BREEZE

K051028 · Afikim Electric Vehicles · INI · Jan 27, 2006 · Physical Medicine

Device Facts

• Record ID: K051028
• Device Name: BREEZE
• Applicant: Afikim Electric Vehicles
• Product Code: INI · Physical Medicine
• Decision Date: Jan 27, 2006
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3800
• Device Class: Class 2

Indications for Use

The Breeze Scooter is intended to provide increased mobility for the elderly and/or disabled persons. It is an aid to independent living. The Breeze does not provide treatment for any ailment, nor does it have diagnostic capability. The Breeze is also suite for the use of elderly persons and physically disabled persons.

Device Story

Breeze is a motorized three-wheeled vehicle designed to provide mobility assistance to elderly or disabled individuals. Device functions as an aid to independent living; it does not provide medical treatment or diagnostic capabilities. Operated by the user for personal transportation. No complex data input, processing, or software-based analysis involved.

Clinical Evidence

No clinical data; bench testing only.

Technological Characteristics

Motorized three-wheeled vehicle. Class II device. Product code INI. Mechanical propulsion system.

Indications for Use

Indicated for elderly and/or physically disabled persons requiring mobility assistance to aid independent living.

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.

Submission Summary (Full Text)

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Public Health Service

JAN 2 7 2006

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Mr. Avner Fishbein Afikim Electric Vehicles Kibbutz Afikim, 15148 Israel

Re: K051028 Trade/Device Name: Breeze Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized three-wheeled vehicle Regulatory Class: II Product Code: INI Dated: December 15, 2005 Received: December 19, 2005

Dear Mr. Fishbein:

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 indictions 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 (Sections 531-542 of the Act); 21 CFR 1 all II applicane, the elections

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Page 2 - Mr. Avner Fishbein

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 of basification for your device on your device to alegally
to proceed to the market 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 the Division of Small
[phone] and its Late Late Lonsumer Assistance at its toll-free number (800) 638-[phone] or at its Internet address http://www.fda.gov/cdrh/dsmadsmamain.html

Sincerely vours.

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Mark N. Melkerson Acting Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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AFIKIM ELECTRIC VEHICLES Kıbbutz Alikim 15148, İsrael Tel: + 972 - 4 - 6: 7 5 4 8 1 4 Fax: + 9 7 2 - 4 - 6 7 5 1 4 5 6 E-mail; [e-mail]

www.afiscooters.com

January 16 2006 Page 1 of 1

## Indications for Use

510(k) Number (if known): K051028

Device Name: Breeze

Indications for Use:

The Breeze Scooter is intended to provide increased mobility for the elderly and/or disabled persons. It is an aid to independent living. The Breeze does not provide treatment for any ailment, nor does it have diagnostic capability.

The Breeze is also suite for the use of elderly persons and physically disabled persons.

Prescription Use AND/OR (Part 21 CFR 801 Subpart D)

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タミやにらんす

Over-The-Counter Use V (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of Device Evaluation (ODE)

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(Division Sign-Off) Division of General, Restorative, and Neurological Devices