Electric Wheelchair, Model: 9000N

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September 16, 2022 Silver Fox Corporation Limited % Iris Fung Regulation Manager Guangdong Jianda Medical Technology Co., Ltd. 906 Room, Longxiang Garden, Tianhe District Guangzhou. 510000 China Re: K221799 Trade/Device Name: Electric Wheelchair, Model: 9000N Regulation Number: 21 CFR 890.3860 Regulation Name: Powered Wheelchair Regulatory Class: Class II Product Code: ITI Dated: June 13, 2022 Received: June 21, 2022 Dear Iris Fung: 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, Tushar Bansal, Ph.D 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 {2}------------------------------------------------ # Indications for Use 510(k) Number (if known) K221799 Device Name Electrical Wheelchair, Model: 9000N #### Indications for Use (Describe) The Electrical Wheelchair (Model: 9000N) is a motor-driven, and indoor transportation vehicle with the intended use to provide mobility to the disabled, the elderly and the infirm for short-distance travel. | 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. This section applies only to requirements of the Paperwork Reduction Act of 1995. ### *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: > Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov "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." {3}------------------------------------------------ ## 510(k) Summary This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of 21 CFR 807.92. ## 1. Submitter Information Sponsor Company Name: Silver Fox Corporation Limited Address: No.18, 1st TongLe Road, TongLe Industrial Zone, TangXa Town, PengJiang District, JiangMen City, GuangDong Province, China. Phone: +86-13422526650 Contact Person (including title): CHEN YAN /QA manager E-mail: Yan.chen@silverfox.cn Application Correspondent: Guangdong Jianda Medical Technology Co Ltd. Address: 906 Room, Longxiang Garden, Tianhe district, Guangzhou, China Contact Person:Ms. Iris Fung Tile: Regulation Manager Tel: +86- 13211147965 Email: mdc-fs@foxmail.com; jianda-lee@foxmail.com ## 2. Subject Device Information Type of 510(k) submission: Traditional Common Name: Powered Wheelchair Trade Name: Electrical Wheelchair Classification Name: Powered Wheelchair Review Panel: Physical Medicine Product Code: ITI Regulation Number: 21 CFR 890.3860 Regulation Class: Class II ## 3. Predicate Device Information Sponsor: JERRY MEDICAL INSTRUMENT (SHANGHAI) CO., LTD. Common Name: Powered Wheelchair Trade Name: Electric Wheelchair {4}------------------------------------------------ 510(k) number: K192739 Review Panel: Physical Medicine Product Code: ITI Regulation Number: 21 CFR 890.3860 Regulation Class: Class II ## 4. Device Description The proposed device, Electrical wheelchair, mainly powered by battery, motivated by DC motor, driven by user controlling joystick and adjusting speed. The electrical wheelchair consists of two foldable armrests, a seat cushion, a foldable frame, two rear driving wheels with hub motor/electromagnetic brake assemblies, two pivoting casters, a Lithiumion battery, a battery charger, a controller and master module. . Wheelchair frame: Foldable for easy storage and transportation. Controller and Master module: control the forward, steering and speed adjustment of the electric wheelchair. Battery: It was installed at the bottom of the wheelchair. Rear wheel (Driving Wheel): equipped with motor and electric brake device. Front wheel: Provide support to keep the wheelchair stable. The battery of electrical wheelchair is Lithium-ion 24V, 11AH, and the charger is Input: 100-240VAC,50- 60Hz, 1.2-0.5A, Output:DC24V,3A The maximum weight limitation of the user is 100kg. This product can be quickly folded, disassembled, and is easy to place in the trunk of a car or lift upstairs. The wheelchair is made of high-quality aluminum alloy. The weight without battery is 23kg. This product is an indoor wheelchair that can be driven indoors or on flat roads near buildings. In principle, it cannot be cross-country. It is not recommended to drive on grass, gravel roads, slopes greater than 12°, and motor vehicle lanes. # 5. Intended Use The Electrical Wheelchair (Model: 9000N) is a motor-driven, and indoor transportation vehicle with the intended use to provide mobility to the disabled, the elderly and the infirm for short-distance travel. # 6. Test Summary of Non-clinical Testing # The Electrical Wheelchair has been evaluated the safety and performance by lab bench testing according to the following standards: - . ISO 7176-1: 2014 Wheelchairs - Part 1: Determination of static stability {5}------------------------------------------------ - . ISO 7176-2: 2017 Wheelchairs - Part 2:Determination of dynamic stability of electrically powered wheelchairs - . ISO 7176-3: 2012 Wheelchairs - Part 3: Determination of effectiveness of brakes - . ISO 7176-4: 2008 Wheelchairs - Part 4: Energy consumption of electric wheelchairs and scooters for determination of theoretical distance range - . ISO 7176-5: 2008 Wheelchairs - Part 5: Determination of overall dimensions, mass and manoeuving space - . ISO 7176-6: 2018 Wheelchairs - Part 6: Determination of maximum speed. acceleration and deceleration of electric wheelchairs - . 