81_FR_68485 81 FR 68293 - Medical Devices; Exemption From Premarket Notification: Method, Metallic Reduction, Glucose (Urinary, Nonquantitative) Test System in a Reagent Tablet Format

81 FR 68293 - Medical Devices; Exemption From Premarket Notification: Method, Metallic Reduction, Glucose (Urinary, Nonquantitative) Test System in a Reagent Tablet Format

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 81, Issue 192 (October 4, 2016)

Page Range68293-68295
FR Document2016-23899

The Food and Drug Administration (FDA) is publishing an order denying a petition requesting exemption from the premarket notification requirements for ``method, metallic reduction, glucose (urinary, nonquantitative)'' devices that are in a reagent tablet format and are classified as class II devices as urinary glucose (nonquantitative) test system (hereinafter referred to as ``copper reduction tablet test''). Urinary glucose (nonquantitative) measurements are used in the diagnosis and treatment of carbohydrate metabolism disorders including diabetes mellitus, hypoglycemia, and hyperglycemia. FDA is publishing this order in accordance with procedures established by the Food and Drug Administration Modernization Act of 1997 (FDAMA).

Federal Register, Volume 81 Issue 192 (Tuesday, October 4, 2016)
[Federal Register Volume 81, Number 192 (Tuesday, October 4, 2016)]
[Rules and Regulations]
[Pages 68293-68295]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-23899]



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Rules and Regulations
                                                Federal Register
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This section of the FEDERAL REGISTER contains regulatory documents 
having general applicability and legal effect, most of which are keyed 
to and codified in the Code of Federal Regulations, which is published 
under 50 titles pursuant to 44 U.S.C. 1510.

The Code of Federal Regulations is sold by the Superintendent of Documents. 
Prices of new books are listed in the first FEDERAL REGISTER issue of each 
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Federal Register / Vol. 81, No. 192 / Tuesday, October 4, 2016 / 
Rules and Regulations

[[Page 68293]]



DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Part 862

[Docket No. FDA-2016-P-1026]


Medical Devices; Exemption From Premarket Notification: Method, 
Metallic Reduction, Glucose (Urinary, Nonquantitative) Test System in a 
Reagent Tablet Format

AGENCY: Food and Drug Administration, HHS.

ACTION: Final order.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA) is publishing an order 
denying a petition requesting exemption from the premarket notification 
requirements for ``method, metallic reduction, glucose (urinary, 
nonquantitative)'' devices that are in a reagent tablet format and are 
classified as class II devices as urinary glucose (nonquantitative) 
test system (hereinafter referred to as ``copper reduction tablet 
test''). Urinary glucose (nonquantitative) measurements are used in the 
diagnosis and treatment of carbohydrate metabolism disorders including 
diabetes mellitus, hypoglycemia, and hyperglycemia. FDA is publishing 
this order in accordance with procedures established by the Food and 
Drug Administration Modernization Act of 1997 (FDAMA).

DATES: This order is effective October 4, 2016.

FOR FURTHER INFORMATION CONTACT: Sheila Connors, Center for Devices and 
Radiological Health (CDRH), Food and Drug Administration, 10903 New 
Hampshire Ave., Bldg. 66, rm. 4620, Silver Spring, MD 20993-0002, 301-
796-6181, [email protected].

SUPPLEMENTARY INFORMATION: 

