K Number
K170701
Device Name
GEN_2 and GEN_3 Mechanical Wheelchairs
Date Cleared
2017-03-24

(16 days)

Product Code
Regulation Number
890.3850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The GEN 2 Mechanical Wheelchair is intended to provide mobility to persons restricted to a seated position. The GEN 3 Mechanical Wheelchair is intended to provide mobility to persons restricted to a seated position.
Device Description
The GEN 2 mechanical wheelchair is a highly adaptable allpurpose wheelchair created for use in developing countries, while allowing for a healthy, personalized fit. The wheelchair features adjustable seating, large castor wheels, an extra-thick cushion and adjustable footrests. The GEN 3 Mechanical Wheelchair is a folding, non-rigid type wheelchair designed for use over rough terrain in developing countries. The wheelchair features adjustable seating, large castor wheels, an extra-thick cushion and adjustable footrests.
More Information

No
The summary describes mechanical wheelchairs with no mention of AI or ML capabilities.

No
The device is a mechanical wheelchair intended for mobility, not to treat or diagnose a medical condition.

No
The device, a mechanical wheelchair, is intended to provide mobility, not to perform any diagnostic functions.

No

The device description clearly outlines physical components like wheels, cushions, and footrests, indicating it is a hardware device.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to "provide mobility to persons restricted to a seated position." This is a mechanical function for physical support and movement.
  • Device Description: The description details the physical components and features of a wheelchair, such as wheels, seating, cushions, and footrests.
  • Lack of IVD Characteristics: There is no mention of:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Providing information about a patient's health status, diagnosis, or treatment based on sample analysis.
    • Any laboratory or clinical testing procedures.

IVD devices are used to examine specimens taken from the human body to provide information for diagnosis, monitoring, or treatment. This device is a mechanical aid for mobility.

N/A

Intended Use / Indications for Use

The GEN 2 Mechanical Wheelchair is intended to provide mobility to persons restricted to a seated position. The GEN 3 Mechanical Wheelchair is intended to provide mobility to persons restricted to a seated position.

Product codes

IOR

Device Description

The GEN 2 mechanical wheelchair is a highly adaptable allpurpose wheelchair created for use in developing countries, while allowing for a healthy, personalized fit. The wheelchair features adjustable seating, large castor wheels, an extra-thick cushion and adjustable footrests.

The GEN 3 Mechanical Wheelchair is a folding, non-rigid type wheelchair designed for use over rough terrain in developing countries. The wheelchair features adjustable seating, large castor wheels, an extra-thick cushion and adjustable footrests.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Non-clinical testing was repeated per ISO standards to those tests affected by the repositioning of the axle. The retesting was performed to the following standards:

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

The non-clinical test results demonstrate the modified GEN 2 and GEN 3 Mechanical Wheelchairs do not raise any issues regarding safety and effectiveness. The testing supports a determination of substantial equivalence to the Free Wheelchair Mission Mechanical Wheelchairs previously cleared by FDA.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K113713, K141691

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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).

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Image /page/0/Picture/2 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" around the perimeter. Inside the circle is a stylized image of three human profiles facing to the right, stacked on top of each other to form a single, abstract figure.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

March 24, 2017

Free Wheelchair Mission % Sharon Rockwell Consultant Sharon Rockwell, Consultant 5582 Chalon Road Yorba Linda, California 92886

Re: K170701

Trade/Device Name: Gen 2, Gen 3 Mechanical Wheelchairs Regulation Number: 21 CFR 890.3850 Regulation Name: Mechanical Wheelchair Regulatory Class: Class I Product Code: IOR Dated: March 1, 2017 Received: March 8, 2017

Dear Ms. Rockwell:

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. 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.

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

1

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 (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. 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 the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely.

