K Number
K220550
Date Cleared
2022-06-14

(109 days)

Product Code
Regulation Number
878.4040
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Disposable Surgical Face Masks are intended to be worn to protect both the patient and healthcare personnel from transferring of microorganisms, body fluids and particulate material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. This is a single use, disposable device(s), provided non-sterile.

Device Description

The Disposable Surgical Face Mask is blue color, single use, flat-folded masks with nose piece and ear loops or ties. The blue colorant is polypropylene (PP) master batch.

The body of the mask is composed of four layers: the inner(4th layer) and outer(1st layers are made of spun-bond polypropylene, the 2nd layer is made of polyethylene film and the 3rd layer is made of melt blown polypropylene. The nose piece is made of Iron core coated with polypropylene, ear loop is made of Nylon and Spandex, and the ties are made of spun-bond polypropylene. Each mask contains ear loops or ties to secure the mask over the user's face and mouth with a bendable nose piece to firmly fit over the nose. This device is not made with natural rubber latex. The disposable surgical face masks are sold non-sterile and are intended to be single use, disposable devices.

AI/ML Overview

The provided FDA 510(k) summary describes the acceptance criteria and the study results for the Disposable Surgical Face Mask (M663BE, M663BT).

Here's a breakdown of the requested information:

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

Test MethodologyPurposeAcceptance CriteriaReported Device Performance
Fluid Resistance (ASTM F1862)To demonstrate resistance to penetration by synthetic blood.ASTM F2100 Level 3 29 out of 32 pass at 160 mmHg for Level 3Pass 32 out of 32 pass at 160 mmHg, 3 lots
Particulate Filtration Efficiency (ASTM F2299)To demonstrate the functionality of the subject device.≥ 98%Pass Average 99.929%, 99.947%, 99.978%
Bacterial Filtration Efficiency (ASTM F2101)To demonstrate the functionality of the subject device.≥ 98%Pass Average 99.8%, 99.9%, 99.8%
Differential Pressure (EN 14683 Annex C)To demonstrate the functionality of the subject device.< 6.0 mmH2O/cm²Pass Average 3.7 mmH2O/cm², 3.8 mmH2O/cm², 3.8 mmH2O/cm²
Flammability (16 CFR 1610)To demonstrate the functionality of the subject device.Class 1Pass, Class 1
Cytotoxicity (ISO 10993-5)To demonstrate the safety of the subject device.Non-cytotoxicUnder the conditions of the study, the device is non-cytotoxic.
Irritation (ISO 10993-10)To demonstrate the safety of the subject device.Non-irritatingUnder the conditions of the study, the device is non-irritating.
Sensitization (ISO 10993-10)To demonstrate the safety of the subject device.Non-sensitizingUnder the conditions of the study, the device is non-sensitizing.

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

  • Fluid Resistance Test:
    • Sample size: 32 samples per lot, tested across 3 lots. (Total 96 masks).
    • Data Provenance: Not explicitly stated, implied to be laboratory testing of manufactured masks.
  • Particulate Filtration Efficiency, Bacterial Filtration Efficiency, Differential Pressure, Flammability, Biocompatibility (Cytotoxicity, Irritation, Sensitization):
    • The specific number of samples for each of these tests is not individually detailed in the provided summary, beyond the "3 lots" mention for fluid resistance which might imply similar lot-based testing for other performance characteristics. The results are typically reported as averages across tests.
    • Data Provenance: Not explicitly stated, implied to be laboratory testing of manufactured masks.

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 Disposable Surgical Face Mask, and the performance evaluation relies on standardized non-clinical laboratory tests rather than expert interpretation of medical images or patient data.

4. Adjudication method for the test set

This information is not applicable as the performance evaluation relies on standardized non-clinical laboratory tests with objective pass/fail criteria, not on human interpretation or adjudication processes.

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. The device is a surgical face mask, and the evaluation does not involve AI or human readers for diagnostic purposes.