I. Statutory Background

    Under section 513 of the Federal Food, Drug, and Cosmetic Act (the 
FD&C Act) (21 U.S.C. 360c), FDA must classify devices into one of three 
regulatory classes: Class I, class II, or class III. FDA classification 
of a device is determined by the amount of regulation necessary to 
provide a reasonable assurance of the safety and effectiveness of the 
device. Under the Medical Device Amendments of 1976 (1976 amendments) 
(Pub. L. 94-295), as amended by the Safe Medical Devices Act of 1990 
(Pub. L. 101-629), devices are to be classified into class I (general 
controls) if there is information showing that the general controls of 
the FD&C Act are sufficient to assure safety and effectiveness; into 
class II (special controls) if general controls, by themselves, are 
insufficient to provide reasonable assurance of safety and 
effectiveness, but there is sufficient information to establish special 
controls to provide such assurance; and into class III (premarket 
approval) if there is insufficient information to support classifying a 
device into class I or class II and the device is a life sustaining or 
life supporting device, or is for a use which is of substantial 
importance in preventing impairment of human health or presents a 
potential unreasonable risk of illness or injury.
    Section 510(k) of the FD&C Act (21 U.S.C. 360(k)) and the 
implementing regulations (21 CFR part 807) require persons who intend 
to market a device intended for human use to submit a premarket 
notification (510(k)) to FDA containing information that allows FDA to 
determine whether the device is ``substantially equivalent'' within the 
meaning of section 513(i) of the FD&C Act to a legally marketed device 
that does not require premarket approval (PMA).
    On November 21, 1997, the President signed into law FDAMA (Pub. L. 
105-115). Section 206 of FDAMA, in part, added a new section, 510(m), 
to the FD&C. Section 510(m)(1) of the FD&C Act requires FDA, within 60 
days after enactment of FDAMA, to publish in the Federal Register a 
list of each type of class II device that does not require a report 
under section 510(k) to provide reasonable assurance of safety and 
effectiveness. Section 510(m) of the FD&C Act further provides that a 
510(k) will no longer be required for these devices upon the date of 
publication of the list in the Federal Register. FDA published that 
list in the Federal Register of January 21, 1998 (63 FR 3142).
    Section 510(m)(2) of the FD&C Act provides that 1 day after the 
date of publication of the list under section 510(m)(1), FDA may exempt 
a class II device on its own initiative or upon petition of an 
interested person if FDA determines that a 510(k) is not necessary to 
provide a reasonable assurance of the safety and effectiveness of the 
device. This section requires FDA to publish in the Federal Register a 
notice of intent to exempt a device, or of the petition, and to provide 
a 30-day comment period. Within 120 days of publication of this 
document, FDA must publish in the Federal Register its final 
determination regarding the exemption of the device that was the 
subject of the notice. If FDA fails to respond to a petition under this 
section within 180 days of receiving it, the petition shall be deemed 
granted.
    FDA classified the urinary glucose (nonquantitative) test system 
into class II effective July 30, 1987 (52 FR 16102 at 16122, May 1, 
1987). The classification for urinary glucose (nonquantitative) test 
system is at Sec.  862.1340 (21 CFR 862.1340). The urinary glucose 
(nonquantitative) test system is identified as a device that is 
intended to measure glucosuria (glucose in urine). Urinary glucose 
(nonquantitative) measurements are used in the diagnosis and treatment 
of carbohydrate metabolism disorders including diabetes mellitus, 
hypoglycemia, and hyperglycemia. Devices under this classification 
regulation require premarket notification under section 510(k) of the 
FD&C Act.

II. Criteria for Exemption

    There are a number of factors FDA may consider to determine whether 
a 510(k) is necessary to provide reasonable assurance of the safety and 
effectiveness of a class II device. These factors are discussed in the 
guidance the Agency issued on February 19, 1998, entitled ``Procedures 
for Class II Device Exemptions from Premarket Notification, Guidance 
for Industry and CDRH Staff'' (Ref. 1). Accordingly, FDA generally 
considers the following factors to determine whether premarket

[[Page 68294]]

notification is necessary: (1) The device does not have a significant 
history of false or misleading claims or risks associated with inherent 
characteristics of the device; (2) characteristics of the device 
necessary for its safe and effective performance are well established; 
(3) changes in the device that could affect safety and effectiveness 
will either (a) be readily detectable by users by visual examination or 
other means such as routine testing, before causing harm, or (b) not 
materially increase the risk of injury, incorrect diagnosis, or 
ineffective treatment; and (4) any changes to the device would not be 
likely to result in a change in the device's classification. FDA may 
also consider that, even when exempting devices, these devices would 
still be subject to the limitations on exemptions.

III. Petition

    On March 18, 2016, FDA received a petition requesting an exemption 
from premarket notification requirements for copper reduction tablet 
tests that are classified as class II devices under Sec.  862.1340, 
urinary glucose (nonquantitative) test system, from Martin O'Connor, 
Germaine Laboratories, Inc. (See Docket No. FDA-2016-P-1026).
    On May 4, 2016 (81 FR 26802), FDA published a notice in the Federal 
Register announcing that this petition had been received in accordance 
with section 510(m)(2) of the FD&C Act. On June 20, 2016 (81 FR 39929), 
FDA republished a notice of the petition due to an inadvertent error in 
the docket number and provided an opportunity for interested persons to 
submit comments on the petition by July 20, 2016. FDA received no 
comments regarding this petition.
    FDA has completed review of the referenced petition and assessed 
the need for 510(k) clearance for copper reduction tablet test against 
the criteria laid out in section II. For the reasons described in this 
document, FDA has determined that premarket notification is necessary 
to provide a reasonable assurance of the safety and effectiveness of 
the copper reduction tablet tests classified under Sec.  862.1340 and 
assigned the classification product code JIM. Accordingly, FDA 
responded to the petition by letter dated September 6, 2016, denying 
the petition within the 180-day timeframe under section 510(m)(2) of 
the FD&C Act. (See Docket No. FDA-2016-P-1026).

