K Number
K133009
Date Cleared
2014-04-23

(210 days)

Product Code
Regulation Number
868.5905
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The BMC-NM, BMC-NM2 Nasal Mask and BMC-FM full face mask channel airflow noninvasively to a patient from a positive airway pressure device such as a continuous positive airway pressure (CPAP) or Bi-level system.

The BMC-NM, BMC-NM2 Nasal Mask and BMC-FM full face mask are:

  • To be used by adult patients (>661bs />30kg) for whom positive airway pressure has been prescribed.
  • Intended for single-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.
Device Description

BMC-NM and BMC-NM2 Nasal Masks are interfaces such that airflow from a positive pressure source is directed to the patient's nose. The masks are held in place with adjustable headgear that straps the mask to the face. BMC-NM and BMC-NM2 Nasal Masks have hard plastic body and softer silicone seal that touches the face and include a pad that rests on the forehead. The seal may inflate once the machine is turned on so the straps do not need to be too tight.

The BMC-NM and BMC-NM2 are safe when used under the conditions and purposes intended as indicated in the labeling provided with the product.

The BMC-NM and BMC-NM2 are prescription devices supplied non-sterile.

BMC-FM full face mask is interfaces such that airflow from a positive pressure source is directed to the patient's mouth and nose. The masks are held in place with adjustable headgear that straps the mask to the face. BMC-FM Full face Mask has plastic body and softer silicone seal that touches the face and include an adjustable pad that rests on the forehead. The seal may inflate once the machine is turned on so the straps do not need to be too tight.

The BMC-FM is safe when used under the conditions and purposes intended as indicated in the labeling provided with the product.

The BMC-FM is prescription device supplied non-sterile.

AI/ML Overview

Here's an analysis of the acceptance criteria and supporting studies for the BMC Medical Co., Ltd. Nasal Mask (BMC-NM, BMC-NM2) and Full Face Mask (BMC-FM) based on the provided 510(k) summary (K133009):

1. Acceptance Criteria and Reported Device Performance

The acceptance criteria are not explicitly stated in a quantitative "acceptance limit" vs. "result" format as might be seen for a new technology with novel performance targets. Instead, the acceptance criteria are implicitly defined by demonstrating "substantial equivalence" to predicate devices through a series of performance tests. The reported device performance is presented in comparison tables against the predicate devices for various specifications.

Here's a table summarizing the implicit acceptance criteria (similarity to predicate) and the reported device performance from the provided document:

Table of Acceptance Criteria (Implicit) and Reported Device Performance

Comparison ElementPredicate Device Performance (Acceptance Benchmark)Applicant Device Performance (Reported)Acceptance Outcome (Implicit)
Nasal Masks (BMC-NM, BMC-NM2)
Therapy Pressure RangeComfortGel™: 4 to 30 hPa; Mirage Activa™: 4-20 hPaBMC-NM: 4 to 30 hPa; BMC-NM2: 4 to 30 hPaMet (within range or similar)
Intentional Leak (4hPa)ComfortGel™: 15 L/min; Mirage Activa™: 19 L/minBMC-NM: 19 L/min; BMC-NM2: 20 L/minMet (similar)
Intentional Leak (12hPa)ComfortGel™: 31 L/min; Mirage Activa™: 34 L/minBMC-NM: 34 L/min; BMC-NM2: 40 L/minMet (similar)
Intentional Leak (20hPa)ComfortGel™: 34 L/min; Mirage Activa™: 45 L/minBMC-NM: 50 L/min; BMC-NM2: 51 L/minMet (similar)
Intentional Leak (30hPa)ComfortGel™: 46 L/min; Mirage Activa™: N/A (max 20hPa)BMC-NM: 68 L/min; BMC-NM2: 72 L/minMet (similar to available)
Dead Space (large size)ComfortGel™: 142.6 ml; Mirage Activa™: 145 mlBMC-NM: 145 ml; BMC-NM2: 135 mlMet (similar)
Resistance/Pressure Drop (50L/min)ComfortGel™: 0.1 hPa; Mirage Activa™: 0.3 hPaBMC-NM: 0.2 hPa; BMC-NM2: 0.2 hPaMet (similar)
Resistance/Pressure Drop (100L/min)ComfortGel™: 0.25 hPa; Mirage Activa™: 0.9 hPaBMC-NM: 0.7 hPa; BMC-NM2: 0.5 hPaMet (similar)
Operating Environment (Temp)ComfortGel™: 5 to 40°C; Mirage Activa™: 5 to 40°CBMC-NM: 5 to 40°C; BMC-NM2: 5 to 40°CMet (identical)
Operating Environment (Humidity)ComfortGel™: 15%-95%; Mirage Activa™: 15%-95%BMC-NM: 10%-93%; BMC-NM2: relative humidity (non-condensing)Met (similar range)
Storage Environment (Temp)ComfortGel™: -20 to +60°C; Mirage Activa™: N/A (listed under operating for predicate)BMC-NM: -20 to +55°C; BMC-NM2: -20 to +60°CMet (similar)
Storage Environment (Humidity)ComfortGel™: up to 95%; Mirage Activa™: N/ABMC-NM: 10%-93%; BMC-NM2: up to 95%Met (similar range)
MaterialsPolycarbonate, Silicon, Urethane, Nylon, SpandexPolycarbonate, Silicon, Nylon & Spandex FabricMet (similar)
Performance TestingIntentional leak, pressure drop, dead space CO2 rebreathingPressure-flow characteristic, dead space (CO2 re-breathing), flow impedance.Met (similar scope)
Full Face Mask (BMC-FM)
Therapy Pressure RangeMirage Quattro™: 4 to 40 hPaBMC-FM: 4 to 30 hPaMet (within range)
Intentional Leak (4 cm H2O)Mirage Quattro™: 22 L/minBMC-FM: 23 L/minMet (similar)
Intentional Leak (8 cm H2O)Mirage Quattro™: 32 L/minBMC-FM: 33 L/minMet (similar)
Intentional Leak (12 cm H2O)Mirage Quattro™: 41 L/minBMC-FM: 43 L/minMet (similar)
Intentional Leak (16 cm H2O)Mirage Quattro™: 48 L/minBMC-FM: 49 L/minMet (similar)
Intentional Leak (20 cm H2O)Mirage Quattro™: 54 L/minBMC-FM: 54 L/minMet (identical)
Intentional Leak (30 cm H2O)Mirage Quattro™: 66L/min (extrapolated)BMC-FM: 69 L/minMet (similar)
Dead Space (large size)Mirage Quattro™: 242 mLBMC-FM: 246 mLMet (similar)
Resistance/Pressure Drop (50L/min)Mirage Quattro™: 0.1 cm H2OBMC-FM: 0.2 cm H2OMet (similar)
Resistance/Pressure Drop (100L/min)Mirage Quattro™: 0.4 cm H2OBMC-FM: 0.3 cm H2OMet (similar)
Inspiratory Resistance (50L/min)Mirage Quattro™: 0.8 cm H2OBMC-FM: 1.0 cm H2OMet (similar)
Expiratory Resistance (50L/min)Mirage Quattro™: 0.8 cm H2OBMC-FM: 1.2 cm H2OMet (similar)
Operating Environment (Temp)Mirage Quattro™: 5°C to 40°CBMC-FM: 5 to 40°CMet (identical)
Operating Environment (Humidity)Mirage Quattro™: 15% to 95%BMC-FM: 10% to 93%Met (similar range)
Storage Environment (Temp)Mirage Quattro™: -20 to +60°CBMC-FM: -20 to +55°CMet (similar)
Storage Environment (Humidity)Mirage Quattro™: 10% to 95% (assumed from operating temp)BMC-FM: 10% to 93%Met (similar range)
MaterialsPolycarbonate, Silicon, Fabric/NylonPolycarbonate, Silicon, Nylon & Spandex FabricMet (similar)
Performance TestingTesting according to ISO 17510-2Testing according to ISO 17510-2Met (identical standard)

2. Sample Size Used for the Test Set and Data Provenance

The document describes "performance bench testing" and "nonclinical tests." These tests are typically conducted on physical samples of the device in a laboratory setting, not with patient data.