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 7176-9: 2009 Wheelchairs - Part 9: Climatic tests for electric 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 : 1989 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 devices - . ISO 7176-19:2008 Wheelchairs - Part 19: Wheeled mobility devices for use as seats in motor vehicles #### EMC - . ISO 7176-21: 2009 Wheelchairs - Part 21: Requirements and test methods for electromagnetic compatibility of electrically powered wheelchairs and scooters, and battery chargers - . IEC 60601-1-2:2014 Medical electrical equipment - Part 1-2: General requirements for safety - Collateral standard: Electromagnetic compatibility - Requirements and tests ### Biocompatibility The parts in contact with the user include: Joystick handle , is made of 100% Nitrile rubber; Joystick buttons are made of 100% silica gel; Upper/lower cover of Joystick are made of 100% ABS; Armrest are {6}------------------------------------------------ made of 100% polyurethane (PU); Seat cushion, is made of 100% Ployester. All contact materials have passed biological tests and are harmless to humans. - . ISO 10993-1:2018 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 skin sensitization ## 7. Comparison to Predicate Device Compare with predicate device, the subject device is very similar in design principle, intended use, functions, material and the applicable standards. The differences between subject device and predicate device do not raise and new questions of safety or effectiveness. | Elements of<br>Comparison | Subject Device | Predicate Device | Verdict | |---------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------| | Product Code | ITI | ITI | Same | | Regulation No. | 21 CFR 890.3860 | 21 CFR 890.3860 | Same | | Class | II | II | Same | | Product name | Electrical Wheelchair | Electric Wheelchair | Same | | 510 (k)<br>Number | K221799 | K192739 | -- | | Models | 9000N | JRWD6010, JRWD6012 | -- | | Intended Use | The Electrical Wheelchair (Model: 9000N) is a motor-driven, and indoor<br>transportation vehicle with the intended<br>use to provide mobility to the disabled,<br>the elderly and the infirm for short-<br>distance travel. | The device is a motor-driven, and<br>indoor transportation vehicle with the<br>intended use to provide mobility to a<br>disabled or an elderly person limited to<br>a seated position. | Same | | Use<br>environment | Indoor use | Indoor use | Same | | Patient<br>Population | This electrical wheelchair is suitable<br>for short-distance travel for the<br>disabled and the elderly person. | The electric wheelchair is intended to<br>provide mobility to a person with a<br>disability or an older adult limited to a<br>sitting position | Same | | Product<br>structure | Consists of two foldable armrests, a<br>backrest, a seat cushion, a foldable<br>frame, two rear driving wheels with | Consists of two foldable armrests, a<br>backrest, a seat cushion, a foldable<br>frame, two rear driving wheels with hub | Same | ### Table1 General Comparison {7}------------------------------------------------ | Elements of<br>Comparison | Subject Device | Predicate Device | Verdict | |---------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------| | | hub<br>motor/electromagnetic brake<br>assemblies, two pivoting casters, a<br>Lithium-ion battery, a battery charger,<br>a controller and master module. | motor/electromagnetic brake<br>assemblies, two pivoting casters, a Li-<br>ion batteries, an off-board battery<br>charger, a control panel, and an electric<br>motor controller. | | | Driving system | Direct drive on the rear wheels | Direct drive on the rear wheels | Same | | Number of<br>wheels | 4 | 4 | Same | | Main frame<br>material | Aluminium alloy | Aluminium alloy | Same | | Motor | DC 24V* 180W * 2pcs | DC24V* 180W*2pcs | Same | | Battery | Lithium-ion 24V, 11AH,1pcs | DC 24V 20Ah Lithium-ion, 1 pcs | Subject Device<br>has a lower output<br>current, but this<br>will not affect the<br>use of the product<br>function and<br>safety. | | Battery charger | Input:AC 100-240V, 50/60Hz<br>Output:DC24V, 3A max | High Power Technology Inc.