K Number
K222507
Device Name
Mobility Scooter (Models: W3431Q, W3431R)
Date Cleared
2023-02-28

(194 days)

Product Code
Regulation Number
890.3800
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
It is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited to a seated position.
Device Description
The Mobility Scooters, Models: W3431Q, W3431R, have a base with Steal frame, two front wheel, two rear wheels, a seat, a tiller console, electric motor, electromagnetic brake, 2 rechargeable Lead-acid Batteries with an off-board charger. The movement of the scooter is controlled by the rider who operates the throttle lever, speed control dial and handle on the tiller console. The device is installed with an electromagnetic brake that will engage automatically when the scooter is not in use and the brake cannot be used manually. The Scooter only can be operated on the flat road.
More Information

No
The description details a standard mobility scooter with manual controls and an electromagnetic brake, with no mention of AI or ML capabilities.

No
The device is a mobility aid for transportation and does not perform any therapeutic function like treating or preventing a disease.

No
The device is described as a transportation vehicle to provide mobility, not to diagnose any condition.

No

The device description clearly outlines numerous hardware components including a steel frame, wheels, seat, tiller console, electric motor, electromagnetic brake, and batteries. It is a physical transportation vehicle, not a software-only device.

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

Here's why:

  • IVD Definition: In Vitro Diagnostic devices are used to examine specimens taken from the human body (like blood, urine, tissue) to provide information about a person's health.
  • Device Description and Intended Use: The provided description clearly states that this device is a "motor driven, indoor and outdoor transportation vehicle" intended to "provide mobility to a disabled or elderly person limited to a seated position." It is a physical mobility aid.
  • Lack of Biological Specimen Analysis: There is no mention of the device interacting with or analyzing any biological specimens.
  • Focus on Mobility: The entire description and intended use revolve around providing physical transportation and mobility.

Therefore, based on the provided information, this device falls under the category of a mobility aid or personal transport device, not an In Vitro Diagnostic.

N/A

Intended Use / Indications for Use

It is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited to a seated position.

Product codes

INI

Device Description

The Mobility Scooters, Models: W3431Q, W3431R, have a base with Steal frame, two front wheel, two rear wheels, a seat, a tiller console, electric motor, electromagnetic brake, 2 rechargeable Lead-acid Batteries with an off-board charger. The movement of the scooter is controlled by the rider who operates the throttle lever, speed control dial and handle on the tiller console. The device is installed with an electromagnetic brake that will engage automatically when the scooter is not in use and the brake cannot be used manually. The Scooter only can be operated on the flat road.

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

Indoor and outdoor transportation vehicle.

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

Non-clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

  • 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 Skin Sensitization
  • ISO 7176-1: 2014, Wheelchairs - Part 1: Determination of static stability
  • ISO 7176-2:2017. Wheelchairs Part 2: Determination of dynamic stability of Powered Wheelchairs
  • ISO 7176-3: 2012, Wheelchairs Part 3: Determination of effectiveness of brakes
  • ISO 7176-4. Third edition 2008-10-01. Wheelchairs Part 4: Energy consumption of electric wheelchairs and scooters for determination of theoretical distance range
  • ISO 7176-5, Second edition 2008-06-01, Wheelchairs - Part 5: Determination of overall dimensions, mass and maneuvering space
  • ISO 7176-6: 2018, Wheelchairs Part 6: Determination of maximum speed, acceleration and deceleration of Powered Wheelchairs
  • ISO 7176-7, 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 7176-9:2009, Wheelchairs Part 9: Climatic tests for Powered Wheelchairs
  • ISO 7176-10:2008, Wheelchairs Part 10: Determination of obstacle-climbing ability of electrically powered wheelchairs
  • ISO 7176-11:2012 Wheelchairs - Part 11: Test dummies.
  • ISO 7176-13, First edition 1989-08-01, Wheelchairs - Part 13: Determination of coefficient of friction of test surfaces
  • ISO 7176-14:2008, Wheelchairs - Part 14: Power and control systems for electrically powered wheelchairs and scooters - Requirements and test methods
  • 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 tdevices.
  • ISO 7176-21:2009 Wheelchairs - Part 21: Requirements and test methods forelectromagnetic compatibility of electrically powered wheelchairs and scooters, and battery chargers
  • ISO 7176-25:2013 Wheelchairs Part 25: Batteries and chargers for powered wheelchairs.
    No clinical study is included in this submission.

