CAREFINE PEN NEEDLE FAMILY INCLUDING QUINTAPOINT AND SUPERPOINT

K141749 · Facet Technologies, LLC · FMI · Jul 29, 2014 · General Hospital

Device Facts

• Record ID: K141749
• Device Name: CAREFINE PEN NEEDLE FAMILY INCLUDING QUINTAPOINT AND SUPERPOINT
• Applicant: Facet Technologies, LLC
• Product Code: FMI · General Hospital
• Decision Date: Jul 29, 2014
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 880.5570
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The CareFine Pen Needle is intended for use with a pen injector device for the subcutaneous injection of insulin.

Device Story

CareFine Pen Needles are single-use, sterile, hypodermic needles for subcutaneous insulin delivery. The device consists of a double-ended cannula mounted in an injection-molded hub with internal threads for attachment to pen injectors. The cannula is lubricated with silicone for ease of insertion. An inner shield protects the patient-end, and an outer cover maintains sterility. The device is used by patients, caregivers, and healthcare professionals. This specific modification introduces a blue-colored inner shield to identify the 8mm needle length. The device is sterilized via EtO terminal sterilization.

Clinical Evidence

No clinical data. Bench testing only, including biocompatibility (ISO 10993-5, -10, -11, -4; ASTM F756-8) and internal needle shield assembly strength testing.

Technological Characteristics

Single-lumen hypodermic needle; 29G-32G gauges; 8mm length. Materials: cannula, injection-molded hub, silicone lubricant. Sterilization: EtO (SAL 10^-6). Connectivity: None. Software: None.

Indications for Use

Indicated for subcutaneous insulin injection using a pen injector device in patients requiring insulin therapy.

Regulatory Classification

Identification

A hypodermic single lumen needle is a device intended to inject fluids into, or withdraw fluids from, parts of the body below the surface of the skin. The device consists of a metal tube that is sharpened at one end and at the other end joined to a female connector (hub) designed to mate with a male connector (nozzle) of a piston syringe or an intravascular administration set.

Predicate Devices

• CareFine™ Pen Needle (K133100)
• CareFine™ Pen Needle with QuintaPoint™ and SuperPoint™ (K140568)

Submission Summary (Full Text)

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Image /page/0/Picture/1 description: The image shows the logo for Facet Technologies. The logo consists of a four-pointed star-like shape on the left, followed by the word "FACET" in large, sans-serif font. Below "FACET" is the word "TECHNOLOGIES" in a smaller, sans-serif font. The logo is simple and modern, with a focus on the company name.

# JUL 2 9 2014

#### 510(k) Summary K141749

As required by the Safe Medical Devices Act (SMDA) of 1990 and in accordance with 21 CFR § 807.92, Content and Format of a 510(k) Summary, the following safety and effectiveness information is provided below:

| Date Prepared: | June 26, 2014 |
|---------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Submitter: | Facet Technologies, LLC<br>112 Town Park Dr.<br>Suite 300<br>Kennesaw, GA 30144<br>Facility Registration Number: 2082882 |
| Company Contact Person: | Jennifer Register<br>Senior Regulatory Affairs Specialist<br>Phone: [phone]<br>FAX: [phone]<br>Email: [e-mail]) |
| Common Name of Device | Insulin Pen Needle |
| Proprietary Name | CareFineTM Pen Needle Family including QuintaPointTM<br>and SuperPointTM |
| Classification Name | Hypodermic Single Lumen Needle |
| Classification Regulation | 21 CFR §880.5570, Class 2 |
| Panel | 80 General Hospital |
| Product Code | FMI |

### [807.92(a)(3)] Predicate Device:

CareFine™ Pen Needle (K133100) Manufactured by Facet Technologies, LLC

CareFine™ Pen Needle with QuintaPoint™ and SuperPoint™ (K140568) Manufactured by Facet Technologies, LLC .

> Confidential and Proprietary Copyright 2014 Facet Technologies, LLC

34

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# [(807.92(a)(4)] Description of Device:

CareFine™ Pen Needles are single use, sterile medical devices designed to be used in conjunction with pen injectors and pen cartridges for the subcutaneous injection of insulin. Pen needles are used by consumers, caregivers and health care professionals. They are offered in various gauge sizes (29G, 30G, 31G and 32G) and the blue needle shield will be offered in 8mm length. CareFine™ Pen Needles are sterile by EtO terminal sterilization, and they are non-toxic and non-pyrogenic.

The pen needle assembly consists of a doubled-ended cannula that is assembled into an injection molded hub using adhesive. The hub has internal threads, which allow it to be screwed onto the pen injector device. This allows the cartridge end of the cannula to penetrate through the rubber septum of the cartridge. The patient-end and the cartridgeend of the cannula are lubricated using a silicone based lubricant for ease of injection and rubber septum penetration.

