K Number
K221435
Device Name
SUPERTILT PLUS (STP)
Date Cleared
2022-10-28

(164 days)

Product Code
Regulation Number
890.3850
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The intended use for the manual (mechanical) wheelchair is to provide mobility to persons who may be restricted to a sitting position. The manual wheelchair is intended for ongoing daily use. The models offer a wide range of customization which allows for a better fit for the end user resulting in comfort, lightweight, easier propelling, transferring, and smooth ride. The manual wheelchair is intended for indoor and outdoor use on firm surfaces free of climbing obstacles. All other uses are prohibited.
Device Description
A mechanical wheelchair is a chair with wheels, designed to be a replacement for walking, where it is propelled by the seated occupant turning the rear wheels by hand. There are also handles behind the seat for someone else to do the pushing. Wheelchairs are used by people for whom walking is difficult or impossible due to illness, injury, or disability. The device is intended for adults only. As oppose to the standard wheelchair properties, the Supertilt Tilt main feature can tilt in space for up to 33 degrees using two gas cylinders that can support up to 250 lbs. The components include frame, back upholstery, seat upholstery, handgrip, armrest, armrest pad, side panel. In terms of biocompatibility, the main direct contact components on long periods in time with the user/client are the arm rest pad, cushion back cushion, headrest pad and footrest padding. Transient contacts with the user/client include arm skirt guard, arm tube, arm socket and footrest tube. The Supertilt Plus in its final finished form is identical to the Concept 45, Invacare, K951138, cleared on 3/20/1995 (legally US marketed device) in formulation, processing, sterilization, and geometry, and no other chemicals have been added (e.g., plasticizers, fillers. device) in formulation, processing, sterilization, and no other chemicals have been added (e.g., plasticizers, fillers, additives, cleaning agents, mold release agents).
More Information

Not Found

No
The description details a mechanical wheelchair with a tilting mechanism and standard components. There is no mention of software, algorithms, or any technology that would suggest AI or ML. The testing performed is related to mechanical and structural standards.

No
A wheelchair provides mobility and support, but it does not treat or cure a disease or condition, which is the definition of a therapeutic device.

No

Explanation: The device is a manual wheelchair, which is a mobility aid. Its intended use is to provide mobility to persons restricted to a sitting position, and it does not perform any diagnostic functions.

No

The device description clearly outlines a mechanical wheelchair with physical components like a frame, wheels, upholstery, and gas cylinders. It also details physical testing performed on the device. There is no mention of software as the primary or sole component.

Based on the provided text, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is clearly stated as providing mobility to persons restricted to a sitting position. This is a mechanical function related to physical support and movement, not the diagnosis of disease or other conditions through the examination of specimens derived from the human body.
  • Device Description: The description details a mechanical chair with wheels, designed as a replacement for walking. It focuses on physical components and their function in providing mobility.
  • Lack of IVD Characteristics: There is no mention of analyzing biological specimens (blood, urine, tissue, etc.), reagents, or any process related to diagnosing or monitoring a medical condition through laboratory testing.

The device is a manual wheelchair, which falls under the category of medical devices used for physical support and mobility.

N/A

Intended Use / Indications for Use

The intended use for the manual (mechanical) wheelchair is to provide mobility to persons who may be restricted to a sitting position. The manual wheelchair is intended for ongoing daily use. The models offer a wide range of customization which allows for a better fit for the end user resulting in comfort, lightweight, easier propelling, transferring, and smooth ride. The manual wheelchair is intended for indoor and outdoor use on firm surfaces free of climbing obstacles. All other uses are prohibited.

Product codes (comma separated list FDA assigned to the subject device)

IOR

Device Description

A mechanical wheelchair is a chair with wheels, designed to be a replacement for walking, where it is propelled by the seated occupant turning the rear wheels by hand. There are also handles behind the seat for someone else to do the pushing. Wheelchairs are used by people for whom walking is difficult or impossible due to illness, injury, or disability. The device is intended for adults only.

As oppose to the standard wheelchair properties, the Supertilt Tilt main feature can tilt in space for up to 33 degrees using two gas cylinders that can support up to 250 lbs.

The components include frame, back upholstery, seat upholstery, handgrip, armrest, armrest pad, side panel.

In terms of biocompatibility, the main direct contact components on long periods in time with the user/client are the arm rest pad, cushion back cushion, headrest pad and footrest padding. Transient contacts with the user/client include arm skirt guard, arm tube, arm socket and footrest tube.

The Supertilt Plus in its final finished form is identical to the Concept 45, Invacare, K951138, cleared on 3/20/1995 (legally US marketed device) in formulation, processing, sterilization, and geometry, and no other chemicals have been added (e.g., plasticizers, fillers.

device) in formulation, processing, sterilization, and no other chemicals have been added (e.g., plasticizers, fillers, additives, cleaning agents, mold release agents).

