Disposable Medical Mask

K210018 · Diasia Biomedical Technology Co., Ltd. · FXX · Apr 11, 2021 · General, Plastic Surgery

Device Facts

• Record ID: K210018
• Device Name: Disposable Medical Mask
• Applicant: Diasia Biomedical Technology Co., Ltd.
• Product Code: FXX · General, Plastic Surgery
• Decision Date: Apr 11, 2021
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4040
• Device Class: Class 2

Intended Use

The disposable medical masks are intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. These 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(s), provided non-sterile.

Device Story

Disposable, three-layer, flat-pleated medical mask; intended for single-use infection control. Construction: outer/inner layers of spunbond polypropylene; middle layer of meltblown polypropylene filter; iron wire nose piece with polypropylene covering; spandex/nylon ear loops. Device worn over nose and mouth to provide physical barrier against blood, body fluids, and particulates. Used in clinical settings or general use by healthcare personnel and patients. Non-sterile; disposable. Provides protection via mechanical filtration of particulates and fluid resistance.

Clinical Evidence

No clinical data. Bench testing only. Performance verified against ASTM F2100-19 Level 3 standards: Fluid Resistance (ASTM F1862, 160 mmHg), BFE (ASTM F2101, ≥99%), PFE (ASTM F2299, ≥99%), Differential Pressure (EN 14683, 4.5 mmH2O/cm²), and Flammability (16 CFR 1610, Class 1). Biocompatibility confirmed per ISO 10993-5 (cytotoxicity) and ISO 10993-10 (irritation/sensitization).

Technological Characteristics

Three-layer nonwoven mask; spunbond/meltblown/spunbond polypropylene construction. Iron wire nose piece with polypropylene covering. Spandex/nylon ear loops. Dimensions: 17.5cm x 9.4cm. Non-sterile. ASTM F2100-19 Level 3 compliant. Mechanical barrier principle.

Indications for Use

Indicated for use by patients and healthcare personnel to reduce exposure to microorganisms, body fluids, and particulate material during infection control practices.

Regulatory Classification

Identification

Surgical apparel are devices that are intended to be worn by operating room personnel during surgical procedures to protect both the surgical patient and the operating room personnel from transfer of microorganisms, body fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and shoe covers, and isolation masks and gowns. Surgical suits and dresses, commonly known as scrub suits, are excluded.

Special Controls

*Classification.* (1) Class II (special controls) for surgical gowns and surgical masks. A surgical N95 respirator or N95 filtering facepiece respirator is not exempt if it is intended to prevent specific diseases or infections, or it is labeled or otherwise represented as filtering surgical smoke or plumes, filtering specific amounts of viruses or bacteria, reducing the amount of and/or killing viruses, bacteria, or fungi, or affecting allergenicity, or it contains coating technologies unrelated to filtration (e.g., to reduce and or kill microorganisms). Surgical N95 respirators and N95 filtering facepiece respirators are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9, and the following conditions for exemption:(i) The user contacting components of the device must be demonstrated to be biocompatible. (ii) Analysis and nonclinical testing must: (A) Characterize flammability and be demonstrated to be appropriate for the intended environment of use; and (B) Demonstrate the ability of the device to resist penetration by fluids, such as blood and body fluids, at a velocity consistent with the intended use of the device. (iii) NIOSH approved under its regulation. (2) Class I (general controls) for surgical apparel other than surgical gowns and surgical masks. The class I device is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to § 878.9.

Predicate Devices

• DemeMASK Surgical Mask (K201479)

Submission Summary (Full Text)

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April 11, 2021

Diasia Biomedical Technology Co., Ltd. % Grace Liu Consultant Shenzhen Joyantech Consulting Co., Ltd 1713A, 17th Floor, Block A, Zhongguan Times Square, Nanshan District Shenzhen, Guangdong 518000 China

Re: K210018

Trade/Device Name: Disposable Medical Mask Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical Apparel Regulatory Class: Class II Product Code: FXX Dated: March 16, 2021 Received: March 23, 2021

Dear Grace Liu:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to 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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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); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for

combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

# Ryan Ortega -S

Ryan Ortega, PhD Acting Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Ouality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K210018

Device Name Disposal Medical Mask

#### Indications for Use (Describe)

The disposable medical masks are intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. These masks are 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.

| Type of Use (Select one or both, as applicable) | |
|-------------------------------------------------|--|
|-------------------------------------------------|--|

Prescription Use (Part 21 CFR 801 Subpart D)

X Over-The-Counter Use (21 CFR 801 Subpart C)

