NovaGuard SA Pro Safety System

K163511 · West Pharmaceutical Services, Inc. · MEG · Feb 2, 2017 · General Hospital

Device Facts

• Record ID: K163511
• Device Name: NovaGuard SA Pro Safety System
• Applicant: West Pharmaceutical Services, Inc.
• Product Code: MEG · General Hospital
• Decision Date: Feb 2, 2017
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 880.5860
• Device Class: Class 2
• Attributes: Pediatric

Intended Use

Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist seff-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.

Device Story

Non-sterile, single-use anti-needlestick accessory for pre-filled ISO standard glass syringes; consists of syringe holder, sleeve, and spring. Assembled with pre-filled syringe by pharmaceutical manufacturer. Upon injection, spring-loaded sleeve covers needle; provides visual, tactile, and audible confirmation of activation. Used by healthcare professionals, patients, or caregivers to prevent accidental needlestick injuries. Modification from predicate includes integrated clip feature on syringe holder to streamline assembly process.

Clinical Evidence

Bench testing only. No clinical data. Verification and validation included syringe assembly force, disassembly force, clip impact test, drop tests, activation security, and RNS replacement. All tests met internal performance standards.

Technological Characteristics

Materials: Polycarbonate (holder, sleeve), Stainless Steel (spring). Biocompatibility per ISO 10993-1. Non-sterile. Mechanical safety feature: spring-actuated sleeve. Dimensions: 1mL long syringe, max 5/8" needle. No software or electronics.

Indications for Use

Indicated for healthcare professionals, patients self-injecting prescribed medications, and caregivers assisting patients; unrestricted patient population including children and adults; for use with pre-filled ISO standard glass syringes (1mL long, max 5/8" needle) for parenteral administration.

Regulatory Classification

Identification

A piston syringe is a device intended for medical purposes that consists of a calibrated hollow barrel and a movable plunger. At one end of the barrel there is a male connector (nozzle) for fitting the female connector (hub) of a hypodermic single lumen needle. The device is used to inject fluids into, or withdraw fluids from, the body.

Predicate Devices

• NovaGuard SA Safety System (K141464)

Submission Summary (Full Text)

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

February 2, 2017

West Pharmaceutical Services, Inc. Ms. Ana Ladino Director of Regulatory Affairs 530 Herman O. West Drive Exton, Pennsylvania 19341-1147

Re: K163511

Trade/Device Name: NovaGuard SA Pro Safety System Regulation Number: 21 CFR 880.5860 Regulation Name: Piston Syringe Regulatory Class: II Product Code: MEG Dated: December 14, 2016 Received: December 15, 2016

Dear Ms. Ladino:

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.

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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 devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) 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 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" (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 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,

Tina
Kiang-S

Tina Kiang, Ph.D. Acting 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) K163511

Device Name NovaGuard SA Pro Safety System

#### Indications for Use (Describe)

Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist seff-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.

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

2 Prescription Use (Part 21 CFR 801 Subpart D)

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

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# 510(K) SUMMARY : K163511

#### NovaGuard SA Pro Safety System Device:

### Company Name:

West Pharmaceutical Services, Inc. 530 Herman O. West Drive Exton, PA 19341-1147 Phone: [phone]

## Contact Person:

Ana Ladino Director of Regulatory Affairs West Pharmaceutical Services, Inc. Phone: [phone] Fax: [phone] E-mail: [e-mail]

## US Agent:

Kevin Lentz Senior Director of Regulatory Affairs West Pharmaceutical Services, Inc. 530 Herman O. West Drive Exton, PA 19341-1147 Phone: [phone] Fax: [phone] E-mail: [e-mail]

Preparation date: January 31, 2017

## Classification:

Classification Name: Piston Syringe Trade Name: NovaGuard SA Safety System Common/Usual Name: Anti Stick Syringe Product Code: MEG Regulation No.: 21 CFR 880.5860 Class: II Panel Identification: General Hospital Panel

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# Predicate Device:

NovaGuard SA Safety System 510(k) K141464.

# Device Description:

The proposed device, NovaGuard SA Pro Safety System, is a non-sterile, single use anti needlestick accessory for pre-filled ISO standard glass syringes that are 1ml long with a max needle length of 5/8". The NovaGuard SA Pro Safety System consist of three components, syringe holder, sleeve and spring. The proposed device will be assembled along with the pre filled syringe by the pharmaceutical company. Upon completion of the injection, the needle is then covered by the sleeve protecting the user from potential sharps needle stick injury. There is a visual, tactile and audible recognition that the device safety feature has activated.

# Indications for use:

Single use device that is indicated for use as an accessory with pre-filled ISO Standard glass syringes to aid in the protection of healthcare professionals, patients who self-inject doctor prescribed medications and individuals that assist self-injecting patients, from accidental needlesticks. The intended patient population is unrestricted and may include children and adults, and parenteral methods of administration.

## Substantial equivalence:

Based on the indications for use, technology, materials of construction and principle of operation the proposed device, NovaGuard SA Pro Safety System, is substantially equivalent to the predicate device, NovaGuard SA Safety System 510(k) K141464.

