K Number
K012104
Device Name
SNOW LOTUS POWDER-FREE LATEX SURGEON'S GLOVES
Date Cleared
2001-08-21

(47 days)

Product Code
Regulation Number
878.4460
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
A Powder Free Latex Surgical Glove is a disposable device intended in surgical settings for medical purpose that is worn on the hand to provide a barrier against potentially infectious materials and other contaminants. A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by the are and A surgeon's grove 15 a device intraction wound from contamination. (21CFR 878.4460)
Device Description
Class I Surgeon's Glove (Powder Free) 79KGO that meets all the requirement of ASTM D3577.
More Information

Not Found

Not Found

No
The document describes a standard surgical glove and does not mention any AI or ML components or functionalities.

No
This device is a surgical glove, intended to provide a barrier against contaminants, not to treat or cure a disease or condition.

No

Explanation: The device is a surgical glove, intended to provide a barrier against contaminants. Its function is protective, not diagnostic.

No

The device description and performance studies clearly indicate a physical medical device (surgical glove) and do not mention any software components.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states the device is a "disposable device intended in surgical settings for medical purpose that is worn on the hand to provide a barrier against potentially infectious materials and other contaminants." This describes a physical barrier device used during surgery.
  • Definition of IVD: IVD devices are used to examine specimens (like blood, urine, or tissue) taken from the human body to provide information about a person's health. This device does not perform such analysis.
  • Device Description: The description confirms it's a "Class I Surgeon's Glove."
  • Performance Studies: The performance studies focus on physical properties, sterility, and biocompatibility, which are relevant to a surgical glove, not an IVD.

Therefore, the information provided strongly indicates that this device is a surgical glove and not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

A Powder Free Latex Surgical Glove is a disposable device intended in surgical settings for medical purpose that is worn on the hand to provide a barrier against potentially infectious materials and other contaminants.
A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by the are and A surgeon's grove 15 a device intraction wound from contamination. (21CFR 878.4460)

Product codes (comma separated list FDA assigned to the subject device)

KGO

Device Description

Class I Surgeon's Glove (Powder Free) 79KGO that meets all the requirement of ASTM D3577.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hand

Indicated Patient Age Range

Not Found

Intended User / Care Setting

surgical settings

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

The performance test data of the powder free surgical gloves manufactured by Beijing Reagent Latex Products Co., Ltd. is given below:
Characteristics: Length, Width, Thickness.
Length (6.5, 7, 7.5, 8, 8.5, 9): Min. 265mm to Min. 280mm
Width (6.5, 7, 7.5, 8, 8.5, 9): 77-88 mm to 108-120 mm
Thickness: Cuff (0.14mm), Palm (0.18mm), Finger (0.22mm)

PHYSICAL PROPERTIES:
Characteristic: Tensile Strength, Elongation at break %, Modulus at 500% elongation
Before Aging: 28MPa, 830%, 3MPa
After Aging: 21MPa, 800%, 3MPa

PERFORMANCE REQUIREMENT:
Sterility: Fails sterility, LEVEL: N/A, AQL: N/A
Dimension: Width, Length, Thickness, LEVEL: S-2, AQL: 4.0
Freedom from Holes: Holes, LEVEL: S-4, AQL: 1.5
Physical Property: Tensile strength, Elongation At break before and after aging, LEVEL: S-2, AQL: 4.0

POWDER CONTENT: PROTEIN CONTENT: 31.4±0.05 Hg/g
BIOCOMPATIBILITY: Biologically Compatible

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

Not Found

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 878.4460 Non-powdered surgeon's glove.

(a)
Identification. A non-powdered surgeon's glove is a device intended to be worn on the hands of operating room personnel to protect a surgical wound from contamination. A non-powdered surgeon's 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).

0

BEIJING REAGENT LATEX PRODUCTS CO., LTD.

ADD: NO.30 SOUTH SANLITUN ROAD, DONGDAQIAO, CHAOWAL, BEUING, P.R.CHINA. POST CODE: 100020 FAX: 86-10-81501067 TEL: 86-10-81502573

KOI2104

AUG 2 1 2001

510K SUMMARY as required by: 807.92 (c)

1.0APPLICANT

BEIJING REAGENT LATEX PRODUCTS CO., LTD. Name: NO. 30 SOUTH SANLITUN ROAD, DONGDAQIAO, CHAOWAI Add .: BEIJING, 100020 P.R.CHINA Tel NO. 86-10-81502573 Fax NO. 86-10-81501067

Contact person: MRS. WANG YANNAN GENERAL MANAGER

  • 2.0 Device trade name: SNOW LOTUS Common Name: Surgeon's Glove Classification Name: Powder Free Surgeon's Glove
    3.0 Legally marketed device to which the company claiming equivalence:

Class I Surgeon's Glove (Powder Free) 79KGO that meets all the requirement of ASTM D3577.

4.0 Description of the device:

Class I Surgeon's Glove (Powder Free) 79KGO that meets all the requirement of ASTM D3577.

