C.T.M. Mobility Scooter HS-268

K192885 · Chien TI Enterprise Co., Ltd. · INI · Dec 9, 2019 · Physical Medicine

Device Facts

• Record ID: K192885
• Device Name: C.T.M. Mobility Scooter HS-268
• Applicant: Chien TI Enterprise Co., Ltd.
• Product Code: INI · Physical Medicine
• Decision Date: Dec 9, 2019
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3800
• Device Class: Class 2

Intended Use

The C.T.M. Mobility Scooter HS-268 is an indoor/outdoor scooter that provides transportation for a disabled or elderly person in age of 16 up to 85 year old.

Device Story

Indoor/outdoor motorized four-wheeled scooter; provides transportation for disabled or elderly users. Rider operates device via hand controls on steering column; rear-wheel drive system; powered by 25.2Vdc lithium battery. Features foldable design; maximum speed 5 mph; 253.5 lbs weight capacity. Uses Dynamic Rhino 50 (DR50) controller for movement and braking. Healthcare provider/clinician not required for operation; intended for patient self-use. Output is physical mobility; assists users in navigating indoor/outdoor environments; improves patient independence.

Clinical Evidence

No clinical data. Substantial equivalence established via bench testing and adherence to FDA-recognized consensus standards, including ISO 7176 series (stability, braking, energy consumption, dimensions, speed, fatigue, climatic, obstacle climbing) and electrical/biocompatibility standards (ISO 10993, IEC 60601).

Technological Characteristics

Four-wheeled motorized scooter; rear-wheel drive; 25.2Vdc lithium battery. Controller: Dynamic Rhino 50 (DR50). Standards: ISO 7176-1 through 7176-22 (performance/safety), ISO 10993-5/10 (biocompatibility), IEC 60601-1/1-2 (electrical safety/EMC), IEC 62133 (battery safety). Foldable form factor; hand-controlled tiller.

Indications for Use

Indicated for disabled or elderly persons aged 16 to 85 requiring indoor/outdoor transportation.

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

• Freerider Corporation Luggie Super (K151944)

Submission Summary (Full Text)

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Chien Ti Enterprise Co., Ltd. Vivian Lo Sales Director No. 13, Lane 227, Fu Ying Rd New Taipei City, Hsin Chuang District, 24258 Taiwan

Re: K192885

Trade/Device Name: C.T.M. Mobility Scooter HS-268 Regulation Number: 21 CFR 890.3800 Regulation Name: Motorized Three-Wheeled Vehicle Regulatory Class: Class II Product Code: INI Dated: October 9, 2019 Received: October 10, 2019

Dear Vivian Lo:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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. 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

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requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email ([e-mail]) or phone [phone] or 301-796-7100).

Sincerely,

Acting Assistant Director, Acute Injuries Devices Team DHT5B: Division of Neuromodulation and Physical Medicine Devices OHT5: Office of Neurological and Physical Medicine Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

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# Indications for Use

510(k) Number (if known) K192885

Device Name C.T.M. Mobility Scooter HS-268

Indications for Use (Describe)

The C.T.M. Mobility Scooter HS-268 is an indoor/outdoor scooter that provides transportation for a disabled or elderly person in age of 16 up to 85 year old.

Type of Use (Select one or both, as applicable)

Prescription Use (Part 21 CFR 801 Subpart D)

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

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Image /page/3/Picture/0 description: The image is a logo for C.T.M. The logo is an oval shape with a gray border. Inside the oval, the letters "C.T.M." are written in red, with blue swooshes above and below the letters.

# EN TI ENTERPRISE CO., LT

ane 227, Fu Ying Rd., Hsin Chuang District., New Taipei City, Taiwan 886-2-2904-1170 · 2903-88 http://www.chienti.com.tv [e-mail] tw

#### 510(k) Summary

CHIEN TI ENTERPRISE CO., LTD.

Company Name: Company Address:

No. 13, Lane 227, Fu Ying Rd New Taipei City, Hsin Chuang District, 24258, TAIWAN (CHINA) [phone] [phone] Ms. Vivian Lo Summary Preparation Date: October 9, 2019

# Device Name:

Contact Person:

Telephone:

Fax:

Trade Name: C.T.M. Mobility Scooter, HS-268 Classification Name: Motorized three-wheeled vehicle Regulation Number: 890.3800 Product Code: INI Device Class: Class 2 Panel: Physical Medicine

# PREDICATE DEVICE:

K151944, Freerider Corporation Luggie Super

# Indications for Use (IFU) statement:

The C.T.M. Mobility Scooter HS-268 is an indoor/outdoor scooter that provides transportation for a disabled or elderly person in age of 16 up to 85 year old.

# Device Description

The C.T.M. Mobility Scooter HS-268 is an indoor/outdoor scooter that is powered by 25.2Vdc, 11000mAh, 277.2Wh (min) and 25.2Vdc, 11600mAh, 292.32Wh (typ) Lithium battery, equipped with four wheels, capacity of 253.5 lbs and a lightweight seat. It's a rear wheel drive scooter with theoretical driving ranges of 9.3 miles. 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 folded/unfolded and is provided with an off-board battery charger. The maximum speed is 5 mph.

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# Substantial Equivalence Comparison

The C.T.M. Mobility Scooter, HS-268 and the Freerider Corporation mobility scooter # Luggie Super (K151944) have similar indications for use and same classification name/ product code.