IV. Order

    After reviewing the petition, FDA has determined that the petition 
failed to provide information to demonstrate that premarket 
notification is not necessary to provide a reasonable assurance of the 
safety and effectiveness of the device. Accordingly, FDA is denying the 
referenced petition for exemption from the premarket notification 
requirements.
    With regard to the first factor (see section II, Criteria for 
Exemption), although there have been no medical device reports reported 
to the Agency in recent years, there have been numerous reports to the 
Agency \1\ and in medical literature of risks associated with the 
inherent characteristics of this device, including possible device-
associated deaths, serious injuries, and malfunctions such as burns, 
explosions of the product bottle due to heat, and consumption of the 
device. For instance, there have been reports in the medical literature 
of patients consuming the tablets because of their similarity to pills, 
which has led to poisoning and one report of a death. Therefore, FDA 
does not agree with the petitioner that the device does not have a 
significant history of risks associated with inherent characteristics 
of the device.
---------------------------------------------------------------------------

    \1\ For more information, see Medical Device Reporting (MDR) 
database at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.CFM.
---------------------------------------------------------------------------

    Additionally, failure to observe the reaction at all times after 
the tablet has been added to the sample is another risk associated with 
the inherent characteristics of the device. This can lead to a false-
negative result and result in improper patient management, which can 
lead to serious injury or possibly death. The petition does not address 
how the device's inherent risks can be mitigated or controlled without 
premarket notification to provide a reasonable assurance of the safety 
and effectiveness of the device.
    With regard to the second factor, the petition stated that 
healthcare and laboratory professionals understand the appropriate use 
of a copper reduction tablet test and that a definitive diagnostic or 
therapeutic decision should not be based on the result of this method. 
However, a copper reduction tablet test can be used to evaluate 
pediatric patients for possible hereditary metabolic disorders through 
detection of reducing substances. For example, although all States 
require mandatory newborn screening for genetic metabolic defects, 
clinical laboratories may still use this device as a screening test on 
pediatric urine samples if there are any suspicions of metabolic 
disease prior to receiving newborn screening results or if the newborn 
screening results do not match the clinical state of the newborn. 
Although further diagnostic testing may be performed to confirm the 
result(s), physicians may immediately treat the newborn relying solely 
on the result of this test while awaiting the results for any followup 
diagnostic tests. False negative results also present a safety and 
effectiveness concern because followup diagnostic testing may not be 
performed, leading to the failure to start needed treatment for the 
newborn. The petition failed to demonstrate that a premarket submission 
is not necessary to provide a reasonable assurance of the safety and 
effectiveness of the device for such uses, and FDA does not agree that 
the characteristics of the device necessary for its safe and effective 
use are well established.
    With regard to the third factor, FDA also does not agree that 
changes in the device that could affect safety and effectiveness will 
either be readily detectable or not materially increase risks. The 
petition claimed that users could employ positive or negative controls 
to validate the reagents performance. However, while available quality 
control materials may contain glucose, they do not contain other 
reducing sugars (e.g., galactose, lactose). Therefore, such materials 
might not readily detect an issue with the device's safety or 
effectiveness in detecting other reducing sugars before causing harm. 
The petition argued that well-established protocols and methods could 
ensure there is no material increase in risk. The petition provided 
insufficient information to support this argument that changes in the 
device that could affect safety and effectiveness will either be 
readily detectable or not materially increase risks. Moreover, changes 
in the device that could affect safety and effectiveness might 
materially increase the risk of injury, incorrect diagnosis or 
ineffective treatment given the device type's intended uses. The 
petition also did not provide information to the contrary. The petition 
did not provide any relevant information regarding the fourth factor.
    In addition to these four factors, FDA considers the ``limitations 
on exemption.'' Manufacturers of any commercially distributed device 
for which FDA has granted an exemption from the requirement of 
premarket notification must still submit a premarket notification to 
FDA prior to marketing the device when any of the limitations of 
exemption are exceeded. The general limitations of exemption from 
premarket notification contained in Sec.  862.9 (21 CFR 862.9) are 
broadly applicable to in vitro diagnostic (IVD) devices classified 
under part 862 (21 CFR part 862). Under Sec.  862.9, the

[[Page 68295]]

exemption from the premarket notification requirements applies, in the 
case of IVD devices, only to those devices under part 862 for which 
misdiagnosis, as a result of using the device, would not be associated 
with high morbidity or mortality. FDA has previously assessed that this 
limitation is exceeded, and a premarket notification is necessary to 
provide a reasonable assurance of the safety and effectiveness of an 
IVD device, when such device is intended for use in screening or 
diagnosis of familial or acquired genetic disorders, including inborn 
errors of metabolism (Sec.  862.9(c)(2)) or intended for use in 
diabetes management (Sec.  862.9(c)(5)). The petition argued that the 
copper reduction tablet test is not intended for use in screening or 
diagnosis of familial and acquired genetic disorders, including inborn 
errors of metabolism, or for use in diabetes management. However, as 
explained previously, FDA disagrees and believes that the copper 
reduction tablet test described in the petition is intended for such 
uses and would likely exceed the limitations previously mentioned.
    Accordingly, for all of the foregoing reasons, the petition failed 
to demonstrate that a premarket submission is not necessary to provide 
a reasonable assurance of the safety and effectiveness of the device 
intended for such uses. Therefore, FDA is issuing this order denying 
the petition requesting exemption for a method, metallic reduction, 
glucose (urinary, nonquantitative) test system in a reagent tablet 
format that is intended to measure glucosuria (glucose in urine) from 
the premarket notification requirements. Manufacturers of this device 
type must continue to submit and receive FDA clearance of a 510(k) 
before marketing their device, as well as comply with all other 
applicable requirements under the FD&C Act.

