K Number
K190534

Validate with FDA (Live)

Date Cleared
2019-05-29

(86 days)

Product Code
Regulation Number
890.3850
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Manual Wheelchair is to provide mobility to persons restricted to a sitting position.

Device Description

The Aluminum Manual Wheelchair is indoor/outdoor wheelchair that has a base with four-wheeled with a seat. The device can be disassembled for transport and it is foldable easily. The device uses a standard sling type back and seat.

Main components:

Main frame, handle sleeve, back upholstery, seat upholstery, armrest, side panel, rear wheel with handle ring, rear wheel axle, legrest, footplate, front fork, front wheels, cross bar.

Main materials:

Main frame, cross bar, legrest: Aluminum, silver/blue coating

Back upholstery, seat upholstery: Cover is polyester non-woven, inside with flame resistant foam

Handle sleeve, handle sleeve, side panel, handle ring, footplate: PVC

Tire of rear wheels, front wheels, armrest pad: PU

AI/ML Overview

The document provided is a 510(k) summary for a Manual Wheelchair (SIVFH2A102) and not an AI/ML medical device. Therefore, the questions related to AI/ML device performance (such as sample size for test/training sets, data provenance, expert ground truth, MRMC studies, standalone performance, etc.) are not applicable to this submission.

This 510(k) submission demonstrates substantial equivalence to a predicate device (K181795 AST Model MA012 and MS019 Rehab Wheelchair) primarily through non-clinical performance testing to consensus standards and a usability study.

Here's the information that can be extracted from the provided document regarding acceptance criteria and device testing:


Device: Manual Wheelchair SIVFH2A102

Predicate Device: K181795 AST Model MA012 and MS019 Rehab Wheelchair

1. Table of Acceptance Criteria and Reported Device Performance

For a mechanical device like a wheelchair, "acceptance criteria" are typically defined by meeting the requirements of specific international consensus standards for safety and performance. The "reported device performance" is essentially a statement of compliance with these standards.

Acceptance Criteria (Standard Requirement)Reported Device Performance (Compliance)
ISO 7176-1:2014: Determination of static stabilityMeets ISO 7176-1:2014
ISO 7176-3:2012: Determination of effectiveness of brakesMeets ISO 7176-3:2012
ISO 7176-5:2008: Determination of dimensions, mass and maneuvering spaceMeets ISO 7176-5:2008
ISO 7176-7:1998: Measurement of seating and wheel dimensionsMeets ISO 7176-7:1998
ISO 7176-8:2014: Requirements and test methods for static, impact and fatigue strengthsMeets ISO 7176-8:2014
ISO 7176-11:2012: Test dummies (General requirement for testing)Tests conducted following this standard
ISO 7176-13:1989: Determination of friction of test surface (General requirement for testing)Tests conducted following this standard
ISO 7176-15:1996: Requirements for information disclosure, documentation and labelingMeets ISO 7176-15:1996
ISO 7176-16:2012: Resistance to ignition of postural support devicesMeets ISO 7176-16:2012
ISO 7176-22:2014: Set-up procedures (General requirement for testing)Tests conducted following this standard
ISO 10993-1:2009: Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management processTesting performed for biocompatibility
ISO 10993-5:2009: Biological evaluation of medical devices - Part 5: Tests for in vitro cytotoxicityTesting performed for biocompatibility
ISO 10993-10:2010: Biological evaluation of medical devices - Part 10: Tests for irritation and delayed-type hypersensitivityTesting performed for biocompatibility
Usability Requirements: User manual comprehension and device operationMeets usability requirement as defined in V&V test report

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

  • Test Set Sample Size: For the performance tests (e.g., static stability, brakes, strengths), typically a small number of physical samples of the device are tested. The document does not specify the exact number of physical units of the wheelchair that were tested.
  • Data Provenance: The tests were conducted internally by the manufacturer, Jiangsu Horizon Medical Science & Technology Co., Ltd. The document does not specify the country of origin for the testing itself, but the manufacturer is based in China. This is a prospective submission for a new device, with testing specifically performed to support the 510(k).

