Nitrile Powder Free Examination Glove, Blue Tested for Use with 32 Chemotherapy Drugs and Fentanyl Permeation Resistance Claim

{0}------------------------------------------------ Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in a stacked format. February 24, 2021 GMP Medicare SDN BHD % David Lim Executive Director TG Medical USA (INC) 165 N. Aspen Avenue Azusa, California 91702 Re: K202003 Trade/Device Name: Nitrile Powder Free Examination Glove, Blue Tested for Use with 32 Chemotherapy Drugs and Fentanyl Permeation Resistance Claim Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I. reserved Product Code: LZA, LZC, QDO Dated: January 15, 2021 Received: January 25, 2021 Dear David Lim: 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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading. If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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. {1}------------------------------------------------ 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); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems. For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100). Sincerely. Ryan Ortega, PhD Acting Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health Enclosure {2}------------------------------------------------ # Indications for Use 510(k) Number (if known) K202003 #### Device Name Nitrile Powder Free Examination Glove, Blue Tested for Use with 32 Chemotherapy Drugs and Fentanyl Permeation Resistance Claim ### Indications for Use (Describe) A patient examination glove is a disposable device intended for medical purpose that is worn on the examiner's hand or finger to prevent contamination between patient and examiner. This glove was tested for use with chemotherapy drugs and Fentanyl Citrate as pet ASTM D6978-05 (Reapproved 2013), Standard Practice for Assessment of Medical Gloves to Permeation by Chemotherapy Drugs. | No | Test Chemotherapy Drug | Concentration (mg/ml) | Minimum breakthrough Detection Time (min) | |----|------------------------|-----------------------|-------------------------------------------| | 1 | Amethopterin | 25 | >240 | | 2 | Bleomycin Sulfate | 15 | >240 | | 3 | Busulfan | 6 | >240 | | 4 | Carboplatin | 10 | >240 | | 5 | Carmustine | 3.3 | 11.0 | | 6 | Cisplatin | 1 | >240 | | 7 | Cyclophosphamide | 20 | >240 | | 8 | Cytarabine | 100 | >240 | | 9 | Dacarbazine | 10 | >240 | | 10 | Docetaxel | 10 | >240 | | 11 | Doxorubicin HCl | 2 | >240 | | 12 | Ellence | 2 | >240 | | 13 | Etoposide | 20 | >240 | | 14 | Fludarabine | 25 | >240 | | 15 | Fluorouracil | 50 | >240 | | 16 | Gemcitabine | 38 | >240 | | 17 | Idarubicin | 1 | >240 | | 18 | Ifosfamide | 50 | >240 | | 19 | Irinotecan | 20 | >240 | | 20 | Mechlorethamine | 1 | >240 | | 21 | Melphalan | 5 | >240 | | 22 | Methotrexate | 25 | >240 | | 23 | Mitomycin C | 0.5 | >240 | | 24 | Mitoxantrone | 2 | >240 | | 25 | Oxaliplatin | 5 | >240 | | 26 | Paclitaxel | 6 | >240 | | 27 | Rituximab | 10 | >240 | | 28 | Thiotepa | 10 | 39 | | 29 | Topotecan | 1 | >240 | | 30 | Trisenox | 1 | >240 | | 31 | Vincristine Sulfate | 1 | >240 | | 32 | Vinorelbine | 10 | >240 | | 33 | Fentanyl Citrate | 100 mcg/2ml | >240 | {3}------------------------------------------------ Please note that Carmustine and Thiotepa have extremely low permeation times of 11 minutes respectively Warning: do not use Carmustine. CAUTION: Testing showed an average breakthrough time of 39 minutes with Thiotepa Type of Use (Select one or both, as applicable) Prescription Use (Part 21 CFR 801 Subpart D) > Over-The-Counter Use (21 CFR 801 Subpart C) # CONTINUE ON A SEPARATE PAGE IF NEEDED. This section applies only to requirements of the Paperwork Reduction Act of 1995. ## *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.* The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. 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