORZ Raney Scalp Clip is a device designed to stop<br>bleeding during surgery on the scalp. |

× Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR .

Over-The-Counter Use _ (21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Miriam C. Provost

Division Sign-Off) Division of General, Restorative and Neurological Devices

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KO33660 510(k) Number_