K Number
K151170
Manufacturer
Date Cleared
2015-07-02

(62 days)

Product Code
Regulation Number
884.5470
Reference & Predicate Devices
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Tosama 100% Organic Cotton Menstrual Tampon is intended for insertion into the vagina for the absorption of menstrual or other vaginal discharge.

Device Description

The device will be offered as a traditional unscented menstrual 100% organic cotton tampon consisting of an absorbent pledget, a withdrawal cord, and an applicator. The pledget is of the traditional cylindrical, bullet-like shape and the applicator has a standard rounded tip to ease insertion. Each tampon is individually wrapped and packaged in multi-unit containers for retail sale. It will be offered in three absorbencies: Regular, Super, and Super Plus.

AI/ML Overview

This document is a 510(k) premarket notification for a menstrual tampon. It is not a study about an AI-powered medical device. Therefore, it does not contain the information required to answer your request regarding acceptance criteria and a study proving a device meets them for an AI device.

The document discusses the substantial equivalence of the "Tosama 100% Organic Cotton Menstrual Tampon" to a predicate device (Naturalena 100% Cotton Tampon). It outlines the general safety and effectiveness of the traditional medical device through non-clinical testing.

Here's why the requested information cannot be provided from this document:

  1. Nature of the Device: The device described is a physical menstrual tampon, not an AI-powered software or system.
  2. Type of Study: The document refers to "non-clinical data" and "testing" (chemical, microbiological, biocompatibility, efficacy) for the tampon, which are standard for physical medical devices to demonstrate safety and effectiveness. It does not describe a clinical study of an AI algorithm's performance.
  3. Missing AI-Specific Information: There is no mention of algorithms, machine learning, AI assistance, human readers, ground truth establishment by experts, or training/test sets in the context of AI.

The requested information is specific to the development and validation of AI/ML-based medical devices, which are not covered by this submission for a menstrual tampon.

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's emblem, which is a stylized representation of a human figure in profile, with three faces overlapping to symbolize health, human services, and the relationship between them. The emblem is encircled by the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a circular arrangement.

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

July 2, 2015

TOSAMA, d.o.o. % Dave Yungvirt CEO Third Party Review Group, LLC 45 Rockefeller Plaza. Suite 2000 New York, NY 10111

Re: K151170

Trade/Device Name: Tosama 100% Organic Cotton Menstrual Tampon Regulation Number: 21 CFR 884.5470 Regulation Name: Unscented menstrual tampon Regulatory Class: II Product Code: HEB Dated: June 16, 2015 Received: June 18, 2015

Dear Dave Yungvirt,

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.

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.

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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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/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 Industry and Consumer Education 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.

Herbert P. Lerner -S

for

Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Indications for Use

510(k) Number (if known) K151170

Device Name

Tosama 100% Organic Cotton Menstrual Tampon

Indications for Use (Describe)

The Tosama 100% Organic Cotton Menstrual Tampon is intended for insertion into the vagina for the absorption of menstrual or other vaginal discharge.

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

Prescription Use (Part 21 CFR 801 Subpart D)

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

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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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:

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510(k) Summary

DATE OF PREPARATION: July 1, 2015

COMPANY/OWNER:TOSAMA, d.o.o.Saranoviceva cesta 35, VirSI-1230 DomzaleSLOVENIA, EU
CONTACT:Marjetka Kralj Kuncic, PhDHead of Quality Control
TELEPHONE:00386 1 7290370
FAX:00386 1 7291244
EMAIL:marjetka.kralj-kuncic@tosama.si

Tosama 100% Organic Cotton Menstrual Tampon DEVICE TRADE NAME: Unscented Menstrual Tampon COMMON NAME: Tampon, Menstrual, Unscented CLASSIFICATION NAME: REGULATION NUMBER: 21 CFR §884.5470 PRODUCT CODE: HEB DEVICE CLASS: =

PREDICATE DEVICE: Naturalena 100% Cotton Tampon (K130609)

DEVICE DESCRIPTION: The device will be offered as a traditional unscented menstrual 100% organic cotton tampon consisting of an absorbent pledget, a withdrawal cord, and an applicator. The pledget is of the traditional cylindrical, bullet-like shape and the applicator has a standard rounded tip to ease insertion. Each tampon is individually wrapped and packaged in multi-unit containers for retail sale. It will be offered in three absorbencies: Regular, Super, and Super Plus.