  • Sample Size: The exact number of samples used for these bench tests (e.g., number of masks tested for resistance, dead space, leak) is not specified in the provided summary.
  • Data Provenance: The tests are explicitly described as "bench tests" and "nonclinical tests." This implies the data is generated in a laboratory setting. No information on country of origin for the data or whether it's retrospective or prospective is relevant or provided, as these are not human subject studies.

3. Number of Experts and Their Qualifications for Ground Truth

  • Number of Experts: Not applicable. This submission relies on objective engineering and performance data derived from bench testing, not expert interpretation of clinical data.
  • Qualifications of Experts: Not applicable.

4. Adjudication Method for the Test Set

  • Adjudication methods (like 2+1, 3+1) are typically used in clinical studies where human interpretation or ground truth establishment is subjective and requires consensus. This is a technical performance study based on objective measurements against standards and predicate device specifications. Therefore, an adjudication method is not applicable and not mentioned.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

  • No MRMC comparative effectiveness study was done. This type of study involves human readers interpreting cases (e.g., medical images) with and without AI assistance. The device in question is a physical medical mask, not an AI diagnostic tool.

6. Standalone (Algorithm Only) Performance Study

  • No standalone performance study of an algorithm was done. This device is a physical medical mask, not an algorithm or software.

7. Type of Ground Truth Used

The "ground truth" for demonstrating substantial equivalence is based on:

  • Objective Technical Specifications: Measurements of physical properties and performance characteristics (e.g., intentional leak, dead space, resistance, operating/storage conditions, materials) derived from international standards (like ISO 17510-2 for the full face mask) and comparison against the technical specifications of the legally marketed predicate devices.
  • Bench Testing Results: The results of the laboratory tests (pressure-flow characteristics, CO2 re-breathing, flow impedance, damp heat, disinfection validation) serve as the evidence to support the claim of similarity to predicates.

8. Sample Size for the Training Set

  • Training Set: Not applicable. This is not a machine learning or AI device that requires training data. The devices are physical medical accessories.

9. How Ground Truth for the Training Set Was Established

  • Ground Truth for Training Set: Not applicable, as there is no training set for this type of device.

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510(k) Summary K133009

APR 2 3 2014

1. 510(k) Owner's Information:

Name:BMC Medical Co., Ltd.
Address:Room 110 Tower A Fengyu Building, No. 115 Fucheng Road
Haidian, Beijing 100036, PEOPLE'S REPUBLIC OF CHINA
Phone:0086-010-51663880-879
Fax:0086-010-51663880-810
Contact person:Jinjing
Date the summary was prepared [807.92(a)(1)]: September. 17, 2013

2. Applicant Device information:

Trade name:BMC-NM Nasal Mask, BMC-NM2 Nasal MaskBMC-FM Full Face Mask
Common name:Vented Face Mask
Name/classification:Accessory to Non-continuous Ventilator
Product code:BZD
Regulation Number:21CFR 868.5905
Device Class:II

3. Predicate Device

3.1 Predicate Device of Nasal Mask BMC-NM and BMC-NM2

Product name: ComfortGeI™ (K092835) Manufacturer: RESPIRONICS Mirage ActivaTM (K030798) Manufacturer: Resmed Product name: Product Code: BZD Intended Use:

  • Mirage ActivaTM Mask (K030798): .
    Mirage ActivaTM mask is an accessory to a non-continuous ventilator (respirator) intended for single-patient use for adult patients prescribed continuous positive airway pressure (CPAP) and bi-level therapy in hospital, clinic, and home environments.

  • . ComfortGel™(K092835):

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The ComfortGel Blue Nasal Mask is intended to provide an interface for application of CPAP or bi-level therapy to patients. The mask is for single patient use in the home or multi-patient use in the hospital/institutional environment. The mask is to be used by patients (>66lbs/30kg) for whom CPAP or bi-level therapy has been prescribed.

