K Number
K210641
Device Name
Disposable Medical Mask
Date Cleared
2021-06-07

(96 days)

Product Code
Regulation Number
878.4040
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Disposable Medical Mask is intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. The face mask is 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. It is intended for adults only (greater than 21 years of age).
Device Description
The Disposable Medical Mask is a blue, flat pleated type mask, which utilizes an Earloop to Wear. It has a nose piece design to fit the facemask around the nose. The Disposable Medical Masks are manufactured with three layers and the inner and outer layers are made of spun-bond polypropylene, and the middle laver is made of melt-blown polypropylene filter. The model of the proposed device, earloop, is held in place over the user's mouth and nose by two elastic ear loops welded to the facemask. The elastic ear loops are not made with natural rubber latex. The nose piece in the mask is in the facemask layers to allow the user to fit the facemask around their nose, made of malleable aluminum wire. The Disposable Medical Masks are sold non-sterile and are intended to be a single-use, disposable device.
More Information

Not Found

No
The device description and performance studies focus on the physical filtration and material properties of a disposable medical mask, with no mention of AI or ML technologies.

No
The device is described as protecting from transfer of microorganisms, body fluids, and particulate material, and reducing potential exposure to blood and body fluids. It is not intended for treating or diagnosing any disease or condition.

No
The device is a Disposable Medical Mask intended for infection control to protect from transfer of microorganisms and fluids. It does not diagnose any condition or disease.

No

The device description clearly outlines a physical, disposable mask made of polypropylene layers with ear loops and a nose piece. The performance studies focus on physical properties and biocompatibility, not software functionality.

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 against the transfer of microorganisms, body fluids, and particulate material by being worn on the face. This is a physical barrier function, not a diagnostic one.
  • Device Description: The description details the physical construction and materials of the mask, again focusing on its function as a barrier.
  • Performance Studies and Key Metrics: The performance studies and key metrics (BFE, PFE, Differential Pressure, Resistance to synthetic blood, Flame Spread, Biocompatibility) are all related to the physical and biological barrier properties of the mask. They do not involve analyzing samples from the human body to diagnose a condition.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.), detecting specific analytes, or providing diagnostic information.

IVD devices are used to examine specimens derived from the human body to provide information for the diagnosis, prevention, monitoring, treatment, or alleviation of disease. This mask does not perform any of these functions.

N/A

Intended Use / Indications for Use

The Disposable Medical Mask is intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. The face mask is 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. It is intended for adults only (greater than 21 years of age).

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

FXX

Device Description

The Disposable Medical Mask is a blue, flat pleated type mask, which utilizes an Earloop to Wear. It has a nose piece design to fit the facemask around the nose. The Disposable Medical Masks are manufactured with three layers and the inner and outer layers are made of spun-bond polypropylene, and the middle laver is made of melt-blown polypropylene filter. The model of the proposed device, earloop, is held in place over the user's mouth and nose by two elastic ear loops welded to the facemask. The elastic ear loops are not made with natural rubber latex. The nose piece in the mask is in the facemask layers to allow the user to fit the facemask around their nose, made of malleable aluminum wire. The Disposable Medical Masks are sold non-sterile and are intended to be a single-use, disposable device. This product contains no components made from natural rubber latex.

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

adults only (greater than 21 years of age).

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 (study type, sample size, AUC, MRMC, standalone performance, key results)

Performance testing was provided to validate and verify that the Disposable Medical Mask, non- sterile, earloop met all requirements of related international standards, including biocompatibility and product specifications. These tests' results demonstrate compliance with the requirements of the consensus standards noted below.

Non-clinical Testing:

  • ASTM F2100-19: Standard Specification for Performance of Materials Used in Medical Face Masks (Performance)
  • ASTM F1862/F1862M-17: Standard Test Method for Resistance of Medical Face Masks to Penetration by Synthetic Blood (Horizontal Projection of Fixed Volume at a Known Velocity (Performance: Fluid Resistance Performance)
  • ASTM F2101-19: Standard Test Method for Evaluating the Bacterial Filtration Efficiency (BFE) of Medical Face Mask Materials, Using a Biological Aerosol of Staphylococcus aureus (Performance: Bacterial Filtration Efficiency (BFE))
  • ASTM F2299-2003: Standard Test Method for Determining the Initial Efficiency of Materials Used in Medical Face Masks to Penetration by Particulates Using Latex Spheres (Performance: Particulate Filtration Efficiency (PFE))
  • ASTM F2100-19 EN14683: 2019 Annex C (Performance: Differential Pressure (Delta P))
  • 16 CFR 1610 (Performance: Flammability)
  • ISO10993-1:2009: Biological evaluation of medical devices--Part 1: Evaluation and testing (Biocompatibility)
  • ISO10993-5:2009: Biological Evaluation of Medical Devices - Part 5 Tests for In Vitro Cytotoxicity (Biocompatibility)
  • ISO10993-10:2002/Amd. 1:2006(E): Biological Evaluation of Medical Devices - Part 10: Tests for Irritation and Delayed-Type Hypersensitivity (Biocompatibility)
  • FDA Guidance: Surgical Masks - Premarket Notification [510(k)] Submissions; Guidance for Industry and FDA (Guidance)

Test Results:

  • Bacterial Filtration Efficiency (BFE, %): ASTM F2101, Acceptance Criteria ≥ 98, Test Result Pass
  • Particulate Filtration Efficiency (PFE, at 0 1 µm, %): ASTM F2299, Acceptance Criteria ≥ 98, Test Result Pass
  • Differential Pressure (Delta P, mm H2O/cm2): ASTM F2100-19 EN 14683:2019, Annex C, 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.