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

The device is intended for adults only.

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)

The following testing was performed on the Manual Tilt Wheelchair model STP in accordance with the requirements of the design control regulations and establisthed quality assurance procedures. ISO 7176-8 - Construction ISO 7176-14:8 - Design ISO 7176-5 - Dimensions ISO 7176-1:9-12 - Stability in Least Stable Configuration ISO 7176-3:7-1 - Efficiency ANSI/RESNA WC/Vol.1:22 Annex A - Operation ISO 7176-15:7, ISO 7176-14:6.1 - Product Literature ISO 7176-7:8.3 - Angular Dimensions

Power Plus Mobility STP wheelchair was built within the standards of ANS/RESNA which involves ISO 7176. It is concluded that the STP is safe and effective as well as substantially equivalent to the predicate device.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K951138

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

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).

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left, there is a symbol representing the Department of Health & Human Services - USA. To the right of the symbol, there is the FDA logo in blue, with the words "U.S. FOOD & DRUG" stacked above the word "ADMINISTRATION".

October 28, 2022

Power Plus Mobility Jason Mohan CEO President 50 Malcom Rd Guelph, ON N1K1A9 Canada

Re: K221435

Trade/Device Name: Supertilt Plus (STP) Regulation Number: 21 CFR 890.3850 Regulation Name: Mechanical Wheelchair Regulatory Class: Class I, reserved Product Code: IOR Dated: February 9, 2022 Received: May 17, 2022

Dear Jason Mohan:

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.

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

1

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 (OS) 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 mediation-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,

Tushar Bansal, PhD Acting 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

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Indications for Use

Submission Number (if known)

K221435

Device Name

SUPERTILT PLUS (STP)

Indications for Use (Describe)

The intended use for the manual (mechanical) wheelchair is to provide mobility to persons who may be restricted to a sitting position. The manual wheelchair is intended for ongoing daily use. The models offer a wide range of customization which allows for a better fit for the end user resulting in comfort, lightweight, easier propelling, transferring, and smooth ride. The manual wheelchair is intended for indoor and outdoor use on firm surfaces free of climbing obstacles. All other uses are prohibited.

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

Prepared on: 2022-09-13

Contact Details

21 CFR 807 92/2(1)

Applicant NamePower Plus Mobility
Applicant Address50 Malcom Rd Guelph ON N1K1A9 Canada
Applicant Contact Telephone4168091301
Applicant ContactMr. Jason Mohan
Applicant Contact Emailjason@powerplusmobility.com

Device Name 21 CFR 807.92(a)(2)

Device Trade NameSUPERTILT PLUS (STP)
Common NameMechanical wheelchair
Classification NameWheelchair, Mechanical
Regulation Number890.3850
Product CodeIOR

Legally Marketed Predicate Devices 21 CFR 807.92(a)(3)

Predicate #Predicate Trade Name (Primary Predicate is listed first)Product Code
K951138Concept 45IOR

Device Description Summary 21 CFR 807.92(a)(4)

A mechanical wheelchair is a chair with wheels, designed to be a replacement for walking, where it is propelled by the seated occupant
turning the rear wheels by hand. There are also handles behind the seat for someone else to do the pushing. Wheelchairs are used by
people for whom walking is difficult or impossible due to illness, injury, or disability. The device is intended for adults only.

As oppose to the standard wheelchair properties, the Supertilt Tilt main feature can tilt in space for up to 33 degrees using two gas
cylinders that can support up to 250 lbs.

The components include frame, back upholstery, seat upholstery, handgrip, armrest, armrest pad, side panel.

In terms of biocompatibility, the main direct contact components on long periods in time with the user/client are the arm rest pad,
cushion back cushion, headrest pad and footrest padding. Transient contacts with the user/client include arm skirt guard, arm tube, arm
socket and footrest tube.

The Supertilt Plus in its final finished form is identical to the Concept 45, Invacare, K951138, cleared on 3/20/1995 (legally US marketed
device) in formulation, processing, sterilization, and geometry, and no other chemicals have been added (e.g., plasticizers, fillers.

device) in formulation, processing, sterilization, and no other chemicals have been added (e.g., plasticizers, fillers, additives, cleaning agents, mold release agents).

Intended Use/Indications for Use

21 CFR 807.92(a)(5)

The intended use for the manual (meelchair is to provide mobility to persons who may be restricted to a sitting position. The manual wheelchair is intended for ongoing daily use. The models offer a wide range of customization which allows for a better fit for the end user resulting in comfort, lightweight, easier propelling, transferring, and smooth ride. The manual wheelchair is intended for indoor and outdoor use on firm surfaces free of climbing obstacles. All other uses are prohibited.

