MAXIMA V, THREE WHEEL SCOOTER, MODEL SC900V MAXIMA V, FOUR WHEEL SCOOTER, MODEL SC940V

{0}------------------------------------------------ K091113 Image /page/0/Picture/1 description: The image shows the logo for Pride Mobility Products Corp. The word "Pride" is written in a stylized font with a thick black line running through the middle of the word. Below the word "Pride" is the text "Mobility Products Corp." in a smaller, less stylized font. The logo is black and white. MAY 1 1 2009 earch & Development 182 Susquehanna Ave Exeter, PA 18643 570-655-5574 FAX 655-2990 www.pridemobility.com ## Exhibit 1 ## 510(k) Summary Pride Mobility Products Corporation Maxima V – Three and Four Wheel Scooter ### Submitter's Name & Address: Pride Mobility Products Corporation 182 Susquehanna Avenue Exeter, Pa. 18643 Phone: (570) 655-5574 Facsimile: (570) 655-2990 #### Contact Person: Thomas Schappert Official Correspondent #### Date Prepared: 04-03-09 ### Name of Device and Proprietary Name: Maxima V, Three and Four Wheel Scooter / Pride Mobility Products Corporation #### Common or Usual Name: Three and Four Wheel Power Scooter #### Classification Name: Physical Medicine / Motorized Three - Wheeled Vehicle ### Product Code: INI #### Comparison to Predicate Devices: The Maxima V, Three and four Wheel Scooters are substantially equivalent to the Pride Mobility Sunrunner SC 400 (K926296), and Sunrunner SC440 (K930953) when comparing, performance, maneuverability, stability, and structure. The performance characteristics and the position of the electronics and drive mechanisms are similar to achieve the same intended use function that enables the user to maintain optimum stability without hindering performance. The major differences between Maxima V, Three and Four Wheel Scooters to the Sunrunner SC400 (K926296) and the Sunrunner SC440 (K930953) are in the weight capacity, Charger, and the Control Mechanisms. {1}------------------------------------------------ Image /page/1/Picture/0 description: The image shows the logo for Pride Mobility Products Corp. The word "Pride" is written in a bold, stylized font, with the letters overlapping each other. Below the word "Pride" is the text "Mobility Products Corp" in a smaller, less bold font. Research & Development 182 Susquehanna Ave Exeter, PA 18643 570-655-5574 FAX 655-2990 www.pridemobility.com ### Device Description: Device Description: The Maxima V, Three and Four Wheel Scooters are heavy duty battery-operated The Maxima V, Three and Tour Wheel Courters. Features include various size removable scoters with programmable Ookloners Free Scooter can be disassembled into seats, a foldable tiller, and an off board charger. The Scooter can be disable seats, a foldable tiller, and an on board than ben "Tries, and seat; this allows for ease of four parts: the rear section, the front section, batteries, include electronic four parts. the rear section, the from assisten, batton, safety features include electronic use when travelling of stoning the society. Prear anti-tip wheels, and front anti-tip wheels on the three wheel model. wheels on the three wheel model. The Maxima V, Three and Four Wheel Scooters are designed for but her limited to The Maxima V, Three and Tour Whoor Gooders are designed for, but not limited to Stablity, and performanos in mina. Pride Mobility Products Corp. providers / retailers and their consumers. ### Intended Use: Intended Use of the Pride Mobility Products Corp. Maxima V, Three and Four The Intended use of the Thue Mobility to disabled persons having limited walking capabilities. ### Non-Clinical Testing: Compliance to applicable Testing Standards is as follows: Compliance to applicable Testing Standards is as lones. RESNA WC Vol.1 2008 DRAFT - Requirements and Test Methods for Wheelchairs (Including Scooters) (Including Scotlers) RESNA WC Vol. 2 2008 DRAFT - Additional Requirements for Wheelchairs (Including Scooters) with Electrical Systems Scoters) with Electrical Systems ANSI/RESNA WC Vol. 2-1998 Section 21 – Requirements and Test Methods for Electromagnetic Compatibility. Electroniagnetic Compatibility: IEC 601-1-1 Medical Electrical Equipment, General Requirements for Safety CAL 117 – Flammability Testing ## Discussion of Clinical Testing Performed: N/A ### Conclusions: The Maxima V, Three and Four Wheel Scooters have the same intended use and The Maxima V, Three and Tour VMGor Scouters have and Sunrunner SC400 (K926296) and Sunrunner similar technological characteristics as the can the predicate comparisons SC440 (K93095), moreover, the non circlesing and rateristics do not raise any demonstrate that any differences in the tour counting V, Three and Four Wheel hew questions of salely of enectiveness. That, the mannel of the passed all the Scooters are substantially oquivalism. necessary testing, and are considered to be safe for user operation. {2}------------------------------------------------ DEPARTMENT OF HEALTH & HUMAN SERVICES Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES-USA" are arranged in a circular pattern around the eagle. The logo is black and white and appears to be a scanned image. Public Health Service Pride Mobility Products Corporation % Mr. Thomas Schappert Official Correspondent 182 Susquehanna Avenue Exeter, Pennsylvania 18643 MAY 11 2009 Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850 Re: K091113 Trade/Device Name: Maxima V, Three and Four Wheel Scooters Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized three-wheeled vehicle Regulatory Class: II Product Code: INI Dated: April 10, 2009 Received: April 17, 2009 Dear Mr. Schappert: 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 rcclassified 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 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 (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. {3}------------------------------------------------ Page 2- Mr. Thomas Schappert If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Center for Devices and Radiological Health's (CDRH's) Office of Compliance at (240) 276-0120. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please contact the CDRH/Office of Surveillance and Biometrics/Division of Postmarket Surveillance at 240-276-3464. For more information regarding the reporting of adverse events, please go to http://www.fda.gov/cdrh/mdr/. You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html. Sincerely yours, Mark N. Melkerson Director Division of General, Restorative, and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health Enclosure {4}------------------------------------------------ ### Exhibit 3 ## Indications for Use 510(k) Number (if known): K ## Device Name: Maxima V, Three and Four Wheel Scooters Indications for Use: The intended use of the Pride Mobility Products Corporation Maxima V, Three The intended ass of the Phas to provide mobility to disabled persons having limited walking capabilities. AND / OR X Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use_ X (21 CFR 807 Subpart C) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) # Concurrence of CDRH, Office of Device Evaluation (ODE) Lullaby (Division Sign-Off) (Division of Surgical, Orthopedic, Divisionative Devices Page 1 of 1 510(k) Number K091113 i