PHILIPS MULTI-PARAMETER MODULE, MODEL M3001A; PHILIPS COMPONENT COMPACT MONITOR, RELEASE A.02, MODEL M1275B

K020531 · Philips Medical Systems · MHX · Mar 20, 2002 · Cardiovascular

Device Facts

• Record ID: K020531
• Device Name: PHILIPS MULTI-PARAMETER MODULE, MODEL M3001A; PHILIPS COMPONENT COMPACT MONITOR, RELEASE A.02, MODEL M1275B
• Applicant: Philips Medical Systems
• Product Code: MHX · Cardiovascular
• Decision Date: Mar 20, 2002
• Decision: SESE
• Submission Type: Special
• Regulation: 21 CFR 870.1025
• Device Class: Class 2
• Attributes: Pediatric

Intended Use

For monitoring, recording, and alarming of multiple physiological parameters of adults, pediatrics, and neonates in health care facilities. EASI 12-lead ECG is only for use on adult and pediatric patients. ST Segment monitoring is restricted to adult patients only. The transcutaneous gas measurement (tcp02 / tcpCO2) is restricted to neonatal patients only.

Device Story

The Philips M1275B Component Compact Monitor, Release A.02, with M3001A Multi-Parameter Module, is a physiological monitoring system used in clinical settings. It acquires various physiological signals, including ECG, blood pressure, oxygen saturation, and transcutaneous gases. The device processes these inputs to provide real-time monitoring, recording, and alarming for healthcare professionals. It supports specialized functions such as EASI 12-lead ECG (adult/pediatric), ST segment monitoring (adult), and transcutaneous gas measurement (neonatal). The system provides visual and audible outputs to assist clinicians in patient assessment and decision-making. It is intended for use by trained healthcare personnel in hospital or clinical environments.

Clinical Evidence

No clinical data. Performance was established through bench testing, including system-level tests, performance tests, and safety testing based on hazard analysis. Pass/Fail criteria were based on specifications cleared for the predicate device.

Technological Characteristics

Multi-parameter physiological monitor. Supports ECG, blood pressure, SpO2, and transcutaneous gas monitoring. Connectivity via network/communication systems. Software-based monitoring and alarm system. Form factor is a compact monitor with modular components.

Indications for Use

Indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters of adult, pediatric, and neonatal patients in health care facilities.

Regulatory Classification

Identification

The arrhythmia detector and alarm device monitors an electrocardiogram and is designed to produce a visible or audible signal or alarm when atrial or ventricular arrhythmia, such as premature contraction or ventricular fibrillation, occurs.

Special Controls

*Classification.* Class II (special controls). The guidance document entitled “Class II Special Controls Guidance Document: Arrhythmia Detector and Alarm” will serve as the special control. See § 870.1 for the availability of this guidance document.

Predicate Devices

• Philips Component Compact Monitor (M1275B) (K013199)

Submission Summary (Full Text)

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# KO20531

## MAR 2 0 2002

#### 510(k) Summary 9.0

This summary of 510(k) safety and effectiveness information is submitted in accordance with the requirements of the Safe Medical Devices Act of 1990 and 21 CFR §807.92.

1. The submitter of this premarket notification is: Dave Osborn Quality Program Manager Philips Medical Systems 3000 Minuteman Road Andover, MA 01810-1085

> 978 659 3178 Tel: [phone] Fax: Email: [e-mail]

This summary was prepared on 13 February, 2002

- 2. The name of this device is the Philips Medical Systems, M1275B Component Compact Monitor. Classification names are as follows:

| Device Panel | Classification | ProCode | Description |
|----------------------------|----------------|---------|-----------------------------------------------------------------------------|
| Panel 73<br>Anesthesiology | 868.1400, II | CCK | Analyzer, Gas, Carbon-<br>Dioxide, Gaseous-Phase |
| | 868.2375, II | BZQ | Monitor, Breathing<br>Frequency |
| | 868.2480, II | LKD | Monitor, Carbon-Dioxide,<br>Cutaneous |
| | 868.2500, II | KLK | Monitor, Oxygen,<br>Cutaneous, for Infant not<br>under Gas Anesthesia |
| Panel 74<br>Cardiovascular | 870.1025, III | DSI | Detector and Alarm,<br>Arrhythmia |
| | 870.1025, III | MLD | Monitor, ST Segment with<br>Alarm |
| | 870.1025, III | MHX | Monitor, Physiological,<br>Patient (with arrhythmia<br>Detection or alarms) |
| | 870.1100, II | DSJ | Alarm, Blood-Pressure |
| | 870.1110, II | DSK | Computer, Blood-Pressure |
| | 870.1130, II | DXN | System, Measurement,<br>Blood-Pressure, Non-<br>Invasive |
| | 870.1435, II | DXG | Computer, Diagnostic,<br>Pre-Programmed, Single-<br>Function |
| | 870.1915, II | KRB | Probe, Thermodilution |
| | 870.2060, II | DRQ | Amplifier and Signal<br>Conditioner, Transducer<br>Signal |
| | 870.2300, II | DRT | Monitor, Cardiac (incl.<br>Cardiotachometer & Rate<br>Alarm) |
| | 870.2340, II | DPS | Electrocardiograph |
| | 870.2340, II | MLC | Monitor, ST Segment |
| | 870.2370, II | KRC | Tester, Electrode,<br>Surface,<br>Electrocardiograph |
| | 870.2450, II | DXJ | Display, Cathode-Ray<br>Tube, Medical |
| | 870.2600, II | DRJ | System, Signal<br>Isolation |

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| Device Panel | Classification | ProCode | Description |
|---------------------------------|----------------|---------|-----------------------------------------------------------------|
| | 870.2700, II | DQA | Oximeter |
| | 870.2770, II | DSB | Plethysmograph, Impedance |
| | 870.2800, II | DSH | Recorder, Magnetic Tape,<br>Medical |
| | 870.2810, I | DSF | Recorder, Paper Chart |
| | - | MSX | System, Network and<br>Communication,<br>Physiological Monitors |
| Panel 80<br>General<br>Hospital | 880.2910, II | FLL | Thermometer, electronic,<br>clinical |

- 3. The new device is substantially equivalent to the previously cleared Philips Component Compact Monitor (M1275B) device marketed pursuant to K013199.
- 4. The modification is a new multi-parameter module.
- The new device has the same Indications for Use, for use by 5. health care professionals whenever there is a need for monitoring the physiological parameters patients, as the legally marketed predicate device.
- 6. The new device has the same technological characteristics as the legally marketed predicate device.
- 7. Verification, validation, and testing activities establish the performance, functionality, and reliability characteristics of the new device with respect to the predicate. Testing involved system level tests, performance tests, and safety testing from hazard analysis. Pass/Fail criteria were based on the specifications cleared for the predicate device and test results showed substantial equivalence. The results demonstrate that Component Compact Monitor meets all reliability requirements and performance claims.

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#### DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image is a seal for the Department of Health & Human Services - USA. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is an image of a bird with three wavy lines extending from its body.

#### Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

### MAR 2 0 2002

Mr. Dave Osborn Quality Program Manager Philips Medical Systems Cardiac and Monitoring Systems 3000 Minuteman Road Andover, MA 01810-1099

Re: K020531

Trade Name: Philips Medical Systems, M1275B Component Monitor, Release A.02, with M3001A Multi-Parameter Module Regulation Number: 21 CFR 870.1025 Regulation Name: Arrhythmia Detector and Alarm Regulatory Class: Class III (three) Product Code: MHX Dated: February 14, 2002 Received: February 19, 2002

Dear Mr. Osborn:

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. Dave Osborn

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.

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 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 21 CFR Part 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 Part 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,

Walter Tunn

Bram D. Zuckerman, M.D. Acting Director Division of Cardiovascular And Respiratory Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Page **_/ of _**/

# 510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

510(k) Number (if known):

Device Name: Philips Medical Systems, M1275B Component Compact Monitor, Release A.02, with M3001A Multi-Parameter Module.

Indications for Use: Indicated for use by health care professionals whenever there is a need for monitoring the physiological parameters patients.

Intended use: For monitoring, recording, and alarming of multiple physiological parameters of adults, pediatrics, and neonates in health care facilities.

EASI 12-lead ECG is only for use on adult and pediatric patients.

ST Segment monitoring is restricted to adult patients only.

The transcutaneous gas measurement (tcp02 / tcpCO2) is restricted to neonatal patients only.

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)

| Prescription Use | <div style="display:inline-block; vertical-align:middle;">✓</div> | OR | Over-The-Counter |
|-----------------------------|-------------------------------------------------------------------|----|------------------|
| Use<br>(Per 21 CFR 801.109) | | | |
| (Optional Format 1-2-96) | | | |

Division of Cardiovascular & Respiratory Devices

510(k) Number: K026531