An injection-molded inner shield is assembled over the patient-end of the cannula to protect the point from damage and accidental needle-sticks. This needle assembly is inserted into a protective injection-molded outer cover and sealed with a peel-away label to provide a sterile barrier and tamper evident seal. The peel-away label is pre-printed with information, which includes the lot number, needle gauge and needle length.

The individual needle assemblies are packaged in cartons, and placed into shippers with appropriate labeling. The shipper cases are palletized and sterilized to a SAL of 10° by EtO terminal sterilization.

The purpose of this Special 510(k) is to request modification to our CareFine™ Pen Needle family to include blue colored inner needle shield to distinguish the 8mm needle length.

The intended use for the modified device remains the same as the predicate device.

## [(807.92(a)(5)] Intended Use / Indication for Use:

The CareFine™ Pen Needle is intended for use with a pen injector device for the subcutaneous injection of insulin.

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#### [(807.92(a)(6)] Technological Characteristics:

The CareFine™ Pen Needle with blue colored needle shield is identical in composition to the CareFine™ Pen Needle family. The only difference is the blue color additive to the inner needle shield to distinguish an 8mm needle length.

The CareFine™ Pen Needle with blue colored inner needle shields are equivalent given that they:

- . Have the same indication for use,
- Do not have any labeling changes that affect the intended use of the device, .
- Do not alter the fundamental scientific technology, .
- . Incorporate the same basic design
- Use the same operating principles, .
- Are manufactured from the same materials, .
- Are sterilized with a resulting SAL of 10to, and �
- Are packaged using same unit and case materials. ●

Based on the comparisons described above to the predicate comparator device, the CareFine™ Pen Needle with blue colored inner needle shields do not raise any new issues of safety and effectiveness.

#### [(807.92(b)(1)]

#### Non-Clinical Performance Data:

Non-clinical performance data was performed and submitted with The CareFine™ Pen Needle Traditional 510(k) (K133100). The CareFine™ Pen Needle with blue colored needle shields is manufactured in accordance with the requirements of the current Good Manufacturing Practices for Medical Devices and follows 21 CFR Subpart C "Design Controls". All verification and validation activities identified by the risk analysis were performed to demonstrate continued conformance with applicable conformance standards. The principle device demonstrated equivalent performance to the predicate device during testing.

| Cytotoxicity | Per ISO 10993-5 |
|---------------------------------|----------------------|
| Sensitization | Per ISO 10993-10 |
| Intracutaneous Reactivity | Per ISO 10993-10 |
| Acute Toxicity | Per ISO 10993-11 |
| Hemocompatibility | Per ISO 10993-4 |
| | ASTM F756-8 |
| Needle Shield Assembly Strength | Internal Test Method |

Based upon the risk analysis the following tests were nerformed

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### [(807.92(b)(2)] Clinical Performance Data:

Clinical data is not required.

# [(807.92(b)(3)] Conclusion:

Based on the design equivalency and the verification activities performed, Facet Technologies, LLC has determined that CareFine™ Pen Needle family with blue inner needle shields are equivalent to the predicate comparator devices currently cleared for marketing in the United States. Differences between the devices do not raise any significant issues of safety and effectiveness.

# [(807.92(d)] Other Information:

None

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Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized caduceus symbol, which features a staff with a snake winding around it, and three bars. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular pattern around the symbol.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MI) 20993-0002

Facet Technologies. LLC Ms. Jennifer Register Senior Regulatory Affairs Specialist 112 Town Park Drive, Suite 300 KENNESAW. GA 30144

July 29, 2014

Re: K141749

Trade/Device Name: CareFine™ Pen Needle Regulation Number: 21 CFR 880.5570 Regulation Name: Needle, Hypodermic. Single Lumen Regulatory Class: Class II Product Code: FMI Dated: June 26, 2014 Received: June 30, 2014

Dear Ms. Register:

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 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

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Page 2 - Ms. Register

forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 331-542 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely vours.

# Mary S: Runner -S

Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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#### Indications for Use

510(k) Number (if known) K141749

Device Name Carefine™ Pen Needle

Indications for Use (Describe)

The CareFine Pen Needle™ is intended for use with a pen injector device for the subculaneous injection of insulin

Type of Use (Select one or both, as applicable)

ا_J Prescription Use (Part 21 CFR 801 Subpart D)

... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Over-The-Counter Use (21 CFR 801 Subpart C)

Date: 2014.07.29 10:33:31 -04'00'

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