K Number
K203078
Device Name
CAREWE Surgical Face Mask Models N001-AW, N002-AW, and N003-AW
Date Cleared
2022-08-19

(675 days)

Product Code
Regulation Number
878.4040
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The CAREWE Surgical Face Masks Models N001-AW, N002-AW, and N003-AW are intended to be worn to protect both the adult patient and healthcare personnel from transfer of microorganisms, body fluids and material. These face masks are intended for use in infection control practices to reduce the posure to blood and body fluids. The masks are single-use and disposable.
Device Description
The CAREWE Surgical Face Masks Models N001-AW, and N003-AW are flat-folded, single-use, disposable face masks which cover the user's nose and mouth. The mask is held in place by two elastic nylon ear loops ultrasonically bound to the mask, which attach to the user's ears. The mask is white. The CAREWE Surgical Face Mask consists of 4 ultrasonically bound layers: 1) an outer layer made of hydrophobic non-woven polypropylene; 2) a middle-layer made of polyester fiber; 3) a medium composed of melt-blown polypropylene; and 4) an inner-layer made of hydrophilic non-woven polypropylene. The mask also features a polyurethane (PU) nose pad which is attached to the mask's interior (on the hydrophilic layer). The mask meets ASTM F2100 Level 2 standards. The design, configuration, materials, and production process are all the same for all three proposed models N001-AW, N003-AW, N003-AW. They are all manufactured with the same technical specifications. The models are labeled differently strictly for marketing, sales and logistic reasons only.
More Information

Not Found

No
The device description and performance studies focus solely on the physical properties and filtration capabilities of a surgical face mask, with no mention of AI or ML technologies.

No
The device is a surgical face mask intended to protect against transfer of microorganisms and body fluids, not to treat or cure a disease or condition.

No

Explanation: The device, a surgical face mask, is intended to protect against transfer of microorganisms and fluids, and is for infection control. It does not perform any diagnostic function.

No

The device description clearly outlines a physical product made of multiple layers of materials and held in place by ear loops. It also details performance testing related to physical properties like fluid resistance, filtration efficiency, and flammability, which are characteristic of hardware devices, not software.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information about a person's health. They are used outside the body (in vitro).
  • Device Description and Intended Use: The description and intended use clearly state that these are surgical face masks worn on the face to protect against the transfer of microorganisms and body fluids. They are a physical barrier.
  • Lack of Specimen Analysis: There is no mention of analyzing any biological specimens or providing diagnostic information based on such analysis.
  • Performance Studies: The performance studies listed (Fluid Resistance, PFE, BFE, etc.) are all related to the physical barrier properties and biocompatibility of the mask, not to the analysis of biological samples.

Therefore, based on the provided information, the CAREWE Surgical Face Masks are medical devices, but they are not In Vitro Diagnostic devices.

N/A

Intended Use / Indications for Use

The CAREWE Surgical Face Masks Models N001-AW, N002-AW, and N003-AW are intended to be worn to protect both the adult patient and healthcare personnel from transfer of microorganisms, body fluids and material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. The masks are single-use and disposable.

Product codes

FXX

Device Description

The CAREWE Surgical Face Masks Models N001-AW, and N003-AW are flat-folded, single-use, disposable face masks which cover the user's nose and mouth. The mask is held in place by two elastic nylon ear loops ultrasonically bound to the mask, which attach to the user's ears. The mask is white.

The CAREWE Surgical Face Mask consists of 4 ultrasonically bound layers:

  • l) an outer layer made of hydrophobic non-woven polypropylene;
    1. a middle-layer made of polyester fiber;
    1. a medium composed of melt-blown polypropylene; and
    1. an inner-layer made of hydrophilic non-woven polypropylene.

The mask also features a polyurethane (PU) nose pad which is attached to the mask's interior (on the hydrophilic layer). The mask meets ASTM F2100 Level 2 standards.