Michael J. Hoffmann -S

Carlos L. Peña, PhD, MS for Director Division of Neurological and Physical Medicine Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K170701

Device Name GEN_2 and GEN_3 Mechanical Wheelchairs

Indications for Use (Describe)

The GEN 2 Mechanical Wheelchair is intended to provide mobility to persons restricted to a seated position. The GEN 3 Mechanical Wheelchair is intended to provide mobility to persons restricted to a seated 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)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

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DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

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"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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Image /page/3/Picture/0 description: The image contains the words "FREE WHEELCHAIR MISSION" in bold, dark blue font. To the right of the text is a stylized logo of a person in a wheelchair. The logo is made up of overlapping circles and rectangles in shades of blue, green, purple, and gray.

510(K) SUMMARY (21 CFR 807.92)

FREE WHEELCHAIR MISSION MECHANICAL WHEELCHAIRS

510(k) Owner:Free Wheelchair Mission
15279 Alton Parkway, Suite 300
Irvine, CA 92618
Tel: 949-273-0858
Fax: 949-273-8471
  • Sharon Rockwell Contact Person: Tel: 714-695-9269 E-mail: srockwell(@writeme.com
  • Date Prepared: March, 2017
  • GEN 2 and GEN 3 Mechanical Wheelchairs Trade Name:
  • Common Name: Mechanical Wheelchair
  • Classification Name: Mechanical wheelchair per 21 CFR 890.3850, IOR
  • Predicate Devices: Free Wheelchair Mission GEN 2 Mechanical Wheelchair. K113713 and GEN 3 Mechanical Wheelchair, K141691
  • Device Description: The GEN 2 mechanical wheelchair is a highly adaptable allpurpose wheelchair created for use in developing countries, while allowing for a healthy, personalized fit. The wheelchair features adjustable seating, large castor wheels, an extra-thick cushion and adjustable footrests.

The GEN 3 Mechanical Wheelchair is a folding, non-rigid type wheelchair designed for use over rough terrain in developing countries. The wheelchair features adjustable seating, large castor wheels, an extra-thick cushion and adjustable footrests.

  • Indication for Use: The GEN 2 Mechanical Wheelchair is intended to provide mobility for persons restricted to a sitting position.
    The GEN 3 Mechanical Wheelchair intended to provide mobility for persons restricted to a sitting position.

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The Indications for Use of the modified devices are identical to those of the predicate devices.

Technological

Characteristics: The modified GEN_2 and GEN_3 Mechanical Wheelchairs are substantially equivalent in design, materials, and intended use to the predicate GEN 2 and GEN 3 Mechanical Wheelchairs. The modification to the Free Wheelchair Mission Mechanical Wheelchairs is a repositioning of the axle to reduce the weight burden on the castor wheels, reducing the downward force required by the attendant to move the castors off the ground to go over a step or curb. The tables below indicate there are no changes to the technological characteristics of the wheelchairs.

FeatureGEN 2 (predicate)GEN 2 (modified device)
Intended UseTo provide mobility to persons
restricted to a seated position.To provide mobility to persons
restricted to a seated position.
Frame materialPowder coated steel frame that meets
ASTM A 53/A 53M-2005 and
JIS G 3444-2004 standardsPowder coated steel frame that meets
ASTM A 53/A 53M-2005 and
JIS G 3444-2004 standards
Frame widths13.5-19.5"13.5-19.5"
Overall widths29" (medium)29" (medium)
Seat depths11.5-17"11.5-17"
Back heights11.8-19"11.8-19"
Weight limit220 lbs220 lbs
Chair weight36 lbs (with footrests)36 lbs (with footrests)
WarrantyNo warrantyNo warranty
ArmrestsFixed in place to serve as armrests
but not to restrict transfers.Fixed in place to serve as armrests
but not to restrict transfers.
Front end typeSwing-awaySwing-away
Back typeStandardStandard
Footrest
hangersNot availableNot available
FootplatesPolypropylene, 280 mm adjustable
range with angles adjustable to 0, ±
7°, ± 14°, and ± 21°.Polypropylene, 280 mm adjustable
range with angles adjustable to 0, ±
7°, ± 14°, and ± 21°.
Extension
tubesNot availableNot available
Back
upholsteryAdjustable to 4 different heightsAdjustable to 4 different heights
Axle platesNot availableNot available

