K Number
K063043
Device Name
SURGICAL FACE MASK, TYPE: TIE-ON, EAR-LOOP
Date Cleared
2007-03-21

(169 days)

Product Code
Regulation Number
878.4040
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Surgical Face Mask of different colors (Green, White, Blue and Pink) is a device intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operation room personnel from transfer of microorganisms, body fluid and particulate material.
Device Description
Modern Healthcare Corp. Surgical Face Mask, type: Tie-on and Ear-loop, are flat pleated 3-ply (at least) masks with an inner and outer layer (spunbonded polypropylene) that sandwich a melt blown polypropylene filter material, also with elastic loops and / or strip. The nosepiece for all Modern Healthcare Corp. Surgical Face Mask is malleable aluminum wire. All the materials used in the construction of the Modern Healthcare Corp. Surgical Face Mask are being used in currently marked devices.
More Information

Not Found

No
The device description and intended use clearly describe a standard surgical face mask, with no mention of AI or ML capabilities. The "Mentions AI, DNN, or ML" and "Mentions image processing" sections are explicitly marked as "Not Found".

No

A therapeutic device is used to treat or cure a disease or condition. This device is described as a surgical face mask intended to protect against the transfer of microorganisms, body fluid, and particulate material, which is a preventative measure rather than a therapeutic one.

No

Explanation: The device is a surgical face mask, which is a barrier device intended to prevent the transfer of microorganisms and fluids. It does not analyze or interpret biological signals or data to make a diagnosis.

No

The device description clearly outlines physical components like spunbonded polypropylene, melt blown polypropylene filter material, elastic loops, and malleable aluminum wire, indicating it is a physical medical device, not software-only.

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 mask is for protecting both the patient and personnel from the transfer of microorganisms, body fluid, and particulate material during surgical procedures. This is a physical barrier function, not a diagnostic test performed in vitro (outside the body).
  • Device Description: The description details the physical construction of the mask (materials, layers, nosepiece, loops). There is no mention of reagents, samples, or any components used for analyzing biological specimens.
  • Lack of IVD Indicators: The document does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring specific substances (analytes)
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions.

Therefore, this surgical face mask is a medical device, but it falls under a different classification than an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

The Surgical Face Mask of different colors (Green, White, Blue and Pink) is a device intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operation room personnel from transfer of microorganisms, body fluid and particulate material.

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

FXX

Device Description

Modern Healthcare Corp. Surgical Face Mask, type: Tie-on and Ear-loop, are flat pleated 3-ply (at least) masks with an inner and outer layer (spunbonded polypropylene) that sandwich a melt blown polypropylene filter material, also with elastic loops and / or strip. The nosepiece for all Modern Healthcare Corp. Surgical Face Mask is malleable aluminum All the materials used in the construction of the Modern Healthcare Corp. Surgical wire. Face Mask are being used in currently marked devices.

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

medical device suppliers, Dentist and Doctor Officers, clinics, Emergency Response Professionals, Hospitals and other healthcare professional for the Intended Use purpose below:

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)

Not Applicable

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.

K060776

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

§ 878.4040 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.

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MODERN HEALTHCARE CORP.
公司:彰化縣田中鎮中州路二段751號
751 CHUNG CHOU RD., SEC. 2. TIEN CHUNG.
CHANG HWA. TAIWAN R.O.C
TEL: 886-4-8752115~8 ; FAX : 886-8743139

MAR 2 1 2007

510(k) SUMMARY "

This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of SMDA 1990 and 21 CFR 807.92

The assigned 510(k) number is : K 063043

Submitter's Name: MODERN HEALTHCARE CORP.

No.751, Chung Chou Rd., Sec. 2, Tien Chun County, Chang-Hwa, 52045, Taiwan, R.O.C.