INDICATION FOR USE: The Tosama 100% Organic Cotton Menstrual Tampon is intended for insertion into the vagina for the absorption of menstrual or other vaginal discharge.

TECHNOLOGICAL CHARACTERISTICS AND SUBSTANTIAL EQUIVALENCE:

The Tosama 100% Orqanic Cotton Menstrual Tampon demonstrates substantial equivalence to the Naturalena 100% Cotton Tampon (K130609). Table 5-1 summarizes the key technological characteristics and features of both the predicates and the new device.

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FeatureTosama 100%Organic CottonMenstrualTamponPredicateNaturalena100% CottonTampon
510(k) NumberK130609
Intended UseThe device isintended for insertioninto the vagina for theabsorption ofmenstrual or othervaginal discharge.The device isintended for insertioninto the vagina for theabsorption ofmenstrual or othervaginal discharge.
DesignTampon withcylindrical shape andbullet-like tip.Applicator withsmooth, rounded tip.Tampon withcylindrical shape andbullet-like tip.Applicator withsmooth, rounded tip.
Dimensions &WeightsDigital TamponsDigital Tampons
Description:Regular DigitalRegular Digital
Length:43.0mm – 46.0mm43.0mm – 46.0mm
Diameter:11.0mm – 12.0mm11.0mm – 12.0mm
Mass:2.30g – 2.70g2.30g – 2.70g
Withdrawal Cord:130mm – 160mm130mm – 160mm
Syngina Absorbency:6.0g – 9.0g6.0g – 9.0g
Description:Super DigitalSuper Digital
Length:48.0mm – 51.0mm48.0mm – 51.0mm
Diameter:12.0mm – 13.0mm12.0mm – 13.0mm
Mass:2.70g – 3.10g2.70g – 3.10g
Withdrawal Cord:130mm – 160mm130mm – 160mm
Syngina Absorbency:9.0g – 12.0g9.0g – 12.0g
Description:Super Plus DigitalSuper Plus Digital
Length:48.0mm – 51.0mm48.0mm – 51.0mm
Diameter:14.0mm – 15.0mm14.0mm – 15.0mm
Mass:3.30g – 3.80g3.30g – 3.80g
Withdrawal Cord:130mm – 160mm130mm – 160mm
Syngina Absorbency:12.0g – 15.0g12.0g – 15.0g
Dimensions &WeightsApplicatorTamponsApplicatorTampons
Description:Regular ApplicatorRegular Applicator
Tampon Length:43.0mm – 46.0mm43.0mm – 46.0mm
Applicator Length:120mm ± 5%120mm ± 5%
Tampon Diameter:11.0mm – 12.0mm11.0mm – 13.0mm
Applicator Diameter:13mm16mm
Tampon Mass:2.00g – 2.30g2.00g – 2.30g
Applicator Mass:3.40g – 3.60g3.40g – 3.60g
Total Mass:5.40g – 5.90g5.40g – 5.90g
Withdrawal Cord:130mm – 160mm130mm – 160mm
FeatureTosama 100%Organic CottonMenstrualTamponPredicateNaturalena100% CottonTampon
Syngina Absorbency:6.0g - 9.0g6.0g - 9.0g
Description:Super ApplicatorSuper Applicator
Tampon Length:43.0mm - 46.0mm48.0mm - 51.0mm
Applicator Length:120mm ± 5%120mm ± 5%
Tampon Diameter:12.0mm - 13.0mm13.0mm - 15.0mm
Applicator Diameter:16mm19mm
Tampon Mass:2.60g - 3.00g2.60g - 3.00g
Applicator Mass:4.10g - 4.30g4.20g - 4.40g
Total Mass:6.70g - 7.30g6.80g - 7.40g
Withdrawal Cord:130mm - 160mm130mm - 160mm
Syngina Absorbency:9.0g - 12.0g9.0g - 12.0g
Description:Super Plus ApplicatorSuper Plus ApplicatorNot included insubmission.
Tampon Length:43.0mm - 46.0mm
Applicator Length:120mm ± 5%
Tampon Diameter:14.0mm - 15.0mm
Applicator Diameter:18mm
Tampon Mass:3.00g - 3.50g
Applicator Mass:4.20g - 4.40g
Total Mass:7.20g - 7.90g
Withdrawal Cord:130mm - 160mm
Syngina Absorbency:12.0g - 15.0g
MaterialsAll ProductsAll Products
Pledget:100% Organic Cotton100% Cotton
Withdrawal Cord:100% Organic Cotton100% Cotton
Applicator:TPOPolyethylene
Individual Wrapping:PolypropylenePolypropylene
Additives &FinishingAgentsHydrophobicwithdrawal cord.Hydrophobic coatingon withdrawal cord.

