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510(k) Data Aggregation

    K Number
    K201095
    Manufacturer
    Date Cleared
    2021-03-19

    (329 days)

    Product Code
    Regulation Number
    878.4040
    Reference & Predicate Devices
    Predicate For
    N/A
    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    Sovereign America Surgical Mask is intended for use by healthcare personnel to protect both patients and healthcare personnel against the transfer of microorganisms, bodily fluids and particulate material. This is a single use, disposable device, provided non-sterile.

    Device Description

    The Sovereign America Surgical Mask is a single use, three-layer, flatpleated surgical mask with ear loops and a nose piece. The device is composed of three layers of nonwoven polypropylene, with the outer layer (Layer 1) and inner layer (Layer 3) being spun-bond nonwoven polypropylene, and the middle layer (Layer 2) being melt-blown nonwoven polypropylene. Layer 1 contains a blue pigment. The device utilizes two elastic ear loops, ultrasonically welded to the mask, to hold the device in place over the users' mouth and nose. The ear loops are polyester spandex elastic, and not made with natural rubber latex. The device also utilizes a malleable nose piece, made of polypropylene coated aluminum wire, to allow the user to fit the device around the bridge of the nose. The mask is provided non-sterile and intended to be a single use, disposable device.

    AI/ML Overview

    Here's a breakdown of the acceptance criteria and the study information for the Sovereign America Surgical Mask (K201095), based on the provided document:

    1. Table of Acceptance Criteria and Reported Device Performance:

    Testing StandardAcceptance Criteria (ASTM F2100 Level 1)Sovereign America Surgical Mask (K201095) Performance
    Fluid Resistance (ASTM F1862)29 out of 32 passed at 80 mmHg29 out of 32 passed at 80 mmHg
    Bacterial Filtration Efficiency (ASTM F2101)≥ 95%99.1 - 99.8%
    Particulate Filtration Efficiency (ASTM F2299)≥ 95%99.55 - 99.91%
    Differential Pressure (EN 14683/MIL-M-36954C)
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