K Number
K213729

Validate with FDA (Live)

Device Name
Clover Glove
Date Cleared
2022-03-26

(120 days)

Product Code
Regulation Number
880.6250
Age Range
All
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticPediatricDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Clover Glove Nitrile Examination Gloves Powder Free is a disposable device intended for medical purpose that is worn on the examiner's hand to prevent contamination between patient and examiner.

Device Description

Clover Glove Nitrile Examination Gloves Powder Free is a Class I device bearing the product code LZA (21CFR 880.6250). They meet all the current specifications listed under the ASTM D6319 -19, Standard Specification for Nitrile Examination Gloves for Medical Application. They are made from acrylonitrilebutadiene copolymer dispersion. These gloves are blue in color having Finger Texture, Ambidextrous and are powder free. The product is non-sterile.

AI/ML Overview

The acceptance criteria and performance of the Clover Glove Nitrile Examination Gloves Powder Free are described below based on the provided FDA 510(k) summary.

1. A table of acceptance criteria and the reported device performance

Test CategoryCharacteristic/TestAcceptance Criteria (ASTM D6319-19 unless specified)Reported Device Performance (Clover Glove)Result
DimensionsLength230mm MinS: 245.15mm, M: 247.1mm, L: 248.30mmPass
Width (for Medium size)95mm ±10M: 92.69 mm (within 95±10)Pass
Width (for Small size)80mm ±10S: 83mm (within 80±10)Pass
Width (for Large size)110mm ±10L: 108.07mm (within 110±10)Pass
Thickness (Palm)S: 0.05 mm Min, M: 0.05 mm Min, L: 0.05 mm MinS: 0.08 mm, M: 0.09 mm, L: 0.09 mmPass
Thickness (Finger)S: 0.05 mm Min, M: 0.05 mm Min, L: 0.05 mm MinS: 0.123mm, M: 0.138mm, L: 0.14mmPass
Physical PropertyTensile Strength (Before Aging)14 MPa MinS: 30.60 MPa, M: 31.72 MPa, L: 37.01 MPaPass
Tensile Strength (After Aging)14 MPa MinS: 30.66 MPa, M: 30.80 MPa, L: 35.46 MPaPass
Ultimate Elongation (Before Aging)500% MinS: 604.61%, M: 575.38%, L: 596.92%Pass
Ultimate Elongation (After Aging)400% MinS: 573.84%, M: 580%, L: 566.15%Pass
Barrier PropertyDetection of Holes (AQL) (ASTM D6319-19, ASTM D5151-19)AQL 2.5 for all sizesAQL 2.5 for all sizesPass
Powder ResiduePowder Free Residue (ASTM D6124-06)≤2 mg/glove MaxS: 0.42mg, M: 0.34mg, L: 0.20mgPass
BiocompatibilityIn Vitro Cytotoxicity (ISO 10993-1:2018)Under the conditions of the study, non-cytotoxic.Under the conditions of the study, cytotoxic. *Different
Skin Sensitization (ISO 10993-1:2018)Under the conditions of the study not a sensitizerUnder the conditions of the study not a sensitizerPass
Skin Irritation (ISO 10993-1:2018)Under the condition of study not an irritantUnder the condition of study not an irritantPass
Acute Systemic Toxicity (ISO 10993-1:2018)Device extracts do not pose a systemic toxicity concern.Device extracts do not pose a systemic toxicity concern.Pass
Material Mediated Pyrogenicity (ISO 10993-1:2018)Device did not demonstrate a material mediated pyrogenicity response.Device did not demonstrate a material mediated pyrogenicity response.Pass

*Note on Cytotoxicity: The device initially showed a cytotoxic response, but additional testing for acute systemic toxicity concluded that the observed cytotoxicity was not a significant clinical concern, as it did not induce systemic toxicity in test animals.

2. Sample size used for the test set and the data provenance

The document does not specify the exact sample sizes used for each of the performance or biocompatibility tests. It refers to "actual data" for the device, implying that testing was conducted on samples of the Clover Glove.

The provenance of the data is that it was generated for the purpose of this 510(k) submission, likely by Clover Glove Company Limited or a contracted testing facility. The specific country of origin for the testing is not stated, but the company itself is located in Thailand. The testing appears to be prospective as it's specifically conducted for regulatory submission.

3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts

This information is not applicable as the device is a medical glove. The 'ground truth' is established by adherence to recognized international standards (ASTM) and biocompatibility testing according to ISO 10993-1, rather than expert consensus on medical images or diagnoses.

4. Adjudication method for the test set

This information is not applicable as the device is a medical glove. The performance is assessed against predefined quantitative and qualitative criteria from established standards, not through adjudication of expert opinions.

5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance

This information is not applicable as the device is a medical glove and not an AI-assisted diagnostic or imaging tool.