3.2 Predicate Device of BMC-FM full face mask

Product name: Mirage Quattro (K113127) Manufacturer: Resmed

Product Code: BZD

Intended Use:

The Mirage Quattro channels airflow noninvasively to a patient from a positive airway pressure device such as a continuous positive airway pressure (CPAP) or bilevel system.

The Mirage Quattro is to be used by adult patients (>66lbs />30kg) for whom positive airway pressure has been prescribed.

The Mirage Quattro is intended for single patient re-use in the home environment and/or multi-patient reuse in the hospital/ institutional environment.

4. Device Description

4.1 BMC-NM and BMC-NM2 Nasal Mask

BMC-NM and BMC-NM2 Nasal Masks are interfaces such that airflow from a positive pressure source is directed to the patient's nose. The masks are held in place with adjustable headgear that straps the mask to the face. BMC-NM and BMC-NM2 Nasal Masks have hard plastic body and softer silicone seal that touches the face and include a pad that rests on the forehead. The seal may inflate once the machine is turned on so the straps do not need to be too tight.

The BMC-NM and BMC-NM2 are safe when used under the conditions and purposes intended as indicated in the labeling provided with the product.

The BMC-NM and BMC-NM2 are prescription devices supplied non-sterile.

4.2 BMC-FM Full Face Mask

BMC-FM full face mask is interfaces such that airflow from a positive pressure source is directed to the patient's mouth and nose. The masks are held in place with adjustable headgear that straps the mask to the face. BMC-FM Full face Mask has plastic body and softer silicone seal that touches the face and include an adjustable pad that rests on the forehead. The seal may inflate once the machine is turned on so the straps do not need to be too tight.

The BMC-FM is safe when used under the conditions and purposes intended as indicated in the labeling provided with the product.

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The BMC-FM is prescription device supplied non-sterile.

5. Statement of intended use

The BMC-NM, BMC-NM2 Nasal Mask and BMC-FM full face mask channel airflow noninvasively to a patient from a positive airway pressure device such as a continuous positive airway pressure (CPAP) or Bi-level system.

The BMC-NM, BMC-NM2 Nasal Mask and BMC-FM full face mask are:

· To be used by adult patients (>661bs />30kg) for whom positive airway pressure has been prescribed.

· Intended for single-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.

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Technical Comparison to the predicate device ﻧﺎ

