K Number
K203702
Device Name
Vinyl Examination Gloves (Yellow)
Date Cleared
2021-02-12

(56 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Vinyl Examination Gloves(Yellow) is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.
Device Description
The subject device is powder free vinyl patient examination gloves. The subject device is yellow. The design of subject device is addressing the standards as ASTM D6124, ASTM D5151, and ASTM D5250. The subject device is nonsterile.
More Information

Not Found

No
The device description and performance studies focus on the physical properties and safety of examination gloves, with no mention of AI or ML.

No
The device, Vinyl Examination Gloves, is intended to prevent contamination and is a barrier device, not a device for treating or curing a medical condition.

No

Explanation: The device is described as an examination glove intended to prevent contamination, not to diagnose any condition or disease.

No

The device is a physical product (gloves) and not software. The description clearly outlines its material, color, and intended use as a physical barrier.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health. These tests are performed outside the body (in vitro).
  • Device Intended Use: The intended use of the Vinyl Examination Gloves is clearly stated as being worn on the examiner's hands to prevent contamination. This is a barrier device used on the body (or rather, on the hands of the user) for protection, not for testing samples from the body.
  • Lack of IVD Characteristics: The description does not mention any testing of biological samples, analysis of bodily fluids, or any diagnostic purpose.

The device is a medical device, but it falls under the category of a barrier device or personal protective equipment (PPE), not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

The Vinyl Examination Gloves(Yellow) is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

Product codes

LYZ

Device Description

The subject device is powder free vinyl patient examination gloves. The subject device is yellow. The design of subject device is addressing the standards as ASTM D6124, ASTM D5151, and ASTM D5250. The subject device is nonsterile.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hands

Indicated Patient Age Range

Not Found

Intended User / Care Setting

examiner

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)

The test results demonstrated that the proposed device complies with the following standards:
ISO 10993-10:2010 Biological Evaluation of Medical Devices - Part 10: Tests For Irritation And Skin Sensitization.
ISO 10993-5:2009 Biological Evaluation of Medical Devices - Part 5: Tests For In Vitro Cytotoxicity
ASTM D6124-06 (Reapproved 2017), Standard Test Method for Residual Powder on Medical Gloves
ASTMD5151-06 (Reapproved2015), Standard Test Method for Detection of Holes in Medical Gloves.
ASTM D5250-19, Standard Specification for Poly (vinyl chloride) Gloves for Medical Application.
Clinical testing is not needed for this device.

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

Irritation: Under the conditions of the study, not an irritant
Sensitization: Under conditions of the study, not a sensitizer.
Cytotoxicity: Under conditions of the study, did not show potential toxicity to L-929 cells.
Before Aging Tensile Strength: 11MPa, min
Ultimate Elongation: 300%min
After Aging Tensile Strength: 11MPa, min
Ultimate Elongation: 300%min
Freedom from Holes: Be free from holes when tested in accordance with ASTM D5151 AQL=2.5
Powder Content: 0.01 mg per glove

Predicate Device(s)

K163168

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.

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Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, with the letters "FDA" in a blue square. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

February 12, 2021

Xinying Trading CO., LTD. % Boyle Wang Official Correspondent Shanghai Truthful information Technology Co., Ltd. RM.608, No.738, Shangcheng Rd., Pudong Shanghai, 200120 Cn

Re: K203702

Trade/Device Name: Vinyl Examination Gloves (Yellow) Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I, reserved Product Code: LYZ Dated: December 1, 2020 Received: December 18, 2020

Dear Boyle Wang:

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 statutes and regulations administered by other Federal agencies. You must comply with all the Act's

1

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 (OS) 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,

For: Elizabeth F. Claverie-Williams, MS 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

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Indications for Use

510(k) Number (if known) K203702

Device Name Vinyl Examination Gloves(Yellow)

Indications for Use (Describe)

The Vinyl Examination Gloves(Yellow) is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

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 K203702

This summary of 510(k) is being submitted in accordance with 21 CFR 807.92.

DATE: December 1, 2020

1.0 Submitter's Information

Name: XINYING TRADING CO.,LTD. Address: Garden Street, Dezhou City 253000, Shandong, China. Phone Number: Contact: Mr. Tongguang Liu Date of Preparation: 11/27/2020

Designated Submission Correspondent

Mr. Boyle Wang Shanghai Truthful Information Technology Co., Ltd. Room 608, No. 738 Shangcheng Rd., Pudong Shanghai, 200120 China Tel: +86-21-50313932 Email: Info@truthful.com.cn

2.0 Device Information

Trade name: Vinyl Examination Gloves (Yellow) Vinyl Patient Examination Glove Common name: Classification name: Non-powdered Patient Examination Glove Model(s): S. M. L. XL

3.0 Classification

Production code: LYZ Regulation number: 21CFR880.6250 Classification: Class I Panel: General Hospital

4.0 Predicate Device Information

Manufacturer: Hebei Hongtai Plastic Products Company Limited Vinyl Patient Examination Gloves (White, Blue, Yellow) Device: 510(k) number: K163168

5.0 Indication for Use

4

The Vinyl Examination Gloves (Yellow) is a disposable device intended for medical purposes that is worn on the examiner's hands to prevent contamination between patient and examiner.