Date summary prepared:

September 29, 2006

Device Name:

  • Classification name: Mask, Surgical .
  • FXX, Class II Classification number:
  • 878.4040 Regulation Number:
  • Surgical Face Mask, Type: Tie-on, Ear-loop . Proprietary name:
  • Common name of device: Surgical Face Mask, Disposable .
  • . Predicate Device: Surgical Face Mask, K060776
  • . Official Correspondent: Dr. Jen, Ke-Min

E-mail: ceirs.jen@msa.hint.net (Tel) 886-3-5208829; (Fax) 886-3-5209783

Address: No.58, Fu Chiun Street, Hsin Chu City, 30067, Taiwan, ROC

Description of the device:

Modern Healthcare Corp. Surgical Face Mask, type: Tie-on and Ear-loop, are flat pleated 3-ply (at least) masks with an inner and outer layer (spunbonded polypropylene) that sandwich a melt blown polypropylene filter material, also with elastic loops and / or strip. The nosepiece for all Modern Healthcare Corp. Surgical Face Mask is malleable aluminum All the materials used in the construction of the Modern Healthcare Corp. Surgical wire. Face Mask are being used in currently marked devices.

Labels/Labeling:

This device will be marked to medical device suppliers, Dentist and Doctor Officers, clinics, Emergency Response Professionals, Hospitals and other healthcare professional for the Intended Use purpose below:

1

Image /page/1/Picture/0 description: The image shows the word "Modern" in a stylized font. The "M" is designed to look like a heart shape. There is a registered trademark symbol to the right of the word.

一粒候,工 MODERN HEALT 公司:彰化縣田中鎮中 751 CHUNG CHOURD TEL : 886-4-8752115-8 : FAX : 886

Discussion of Clinical Tests Performed:

Not Applicable

Conclusions:

Modern Healthcare Corp., Surgical Face Mask, type: Tie-on and Ear-loop, has the same intended use and technological characteristics as the predicated devices (K060776). Moreover, bench testing contained in this submission supplied demonstrates that the technological characteristics do not raise any new question of safety or effectiveness. Modern Healthcare Corp., Surgical Face Mask, type: Tie-on and Ear-loop, is substantially equivalent to the predicated device.

Thus the new device is substantially equivalent to the predicate devices.

2

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is a stylized image of an eagle or other bird-like figure with three wing-like shapes.

ood and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Modern Healthcare Corporation C/O Dr. Ke-Min Jen Official Correspondent ROC Chinese-European Industrial Research Society No. 58, Fu-Chiun Street Hsin-Chu City 30067 TAIWAN, ROC

MAR 2 1 2007

Re: K063043

Trade/Device Name: Surgical Face Mask, Type: Tie-on, Ear Loop Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: II Product Code: FXX Dated: January 23, 2007 Received: January 29, 2007

Dear Dr. Jen:

We have reviewed vour 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.

3

Page 2 - Dr. Jen

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); 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), please contact the Office 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 Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Chiu-Lien, Ph.D.

Chiu 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

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Image /page/4/Picture/0 description: The image shows the word "Modern" in a stylized font. The "M" is designed to look like a heart shape. There is a circled R symbol next to the word, indicating a registered trademark.

新橡膠工業股份有限公司
MODERN HEALTHCARE CORP.
公司:彰化縣田中鎮中川路二段751號
751 CHUNG CHOU RD.. SEC. 2. TIEN CHUNG
CHANG HWA TAIWAN R.O.C
TEL: 886-4-8752115-8 FAX: 886-8743139

Indications for Use

510 (K) Number ( If Known ):

Device Name: Surgical Face Mask, Type: Tie-on, Ear-loop

Indications for Use:

The Surgical Face Mask of different colors (Green, White, Blue and Pink) is a device intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operation room personnel from transfer of microorganisms, body fluid and particulate material.

! CAUTION:

This Surgical Face Mask is non-sterilized and disposable for use.

Prescription Use

AND/OR

Over-The-Counter Use √

(Part 21 CFR 801 Subpart D)

(21 CFR 807 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

Shake It Mugler D

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