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# 510(k) Summary

# K210018

# 1. Contact Details

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## 1.1 Applicant information

| Applicant Name | Diasia Biomedical Technology Co., Ltd. |
|----------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Address | 2F/3F301/4F (Building A) & 2F (Building B), Fuxinlin<br>Industrial Park, Hangcheng Industrial Zone, Taoyuan,<br>Xixiang, Bao'an District, Shenzhen, Guangdong, China |
| Contact person | Jason Luo |
| Phone No. | [phone] |
| E-mail | [e-mail] |
| Date Prepared | 2021-04-05 |

#### 1.2 Submission Correspondent

| Image: logo | Shenzhen Joyantech Consulting Co., Ltd<br>1713A, 17th Floor, Block A, Zhongguan Times Square,<br>Nanshan District, Shenzhen, Guangdong Province, China |
|-------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------|
| 卓远天成 | |
| Phone No. | [phone] |
| Contact person | Grace Liu; Field Fu; |
| Contact person's e-mail | [e-mail]; [e-mail] |
| Website | http://www.cefda.com |

# 2. Device Information

| Trade name | Disposable Medical Mask |
|---------------------|-------------------------|
| Common name | Surgical Face Mask |
| Model | TP175x94 |
| Classification | II |
| Classification name | Mask, Surgical |
| Product code | FXX |
| Regulation No. | 21 CFR 878.4040 |

# 3. Legally Marketed Predicate Device

| Trade Name | DemeMASK Surgical Mask |
|---------------|------------------------|
| 510(k) Number | K201479 |
| Product Code | FXX |
| Manufacturer | DemeTECH Corporation |

#### 4. Device Description

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The proposed device is a three-layer, flat pleated mask. Each mask is composed of a mask body, a nose piece and two ear loops. The mask body is manufactured with three layers, the inner layer and the outer layer are made of spunbond polypropylene nonwoven fabric, and the middle layer is made of meltblown polypropylene nonwoven fabric.

The model of proposed device, ear-loop, is held in place over the user's mouth and nose by two elastic ear loops welded to the mask body. The elastic ear loops are made of spandex and nylon, not made from natural rubber latex.

The nose piece is in the layers of face mask to allow the user to fit the face mask around his nose, which is a iron wire with polypropylene covering.

The proposed device is provided non-sterile and is intended to be a single use, disposable device.

## 5. Intended Use/Indication for Use

The disposable medical masks are intended to be worn to protect both the patient and healthcare personnel from transfer of microorganisms, body fluids and particulate material. These 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(s), provided non-sterile.

| Table 1 Substantial Equivalence Comparison | | | |
|-----------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------|
| Item | Proposed Device<br>(K210018) | Predicate Device<br>(K201479) | Comment |
| Product name | Disposable Medical Mask | DemeMASK Surgical Mask | None |
| Manufacturer | Diasia Biomedical<br>Technology Co., Ltd. | DemeTECH Corporation | None |
| Product Code | FXX | FXX | Same |
| Regulation Number | 21 CFR § 878.4040 | 21 CFR § 878.4040 | Same |
| Classification | Class II | Class II | Same |
| OTC use | Yes | Yes | Same |
| ASTM Level (ASTM<br>F2100-19) | Level 3 | Level 3 | Same |
| Indications for use | The disposable medical<br>masks are intended to be<br>worn to protect both the<br>patient and healthcare<br>personnel from transfer of<br>microorganisms, body<br>fluids and particulate<br>material. These masks are<br>intended for use in infection<br>control practices to reduce<br>the potential exposure to | The Disposal Surgical Face<br>Masks are intended to be<br>worn to protect both the<br>patient and healthcare<br>personnel from transfer of<br>microorganisms, body fluids<br>and particulate material.<br>These face masks are<br>intended for use in infection<br>control practices to reduce<br>the potential exposure to | Same |
| | blood and body fluids. This is<br>a single use, disposable<br>device(s), provided<br>non-sterile. | blood and body fluids. This is<br>a single use, disposable<br>device provided non-sterile. | |
| Design feature | Ear-loop | Ear-loop | Same |
| Mask style | Flat Pleated | Flat Pleated | Same |
| Use | Single Use, Disposable | Single Use, Disposable | Same |
| Specifications and<br>Dimensions | Length: 17.5cm±0.5cm<br>Width: 9.4cm ±0.5cm | Length: 17.5cm±1cm<br>Width: 9.5cm±1cm | Similar |
| Sterility | Non-Sterile | Non-Sterile | Same |
| Materials | | | |
| Outer layer | Spunbond polypropylene | Spunbond polypropylene | Same |
| Middle layer | Meltblown polypropylene<br>filter | Meltblown polypropylene<br>filter | Same |
| Inner layer | Spunbond polypropylene | Spunbond polypropylene | Same |
| Nose piece | Iron wire with polypropylene<br>covering | Galvanized wire coated with<br>polyethylene | Different<br>(Issue 1) |
| Ear loop | Spandex and Nylon - Not<br>made from natural rubber<br>latex | Spandex and Nylon - Not<br>made from natural rubber<br>latex | Same |
| Performance | | | |
| Fluid Resistance<br>ASTM F1862 | Pass at 160 mmHg | Pass at 160 mmHg | Same |
| Bacterial Filtration<br>Efficiency<br>ASTM F2101 | Pass at ≥99% | Pass at ≥99% | Same |
| Particulate Filtration<br>Efficiency<br>ASTM F2299 | Pass at ≥99% | Pass at ≥99% | Same |
| Differential Pressure<br>(Delta-P) | Pass at <6.0 mmH2O/cm² | Pass at <6.0 mmH2O/cm² | Same |
| Flammability<br>16 CFR 1610 | Class 1 | Class 1 | Same |
| Biocompatibility<br>ISO 10993-5 and<br>ISO 10993-10 | Under the conditions of the<br>studies employed, the<br>device is non-cytotoxic,<br>non-sensitizing | Under the conditions of the<br>studies employed, the<br>device is non-cytotoxic,<br>non-sensitizing | Same |

