K Number
K013267
Device Name
POWDER FREE (POLYMER COATED) NON CHLORINATED WHITE LATEX EXAMINATION GLOVES WITH PROTEIN CONTENT LABELING CLAIM (50 MICS
Date Cleared
2002-03-08

(158 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
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. (21CFR 880.6250)
Device Description
Latex Patient Examination glove , Powder free coated , Non chlorinated , non sterile (White) 50 micrograms or less of total water extractable protein per gram
More Information

Not Found

Not Found

No
The device description and intended use clearly define a standard patient examination glove, with no mention of AI/ML or related technologies. The performance studies focus on biological safety, not algorithmic performance.

No.
The device, a patient examination glove, is intended to prevent contamination between patient and examiner, not to treat or diagnose a disease or condition.

No

This device is a patient examination glove, intended to prevent contamination between patient and examiner. It does not perform any diagnostic function.

No

The device description clearly states it is a "Latex Patient Examination glove," which is a physical hardware device.

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 "Patient examination glove...worn on the examiner's hand or finger to prevent contamination between patient and examiner." This describes a physical barrier function, not a diagnostic test performed on samples taken from the body.
  • Device Description: The description details the material and properties of the glove, which are relevant to its barrier function and safety for skin contact, not to any diagnostic capability.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in samples
    • Providing information for diagnosis, monitoring, or screening
    • Reagents or test kits

The performance studies described (dermal irritation and sensitization) are related to the safety and biocompatibility of the glove for its intended use as a physical barrier, not to its diagnostic accuracy.

N/A

Intended Use / Indications for Use

A patient examination glove is a disposable device intended for medical purposes that is worn on the examiners hand or finger to prevent contamination between patient and examiner.

Product codes

80LYY, LYY

Device Description

Latex Patient Examination glove , Powder free coated , Non chlorinated , non sterile (White). 50 micrograms or less of total water extractable protein per gram.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

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

Not Found

Key Metrics

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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.

0

Siam Sempermed Corp., Ltd.

110 Moo 8 Kanjanavanit Rd., Hat Yai, Songkhla, Thailand 90230 Tel: 66 074 291 648 to 9 Fax: 66 074 291 650

MAR 8 2002

510 (k) SUMMARY

1.0 APPLICANT:

Dr. POONSUK CHERDKIATGUMCHAI SIAM SEMPERMED CORPORATION., Ltd. 110 MOO 8 KANJANAVANIT ROAD PATHONG HATYAI SONGKHLA THAILAND 90230 TEL: 66 074 291 648 OR 291 649 FAX: 66 074 291 650

2.0 CONTACT PERSON

Dr. POONSUK CHERDKIATGUMCHAI SIAM SEMPERMED CORPORATION., Ltd. 110 MOO 8 KANJANAVANIT ROAD PATHONG HATYAI SONGKHLA THAILAND 90230 TEL: 66 074 291 648 OR 291 649 FAX: 66 074 291 650

Mrs. KATIE LEVINSON SEMPERMED USA Inc. 30798 US Hwy. 19 N Palm Harbor, USA FL 34684 TEL: 727 787 7250 FAX: 727 787 7558

Page 1 (2)

3.0 Device Class: I Product code: 80LYY

4.0 Specification: Latex patient examination glove , Powder free coated , Non chilorinated -Class I 80LYY meets all of the requirements of ASTM standard D3578-00

5.0 Device Description: Latex Patient Examination glove , Powder free coated , Non chlorinated , non sterile (White)

50 micrograms or less of total water extractable protein per gram

6.0 Intended use: A patient examination glove is a disposable device intended for medical purposes that is worn on the examiners hand or finger to prevent contamination between patient and examiner.

7.0 Surface treatment: polymer coated

8.0 Primary Dermal Irritation in Rabbits Guinea Pig Sensitization (Buehler) : Consumer Product Testing Co. Experiment reference number : T00-0175 , T01-0112

Conclusion : According to Federal Hazardous Substances Act Regulation , (16 CFR 1500.41), and under the conditions of this test . This test article is not a primary dermal irritant

: This test article is not a sensitizer in guinea pigs, under condition of this test.

This document and its contents are confidential. Do not discuss with or give access to people not designated.

1

KO 3261

Siam Sempermed Corp., Ltd.

510 (k) SUMMARY

Page 2 (2)

CONFIDENTIAL

9.0 QUALITY CHARACTERISTICS

DimensionsMeet ASTM D 3578-00
Physical PropertiesMeet ASTM D 3578-00
Protein content50 ug/g or less
Residue PowderMeet ASTM D 3578-00
Freedom from pinholesMeet ASTM D 3578-00
Meet ASTM D 5151

Glove , Non chlorinated 10. Conclusion: Siam Sempermed Latex Patient Examination Glove ,Powder free coated (White)

meet the ASTM standard or equivalent standard meet pinhole FDA requirements meet labeling claims (see 5.0 and 6.0 above)

P. Oberndörfer

Dr. POONSUK CHERDKIATGUMCHAI Chief Quality Officer August 22 ,2001

This document and its contents are confidential. Do not discuss with or give access to people not designated.

2

Public Health Service

Image /page/2/Picture/2 description: The image is a black and white seal for the U.S. Department of Health & Human Services. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is a stylized image of an eagle with its wings spread.

8 2002 MAR

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Siam Sempermed Corporated, Limited C/O Ms. Katie Levinson Sempermed USA, Incorporated 30798 US Highway 19 North Palm Harbor, Florida 34684

Re: K013267

Trade/Device Name: Powder Free (polymer Coated) Non-Chlorinated White Latex Examination Gloves with Protein Content Labeling Claim ( 50 Micrograms or Less) Regulation Number: 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LYY Dated: February 14, 2002 Received: February 25, 2002

Dear Ms. Levinson :

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 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.

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

3

Page 2 - Ms. Levinson

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); 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.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Timothy A. Ulatowski Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

4

INDICATION FOR USE

Siam Sempermed Corp., Ltd. Applicant:

510(k) Number: 013267

Device Name: Latex Examination Glove, Powder-Free, Coated, Non-Chlorinated, White with a Protein Content of 50 Micrograms or Less of Total Water Extractable Protein per Gram

Indications For Use:

A Patient examination glove is a disposable device intended for medical A r adom examiner's hands or finger to prevent contamination between patient and examiner. (21CFR 880.6250)

Olin S. Lin

(Division Sign-Off) Division of Dental, Infection Control, and General Hospital Devi 510(k) Number _

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

Concurrence of CDRH, Office of Device Evaluation (ODE)