The following modifications have been made to the predicate device, NovaGuard SA Safety System 510(k) K14146:

- . Syringe holder modifications to implement integrated clip features instead of a separate clip component.
- . Syringe holder modifications to aid in the molding and assembly process and to smooth the syringe holder fingers profile.

The predicate device. NovaGuard SA Safety System (K141464) includes a separate clip component. The proposed device, NovaGuard SA Pro Safety System includes an integrated clip feature on the syringe holder instead of a separate clip component. This change was implemented to facilitate the pharmaceutical manufacturer assembly process of the proposed device, NovaGuard SA Pro Safety System, with their prefilled syringe. This device modification eliminates the need to assemble a clip component as a separate operation.

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| Areas for<br>Comparison | Predicate Device:<br>NovaGuard SA Safety<br>System (K141464) | Proposed Device:<br>NovaGuard SA Pro<br>Safety System | Comparison |
|------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------|
| Indications for<br>Use | Single use device that is<br>indicated for use as an<br>accessory with pre-<br>filled ISO Standard<br>glass syringes to aid in<br>the protection of<br>healthcare<br>professionals, patients<br>who self-inject doctor<br>prescribed medications<br>and individuals that<br>assist self-injecting<br>patients from accidental<br>needle sticks. The<br>intended patient<br>population is<br>unrestricted and may<br>include children and<br>adults and parenteral<br>methods of<br>administration. | Single use device that is<br>indicated for use as an<br>accessory with pre-<br>filled ISO Standard<br>glass syringes to aid in<br>the protection of<br>healthcare<br>professionals, patients<br>who self-inject doctor<br>prescribed medications<br>and individuals that<br>assist self-injecting<br>patients from accidental<br>needle sticks. The<br>intended patient<br>population is<br>unrestricted and may<br>include children and<br>adults and parenteral<br>methods of<br>administration. | Identical |
| Use | Single Use | Single Use | Identical |
| Prescription Use | Yes | Yes | Identical |
| Contraindication | None | None | Identical |
| Components | Syringe holder, sleeve,<br>spring and clip | Syringe holder, sleeve<br>and spring | Modified<br>Integrated clip<br>replaces the clip<br>component |
| Compatible<br>Syringes | Pre-filled ISO Standard<br>glass syringes | Pre-filled ISO Standard<br>glass syringes | Identical |
| Syringe size | 1mL Long | 1mL Long | Identical |
| Needle Length | Max 5/8" length | Max 5/8" length | Identical |
| Needle shield<br>requirement | Rigid | Rigid | Identical |
| Syringe holder<br>material of | Polycarbonate | Polycarbonate | Identical |
| Areas for<br>Comparison | Predicate Device:<br>NovaGuard SA Safety<br>System (K141464) | Proposed Device:<br>NovaGuard SA Pro<br>Safety System | Comparison |
| construction | | | |
| Sleeve material of<br>construction | Polycarbonate | Polycarbonate | Identical |
| Spring material of<br>construction | Stainless Steel | Stainless Steel | Identical |
| Clip material of<br>construction | Polycarbonate | N/A | Modified<br>The NovaGuard SA<br>Pro Safety System<br>does not have a<br>separate clip<br>component |
| Biocompatible | Yes<br>Per ISO 10993-1 | Yes<br>Per ISO 10993-1 | Identical |
| Sterilization | Non- sterile | Non- sterile | Identical |

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# Performance Testing:

Based on the verification and validation activities, along with the risk assessment evaluation, it was determined that the following tests needed to be performed on the proposed device, NovaGuard SA Pro Safety System.

- Syringe assembly force
- Pre-activation disassembly force (force applied to RNS) ●
- . Pre-Activation Disassembly Force Test (force applied to cannula)
- Clip impact test (Integrated clip feature test) ●
- Drop Test Post-activation with PFS ●
- Drop Test - Pre-activation with PFS
- Activation Security
- . RNS replacement

All testing met the required acceptance criteria.

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| Performance Testing Summary | |
|------------------------------------------------------------------|------------------------------------------|
| Test Name | Testing Standard |
| Syringe assembly force | Tested to internal performance standards |
| Pre-activation disassembly force (force applied to RNS) | Tested to internal performance standards |
| Pre-Activation Disassembly Force Test (force applied to cannula) | Tested to internal performance standards |
| Clip impact test (Integrated clip feature test) | Tested to internal performance standards |
| Drop Test - Post-activation with PFS | Tested to internal performance standards |
| Drop Test - Pre-activation with PFS | Tested to internal performance standards |
| Activation Security | Tested to internal performance standards |
| RNS replacement | Tested to internal performance standards |

The bench testing evaluation of the proposed device, NovaGuard SA Pro Safety System, does not raise any additional concerns regarding safety and effectiveness and may therefore be considered substantially equivalent to the predicate device.

## Clinical Testing:

The proposed device, NovaGuard SA Pro Safety System, modifications did not affect the device design impacting activation of the safety prevention feature therefore based upon their risk analysis a simulated use study was deemed not necessary.

# Conclusion:

Based on the indications for use, technology, materials of construction and principle of operation the proposed device NovaGuard SA Pro Safety System, is substantially equivalent to the predicate device, NovaGuard SA Safety System (K141464).