SIMPLISSE ELECTRIC BREASTFEEDING COMPANION

K093648 · Simplisse, Inc. · HGX · Jul 14, 2010 · Obstetrics/Gynecology

Device Facts

• Record ID: K093648
• Device Name: SIMPLISSE ELECTRIC BREASTFEEDING COMPANION
• Applicant: Simplisse, Inc.
• Product Code: HGX · Obstetrics/Gynecology
• Decision Date: Jul 14, 2010
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 884.5160
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Simplisse Electric Breastfeeding Companion is a personal use electric powered device used to express milk from the breast of lactating women. The device is not intended for hospital use

Device Story

Personal use electric breast pump; used by lactating women to express milk. Device utilizes reciprocating piston pump mechanism controlled by microprocessor to provide adjustable suction levels and cycle speeds. Features active breast massage and overflow protection. Breast cup interface constructed from thermoplastic elastomer and rigid plastic. Operates via AC power cord. User adjusts settings to facilitate milk expression; output is collected milk. Intended for home use; provides benefit of safe, effective milk collection.

Clinical Evidence

Bench testing only. Device demonstrated ability to provide sufficient vacuum pressure to safely and effectively express and collect milk from lactating women in accordance with product labeling.

Technological Characteristics

Powered breast pump; reciprocating piston mechanism; microprocessor-controlled. Materials: thermoplastic elastomer and rigid plastic (biocompatible, FDA food additive compliant per 21 CFR 176, 177, 178). Power: AC cord. Features: adjustable suction/cycle speed, active breast massage, overflow protection. Weight: 4-5 lbs.

Indications for Use

Indicated for lactating women for the expression of breast milk. Personal use device; not for hospital use.

Regulatory Classification

Identification

A powered breast pump in an electrically powered suction device used to express milk from the breast.

Predicate Devices

• Medela's Pump In Style (K950750)
• Ameda-Egnell Purely Yours (K973501)
• Even Flo Comfort Control (K983776)

Submission Summary (Full Text)

{0}------------------------------------------------

K093648 page 1 of 3

JUL 1 4 2010

## Section 5: 510(k) Summary

#### Submitted By: 1.0

Simplisse Inc. 4433 Fyler Ave St. Louis, MO 63116 Establishment Registration Number: None

Primary Contact: Glen Feye, President Accurate Consultants, Inc. 1340 West Pennsylvania Ave. San Diego, CA 92103 Telephone: [phone] Fax: [phone] [e-mail]

#### 2.0 Date Submitted:

November 30, 2009

#### 3.0 Device Name(s):

#### 3.1 Trade Name:

Simplisse Electric Breastfeeding Companion

#### Common Name: 3.2

Powered Breast Pump

#### 3.3 Classification Name

Electric Breast Pump (21CFR 884.5160, Product code - HGX )

#### 4.0 Predicate Devices:

{1}------------------------------------------------

| Candidate | Predicates | Manufacturer | Docket Number |
|-----------------------------------------------------|------------------------------|----------------------------|---------------|
| Simplisse<br>Electric<br>Breastfeeding<br>Companion | Medela's Pump In<br>Style | Medela Inc. | K950750 |
| | Ameda-Egnell<br>Purely Yours | Ameda<br>Medizintechnik AG | K973501 |
| | Even Flo Comfort<br>Control | Evenflow Co., Inc. | K983776 |

#### 5.0 Intended Use:

The Simplisse Electric Breastfeeding Companion is a personal use electric powered device used to express milk from the breast of lactating women. The device is not intended for hospital use

#### 6.0 Comparison to Predicate Devices:

The following table summarizes the basic similarities and differences between the candidate- Simplisse Electric Breastfeeding Companion and the predicates identified in Section 4.0 of this 510(k) Summary section.

