K Number
K040916
Device Name
VITALCARE POWDER FREE SYNTHETIC VINYL EXAMINATION GLOVE
Date Cleared
2005-05-04

(391 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 examiners hand or finger to prevent contamination between the patient and examiner.
Device Description
VitalCare Powder Free Synthetic Vinyl Examination Glove. A patient examination glove is a disposable device intended for medical purposes that is worn on the hand of healthcare professional and similar personnel to prevent contamination between the healthcare personnel and the patient's body, fluids, waste or environment.
More Information

Not Found

No
The device is a simple examination glove and the summary contains no mention of AI or ML.

No

The device description indicates it is an examination glove used to prevent contamination, which is a barrier function, not a therapeutic intervention to treat or alleviate a medical condition.

No
Explanation: The device is an examination glove, used to prevent contamination between patient and examiner, not to diagnose a condition.

No

The device is a physical examination glove, which is a hardware medical device, not a software-only device. The description focuses on physical properties and performance tests related to the glove material and function.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly states the glove is "worn on the examiners hand or finger to prevent contamination between the patient and examiner." This is a barrier function, not a diagnostic function performed in vitro (outside the body).
  • Device Description: The description reinforces the barrier function, preventing contamination between healthcare personnel and the patient's body, fluids, waste, or environment.
  • Lack of Diagnostic Activity: There is no mention of the device being used to analyze samples (blood, urine, tissue, etc.) or to provide information about a patient's health status or condition.
  • Performance Studies: The performance studies focus on physical properties (strength, dimensions, powder content, leak resistance) and biocompatibility (skin irritation/sensitization), which are relevant for a barrier device, not a diagnostic one.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This glove does not perform any of those functions.

N/A

Intended Use / Indications for Use

A patient examination glove is a disposable device intended for medical purposes that is worn on the hand of healthcare professional and similar personnel to prevent contamination between the healthcare personnel and the patient's body, fluids, waste or environment.

Product codes

LYZ

Device Description

VitalCare Powder Free Synthetic Vinyl Examination Glove.

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

healthcare professional and similar personnel

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)

VitalCare Powder Free Vinyl Examination Glove meets all requirements for ASTM Standard D-5250-00 physical and dimensional testing, ASTM D6124-01 for starch to determine the gloves meet the powder free claim, no more than 2mg powder per glove. FDA 1000ml Water Leak Test. Primary Skin Irritation and Skin Sensitization tests demonstrate no skin irritation or sensitization.

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

Not Found

Predicate Device(s)

VitalCare Vinyl Powdered Examination Glove, K 992289

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

MAY - 4 2005

K 0409/6

510(k) Summary
----------------
Date:March 24, 2004
Submitter:VitalCare Group Inc.
8935 NW 27th Street
Miami Fl. 33172
Contact:Michael McAvenia
Director of Quality Assurance
(305) 620-4007
Fax: (305) 620-5220
Internet: michaelm@vitalcare.com
Establishment Number:1063200
Address of Manufacturing Site:VitalCare Malaysia, SDN BHD, Inc.
Lot 7, Jalan 16/11
Shah Alan - Selangor
Malaysia
Name of Device:VitalCare Powder Free Synthetic Vinyl Examination
Glove
Predicate Device:VitalCare Vinyl Powdered Examination Glove
Device Common and Classification Name(s):
Common Name: Powder Free Exam Glove
Classification Name: Glove, Patient Examination, Vinyl
Classification Information:
Class:Class IPanel:General HospitalProduct Code:LYZCite:880.6250Class:Class IPanel:General HospitalProduct Code:LYZCite:880.6250
Class:Class I
Panel:General Hospital
Product Code:LYZ
Cite:880.6250

1

Intended Use of the New Device: A patient examination glove is a disposable device intended for medical purposes that is worn on the hand of healthcare professional and similar personnel to prevent contamination between the healthcare personnel and the patient's body, fluids, waste or environment

Guidance Documents: ASTM -D-5250-00, ASTM- D-6124-01, FDA 1000 ml Water Leak Test.

2

Feature\ClaimDetailPredicate
Intended UseA patient examination glove is a disposable device
intended for medical purposes that is worn on the
hand of healthcare professional and similar personnel
to prevent contamination between the healthcare
personnel and the patient's body, fluids, waste or
environmentSimilar
MaterialsVinyl, Synthetic
Plastic Bag
CorrugatedSimilar
Similar
Similar
LabelingVitalCare Powder Free Synthetic Vinyl Examination
Glove
Reorder Number
Size
Quantity
Non - Sterile, pouch and shipping case
Manufacturer AddressPowdered
Similar
Similar
Similar
Similar
Similar
Similar
PackagingOne plastic bag, 100 pouches per caseSimilar

3

Labels, Labeling: See Attachments

: !