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

This information is not applicable. The device is a surgical face mask, and its performance evaluation does not involve an algorithm.

7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)

The "ground truth" for the device's performance is established by reference to established industrial standards and test methods. For example:

  • Fluid Resistance: ASTM F1862 and ASTM F2100 Level 3.
  • Particulate Filtration Efficiency: ASTM F2299.
  • Bacterial Filtration Efficiency: ASTM F2101.
  • Differential Pressure: EN 14683 Annex C.
  • Flammability: 16 CFR 1610.
  • Biocompatibility: ISO 10993 (Parts 5 and 10).

8. The sample size for the training set

This information is not applicable. The device is a surgical face mask and its development and evaluation do not involve machine learning models that require a training set.

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

This information is not applicable for the reasons stated in point 8.

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

August 3, 2022

Makrite Industries, Inc. % Ivy Wang Technical Manager Shanghai Sungo Management Consulting Company Limited 14th Floor, 1500# Century Avenue Shanghai, 200122 China

Re: K220550

Trade/Device Name: Disposable Surgical Face Mask (M663BE, M663BT) Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical apparel Regulatory Class: Class II Product Code: FXX

Dear Ivy Wang:

The Food and Drug Administration (FDA) is sending this letter to notify you of an administrative change related to your previous substantial equivalence (SE) determination letter dated June 14, 2022. Specifically, FDA is updating this SE Letter for a typographical error in the company name as an administrative correction.

Please note that the 510(k) submission was not re-reviewed. For questions regarding this letter please contact Brent Showalter, Ph.D., OHT6: Office of Orthopedic Devices, 240-402-1840, brent.showalter(@fda.hhs.gov.

Sincerely,

Brent Showalter -S

Brent Showalter, Ph.D. Assistant Director DHT6B: Division of Spinal Devices OHT6: Office of Orthopedic Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

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Image /page/1/Picture/0 description: The image contains the logos of the Department of Health & Human Services and the Food and Drug Administration (FDA). The Department of Health & Human Services logo is on the left, and the FDA logo is on the right. The FDA logo includes the letters "FDA" in a blue square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION" in blue text.

June 14, 2022

Makrite Industries Co, Inc. % Ivy Wang Technical Manager Shanghai Sungo Management Consulting Company Limited 14th Floor, 1500# Century Avenue Shanghai, 200122 China

Re: K220550

Trade/Device Name: Disposable Surgical Face Mask (M663BE, M663BT) Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: FXX Dated: May 10, 2022 Received: May 16, 2022

Dear Ivy Wang:

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 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,

Katherine D. Kavlock -S

for

Brent Showalter, Ph.D. Assistant Director DHT6B: Division of Spinal Devices OHT6: Office of Orthopedic 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) K220550

Device Name Disposable Surgical Face Mask (M663BE, M663BT)

Indications for Use (Describe)

The Disposable Surgical Face Masks are intended to be worn to protect both the patient and healthcare personnel from transferring of microorganisms, body fluids and particulate material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. This is a single use, disposable device(s), provided non-sterile.

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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K220550 Page 1 of 4

510(K) Summary

Prepared date: 2022-02-16 A. Applicant: MAKRITE INDUSTRIES, INC. Address: 11F-5., NO.79, Sec.1, Xintai 5th Rd., XiZhi Dist., New Taipei City 221, Taiwan Contact Person: Bob Wen Tel: +886-2-26982419 Fax: +886-2-26982423 Email: bobwen(@makrite.com.tw

Submission Correspondent: Primary contact: Ms. Ivy Wang Shanghai SUNGO Management Consulting Co., Ltd. Room 1401, Dongfang Building, 1500# Century Ave., Shanghai 200122, China Tel: +86-21-58817802 Email: haiyu.wang@sungoglobal.com Secondary contact: Mr. Raymond Luo Room 1401, Dongfang Building, 1500# Century Ave., Shanghai 200122, China Tel: +86-21-68828050 Email: fda.sungo@@gmail.com

B. Device:

Trade Name: Disposable Surgical Face Mask Common Name: Disposable Surgical Mask Model: M663BE, M663BT

Regulatory Information Classification Name: Surgical Face Mask Classification: Class II Product code: FXX Regulation Number: 878.4040 Review Panel: Surgical Apparel

C. Predicate device:

K210433 Surgical Face Mask Wuhan Dymex Healthcare Co., Ltd.

