VISI MOBILE MONITIORING SYSTEM
Device Facts
| Record ID | K133586 |
|---|---|
| Device Name | VISI MOBILE MONITIORING SYSTEM |
| Applicant | Sotera Wireless, Inc. |
| Product Code | MWI · Cardiovascular |
| Decision Date | Dec 18, 2013 |
| Decision | SESE |
| Submission Type | Special |
| Regulation | 21 CFR 870.2300 |
| Device Class | Class 2 |
Indications for Use
The ViSi Mobile Monitoring System is intended for use by clinicians and medically qualified personnel for single or multi-parameter vital signs monitoring of adult patients. It is indicated for ECG (3 or 5 leadwire), respiration rate (RESP), heart rate (HR), non-invasive blood pressure (NIBP), non-invasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO2), pulse rate (PR), and skin temperature (TEMP) in hospital-based facilities; including general medical-surgical floors, intermediate care floors, and emergency departments. The ViSi Mobile Monitoring System may be used as standalone devices or networked to central station through wireless 802.11 communication.
Device Story
ViSi Mobile Monitoring System is a body-worn, portable vital signs monitor; features high-resolution touch screen with visual/audible alarms. Continuously measures ECG, heart rate, SpO2, pulse rate, respiration rate, and temperature; performs NIBP as one-time or interval measurements. Used by clinicians/medically qualified personnel in hospital facilities. Device functions as standalone or networked via 802.11 wireless to central station. Provides real-time waveforms and vital sign data to assist clinicians in patient assessment and clinical decision-making; enables continuous monitoring to improve patient safety.
Clinical Evidence
No clinical data provided; substantial equivalence is based on design and technological similarities to the predicate device.
Technological Characteristics
Body-worn, portable monitor with touch screen display. Measures ECG (3/5 lead), SpO2, respiration, heart rate, NIBP, and temperature. Connectivity via 802.11 wireless network. System includes visual and audible alarms.
Indications for Use
Indicated for adult patients in hospital settings (general medical-surgical, intermediate care, emergency departments) requiring monitoring of ECG, respiration rate, heart rate, NIBP, SpO2, pulse rate, and skin temperature.
Regulatory Classification
Identification
A cardiac monitor (including cardiotachometer and rate alarm) is a device used to measure the heart rate from an analog signal produced by an electrocardiograph, vectorcardiograph, or blood pressure monitor. This device may sound an alarm when the heart rate falls outside preset upper and lower limits.
Predicate Devices
- ViSi Mobile Monitoring System (K122036)
Submission Summary (Full Text)
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K133586 Page 1 of 1
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www.soterawireless.com
## 8 510(K) SUMMARY
DEC 18 2013
| Date prepared | November 20, 2013 |
|---------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Name | Sotera Wireless, Inc.<br>9444 Waples Street, Suite 280<br>San Diego, CA 92121<br>T. 858.373.4841; F. 858.427.4639 |
| Contact person | Eben Gordon<br>Senior Director, Regulatory |
| Trade name | ViSi Mobile Monitoring System |
| Common name | Vital signs monitor |
| Regulation Name | Cardiac Monitor Including Cardiotachometer and Rate Alarm |
| Classification number | 21 CFR 870.2300 |
| Product code | MWI, DRT, DXN, DQA, FLL |
| Regulatory class | II |
| Predicate devices | ViSi Mobile Monitoring System; K122036 (Clearance: 8/18/2012) |
| Description | The ViSi Mobile Monitoring System is a lightweight, portable patient vital signs<br>monitor featuring a high resolution, full color touch screen display, with visual<br>and audible alarms and alerts. The ViSi Mobile Monitor is body-worn and<br>designed to continuously measure ECG, heart rate, SpO2, pulse rate, respiration<br>rate, and temperature. The ECG, SpO2, and Respiration waveforms are viewable<br>on demand. NIBP can be measured as a onetime measurement, or it can be<br>measured automatically at predefined intervals |
| Indications for use | The ViSi Mobile Monitoring System is intended for use by clinicians and<br>medically qualified personnel for single or multi-parameter vital signs monitoring<br>of adult patients. It is indicated for ECG (3 or 5 leadwire), respiration rate<br>(RESP), heart rate (HR), non-invasive blood pressure (NIBP), non-invasive<br>monitoring of functional oxygen saturation of arterial hemoglobin (SpO2), pulse<br>rate (PR), and skin temperature (TEMP) in hospital-based facilities; including<br>general medical-surgical floors, intermediate care floors, and emergency<br>departments.<br>The ViSi Mobile Monitoring System may be used as standalone devices or<br>networked to central station through wireless 802.11 communication. |
| Summary of<br>substantial equivalence | The device design, technology, materials, processes, etc. have not been changed<br>with this application. The modification is only to increase the time to alarm for<br>critically low, low, and high heart rates; therefore the ViSi Mobile Monitoring<br>System as described in this submission is substantially equivalent to the predicate<br>device. |
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## DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002
December 18, 2013
Sotera Wireless, Inc. Eben Gordon Senior Director, Regulatory 9444 Waples Street Suite 280 San Diego, CA 92121 US
Re: K133586
> Trade/Device Name: Visi Mobile Monitioring System Regulation Number: 21 CFR 870.2300 Regulation Name: Cardiac Monitor (Including Cardiotachometer And Rate Alarm) Regulatory Class: Class II (two) Product Code: MWI, DRT, DXN, DQA, FLL Dated: November 20, 2013 Received: November 21, 2013
Dear Eben Gordon:
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.
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
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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 devicerelated 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 contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address
http://www.fda.gov/MedicalDevices Resourcesfor You/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 (800) 638 2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.
Sincerely yours.
Owen-DEaris-S
for
Bram D. Zuckerman, M.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health
Enclosure
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Sotera Wireless, Inc. ViSi Mobile Monitoring System Special 510(k)
A and a compression in
## 7 INDICATIONS FOR USE
510(k) Number (if known): __
ViSi Mobile Monitoring System _ Device Name: __________
Indications for Use:
The ViSi Mobile Monitoring System is intended for use by clinicians and medically qualified personnel for single or multi-parameter vital signs monitoring of adult patients. It is indicated for ECG (3 or 5 leadwire), respiration rate (RESP), heart rate (HR), non-invasive blood pressure (NIBP), non-invasive monitoring of functional oxygen saturation of arterial hemoglobin (SpO2), pulse rate (PR), and skin temperature (TEMP) in hospital-based facilities; including general medical-surgical floors, intermediate care floors, and emergency departments.
The ViSi Mobile Monitoring System may be used as standalone devices or networked to central station through wireless 802.11 communication.
Prescription Use _____________________________________________________________________________________________________________________________________________________________
AND/OR
Over the Counter Use _________________________________________________________________________________________________________________________________________________________
(Part 21 CFR 801 Subpart D)
(21 CFR 801 Subpart C)
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Concurrence of CDRH, Office of Device Evaluation (ODE)
Digitally signed by
Faris -S
Date: 2013.12.18
11:00:10 -05'00'
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