6.1 Comparison table1 (Nasal mask to its predicate device

Comparison ElementsApplicant DevicePredicated Device
BMC-NMBMC-NM2ComfortGelTM(K092835)Mirage ActivaTM (K030798)
Device nameNasal maskNasal maskNasal maskNasal mask
Classification nameAccessory toNon-continuousVentilatorAccessory toNon-continuousVentilatorAccessory to Non-continuousVentilatorAccessory to Non-continuousVentilator
Product codeBZDBZDBZDBZD
Comparison statement:The applicant devices are substantially equivalent to the predicate devices.
Intended UseThe BMC-NM and BMC-NM2 Nasal Maskchannel airflow noninvasively to a patientfrom a positive airway pressure device suchas a continuous positive airway pressure(CPAP) or Bi-level system.The BMC-NM and BMC-NM2 Nasal Maskare:To be used by adult patients (>66lbs />30kg) for whom positive airway pressurehas been prescribed. Intended for single-patient reuse inhome environment and multi-patient re-usein the hospital/institutional environment.The ComfortGel Blue Nasal Maskis intended to provide an interfacefor application of CPAP or bi-leveltherapy to patients. The mask is forsingle patient use in the home ormulti-patient use in thehospital/institutional environment.The mask is to be used by patients(>66lbs/30kg) for whom CPAP orbi-level therapy has beenprescribed.Mirage ActivaTM mask is anaccessory to anon-continuous ventilator(respirator) intended forsingle-patient use for adultpatients prescribedcontinuous positive airwaypressure (CPAP) andbi-level therapy in hospital,clinic, and homeenvironments.
Indications for useThe BMC-NM and BMC-NM2 Nasal Maskchannel airflow noninvasively to a patientThe ComfortGel Blue Nasal Maskis intended to provide an interfaceMirage ActivaTM mask is anaccessory to a
Applicant DevicePredicated Device
Comparison ElementsBMC-NMBMC-NM2ComfortGel™(K092835)Nasal MaskMirage Activa™ (K030798)
from a positive airway pressure device such as a continuous positive airway pressure (CPAP) or Bi-level system. The BMC-NM and BMC-NM2 Nasal Mask are: To be used by adult patients (>66lbs / >30kg) for whom positive airway pressure has been prescribed.Intended for single-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.for application of CPAP or bi-level therapy to patients. The mask is for single patient use in the home or multi-patient use in the hospital/institutional environment. The mask is to be used by patients (>66lbs/30kg) for whom CPAP or bi-level therapy has been prescribed.non-continuous ventilator (respirator) intended for single-patient use for adult patients prescribed continuous positive airway pressure (CPAP) and bi-level therapy in hospital, clinic, and home environments.
Target populationAdult (>66lbs / >30kg)Adult (>66lbs / >30kg)Adult (>66lbs/30kg)Adult
Environment of usehome or hospital/institutional environmenthome or hospital/institutional environmenthome or hospital/institutional environmenthospital/clinic and home environment
Patient usage typeSingle-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.Single-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.Single-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.Single patient reuse
Anatomical siteNoseNoseNoseNose
Provided sterile or non-sterileNot sterileNot sterileNot sterileNot sterile
Comparison StatementThe applicant devices are substantially equivalent to the predicate devices.
DesignNasal interface and headgearNasal interface and headgearNasal interface and headgearNasal interface and headgear
Number of mask sizeThree-small, medium, and largeThree-small, medium, and largeThree-small, medium, and largeFour-small, medium, large,
Comparison ElementsApplicant DevicePredicated Device
BMC-NMBMC-NM2ComfortGelTM Nasal(K092835)Mirage ActivaTM (K030798)large and wide
Patient circuit connection22mm entrainment valve elbow22mm entrainment valve elbow22mm entrainment valve elbow22mm entrainment valve elbow
Comparison StatementThe applicant devices are substantially equivalent to the predicate devices.
Therapy Pressure range4 to 30 hPa4 to 30 hPa4 to 30 hPa4-20hPa
Intentional leak4hPa=19L/min12hPa=34/min20hPa=50L/min30hPa=68L/min4hPa=20L/min12hPa=40/min20hPa=51L/min30hPa=72L/min4hPa=15L/min12hPa=31/min20hPa=34L/min30hPa=46L/min4hPa=19L/min12hPa=34L/min20hPa=45L/min
Dead space (large size)145ml135ml142.6ml145ml
Resistance/ Pressure Drop0.2 hPa at 50L/min0.7 hPa at 100L/min0.2 hPa at 50 L/min0.5 hPa at 100 L/min0.1 hPa at 50L/min0.25 hPa at 100L/min.0.3 hPa at 50L/min0.9 hPa at 100L/min
Operating environment5 to 40°C10% to 93% relative humidity, non-condensing5 to 40°Crelative humidity, non-condensing5 to 40°C15% to 95% relative humidity, non-condensing5 to 40°C15% to 95% relative humidity, non-condensing

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Applicant DevicePredicated Device
Comparison ElementsBMC-NMBMC-NM2ComfortGelTM(K092835)Nasal MaskMirage ActivaTM (K030798)
Storage environment-20 to +55°C10% to 93% relative humidity, non-condensing-20 to +60°Cup to 95% relative humidity, non-condensing-20 to +60°Cup to 95% relative humidity, non-condensing
Comparison StatementThe applicant devices have similar specifications as the predicate devices.
PolycarbonateSiliconPolycarbonateSiliconPolycarbonateSilicon
Main materialsNylon & spandex FabricGUrethane gel/EVAUrethane film"Breathoprene" fabric
UBL, Urethane Foam, and Lycra
Comparison StatementThe applicants devices have similar materials with the predicate devices.
Safety elementPerformance testingTested to determine the pressure-flow characteristic, dead space (CO2 re-breathing), and flow impedance.Intentional leak, pressure drop, dead space CO2 rebreathing, dead space testing test.Tested to determine the pressure-flow characteristic, (CO2 re-breathing), and flow impedance.
Clinical testingNone clinical testing neededNone clinical testing needed
Human factorsCompliance with FDA guidanceCompliance with FDA guidance
Comparison StatementThe applicant devices are substantially equivalent to the predicate devices.
Label and LabelingCompliance with FDA guidanceCompliance with FDA guidance

