SOLO INSULIN PATCH PUMP

K090245 · Medingo , Ltd. · LZG · Jul 23, 2009 · General Hospital

Device Facts

• Record ID: K090245
• Device Name: SOLO INSULIN PATCH PUMP
• Applicant: Medingo , Ltd.
• Product Code: LZG · General Hospital
• Decision Date: Jul 23, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.5725
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Solo™ Insulin Patch Pump is intended for the continuous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. The Solo™ Insulin Patch Pump is for prescription use only.

Device Story

Solo™ Insulin Patch Pump is a miniature, portable, programmable insulin pump adhering to patient skin. Comprised of two parts: disposable insulin reservoir and reusable pump unit containing pumping mechanism and electronics. Controlled via remote control unit. Delivers basal and bolus insulin doses at physician-prescribed rates, volumes, and patterns. Modular design allows disconnection/reconnection of dispensing unit from cannula. Communication between pump and controller via radio frequency. Used by patients for diabetes management; provides continuous insulin delivery to maintain glycemic control.

Clinical Evidence

Bench testing only. No clinical data provided. Performance evaluations included biocompatibility, insulin compatibility, microbial ingress, cleaning/disinfection verification, shelf life, electrical safety, environmental, EMC, and RF compatibility testing. Software validation performed by external contractor.

Technological Characteristics

External, portable insulin infusion pump. Modular design with disposable reservoir and reusable pump unit. Radio frequency communication. Controlled by hand-held remote. Includes mechanical and software safety features, alarms, and alerts. Sterilization method and lifetime of sterile parts identical to predicates.

Indications for Use

Indicated for persons with diabetes mellitus requiring insulin therapy for continuous insulin delivery at set and variable rates. Prescription use only.

Regulatory Classification

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.

Predicate Devices

• iXL Diabetes Management System (K031373, K042792)
• Paradiam Model 515 (K073356)

Submission Summary (Full Text)

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### 510(K) Summary

# Solo™ Insulin Patch Pump 510(k) Number K090245

#### Date Prepared: July 21, 2009.

#### Applicant's Name:

Medingo Ltd.

Yoqneam Industrial Park Building 7 - 3rd floor P.O. Box 261 · Yogneam, Israel, 20692 Phone: [phone] Fax: [phone]

#### Contact Person:

Name: Arava HaCohen Title: VP Quality and Regulatory Affairs Tel: [phone] Fax: [phone] Email: [e-mail]

#### Trade Name:

Solo™ Insulin Patch Pump

#### Classification Name:

Insulin infusion pump

#### Classification:

Requlation # (21 CFR 880.5725), FDA has classified insulin infusion pumps as class II devices (product code LZG) and they are reviewed by the General Hospital panel.

#### Predicate Devices:

- > iXL Diabetes Management System (Insulet Corp.), product code LZG, cleared for marketing under K031373, K042792
Solo™ Insulin Patch Pump - Page 5-2

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- > Paradiam Model 515 (Medtronic Minimed), product code LZG, cleared for marketing under K073356.
#### Intended Use:

The Solo™ Insulin Patch Pump is intended for the continuous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin.

#### Device Description:

The Solo™ Insulin Patch Pump (Solo™) is a miniature, portable programmable insulin pump, which adheres to the patient's skin. The patch is comprised of two connected parts: a disposable reservoir, in which the insulin is stored and a reusable pump, which includes the pumping mechanism and electronic components. The patch is controlled via a remote control unit.

The Solo™ Insulin Patch Pump is designed to deliver basal and bolus insulin doses at various rates, volumes and patterns, as prescribed by the user's physician, and includes the features available in the predicate devices.

#### Technological Characteristics:

The Solo™ Insulin Patch Pump's technological characteristics are the same as those of its predicate devices. Same as its predicates, Solo™ is an external, portable insulin infusion pump controlled by a hand-held controller. Same as Insulet's OmniPod, Solo™ communication is by means of radio frequency.

Same as OmniPod, the Solo™ insulin dispensing patch is worn on the user's skin. Same as Minimed's Paradigm, the Solo™ has a modular design which enables disconnection and reconnection of the insulin dispensing unit from the cannula at the user's discretion.

Sterilization method and use lifetime of the sterile parts is identical to the predicate devices.

Solo™ includes the same functions, mechanical and software safety features, and alarms and alerts as the predicate devices.

Solo™ Insulin Patch Pump - Page 5-3

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#### Performance Tests:

Solo™ accuracy and In-house functional performance testing of Solo™ was conducted in Medingo according to a verification and validation plan based on risk analysis, literature search and requirements of applicable standards.

The following studies were conducted in certified contract laboratories: Biocompatibility, Insulin Compatibility, microbial ingress, cleaning and disinfection verification, Shelf life, Electrical Safety, Environmental, EMC and RF Compatibility. Software validation was performed in Medingo by an external software QA contractor.

Solo™ and its components successfully passed all performance evaluations according to its performance criteria.

### Conclusion:

Medingo believes that, based on the information provided in this submission, the Solo™ Insulin Patch Pump is substantially equivalent to its predicate devices without raising any new safety or effectiveness issues.

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#### DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is an abstract symbol that resembles an eagle or bird-like figure with stylized wings and tail feathers.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Ms. Arava Hacohen Vice President Quality and Regulatory Affairs Medingo Limited Yogneam Industrial Park Building 7 - 3rd Floor P.O. Box 261 Yogneam 20692 ISRAEL

CIUL 2 8 2009

Re: K090245

Trade/Device Name: Solo™ Insulin Patch Pump Regulation Number: 21 CFR 880.5725 Regulation Name: Infusion Pump Regulatory Class: II Product Code: LZG Dated: July 8, 2009 Received: July 15, 2009

Dear Ms. Hacohen:

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.

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#### Page 2 - Ms. Hacohen

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/ CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. 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/cdrh/mdr/ 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 Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Cenam E. Anster br
Saml. Preston, D.D.S., M.A.

Susan Runner, D.D.S., M.A. Acting Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# INDICATIONS FOR USE STATEMENT

# 510(k) Number (if known): K090245

#### Device Name:

Solo™ Insulin Patch Pump

## Indications for Use:

The Solo™ Insulin Patch Pump is intended for the continuous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin.

The Solo™ Insulin Patch Pump is for prescription use only.

510(k) Number: K090245

OR Prescription Use _ ﮨﮯ (Per 21 CFR 801.109)

Over the Counter Use

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

(Division Sign-Off)

Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number: k010245

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