#### 6. Substantial Equivalence Comparison

Table 1 Substantial Equivalence Comparison

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lssue 1: The differences in the materials do not raise additional questions for safety and effectiveness. Performance testing including biocompatibility evaluation has been performed on the final finished device which includes all construction materials.

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# 7. Non-clinical Testing

#### 7.1 Biocompatibility testing

The Medical Surgical Mask has been subjected to biocompatibility studies to demonstrate the safety of device. The biocompatibility studies are in accordance with ISO10993:

- A In Vitro Cytotoxicity (ISO 10993-5): the device was non-cytotoxic;
- ♪ Skin Irritation (ISO 10993-10): the device was non-irritating;
- > Skin Sensitization (ISO 10993-10): the device was non-sensitizing.

There is no additional safety risk for the proposed device when compared with the predicate device.

#### 7.2 Performance testing - Bench

The performance testing was determined according to "ASTM F2100-19 Standard Specification for Performance of Materials Used in Medical Face Masks" to demonstrate the effectiveness of device.

| Test | Purpose | Acceptance Criteria<br>per ASTM F2100-19<br>Level 3 (AQL=4.0%) | Subject Device Test Results<br>ASTM F2100-19<br>Level 3 | | Average |
|---------------------------------------------------------------|----------------------------------------------------------------------------------|----------------------------------------------------------------|-------------------------------------------------------------------------------|--|------------------|
| Fluid Resistance<br>(ASTM F1862) | Determine synthetic<br>blood penetration<br>resistance. | Pass at 160 mmHg | Pass at 160 mmHg<br>(96/96)<br>32 Samples each from<br>3 non-consecutive lots | | N/A |
| Bacterial filtration<br>efficiency (BFE)<br>(ASTM F2101) | Determine the<br>bacterial filtration<br>efficiency. | $\ge$ 98% | Pass (96/96)<br>32 Samples each from<br>3 non-consecutive lots | | 99.9% |
| Particulate<br>filtration<br>efficiency (PFE)<br>(ASTM F2299) | Determine<br>submicron<br>particulate filtration<br>efficiency at 0.1<br>micron. | $\ge$ 98% | Pass (96/96)<br>32 Samples each from<br>3 non-consecutive lots | | 99.8% |
| Differential<br>pressure<br>(Delta-P)<br>(EN 14683) | Determine breathing<br>resistance or<br>differential pressure. | < 6.0 mmH2O/cm² | Pass (96/96)<br>32 Samples each from<br>3 non-consecutive lots | | 4.5<br>mmH2O/cm² |
| Flammability<br>(16 CFR 1610) | Determine<br>flammability or flame<br>spread. | Class 1 | Pass (96/96)<br>32 Samples each from<br>3 non-consecutive lots | | N/A |

#### Table 2 Summary of Performance Testing

# 8. Clinical Testing

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No clinical study is included in this submission.

## 9. Conclusions

The proposed device has the same indication for use and similar technological characteristic as the predicate device. Non-clinical testing demonstrates that the proposed device performs as safe and effective as the predicate device.