← Product Code [FXX](/productcode/FXX) · K212460
# Medical Surgical Mask (Model: ZKM-U01(non-sterilized type 17.5cm×9.5cm)) (K212460)
_Guangzhou Zhengkang Medical Equipment Co.,Ltd · FXX · Nov 5, 2021 · General, Plastic Surgery · SESE_
**Canonical URL:** https://fda-staging.innolitics.com/device/K212460
## Device Facts
- **Applicant:** Guangzhou Zhengkang Medical Equipment Co.,Ltd
- **Product Code:** [FXX](/productcode/FXX.md)
- **Decision Date:** Nov 5, 2021
- **Decision:** SESE
- **Submission Type:** Traditional
- **Regulation:** 21 CFR 878.4040
- **Device Class:** Class 2
- **Review Panel:** General, Plastic Surgery
## Indications for Use
Medical Surgical Mask is intended to be worn to protect both patients and healthcare workers against transfer of microorganisms, body fluids and particulate materials. This is a single use device, provided non-sterile.
## Device Story
Medical Surgical Mask; three-layer flat pleated mask; non-sterile; single-use. Outer/inner layers: non-woven fabric; middle layer: melt-blown fabric; earloops: polyester textured yarn; nose piece: polyethylene. Used in clinical settings by healthcare workers and patients. Provides barrier protection against microorganisms, body fluids, and particulates. User adjusts nose piece to bridge of nose for fit. Benefits include reduced exposure to contaminants during surgical or medical procedures.
## Clinical Evidence
Bench testing only. No clinical data. Performance testing included: Fluid Resistance (ASTM F1862-17, pass at 120 mmHg), Particulate Filtration Efficiency (ASTM F2299-17, 99.99%), Bacterial Filtration Efficiency (ASTM F2101-19, >99.8%), Differential Pressure (EN 14683:2019/ASTM F2100-19, 5.5 mmH2O/cm²), and Flammability (16 CFR 1610, Class I). Biocompatibility testing (ISO 10993-5, ISO 10993-10) confirmed no cytotoxicity, sensitization, or irritation.
## Technological Characteristics
Three-layer flat pleated mask. Materials: non-woven fabric (outer/inner), melt-blown fabric (middle), polyester textured yarn (earloops), polyethylene (nose piece). Dimensions: 17.5cm x 9.5cm. Performance: ASTM F2100 Level 2. Non-sterile. No energy source. No software.
## Regulatory 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
- Avianz® Surgical Face Mask ([K200847](/device/K200847.md))
## Submission Summary (Full Text)
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Nov 5. 2021
Guangzhou ZhengKang Medical Equipment Co.,Ltd Tracy Che Registration engineer Feiying Drug & Medical Consulting Technical Service Group Rm 2401 Zhenye International Business Center, No. 3101-90 Qianhai Road Shenzhen, Guangdong 518052 China
Re: K212460
Trade/Device Name: Medical Surgical Mask (Model: ZKM-U01(non-sterilized type 17.5cm×9.5cm)) Regulation Number: 21 CFR 878.4040 Regulation Name: Surgical apparel Regulatory Class: Class II Product Code: FXX Dated: July 27, 2021 Received: August 5, 2021
Dear Tracy Che:
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 809); 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 (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).
Sincerely,
For Clarence W. Murray, III, PhD Assistant Director DHT4B: Division of Infection Control and Plastic Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health
Enclosure
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# Indications for Use
510(k) Number (if known) K212460
Device Name
Medical Surgical Mask (Model: ZKM-U01(non-sterilized type 17.5cm×9.5cm))
Indications for Use (Describe)
Medical Surgical Mask is intended to be worn to protect both patients and healthcare workers against transfer of microorganisms, body fluids and particulate materials. This is a single use device, 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
This "510(k) Summary" of 510(k) safety and effectiveness information is submitted in accordance with requirements of Title 21, CFR Section 807.92.
