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510(k) Data Aggregation

    K Number
    K250082
    Date Cleared
    2025-06-18

    (156 days)

    Product Code
    Regulation Number
    878.4040
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Procedure mask/Surgical mask/Face mask

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Procedure mask/Surgical mask/Face mask is 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, provided non-sterile.

    Device Description

    The subject device is a three-layer, single-use, flat-pleated mask. The inner and outer layers of the mask are made of polypropylene nonwoven, and the middle layer is made of polypropylene melt-blown nonwoven. The subject device is available in one type, ear loop. The ear loops are made of polyester and spandex. The ear loops model is held in place over the users' mouth and nose by two elastic ear loops welded to the mask. The nose clip is made of Iron and polypropylene. Users can adjust the nose clip according to the shape of the bridge of the nose, and fix the mask on the bridge of the nose to prevent the mask from falling off. The ear loop masks are available in two size, 17.5 × 9.5 cm and 14.5 × 9.5 cm. And the colors for the ear loop mask are yellow, blue and white. The ear loop masks are available in level 1, level 2 and level 3 masks based on ASTM F2100-23. This is a single-use, disposable device, provided non-sterile.

    AI/ML Overview

    The provided document is a 510(k) Clearance Letter for a medical device: Procedure mask/Surgical mask/Face mask. This type of document, specifically the "Summary of Non-Clinical Test" section, details the performance characteristics required for the device to meet regulatory standards.

    Here's an analysis of the acceptance criteria and the study that proves the device meets them, based on the provided text:

    Important Note: The provided document is for a medical mask, not an AI-powered diagnostic device. Therefore, many of the typical questions regarding AI/software performance studies (e.g., sample size for test set, number of experts, adjudication, MRMC studies, training set details, ground truth for AI) are not applicable to this submission. The "study" here refers to physical and biological performance testing of the mask material itself.


    Acceptance Criteria and Reported Device Performance

    The acceptance criteria are based on established standards like ASTM F2100-23, ASTM F1862/F1862M-24, ASTM F2101-23, EN 14683:2019+AC:2019, 16 CFR Part 1610, and ISO 10993 series. The table below summarizes these criteria and the reported performance:

    Table 1: Acceptance Criteria and Reported Device Performance

    Test MethodologyPurposeAcceptance CriteriaReported Device Performance (Result)
    Resistance to Penetration by Synthetic blood (ASTM F1862/F1862M-24)To evaluate the effectiveness of the test article from possible exposure to blood and other body fluids.Level 1: No penetration at 80 mmHg
    Level 2: No penetration at 120 mmHg
    Level 3: No penetration at 160 mmHgYellow mask (Level 1): Pass at 80 mmHg
    White mask (Level 1): Pass at 80 mmHg
    Blue mask: Level 1: Pass at 80 mmHg, Level 2: Pass at 120 mmHg, Level 3: Pass at 160 mmHg
    Particulate Filtration Efficiency (ASTM F3502-24)To determine the particle filtration efficiency (PFE) of the test article.Level 1: ≥ 80%
    Level 2: ≥ 85%
    Level 3: ≥ 85%Yellow mask (Level 1): greater than 80% efficiency
    White mask (Level 1): greater than 80% efficiency
    Blue mask (Level 1): greater than 80% efficiency
    Blue mask (Level 2): greater than 85% efficiency
    Blue mask (Level 3): greater than 85% efficiency
    Bacterial Filtration Efficiency (ASTM F2101-23)To determine the bacterial filtration efficiency (BFE) of the test article.Level 1: ≥ 95%
    Level 2: ≥ 98%
    Level 3: ≥ 98%Yellow mask (Level 1): greater than 95% efficiency
    White mask (Level 1): greater than 95% efficiency
    Blue mask (Level 1): greater than 95% efficiency
    Blue mask (Level 2): greater than 98% efficiency
    Blue mask (Level 3): greater than 98% efficiency
    Differential Pressure (EN 14683:2019+AC:2019 Annex C)To determine the differential pressure of the test article.Level 1:
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    K Number
    K223232
    Date Cleared
    2023-03-06

    (138 days)

    Product Code
    Regulation Number
    878.4040
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Procedure mask/Surgical mask/Face mask

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Procedure mask/Surgical mask is 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, provided non-sterile.

    Device Description

    The proposed device is a three-layer, single-use, flat- pleated mask. The inner and outer layers of the mask are made of polypropylene nonwoven, and the middle layer is made of polypropylene melt-blown nonwoven. The proposed devices are available in two types, ear loop and tie-on. The ear loops are made of polyester and spandex, and the ties are made of polypropylene nonwoven. The ear loops/ties are used to secure the mask over the users' mouth and face. The nose clip is made of Iron and polypropylene. Users can adjust the nose piece according to the shape of the nose, and fix the mask on the bridge of the nose to prevent the mask from falling off. The ear loop masks are available in two size, 17.5×9.5 cm and 14.5×9 cm; the tie-on mask is available in one size, 17.5×9.5 cm. And the colors for the ear loop mask are blue and black; the color for the tie-on mask is blue. Both the ear loop and tie-on masks are available in level 3 masks based on ASTM F2100-19 due to the difference in gram weight of the mask body. The proposed device is provided in non-sterile.