V. Reference

    The following reference is on display in the Division of Dockets 
Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, 
Rm. 1061, Rockville, MD 20852, and is available for viewing by 
interested persons between 9 a.m. and 4 p.m., Monday through Friday; it 
is also available electronically at http://www.regulations.gov. FDA has 
verified the Web site address, as of the date this document publishes 
in the Federal Register, but Web sites are subject to change over time.

1. ``Procedures for Class II Device Exemptions from Premarket 
Notification, Guidance for Industry and CDRH Staff,'' February 1998, 
available at http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM080199.pdf.

    Dated: September 28, 2016.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2016-23899 Filed 10-3-16; 8:45 am]
 BILLING CODE 4164-01-P



                                                                                                                                                                                                   68293

                                                  Rules and Regulations                                                                                         Federal Register
                                                                                                                                                                Vol. 81, No. 192

                                                                                                                                                                Tuesday, October 4, 2016



                                                  This section of the FEDERAL REGISTER                    I. Statutory Background                               devices upon the date of publication of
                                                  contains regulatory documents having general                                                                  the list in the Federal Register. FDA
                                                                                                             Under section 513 of the Federal
                                                  applicability and legal effect, most of which                                                                 published that list in the Federal
                                                  are keyed to and codified in the Code of                Food, Drug, and Cosmetic Act (the
                                                                                                          FD&C Act) (21 U.S.C. 360c), FDA must                  Register of January 21, 1998 (63 FR
                                                  Federal Regulations, which is published under                                                                 3142).
                                                  50 titles pursuant to 44 U.S.C. 1510.                   classify devices into one of three
                                                                                                          regulatory classes: Class I, class II, or                Section 510(m)(2) of the FD&C Act
                                                  The Code of Federal Regulations is sold by              class III. FDA classification of a device             provides that 1 day after the date of
                                                  the Superintendent of Documents. Prices of              is determined by the amount of                        publication of the list under section
                                                  new books are listed in the first FEDERAL               regulation necessary to provide a                     510(m)(1), FDA may exempt a class II
                                                  REGISTER issue of each week.                            reasonable assurance of the safety and                device on its own initiative or upon
                                                                                                          effectiveness of the device. Under the                petition of an interested person if FDA
                                                                                                          Medical Device Amendments of 1976                     determines that a 510(k) is not necessary
                                                  DEPARTMENT OF HEALTH AND                                (1976 amendments) (Pub. L. 94–295), as                to provide a reasonable assurance of the
                                                  HUMAN SERVICES                                          amended by the Safe Medical Devices                   safety and effectiveness of the device.
                                                                                                          Act of 1990 (Pub. L. 101–629), devices                This section requires FDA to publish in
                                                  Food and Drug Administration                                                                                  the Federal Register a notice of intent
                                                                                                          are to be classified into class I (general
                                                                                                          controls) if there is information showing             to exempt a device, or of the petition,
                                                  21 CFR Part 862                                                                                               and to provide a 30-day comment
                                                                                                          that the general controls of the FD&C
                                                                                                          Act are sufficient to assure safety and               period. Within 120 days of publication
                                                  [Docket No. FDA–2016–P–1026]                            effectiveness; into class II (special                 of this document, FDA must publish in
                                                                                                          controls) if general controls, by                     the Federal Register its final
                                                  Medical Devices; Exemption From                                                                               determination regarding the exemption
                                                                                                          themselves, are insufficient to provide
                                                  Premarket Notification: Method,                                                                               of the device that was the subject of the
                                                                                                          reasonable assurance of safety and
                                                  Metallic Reduction, Glucose (Urinary,                                                                         notice. If FDA fails to respond to a
                                                                                                          effectiveness, but there is sufficient
                                                  Nonquantitative) Test System in a                                                                             petition under this section within 180
                                                                                                          information to establish special controls
                                                  Reagent Tablet Format                                                                                         days of receiving it, the petition shall be
                                                                                                          to provide such assurance; and into
                                                  AGENCY:    Food and Drug Administration,                class III (premarket approval) if there is            deemed granted.
                                                  HHS.                                                    insufficient information to support                      FDA classified the urinary glucose
                                                                                                          classifying a device into class I or class            (nonquantitative) test system into class
                                                  ACTION:   Final order.
                                                                                                          II and the device is a life sustaining or             II effective July 30, 1987 (52 FR 16102
                                                  SUMMARY:    The Food and Drug                           life supporting device, or is for a use               at 16122, May 1, 1987). The
                                                  Administration (FDA) is publishing an                   which is of substantial importance in                 classification for urinary glucose
                                                  order denying a petition requesting                     preventing impairment of human health                 (nonquantitative) test system is at
                                                  exemption from the premarket                            or presents a potential unreasonable risk             § 862.1340 (21 CFR 862.1340). The
                                                  notification requirements for ‘‘method,                 of illness or injury.                                 urinary glucose (nonquantitative) test
                                                  metallic reduction, glucose (urinary,                      Section 510(k) of the FD&C Act (21                 system is identified as a device that is
                                                  nonquantitative)’’ devices that are in a                U.S.C. 360(k)) and the implementing                   intended to measure glucosuria (glucose
                                                  reagent tablet format and are classified                regulations (21 CFR part 807) require                 in urine). Urinary glucose
                                                  as class II devices as urinary glucose                  persons who intend to market a device                 (nonquantitative) measurements are
                                                  (nonquantitative) test system                           intended for human use to submit a                    used in the diagnosis and treatment of
                                                  (hereinafter referred to as ‘‘copper                    premarket notification (510(k)) to FDA                carbohydrate metabolism disorders
                                                  reduction tablet test’’). Urinary glucose               containing information that allows FDA                including diabetes mellitus,
                                                  (nonquantitative) measurements are                      to determine whether the device is                    hypoglycemia, and hyperglycemia.
                                                  used in the diagnosis and treatment of                  ‘‘substantially equivalent’’ within the               Devices under this classification
                                                  carbohydrate metabolism disorders                       meaning of section 513(i) of the FD&C                 regulation require premarket
                                                  including diabetes mellitus,                            Act to a legally marketed device that                 notification under section 510(k) of the
                                                  hypoglycemia, and hyperglycemia. FDA                    does not require premarket approval                   FD&C Act.
                                                  is publishing this order in accordance                  (PMA).
                                                                                                             On November 21, 1997, the President                II. Criteria for Exemption
                                                  with procedures established by the Food
                                                  and Drug Administration Modernization                   signed into law FDAMA (Pub. L. 105–                      There are a number of factors FDA
                                                  Act of 1997 (FDAMA).                                    115). Section 206 of FDAMA, in part,                  may consider to determine whether a
                                                                                                          added a new section, 510(m), to the                   510(k) is necessary to provide
                                                  DATES: This order is effective October 4,
                                                                                                          FD&C. Section 510(m)(1) of the FD&C                   reasonable assurance of the safety and
                                                  2016.
                                                                                                          Act requires FDA, within 60 days after                effectiveness of a class II device. These
asabaliauskas on DSK3SPTVN1PROD with RULES




