VCS, MODEL S4T

K052558 · Cycling and Health Tech. Industry R&D Center/Chc · INI · Oct 27, 2005 · Physical Medicine

Device Facts

• Record ID: K052558
• Device Name: VCS, MODEL S4T
• Applicant: Cycling and Health Tech. Industry R&D Center/Chc
• Product Code: INI · Physical Medicine
• Decision Date: Oct 27, 2005
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3800
• Device Class: Class 2

Intended Use

The VCS S4T scooter is motor driven, indoor and outdoor transportation, vchicles with the intended use to provide mobility to disabled or civerly persons limited to a seated position.

Device Story

VCS S4T is a battery-operated, motorized three-wheeled scooter for indoor/outdoor transportation. Operated by the user via a tiller handle and thumb-actuated potentiometer throttle control lever to manage forward and reverse motion. Provides mobility for disabled or elderly individuals restricted to a seated position. Device functions as a personal transport vehicle; no complex clinical integration or automated decision-making involved.

Clinical Evidence

No clinical data; bench testing only.

Technological Characteristics

Battery-operated motorized three-wheeled vehicle. Features tiller steering and thumb-operated potentiometer throttle control. Class II device under 21 CFR 890.3800.

Indications for Use

Indicated for disabled or elderly persons limited to a seated position requiring indoor/outdoor 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

• Bewell SC 20 (K043326)

Submission Summary (Full Text)

{0}------------------------------------------------

K052558
TR

## Vehicles Technology Co. I

No. 238, San Tsun 1st, Yung Kang City, Tainan, Taiwan Fax: [phone] e-mail: [e-mail] Tel: [phone]

# 510(k) Summary

#### Device

Trade name: VCS S4T scooter

Common name: Electrical scooter

907 % 7 410

Classification name: Motorized three-wheeled vehicle

Medical specialty (Panel): Physical Medicine Device

Regulation number: 890.3800

Product Code: 89INI

Classification: Class II

### Predicate devices

### Bewell SC 20 (K043326)/Cycling and Health Tech Industry R&D Center/CHC Intend use of device

VCS S4T scooter is intended for an indoor/outdoor scooter that provides transportation for disabled or elderly persons limited to a seated position.

### Device description:

The VCS S4T scooter is an indoor/outdoor transportation vehicles which is battery operated. The movement of the scooter is controlled by a tiller handle and a thumb operated potentiometer throttle control lever to engage and disengage the scooter motion in both the forward and reverse directions.

### Substantial equivalence:

The VCS S4T scooter is substantially equivalent to the Bewell SC 20 (K043326) manufactured by Cycling and Health Tech Industry R&D Center/CHC.

There are minor differences in performance specifications of the scooters, these differences do not alter the intended function and use of the device, nor do they raise any new questions pertaining to safety or effectiveness. Therefore, Vehicles Technology believes that the VCS S4T scooter is substantially equivalent to legally marketed devices currently in commercial distribution.

{1}------------------------------------------------

Image /page/1/Picture/1 description: The image shows the seal of the Department of Health and Human Services (HHS). The seal features a stylized caduceus, a symbol often associated with medicine and healthcare, consisting of a staff with two snakes coiled around it. The words "DEPARTMENT OF HEALTH AND HUMAN SERVICES. USA" are arranged in a circular pattern around the caduceus. The seal is simple and monochromatic.

Public Health Service

OCT 2 7 2005

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Chang Wan Lan Cycling and Health Tech Industry R&D Center/CHC No. 17, 37th Road Taichung Industry Park Taichung, China (Taiwan) 407

Re: K052558

Trade/Device Name: VCS S4T Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized three-wheeled vehicle Regulatory Class: II Product Code: INI Dated: October 12, 2005 Received: October 18, 2005

Dear Chang Wan Lan:

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 cnactment 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.

{2}------------------------------------------------

Page 2 -Chang Wan Lan

This letter will allow you to begin marketing your device as described in your Section 510(k) I mis letter will anon your to organ finding of substantial equivalence of your device to a legally premaired predicated 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 rr you desire specific aarnoliance 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 other Echoral International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html

Sincerely yours,

Signature

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

Enclosure

{3}------------------------------------------------

3. Device descriptive information

3.1 Statement of indication for use

# Statement of Indications for Use

510(k) Number (if known): k052558

Device Name: VCS S4T

Indications for Use:

The VCS S4T scooter is motor driven, indoor and outdoor transportation, vchicles with the intended use to provide mobility to disabled or civerly persons limited to a seated position.

Prescription Use __________ Over-The-Counter Use _ X (Part 21 CFR 807 Subpart C) (Part 21 CFR 801 Subpart D) AND/OR (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE OF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE) Page 1 of 1

Signature

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

510(k) Number_KoSZS K

(Posted November 13, 2003)