FORU KV10HB

K072027 · Kwang Yang Motor Co., Ltd. · ITI · Aug 20, 2007 · Physical Medicine

Device Facts

• Record ID: K072027
• Device Name: FORU KV10HB
• Applicant: Kwang Yang Motor Co., Ltd.
• Product Code: ITI · Physical Medicine
• Decision Date: Aug 20, 2007
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3860
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The ForU KV10HB powered wheelchair is motor driven, indoor and outdoor transportation vehicles with the intended use to provide mobility to disabled or elderly persons limited to a seated position.

Device Story

ForU KV10HB is a battery-operated, lightweight powered wheelchair designed for indoor and outdoor use. It features a modular design that disassembles into two components (seat frame and body frame with motors/battery) to facilitate transport. The device is operated by the user via a controller (PG VR2) to drive DC motors connected to a sealed transaxle. It provides mobility for disabled or elderly individuals. The device is intended for over-the-counter use. Clinical benefit includes increased independence and mobility for users with physical limitations.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Powered wheelchair; DC 24V motors; Gel/Seal Lead-Acid 12V batteries; PG VR2 controller; sealed transaxle direct drive; solid tires (6" front/rear, 12.8" middle); modular frame design; 10-degree slope grade ability; 6.5 km/hr max speed; on-board automatic charger.

Indications for Use

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

Regulatory Classification

Identification

A powered wheelchair is a battery-operated device with wheels that is intended for medical purposes to provide mobility to persons restricted to a sitting position.

Predicate Devices

• CWD01 (K062888)

Submission Summary (Full Text)

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K072027

AUG 2 0 2007

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KWANG YANG MOTOR CO., LTD.

No. 35, Wan Hsing Street, San Min Dist., 803, Kaohsiung, Taiwan TEL: [phone] FAX: [phone]

# 510(k) Summary

### Device

Trade name: ForU KV10HB powered wheelchair

Common name: Powered wheelchair

Classification name: Powered wheelchair

Medical specialty (Panel): Physical Medicine Device

Regulation number: 890.3860

Product Code: ITI

Classification: Class II

### Predicate devices

CWD01 (K062888) / EMG Technology Co. Ltd.

Intend use of device

ForU KV10HB powered wheelchair is intended for an indoor/outdoor power wheelchair that provides transportation for disabled or elderly persons limited to a seated position.

# Device description:

The ForU powered wheelchair is an indoor/outdoor powered wheelchair that is battery operated. The design of this wheelchair is basically similar to other powered wheelchairs that are already on the market. But the ForU KV10HB is kind oh a new class of lightweight powered wheelchair. By providing a powered wheelchair that breaks down into two manageable components (seat frame, body frame with motors and battery pack), a user can have a more practical alternative when traveling long distances by bus, train, etc.

## Substantial equivalence:

The ForU KV10HB powered wheelchair is substantially equivalent to the CWD01 (K062888) manufactured by EMG Technology Co. Ltd..

There are minor differences in performance specifications of the powered wheelchairs, 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, KWANG YANG MOTOR CO., LTD. believes that the ForU KV10HB powered wheelchair is substantially equivalent to legally marketed devices currently in commercial distribution.

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KWANG YANG MOTOR CO., LTD. CO., LTD.
No. 35, Wan Hsing Street, San Min Dist., 803, Kaohsiung, Taiwan
TEL: [phone] FAX: [phone]