                                                  FOR FURTHER INFORMATION CONTACT:                        enactment of FDAMA, to publish in the                 factors are discussed in the guidance the
                                                  Sheila Connors, Center for Devices and                  Federal Register a list of each type of               Agency issued on February 19, 1998,
                                                  Radiological Health (CDRH), Food and                    class II device that does not require a               entitled ‘‘Procedures for Class II Device
                                                  Drug Administration, 10903 New                          report under section 510(k) to provide                Exemptions from Premarket
                                                  Hampshire Ave., Bldg. 66, rm. 4620,                     reasonable assurance of safety and                    Notification, Guidance for Industry and
                                                  Silver Spring, MD 20993–0002, 301–                      effectiveness. Section 510(m) of the                  CDRH Staff’’ (Ref. 1). Accordingly, FDA
                                                  796–6181, Sheila.Connors@fda.hhs.gov.                   FD&C Act further provides that a 510(k)               generally considers the following factors
                                                  SUPPLEMENTARY INFORMATION:                              will no longer be required for these                  to determine whether premarket


                                             VerDate Sep<11>2014   17:56 Oct 03, 2016   Jkt 241001   PO 00000   Frm 00001   Fmt 4700   Sfmt 4700   E:\FR\FM\04OCR1.SGM   04OCR1