5.0 Intended use of the Device:

A Powder Free Latex Surgical Glove is a disposable device intended in surgical settings for medical purpose that is worn on the hand to provide a barrier against potentially infectious materials and other contaminants.

1

BEIJING REAGENT LATEX PRODUCTS CO., LTD. ADD: NO.30 SOUTH SANLITUN ROAD, DONGDAQIAO, CHAOWAI, BEIJING, P.R.CHINA. FAX: 86-10-81501067 POST CODE: 100020 TEL: 86-10-81502573

6.0 Technological characteristics of the device compared to predicate device.

| Measured Parameters of Latex Surgical Gloves Powder Free
manufactured by Beijing Reagent Products Co., Ltd. | | | ASTM D3577-00
Requirement for Latex
Surgical Gloves
Powder Free |
|----------------------------------------------------------------------------------------------------------------|--------|------------|--------------------------------------------------------------------------|
| Characteristics | Size | Value | |
| Length | 6.5 | Min.265 mm | Min. 265mm |
| | 7 | Min.270 mm | Min. 265mm |
| | 7.5 | Min.270 mm | Min. 265mm |
| | 8 | Min.270 mm | Min. 265mm |
| | 8.5 | Min.280 mm | Min. 265mm |
| | 9 | Min.280 mm | Min. 265mm |
| Width | 6.5 | 77-88 mm | 83±6 mm |
| | 7 | 84-94 mm | 89±6 mm |
| | 7.5 | 90-100 mm | 95±6 mm |
| | 8 | 96-108 mm | 102±6 mm |
| | 8.5 | 102-114 mm | 108±6 mm |
| | 9 | 108-120 mm | 114±6 mm |
| Thickness | Cuff | 0.14mm | Min.0.10 mm |
| | Palm | 0.18mm | Min.0.10 mm |
| | Finger | 0.22mm | Min.0.10 mm |

7.0 PHYSICAL PROPERTIES

BEFORE AGINGAFTER AGING
CharacteristicsValueASTM D3577ValueASTM D3577
Tensile Strength28MPa24MPa21MPa18MPa
Elongation at break %830%750%800%560%
Modulus at 500%
elongation3MPa5.5Mpa(max)

2

BEIJING REAGENT LATEX PRODUCTS CO., LTD.

K012104

ADD: NO.30 SOUTH SANLITUN ROAD, DONGDAQIAO, CHAOWAL, BEIJING, P.R.CHINA. FAX: 86-10-81501067 TEL: 86-10-81502573

POST CODE: 100020

8.0 PERFORMANCE REQUIREMENT

| Characteristics | Related
defects | Inspection
Level | Level as per
ASTM | AQL | AQL as per
ASTM D3577 |
|-----------------------|----------------------------------------------------------------------------|---------------------|----------------------|-----|--------------------------|
| Sterility | Fails sterility | As per ISO | As per USP | N/A | N/A |
| Freedom from
Holes | Holes | G-I | G-I | 1.5 | 1.5 |
| Dimension | Width
Length
Thickness | S-2 | S-2 | 4 | 4 |
| Physical
Property | Tensile
strength
Elongation
At break
before and
after aging | S-2 | S-2 | 4 | 4 |

POWDER CONTENT

VALUEASTM REQUIREMENT
0.38mg/glove2mg/glove max

PROTEIN CONTENT

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BIOCOMPATIBILITY:

VALUEFDA REQUIREMENT
Biologically CompatibleBiologically Compatible

3

Image /page/3/Picture/0 description: The image contains a sequence of alphanumeric characters, specifically "K012104". The characters are handwritten and appear to be on a white background. The numbers are clearly written and easy to read.

BEIJING REAGENT LATEX PRODUCTS CO., LTD. ADD: NO.30 SOUTH SANLITUN ROAD, DONGDAQIAO, CHAOWAI, BEIJING, P.R.CHINA. POST CODE: 100020 TEL: 86-10-81502573 FAX: 86-10-81501067

9.0 Performance Data:

The performance test data of the powder free surgical gloves manufactured by Beijing Reagent Latex Products Co., Ltd. is given below:

Measured Parameters of Latex Surgical Gloves Powder Free
manufactured by Beijing Reagent Latex Products Co., Ltd.
CharacteristicsSizevalue
Length6.5Min.265 mm
7Min.270 mm
7.5Min.270 mm
8Min.270 mm
8.5Min.280 mm
9Min.280 mm
Width6.577-88 mm
784-94 mm
7.590-100 mm
896-108 mm
8.5102-114 mm
9108-120 mm
ThicknessCuff0.14mm
Palm0.18mm
Finger0.22mm

PHYSICAL PROPERTIES

CharacteristicBefore AgingAfter Aging
Tensile Strength28MPa21MPa
Elongation at break %830%800%
Modulus at 500% elongation3MPa3MPa

4

BEIJING REAGENT LATEX PRODUCTS CO., LTD.

Image /page/4/Picture/1 description: The image shows a sequence of handwritten numbers. The numbers appear to be "1012104". The numbers are written in black ink on a white background. The handwriting is somewhat stylized, with some numbers slightly overlapping.