Table 5-1: Comparison of Proposed Device with Predicate Devices

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The proposed Tosama 100% Organic Cotton Menstrual Tampon and the Naturalena predicate device have the following two differences:

  • Naturalena uses Repellan T anti-wicking agent in its withdrawal cord, while the 1. proposed device uses Sevophob. Both are a paraffin-based resin used to ensure the cord does not wick menstrual fluid out of the vaqina.
    1. Naturalena uses a polyethylene plastic for the applicator material, while the proposed device uses a thermoplastic olefin plastic for the applicator material.

The proposed device is essentially identical to the Naturalena predicate device other than the differences listed above. It has been demonstrated through biocompatibility and performance testing that neither of the two differences have an impact on the safety and effectiveness of the device. Although the addition of the wicking agent to the withdrawal cord could potentially impact the safety (biocompatibility) of the

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device, it has been confirmed as safe through appropriate biocompatibility testing. SUMMARY OF NON-CLINICAL DATA:

All materials used in the construction of Tosama 100% Organic Cotton Menstrual Tampons as well as complete devices have been subjected to the following tests in accordance with recommended requirements and proper consideration of its intended use:

  • · Chemical analysis for pesticide, dioxin, phthalate, and PCB residues;
  • Microbiological testing for enumeration per Ph. Eur. 2.6.12/2.6.13. Toxic Shock Syndrome Toxin-1 production, vaginal microflora growth alteration, and S. aureus growth enhancement:
  • · Biocompatibility testing of the pledget as follows:
    • o ISO 10993-5:2009: Tests for in vitro cytotoxicity;
    • ISO 10993-10:2010: Tests for irritation and skin sensitization;
    • o ISO 10993-11:2006: Tests for systemic toxicity;
  • · Biocompatibility testing of the applicator as follows:
    • o ISO 10993-5:2009: Tests for in vitro cytotoxicity;
    • o ISO 10993-10:2010: Tests for irritation and skin sensitization:
  • Efficacy testing according to the FDA Guidance on Menstrual Tampons and Pads:
    • Syngina absorbency according to 21 CFR 801.430(f)(2); o
    • fiber loss: o
    • withdrawal cord pull-out resistance; o
    • o tampon integrity.

The results of these tests support the conclusion that the proposed device is safe for its intended use.

CONCLUSIONS:

The intended use and indications for use, as well as the safety and effectiveness, of Tosama 100% Organic Cotton Menstrual Tampons and that of the Naturalena predicate device as unscented menstrual tampons are identical. Chemical, biocompatibility, microbiological, and efficacy testing show this to be verifiable. Thus, the Tosama 100% Organic Cotton Menstrual Tampon is substantially equivalent to the legally marketed predicate device Naturalena 100% Cotton Tampon (K130609).

§ 884.5470 Unscented menstrual tampon.

(a)
Identification. An unscented menstrual tampon is a device that is a plug made of cellulosic or synthetic material that is inserted into the vagina and used to absorb menstrual or other vaginal discharge. This generic type of device does not include menstrual tampons treated with scent (i.e., fragrance materials) or those with added antimicrobial agents or other drugs.(b)
Classification. Class II (performance standards).