OXLIFE FREEDOM FIVE OXYGEN CONCENTRATORS, MODEL KXF5

K060922 · Oxlife, LLC · CAW · May 30, 2006 · Anesthesiology

Device Facts

• Record ID: K060922
• Device Name: OXLIFE FREEDOM FIVE OXYGEN CONCENTRATORS, MODEL KXF5
• Applicant: Oxlife, LLC
• Product Code: CAW · Anesthesiology
• Decision Date: May 30, 2006
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 868.5440
• Device Class: Class 2
• Attributes: Therapeutic

Indications for Use

The OxLife oxygen concentrators are intended to provide supplemental oxygen. The device is not intended for life support nor does it provide any patient monitoring capabilities.

Device Story

The OxLife Freedom Five is a portable oxygen concentrator designed for home, institutional, or mobile use. It functions by drawing room air through pre-filters and HEPA filters via a compressor. The system utilizes two aluminum molecular sieve tanks; a pressure swing adsorption process binds nitrogen and water from the air, concentrating oxygen to approximately 93%. The device operates on a repetitive cycle where one tank generates oxygen for the patient while the other is flushed of nitrogen. It supports both 110V AC and 12V DC power sources. The device is operated by the patient or caregiver to provide supplemental oxygen; it is not life-supporting or life-sustaining and lacks patient monitoring capabilities. Healthcare providers prescribe the device to assist patients requiring supplemental oxygen therapy.

Clinical Evidence

Bench testing only. Testing confirmed oxygen concentration output meets specifications and the inverter provides adequate power from a 12V DC source.

Technological Characteristics

Molecular sieve material for nitrogen/water adsorption; aluminum welded sieve tanks; compressor-based vacuum/pressure system; HEPA filtration; 110V AC and 12V DC power input; portable form factor.

Indications for Use

Indicated for the administration of supplemental oxygen to patients requiring such therapy. Prescription use only.

Regulatory Classification

Identification

A portable oxygen generator is a device that is intended to release oxygen for respiratory therapy by means of either a chemical reaction or physical means (e.g., a molecular sieve).

Predicate Devices

• OxLife Oxygen Concentrator (K971964)
• OxLife Oxygen Concentrator (K933081)

Submission Summary (Full Text)

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MAY 30 2006

K060922

OXLIFE LLC APPLICATION FOR SPECIAL 510(k) "Freedom Five" 3/31/2006 Page 12 of 25

#### 10.0 510(k) Summary

| 10.1 Submitters Name: | OxLife LLC |
|------------------------------------------------|--------------------------------------------------------------------|
| 10.2 Submitters Address: | 141 Twin Springs Rd Hendersonville NC<br>28792 |
| 10.3 Submitters Phone & Fax: | 828-684-7353 ph. 828-684-8990 fx. |
| 10.4 Contact Person: | Margaret K. Poteat<br>General Manager/Management<br>Representative |
| 10.5 Date Summary Prepared: | March 21, 2006 |
| 10.6 Trade/Proprietary Name: | OxLife Freedom Five™ Oxygen<br>Concentrators |
| 10.7 Common/Usual Name: | Oxygen Concentrator |
| 10.8 Classification Name: | Portable Oxygen Concentrator |
| 10.9 Comparison to Currently Marketed Devices: | The modified OxLife Oxygen Concentrator is |

substantially equivalent to the existing OxLife Oxygen Concentrator (K971964 & K933081)

#### 10.10 Device Description:

The OxLife Oxygen Concentrators are prescription devices designed to provide an inexpensive supply of supplemental oxygen in a home, automobile or institution without a continuous source of purified oxygen. They are not life-supporting nor life-sustaining devices. The devices operate through the use of molecular sieve material that binds with the water and nitrogen in filtered room air to leave a gas that is approximately 93% oxygen when delivered to the patient. The compressor creates a vacuum to suck room air through a pre-filter and HEPA filter into a holding tank. At the same time, downstream of the compressor, the air from the previous cycle is pressurized into one of the two aluminum welded molecular sieve tanks. As the oxygen is forced out of the end of the tank, it enters a "T" fitting that directs most of the gas to flush the nitrogen out of the second molecular sieve tank into the ambient air. The remaining oxygen is delivered to the patient. On the next cycle, the air is directed into the second molecular sieve tank with the oxygen generated flushing the first tank and continuing the supply to the patient. This repetitive cycle generates the oxygen

Previously Legally Marketed unmodified device # K971964 Small Business Decision Number SBD068194 EIN # 41-2095576 Payment ID 6025035-956733

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OXLIFE LLC APPLICATION FOR SPECIAL 510(k) "Freedom Five" Page 13 of 25 3/31/2006

# 510(k) Summary page two

necessary to flush and prepare the saturated sieve tank while supplying the patient with a continuous flow of high concentration oxygen.

All models have inverter capability to use a 12 Volt DC power as well as 110v.

#### 10.11 Indications for Use:

The OxLife oxygen concentrators are intended to provide supplemental oxygen. The device is not intended for life support nor does it provide any patient monitoring capabilities.

#### 10.12 Technological Characteristics:

The OxLife oxygen concentrator operates by using molecular sieve material to absorb water and nitrogen from filtered air. The resulting gas has an increased concentration of oxygen. This technology is well established and has been used in the predicate device as well as other legally marketed products. These modifications have not affected the technological characteristics of the device.

#### 10.13 Performance Data:

The results of the oxygen concentration testing confirm that the oxygen output of the modified devices meets specifications and is substantially equivalent to the predicate device. Also, the inverter provides adequate power to run the devices from a 12 Volt DC power source.

### 10.14 Conclusion:

Based on the design, performance specifications and testing and intended use, the modified OxLife Oxygen Concentrators are substantially equivalent to the currently marketed devices.

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized depiction of an eagle or bird-like figure with three curved lines representing its wings or feathers. The text "DEPARTMENT OF HEALTH AND HUMAN SERVICES . USA" is arranged in a circular pattern around the bird symbol.

્રસ

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY 30 2006

Ms. Margaret K. Poteat Genera Manager/Management Representative Oxlife Limited Liability Company 141 Twin Springs Road Hendersonville, North California 28792

Re: K060922

Trade/Device Name: Oxlife Freedom Five Oxygen Concentrators Regulation Number: 868.5440 Regulation Name: Portable Oxygen Generator Regulatory Class: II Product Code: CAW Dated: May 18, 2006 Received: May 19, 2006

Dear Ms. Poteat:

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 such 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 - Mr. Poteat

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); 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.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits vour device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). 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.

Susan Runger
Chiu Lin, Ph.D.

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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#### APPENDIX D

## Indications for Use

510(k) Number: K060922

Device Name: Oxlife Freedom Five Oxygen Concentrators

Indications For Use: The OxLife Oxygen Concentrators are indicated for the administration for supplemental oxygen.

Prescription Use \$\sqrt{}\$
(Part 21 CFR 801 Subpart D)

AND/OR

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

huybalion

(Division Sign Off) Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number: K060922

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