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Proposed DevicePrimary Predicate Device
510K NumberK221435K951138
Product CodeIORIOR
Classification NameWheelchair, MechanicalWheelchair, Mechanical
ModelSupertilt PlusConcept 45
ManufacturerPower Plus Mobility Inc.Invacare Corporation
Indications for UseThe intended use for the manual (mechanical) wheelchair is to
provide mobility to persons who may be restricted to a sitting
position. The manual wheelchair is intended for ongoing daily
use. The models offer a wide range of customization which
allows for a better fit for the end user resulting in comfort,
lightweight, easier propelling, transferring, and smooth ride. The
manual wheelchair is intended for indoor and outdoor use on
firm surfaces free of climbing obstacles. All other uses are
prohibited.The intended use for the manual (mechanical) wheelchair is to
provide mobility to persons who may be restricted to a sitting
position. The manual wheelchair is intended for ongoing daily
use. The models offer a wide range of customization which
allows for a better fit for the end user resulting in comfort,
lightweight, easier propelling, transferring, and smooth ride. Th
manual wheelchair is intended for indoor and outdoor use on
firm surfaces free of climbing obstacles. All other uses are
prohibited.
Basic DesignSTP is a compact manual wheelchair with 2 gas cylinders that
enables tilt-in-space capability, built with a steel frame on 4
wheels, paint covered, with essential accessories as well as back
and seating upholstery.Concept 45 is a compact manual tilt-in-space wheelchair with ar
optional reclining back.
MaterialsSteel (frame, armrest, caster fork, headrest frame, anti-tipper
tube, rear axle), aluminum (wheel lock, footrest frame,
footplate, handrim, custom headrest ball joint), PVC (armrest
pad mount, rear wheel rim and spacers, caster rim, skirt guard),
ABS (solid seat)Steel (frame, armrest, caster fork, rear axle, footrests, headrest
frame, wheel lock) aluminum (hand rim). Other materials
undocumented
ComponentsArmrest
Rear Axle
Rear Wheel
Caster Fork
Casters
Headrest
Back Upholstery
Seat Seat Upholstery
FootrestArmrest
Rear Axle
Rear Wheel
Caster Fork
Casters
Headrest
Back Upholstery
Seat Seat Upholstery
Footrest
Occupant Mass GroupIIIIII
Control ModeManualManual
Total Mass60 lbs (Approx.)55 lbs (Approx.) without front riggings
Weight Capacity250 lbs250 lbs
Overall Width28.45" (regular 18"x18")23.25"
Overall Length49.67" (with footrest), 35.39" (with no footrest and retracted
spreader bar)44.75"
Overall Height39.69" (no headrest), 48.16" (with headrest)40"
Seat to Floor HeightAdjustable from 12.25" to 18.25", based on various wheel
configurationsAdjustable from 14.5" to 18.75"
Tilt Adjustment0 to 33 degrees0 to 45 degrees
Recline Tilt Adjustment0 to 15 degrees of fixed recline adjustment0 to 20 degrees
Wheel LockAluminum push or pull to lockPush or pull to Lock
Front RiggingsSwingaway footrestSwingaway footrests
Rear AxleStandard (Permanent) or Quick ReleasePermanent or Quick Release
Seat Dimensions18"x18"15"-20"
Brake MechanismPush to Lock or Pull to Lock Wheel LocksPush to Lock or Pull to Lock Wheel Locks
Front and Rear Wheel Tire Dimensions6" Caster with 22" Rear Wheel7" Caster with 22"Rear Wheel
Minimum Curb ClearanceNot Publically Available
Curb Climbing AbilityNot Publically Available
Minimum Turning Radius83cmNot Publically Available
Upholstery MaterialStandard Darlex. TFK4 Waternroof at the bottomNot Publically Available

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Indications for Use Comparison

The indications for use is the same as the predicate device.

Technological Comparison

The Supertilt Plus has the similar technical characteristics as the predicate device such as tilt and adjustable recline. Both devices have adjustable back angle, arm rest, headrest, as well as similar seat depths and widths.

Non-Clinical and/or Clinical Tests Summary & Conclusions 21 CFR 807.92(b)

The following testing was performed on the Manual Tilt Wheelchair model STP in accordance with the requirements of the design control regulations and establisthed quality assurance procedures. ISO 7176-8 - Construction ISO 7176-14:8 - Design ISO 7176-5 - Dimensions ISO 7176-1:9-12 - Stability in Least Stable Configuration ISO 7176-3:7-1 - Efficiency ANSI/RESNA WC/Vol.1:22 Annex A - Operation ISO 7176-15:7, ISO 7176-14:6.1 - Product Literature ISO 7176-7:8.3 - Angular Dimensions

Power Plus Mobility STP wheelchair was built within the standards of ANS/RESNA which involves ISO 7176. It is concluded that the STP is safe and effective as well as substantially equivalent to the predicate device.

21 CFR 807.92(a)(5)

21 CFR 807.92(a)(6)