The design, configuration, materials, and production process are all the same for all three proposed models N001-AW, N003-AW, N003-AW. They are all manufactured with the same technical specifications. The models are labeled differently strictly for marketing, sales and logistic reasons only.

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

Adult patient

Intended User / Care Setting

Healthcare 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

Non-clinical performance tests were conducted to verify appropriate safety and effectiveness.

  • Fluid Resistance (ASTM F1862): 29 out of 32 Pass at 120 mmHg (Acceptance Criteria: ≥ 98% for Level 2) - Results: Pass
  • Particulate Filtration Efficiency (PFE) (ASTM F2100): Results: Pass (Acceptance Criteria: ≥ 98% for Level 2)
  • Bacterial Filtration Efficiency (BFE) (ASTM F2101): Results: Pass (Acceptance Criteria: ≥ 98% for Level 2)
  • Differential Pressure (Delta P) (ASTM F2100): Results: Pass (Acceptance Criteria:

§ 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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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: a symbol on the left and the FDA name on the right. The symbol on the left is a stylized image of a human figure, while the FDA name on the right is written in blue letters. The words "U.S. FOOD & DRUG ADMINISTRATION" are written in a clear, sans-serif font.

August 19, 2022

HuiZhou TianChang Industrial Co., Ltd % Viky Verna CEO Mhetra LLC 848 Brickell Ave. PH 5 Miami, Florida 33131

Re: K203078

Trade/Device Name: CAREWE Surgical Face Mask Models N001-AW, N002-AW, and N003-AW Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: FXX Dated: August 8, 2022 Received: August 10, 2022

Dear Viky Verna:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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

1

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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Bifeng Qian, M.D., Ph.D. Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K203078

Device Name

CAREWE Surgical Face Mask Models N001-AW, N002-AW, and N003-AW

Indications for Use (Describe)

The CAREWE Surgical Face Masks Models N001-AW, N002-AW, and N003-AW are intended to be worn to protect both the adult patient and healthcare personnel from transfer of microorganisms, body fluids and material. These face masks are intended for use in infection control practices to reduce the posure to blood and body fluids. The masks are single-use and disposable.

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

Registration Under Part 375, ECL Subject to CleanupBrownfield Cleanup Under Part 375, ECL Subject to Cleanup
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

| | Prescription Use (Part 21 CFR 801 Subpart D)

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

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510(k) Summary K203078

1. Applicant/ Device Information

Submitter Name:Hui Zhou Tian Chang Industrial Co. Ltd
Responsible person:Johnny Chan
E-mail:johnny.chan@hktcgroup.com
Official Correspondent:
Contact person:Viky Verna, MS BME, MS Pharm, RAC
Phone:+41 76 375 9 811
Fax:+41 26 492 5 071
E-mail:viky.verna@mhetra.com
Date prepared:August 18, 2022
Device NameCAREWE Surgical Face Mask Models N001-AW, N002-AW, and N003-AW
510(k) NumberK203078
Common NameSurgical Face Mask
Classification Name:Surgical apparel
Classification Regulation:21CFR 878.4040
Product Code:FXX

2. Predicate Device Information

ManufacturerGUANGDONG KAIDI GARMENTS CO., LTD
Device NameDisposable Medical Surgical Face Masks
510(k) NumberK202211
Classification Name:Surgical apparel
Classification Regulation:21CFR 878.4040
Product Code:FXX

3. Device Description

The CAREWE Surgical Face Masks Models N001-AW, and N003-AW are flat-folded, single-use, disposable face masks which cover the user's nose and mouth. The mask is held in place by two elastic nylon ear loops ultrasonically bound to the mask, which attach to the user's ears. The mask is white.

The CAREWE Surgical Face Mask consists of 4 ultrasonically bound layers:

  • l) an outer layer made of hydrophobic non-woven polypropylene;
    1. a middle-layer made of polyester fiber;
    1. a medium composed of melt-blown polypropylene; and
    1. an inner-layer made of hydrophilic non-woven polypropylene.