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Comparison ElementsApplicant DevicePredicated Device
BMC-NMComfortGelTM(K092835)
BMC-NM2Nasal Mask
Mirage ActivaTM (K030798)
Comparison StatementThe applicant devices are substantially equivalent to the predicate devices.

6.2 Comparison table 2 (Full face mask to Mirage Quattro (K113127)

Comparison ElementsApplicant DevicePredicated Device
Device nameBMC-FMMirage QuattroTM (K113127)
Classification nameFull Face MaskFull Face Mask
Product codeAccessory to Non-continuous VentilatorAccessory to Non-continuous Ventilator
BZDBZD
Comparison statement: The applicant device is substantially equivalent to the predicate device.
Intended UseThe BMC-FM full face mask channel airflownoninvasively to a patient from a positive airwaypressure device such as a continuous positiveairway pressure (CPAP) or Bi-level system.The BMC-FM full face mask are:The full face mask is:To be used by adult patients (>66lbs />30kg) for whom positive airwaypressure has been prescribed.Intended for single-patient reuse in homeenvironment and multi-patient re-use inthe hospital/institutional environment.The Mirage Quattro channels airflow noninvasivelyto a patient from a positive airway pressure devicesuch as a continuous positive airway pressure (CPAP)or bilevel system.The Mirage Quattro is to be used by adult patients(>66 lb / 30 kg) for whom positive airway pressure hasbeen prescribed.The Mirage Quattro is intended for single-patientre-use in the home environment and multipatientre-use in the hospital/institutional environment.
Comparison ElementsApplicant DeviceBMC-FMPredicated DeviceMirage QuattroTM(K113127)
Indications for useThe BMC-FM full face mask channels airflownoninvasively to a patient from a positive airwaypressure device such as a continuous positiveairway pressure (CPAP) or Bi-level system.The BMC-FM full face mask are:The full face mask is:•To be used by adult patients (>66lbs />30kg) for whom positive airwaypressure has been prescribed.• Intended for single-patient reuse in homeenvironment and multi-patient re-use in thehospital/institutional environment.The Mirage Quattro channels airflow noninvasively toa patient from a positive airway pressure device suchas a continuous positive airway pressure (CPAP) orbilevel system.The Mirage Quattro is to be used by adult patients(>66 lb / 30 kg) for whom positive airway pressure hasbeen prescribed.The Mirage Quattro is intended for single-patientre-use in the home environment and multipatientre-use in the hospital/institutional environment.
Target populationAdult (>66lbs />30kg)Adult (>66lbs/30kg)
Environment of useHome environment and the hospital/institutionalenvironmentHome environment and the hospital/institutionalenvironment
Patient usage typesingle-patient reuse in home environment andmulti-patient re-use in the hospital/institutionalenvironmentsingle-patient re-use in the homeenvironment and multi-patient re-use in thehospital/institutional environment
Anatomical siteNose and mouthNose and mouth
Provided sterile or non-sterileNot sterileNot sterile
Comparison StatementThe applicant device is substantially equivalent to the predicate device.
Designface interface and headgearface interface and headgear
Number of mask sizeThree-small, medium, and largeFour -Extra small, small, medium, and large