<br>HP0180WL2<br>Input: 100-240 VAC<br>Output: DC 24V, 6 Amp | Subject Device<br>has a lower output<br>current, but this<br>will not affect the<br>use of the product<br>function and<br>safety. | # Table2 Performance Comparison | Elements of | Subject Device | Predicate Device | | Verdict | |-------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Comparison | | JRWD6010 | JRWD6012 | | | Dimensions | 39.0"x24.0"x38.0" | 38.1"x24.0"x37.0" | 39.3"x23.6"x37.0" | Similar | | Folded<br>Dimensions | 26.0"x24.0"x16.0" | Not publicly available | | -- | | Seat Cushion<br>size | 18.0"x18.0"x3.0" | Not publicly available | | -- | | Weight,w/<br>Battery | 50lbs./23kg | 58.4 lbs. /26.5kg | 58.2 lbs./26.4kg | Subject Device has a<br>lighter weight, but this<br>will not affect the use of<br>the product function and<br>safety. | | Frame design | Foldable/<br>The device consists of a foldable<br>and non-rigid type of power<br>wheelchair base with rear drive<br>and 2 casters in the front and 2<br>anti-tippers in the rear. | Foldable /<br>The device consists of a foldable and<br>non-rigid type of power wheelchair base<br>with rear drive and 2 casters in the front<br>and two anti-tippers in the rear. | | Same | | Folding<br>mechanism | A foldable seat frames<br>(The backrest could be folded to | A foldable seat frames<br>(The backrest could be folded to seat) | | Same | | Elements of | | Predicate Device | | | | Comparison | Subject Device | JRWD6010 | JRWD6012 | Verdict | | | seat) | | | | | Front wheel<br>(inch ) | 8 | 8<br>(PU solid tire) | | | | Rear tire<br>(inch) | 8<br>(PU solid tire) | 10<br>(PU solid tire) | 12<br>(Pneumatic tire) | Smaller sizes of rear<br>wheels, The difference<br>will not raise any new<br>safety and effectiveness<br>concerns. | | Cruising<br>Range(km) | 15.5 | 20 | | Subject Device has a<br>shorter cruising range,<br>but this will not affect<br>the use of the product<br>function and safety. | | Obstacle<br>climbing(mm) | 25 | 50 | | Subject Device has<br>a<br>lower obstacle climbing,<br>but this will not affect<br>the use of the product<br>function and safety. | | Max. Speed<br>(km/h) | 4.5 | 6 | | Subject Device has a<br>smaller Max. speed, but<br>this will not affect the<br>of the product<br>use<br>function and safety. | | Static stability<br>forward | 18.2° | 21.8° | | Both of the devices are<br>evaluated according to | | Static stability<br>rearward | 18.0° | 19° | | standard<br>ISO 7176-<br>1:2014, so the different | | Static stability<br>sideways | Left: 17.6°<br>Right: 16.6° | 19.2° | | static stability will not<br>impact the safety and<br>effectiveness. | | Max. loading<br>(kg) | 220lbs(100kg) | 220lbs (100kg) | | Same | | Maximum<br>safe<br>operational<br>incline | 10° | 10 degrees | | Same | | Min. Turning<br>radium | 950mm | 1820mm | | The difference in the<br>tuming radius will bring<br>more convenience when<br>it turns.The difference<br>will not raise any new<br>safety and effectiveness<br>concerns. | | Minimum<br>braking<br>distance | ≤1meter (39<br>inches )<br>flat,<br>≤1.6meter (63 inches) at 3°slope | 1m | | Similar | | Max Speed<br>Forwards | 2.46mph(3.96km/h) | 3.75 mph (6 km/h) | | Both of the devices are<br>evaluated according to | | Max. Speed<br>Backward | 1.57mph(2.52km/h) | 2.80 mph (4.5 km/h) | | standard<br>ISO 7176-<br>6:2018, so the different | | Elements of<br>Comparison | Subject Device | Predicate Device | | Verdict | | | | JRWD6010 | JRWD6012 | | | | | | | will not impact the<br>safety and effectiveness | | Controller | Silver Fox Corporation Limited | PG Drives Technology Ltd., new VSI | | Different Although<br>different controller is<br>used, both the control<br>system, including the<br>joystick controller, the<br>electromagnetic brakes<br>are similar. The joystick<br>controls the directions<br>and speed of movement,<br>and when the joystick is<br>released, the powered<br>wheelchair will slow<br>down to stop and the<br>brakes will<br>automatically re-engage.<br>The controller also<br>provides the battery<br>status displaying and<br>abnormal condition<br>displaying. Both of the<br>control systems are<br>evaluated according to<br>standard ISO 7176-<br>14:2008 and software<br>validation requirement<br>and there are no new<br>safety and effectiveness<br>concerns due to the<br>difference. | | Speed control<br>method | Joystick control method | | Joystick control method | Same | {8}------------------------------------------------ {9}------------------------------------------------ # Table3 Safety Comparison | Elements of<br>Comparison | Subject Device | Predicate Device | Verdict | |------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------| | Main materials | Frame: Aluminiumalloy;<br>Wheel, Armrest: PU;<br>Backrest:polyeter | Frame: Aluminiumalloy;<br>Wheel, Armrest: PU;<br>Backrest: oxford cloth | The material for the<br>main frame is the same.