A. PAUL LUSTIG, SUITE 360, 1415 DIS., INC., LAWRENCE, KS 66049
TEL: [phone] FAX: [phone]

The substantial equivalence comparison of the ForU KV10HB and CWD01

| | <i>ForU</i> KV10HB | CWD01 (K062888) |
|--------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------|
| Intended use | It is motor driven, indoor and outdoor transportation<br>vehicles with the intended use to provide mobility to<br>disabled or elderly persons limited to a seated position. | It is intended for medical purposes to provide<br>mobility to persons restricted to a sitting position. |
| Maximum loading | 165 kg (3501bs) | 136 kg (300 lbs) |
| Overall height | 1140 mm (44.9") | 1130 mm (44.5") |
| Overall length | 1032 mm (40.6") | 900 mm (35.4") |
| Overall width | 644mm (25.4") | 650 mm (25.6") |
| Seat overall height | 600 mm (23.6") | |
| Seat overall width | 800 mm (31.5") | 18" |
| Seat overall depth | 500 mm (19.7") | |
| Seat overall weight | 21 kg (46.2 lbs) | |
| Motor output | DC 24V, 200 W, 2 Pcs | 260W x DC24V × 2Pcs |
| Controller | PG VR2 | Dynamic Shark |
| Rear wheel drive | Sealed transaxle direct drive | |
| Battery | Gel/Seal Lead-Acid 12V × 50AH × 2PCs | Lead-Acid 12V×35AH×2PCs |
| Charger | DC 24V 5 AMP (Automatic Type) on-board | DC 24V 5A, off-board |
| Front/Rear wheel | 6" Solid tire × 2 PCs | 6" penumatic tire × 2 PCs |
| Middle wheel | 12.8" Solid tire × 2 PCs | 10" PU foaming tire × 2 PCs |
| Continuous) | The substantial equivalence comparison of the <i>ForU KV10HB</i> and <i>CWD01</i> | |
| | <i>ForU KV10HB</i> | <i>CWD01</i> (K062888) |
| Armrest | Fixed | Removable |
| Break system | | Intelligent regenerative electromagnetic brake |
| | Braking distance<br>Forward: 0.9 m(35.4") at max speed | |
| Net weight w | | 83.5kg (183.7 lbs) includes batteries |
| Battery | 98 kg (215.6 lbs) | |
| | | |
| Heaviest piece<br>weight | 44 kg (96.8 lbs.) body frame with motor | |
| Slope grade ability | 10 degree | 12 degree |
| Per-charge distance | Up to 37 km (23.1 miles) | 40 km (24 miles) |
| Maximum speed | Up to 6.5 km/hr (4.1 mph), variable | 5 km/h (3.2 mph) |
| Turning radius | 515 mm (20.3") | |
| Maximum curb<br>height | 80 mm (3.147") | |
| Suspension | Front/Rear: No, Middle: Yes | Cross brace |
| Horn | | Yes |

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KWANG YANG MOTOR CO., LTD.
No. 35, Wan Hsing Street, San Min Dist., 803, Kaohsiung, Taiwan
TEL: [phone] FAX: [phone]

TEL: [phone] FAX: [phone]
TEL: [phone] FAX: [phone]

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Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized caduceus symbol, which is a staff with two snakes entwined around it, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged in a circular pattern around the symbol. The caduceus is depicted with three abstract, wave-like forms, and the text is in a simple, sans-serif font.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Kwang Yang Motor Co., Ltd. % Mr. Yen, Wen Hsi No. 35, Wan Hsing Street San Min Dist., 803 Kaohsiung, Taiwan

AUG 2 0 2007

K072027 Re: Trade/Device Name: ForU KV10HB Powered Wheelchair Regulation Number: 21 CFR 890.3860 Regulation Name: Powered wheelchair Regulatory Class: Class II Product Code: ITI Dated: July 20, 2007 Received: July 24, 2007

Dear Mr. Yen, Wen Hsi:

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 - Mr. Yen, Wen Hsi

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 toll-free number [phone] or [phone] or the Internet address http://www.fda.gov/cdrb/industry/support/index.html.

Sinc

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

Enclosure

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3. Device descriptive information

3.1 Statement of indication for use

# Statement of Indications for use

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: ForU KV10HB

Indications for use:

The ForU KV10HB powered wheelchair is motor driven, indoor and outdoor transportation vehicles with the intended use to provide mobility to disabled or elderly persons limited to a seated position.

| Prescription Use | | Over-The-Counter Use X | | | |
|---------------------------------------------------------------|----------|-----------------------------|-------------|--|--|
| (Part 21 CFR 801 Subpart D) | AND/OR | (Part 21 CFR 807 Subpart C) | | | |
| (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 | | |
| (Division Sign-Off) | | | | | |
| Division of General, Restorative,<br>and Neurological Devices | | | | | |
| 510(k) Number | I2072027 | | | | |

(Posted November 13, 2003)