K Number
K212699
Device Name
Disposable Powder Free Polyethylene Examination Gloves
Date Cleared
2022-05-31

(279 days)

Product Code
Regulation Number
880.6250
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Disposable Powder Free Polyethylene Examination Gloves are powder free and non-sterile disposable devices intended for medical purposes that are worn on the examiner's hand or finger to prevent contamination between patient and examiner.
Device Description
The Disposable Powder Free Polyethylene Examination Gloves are non-sterile disposable patient examination glove. The gloves are made of translucent (clear), low density polyethylene material and are powder free. The Disposable Powder Free Polyethylene Examination Gloves come in four sizes: Small, Medium, Large, X Large. The Disposable Powder Free Polyethylene Examination Gloves act as a barrier to prevent contamination between patient and examiner. The physical and performance characteristics of the device meets all requirements of ASTM D5250 and ASTM D5151.
More Information

Not Found

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

No

Explanation: The device is a barrier to prevent contamination, not to treat or cure a disease or condition. It is a diagnostic aid/tool as it prevents contamination during examination.

No

Explanation: The device is a disposable glove intended to prevent contamination, acting as a barrier. It does not provide any diagnostic information or analysis.

No

The device is a physical glove made of polyethylene material, 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 (like blood, urine, or tissue) taken from the human body to provide information about a person's health. This testing is done outside of the body (in vitro).
  • Device Function: The description clearly states the gloves are "worn on the examiner's hand or finger to prevent contamination between patient and examiner." Their primary function is a physical barrier.
  • Lack of Diagnostic Testing: There is no mention of the gloves being used to analyze biological samples or provide any diagnostic information about a patient's condition.
  • Performance Studies: The performance studies focus on the physical properties of the gloves (tensile strength, elongation, water leak, biocompatibility), not on their ability to perform a diagnostic test.

The device is a medical device, specifically a patient examination glove, but it does not fit the definition of an In Vitro Diagnostic device.

N/A

Intended Use / Indications for Use

Disposable Powder Free Polyethylene Examination Gloves are powder free and non-sterile disposable devices intended for medical purposes that are worn on the examiner's hand or finger to prevent contamination between patient and examiner.

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

LZA

Device Description

The Disposable Powder Free Polyethylene Examination Gloves are non-sterile disposable patient examination glove. The gloves are made of translucent (clear), low density polyethylene material and are powder free. The Disposable Powder Free Polyethylene Examination Gloves come in four sizes: Small, Medium, Large, X Large.

The Disposable Powder Free Polyethylene Examination Gloves act as a barrier to prevent contamination between patient and examiner. The physical and performance characteristics of the device meets all requirements of ASTM D5250 and ASTM D5151.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

hand or finger

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 Disposable Powder Free Polyethylene Examination Gloves meet requirements per ASTM D5250-19, per ASTM D 5151-19, per ASTM D6124-06 (Reapproved 2017), ISO 10993-5: 2009 and ISO 10993-10: 2010.

Those verification tests of gloves were performed by qualified test center according to the above standards and included dimensions, tensile strength (before & after aging) & elongated rate (before & after aging), powder residual, water leak testing, and biocompatibility. The overall results of the testing demonstrated that the subject glove passed testing performed according to ASTM D5250-19. Tensile strength (Before & After aging) was demonstrated as more than 11MPa, elongated rate (before & after aging) was demonstrated as more than 300%, powder residual was demonstrated as less than 2mg/glove. The subject glove also did not raise any biocompatibility concerns when tested according to ISO 10993-5 and ISO 10993-10.

