POLYCOAT POWDERED LATEX EXAMINATION GLOVE WITH ALOE VERA & PROTEIN CONTENT LABELING CLAIM (200 MICROGRAMS OR LESS)

{0}------------------------------------------------ | FEB 04 2002 | K013254<br>510(K) SUMMARY<br>(as required by 807.92(c)) | |----------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Submitter of 510(k): | Top Quality Manufacturing<br>6800 Lindbergh Ave.<br>Philadelphia, PA 19142 | | | Phone:<br>1-800-468-4886 | | Contact Person: | Marc Sinkow | | Date of Summary: | October 25, 2001 | | Trade Name: | Powdered Latex Examination Glove with Aloe Vera | | Classification Name: | Glove, Patient Examination, Poly | | Predicate Device: | Top Quality Skingard Polycoat Gloves K004018 | | Intended Use: | The Top Quality Skingard Polycoat Powdered Latex<br>Examination Glove with Aloe Vera is intended for medical<br>purposes to be worn on the examiner's hand or finger to<br>prevent contamination between patient and examiner | Device Comparison: | | Polycoat Glove with<br>Aloe Vera | Skingard Polycoat<br>Gloves | |-------------------|----------------------------------|-----------------------------| | 510(k) | | K004018 | | Testing Completed | | | | | ASTM D5712-95 | Same | | | ASTM D3578-00 | Same | | | ASTM D6124 | Same | | Intended Use | Examination | Same | | Glove | Latex | Same | | Packaging | 100 | 100 | | Glove Coating | Silicone | Silicone | | Powdered | Yes | Yes | | With Aloe Vera | Yes | No | {1}------------------------------------------------ Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines. Public Health Service FEB 0 4 2002 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 Top Quality Manufacturing, Incorporated C/O Mr. Arthur Ward Regulatory & Marketing Services, Incorporated 962 Allegro Lane Apollo Beach, Florida 33572 Re: K013254 Trade/Device Name: Polycoat Powdered Latex Examination Glove with Aloe Vera and Protein Content Labeling Claim (200 Micrograms or Less) Regulation Number: 880.6250 Regulation Name: Patient Examination Gloves Regulatory Class: I Product Code: LYY Dated: October 29, 2001 Received: November 14, 2001 Dear Mr. Ward: 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. 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 {2}------------------------------------------------ ## Page 2 - Mr. Ward 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 and additionally 21 CFR Part 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4618. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html Sincerely yours, K. Allalutka Timothy A. Ulatowski Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {3}------------------------------------------------ ## 510(k) Number (if known): K013254 Top Quality Manufacturing, Inc. - Polycoat Powdered Latex Examination Device Name: Glove with Aloe Vera + PROTEN CONTENT LABELING COMMICROGRAM OR W Indications For Use: The Top Quality Skingard Polycoat Powdered Latex Examination Glove with Aloe Vera is intended for medical purposes to be worn on the examiner's hand or finger to prevent contamination between patient and examiner. ## (PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Prescription Use (Per 21 CFR 801.109) OR Over-The-Counter Use Clim S. Lin (Division Sign-Off) Division of Dental, Infection Control, and General Hospital Devic r Offer Namber (Optional Format 1-2-96)