0

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June 7, 2021

Tuosheng Protective Products (Ningbo) Co., Ltd % Charles Mack Principal Engineer Irc 2950 E Lindrick Drive Chandler, Arizona 85249

Re: K210641

Trade/Device Name: Disposable Medical Mask Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: FXX Dated: April 30, 2021 Received: May 5, 2021

Dear Charles Mack:

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.

1

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 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 medical devices and radiation-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 Clarence W. Murray III, Ph.D. Acting 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)

K210641

Device Name Disposable Medical Mask

Indications for Use (Describe)

The Disposable Medical Mask is intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. The face mask is 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. It is intended for adults only (greater than 21 years of age).

Type of Use (Select one or both, as applicable)
-------------------------------------------------
Registration Under Part 375, ECL Subject to Cleanup Plan
Brownfield Cleanup Program Under Article 27, Title 14, ECL

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

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

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3

K210641 510(k) SUMMARY

Preparation Date:June 3, 2021
Manufacturer's Name and Address:TUOSHENG PROTECTIVE
PRODUCTS (NINGBO) CO.,LTD
No 1728 Xiaolin Ave, North Industrial
Zone, Xiaolin Town, Cixi City, Zhejiang
Province, CHINA315321
Mr. Nanping Yuan
General Manager
Tel: 86-574-63795109
Fax: 86-574-63795109
Email: yuan@tuoshengprotective.com
FDA Establishment Registration No.:
3016844771
Designated Submission Correspondent
and US Agent:IRC USA
2950 E Lindrick Dr., Chandler, Arizona
85249, USA
Mr. Charles Mack
PRINCIPAL ENGINEER
Tel: 931-6254938
Email: charliemack@irc-us.com
Telephone Number:931-625-4938
Email Address:charliemack@irc-us.com
Trade Name:Disposable Medical Mask
Common Name(s):Disposable Medical Mask
Regulation Name(s):mask, surgical
Regulation Number(s):21CFR878.4040
Product Code:FXX
Device Class:Class II
Predicate Device:Xiantao Rayxin Medical Products Co.,
Ltd.
Disposable Surgical Face Mask
K153496

4

Device Description:

The Disposable Medical Mask is a blue, flat pleated type mask, which utilizes an Earloop to Wear. It has a nose piece design to fit the facemask around the nose. The Disposable Medical Masks are manufactured with three layers and the inner and outer layers are made of spun-bond polypropylene, and the middle laver is made of melt-blown polypropylene filter. The model of the proposed device, earloop, is held in place over the user's mouth and nose by two elastic ear loops welded to the facemask. The elastic ear loops are not made with natural rubber latex. The nose piece in the mask is in the facemask layers to allow the user to fit the facemask around their nose, made of malleable aluminum wire. The Disposable Medical Masks are sold non-sterile and are intended to be a single-use, disposable device.

This product contains no components made from natural rubber latex.

Intended Use / Indications for Use

The Disposable Medical Mask is intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. The face mask is 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. It is intended for adults only (greater than 21 years of age).