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

  • Length: >= 230mm
  • Width: Small 85 +/- 5mm, Medium 95 +/- 5mm, Large 105 +/- 5mm, X large 115 +/- 5mm
  • Thickness: >= 0.08mm (finger, palm)
  • Tensile strength (Before & After aging): >= 11MPa
  • Elongated rate (Before & After aging): >= 300%
  • Freedom from pinholes: Do not show droplet, stream or other type of water leakage at Inspection Level I AQL2.5
  • Powder Residual: Less than 2.0mg/glove
  • In vitro cytotoxicity: The test article should not have potential toxicity to L-929 in the MTT method.
  • Skin sensitization: The test article should not cause delayed dermal contact sensitization in the guinea pig.
  • Skin irritation: The irritation response category in the rabbit should be negligible.

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K173228

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" in a square, followed by the words "U.S. FOOD & DRUG ADMINISTRATION".

May 31, 2022

Mastermax Plastic (Huizhou) LTD % Tracy Che Registration Engineer Feiying Drug & Medical Consulting Technical Service Group Rm 2401 Zhenye International Business Center, No. 3101-90 Oianhai Road Shenzhen, Guangdong 518100 China

Re: K212699

Trade/Device Name: Disposable Powder Free Polyethylene Examination Gloves Regulation Number: 21 CFR 880.6250 Regulation Name: Non-Powdered Patient Examination Glove Regulatory Class: Class I. reserved Product Code: LZA Dated: April 26, 2022 Received: May 2, 2022

Dear Tracy Che:

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.

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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.

Clarence W. Murray III, 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) K212699

Device Name

Disposable Powder Free Polyethylene Examination Gloves

Indications for Use (Describe)

Disposable Powder Free Polyethylene Examination Gloves are powder free and non-sterile disposable devices intended for medical purposes that are worn on the examiner's hand or finger to prevent contamination between patient and examiner.

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)

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K212699

510k Summary

This 510(k) Summary is submitted in accordance with requirements of Title 21, CFR Section 807.92.

(1) Applicant information:

510(k) owner's name:Mastermax Plastic (Huizhou) LTD
Address:No.1, Qingli 3rd Road, Shuikou, Huicheng district, Huizhou,
Guangdong, China
Contact person:Benson Xu
Phone number:+86-752-2315076
Email:Bensonmastermax1@126.com
Date of summary prepared:2022-5-24

(2) Proprietary name of the device

Trade name/model:Disposable Powder Free Polyethylene Examination Gloves
Common name:Polymer Patient Examination Glove
Regulation number:21 CFR 880.6250
Product code:LZA
Review panel:General Hospital
Regulation class:Class I

(3) Predicate device

SponsorJiangsu U-MED Rubber & Plastic Products Co.,Ltd.
Device Name and ModelU-MED Powder Free Polyethylene Examination Gloves, Blue Color
510(k) NumberK173228
Product CodeLZA
Regulation Number21 CFR 880.6250
Regulation ClassClass I

(4) Description/ Design of device:

The Disposable Powder Free Polyethylene Examination Gloves are non-sterile disposable patient examination glove. The gloves are made of translucent (clear), low density polyethylene material and are powder free. The Disposable Powder Free Polyethylene Examination Gloves come in four sizes: Small, Medium, Large, X Large.

The Disposable Powder Free Polyethylene Examination Gloves act as a barrier to prevent

4

contamination between patient and examiner. The physical and performance characteristics of the device meets all requirements of ASTM D5250 and ASTM D5151.

(5) Indications for use:

Disposable Powder Free Polyethylene Examination Gloves are powder free and non-sterile disposable devices intended for medical purposes that are worn on the examiner's hand or finger to prevent contamination between patient and examiner.

