POWDERED SYNTHETIC VINYL PATIENT EXAMINATION GLOVES, WHITE

K030200 · Kaohsiung Brothers Products Corp. · LYZ · Mar 20, 2003 · General Hospital

Device Facts

• Record ID: K030200
• Device Name: POWDERED SYNTHETIC VINYL PATIENT EXAMINATION GLOVES, WHITE
• Applicant: Kaohsiung Brothers Products Corp.
• Product Code: LYZ · General Hospital
• Decision Date: Mar 20, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 880.6250
• Device Class: Class 1

Intended Use

A medical glove is worn on the hand of healthcare and similar personnel to prevent contamination between healthcare personnel and patient.

Device Story

Powdered synthetic vinyl patient examination gloves; worn on hands of healthcare personnel; serves as protective barrier to prevent cross-contamination between patient and clinician; used in clinical or similar settings; disposable.

Clinical Evidence

No clinical data; bench testing only.

Technological Characteristics

Synthetic vinyl material; powdered; patient examination glove; Class I medical device.

Indications for Use

Indicated for use by healthcare and similar personnel as a protective barrier to prevent cross-contamination between personnel and patients.

Regulatory Classification

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.

Submission Summary (Full Text)

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MAR 2 0 2003

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Kaohsiung Brothers Products Corporation C/O Mr. Chien Lin 2631 North Magnolia Street Chicago, Illinois 60614

Re: K030200

Trade/Device Name: Powdered Synthetic Vinyl Patient Examination Gloves, White Regulation Number: 880.6250 Regulation Name: Patient Examination Gloves Regulatory Class: I Product Code: LYZ Dated: January 15, 2003 Received: January 21, 2003

Dear Mr. Lin:

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. 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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such 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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Page 2 - Mr. Lin

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); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act): 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801). please contact the Office of Compliance at [phone] Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely vours.

Pierce Cusimito for

Susan Runner, DDS, MA Interim Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Image /page/2/Picture/1 description: The image shows a black and white logo. The logo is a square with a stylized letter "B" inside. The letter "B" is made up of two horizontal bars, with the top bar slightly smaller than the bottom bar. The logo is simple and modern.

KAOHSIUNG BROTHERS PRODUCTS CORPORATION Office : 23, Kooshan 3rd Road, Kaohsiung, Taiwan, R.O.C. : 886-7-5612201~5 Tel : [phone]~7 Fax E-Mai I : [e-mail]

## ATTACHMENT B

## INDICATION FOR USE STATEMENT

510K Number (if known): ______________________________________________________________________________________________________________________________________________________ Device Name: Powdered Synthetic Vinyl Patient Examination Gloves, White

Indications For Use:

A medical glove is worn on the hand of healthcare and similar personnel to prevent contamination between healthcare personnel and patient.

LONG FIRST ( XIAMEN ) PLASTICS CO., LTD.

stone chem

STONE CHEN

( PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED )

.............................................................................................................................................................................. Concurrence of CDRH, Office of Device Evaluation (ODE)

| Prescription Use | OR |
|----------------------|----|
| (Per 21 CFR 801.109) | |
| (Division Sign-Off) | |

General Hospital (Optional Form)

Division of Anesthesiology, General Hospital, Infection Control, Dental Devices

510(k) Number: K030200

Over-The-Counter Use

(Optional Format 1-2-96)