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

  • Not Applicable for a mechanical device. "Ground truth" in the context of AI/ML or diagnostic devices refers to a definitive classification or measurement established by experts (e.g., radiologists, pathologists) or a gold standard. For a wheelchair, performance is measured against objective engineering standards.

4. Adjudication Method for the Test Set

  • Not Applicable for a mechanical device. Adjudication methods are relevant for subjective interpretations, common in clinical studies involving multiple readers.

5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was Done

  • No, Not Applicable. This type of study is relevant for diagnostic devices, particularly AI-powered ones, to assess how AI assistance impacts human reader performance. This is a mechanical device.

6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done

  • No, Not Applicable. This refers to AI algorithm performance. The device is a mechanical wheelchair.

7. The Type of Ground Truth Used

  • Not Applicable in the typical sense. The "ground truth" for this device's performance is established by the international consensus standards (ISO 7176 series, ISO 10993 series). Compliance with the objective test methods outlined in these standards serves as the evidence of performance and safety, rather than expert consensus on diagnostic images or pathology.

8. The Sample Size for the Training Set

  • Not Applicable. This is a mechanical device, not an AI/ML device that requires a training set.

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

  • Not Applicable. As above, no training set is involved.

Additional Information from the Document:

  • Usability Study: A usability study was performed with 15 participants. They read the user manual and were able to understand the questions and operate the device. This demonstrates that the instructions are sufficient for safe and proper use.
  • Non-Clinical Testing Data: The submission relies heavily on non-clinical testing data to demonstrate substantial equivalence, arguing that the device meets "performance requirements per ISO 7176-1:2014, ISO 7176-3: 2012, etc." and is "safe and effective, and its performances meet the requirements of the pre-defined acceptance criteria and intended use."
  • Clinical Data: The submission explicitly states: "According to the non-clinical test results, the proposed devices are as safe, as effective and perform as well as the predicate device. So the proposed device is Substantially Equivalent (SE) to the predicate device which is US legally market device." This implies no clinical studies were performed or relied upon for this 510(k) submission, typical for Class I devices or those demonstrating substantial equivalence through engineering performance and labeling.

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May 29, 2019

Jiangsu Horizon Medical Science & Technology Co., Ltd. % Jinghua Zhou Regulation Control Manager Guangzhou Junyi Information Technology Co., Ltd. Room 215, Huaming Building, Chebei Road Guangzhou, 511660 CN

Re: K190534

Trade/Device Name: Manual Wheelchair SIVFH2A102 Regulation Number: 21 CFR 890.3850 Regulation Name: Mechanical Wheelchair Regulatory Class: Class I Product Code: IOR Dated: March 4, 2019 Received: March 4, 2019

Dear Jinghua Zhou:

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/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; 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 http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). 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 (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Vivek Pinto, PhD Assistant Director, Acute Injury Devices Team DHT5B: Division of Neuromodulation and Physical Medicine Devices OHT5: Office of Neurological and Physical Medicine 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) K190534

Device Name Manual Wheelchair SIVFH2A102

Indications for Use (Describe)

The Manual Wheelchair is to provide mobility to persons restricted to a sitting position.

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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Section 5 - 510(k) Summary

Date of Summary Preparation: February 22, 2019

1. Submitter's Identifications

Submitter's Name: Jiangsu Horizon Medical Science & Technology Co., Ltd. Address: No.1 Guanhe Road, Situ Town, Danyang City, Jiangsu Province, China, 212331 Contact Person: Cheng Gong Contact Title: QA Manager Contact E-mail Address: markgong@phoenixmedical.cn Telephone: +86-0511-86808686 Fax: +86-0511-86160891

2. Correspondent's Identifications

Correspondent's Name: Guangzhou Junyi Information Technology Co., Ltd. Address: Room 215, Huaming Building, Chebei Road, Guangzhou, P.R. China ZIP Code: 511660 Contact Person: Jinghua Zhou Contact Title: Regulation Control Manager Contact E-mail Address: admanzhou@126.com Telephone: +86-20-82329549 Fax: +86-20-82329549

3. Name of the Device

Device Classification Name: Wheelchair, Mechanical Product Name: Mechanical Wheelchair Trade Name: Manual Wheelchair SIVFH2A102 Model: SIVFH2A102 Classification Panel: Physical Medicine Regulation Number: 21 CFR 890.3850 Product Code: IOR Device Classification: Class I

4. The Predicate Devices

K181795 AST Model MA012 and MS019 Rehab Wheelchair

5. Device Description

The Aluminum Manual Wheelchair is indoor/outdoor wheelchair that has a base with four-wheeled with a seat. The device can be disassembled for transport and it is foldable easily. The device uses a standard sling type back and seat.