D. Indications for use:

The Disposable Surgical Face Masks are intended to be worn to protect both the patient and healthcare personnel from transferring of microorganisms, body fluids and particulate material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. This is a single use, disposable device(s), provided non-sterile.

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E. Device Description:

The Disposable Surgical Face Mask is blue color, single use, flat-folded masks with nose piece and ear loops or ties. The blue colorant is polypropylene (PP) master batch.

The body of the mask is composed of four layers: the inner(4th layer) and outer(1st layers are made of spun-bond polypropylene, the 2nd layer is made of polyethylene film and the 3rd layer is made of melt blown polypropylene. The nose piece is made of Iron core coated with polypropylene, ear loop is made of Nylon and Spandex, and the ties are made of spun-bond polypropylene. Each mask contains ear loops or ties to secure the mask over the user's face and mouth with a bendable nose piece to firmly fit over the nose. This device is not made with natural rubber latex. The disposable surgical face masks are sold non-sterile and are intended to be single use, disposable devices.

DeviceProposed DevicePredicate DeviceResult
ManufacturerMAKRITE INDUSTRIES, INC.Wuhan Dymex Healthcare Co., Ltd.
510K number-K210433-
Model nameDisposable Surgical Face MaskSurgical Face MaskSame
ClassificationClass II Device, FXX (21 CFR878.4040)Class II Device, FXX (21 CFR878.4040)Same
Intended useThe Disposable Surgical Face Masks are intended to be worn to protect both the patient and healthcare personnel from transferring of microorganisms, body fluids and particulate material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. This is a single use, disposable device(s), provided non-sterile.The Surgical Face Masks are intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. This is a single use, disposable device(s), provided non-sterile.Same
ModelEar loop, Tie-on, Flat pleated, 4 layersEar loop, Tie-on, Flat pleated, 3 layersDifferent
MaterialOuter layerSpun-bond polypropyleneSame
Middle layer2nd layer: polyethylene film/
3rd layer: Melt blown polypropyleneMelt-blown PolypropyleneSame
Inner layerSpun-bond polypropylene nonwoven fabricSpun-bond polypropyleneSame
Nose clipIron core coated with polypropyleneMalleable polyethylene wireDifferent
Ear loopsNylon, SpandexSpandexDifferent
TiesSpun-bond polypropyleneSpunbond PolypropyleneSame
ColorBlueBlueSame
Dimension (Length)17.5cm+/-0.45cm17.5cm+/-0.2cmSimilar
Dimension (Width)9.5cm+/-0.45cm9.5cm+/-0.2cmSimilar
OTC useYesYesSame
SterilityNon-SterileNon-SterileSame
UseSingle Use, DisposableSingle Use, DisposableSame
ASTM F2100 levelLevel 3Level 3Same
Fluid Resistance Performance ASTM F186232 out of 32 pass at 160 mmHg32 out of 32 pass at 160 mmHgSame
Particulate Filtration Efficiency ASTM F2299$\geq 98%$$\geq 98%$Same
Bacterial Filtration Efficiency ASTM F2101$\geq 98%$$\geq 98%$Same
Differential Pressure (Delta P) EN 14683 Annex C$< 6.0mmH2O/cm2$$< 6.0mmH2O/cm2$Same
Flammability 16 CFR 1610 16Class 1Class 1Same
BiocompatibilityISO10993ISO10993Same

F. Comparison with predicate device

Table 1 General Comparison

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G. Non-Clinical Test Conclusion