6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done

This information is not applicable as the device is a medical glove and not an algorithm or AI system.

7. The type of ground truth used

The ground truth for the performance tests (dimensions, physical properties, barrier properties, powder residue) is based on established standard specifications, specifically ASTM D6319-19 (Standard Specification for Nitrile Examination Gloves for Medical Application), ASTM D5151-19 (Standard Test Method for Detection of Holes in Medical Gloves), and ASTM D6124-06 (Reapproved 2017) (Standard Test Method for Residual Powder on Medical Gloves).

For biocompatibility, the ground truth is established by adherence to internationally recognized standards for biological evaluation of medical devices, specifically ISO 10993-1:2018 (Biological Evaluation of Medical Devices - Part 1, Evaluation and Testing within a Risk Management Process).

8. The sample size for the training set

This information is not applicable as the device is a physical medical product (gloves) and not a machine learning model requiring a training set.

9. How the ground truth for the training set was established

This information is not applicable for the same reason as point 8.

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: a symbol on the left and the FDA name and title on the right. The symbol on the left is a stylized representation of a human figure, while the text on the right reads "FDA U.S. FOOD & DRUG ADMINISTRATION" in blue letters.

March 26, 2022

Clover Glove Company Limited % Manoj Zacharias US Agent Liberty Management Group Limited 75 Executive Drive, Suite 114 Aurora, Illinois 60504

Re: K213729

Trade/Device Name: Clover Glove Nitrile Examination Gloves Powder Free Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I Product Code: LZA Dated: March 02, 2022 Received: March 07, 2022

Dear Manoj Zacharias:

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.

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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 mediation-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.

Bifeng Qian, M.D., Ph.D. 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 Ouality Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K213729

Device Name

Clover Glove Nitrile Examination Gloves Powder Free

Indications for Use (Describe)

Clover Glove Nitrile Examination Gloves Powder Free is a disposable device intended for medical purpose that is worn on the examiner's hand to prevent contamination between patient and examiner.

Type of Use (Select one or both, as applicable)
---------------------------------------------------

Prescription Use (Part 21 CFR 801 Subpart D)

X Over-The-Counter Use (21 CFR 801 Subpart C)

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Image /page/3/Picture/0 description: The image shows the logo for Clover Glove. The logo consists of a four-leaf clover on the left, with the top two leaves being green and the bottom left leaf being red. The bottom right leaf is also green. To the right of the clover is the word "CLOVER" in gray, with the "V" in red. Below the word "CLOVER" is a horizontal line, and below that is the word "GLOVE" in gray, with the "G" in orange.

510(k) SUMMARY (K213729)

[AS REQUIRED BY 21CFR807.92]

I. SUBMITTER

510(k) Owner's NameClover Glove Company Limited
Address1999/8 District Sriwara Village, Ladphrao 94 (Punjamit),Sriwara Rd, Plabphla, Wang Thong Lang, Krung Thep MahaNakhon, Thailand 10240
Telephone+66 64 92 44991
Contact personMr.Pongsin Pongwachirint
DesignationManaging Director
Contact Emailpongsin.p@cloverglove.co.th
Date of Summary Prepared25.03.2022

II. DEVICE

Device Trade NameClover Glove
Device Common NameNitrile Examination Gloves Powder Free
Device Classification nameNon-powdered patient examination glove
Regulation Number21 CFR 880.6250
ClassI
Product CodeLZA

III. PREDICATE DEVICE

Predicate Device NameJr Medic Blue Nitrile Examination Gloves Powder Free
510(k) NumberK192333
Regulation Number21 CFR 880.6250
ClassI
Product CodeLZA

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Image /page/4/Picture/0 description: The image shows the logo for Clover Glove. The logo consists of a four-leaf clover on the left, with the top two leaves being green and the bottom left leaf being red. The bottom right leaf is also green. To the right of the clover is the word "CLOVER" in gray letters, except for the "V" which is red. Below the word "CLOVER" is a green line, and below that is the word "GLOVE" in gray letters, except for the "G" which is orange.

IV. DEVICE DESCRIPTION

Clover Glove Nitrile Examination Gloves Powder Free is a Class I device bearing the product code LZA (21CFR 880.6250). They meet all the current specifications listed under the ASTM D6319 -19, Standard Specification for Nitrile Examination Gloves for Medical Application. They are made from acrylonitrilebutadiene copolymer dispersion. These gloves are blue in color having Finger Texture, Ambidextrous and are powder free. The product is non-sterile.

V. INDICATIONS OF USE

Clover Glove Nitrile Examination Gloves Powder Free is a disposable device intended for medical purpose that is worn on the examiner's hand to prevent contamination between patient and examiner.

VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE

SI.NoFeatures comparedProposed DevicePredicate DeviceResult
General Information
1.510(k) NumberK213729K192333-
2.ManufacturerClover Glove Company LimitedJR Engineering & MedicalTechnologies (M) SDN.BHD-
3.ClassificationIISame
4.Regulation number21 CFR 880.625021 CFR 880.6250Same
5.Product CodeLZALZASame
6.Indication For UseClover Glove Nitrile ExaminationGloves Powder Free is a disposabledevice intended for medicalpurpose that is worn on theexaminer's hand to preventcontamination between patientand examiner.Jr Medic Blue Nitrile ExaminationGloves Powder Free are intendedfor medical purposes that is wornon the examiner's hands toprevent contamination betweenpatient and examiner.Same
7.MaterialNitrileNitrileSame
8.ColorBlueBlueSame
9.TextureFinger TextureFinger textureSame
10.AmbidextrousYesData not available-
11.SizeS, M, LXS, S, M, L, XLSimilar
12.OTC UseYesYesSame
SI.NoFeatures comparedProposed DevicePredicate DeviceResult
13.ReusabilitySingle useSingle useSame
14.SterilityNon- sterileNon- sterileSame
15.DimensionsLength Min 230 mmWidth Min 95±10Mm (for medium size)Length Min 230 mmWidth Min 95±10Mm (for medium size)Same
16.ThicknessPalm min 0.05 mmFinger min 0.05 mmPalm min 0.05 mmFinger min 0.05 mmSame
17.Physical PropertiesBefore AgingTensile Strength min 14 MPaUltimate Elongation Min 500%After AgingTensile Strength min 14 MPaUltimate Elongation Min 400%Before AgingTensile Strength min 14 MPaUltimate Elongation Min 500%After AgingTensile Strength min 14 MPaUltimate Elongation Min 400%Same
18.Detection of HolesPasses AQL 2.5Passes AQL 1.5Similar
19.Powder Free Residue≤2 mg/glove Max≤2 mg/glove MaxSame
20.Shelf Life3 YearsData Not Available-
21.Biocompatibility StudyIn Vitro CytotoxicityUnder the conditions of the study,cytotoxic. Additional testing wasperformed to determine if this wasa systemic toxicity concern.Under the conditions of the study,cytotoxic. Additional testing wasperformed to determine if thiswas a systemic toxicity concern.Same
Skin SensitizationUnder the condition of the studynot a sensitizerUnder the condition of the studynot a sensitizerSame
Skin IrritationUnder the condition of the studynot an irritantUnder the condition of the studynot an irritantSame
Acute SystemicToxicityUnder the conditions of study, thedevice extracts do not pose asystemic toxicity concernUnder the conditions of study, thedevice extracts do not pose asystemic toxicity concernSame
Material MediatedPyrogenicityUnder the conditions of the study, thedevice did not demonstrate amaterial mediated pyrogenicityresponse.Under the conditions of thestudy, the device did notdemonstrate a material mediatedpyrogenicity response.Same

Table 1: General Comparison

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Image /page/5/Picture/0 description: The image shows the logo for Clover Glove. The logo consists of a four-leaf clover on the left and the words "CLOVER GLOVE" on the right. The clover has two green leaves, one red leaf, and one yellow leaf. The words "CLOVER GLOVE" are in gray, with the "V" in "CLOVER" being red and the "G" in "GLOVE" being yellow. A green line separates the two words.

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Image /page/6/Picture/0 description: The image is a logo for Clover Glove. The logo consists of a four-leaf clover on the left and the words "CLOVER GLOVE" on the right. The clover is made up of four circles, with the top left circle being red, the top right and bottom left circles being green, and the bottom right circle being orange. The word "CLOVER" is in gray, except for the letter "V", which is red. The word "GLOVE" is in gray, except for the letter "G", which is orange.

PERFORMANCE DATA VII.

A. Non- Clinical Data

Performance Tests

Clover Glove Nitrile Examination Gloves Powder Free is subjected to the following performance tests according to the requirements of Guidance for Industry and FDA Staff - Medical Glove Guidance Manual and found to be safe and efficient with respect to its intended use:

  • Dimension
  • Physical property
  • Barrier property tests
    • Δ Detection of Holes in Medical Gloves
  • Powder Free Residue
SINo.TestsProposed DeviceActual DataAcceptance CriteriaResult
1.SizeLengthWidthSizeLengthWidth
DimensionLength, Width andThicknessS245.15mm83mmS80mm±10Pass
M247.1 mm92.69 mmM230mm Min95mm ±10
L248.30mm108.07mmL110mm ±10
ASTM D6319-19ThicknessThickness
Standard Specification forNitrile Examination Glovesfor Medical ApplicationSizePalmFingerSizePalmFinger
S0.08 mm0.123mmS0.05 mm0.05 mmPass
M0.09 mm0.138mmMMinMin
L0.09 mm0.14mmL
2.Tensile strengthTensile strength
Physical propertyTensile strength andUltimate ElongationSizeBeforeAgingAfterAgingSizeBeforeAgingAfterAging
S30.60 MPa30.66 MPaS14 MPa14 MPaPass
M31.72 MPa30.80 MPaMMinMin
L37.01 MPa35.46 MPaL
ASTM D6319-19Standard Specification forNitrile Examination Glovesfor Medical ApplicationUltimate ElongationUltimate Elongation
SizeBeforeAgingAfterAgingSizeBeforeAgingAfterAging
S604.61%573.84%S500%400%
M575.38%580%MMinMin
L596.92%566.15%L

Table 2: Performance Testing Summary

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Image /page/7/Picture/0 description: The image shows the logo for Clover Glove. The logo has a four-leaf clover on the left side, with the top two leaves being green and the bottom left leaf being red and the bottom right leaf being green. To the right of the clover is the word "CLOVER" in gray, with the "V" in red. Below the word "CLOVER" is a green line, and below that is the word "GLOVE" in gray, with the "G" in orange.

SINo.TestsProposed DeviceActual DataAcceptance CriteriaResult
3.Barrier property testsDetection of Holes inMedical GlovesASTM D6319-19ASTM D5151-19Standard Test Method forDetection of Holes in MedicalGlovesAQL 2.5 for all sizesAQL 2.5 for all sizesPass
4.Powder Free ResidueSizeResidual powder contentSizeResidual powder content
ASTM D6124-06(Reapproved 2017)S0.42mgSPass
Standard Test Method forM0.34mgM≤2Mg/ Glove Max
Residual Powder on MedicalGlovesL0.20mgL

Biocompatibility B.

The materials used in the Clover Glove Nitrile Examination Gloves Powder Free are biocompatible based on the biocompatibility tests mentioned in the Guidance for Industry and FDA Staff - Medical Glove Guidance Manual:

  • In Vitro Cytotoxicity
  • Skin Sensitization
  • Skin Irritation
  • Acute Systemic Toxicity
  • Material Mediated Pyrogenicity

These tests were performed according to ISO 10993-1:2018, Biological Evaluation of Medical Devices -Part 1, Evaluation and Testing within a Risk Management Process.

Table 3: Biocompatibility Test Summary
--------------------------------------------
SI.NoTest PerformedProposed DeviceAcceptance CriteriaResult
1.In Vitro CytotoxicityUnder the conditions of the study,cytotoxic.Additionaltestingwasperformed to determine if this was asystemic toxicity concern.Under the conditions of thestudy, non-cytotoxic.Different
2.Skin SensitizationUnder the conditions of the study nota sensitizerUnder the conditions of thestudy not a sensitizerPass
3.Skin IrritationUnder the condition of study not anirritantUnder the condition of studynot an irritantPass

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Image /page/8/Picture/0 description: The image shows the logo for Clover Glove. The logo has a four-leaf clover on the left side, with the top two leaves being green and the bottom left leaf being red. The bottom right leaf is also green. To the right of the clover is the word "CLOVER" in gray letters, except for the "V" which is red. Below the word "CLOVER" is a green line, and below that is the word "GLOVE" in gray letters, except for the "G" which is yellow.

4.Acute Systemic ToxicityUnder the conditions of study, the device extracts do not pose a systemic toxicity concernUnder the conditions of study, the device extracts do not pose a systemic toxicity concernPass
5.MaterialMediatedPyrogenicityUnder the condition of the study, The device did not demonstrate a Material mediated pyrogenicity responseUnder the conditions of the study, the device did not demonstrate a material mediated pyrogenicity response.Pass
    • Since the cytotoxic study showing positive cytotoxic response, additional testing for acute systemic toxicity is conducted to determine if this was a systemic toxicity concern and it showed that the subject glove did not induce systemic toxicity in the test animals, which demonstrated that the cytotoxicity reactivity observed is not a significant concern in clinical settings.

C. Clinical Test Data

Clinical study was not conducted as clinical data is not needed for Clover Glove Nitrile Examination Gloves Powder Free.

VIII. CONCLUSION

The conclusion drawn from the non-clinical tests demonstrate that the subject device in 510(k) submission, Clover Glove Nitrile Examination Gloves Powder free is as effective, and performs as well as or better than the legally marketed predicate device, K192333.

§ 880.6250 Non-powdered patient examination glove.

(a)
Identification. A non-powdered 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. A non-powdered patient examination glove does not incorporate powder for purposes other than manufacturing. The final finished glove includes only residual powder from manufacturing.(b)
Classification. Class I (general controls). The device, when it is a finger cot, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 880.9.