5

FeaturesSubject DevicePredicate DeviceComparison
DeviceDisposable Medical MaskDisposable Surgical Face MaskN/A
ModelEar LoopEar Loop and Tie-OnN/A
ManufacturerTuosheng Protective Products (Ningbo) Co., Ltd.Xiantao Rayxin Medical Products Co., ltd.N/A
510(k)K210641K153496N/A
Indication for UseThe Disposable Medical Mask is intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids, and particulate material. The face mask is 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. It is intended for adults only (greater than 21 years of age).The Disposable 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.Similar
OTC or PrescriptionOTCOTCIdentical
Product CodeFXXFXXIdentical
ClassificationClass 2, CFR878.4040Class 2, CFR878.4040Identical
Material:
Outer facing layerSpun-bond polypropyleneSpun-bond polypropyleneIdentical
Middle layerMelt blown polypropylene filterMelt blown polypropylene filterIdentical
Inner facing layerSpun-bond polypropyleneSpun-bond polypropyleneIdentical
Nose pieceMalleable aluminum wireMalleable aluminum wireIdentical
EarloopPolyurethane + PolyesterPolyesterDifferent
ColorantPolypropylene (PP) master batchPolypropylene (PP) master batchIdentical
Design featuresColor: Blue
Ear LoopColor: Blue
Ear LoopIdentical
Mask StyleFlat PleatedFlat PleatedIdentical
Specification and
DimensionLength: 17.5 cm ± 0.85 cm
Width: 9.5 cm ± 0.45 cmLength: 17.5cm±1cm
Width: 9.5cm±1cmIdentical
FeaturesSubject DevicePredicate DeviceComparison
SterilityNon-sterileNon-sterileIdentical
UsageDisposable, Single UseDisposable, Single UseIdentical
Performance:
Performance
Testing (ASTM
F2100-19)Level 2Level 2Identical
Fluid Resistance
Performance ASTM
F186232 out of 32 pass at 120mmHg32 out of 32 pass at 120mmHgMeets the ASTM F2100-19 Requirements
for Level 2 Classification
Particulate Filtration
Efficiency ASTM
F2299Average 99.37%Average 98.46%Meets the ASTM F2100-19 Requirements
for Level 2 Classification
Bacterial Filtration
Efficiency ASTM
F2101Average 99.54%Average 98.70%Meets the ASTM F2100-19 Requirements
for Level 2 Classification
Differential Pressure
(Delta P)
EN 14683:2019,
Annex C4.00 mm H2O/cm²4.2 mm H2O/cm²Meets the ASTM F2100-19 Requirements
for Level 2 Classification
Flammability 16 CFR
1610Class 1
Non-FlammableClass 1
Non-FlammableIdentical
Biocompatibility
Cytotoxicity (ISO
10993-5)Under the conditions of the study, not
cytotoxic. Complies with ISO-10993-5.Under the conditions of the study, not
cytotoxicity effectIdentical
Sensitization (ISO
10993-10)Under conditions of the study, not a
sensitizer. Complies with ISO-10993-10.Under conditions of the study, not a
sensitizer.Identical
Irritation (ISO 10993-
  1.                               | Under the conditions of the study, not an
    

irritant. Complies with ISO-10993-10. | Under the conditions of the study, not an
irritant | Identical |

Comparison of Technological Characteristics with the Predicate Device

6

Discussion:

Although the materials used in the ear loops of the subject and predicate masks are not the final subject masks are tested for biocompatibility and specification performance. Therefore, this difference does not raise any new questions about safety and effectiveness.

Although there is a slight difference in performance test results between the subject device, they comply with the same performance standards, for ASTM F2100 Level 2. The minor differences in the technological characteristics do not raise issues on the safety and effectiveness of the subject device.

7

Performance Testing

Performance testing was provided to validate and verify that the Disposable Medical Mask, non- sterile, earloop met all requirements of related international standards, including biocompatibility and product specifications. These tests' results demonstrate compliance with the requirements of the consensus standards noted below.

Non-clinical Testing

StandardsScope
ASTM F2100-19
Standard Specification for Performance of Materials Used in Medical
Face MasksPerformance
ASTM F1862/F1862M-17
Standard Test Method for Resistance of Medical Face Masks to
Penetration by Synthetic Blood (Horizontal Projection of Fixed Volume at
a Known VelocityPerformance:
Fluid Resistance
Performance
ASTM F2101-19
Standard Test Method for Evaluating the Bacterial Filtration Efficiency
(BFE) of Medical Face Mask Materials, Using a Biological Aerosol of
Staphylococcus aureusPerformance:
Bacterial Filtration
Efficiency (BFE)
ASTM F2299-2003
Standard Test Method for Determining the Initial Efficiency of Materials
Used in Medical Face Masks to Penetration by Particulates Using Latex
SpheresPerformance:
Particulate Filtration
Efficiency (PFE)
ASTM F2100-19
EN14683: 2019 Annex CPerformance:
Differential Pressure
(Delta P)
16 CFR 1610Performance:
Flammability
ISO10993-1:2009
Biological evaluation of medical devices--Part 1: Evaluation and testingBiocompatibility
ISO10993-5:2009
Biological Evaluation of Medical Devices - Part 5 Tests for In Vitro
Cytotoxicity.Biocompatibility
ISO10993-10:2002/Amd. 1:2006(E)
Biological Evaluation of Medical Devices - Part 10: Tests for Irritation
and Delayed-Type HypersensitivityBiocompatibility
FDA Guidance: Surgical Masks - Premarket Notification [510(k)]
Submissions; Guidance for Industry and FDAGuidance

8

| Test | Standards | Acceptance Criteria
for Level 2 Mask | Test Result |
|--------------------------------------------------------------------------------------------------|--------------------------------------------|-----------------------------------------|-------------|
| Bacterial Filtration Efficiency
(BFE, %) | ASTM F2101 | ≥ 98 | Pass |
| Particulate Filtration
Efficiency (PFE, at 0 1 µm, %) | ASTM F2299 | ≥ 98 | Pass |
| Differential Pressure
(Delta P, mm H2O/cm2) | ASTM F2100-19
EN 14683:2019,
Annex C |