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Main components:

Main frame, handle sleeve, back upholstery, seat upholstery, armrest, side panel, rear wheel with handle ring, rear wheel axle, legrest, footplate, front fork, front wheels, cross bar.

Main materials:

Main frame, cross bar, legrest: Aluminum, silver/blue coating

Back upholstery, seat upholstery: Cover is polyester non-woven, inside with flame resistant foam

Handle sleeve, handle sleeve, side panel, handle ring, footplate: PVC

Tire of rear wheels, front wheels, armrest pad: PU

6. Intended Use of Device

The Manual Wheelchair is to provide mobility to persons restricted to a sitting position.

7. Summary of Substantial Equivalence

Proposed DevicePredicate deviceComparison
510k NumberK190534K181795-----
Product CodeIORIORSame
Proprietary NameManual WheelchairSIVFH2A102AST Model MA012and MS019 RehabWheelchair-----
ModelSIVFH2A102MA012 and MS019-----
ManufacturerJiangsu HorizonMedical Science &Technology Co., Ltd.Sichuan ASTMedical EquipmentCo., Ltd.-----
Indications for UseThe ManualWheelchair is toprovide mobility topersons restricted toa sitting position.The AST ModelMA012 and MS019Rehab Wheelchairsare to providemobility to personslimited to a sittingposition.Same
Type of UseOver-the-counterOver-the-counterSame
Basic DesignThe AluminumManual Wheelchairis indoor/outdoorwheelchair that has abase withfour-wheeled with aThe AST ModelMA012 and MS019Rehab Wheelchairare manualwheelchairs.They have adjustableSimilarThe structureand materialsof main frameof the proposeddevice and
seat. The device canarmrests, andpredicate
be disassembled formultipleposition. The castersdevice are
transport and it isare 6"/7"/8" PUsame, only
foldable easily. Thewheels with heightindividual
device uses aadjustable forks andmaterials are
standard sling typethe rear wheels aredifferent, such
back and seat.20"/22"/24"*1-3/8"as back
Aluminum framepolyurethaneupholstery and
with silver/blue(MA012 andseat upholstery,
coating and foldingMS019).etc.
backrestAluminum frameThe differences
Flip back armrestwith liquid coateddo not raise
PU padand folding backrestsafety and
Detachable andFlip-up andeffectiveness
elevating footrestdetachable armrestof the proposed
Front caster PU tiresPU paddevice.
and detachable rearDetachable footrest
wheel PU tiresFront casters PU
Polyester non-woventires and quick
cover of backrelease rear wheel
upholstery and seatPU tires
upholsteryNylon cushion
Main frame, cross
bar, legrest:AST Model MA012Similar
Aluminum,Rehab Wheelchair:The Main
silver/blue coatingAluminum framestructural
Back upholstery, seatwith liquid coatedmaterials and
upholstery: Cover isand folding backrestwheels
polyesterFlip-up andmaterials are
non-woven, insidedetachable armrestsame.
Materialswith flame resistantPU padThe differences
foamHandle sleeve,Detachable footrestdo not raise
handle sleeve, sideFront casters PUsafety and
panel, handle ring,tires and quickeffectiveness
footplate: PVCrelease rear wheelof the proposed
Tire of rear wheels,PU tiresdevice.
front wheels, armrestNylon cushion
pad: PU
Main frame, handleAST Model MA012Same
sleeve, backRehab Wheelchair:Although the
Componentsupholstery, seatMain frame, handleexpressions are
upholstery, armrestsleeve, backdifferent, the
pad, armrest, sideupholstery, seatmain
wheel panel, rearupholstery, armrestcomponents
with handle ring, pad, rear wheel axle, legrest, footplate, brake, front fork, front wheels, cross bar.armrest, side panel, front casters, rear wheel, legrest, footplate, brake, front fork, cross-brace.are same.
Control ModeMechanicalMechanicalSame
Length1030mmModel MA012:1173mm(±1mm)SimilarThe two physical
DimensionWidth660mmModel MA012:645mm (±1mm)dimensions are different. The difference does
Height930mmModel MA012:892mm (±1mm)not affect the effectiveness and safety.
Net weight30.2 lbs/13.7kgModel MA012:17.2kg/38lbsSimilarThe proposed device is heavier than the predicate device.
Weight capacity275 lbs/125kgModel MA012:300lbs/136kgSimilarWeight capacity of the proposed device is less than the predicate device.
Seat width460mm(18")Model MA012:16"(406mm)18"(457mm)20"(508mm)SimilarDifferent seat sizes do not
Seat height510mm(20")Model MA012:19.7"(500mm)raises the safety and
Seat depth425mm(16.7")Model MA012:16"-20"(406mm-508mm)effectiveness of the device.
Frame typefoldablefoldableSame
Cross-brace configuration18"14", 16", 18", 20" or 22"Same