6.0 Device Description

The subject device is powder free vinyl patient examination gloves. The subject device is yellow. The design of subject device is addressing the standards as ASTM D6124, ASTM D5151, and ASTM D5250. The subject device is nonsterile.

7.0 Summary Comparing Technological Characteristics with Predicate Device

ItemSubject devicePredicated deviceComparison
510(k) numberK203702K163168
Product CodeLYZLYZSame
Regulation No.21CFR880.625021CFR880.6250Same
ClassIISame
Intended UseThe Vinyl Examination
Gloves(Yellow) is a
disposable device
intended for medical
purposes that is worn on
the examiner's hands to
prevent contamination
between patient and
examiner.The Vinyl Examination
Glove (White, Blue, or
Yellow) is a disposable
device intended for
medical purposes that
is worn on the
examiner's hands to
prevent contamination
between patient and
examiner.Same
Powdered or Powered freePowdered freePowdered freeSame
Design FeatureambidextrousambidextrousSame
Labeling InformationSingle use, powder free,
device color, device
name, glove size and
quantity, Vinyl
Examination Gloves,
Non-SterileSingle use, powder
free, device color,
device name, glove
size and quantity, Vinyl
Examination Gloves,
Non-SterileSimilar

Table1-General Comparison

Table2 Device Dimensions Comparison

| Predicate

Device(K163168)DesignationSizeTolerance
Length, mmXS
230S
230M
235L
245XL
245min
Width, mm808595105115$\pm 5$

5

Thickness, mm:
Finger0.05min
Palm0.08min
Subject DeviceDesignationSizeTolerance
SMLXL
Length, mm240240240240±10
Width, mm8595105115±5
Thickness, mm:
Finger, mm0.10±0.05
Palm, mm0.08min
RemarkSIMILAR

Table 3 Performance Comparison

ItemSubject devicePredicated deviceComparison
ColorantYellowWhite, Blue, YellowSimilar
Physical
PropertiesBefore
Aging
Tensile
Strength11MPa, min15MPa, minSimilar
Ultimate
Elongation300%min380%minSimilar
After
Aging
Tensile
Strength11MPa, min15MPa, minSimilar
Ultimate
Elongation300%min380%minSimilar
Comply with ASTM D5250Comply with ASTM D5250SAME
Freedom from HolesBe free from holes when tested in accordance with ASTM D5151 AQL=2.5Be free from holes when tested in accordance with ASTM D5151 AQL=2.5SAME
Powder Content0.01 mg per gloveMeet the requirements of
ASTM D6124SIMILAR

Analysis 2: The tensile strength and ultimate elongation are different with that of the predicate, but they all meet the requirements of ASTM D5250, so the differences do not raise any new safety or performance questions.

Table4 Safety Comparison

ItemSubject devicePredicated deviceComparison
MaterialVinylVinylSAME
BiocompatibilityIrritationUnder the conditions of the study, not an irritantComply with ISO10993-10SAME

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| | Sensitization | Under conditions of the
study, not a sensitizer. | Under conditions of the
study not a sensitizer | |
|--------------------|---------------|-----------------------------------------------------------------------------------------|---------------------------------------------------|-----------|
| | Cytotoxicity | Under conditions of the
study, did not show
potential toxicity to L-929
cells. | / | DIFFERENT |
| Label and Labeling | | Meet FDA's Requirement | Meet FDA's
Requirement | SIMILAR |

8.0 Non-Clinical Test Conclusion

The test results demonstrated that the proposed device complies with the following standards:

ISO 10993-10:2010 Biological Evaluation of Medical Devices - Part 10: Tests For Irritation And Skin Sensitization.

ISO 10993-5:2009 Biological Evaluation of Medical Devices - Part 5: Tests For In Vitro Cytotoxicity

ASTM D6124-06 (Reapproved 2017), Standard Test Method for Residual Powder on Medical Gloves

ASTMD5151-06 (Reapproved2015), Standard Test Method for Detection of Holes in Medical Gloves.

ASTM D5250-19, Standard Specification for Poly (vinyl chloride) Gloves for Medical Application.

9.0 Clinical Test Conclusion

Clinical testing is not needed for this device.

10.0_Conclusion

The conclusions drawn from the nonclinical tests demonstrate that the proposed device is as safe, as effective, and performs as well as or better than the legally marketed predicated device.