Non-clinical tests were conducted to verify that the proposed device met all design specification for the standards and test methods. The test results demonstrated that the proposed device complies with the following standards and the requirements stated in the Guidance for Industry and FDA Staff: Surgical Masks - Premarket Notification [510(k)] Submission issued on March 5, 2004:

  • A ISO 10993-5: 2009 Biological Evaluation of Medical Devices -- Part 5: Tests For In Vitro Cytotoxicity
  • A ISO 10993-10: 2010 Biological Evaluation of Medical Devices - Part 10: Tests for Irritation and Skin Sensitization

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  • A ASTM F2100, Standard Specification for Performance of Materials Used in Medical Face Masks
  • ASTM F1862, Standard Test Method for Resistance of Medical Face Masks to Penetration by Synthetic Blood (Horizontal Projection of Fixed Volume at A Known Velocity);

  • EN 14683, Medical Face Masks-Requirements and Test Methods; A
  • ASTM F2101, Standard Test Method for Evaluating the Bacterial Filtration Efficiency (BFE) Of Medical Face Mask Materials, Using A Biological Aerosol of Staphylococcus Aureus;

  • ASTM F2299, stand test method for determining the initial efficiency of materials used in medical face masks to penetration by particulates using latex spheres;

  • 16 CFR 1610, Standard for the Flammability of clothing textiles;

Test MethodologyPurposeAcceptance Criteria:Result
Fluid ResistanceASTM F2100 Level 329 out of 32 pass at160 mmHg for level 3Pass32 out of 32 pass at 160 mmHg, 3 lots
ParticulateFiltrationEfficiencyThe purpose ofthe performancetesting is todemonstrate thefunctionality ofthe subjectdevice.≥ 98%PassAverage 99.929%, 99.947%,99.978%
Bacterial FiltrationEfficiency≥ 98%PassAverage 99.8%, 99.9%,99.8%
DifferentialPressure< 6.0mmH2O/cm²PassAverage 3.7mmH2O/cm²,3.8mmH2O/cm²,3.8mmH2O/cm²
FlammabilityClass 1Pass, Class 1
CytotoxicityThe purpose ofthe testing is todemonstrate thesafety of thesubject device.Non-cytotoxicUnder the conditions of thestudy, the device isnon-cytotoxic.
IrritationNon-irritatingUnder the conditions of thestudy, the device isnon-irritating.
SensitizationNon-sensitizingUnder the conditions of thestudy, the device isnon-sensitizing

Table 2 - Performance Testing & Biocompatibility

H. Clinical Test Conclusion

No clinical study is included in this submission.

I. Conclusion

The conclusions drawn from the nonclinical tests demonstrate that the subject device is as safe, as effective, and performs as well as or better than the legally marketed predicate device K210433.

§ 878.4040 Surgical apparel.

(a)
Identification. Surgical apparel are devices that are intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operating room personnel from transfer of microorganisms, body fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and shoe covers, and isolation masks and gowns. Surgical suits and dresses, commonly known as scrub suits, are excluded.(b)
Classification. (1) Class II (special controls) for surgical gowns and surgical masks. A surgical N95 respirator or N95 filtering facepiece respirator is not exempt if it is intended to prevent specific diseases or infections, or it is labeled or otherwise represented as filtering surgical smoke or plumes, filtering specific amounts of viruses or bacteria, reducing the amount of and/or killing viruses, bacteria, or fungi, or affecting allergenicity, or it contains coating technologies unrelated to filtration (e.g., to reduce and or kill microorganisms). Surgical N95 respirators and N95 filtering facepiece respirators are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9, and the following conditions for exemption:(i) The user contacting components of the device must be demonstrated to be biocompatible.
(ii) Analysis and nonclinical testing must:
(A) Characterize flammability and be demonstrated to be appropriate for the intended environment of use; and
(B) Demonstrate the ability of the device to resist penetration by fluids, such as blood and body fluids, at a velocity consistent with the intended use of the device.
(iii) NIOSH approved under its regulation.
(2) Class I (general controls) for surgical apparel other than surgical gowns and surgical masks. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9.