PACIFIC HEMOSTASIS REFERENCE EMULSION

K013397 · Fisher Diagnostics · JIX · Feb 15, 2002 · Clinical Chemistry

Device Facts

• Record ID: K013397
• Device Name: PACIFIC HEMOSTASIS REFERENCE EMULSION
• Applicant: Fisher Diagnostics
• Product Code: JIX · Clinical Chemistry
• Decision Date: Feb 15, 2002
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 862.1150
• Device Class: Class 2

Intended Use

Pacific Hemostasis Reference Emulsion is intended to be used on Instrumentation Laboratories ACL system.

Device Story

Pacific Hemostasis Reference Emulsion functions as a reagent for in vitro coagulation studies; used on Instrumentation Laboratories ACL systems. Device provides standardized reference material for laboratory coagulation testing; assists clinicians in assessing patient coagulation status. Operated by laboratory technicians in clinical settings; output used to calibrate or verify coagulation assay performance. Benefits include improved accuracy and consistency of coagulation diagnostic results.

Clinical Evidence

Bench testing only.

Technological Characteristics

In vitro diagnostic reagent; liquid emulsion form factor; designed for use with Instrumentation Laboratories ACL system; class II device (21 CFR 864.5425).

Indications for Use

Indicated for use on Instrumentation Laboratories ACL systems for in vitro coagulation studies.

Regulatory Classification

Identification

A calibrator is a device intended for medical purposes for use in a test system to establish points of reference that are used in the determination of values in the measurement of substances in human specimens. (See also § 862.2 in this part.)

Special Controls

*Classification.* Class II (special controls). The device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 862.9.

Submission Summary (Full Text)

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Food and Drug Administration 2098 Gaither Road Rockville MD 20850

Jerald Steiner, Ph.D. FEB 1 5 2002 Senior Applications Scientist Fisher Diagnostics 8365 Valley Pike P.O. Box 307 Middletown, Virginia 22645-0307

> k013397 Trade/Device Name: Pacific Hemostasis Reference Emulsion Regulation Number: 21 CFR § 864.5425 Regulation Name: Multipurpose System for in vitro coagulation studies Regulatory Class: II Product Code: GGN Dated: December 17, 2001 Received: December 19, 2001

Dear Dr. Steiner:

Re:

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.

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 (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.

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This letter will allow you to begin marketing your device as described in your 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 your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other general information on your responsibilities under the Act may be obtained 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/dsma/dsmamain.html".

Sincerely yours,

Steven Autman

Steven I. Gutman, M.D., M.B.A. Director Division of Clinical Laboratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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## Indications for Use Form

Pacific Hemostasis Reference Emulsion is intended to be used on Instrumentation Laboratories ACL system.

Josephine Boutte

cal Laboratory Devices

**510(k) Number** Ko