K Number
K021961
Device Name
POWDER-FREE POLY-VINYL EXAM GLOVES, COLOR: WHITE
Date Cleared
2002-07-02

(18 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
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.
Device Description
POWDER-FREE POLY-VINYL EXAM GLOVES, COLOR: WHITE
More Information

Not Found

No
The summary describes a standard examination glove and contains no mention of AI, ML, or related technologies.

No
The device, a patient examination glove, is intended to prevent contamination, not to treat or cure a disease or condition.

No
Explanation: The device is a "patient examination glove," which is used for contamination prevention during examinations. It does not perform any diagnostic function.

No

The device is a physical product (gloves) and not software.

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 device used during patient examination, not a device used to examine specimens in vitro (outside the body) to diagnose or monitor a condition.
  • Device Description: The description "POWDER-FREE POLY-VINYL EXAM GLOVES" further reinforces that it's a physical barrier, not a diagnostic tool.
  • Lack of IVD Characteristics: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological specimens (blood, urine, tissue, etc.)
    • Detecting specific analytes (proteins, DNA, antibodies, etc.)
    • Providing diagnostic information about a patient's health status.

Therefore, this device falls under the category of a medical device used for protection and hygiene during patient care, not an in vitro diagnostic device.

N/A

Intended Use / Indications for 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.

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

LZA, LYZ

Device Description

POWDER-FREE POLY-VINYL EXAM GLOVES, Color: WHITE

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

healthcare professionals at Dentist and Doctor Offices, Laboratories, Clinics and Hospitals

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)

This device has met or exceeded the following standards and/or tests:
ASTM D 5250-00
ASTM D 5151-00
ASTM D 6124-00
Bio-Burden
Bio-Compatibility: Dermal Sensitization Primary Skin Irritation

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.

K992979, K002340

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

§ 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

JUL = 2 2002

Ko21961

510(k) SUMMARY

| Submitted For: | COPIOUMED INTERNATIONAL, INC.
6f-1, No. 169-12, Sec. 2
Chang AN East Road
Taipei, Taiwan, ROC |
|--------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Submitted By: | TUCKER & ASSOCIATES
Official Correspondent for Copioumed International, Inc.
JANNA P. TUCKER, President-CEO
198 Avenue de la D'emerald
Sparks, NV 89434-9550 |
| Phone: | 775-342-2612 |
| Fax: | 775-342-2613 |
| E-Mail: | Tuckerjan@aol.com |
| Date of Submission: | 10 June 2002 |
| Device Name: | POWDER-FREE POLY-VINYL EXAM GLOVES,
COLOR: WHITE
Class I Device, 80LZA |
| Proprietary Name: | (Multiple Labels) Powder-Free Poly-Vinyl Exam Gloves,
Color: White |
| Labels/Labeling: | This device will be marketed to healthcare professionals at
Dentist and Doctor Offices, Laboratories, Clinics and
Hospitals through its distributors for the intended use. |
| 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. |
| Substantial Equivalence: | Both in its intended use and/or physical
characteristics, this device is equivalent to devices
currently marketed by U.S. companies. Except for color, it
is substantially Equivalent to the devices manufactured
by Shanghai Poseidon Plastic Products Company Limited,
(K992979) and Glormed International (K002340) |

EXHIBIT L
Page 50 of 51

1

510k) Summary page 2.

Test Results (Means and/or Successful Results:

This device has met or exceeded the following standards and/or tests:

ASTM D 5250-00 ASTM D 5151-00 ASTM D 6124-00 Bio-Burden

Bio-Compatibility: Dermal Sensitization Primary Skin Irritation

Conclusion:

Except for color, this device is substantially equivalent to the devices approved as K992979 and K002340

EXHIBIT L
Page 51 of 51

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's name in a circular arrangement around a symbol. The symbol is a stylized representation of an eagle with three profiles, suggesting a focus on people and health.

JUL = 2 2002

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Copioumed International, Incorporated C/O Ms. Janna P. Tucker Tucker & Associates 198 Avenue De La D' Emerald Sparks. Nevada 89434-9550

Re: K021961

Trade/Device Name: Powder-Free Poly-Vinyl Examination Gloves, White Regulation Number: 880.6250 Regulation Name: Patient Examination Gloves Regulatory Class: I Product Code: LYZ Dated: June 10, 2002 Received: June 14, 2002

Dear Ms. Tucker:

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 of the Act or any Federal statutes and regulations administered by other Federal agencies.

3

Page 2 - Ms. Tucker

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.qov/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

Enclosure

4

INDICATIONS FOR USE

COPIOUMED INTERNATIONAL, INC. APPLICANT: K021961 510(k) NUMBER: POWDER-FREE POLY-VINYL DEVICE NAME: EXAMINATION GLOVES, COLOR: WHITE

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.

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Per 21 CFR 801.109) OR

Over-The-Counter Use__________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)

Qlin S. Lim

EXHIBIT B
Page 2 of 51

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