The mask also features a polyurethane (PU) nose pad which is attached to the mask's interior (on the hydrophilic layer). The mask meets ASTM F2100 Level 2 standards.

The design, configuration, materials, and production process are all the same for all three proposed models N001-AW, N003-AW, N003-AW. They are all manufactured with the same technical specifications. The models are labeled differently strictly for marketing, sales and logistic reasons only.

4

4. Indications For Use

The CAREWE Surgical Face Masks Models N001-AW, and N003-AW are intended to be worn to protect both the adult patient and healthcare personnel from transfer of microorganisms, body fluids and material. These face masks are intended for use in infection control practices to reduce the potential exposure to blood and body fluids. The masks are single-use and disposable.

న. Comparison of Technological Characteristics

Table 5.1 provides a comparison of the predominant technical characteristics of the subject device and the legally marketed predicate device.

DescriptionPredicate DeviceSubject DeviceComparison
Device NameDisposable Medical Surgical
Face MasksCAREWE Surgical Face Mask
Models N001-AW, N002-AW, and
N003-AWN/A
510(k) NumberK202211K203078N/A
ManufacturerGuangdong Kaidi Garments Co.,
LtdHui Zhou Tian Chang Industrial Co.
LtdN/A
Classification,
Product Code and
RegulationClass II Device, FXX (21 CFR
878.4040)Class II Device, FXX (21 CFR
878.4040)Same
Classification name/
panelSurgical apparel/ General
HospitalSurgical apparel/ General
HospitalSame
Indications For UseThe Disposable Medical
Surgical Face Masks are
intended to be worn to
protect both the patient and
healthcare personnel from
transfer of microorganisms,
body fluids and particulate
material. These face masks
are intended for use in
infection control practices to
reduce the potential
exposure to blood and body
fluids. This is a single use,
disposable device(s),
provided non-sterile.The CAREWE Surgical Face
Masks Models N001-AW, N002-
AW, and N003-AW are intended
to be worn to protect both the
adult patient and healthcare
personnel from transfer of
microorganisms, body fluids and
material. These face masks are
intended for use in infection
control practices to reduce the
potential exposure to blood and
body fluids. The masks are
single-use and disposable.Similar
DesignFlat pleatedButterfly flat-foldDifferent
Outer Facing layerSpunbound non-woven
fabricNon-woven PP hydrophobicSimilar
Inner Facing layerSpunbound non-woven fabricNon-woven PP hydrophilicSimilar
Filter MediaN/AMeltblown PP chargedDifferent
MiddleMelt-blown non-woven fabricPolyester FiberDifferent
Nose PiecePolyethylene (PE) & iron wirePolyvinylchloride (PVC) &
annealed iron wireSimilar
Layers3ply4plyDifferent

Table 5.1: Comparison of Technological Characteristics

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DescriptionPredicate DeviceSubject DeviceComparison
Ear Loop/ StrapEar Loop (Nylon & Spandex)Ear Loop (Nylon)Similar
Nose FoamN/APolyurethane (PU)N/A
UseSingle Use, DisposableSingle Use, DisposableSame
OTC useYesYesSame
SterilityNon-SterileNon-SterileSame
ASTM F2100Level 2Level 2Same
  1. Summary of Non-clinical Performance Tests:

The following tests were performed to verify appropriate safety and effectiveness.

| Description | Purpose | Acceptance Criteria
(Level 2) | Results |
|-------------------------------------------------------------|--------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------|---------|
| Fluid Resistance
ASTM F1862 | Demonstrate adequate
resistance to fluid penetration | 29 out of 32 Pass at 120
mmHg | Pass |
| Particulate
Filtration
Efficiency (PFE)
ASTM F2100 | Demonstrate adequate
particulate barrier properties | ≥ 98% | Pass |
| Bacterial Filtration
Efficiency (BFE)
ASTM F2101 | Demonstrate adequate
bacterial barrier properties | ≥ 98% | Pass |
| Differential Pressure
(Delta P) ASTM
F2100 | Demonstrate adequate air
penetration properties |