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510(k) Data Aggregation

    K Number
    K220520
    Manufacturer
    Date Cleared
    2022-12-15

    (295 days)

    Product Code
    Regulation Number
    878.4040
    Reference & Predicate Devices
    Predicate For
    N/A
    Why did this record match?
    Reference Devices :

    K101000

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

    The PM Excellence SEQUR 100 Surgical Face Masks (for single use only) are indicated as protective nose and mouth covering for healthcare workers and patients. These face masks are intended for use in infection control practices as well as any medical or surgical procedure or situations where there is a risk of exposure to microorganism, body fluid, and particulate materials.

    Device Description

    PM Excellence SEQUR 100 Surgical Face Mask (light blue) for single use only, are pleated 3-ply masks that consist of the following materials: hydrophobic nonwoven PP (polypropylene) spunbond 35 gsm, 17.5cm, light blue (outer layer); nonwoven PP (poly propylene) spunbond 30gsm, 19.5cm, white (inner layer); and nonwoven PP (polypropylene) meltblown 30gsm, 17.5cm, white (middle filter layer). The PM Excellence SEQUR 100 Surgical Face Mask Light Blue also utilizes soft, latex-free elastic earloops and malleable wire nose piece.

    AI/ML Overview

    This document describes the performance testing for the PM Excellence SEQUR 100 Surgical Face Mask. This is a medical device, and the testing outlined is to demonstrate substantial equivalence to a predicate device, as required for a 510(k) submission to the FDA. The "acceptance criteria" and "study that proves the device meets the acceptance criteria" in this context refer to the a set of standardized performance tests that surgical masks must pass, and the results of those tests for the new device.

    Here's a breakdown of the requested information based on the provided text:

    1. Table of Acceptance Criteria and Reported Device Performance

    Test Method / ItemAcceptance CriteriaReported Device PerformanceResult
    Fluid Resistance (ASTM F1862)29 out of 32 pass at 160 mmHg31 out of 32 pass at 160 mmHgPass
    Differential Pressure (EN 14683: 2019 Annex C)
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    K Number
    K123787
    Date Cleared
    2013-07-17

    (219 days)

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

    K101000

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

    The GreenCross Surgical Masks are indicated as a protective nose and mouth covering for health care workers and patients involved in medical and surgical procedures. The masks are indicated in any procedure or situations where there is a risk of microorganism, body fluid, and particulate aerosol transfer.

    Device Description

    GreenCross surgical masks, Type: Earloop or Tie-on, are pleated 3-ply mask. Inner and outer layers are made of 100% spun-bond polypropylene. Middle player is made of 100% meltblown polypropylene filter media. Ear-loops are made of soft latex free elastic loops. All of the materials used in the construction of the GreenCross surgical masks are being used in currently marketed devices, except the nose piece used plastic wire instead of aluminum wire.

    AI/ML Overview

    K123787: GreenCross Surgical Mask Acceptance Criteria and Performance Study Analysis

    This submission describes the non-clinical performance testing of the GreenCross Surgical Mask to establish substantial equivalence to a predicate device (K101000).

    1. Table of Acceptance Criteria and Reported Device Performance

    The acceptance criteria for each test are implicitly set by achieving comparable performance to the predicate device, or by meeting the "relevant requirements in the test standards." The reported device performance is directly compared to the predicate device's performance.

    TestAcceptance Criteria (Implicit)GreenCross Surgical Mask PerformancePredicate Device (K101000) Performance
    Fluid Resistance (ASTM F1862)Comparable to predicate; meets relevant standard requirements29 out of 32 pass at 120 mm Hg31 out of 32 pass
    Particle Filtration Efficiency (ASTM F2299)Comparable to predicate; meets relevant standard requirements99.1%99.8%
    Bacteria Filtration Efficiency (ASTM F2101)Comparable to predicate; meets relevant standard requirements99.8%99.9%
    Differential Pressure (MIL-M-36945C)Comparable to predicate; meets relevant standard requirements2.6-2.9 (mm Water/cm²)3.7-4.0 (mm Water/cm²)
    Flammability (16CFR 1610)Class 1 None FlammableClass 1 None FlammableClass 1 None Flammable
    Biocompatibility (ISO 10993-5, -10)BiocompatibleBiocompatibleBiocompatible

    2. Sample Size Used for the Test Set and Data Provenance

    The document does not explicitly state the specific sample sizes used for each individual non-clinical test (e.g., number of masks tested for BFE, PFE). For the Fluid Resistance test (ASTM F1862), the result "29 out of 32 pass" indicates a sample size of 32 masks for that particular test.

    The data provenance is from non-clinical tests conducted by the manufacturer, Jingzhou Haixin Green Cross Medical Products Co., Ltd. The country of origin for the testing is not explicitly stated, but the manufacturer is based in Wuhan City, Hubei, P. R, China. These are prospective test results generated specifically for this submission.

    3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications

    This section is not applicable. The ground truth for this device is based on objective, standardized laboratory performance tests designed to measure physical properties and filtration capabilities. It does not involve human expert interpretation or subjective evaluation.

    4. Adjudication Method for the Test Set

    This section is not applicable. As the ground truth is established through standardized laboratory tests, there is no need for expert adjudication.

    5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

    An MRMC study was not performed. This submission is for a surgical mask, and its performance is evaluated through non-clinical bench testing, not by comparing human reader performance.

    6. Standalone (Algorithm Only) Performance

    This section is not applicable. As this is a physical medical device (surgical mask), there is no algorithm or AI involved.

    7. Type of Ground Truth Used

    The ground truth used for evaluating the GreenCross Surgical Mask is based on objective, standardized laboratory performance testing as outlined by international and national standards (e.g., ASTM F2101, ASTM F2299, ASTM F1862, MIL-M-36945C, 16CFR 1610, ISO 10993). These standards define specific methodologies and criteria for measuring the performance attributes of surgical masks.

    8. Sample Size for the Training Set

    This section is not applicable. This is a physical device, not an AI/ML algorithm, so there is no "training set."

    9. How the Ground Truth for the Training Set Was Established

    This section is not applicable. There is no training set for a physical surgical mask.

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