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510(k) Data Aggregation

    K Number
    K212293
    Date Cleared
    2021-10-25

    (95 days)

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

    The Surgical Mask (Model: WK1701-02A, WK1701-03A and WK1701-04A) is intended to be worn to protect both the patient and healthcare personnel from the transfer of microorganisms, body fluids, and particulate material. The Surgical 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.

    The Model WK1701-02A is Level 1 barrier as ASTM F2100 requirements.

    The Model WK1701-03A is Level 2 barrier as ASTM F2100 requirements.

    The Model WK1701-04A is Level 3 barrier as ASTM F2100 requirements.

    Device Description

    The proposed device(s) includes 3 models, which are WK1701-02A, WK1701-03A and WK1701-04A. Three of them all are Blue color, and Flat Pleated type mask, utilizing Ear Loops' way for wearing, and they all have Nose Piece design for fitting the facemask around the nose.

    All three models of proposed device(s) share same materials and structure, they all are manufactured with three layers, the inner and outer layers are made of polypropylene spunbond fabric, and the middle layer is made of polypropylene meltblown fabric.

    The proposed device(s) of Level 1, Level 2 and Level 3 have the same material. The proposed device(s) are manufactured with three layers, the inner and outer layers are made of polypropylene spunbond fabric, and the middle layer is made of polypropylene meltblown fabric.

    The nose piece contained in the proposed device(s) is in the layers of the facemask to allow the user to fit the facemask around their nose, which is made of polypropylene coated galvanized iron wire.

    The proposed device(s) 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 made with nylon and spandex.

    The proposed device(s) are sold non-sterile and are intended to be single-use, disposable devices.

    AI/ML Overview

    The provided document is a 510(k) Premarket Notification for a Surgical Mask, not a deep learning AI device. Therefore, the questions related to deep learning AI evaluation (such as sample size for training/test sets, data provenance, number of experts for ground truth, adjudication methods, MRMC studies, standalone performance, and ground truth establishment for training data) are not applicable to this submission.

    The document describes the acceptance criteria and the study that proves the device meets those criteria for Surgical Masks, based on non-clinical performance and biocompatibility testing.

    Here's the information extracted from the document relevant to the acceptance criteria and device performance:

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

    The document provides several tables detailing the performance characteristics and comparisons. The most direct representation of acceptance criteria and results for the proposed device is found in the "Non-Clinical Test Conclusion" section (pages 7-8).

    Test MethodPurposeAcceptance CriteriaReported Device Performance (Results)
    ASTM F2101-19 (Bacterial Filtration Efficiency, BFE)Verify the Bacterial Filtration Efficiency (BFE) performance of the subject device.Level 1: ≥95%;
    Level 2: ≥98%;
    Level 3: ≥98%;WK1701-02A (Level 1): 99.9%
    WK1701-03A (Level 2): 99.8 - 99.9%
    WK1701-04A (Level 3): 99.8 - 99.9%
    EN 14683-2019+AC:2019 Annex C (Differential Pressure)Verify the Differential Pressure (Delta P) performance of the subject device.Level 1:
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