The C.T.M. Mobility Scooter, HS-268 and the Freerider Corporation mobility scooter #Luggie Super have similar design features. Regarding the HS-268, the dimension is bigger and heavier, but not significantly. Both scooters have same 4 wheels, rear-wheel drive technology, electro-mechanical brakes. The control systems are used for exact same model, Dynamic Rhino 50 controllers (DR50). The features on the tiller and controller are same. Each scooter has s single motor and battery. The differences are motor size, capacity and output of battery. All the differences don't affect the safety and performance after verified by safety and performance test.

The HS-268 with its built in modern technologies for improvements in effectiveness and safety, in many comparable criterions, considered fairly similar to its predicate device: Luggie Super. Furthermore, the HS-268 has been also tested to applicable ANSVRESNA. ISO. IEC standards which are included in this submission.

| Category | C.T.M. Mobility Scooter,<br>HS-268<br>New device | Freerider Corporation<br>Luggie Super<br>K151944 | Result of<br>Comparison |
|---------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------|
| Indications for<br>Use | The C.T.M. Mobility Scooter<br>HS-268 is an indoor/outdoor<br>scooter that provides<br>transportation for a disabled<br>or elderly person in age of 16<br>up to 85 year old. | The FR-L05 (Luggie Super)<br>provides transportation for<br>an elderly or disabled<br>person. It can be used in a<br>variety of indoor and<br>outdoor settings. | Similar |
| Prescription Use<br>or<br>Over-the-counter<br>Use | Over-the-counter Use | Over-the-counter Use | Same |
| The generic<br>name of the<br>device | Electric scooter | Electric scooter | Same |
| Classification<br>name | 890.3800 Motorized<br>3-wheeled vehicle | 890.3800 Motorized<br>3-wheeled vehicle | Same |
| Product Code | INI | INI | Same |

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# Non-clinical tests

The safety tests, such as biocompatibility and electrical safety have been performed and meet the requirement of following FDA Recognized Consensus Standards.

| ● ISO | 10993-5 | Part 5: Test for in vitro cytotoxicity |
|-------|------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| ● ISO | 10993-10 | Part 10: Tests for irritation and skin sensitization |
| ● EN | 60601-1:2006<br>+A11:2011 +<br>A1:2013 +<br>A12:2014 | Part 1: General Requirements for basic safety and essential performance |
| ● IEC | 60601-1-2 | Part 1-2: General requirements for basic safety and essential performance –<br>Collateral standard: Electromagnetic compatibility – Requirements and tests |
| ● ISO | 7176-14 | Wheelchairs - Part 14: Power and control systems for electrically powered<br>wheelchairs and scooters - Requirements and test methods |
| ● ISO | 7176-21 | Wheelchairs - Part 21: Requirements and test methods for electromagnetic<br>compatibility of electrically powered wheelchairs and scooters, and battery<br>chargers |
| ● IEC | 62133 | Secondary cells and batteries containing alkaline or other non-acid electrolytes<br>Safety requirements for portable sealed secondary lithium cells, and for batteries<br>made from them, for use in portable applications - Part 2: Lithium systems |

Regarding the performance, the bench tests were performed in accordance with following FDA Recognized Consensus Standards. All tests passed the requirement to demonstration that new device is as substantial equivalent as the predicate device.

- Wheelchairs Part 1: Determination of static stability ● ISO 7176-1
- Wheelchairs Part 2: Determination of dynamic stability of electric wheelchairs ● ISO 7176-2
- Wheelchairs Part 3: Determination of effectiveness of brakes 7176-3 ● ISO

● ISO 7176-4 Wheelchairs - Part 4: Energy consumption of electric wheelchairs and scooters for determination of theoretical distance range

- · ISO 7176-5 Wheelchairs Part 5: Determination of overall dimensions, mass and manoeuvring space
- Wheelchairs Part 6: Determination of maximum speed, acceleration and • ISO 7176-6

deceleration of electric wheelchairs

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- ISO 7176-7 Wheelchairs - Part 7: Measurement of seating and wheel dimensions
- ISO 7176-8 Wheelchairs - Part 8: Requirements and test methods for static, impact and fatigue strengths
- ISO 7176-9 Wheelchairs - Part 9: Climatic tests for electric wheelchairs
- ISO 7176-10 Wheelchairs - Part 10: Determination of obstacle-climbing ability of electrically

powered wheelchairs

- . ISO 7176-11: Wheelchairs Part 11: Test Dummies
- . ISO 7176-13: Wheelchairs Part 13: Determination of coefficient of friction of Test Surfaces
- ISO 7176-15 Wheelchairs - Part 15: Requirements for information disclosure, documentation and

#### labeling

- ISO 7176-16 Wheelchairs - Part 16: Resistance to ignition of postural support devices
- 7176-22 Wheelchairs Part 22: Set-up procedures ● ISO

#### Clinical study

This 510(k) submission does not utilize clinical study for establishing substantial equivalence therefore this section does not apply.

#### Conclusions:

C.T.M. mobility scooter, HS-268 has similar indications for use and similar technological characteristics as the above predicate devices. Moreover, information contained in this submission supplied demonstrates that any differences in their characteristics do not raise any different questions of safety or effectiveness. Thus, C.T.M. mobility scooter. HS-268 is substantially equivalent to the predicate devices with respect to its indications for use, technological characteristics and performance characteristics.