ItemSubject devicePredicate deviceComparison
CompanyMastermax Plastic (Huizhou) LTDJiangsu U-MED Rubber &
Plastic Products Co.,Ltd/
Trade nameDisposable Powder Free
Polyethylene Examination
GlovesU-MED Powder Free
Polyethylene Examination
Gloves, Blue Color/
510 (k) numberK212699K173228/
Regulation
number21CFR 880.625021 CFR 880.6250Same
Product codeLZALZASame
SizeSmall/ Medium/ Large/X largeSmall/ Medium/ Large/X largeSame
ClassIISame
Indications for
use / Intended
useDisposable Powder Free
Polyethylene Examination
Gloves are powder free and
non-sterile disposable devices
intended for medical purposes
that are worn on the
examiner's hand or finger to
prevent contamination
between patient and examiner.Powder Free Polyethylene
Examination Gloves, Blue
Color is a non-sterile
disposable device intended for
medical purposes that is worn
on the examiner's hand or
finger to prevent
contamination between patient
and examiner.Similar
Device
Description and
SpecificationsMeets ASTM D5250-19Meets ASTM D5250-06
(Reapproved 2015)Similar
Dimensions:
Overall length,
Width,
Palm and Finger
thicknessMeets ASTM D5250-19Meets ASTM D5250-06
(Reapproved 2015)Similar
ItemProposed devicePredicate deviceRemark
Physical
Properties
Tensile Strength
before
aging/after
agingMeets ASTM D5250-19Meets ASTM D5250-06
(Reapproved 2015)Similar
Ultimate
Elongation
before
aging/after
agingMeets ASTM D5250-19Meets ASTM D5250-06
(Reapproved 2015)
Freedom from
Pinholes
HolesHoles at
Inspection Level I
AQL2.5Holes at
Inspection Level I
AQL2.5Same
Residual
PowderMeets ASTM D5250-19Meets ASTM D5250-06
(Reapproved 2015)Similar
Materials used
to fabricate the
devicesPolyethylenePolyethyleneSame
ColorTranslucent [clear]Blue colorDifferent
Performance
Data StandardMeets ASTM D5151-19
ASTM D5250-19
ASTM D6124-06
(Reapproved 2017)Meets ASTM D5151-06
(Reapproved 2015)
ASTM D5250-06
(Reapproved 2015)
ASTM D6124-06
(Reaffirmation 2011)Similar
Single Patient
UseSingle Patient UseSingle Patient UseSame
BiocompatibilityUnder the conditions of this
study, not have cytotoxicity
and
Under the conditions of this
study, not an irritant and
Under the conditions ofthisUnder the conditions of this
study, not an irritant and Under
the conditions of this study,
not a sensitizer.
SKIN IRRITATIONSimilar
ItemProposed devicePredicate deviceRemark
study, not a sensitizer.
SKIN IRRITATION
and SENSITIZATION
STUDIES Meet ISO
10993-10: 2010
In Vitro Cytotoxicity Meets
ISO 10993-5: 2009DERMAL and
SENSITIZATION STUDIES
Meets ISO 10993-10 Third
Edition 2010-08-01
LabelingThere are no special labeling
claims and we do not claim
our gloves as hypoallergenic
on our labels.
-Powder Free
-Patient Examination Glove
-Single Use Only
-Lot
Shelf life of 3 yearsThere are no special labeling
claims and we do not claim
our gloves as hypoallergenic
on our labels.
-Powder Free
-Patient Examination Glove
-Single Use Only
  • Manufactured For:
  • Lot | Similar |

(6) Technological Characteristics Comparison:

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(7) Summary of the Technological Characteristics of the Device:

Disposable Powder Free Polyethylene Examination Gloves are summarized with the following technological characteristics compared to ASTM or equivalent standard.

CharacteristicsStandard
DimensionASTM D 5250-19
Length $\geq$ 230mm
Width
Small 85±5mm
Medium 95±5mm
Large 105±5mm
X large 115±5mm
Thickness
Finger $\geq$ 0.08mm
Palm $\geq$ 0.08mm
Physical PropertiesASTM D 5250-19
Tensile strength (Before & After aging) $\geq$ 11MPa
Elongated rate (Before & After aging) $\geq$ 300%
Freedom from pinholes
● ASTM D5250-19 Passed Standard
● ASTM D5151-19 Acceptance Criteria
Powder ResidualASTM standard D5250-19 and D6124-06
(Reapproved 2017) Meets