## (1) Applicant information
| 510 (k) owner's name: | Guangzhou ZhengKang Medical Equipment Co.,Ltd | | | |
|---------------------------|-----------------------------------------------------------|--|--|--|
| Address: | Room101,No.9Nanling Zhongxin Kuang Road,Taihe Town,Baiyun | | | |
| | District,GuangZhou,China | | | |
| Contact person: | Mike Wu | | | |
| Phone number: | 86-13600073056 | | | |
| Fax number: | / | | | |
| Email: | info@zkmedical.com | | | |
| Date of summary prepared: | 2021.08.02 | | | |
## (2) Reason for the submission
New device, there were no prior submissions for the device.
## (3) Proprietary name of the device
| Trade name: | Medical Surgical Mask |
|--------------------|---------------------------|
| Regulation Name: | Surgical apparel |
| Regulation number: | 21 CFR 878.4040 |
| Product code | FXX |
| Review panel: | General & Plastic Surgery |
| Regulation class: | Class II |
## (4) Predicate device
| Sponsor | Mexpo International Inc. |
|-------------------|----------------------------|
| Device Name | Avianz® Surgical Face Mask |
| 510(k) Number | K200847 |
| Product Code | FXX |
| Regulation Number | 21 CFR 878.4040 |
| Regulation Class | II |
## (5) Description/ Design of device
Medical Surgical Mask is a non-sterile, single use, three-layer mask with earloops and nose piece. The Medical Surgical Mask is manufactured with three layers, the outer and inner layers are made
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of non-woven fabric, and the middle layer is made of melt-blown fabric. The earloops are made of polyester textured yarn. The nose piece is made of polyethylene, which allow the users to adjust the nose piece according to the shape of the bridge of the nose.
## (6) Indications for use
Medical Surgical Mask is intended to be worn to protect both patients and healthcare workers against transfer of microorganisms, body fluids and particulate materials. This is a single use device, provided non-sterile.
## (7) Materials
| Component of
Device Requiring
Biocompatibility | Material of Component | Body Contact
Category
(ISO 10993-1) | Contact Duration
(ISO 10993-1) |
|------------------------------------------------------------------------------|-------------------------------------------------------------------------------------|-------------------------------------------|-----------------------------------|
| Medical Surgical
Mask ( ZKM-U01
(non-sterilized type
17.5cm×9.5cm)) | Non-woven fabric,
Melt-blown fabric,
Polyester textured yarn,
Polyethylene | Surface-contacting
device: skin | > 24h to 30 d |
The body-contacting material used in the Medical Surgical Mask have all passed biocompatibility test. Details can be seen in "Biocompatibility Discussion".
| Item | Proposed device | Predicate device | Remark | |
|------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------|-----------------------------------------------------------------|
| Trade name | Medical Surgical Mask | Avianz® Surgical Face Mask | / | |
| 510 (k) number | K212460 | K200847 | / | |
| Regulation number | 21 CFR 878.4040 | 21 CFR 878.4040 | Same | |
| Regulation description | Surgical apparel | Surgical apparel | Same | |
| Product code | FXX | FXX | Same | |
| Class | II | II | Same | |
| Indications for use/ Intended use | Medical Surgical Mask is intended to be worn to protect both patients and healthcare workers against transfer of microorganisms, body fluids and particulate materials. This is a single use device, provided non-sterile. | When properly worn, the surgical face masks are intended to protect both patient and healthcare workers from transfer of microorganisms, body fluids and airborne particles. This device is non-sterile and for single use only. | Similar, only wording difference | |
| | | | | |
| Materials | Inner layer | Non-woven fabric | Spunbond Polypropylene | Similar |
| | Middle layer | Melt-blown fabric | Melt Blown
Polypropylene
Filter | Similar |
| | Outer layer | Non-woven fabric | Spunbond Polypropylene | Similar |
| | Nose piece | Polyethylene | Single Galvanize Wire,
Coated By PE | Differences resolved by
biocompatibility testing |
| | Headband | Polyester textured yarn | Not made with natural