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

Not Found

Predicate Device(s)

K220206

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 890.3800 Motorized three-wheeled vehicle.

(a)
Identification. A motorized three-wheeled vehicle is a gasoline-fueled or battery-powered device intended for medical purposes that is used for outside transportation by disabled persons.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" and the words "U.S. Food & Drug Administration".

February 28, 2023

Zhejiang Innuovo Rehabilitation Devices Co.,Ltd % Jarvis Wu Consultant Shanghai Sungo Management Consulting Company Limited 14th floor, 1500# Century Ave., Shanghai 200122, China Shanghai, Shanghai 200122 China

Re: K222507

Trade/Device Name: Mobility Scooter (Models: W3431Q, W3431R) Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized Three-Wheeled Vehicle Regulatory Class: Class II Product Code: INI Dated: February 23, 2023 Received: February 23, 2023

Dear Jarvis Wu:

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

1

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/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, Heather L. Dean -S

Heather Dean, 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

2

Indications for Use

510(k) Number (if known) K222507

Device Name Mobility Scooter (Models: W3431Q, W3431R)

Indications for Use (Describe)

It is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited 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)

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3

510(k) Summary K22507

Document Prepared Date: 2023/2/22

A. Applicant:

Zhejiang Innuovo Rehabilitation Devices Co.,Ltd Address: No.196 Industry Road, Hengdian Movie Zone, Dongyang, Zhejiang,China Contact Person: Leo Zheng Tel: + 86 18358936043

Submission Correspondent: Primary contact: Mr. Jarvis Wu Shanghai SUNGO Management Consulting Co., Ltd. 14th Floor, Dongfang Building, 1500# Central Ave., Shanghai 200122, China Tel: +86-21-58817802 Email: haiyu.wang@sungoglobal.com Secondary contact: Mr. Raymond Luo 14th Floor, Dongfang Building, 1500# Central Ave., Shanghai 200122, China Tel: +86-21-68828050 Email: fda.sungo@gmail.com

B. Device:

Trade Name: Mobility Scooter Common Name: Scooter Model: W3431Q, W3431R

Regulatory Information Classification Name: Motorized three-wheeled vehicle Classification: Class II Product code: INI Regulation Number: 890.3800 Review Panel: Physical Medicine

C. Predicate device:

510k number: K220206 Device Name: Scooter Model: W3468A Zhejiang Innuovo Rehabilitation Devices Co.,Ltd

4

Zhejiang Innuovo Rehabilitation Devices Co.,Ltd

No.196 Industry Road, Hengdian Movie Zone, Dongyang, Zhejiang,China

D. Indications for use of the device:

It is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited to a seated position.

E. Device Description:

The Mobility Scooters, Models: W3431Q, W3431R, have a base with Steal frame, two front wheel, two rear wheels, a seat, a tiller console, electric motor, electromagnetic brake, 2 rechargeable Lead-acid Batteries with an off-board charger. The movement of the scooter is controlled by the rider who operates the throttle lever, speed control dial and handle on the tiller console. The device is installed with an electromagnetic brake that will engage automatically when the scooter is not in use and the brake cannot be used manually. The Scooter only can be operated on the flat road.