Table 1 Comparison to Predicate Device

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Back styleFixedModelMS019:FixedModelMA012:Adjustablepredicatedevice includewith that ofproposeddevice.SameBack style ofproposeddevice is sameas predicatedevice modelMS019.
Anti-tippersOptionalOptionalSame
WheelconstructionQuick releaseModelMA012:Quick releaseModelMS019:FixedSameWheelconstruction ofproposeddevice is sameas predicatedevice modelMA012.
TiresFront: 8"Rear: 24"Front: 6",7",8"Rear: 20",22",24"SameThe tires sizesof proposeddeviceareincludedtothoseofpredicatedevice.
ArmrestFlip back armrestModelMA012:HeightAdjustabledesk length armrest,Flip backModelMS019:Fixed or adjustableheight; desk or fulllength; removableSimilarThe heightofarmrestofproposeddevice can notbe adjustable.
Foot restOptional/swingawayOptional/swingawaySame
Rear Axle PositionSingleMultipleSimilarThe rear axleof proposeddevice has onlyone size.
FrameConstructionFoldable frameFoldable frameSame
Frame MaterialAluminumModel MA012:AluminumModel MS019: SteelSameThe framematerial ofproposeddevice is sameas predicatedevice modelMA012.
Safety FeatureManual Wheel LockManual Wheel LockSame
StandardISO7176-1ISO7176-3ISO7176-5ISO7176-7ISO7176-8ISO7176-11ISO7176-13ISO7176-15ISO7176-16ISO7176-22ISO10993-1ISO10993-5ISO10993-10ISO7176-1ISO7176-3ISO7176-5ISO7176-7ISO7176-8ISO7176-11ISO7176-13ISO7176-15ISO7176-16ISO7176-22ISO10993-1ISO10993-5ISO10993-10Same

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8. Substantial Equivalence discussion:

Our device and the predicate device are almost identical in terms of all areas described in the above table (Table 1). There are some minor differences with the predicate device don't affect the safety or effectiveness of the subject device.

The following table (Table 2) shows similarities and differences of the performance between our device and the predicate device. Tests were conducted following the recommended procedures outlined in the respective consensus standards, and results for "Manual Wheelchair SIVFH2A102" met all relevant requirements in the test standards, our internal specifications, and are comparable to the predicate device.

DescriptionProposed DevicePredicate device
Static stabilityMeets ISO 7176-1:2014Meets ISO 7176-1:2014
Effectiveness of brakesMeets ISO 7176-3:2012Meets ISO 7176-3:2012
Dimensions, mass andmaneuvering spaceMeets ISO 7176-5:2008Meets ISO 7176-5:2008
Seating and wheeldimensionsMeets ISO 7176-7:1998Meets ISO 7176-7:1998

Table 2: Comparison of Performance Testing

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Static, impact, and fatiguestrengthsMeets ISO 7176-8:2014Meets ISO 7176-8:2014
Information disclosure,documentation andLabelingMeets ISO 7176-15:1996Meets ISO 7176-15:1996
Resistance to ignitionMeets ISO 7176-16:2012Meets ISO 7176-16:2012

Jiangsu Horizon Medical Science & Technology Co., Ltd.