rubber latex | Differences resolved by
biocompatibility testing |
| | Mask style | Flat pleated | Flat pleated | Same |
| | Design feature | Earloop | Earloop | Same |
| | Dimensions | 17.5cm×9.5cm | (17.5cm±0.5cm)×(9.0cm± 0.5cm) | Similar |
| | Latex | Not made with natural
rubber latex | Not made with natural
rubber latex | Same |
| Color | | Blue | White | Differences resolved by
biocompatibility testing |
| Sterility | | Non-sterile | Non-sterile | Same |
| Use | | Single use | Single use | Same |
| Prescription or OTC | | OTC | OTC | Same |
| ASTM F2100 Level | | Level 2 | Level 2 | Same |
| | Performance test result | | | |
| Fluid resistance | | No penetration pass at 120 mmHg | 30 out of 32 pass at 120 mmHg | Similar |
| Particle Filtration
Efficiency | | Average 99.99% | 99.9% | Same |
| Bacterial Filtration
Efficiency | | Average > 99.8% | > 99.9% | Similar |
| Flammability Class | | Class 1 | Class 1 | Same |
| Delta - P | | Average 5.5 mmH2O/cm² | 3.0 mmH2O/cm² | Similar, both
masks met
requirements of
<6.0 mmH2O/cm² |
| | | | | |
| Biocompatibility | | No cytotoxicity (ISO 10993- 5)
No sensitization (ISO 10993- 10) | Non-Cytotoxic,
Non-Sensitizing,
Non-Irritating | Same |
| | | | | |
| | | | | |
## (8) Comparison to Predicate Device
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| No irritation (ISO 10993-
10) | | |
|----------------------------------|--|--|
|----------------------------------|--|--|
## (9) Non-clinical studies and tests performed
The following performance tests of Medical Surgical Mask were conducted:
| Test Methodology | Purpose | Acceptance criteria | Results |
|--------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Fluid Resistance
Performance
ASTM F1862-17 | To evaluate the effectiveness of the test article in protecting the user from possible exposure to body fluids. | No penetration pass at 120mmHg | Pass, no penetration pass at 120mmHg |
| Particulate Filtration
Efficiency ASTM
F2299-17 | To evaluate the effectiveness of the test article in protecting the user from possible exposure to particulates. | ≥98% | Pass, average 99.99% |
| Bacterial Filtration
Efficiency
ASTM F2101-19 | To evaluate the bacterial filtration efficiency (BFE) of mask. | ≥98% | Pass, average > 99.8% |
| Differential Pressure
(Delta P) EN
14683:2019,
Annex C and ASTM
F2100-19 | To measure the differential pressure of mask which is related to breathability. | <6.0 mmH2O/cm² | Pass, average 5.5 mmH2O/cm² |
| Flammability 16
CFR 1610 | To evaluate the flammability of mask. | Class 1 | Pass, Class I |
| In vitro cytotoxicity
ISO 10993-5 | To evaluate the biological safety of the product which has direct contact with intact skin. | The test article should not have potential toxicity to L-929 in the MTT method. | Pass, the test article Surgical face mask has no potential toxicity to L-929 in the MTT method. |
| Skin sensitization
ISO 10993-10 | To evaluate the biological safety of the product which has direct contact with intact skin. | The test article should not cause delayed dermal contact sensitization in the guinea pig. | Pass, the test article showed no evidence of delayed dermal contact sensitization in the guinea pig. The test article Surgical face |
| | | | |
| Skin irritation
ISO 10993-10 | To evaluate the
biological safety of the
product which has
direct contact with
intact skin. | The irritation response
category in the rabbit
should be negligible. | mask has no potential
skin sensitization on
guinea pigs in the
extraction method. |
| | | | Pass, the response of
the test article extract
was categorized as
negligible under the
test condition. The test
article Surgical Face
Mask has no potential
skin irritation on
rabbit in the extraction
method. |
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# (10) Conclusion
Based on the nonclinical tests performed, the subject device, Medical Surgical Mask, is as safe, as effective, and performs as well as the legally marketed predicate device, K200847, Avianz® Surgical Face Mask.
---
**Source:** [https://fda-staging.innolitics.com/device/K212460](https://fda-staging.innolitics.com/device/K212460)
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