ZIP'R4/ ZIP'R4 XTRA SCOOTER

K102361 · Global Fabtech Wheelchair (Shanghai) Co., Ltd. · INI · Oct 4, 2010 · Physical Medicine

Device Facts

• Record ID: K102361
• Device Name: ZIP'R4/ ZIP'R4 XTRA SCOOTER
• Applicant: Global Fabtech Wheelchair (Shanghai) Co., Ltd.
• Product Code: INI · Physical Medicine
• Decision Date: Oct 4, 2010
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3800
• Device Class: Class 2

Intended Use

Zip'r4 and Zip'r4 Xtra scooter are intended for the indoor/outdoor electrical scooter that provide transportation for disabled or elderly persons limited to a seated position.

Device Story

Zip'r4 and Zip'r4 Xtra are battery-powered, rear-wheel-drive, three-wheeled electrical scooters for indoor/outdoor use. Designed for disabled or elderly individuals with limited mobility. Device features a modular, rigid welded steel frame that disassembles into three components (seat, body, battery pack) for transport. Operates via an electric motor (155W, DC24V) controlled by a PG S-Drive 45A controller; includes electromagnetic braking and lighting system. Powered by two 12V lead-acid batteries; max speed 6.8 km/hr (4.25 mph); range 16 km (10 miles); weight capacity 113 kg (250 lbs). Operated by the user via tiller controls. Provides mobility and independence for daily activities and travel.

Clinical Evidence

Bench testing only. Compliance demonstrated with ANSI/RESNA WC/Vol.1 (sections 1, 6), ANSI/RESNA WC/Vol.2 (section 21), ISO 7176 (parts 1, 6, 21), IEC 61000-4-2, IEC 61000-4-3, CISPR 11, and California Bureau of Home Furnishings 117 flammability standards.

Technological Characteristics

Welded steel frame; 155W DC24V drive system; PG S-Drive 45A motor controller; electromagnetic braking; two 12V lead-acid batteries; off-board 2A charger. Max speed 6.8 km/hr; 113 kg weight capacity. Standards: ANSI/RESNA WC/Vol.1, ISO 7176, IEC 61000-4-2/3, CISPR 11.

Indications for Use

Indicated for disabled or elderly persons limited to a seated 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

• KYMCO ForU EQ 20 (K082901)

Submission Summary (Full Text)

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# Global FabTech Wheelchair (Shanghai) Co., Ltd.

No. 318, TianFu Rd., Jiuting Songjiang, Shanghai, 201615, China FAX: [phone] TEL: [phone]

# 510(k) Summary

K102361

This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of 21 CFR Part 807.92. Date of summary was prepared: July 30, 2010

Device

. . .

## DCT 4 2010

Trade name: Zip'r4 / Zip'r4 Xtra scooter

Common name: Electrical scooter

Classification name: Motorized three-wheeled vehicle

Medical specialty (Panel): Physical Medicine Device

Regulation number: 890.3800

Product Code: INI

Classification: Class II

### Predicate devices

KYMCO ForU EQ 20 (K082901) / KWANG YANG MOTOR CO. LTD.

### Intend use of device

Zip'r4 and Zip'r4 Xtra scooter are intended for the indoor/outdoor electrical scooter that provide transportation for disabled or elderly persons limited to a seated position.

### Device description:

The Zip'r4 and Zip'r4 Xtra scooter are the indoor/outdoor electrical scooter. The design of the scooters is basically similar to other electrical scooters that are already on the market. By providing the electrical scooter that breaks down into three 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.

The Zip'r4 and Zip'r4 Xtra scooters are with a 113 kg (250 Ibs) weight capacity. They are basic conventional rear wheel drive, rigid frame vehicle that are battery powered. They consist primarily of a welded steel frame, lighting system, a sealed powered. Incor (155W, DC24V) drive system, electromagnetic braking system, electric motor controller (PG S-Drive 45A) and two batteries with an off-board battery charger (2A). They are powered by two 12 volt lead-acid DC batteries with 16 km (10 miles) with 12 AH which maximum speed upto 6.8 km/hr (4.25 mph).

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# Global FabTech Wheelchair (Shanghai) Co., Ltd.

No. 318, TianFu Rd., Jiuting Songjiang, Shanghai, 201615, China TEL: [phone] FAX: [phone]

## Summary of non-clinical testing

| The Zip'r4 and Zip'r4 Xtra scooter complied with the requirements of ANSI/RESNA WC/Vol.1 section 1-1998 / ISO7176-1-1999, ANSI/RESNA WC/Vo1.1 section 6-1998 / ISO7176-6-2001, ANSVRESNA WC/Vo1.2 section 21-1998 / ISO7176-21-2003, IEC 61000-4-2-2001, IEC 61000-4-3-2008, CISPR 11: 2004+A2: 2006, and California Bureau of Home Furnishings 117 Flammability Standards.

## Statement of substantial equivalence

The Zip'r4 and Zip'r4 Xtra scooter are substantially equivalent to the KYMCO ForU EQ 20 (K082901) manufactured by KWANG YANG MOTOR CO. LTD.. There are minor differences in performance specifications of the electrical 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.

### Conclusion

In accordance with the Federal Food, Drug and Cosmetic Act, 21 CFR Part 807 and based on the information provided in this premarket notification, Global FabTech Wheelchair (Shanghai) Co., Ltd. concludes that, Zip'r4 and Zip'r4 Xtra scooter are substantially equivalent to predicate devices as described herein.

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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 stylized eagle with three stripes forming its wing and tail. The eagle is enclosed in a circle with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" around the perimeter of the circle.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Global FabTech Wheelchair (Shanghai) Co., Ltd. % Ms. Junnata Chang 16F-2 (16A), No. 462, Sec. 2, ChongDe Road, Beitun District Taichung, China (Taiwan) 406

Re: K102361

Trade/Device Name: Zip'r4 and Zip'r4 Xtra scooter Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized three-wheeled vehicle Regulatory Class: Class II Product Code: INI Dated: September 1, 2010 Received: September 1, 2010

4 2017

Dear Ms. Chang:

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. Iisting 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 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 (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

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Page 2 - Ms. Junnata Chang

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.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

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/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

for Thomas Collins

Mark N. Melkerson Director Division of Surgical. Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# Statement of Indications for Use

510(k) Number (if known): __K102361

Device Name: Zip'r4 and Zip'r4 Xtra scooter

Indications for Use:

To provide mobility to disabled or elderly persons limited to a seated position.

Over-The-Counter Use __ X Prescription Use _ (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

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Division of Surgical, Orthropedic, and Restorative Devices

510(k) Number K102361

(Posted November 13, 2003)