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Port No.: BMC-TF (FDA)-STA
Comparison ElementsApplicant DevicePredicated Device
Patient circuit connectionBMC-FM22mm entrainment valve elbowMirage QuattroTM (K113127)22mm entrainment valve elbow
Comparison StatementThe applicant device is substantially equivalent to the predicate device.
Therapy Pressure range4 to 30 hPa4 to 40 hPa
Intentional leak4 cm H2O =23 L/min8 cm H2O =33 L/min12 cm H2O =43 L/min16 cm H2O =49 L/min20 cm H2O =54 L/min25 cm H2O =63 L/min30 cm H2O =69 L/min4 cm H2O =22 L/min8 cm H2O =32 L/min12 cm H2O =41 L/min16 cm H2O =48 L/min20 cm H2O =54 L/min24cm H2O =60L/min28cm H2O =66L/min32cm H2O =72L/min36cm H2O =72L/min38cm H2O =77L/min40cm H2O =82 L/min
Device SpecificationsDead space (large size)246mL242 mL
Resistance/ Pressure Dropat 50L/min: 0.2 cm H2Oat 100L/min: 0.3 cm H2Oat 50 L/min: 0.1 cm H2Oat 100 L/min: 0.4 cm H2O
Inspiratory and expiratory resistance (with Anti Asphyxia Valve open to atmosphere)Inspiration at 50 L/min 1.0 cm H2OExpiration at 50 L/min 1.2 cm H2OInspiration at 50 L/min 0.8 cm H2OExpiration at 50 L/min 0.8 cm H2O
Operating environment5 to 40°C10% to 93 % relative humidity non-condensing5°C to 40°C15% to 95% relative humidity non-condensing
Report No.:

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Premarket Notification 510(k) Submission-510(k) SummaryReport No.: BMC-TF (FDA)-STA
Comparison ElementsApplicant DevicePredicated Device
BMC-FMMirage QuattroTM(K113127)
Storage andenvironment-20 to +55°C-20 to +60°C
10% to 93% relative humidity, non-condensing10% to 95% relative humidity, non-condensing
Comparison StatementThe applicant device has similar specifications as the predicate device.
PolycarbonatePolycarbonate
SiliconSilicon
MaterialsNylon &spandex FabricFabric/Nylon
Comparison StatementThe applicants device has similar materials with the predicate devices.
SafetyelementPerformance testingTesting according to ISO 17510-2Testing according to ISO 17510-2
Clinical testingNone clinical testing neededNone clinical testing needed
Comparison StatementThe applicant device is substantially equivalent to the predicate device.
Label and LabelingCompliance with FDA guidanceCompliance with FDA guidance
Comparison StatementThe applicant device is substantially equivalent to the predicate device.

Premarket Notification 510(k) Submission-510(k) Summary

:

.

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Safety elemer

Biocompatibility t

ModelBMC-NM------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------BMC-NM2BMC-FMNasal pillow mask(K112271LEAR - SEA - A - A - A - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------PolycarbonatePolycarbonatePolycarbonat
MaterialsSiliconSilicon------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Silicon
Nylon &spandex FabricNylon &spandex Fabricמשפחת משמעות משמעות מורי ויווי את העיריון וויינור ויידי מרצות הNylon &spandex Fabric

rials used in BMC-NM, BMC-NM2 and BMC-FM in this submission are exactly the same as those materials used in nasal in nasa

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ModelBMC-NMBMC-NCARD AND CHARGE CONNUMBER LA . COLLEGION . LABMC-FAll and and the first of the different of
STERE THE STORE THE CONSTITUTION OF THE CONTRACT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFECT PERFEContactEissue contactingissue contactingA A B A B A Ff
The state of the state of the state of the status anduration of contactPermanent contactPermanent contact

Nonclinical tes

y the substantial equivalence claim, the BMC-NM, BMC-NM2 were performance bench tested against the Mirage Activa™ (
8) and ComfortGel™ (K092835), the BMC-FM was performance b

Te besting includes performance test, dans heat tost and disinest. In the performane ests.it ums
the pasive chiation on the cessare of tow and the dedepter anders of ander o

op tests show that BMC-NM, BMC-NM2, BMC-FM(Fully assembled and without packaging) and the carton packaging are
and routine handling.