    AI/ML Overview

    This document is a 510(k) Summary for a medical device (Procedure mask/Surgical mask/Face mask). The information provided demonstrates that the device meets the acceptance criteria through non-clinical testing.

    Here's the breakdown of your requested information:

    1. A table of acceptance criteria and the reported device performance

    Test MethodologyAcceptance Criteria (Level 3 ASTM F2100-19)Reported Device Performance (Proposed Device)
    Resistance to Penetration by Synthetic bloodNo penetration at 160 mmHgPass at 160mmHg
    Particulate Filtration Efficiency (PFE)≥98%Blue mask: Pass at 99.75 %
    Black mask: Pass at 99.03 %
    Bacterial Filtration Efficiency (BFE)≥98%Blue mask: Pass at 99.87 %
    Black mask: Pass at 98.90 %
    Differential Pressure
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    K Number
    K220194
    Date Cleared
    2022-05-17

    (113 days)

    Product Code
    Regulation Number
    878.4040
    Reference & Predicate Devices
    Why did this record match?
    Device Name :

    Procedure mask/Surgical mask/Face mask

    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Procedure mask/Surgical mask is 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, provided non-sterile.

    Device Description

    The proposed device is a three-layer, single-use, flat- pleated mask. The inner and outer layers of the mask are made of polypropylene nonwoven, and the middle layer is made of polypropylene melt-blown nonwoven. The proposed devices are available in two types, ear loop and tie-on. The ear loops are made of polyester and spandex, and the ties are made of polypropylene nonwoven. The ear loops/ties are used to secure the mask over the users' mouth and face. The nose clip is made of Iron and polypropylene. Users can adjust the nose piece according to the shape of the nose, and fix the mask on the bridge of the nose to prevent the mask from falling off. The ear loop masks are available in two size, 17.5×9.5 cm and 14.5×9 cm; the tie-on mask is available in one size, 17.5×9.5 cm. And the colors for the ear loop mask are blue and black; the color for the tie-on mask is blue. Both the ear loop and tie-on masks are available in level 1 and level 2 masks based on ASTM F2100-19 due to the difference in gram weight of the mask body. The proposed device is provided in non-sterile.

    AI/ML Overview

    The provided text is a 510(k) Summary for a medical device (Procedure mask/Surgical mask/Face mask). It details non-clinical tests conducted to prove substantial equivalence to a predicate device, rather than the development and validation of an AI-powered diagnostic device.

    Therefore, I cannot extract information related to:

    • Study that proves the device meets acceptance criteria: The document describes non-clinical performance testing of a physical product (face mask) against established standards, not an AI model's performance.
    • Sample size used for the test set and data provenance: No test set of patient data, images, or cases is mentioned. The tests are on material properties of the mask.
    • Number of experts used to establish ground truth and qualifications: Ground truth for a face mask's performance is established by standardized physical and biological tests, not expert consensus on medical images or patient data.
    • Adjudication method for the test set: Not applicable as there's no diagnostic test set requiring adjudication.
    • Multi-reader multi-case (MRMC) comparative effectiveness study: Not applicable, as this is for evaluating human reader performance with and without AI assistance for interpretation tasks.
    • Standalone (algorithm only without human-in-the-loop performance) study: Not applicable, as this is a physical medical device, not an algorithm.
    • Type of ground truth used (expert consensus, pathology, outcomes data, etc.): Ground truth here refers to the measured physical and biological properties of the mask.
    • Sample size for the training set: There is no training set mentioned, as this is not an AI/ML device.
    • How the ground truth for the training set was established: Not applicable.

    Instead, I can present the acceptance criteria and reported device performance from the non-clinical tests for the traditional medical device (face mask) as provided in the document.

    1. Table of Acceptance Criteria and Reported Device Performance

    Test MethodologyPurposeAcceptance CriteriaResult (Proposed Device)
    Resistance to Penetration by Synthetic Blood (ASTM F1862/F1862M: 2017)To evaluate the effectiveness of the test article from possible exposure to blood and other body fluids.Level 1: No penetration at 80 mmHgLevel 1: Pass at 80mmHg
    Level 2: No penetration at 120 mmHgLevel 2: Pass at 120mmHg
    Particulate Filtration Efficiency (PFE) (ASTM F2299/F2299M-03 (2017))To determine the particle filtration efficiency (PFE) of the test article.Level 1: ≥95%Blue mask: Pass at 96.05%
    Black mask: Pass at 96.03%
    Level 2: ≥98%Blue mask: Pass at 98.78%
    Black mask: Pass at 98.75%
    Bacterial Filtration Efficiency (BFE) (ASTM F2101: 2019)To determine the bacterial filtration efficiency (BFE) of the test article.Level 1: ≥95%Blue mask: Pass at 98.25%
    Black mask: Pass at 98.25%
    Level 2: ≥98%Blue mask: Pass at 98.72%
    Black mask: Pass at 98.73%
    Differential Pressure (EN 14683:2019+AC: 2019 Annex C)To determine the differential pressure of the test article.Level 1:
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