| Characteristic | Candidate | Predicates | | |
|------------------------------------------------------------------|--------------------------------------------------|----------------------------|-----------------------------------------|-----------------------------------------------|
| Name | Simplisse Electric<br>Breastfeeding<br>Companion | Medela Pump<br>In Style | Ameda-Egnell<br>Purely Yours | Even Flo<br>Comfort<br>Control |
| 510(k) No. | None | K950750 | K973501 | K983776 |
| Intended Use | To Express Milk | To Express<br>Milk | To Express Milk | To Express<br>Milk |
| Materials -21<br>CFR Parts<br>176, 177, and<br>178<br>compliant. | Yes | Yes | Yes | Yes |
| Power Source | 1. AC Power Cord | 1. AC Power<br>Cord | 1. AC Power<br>Cord<br>2.6 AA Batteries | 1. AC Power<br>Cord<br>2. 12 V Car<br>Adapter |
| Control<br>Mechanism | Microprocessor | Mechanical | Microprocessor | Mechanical |
| Pump Type | Reciprocating<br>Piston | Reciprocating<br>Diaphragm | Reciprocating<br>Piston | Reciprocating<br>Diaphragm |

{2}------------------------------------------------

| Single or<br>Double Breast<br>Pumping | Both | Both | Both | Both |
|---------------------------------------|-------------------------------------------------|---------------|--------------------------------------------------------------|---------------|
| Adjustable<br>Suction<br>Levels | Yes | Yes | Yes | Yes |
| Adiustable<br>Cycle Speed | Yes | Yes | Yes | Yes |
| Overflow<br>Protection | Yes | No | Yes | Yes |
| Breast Cup-to<br>Breast<br>Interface | Thermoplastic<br>Elastomer and Rigid<br>Plastic | Rigid Plastic | Rigid Plastic<br>(Partial Silicone<br>covering<br>available) | Rigid Plastic |
| Active Breast<br>Massage | Yes | No | No | No |
| Weight | 4-5 pounds | 7-8 pounds | 5-6 pounds | 3-5 pounds |

## Design and Materials

All milk and human contact components from the Simplisse Electric Breastfeeding Companion and the predicates are manufactured from materials that meet FDA food additive criteria as set forth in Part 21 Code of Federal Regulations Parts 176, 177, and 178. In addition, the Breast Cup has been tested for biocompatibility per established guidelines.

#### 7.0 Summary of Non-Clinical Performance Data:

Testing of the device has demonstrated that the Simplisse Electric Breastfeeding Companion meets established requirements when used in the manner and environment specified in product labeling.

#### 8.0 Conclusion:

The Simplisse Electric Breastfeeding Companion is substantially equivalent to its predicate devices. Based upon the test data submitted, the device provides sufficient vacuum pressure to safely and effectively express and collect milk from lactating women.

{3}------------------------------------------------

Image /page/3/Picture/0 description: The image shows a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized eagle emblem, consisting of three curved lines representing the eagle's body and wings. The eagle's head is suggested by a small, pointed shape at the right side of the emblem.

# DEPARTMENT OF HEALTH & HUMAN SERVICES,

Food and Drug Administration 10903 New Hampshire Avenue Document Mail Center - WO66-G609 Silver Spring, MD 20993-0002

Simplisse Inc. c/o Mr. Glen Feve President Accurate Consultants, Inc. 1340 West Pennsylvania Ave. SAN DIEGO CA 92103

K093648

Re:

Trade Name: Simplisse Electric Breastfeeding Companion Regulation Number: 21 CFR §884.5160 Regulation Name: Powered breast pump Regulatory Class: II Product Code: HGX Dated: July 7, 2010 Received: July 9, 2010

Dear Mr. Feye:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

JUL 1 4 2010

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); medical device reporting of medical device-related

{4}------------------------------------------------

Enclosure.

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/MedicalDevices/Safety/ReportaProblem/default.htm 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/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Janine M. Morris

Acting Director, Division of Reproductive, Abdominal, and Radiological Devices office of Device Evaluation Center for Devices and Radiological Health

{5}------------------------------------------------

### Section 4: Indications for Use Statements

# Indications for Use

510(k) Number (if known):

Device Name: Simplisse Electric Breastfeeding Companion

Indications for Use:

A personal use electric powered device used to express milk from the breast of lactating women.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use X (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)

Page 1 of

---

(Division Sign-Off)
Division of Reproductive, Abdominal, and
Radiological Devices

510(k) Number

Simplisse Inc. Section 510(k) Notification Powered Breast Pump