lamp heat tests state that the BMC-NM2 and BMC-FM withstand damp heat test with no damage to mask component

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Premarket Notification 510(k) Submission-510(k) SummaryReport No.: BMC-TF (FDA)-STA
without noticeable degradation of materials or negative impact of component form, fit or function.
The disinfection validation tests show that the BMC-NM, BMC-NM2,BMC-FM may be either thermally or chemically disinfected/reprocessedthirty (30) times with no damage to mask components, and without noticeable degradation of materials or negative impact of component form,fit or function.
In a conclusion, The test reports show that the BMC-NM Nasal Mask, BMC-NM2 Nasal Mask and BMC-FM Full Face Mask are substantiallyequivalent to the predicate device.
7.3 Clinical test
Use of face masks with CPAP or bi-level therapy is proven technology and is well accepted by the medical community. The Bench testingdemonstrates that the devices perform in an equivalent manner or that they are substantially equivalent to the predicate devices.
8. Conclusion:
The conclusion drawn from these tests is that the performance of the nasal mask BMC-NM, BMC-NM2 and full face mask BMC-FM aresubstantially equivalent to the predicate devices.

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Image /page/13/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized human figure with three arms or branches extending upwards. The figure is enclosed within a circle, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is arranged around the upper portion of the circle.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

April 23, 2014

BMC Medical Co., Ltd. Ms. Jiniing 5/F Main Building, No.19 Gucheng Street West Shijingshan, 100043 Beijing, PEOPLE'S REPUBLIC OF CHINA

Re: K133009

Trade/Device Name: Nasal mask BMC-NM, BMC-NM2 and Full face mask BMC-FM Regulation Number: 21 CFR 868.5905 Regulation Name: Vented Face Mask Regulatory Class: Class II Product Code: BZD Dated: March 20, 2014 Received: March 24, 2014

Dear Ms. Jinjin:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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.

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Page 2 - Ms. Jinjing

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); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); 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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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 (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Digitally signed by
Richard C. Chapman
Date: 2014.04.23
14:23:55 -04'00'

for

. I' . ..

Erin I. Keith Acting Division Director Division of General Hospital, Respiratory, Anesthesiology Infectious Control, and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: December 31, 2013 See PRA Statement on last page.

510(k) Number (if known) K133009

Device Name

Nasal mask BMC-NM, BMC-NM2 and Full face mask BMC-FM

Indications for Use (Describe)

The BMC-NM, BMC-NM2 Nasal Mask and BMC-FM full face mask channel airflow noninvasively to a patient from a positive airway pressure device such as a continuous positive airway pressure (CPAP) or Bi-level system.

The BMC-NM, BMC-NM2 Nasal Mask and BMC-FM full face mask are:

  • · To be used by adult patients (>661bs />30kg) for whom positive airway pressure has been prescribed.
    · Intended for single-patient reuse in home environment and multi-patient re-use in the hospital/institutional environment.

Type of Use (Select one or both, as applicable)

X Prescription Use (Part 21 CFR 801 Subpart D)

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

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

THE SECT OF CONTRACT CONTRACTOR FOR FOR FOR FOR FOR FOR FOR FOR MESSION OF STORES OF CONSTITUTION OF

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

James J

Digitally signed by James J. Lee DN: c=US, o=U.S. Government, ou=HHS, ou=FDA, People, cn=James J. Lee, 0.9.2342 19200300.100.1.1=2000954859 Date: 2014.04.23 13:35:24 -04'00'

Anya Harry Acting branch

FORM FDA 3881 (9/13)

8 PSC Publishing Services (30)) 441-6740

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This section applies only to requirements of the Paperwork Reduction Act of 1995.

*DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW."

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

§ 868.5905 Noncontinuous ventilator (IPPB).

(a)
Identification. A noncontinuous ventilator (intermittent positive pressure breathing-IPPB) is a device intended to deliver intermittently an aerosol to a patient's lungs or to assist a patient's breathing.(b)
Classification. Class II (performance standards).