                                                  68294             Federal Register / Vol. 81, No. 192 / Tuesday, October 4, 2016 / Rules and Regulations

                                                  notification is necessary: (1) The device               provide information to demonstrate that               Although further diagnostic testing may
                                                  does not have a significant history of                  premarket notification is not necessary               be performed to confirm the result(s),
                                                  false or misleading claims or risks                     to provide a reasonable assurance of the              physicians may immediately treat the
                                                  associated with inherent characteristics                safety and effectiveness of the device.               newborn relying solely on the result of
                                                  of the device; (2) characteristics of the               Accordingly, FDA is denying the                       this test while awaiting the results for
                                                  device necessary for its safe and                       referenced petition for exemption from                any followup diagnostic tests. False
                                                  effective performance are well                          the premarket notification requirements.              negative results also present a safety and
                                                  established; (3) changes in the device                     With regard to the first factor (see               effectiveness concern because followup
                                                  that could affect safety and effectiveness              section II, Criteria for Exemption),                  diagnostic testing may not be
                                                  will either (a) be readily detectable by                although there have been no medical                   performed, leading to the failure to start
                                                  users by visual examination or other                    device reports reported to the Agency in              needed treatment for the newborn. The
                                                  means such as routine testing, before                   recent years, there have been numerous                petition failed to demonstrate that a
                                                  causing harm, or (b) not materially                     reports to the Agency 1 and in medical                premarket submission is not necessary
                                                  increase the risk of injury, incorrect                  literature of risks associated with the               to provide a reasonable assurance of the
                                                  diagnosis, or ineffective treatment; and                inherent characteristics of this device,              safety and effectiveness of the device for
                                                  (4) any changes to the device would not                 including possible device-associated                  such uses, and FDA does not agree that
                                                  be likely to result in a change in the                  deaths, serious injuries, and                         the characteristics of the device
                                                  device’s classification. FDA may also                   malfunctions such as burns, explosions                necessary for its safe and effective use
                                                  consider that, even when exempting                      of the product bottle due to heat, and                are well established.
                                                  devices, these devices would still be                   consumption of the device. For                           With regard to the third factor, FDA
                                                  subject to the limitations on                           instance, there have been reports in the              also does not agree that changes in the
                                                  exemptions.                                             medical literature of patients consuming              device that could affect safety and
                                                                                                          the tablets because of their similarity to            effectiveness will either be readily
                                                  III. Petition                                                                                                 detectable or not materially increase
                                                                                                          pills, which has led to poisoning and
                                                     On March 18, 2016, FDA received a                    one report of a death. Therefore, FDA                 risks. The petition claimed that users
                                                  petition requesting an exemption from                   does not agree with the petitioner that               could employ positive or negative
                                                  premarket notification requirements for                 the device does not have a significant                controls to validate the reagents
                                                  copper reduction tablet tests that are                  history of risks associated with inherent             performance. However, while available
                                                  classified as class II devices under                    characteristics of the device.                        quality control materials may contain
                                                  § 862.1340, urinary glucose                                Additionally, failure to observe the               glucose, they do not contain other
                                                  (nonquantitative) test system, from                     reaction at all times after the tablet has            reducing sugars (e.g., galactose, lactose).
                                                  Martin O’Connor, Germaine                               been added to the sample is another risk              Therefore, such materials might not
                                                  Laboratories, Inc. (See Docket No. FDA–                 associated with the inherent                          readily detect an issue with the device’s
                                                  2016–P–1026).                                           characteristics of the device. This can               safety or effectiveness in detecting other
                                                     On May 4, 2016 (81 FR 26802), FDA                    lead to a false-negative result and result            reducing sugars before causing harm.
                                                  published a notice in the Federal                       in improper patient management, which                 The petition argued that well-
                                                  Register announcing that this petition                  can lead to serious injury or possibly                established protocols and methods
                                                  had been received in accordance with                    death. The petition does not address                  could ensure there is no material
                                                  section 510(m)(2) of the FD&C Act. On                   how the device’s inherent risks can be                increase in risk. The petition provided
                                                  June 20, 2016 (81 FR 39929), FDA                        mitigated or controlled without                       insufficient information to support this
                                                  republished a notice of the petition due                premarket notification to provide a                   argument that changes in the device that
                                                  to an inadvertent error in the docket                   reasonable assurance of the safety and                could affect safety and effectiveness will
                                                  number and provided an opportunity                      effectiveness of the device.                          either be readily detectable or not
                                                  for interested persons to submit                           With regard to the second factor, the              materially increase risks. Moreover,
                                                  comments on the petition by July 20,                    petition stated that healthcare and                   changes in the device that could affect
                                                  2016. FDA received no comments                          laboratory professionals understand the               safety and effectiveness might
                                                  regarding this petition.                                appropriate use of a copper reduction                 materially increase the risk of injury,
                                                     FDA has completed review of the                      tablet test and that a definitive                     incorrect diagnosis or ineffective
                                                  referenced petition and assessed the                    diagnostic or therapeutic decision                    treatment given the device type’s
                                                  need for 510(k) clearance for copper                    should not be based on the result of this             intended uses. The petition also did not
                                                  reduction tablet test against the criteria              method. However, a copper reduction                   provide information to the contrary. The
                                                  laid out in section II. For the reasons                 tablet test can be used to evaluate                   petition did not provide any relevant
                                                  described in this document, FDA has                     pediatric patients for possible hereditary            information regarding the fourth factor.
                                                  determined that premarket notification                                                                           In addition to these four factors, FDA
                                                                                                          metabolic disorders through detection of
                                                  is necessary to provide a reasonable                                                                          considers the ‘‘limitations on
                                                                                                          reducing substances. For example,
                                                  assurance of the safety and effectiveness                                                                     exemption.’’ Manufacturers of any
                                                                                                          although all States require mandatory                 commercially distributed device for
                                                  of the copper reduction tablet tests                    newborn screening for genetic metabolic
                                                  classified under § 862.1340 and                                                                               which FDA has granted an exemption
                                                                                                          defects, clinical laboratories may still              from the requirement of premarket
                                                  assigned the classification product code                use this device as a screening test on
                                                  JIM. Accordingly, FDA responded to the                                                                        notification must still submit a
                                                                                                          pediatric urine samples if there are any              premarket notification to FDA prior to
                                                  petition by letter dated September 6,
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                                                                                                          suspicions of metabolic disease prior to              marketing the device when any of the
                                                  2016, denying the petition within the                   receiving newborn screening results or
                                                  180-day timeframe under section                                                                               limitations of exemption are exceeded.
                                                                                                          if the newborn screening results do not               The general limitations of exemption
                                                  510(m)(2) of the FD&C Act. (See Docket                  match the clinical state of the newborn.
                                                  No. FDA–2016–P–1026).                                                                                         from premarket notification contained
                                                                                                                                                                in § 862.9 (21 CFR 862.9) are broadly
                                                  IV. Order                                                 1 For more information, see Medical Device
                                                                                                                                                                applicable to in vitro diagnostic (IVD)
                                                                                                          Reporting (MDR) database at http://
                                                    After reviewing the petition, FDA has                 www.accessdata.fda.gov/scripts/cdrh/cfdocs/           devices classified under part 862 (21
                                                  determined that the petition failed to                  cfMAUDE/search.CFM.                                   CFR part 862). Under § 862.9, the