5

FeatureGEN_2 (predicate)GEN_2 (modified device)
Wheel sizes26"26"
Wheel typesSpokeSpoke
Tire typesPneumaticPneumatic
HandrimsPowder coated steelPowder coated steel
Caster sizes8"8"
Caster typesRubberRubber
Forks sizes5"5"
Wheel locksPull to lockPull to lock
Anti tips tubesNoNo
Standards
appliedISO 7176-1, 3, 5, 7, 8, 11, 13, 15, 16ISO 7176-1, 3, 5, 7, 8, 11, 13, 15, 16
Frame styleRigidRigid
Tubing wall
thickness0.079" throughout0.079" throughout
Tube
propertiesASTM A 53/A 53M-2005
JIS G 3444-2004ASTM A 53/A 53M-2005
JIS G 3444-2004
FeatureGEN_3 (predicate)GEN_3 (modified device)
Intended UseTo provide mobility to persons
restricted to a seated position.To provide mobility to persons
restricted to a seated position.
Frame materialPowder coated steel frame that meets
ASTM A 53/A 53M-2005 and
JIS G 3444-2004 standardsPowder coated steel frame that meets
ASTM A 53/A 53M-2005 and
JIS G 3444-2004 standards
Frame widths14.5-20.5"14.5-20.5"
Overall widths25.6-31.5"25.6-31.5"
Seat depths11.5-17"11.5-17"
Back heights11.8-19"11.8-19"
Weight limit220 lbs220 lbs
Chair weight50 lbs (with footrests)50 lbs (with footrests)
Warrantyno Warrantyno Warranty
ArmrestsFixed in place to serve as armrests
but not to restrict transfers.Fixed in place to serve as armrests
but not to restrict transfers.
Front end typeSwing-awaySwing-away
Back typeStandardStandard
Footrest
hangersNot availableNot available
FootplatesPolypropylene, 280 mm adjustable
range with angles adjustable to 0 +Polypropylene, 280 mm adjustable
range with angles adjustable to 0 +

6

FeatureGEN_3 (predicate)GEN_3 (modified device)
7°, ± 14°, and ± 21°.7°, ± 14°, and ± 21°.
Extension
tubesNot availableNot available
Back
upholsteryAdjustable to 4 different heightsAdjustable to 4 different heights
Axle platesNot availableNot available
Wheel sizes26"26"
Wheel typesSpokeSpoke
Tire typesPneumaticPneumatic
HandrimsPowder coated steelPowder coated steel
Caster sizes8"8"
Caster typesRubberRubber
Forks sizes5"5"
Wheel locksPull to lockPull to lock
Anti tips tubesNoNo
Standards
appliedISO 7176-1, 3, 5, 7, 8, 11, 13, 15, 16ISO 7176-1, 3, 5, 7, 8, 11, 13, 15, 16
Frame styleNon-rigid (folding)Non-rigid (folding)
Tubing wall
thickness0.079" throughout0.079" throughout
Tube
propertiesASTM A 53/A 53M-2005
JIS G 3444-2004ASTM A 53/A 53M-2005
JIS G 3444-2004

The indications for use for the modified GEN 2 and GEN 3 Mechanical Wheelchairs are unchanged. The fundamental technology used in the GEN 2 and GEN 3 chairs is unchanged from the predicate devices. The information provided supports a substantial equivalence decision based on the repeat pre-clinical testing of the forward, rearward and lateral static stability tests performed in accordance with ISO 7176-1:2014. The modification does not affect the performance of the devices and does not raise new types of safety or effectiveness questions.

Non-Clinical
Performance Data:Non-clinical testing was repeated per ISO standards to those tests
affected by the repositioning of the axle. The retesting was
performed to the following standards:
1) ISO 7176-1:2014 Wheelchairs - Part 1: Determination of static
    1. ISO 7176-1:2014 Wheelchairs Part 1: Determination of static stability

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Conclusions: The non-clinical test results demonstrate the modified GEN 2 and GEN_3 Mechanical Wheelchairs do not raise any issues regarding safety and effectiveness. The testing supports a determination of substantial equivalence to to the Free Wheelchair Mission Mechanical Wheelchairs previously cleared by FDA.