ESG 4-WHEEL SCOOTER, ESG-03

K033204 · Emg Technology Co., Ltd. · INI · Nov 12, 2003 · Physical Medicine

Device Facts

• Record ID: K033204
• Device Name: ESG 4-WHEEL SCOOTER, ESG-03
• Applicant: Emg Technology Co., Ltd.
• Product Code: INI · Physical Medicine
• Decision Date: Nov 12, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3800
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The device is intended for medical purposes to provide mobility to persons restricted to a sitting position.

Device Story

Battery-operated 4-wheel electric scooter; provides mobility for individuals restricted to seated position. Rider operates via hand controls on steering column. Indoor/outdoor use. Disassemblable for transport; includes onboard battery charger. Electronic systems (controller, batteries, charger) are UL certified. Output is physical mobility for the user. Clinical benefit is increased independence for mobility-impaired patients.

Clinical Evidence

Bench testing only. Compliance with ANSI/RESNA WC/Vol.2-1998, CISPR 11: 1990, EN61000-3-2: 1995, and IEC61000-3-3: 1995 for electrically powered wheelchairs and scooters.

Technological Characteristics

4-wheel electric scooter; battery-powered; hand-controlled steering column; disassemblable frame. Electronic systems (controller, batteries, charger) are UL certified. Tested to ANSI/RESNA WC/Vol.2-1998, CISPR 11, EN61000-3-2, and IEC61000-3-3 standards.

Indications for Use

Indicated for persons restricted to a sitting position requiring mobility assistance.

Regulatory Classification

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.

Predicate Devices

• WU'S 4-WHEELED NEO SCOOTER WT-L4 (K013763)

Submission Summary (Full Text)

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K033204

September 28, 2003

NOV 1 2 2003

## EMG TECHNOLOGY CO. LTD.

No. 12-1,Lane 267, Sec. 3, Min Sheng Road, Taya Hsiang, Taichung Hsien, 428, Taiwan, ROC Telephone: [phone] Fax: [phone] E-mail: emg.tech(@msa.hinrt.net

## 46 510(k) SUMMARY "

Submitter's Name: EMG Technology Co., Ltd.

No. 12-1, Lane 267, Sec. 3, Min Sheng Road, Taya Hsiang, Taichung Hsien, 428, Taiwan, ROC

Date summary prepared:

Device Name:

| Proprietary Name: | ESG 4-WHEEL SCOOTER, ESG-03 |
|-----------------------|----------------------------------------------------------|
| Common or Usual Name: | Electrical Scooter |
| Classification Name: | Motor Three-Wheeled Vehicle, Class II<br>21 CFR 890.3800 |

Indications for Use:

The device is intended for medical purposes to provide mobility to persons restrict to a seated position.

Description of the device:

The ESG 4-WHEEL SCOOTER, ESG-03 is an indoor / outdoor electric scooter tl is battery operated. It has a base with four-wheeled with a seat. The movement of the scooter is controlled by the rider who uses hand controls located at the top of the steering column. The device can be disassembled for transport and is provided with an onboard battery charger.

Performance Testing:

EMC Report ANSI / RESNA WC/Vol.2-1998, CISPR 11: 1990, EN61000-3-2: 1995, IEC61000-3-3: 1995 (Electrically powered wheelchairs, scooters, and their chargers - requirements and test methods)

Legally marketed device for substantial equivalence comparison: WU'S 4-WHEELED NEO SCOOTER WT-L4 (K013763)

, s

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## EMG TECHNOLOGY CO. LTD.

No. 12-1,Lane 267, Sec. 3, Min Sheng Road, Taya Hsiang, Taichung Hsien, 428, Taiwan, ROC Telephone: [phone] Fax: [phone] E-mail: [e-mail]

Summary for substantial equivalence comparison:

The electronic systems between two devices are the same and all passed by the UL certificated, for instance the electronic controller, batteries and recharge. Thus the same safety level for the two devices is assured. The major differences existing of the two 4-wheelled scooters are the different controller, and the new device, ESG-03, is more agile and easy to storage or transportation and the predicate device. WT-L4, is for general use. Besides the overall dimension, the size of tires, and the weight are differences between the two devices. The overall appearance differences are not safety aspect. So the new device is substantially equivalent to the predicate devices in this aspect.

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular border with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the circumference. Inside the circle is a stylized image of a bird or eagle with three curved lines representing its wings or feathers.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

NOV 1 2 2003

EMG Technology Co., Ltd. C/o Dr. Ke-Min Jen ROC Chinese-European Industrial Research Society No. 58. Fu-Chiun St. Hsin-Chu City, China (Taiwan) 300

Re: K033204

Trade/Device Name: ESG 4-Wheeled Scooter, ESG-03 Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized three-wheeled vehicle Regulatory Class: II Product Code: INI Dated: October 8, 2003 Received: October 20, 2003

Dear Dr. Jen:

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.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA). it may be subject to such 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 requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); 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.

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## Page 2 - Dr. Ke-Min Jen

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). 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 [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

Mark A. Milliman

Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510 (K) NUMBER ( IF KNOW ): _ TBA_____________________________________________________________________________________________________________________________________________ DEVICE NAME: ESG 4-Wheel Scooter ESG-03_

INDICATIONS FOR USE:

The device is intended for medical parposes to provide mobility to persons restricted to a sitting position.

( PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE )

Concurrence of CDRH, office of Device Evaluation (ODE )

| Prescription Use | |
|------------------------------|---|
| OR | |
| Over - The -- Counter -- Use | ✓ |

( Per 21 CFR 801.109 ) (Optional Format 1-2-96 )

(Division Sign-Off)

Division of General Restorative

and Neurological Devices

| 510(k) Number | K033204 |
|---------------|---------|
|---------------|---------|

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