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                                                                    Federal Register / Vol. 81, No. 192 / Tuesday, October 4, 2016 / Rules and Regulations                                        68295

                                                  exemption from the premarket                                  February 1998, available at http://             class III. FDA classification of a device
                                                  notification requirements applies, in the                     www.fda.gov/downloads/                          is determined by the amount of
                                                  case of IVD devices, only to those                            MedicalDevices/                                 regulation necessary to provide a
                                                  devices under part 862 for which                              DeviceRegulationandGuidance/                    reasonable assurance of the safety and
                                                                                                                GuidanceDocuments/UCM080199.pdf.
                                                  misdiagnosis, as a result of using the                                                                        effectiveness of the device. Under the
                                                  device, would not be associated with                      Dated: September 28, 2016.                          Medical Device Amendments of 1976
                                                  high morbidity or mortality. FDA has                    Leslie Kux,                                           (1976 amendments) (Pub. L. 94–295), as
                                                  previously assessed that this limitation                Associate Commissioner for Policy.                    amended by the Safe Medical Devices
                                                  is exceeded, and a premarket                            [FR Doc. 2016–23899 Filed 10–3–16; 8:45 am]           Act of 1990 (Pub. L. 101–629), devices
                                                  notification is necessary to provide a                  BILLING CODE 4164–01–P                                are to be classified into class I (general
                                                  reasonable assurance of the safety and                                                                        controls) if there is information showing
                                                  effectiveness of an IVD device, when                                                                          that the general controls of the FD&C
                                                  such device is intended for use in                      DEPARTMENT OF HEALTH AND                              Act are sufficient to assure safety and
                                                  screening or diagnosis of familial or                   HUMAN SERVICES                                        effectiveness; into class II (special
                                                  acquired genetic disorders, including                                                                         controls) if general controls, by
                                                  inborn errors of metabolism                             Food and Drug Administration                          themselves, are insufficient to provide
                                                  (§ 862.9(c)(2)) or intended for use in                                                                        reasonable assurance of safety and
                                                  diabetes management (§ 862.9(c)(5)).                    21 CFR Part 862                                       effectiveness, but there is sufficient
                                                  The petition argued that the copper                                                                           information to establish special controls
                                                                                                          [Docket No. FDA–2016–P–0159]
                                                  reduction tablet test is not intended for                                                                     to provide such assurance; and into
                                                  use in screening or diagnosis of familial               Medical Devices; Exemption From                       class III (premarket approval) if there is
                                                  and acquired genetic disorders,                         Premarket Notification; Method,                       insufficient information to support
                                                  including inborn errors of metabolism,                  Metallic Reduction, Glucose (Urinary,                 classifying a device into class I or class
                                                  or for use in diabetes management.                      Nonquantitative) Test System in a                     II and the device is a life-sustaining or
                                                  However, as explained previously, FDA                   Reagent Tablet Format                                 life-supporting device, or is for a use
                                                  disagrees and believes that the copper                                                                        which is of substantial importance in
                                                  reduction tablet test described in the                  AGENCY:    Food and Drug Administration,              preventing impairment of human
                                                  petition is intended for such uses and                  HHS.                                                  health, or presents a potential
                                                  would likely exceed the limitations                     ACTION:   Final order.                                unreasonable risk of illness or injury.
                                                  previously mentioned.                                                                                            Section 510(k) of the FD&C Act (21
                                                     Accordingly, for all of the foregoing                SUMMARY:    The Food and Drug                         U.S.C. 360(k)) and the implementing
                                                  reasons, the petition failed to                         Administration (FDA) is publishing an                 regulations (21 CFR part 807) require
                                                  demonstrate that a premarket                            order denying a petition requesting                   persons who intend to market a device
                                                  submission is not necessary to provide                  exemption from the premarket                          intended for human use to submit a
                                                  a reasonable assurance of the safety and                notification requirements for method,                 premarket notification (510(k)) to FDA