F. Non-Clinical Test Conclusion

Non-clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

  • 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 > Skin Sensitization
  • ISO 7176-1: 2014, Wheelchairs - Part 1: Determination of static stability

  • ISO 7176-2:2017. Wheelchairs Part 2: Determination of dynamic stability of Powered Wheelchairs >
  • ISO 7176-3: 2012, Wheelchairs Part 3: Determination of effectiveness of brakes >
  • ISO 7176-4. Third edition 2008-10-01. Wheelchairs Part 4: Energy consumption of > electric wheelchairs and scooters for determination of theoretical distance range
  • ISO 7176-5, Second edition 2008-06-01, Wheelchairs - Part 5: Determination of overall dimensions, mass and maneuvering space

  • ISO 7176-6: 2018, Wheelchairs Part 6: Determination of maximum speed, > acceleration and deceleration of Powered Wheelchairs
  • ISO 7176-7, 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 7176-9:2009, Wheelchairs Part 9: Climatic tests for Powered Wheelchairs >
  • ISO 7176-10:2008, Wheelchairs Part 10: Determination of obstacle-climbing ability > of electrically powered wheelchairs
  • ISO 7176-11:2012 Wheelchairs - Part 11: Test dummies.

  • ISO 7176-13, First edition 1989-08-01, Wheelchairs - Part 13: Determination of coefficient of friction of test surfaces

  • ISO 7176-14:2008, Wheelchairs - Part 14: Power and control systems for electrically powered wheelchairs and scooters - Requirements and test methods

  • 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 tdevices. >
  • ISO 7176-21:2009 Wheelchairs - Part 21: Requirements and test methods forelectromagnetic

5

Zhejiang Innuovo Rehabilitation Devices Co.,Ltd No.196 Industry Road, Hengdian Movie Zone, Dongyang, Zhejiang,China compatibility of electrically powered wheelchairs and scooters, and battery chargers

  • ISO 7176-25:2013 Wheelchairs Part 25: Batteries and chargers for powered wheelchairs ハ

G. Clinical Test Conclusion

No clinical study is included in this submission.

H. Comparison with predicate Device

Table 1 General Comparison

| Elements of

ComparisonPredicate Device (K220206)Subject DeviceRemark
ManufacturerZhejiang Innuovo Rehabilitation
Devices Co.,LtdZhejiang Innuovo Rehabilitation
Devices Co.,LtdSame
Common or
Usual nameScooterScooterSame
Model(s)W3468AW3431Q, W3431R--
Indications
for useIt is a motor driven, indoor and
outdoor transportation vehicle with the
intended use to provide mobility to a
disabled or elderly person limited to a
seated position.It is a motor driven, indoor and
outdoor transportation vehicle with the
intended use to provide mobility to a
disabled or elderly person limited to a
seated position.S.E.
Overall
dimension1075 mm x 500 mm x 920 mm1020 mm x 500 mm x 840 mmSimilar
Frame
MaterialSteelSteelS.E.
Frame styleFoldable seat, removable battery pack,
disassemble for transportFoldable seat, removable battery pack,
disassemble for transportS.E.
Front wheel
size200 x 50 mm190 x 55 mmAnalysis
Front Wheels
Quantity22S.E.
Rear wheel
size200 x 50 mm190 x 55 mmAnalysis
Rear Wheels
Quantity22S.E.
Ground
clearance100mm(3.9")45 mmAnalysis
Max
Loading( on
level ground)136kg120kgAnalysis
Turn Radius1350mm(53")1650mmAnalysis
Motor output250W24 V 180WAnalysis
Drive SystemRear Wheel DriveRear Wheel DriveS.E.
BrakesElectromagnetic brakeElectromagnetic brakeS.E.
BatteryLead Acid 12V x 2 (12Ah or 20Ah)Lead-acid 12V12Ah*2S.E.
Charger24V/2A24V/2AS.E.
Max Speed6.4km/h6 km/hS.E.
Slope Grade
Ability9 degree9 degreeS.E.
Travel
Distance14km / 9 Miles (12Ah)15 km/9.32 MilesS.E.
Arm Rests
(Distance
between
armrests)44 cm44-56 cmAnalysis
ControllerPG45A45ASimilar
Time to
brake0.7-1s