The tests were performed following the general requirements outlined in ISO 7176-11:2012, ISO 7176-13:1989, ISO 7176-22:2014.

A brief discussion of the non-clinical testing data that was submitted, referenced or relied on to demonstrate that the Proposed Device is safe and effective, and whose performance meets the requirements of its user-defined acceptance criteria and intended uses:

"Mechanical Wheelchair SIVFH2A102" meets performance requirements per ISO 7176-1:2014, ISO 7176-3: 2012, ISO 7176-5:2008, ISO 7176-7:1998, ISO 7176-8:2014, ISO 7176-11:2012, 7176-13: 1989, ISO 7176-15: 1996, ISO 7176-16:2012 and ISO 7176-22:2014. It is safe and effective, and its performances meet the requirements of the pre-defined acceptance criteria and intended use.

A brief discussion of the clinical submitted, reference, or relied on in the premarket notification submission for a determination of substantial equivalence.

According to the non-clinical test results, the proposed devices are as safe, as effective and perform as well as the predicate device. So the proposed device is Substantially Equivalent (SE) to the predicate device which is US legally market device.

9. Non-Clinical Tests Performed:

The following testing was performed on the "Mechanical Wheelchair SIVFH2A102" in accordance with the requirements of the design control regulations and established quality assurance procedures.

Safety and performance:

ISO 7176-1:2014 Wheelchairs - Part 1: Determination of static stability

ISO 7176-3:2012 Wheelchairs - Part 3: Determination of effectiveness of brakes

ISO 7176-5:2008 Wheelchairs - Part 5: Determination of dimensions, mass and maneuvering space

ISO 7176-7:1998 Wheelchairs - Part 7: Measurement of seating and wheel dimensions

ISO 7176-8:2014 Wheelchairs - Part 8: Requirements and test methods for static, impact and fatigue strengths

ISO 7176-11:2012 Wheelchairs - Part 11: Test dummies

ISO 7176-13:1989 Wheelchairs - Part 13: Determination of friction of test surface

ISO 7176-15:1996 Wheelchairs - Part 15: Requirements for information disclosure, documentation and labeling

ISO 7176-16:2012 Wheelchairs - Part 16: Resistance to ignition of postural support

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devices

ISO 7176-22:2014 Wheelchairs - Part 22: Set-up procedures

Biocompatibility:

ISO 10993-1:2009 Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process

ISO 10993-5:2009 Biological evaluation of medical devices - Part 5: Tests for in vitro cytotoxicity

ISO 10993-10:2010 Biological evaluation of medical devices - Part 10: Tests for irritation and delayed-type hypersensitivity

10. Usability Study:

The 15 participants read the User Manual before initial use of the device. They can understand the questions and answer them. The 15 participants can operate the device referring to the User Manual.

Based on the verification & validation testing records provided, we concluded that the Manual Wheelchair, Model SIVFH2A102 is considered to meet the usability requirement as defined in the verification & validation test report.

These non-clinical tests demonstrate that the labeling for the Manual Wheelchair, Model SIVFH2A102, manufactured by Jiangsu Horizon Medical Science & Technology Co., Ltd. and also distributed by US-Distributors is comprehensive, was well understood by a variety of "patients", and provided sufficient information for safe and proper use of the device.

11. Conclusion:

Based on the comparison of the proposed device of SIVFH2A102 is determined to be Substantially Equivalent (SE) to the predicate device of AST Model MA012 and MS019 Rehab Wheelchair, in respect of safety and effectiveness.

§ 890.3850 Mechanical wheelchair.

(a)
Identification. A mechanical wheelchair is a manually operated device with wheels that is intended for medical purposes to provide mobility to persons restricted to a sitting position.(b)
Classification. Class I (general controls).