                                                  effectiveness of the device intended for                metallic reduction, glucose (urinary,                 containing information that allows FDA
                                                  such uses. Therefore, FDA is issuing                    nonquantitative) devices that are in a                to determine whether the device is
                                                  this order denying the petition                         reagent tablet format and are classified              ‘‘substantially equivalent’’ within the
                                                  requesting exemption for a method,                      as class II devices as urinary glucose                meaning of section 513(i) of the FD&C
                                                  metallic reduction, glucose (urinary,                   (nonquantitative) test system                         Act to a legally marketed device that
                                                  nonquantitative) test system in a reagent               (hereinafter referred to as ’’copper                  does not require premarket approval.
                                                  tablet format that is intended to measure               reduction tablet test’’). Urinary glucose                On November 21, 1997, the President
                                                  glucosuria (glucose in urine) from the                  (nonquantitative) measurements are                    signed into law FDAMA (Pub. L. 105–
                                                  premarket notification requirements.                    used in the diagnosis and treatment of                115). Section 206 of FDAMA, in part,
                                                  Manufacturers of this device type must                  carbohydrate metabolism disorders                     added section 510(m) to the FD&C Act.
                                                  continue to submit and receive FDA                      including diabetes mellitus,                          Section 510(m)(1) of the FD&C Act
                                                  clearance of a 510(k) before marketing                  hypoglycemia, and hyperglycemia. FDA                  requires FDA, within 60 days after
                                                  their device, as well as comply with all                is publishing this order in accordance                enactment of FDAMA, to publish in the
                                                  other applicable requirements under the                 with procedures established by the Food               Federal Register a list of each type of
                                                  FD&C Act.                                               and Drug Administration Modernization                 class II device that does not require a
                                                                                                          Act of 1997 (FDAMA).                                  report under section 510(k) of the FD&C
                                                  V. Reference                                                                                                  Act to provide reasonable assurance of
                                                    The following reference is on display                 DATES: This order is effective October 4,
                                                                                                                                                                safety and effectiveness. Section 510(m)
                                                  in the Division of Dockets Management                   2016.                                                 of the FD&C Act further provides that a
                                                  (HFA–305), Food and Drug                                FOR FURTHER INFORMATION CONTACT:                      510(k) will no longer be required for
                                                  Administration, 5630 Fishers Lane, Rm.                  Sheila Connors, Center for Devices and                these devices upon the date of
                                                  1061, Rockville, MD 20852, and is                       Radiological Health (CDRH), Food and                  publication of the list in the Federal
                                                  available for viewing by interested                     Drug Administration, 10903 New                        Register. FDA published that list in the
                                                  persons between 9 a.m. and 4 p.m.,                      Hampshire Ave., Bldg. 66, Rm. 4620,                   Federal Register of January 21, 1998 (63
                                                  Monday through Friday; it is also                       Silver Spring, MD 20993–0002, 301–                    FR 3142).
                                                  available electronically at http://                     796–6181, Sheila.Connors@fda.hhs.gov.                    Section 510(m)(2) of the FD&C Act
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                                                  www.regulations.gov. FDA has verified                   SUPPLEMENTARY INFORMATION:                            provides that 1 day after the date of
                                                  the Web site address, as of the date this                                                                     publication of the list under section
                                                  document publishes in the Federal                       I. Statutory Background                               510(m)(1), FDA may exempt a class II
                                                  Register, but Web sites are subject to                    Under section 513 of the Federal                    device on its own initiative or upon
                                                  change over time.                                       Food, Drug, and Cosmetic Act (the                     petition of an interested person, if FDA
                                                  1. ‘‘Procedures for Class II Device                     FD&C Act) (21 U.S.C. 360c), FDA must                  determines that a 510(k) is not necessary
                                                        Exemptions from Premarket Notification,           classify devices into one of three                    to provide reasonable assurance of the
                                                        Guidance for Industry and CDRH Staff,’’           regulatory classes: Class I, class II, or             safety and effectiveness of the device.


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Document Created: 2016-10-04 03:04:23
Document Modified: 2016-10-04 03:04:23
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionRules and Regulations
ActionFinal order.
DatesThis order is effective October 4, 2016.
ContactSheila Connors, Center for Devices and Radiological Health (CDRH), Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 66, rm. 4620, Silver Spring, MD 20993-0002, 301- 796-6181, [email protected]
FR Citation81 FR 68293 

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