Package labels: Copies of the labels for the Powder Free Synthetic Vinyl Exam glove pouch and shipping case are included. See Attachment 1

Promotional Materials: No promotional materials have been developed for this device.

Engineering Drawings: Engineering drawings, with dimensions and tolerances, are included in Attachment 2

Performance Data: VitalCare Powder Free Vinyl Examination Glove meets all requirements for ASTM Standard D-5250-00 physical and dimensional testing, ASTM D6124-01 for starch to determine the gloves meet the powder free claim, no more than 2mg powder per glove. FDA 1000ml Water Leak Test. Primary Skin Irritation and Skin Sensitization tests demonstrate no skin irritation or sensitization.

Comparative Claims: No comparative claims are made for the VitalCare Powder Free Synthetic Vinyl Examination glove. The glove is not claimed as hypoallergenic. It will not be compared in labeling or advertising to other devices.

Unique Designs: The design of the VitalCare Powder Free Vinyl Examination Glove is not unique.

Sterilization Information: Bulk Non - Sterile

Description of the Marketed Equivalent Device: Classified by FDA's General Hospital Panel as Class I, 21 CFR 880.6250, Powdered Vinyl Examination Glove, 880 LYZ meets all the requirements of ASTM Standard D5250-00

Device Trade or Proprietary Name: VitalCare Powdered Vinyl Examination Glove

Device Common and Classification Name(s):

Common Name: Powdered Exam Glove Classification Name: Glove, Patient Examination, Vinyl

4

Classification Information:

Class I Panel: General Hospital Product Code: LYZ Cite: 880.6250

Document Control Number: K 992289

Type of Device: Patient Examination Glove

Use with other devices: N\A

Intended Use of the Marketed Equivalent Device: A patient examination glove is a disposable device intended for medical purposes that is worn on the hand of healthcare professional and similar personnel to prevent contamination between the healthcare personnel and the patient's body, fluids, waste or environment.

Labels and Labeling: See Attachment 3

Summary of technological characteristics of new device compared to predicate device: The proposed device has the same technological characteristics and is substantially equivalent to the predicate device, however, the glove is not powdered.

5

Image /page/5/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized depiction of an eagle or bird-like figure with three heads, suggesting a sense of unity or collaboration. The text "DEPARTMENT OF HEALTH AND HUMAN SERVICES - USA" is arranged in a circular pattern around the central emblem.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY - 4 2005

Mr. Michael McAvenia Director, Quality Assurance VitalCare Group, Incorporated 15800 NW 13th Avenue Miami, Florida 33169

Re: K040916

Trade/Device Name: VitalCare Powder Free Synthetic\Vinyl Examination Glove Regulation Number: 880.6250 Regulation Name: Patient Examination Glove Regulatory Class: I Product Code: LYZ Dated: February 1, 2005 Received: April 20, 2005

Dear Mr. McAvenia:

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 mendments, 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 approvisions of the Act. The general controls provisions of the Act include controls providents or 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 If your de roe is onabitional controls. Existing major regulations affecting (1 Writ), it may be backed in the Code of Federal Regulations, Title 21, Parts 800 to 898. In your device to real rot 10 loasish further announcements concerning your device in the Federal Register.

6

Page 2 - Mr. McAvenia

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 modi that I Dr mas made statutes and regulations administered by other Federal agencies. of the Act of ally I ouchar time Act's requirements, including, but not limited to: registration r od listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice und noting (21 et read in the quality systems (QS) regulation (21 CFR Part 820); and if requirements as bettronic 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 premiurner notified 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), 11 you dosite specific across of Compliance at (240) 276-0115. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the maj vours 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/industry/support/index.html.

Sincerely yours,

Spute Y. Michai O ms.

Chíu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

7

Indications for Use

510(k) Number (if known): K040916

Device Name: VitalCare Powder Free Synthetic\Viry| Examination Glove

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 the patient and examiner.

Prescription Use (Part 21 CFR 801 Subpart D) AND/OR

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

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Shade P. Murphy S. 305

Page 1 of

(Division Sign-Off)
Division of Anesthesiology, General Hospital,
Infection Control, Dental Devices

510(k) Number:

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