<br>Biocompatibility<br>evaluation has been<br>carried out per ISO<br>10993-1. | | Materials<br>contacting user | Armrest: PU;<br>Backrest, Seat cushion: polyeter<br>Joystick handle : Nitrile rubber;<br>Joystick buttons: silica gel;<br>Upper/lower cover of Joystick:<br>ABS | Armrest: PU:<br>Backrest: oxford cloth<br>Seat: oxford cloth<br>newVSi electric wheelchair<br>controller:<br>Joystick knob: Santoprene 101-80;<br>Joystick Gaiter: Silicone 3032<br>(50%) & 5031 (50%)<br>Enclosure Moulding(s): ABS/PC<br>Wonderloy PC-540<br>Keypad: Silicone keypad coatings | There are no new safety<br>and effectiveness<br>concerns due to the<br>difference. | {10}------------------------------------------------ | Elements of<br>Comparison | Subject Device | Predicate Device | Verdict | |-----------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------|---------| | | | TC-2407 & CH-6330 | | | Biocompatibility<br>of materials<br>contacting user | Comply with ISO 10993-1, FDA<br>Cytotoxicity (ISO 10993-5:2009),<br>Sensitization and Intracutaneous<br>Reactivity (ISO 10993-10:2010) | Comply with ISO 10993-1, FDA<br>Cytotoxicity (ISO 10993-5:2009),<br>Sensitization and Intracutaneous<br>Reactivity (ISO 10993-10:2010) | Same | | Label and<br>Labeling | Conforms to FDA Regulatory<br>Requirements | Conforms to FDA Regulatory<br>Requirements | Same | | Level of<br>Concern of the<br>Software | Moderate | Moderate | Same | ## 8. Summary of substantial equivalence discussion The 9000N electrical wheelchair complied with the requirements of ISO 7176-2:2017, ISO 7176-3:2012, ISO 7176-4:2008, ISO 7176-5:2008, ISO 7176-6:2018, ISO 7176-7:1998, ISO 7176-8:2014. ISO 7176-9:2009. ISO 7176-10:2008. ISO 7176-11:2012. ISO 7176-13:1989. ISO 7176-14:2008. ISO 7176-15:1996, ISO 7176-16:2012, ISO 7176-19:2008, ISO 7176-21:2009, IEC 60601-1-2:2014, ISO 10993-1:2018, ISO10993-5:2009, ISO 10993-10:2010.. The intended uses for both devices are the same. Mainframes of two devices are folded by way of front and rear close, and frame materials all meet the Tensile Strength, Yield Load, and Elongation tests. The design principles of the controller and Driving system are the same, and both meet the requirements of the ISO 7176-14:2008. Software validation is carried out on both control systems. Brake system and speed control are designed in the same way as well, and both meet the requirements of the ISO 7176-3:2012. Maximum obstacle climbing, Max Speed and Static stability different while such differences will not impact the safety and effectiveness of the subject device or raise new safety and effectiveness concerns as well as both meet the requirements of the ISO 7176-2:2001,ISO 7176-6: 2018, ISO 7176-10:2008. The biocompatibility of the Predicate device and Subject device meet the requirements of the ISO 10993-5:2009 & ISO 10993-10:2010. The flame retardant test of the seat cushion and armrest of subject device is carried out according to the ISO 7176-16 test. Therefore, the subject device meets the flame retardancy of FDA requirements. In conclusion, the technological characteristics, features, specifications, materials, mode of operation, and intended use of the device substantially equivalent to the predicate quoted above. The differences between the subject device and predicate devices do not raise new issues of safety or effectiveness. The differences between the subject device and predicate devices do not raise new issues of safety or effectiveness. ## 9. Summary of Clinical Test {11}------------------------------------------------ No animal study and clinical studies are available for our device. Clinical testing was not required to demonstrate the substantial equivalence of the electrical wheelchair to its predicate device. ## 10. Conclusion The differences between 9000N electrical wheelchair and its predicate devices do not introduce a new intended use and do not raise new issues of safety and effectiveness. Verification and Validation testing demonstrated that no adverse effects have been introduced by these differences and that the device performs as intended. From the results of nonclinical testing described, it can be concluded that 9000N electrical wheelchair is substantially equivalent to the legally marketed predicate device. ## 11. Summary Prepared Date 13 June 2022