ADD: NO.30 SOUTH SANLITUN ROAD, DONGDAQIAO, CHAOWAI, BEIJING, P.R.CHINA. POST CODE: 100020 TEL: 86-10-81502573 FAX: 86-10-81501067

PERFORMANCE REQUIREMENT

CharacteristicsRelated defectsLEVELAQL
SterilityFails sterilityN/AN/A
DimensionWidth
Length
ThicknessS-24.0
Freedom
from HolesHolesS-41.5
Physical
PropertyTensile
strength
Elongation
At break
before and
after agingS-24.0

POWDER CONTENT: PROTEIN CONTENT: 31.4±0.05 Hg/g BIOCOMPATIBILITY: Biologically Compatible

  1. Clinical Data: N/A

11. CONCLUSION OF PERFORMANCE TEST DATA:

The Powder Free Surgical Glove manufactured by BEIJING REAGENT LATEX PRODUCTS CO., LTD. Meet or exceed the ASTM D 3577 Meet FDA Pin holes Requirement Meet labeling claim as shown by the Requirment

12. ANY OTHER INFORMATION

Any other information required by FDA regarding product safety and effectiveness will be provided on request.

5

Image /page/5/Picture/1 description: The image is a black and white logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three curved lines representing its wings. The eagle is enclosed within a circular border containing the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA". The text is arranged around the top and sides of the circle.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 2 1 2001

Mr. Wang Yannan General Manager Beijing Reagent Latex Products No. 30 South Sanlitun Road, Dongdaqiao Chaowai, Beijing, P.R. CHINA

K012104 Re : "Snow Lotus" Powder-Free Latex Trade/Device Name: Surgeon's Gloves 878.4460 Regulation Number: Regulatory Class: I Product Code: KGO Dated: November 30, 2001 Received: July 5, 2001

Dear Mr. Yannan:

We have reviewed your Section 510(k) notification of intent to we have reviewed your beccion 310mm, and we have determined the market the device fererenced above the indications for device is substancially equivalently marketed predicate use stated in the encreate, commerce prior to May 28, 1976, devices marketed in incerbead as Device Amendments, or to the enactment date of the neasified in accordance with the devices that have been recrabbilding, and Cosmetic Act (Act).
provisions of the Federal Food, and inchingt to the general provisions of the reactar toon andy, subject to the general controls provisions of the Act. The general controls controls provisions of choude requirements for annual provisions of the Act therauc requeed manufacturing practice, registration, firsting or as resinst misbranding and adulteration.

If your device is classified (see above) into either class II II your device is crabblied (boo wearket Approval), it may (Special Controls) or Stimbling Controls. Existing major be subject to such addrerends ice can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A rederal Regulations, freic ar, farob assumes compliance with Subscancially equivalenceuring Practice requirements, as set the Current Good Manaracter Regulation (QS) for Medical Forch In the Quarty of CFR Part 820) and that, Devices. Ocheral regarations, the Food and Drug Chrough periodic QB Inbecount) such assumptions. Failure to

6

Page 2 - Yannan

comply with the GMP regulation may result in regulatory Ith the GMP regulation may publish further announcements action. action. In addition, FDA may purchasis manufactor of the mote:
concerning your device in the tendersion whicssion does concerning your device in the readlication submission does this response to your premaince neer have under sections 531 not affect any obligation you might under the Electronic through 542 of the Act 101 devices and 1 and 1 mm . . . Product Radiation Control provisions, or other Federal laws or requlations.

This letter will allow you to begin marketing your device as This lecter will afrow your smarket notification.
described in your 510(k) premarket notification. The FDA described in your 510\x) prematice notribution to a legally
finding of substantial equivalence of your leggification for your finding of substancial equivalines of plassification for your marketed predicate device resures in a olaboration.
device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling If you desire specific advice rol additionally 809.10 for in regulation (21 cm Fare over are over act the Office of
vitro diagnostic devices), please contact the for quogti Compliance at (301) 594-4622. Additionally, for questions on Compliance at (301) 354 ising of your device, please contact the promotion and advertising or your actise.
the Office of Compliance at (301) 594-4639. Also, please note ene regulation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other general premarket notification (zick over the Act may be Information on your respon of Small Manufacturers obtained from the Division or among comment its toll-free number International and Comsumer Abbrando at its internet address (800) 650 2041 01 - (202) /dsma/dsmamain.html".

Sincerely yours,

Patricia Cuenite/for

Timothy A. Ulatowski Director Director and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

Indication for Use Statement

Applicant: Beijing Reagent Latex Products

510(k) Number (if known): _KOLZI_O 4

Device Name: Powder Free Latex Surgeon's Gloves

Indications For Use:

A surgeon's glove is a device made of natural or synthetic rubber intended to be worn by
the are and A surgeon's grove 15 a device intraction wound from contamination. (21CFR 878.4460)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Qiu S. Lim

(Division Sign-Off) (Division Sign-On)
Division of Dental, Infection Control,
Division of Dental, Infection Devices Division oral Hospital Device 510(k) Number --