(MULTIPLE LABELS) POWDER-FREE POLY-VINYL EXAM GLOVES, COLOR: YELLOW

{0}------------------------------------------------ K021743 # JUN 1 0 2002 # 510(k) SUMMARY | Submitted For: | COPIOUMED INTERNATIONAL, INC.<br>6f-1, No. 169-12, Sec. 2<br>Chang AN East Road<br>Taipei, Taiwan, ROC | |--------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Submitted By: | TUCKER & ASSOCIATES<br>Official Correspondent for Copioumed International, Inc.<br>JANNA P. TUCKER, President-CEO<br>198 Avenue de la D'emerald<br>Sparks, NV 89434-9550 | | Phone: | 775-342-2612 | | Fax: | 775-342-2613 | | E-Mail: | Tuckerjan@aol.com | | Date of Submission: | 20 May 2002 | | Device Name: | POWDER-FREE POLY-VINYL EXAM GLOVES,<br>COLOR: YELLOW<br>Class I Device, 80LZA | | Proprietary Name: | (Multiple Labels) Powder-Free Poly-Vinyl Exam Gloves,<br>Color: Yellow | | Labels/Labeling: | This device will be marketed to healthcare professionals at<br>Dentist and Doctor Offices, Laboratories, Clinics and<br>Hospitals through its distributors for the intended use. | | Intended Use: | A patient examination glove is a disposable device intended<br>for medical purposes that is worn on the examiner's hand<br>or finger to prevent contamination between patient and<br>examiner. | | Substantial Equivalence: | Both in its intended use and/or physical<br>characteristics, this device is equivalent to devices<br>currently marketed by U.S. companies. It is substantially<br>Equivalent to the devices manufactured by Shanghai<br>Poseidon Plastic Products Company Limited, (K992979)<br>and Glormed International (K002340) | EXHIBIT L Page 45 of 46 {1}------------------------------------------------ K021743 510k) Summary page 2. Test Results (Means and/or Successful Results: This device has met or exceeded the following standards and/or tests: ASTM D 5250-00 ASTM D 5151-00 ASTM D 6124-00 Bio-Burden Bio-Compatibility: Dermal Sensitization Primary Skin Irritation Conclusion: This device is substantially equivalent to the devices Approved as K992979 and K002340 EXHIBIT L Page 46 of 46 {2}------------------------------------------------ #### DEPARTMENT OF HEALTH & HUMAN SERVICES Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the top half of the circle. Inside the circle is an abstract image of an eagle with three lines representing its wings and head. Public Health Service ### JUN 1 0 2002 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 Copioumed International, Incorporated C/O Ms. Janna P. Tucker Tucker & Associates 198 Avenue De La D' Emerald Sparks. Nevada 89434-9550 Re: K021743 Trade/Device Name: Powder-Free Poly-Vinyl Examination Gloves, Color Yellow Regulation Number: 880.6250 Regulation Name: Patient Examination Gloves Regulatory Class: I Product Code: LZA Dated: May 20, 2002 Received: May 28, 2002 Dear Ms. Tucker: 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 vour 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. {3}------------------------------------------------ #### Page 2 - Ms. Tucker 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 (301) 594-4618. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. 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 (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.qov/cdrh/dsma/dsmamain.html Sincerely yours Tim A. Utterback Timt th A. Ulatowski Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {4}------------------------------------------------ ### INDICATIONS FOR USE ## APPLICANT: COPIOUMED INTERNATIONAL, INC. 14021743 510(k) NUMBER: DEVICE NAME: POWDER-FREE POLY-VINYL EXAM GLOVES, COLOR: YELLOW A patient examination glove is a disposable device intended for medical purposes that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Prescription Use (Per 21 CFR 801.109) OR Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________ (Optional Format 1-2-96) (Optional) (Division Sign-Off) Division of Dental, Infection Control, and General Hospital Dev 510:k) Number