Powered Wheelchair (NXN20-208, NXN20-211)

K241603 · Zhejiang Nysin Medical Co., Ltd. · ITI · Nov 20, 2024 · Physical Medicine

Device Facts

• Record ID: K241603
• Device Name: Powered Wheelchair (NXN20-208, NXN20-211)
• Applicant: Zhejiang Nysin Medical Co., Ltd.
• Product Code: ITI · Physical Medicine
• Decision Date: Nov 20, 2024
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.3860
• Device Class: Class 2

Intended Use

The device is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited to a seated position.

Device Story

Powered wheelchair (models NXN20-208, NXN20-211) provides mobility for disabled or elderly users. Device consists of foldable frame (aluminum alloy or carbon fiber), seat, backrest, armrests, safety belt, two rear driving wheels with DC brushless motors, two pivoting casters, two Li-ion batteries, and joystick control panel. User operates joystick to control speed and direction; releasing joystick triggers automatic electromagnetic braking. Device is intended for indoor and outdoor use. Controller manages motor output, battery status, and error displays. Benefits include increased mobility for users with limited physical capacity. Device is battery-powered and rechargeable via off-board charger.

Clinical Evidence

No clinical data. Substantial equivalence supported by bench testing including static/dynamic stability, braking effectiveness, energy consumption, obstacle climbing, and electromagnetic compatibility per ISO 7176 standards and IEC 60601-1-2.

Technological Characteristics

Powered wheelchair; DC24V 200W brushless motors; 24V 12Ah Li-ion batteries. Frame: Aluminum alloy (NXN20-208) or Aluminum alloy/Carbon fiber (NXN20-211). Control: Joystick-based electronic controller. Braking: Automatic electromagnetic. Connectivity: None. Standards: ISO 7176 series (stability, braking, dimensions, speed, EMC), IEC 60601-1-2, ISO 10993-1 (biocompatibility).

Indications for Use

Indicated for disabled or elderly persons with mobility difficulties who are limited to a seated position.

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

• A08 Power Wheelchair (K163204)

Submission Summary (Full Text)

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

Image /page/0/Picture/0 description: The image shows the logo of the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and consists of the letters "FDA" stacked on top of the words "U.S. FOOD & DRUG ADMINISTRATION".

November 20, 2024

Zhejiang Nysin Medical Co., Ltd. % Boyle Wang Manager Shanghai Truthful Information Technology Co., Ltd. Room 1801, No. 161 East Lujiazui Rd., Pudong Shanghai. 200120 China

Re: K241603

Trade/Device Name: Powered Wheelchair (NXN20-208, NXN20-211) Regulation Number: 21 CFR 890.3860 Regulation Name: Powered Wheelchair Regulatory Class: Class II Product Code: ITI Dated: October 21, 2024 Received: October 21, 2024

Dear Boyle Wang:

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 (the 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 available 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.

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device"

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

(https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review. the OS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

All medical devices, including Class I and unclassified devices and combination product device constituent parts are required to be in compliance with the final Unique Device Identification System rule ("UDI Rue"). The UDI Rule requires, among other things, that a device bear a unique device identifier (UDI) on its label and package (21 CFR 801.20(a)) unless an exception or alternative applies (21 CFR 801.20(b)) and that the dates on the device label be formatted in accordance with 21 CFR 801.18. The UDI Rule (21 CFR 830.300(a) and 830.320(b)) also requires that certain information be submitted to the Global Unique Device Identification Database (GUDID) (21 CFR Part 830 Subpart E). For additional information on these requirements, please see the UDI System webpage at https://www.fda.gov/medical-devices/device-advicecomprehensive-regulatory-assistance/unique-device-identification-system-udi-system.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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).

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

Sincerely,

# Tushar Bansal -S

for Heather Dean, PhD Assistant Director, Acute Injury 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

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

#### Indications for Use

Submission Number (if known)

K241603

Device Name

Powered Wheelchair (NXN20-208, NXN20-211)

Indications for Use (Describe)

The device is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited to a seated position.

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)

#### CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

#### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.*

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

> Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

{4}------------------------------------------------

## 510(k) Summary

## K241603

This summary of 510(k) safety and effectiveness information is being submitted in accordance with requirements of 21 CFR 807.92.

#### 1.0 Submitter's information

Name: Zhejiang Nysin Medical Co., Ltd. Address: Building 13, No. 305 Jiulong North Road, Dongcheng District, Yongkang, Jinhua City, Zhejiang Province, China Tel: [phone] Contact: Zhang Xiaoying

#### Designated Submission Correspondent

Mr. Boyle Wang Shanghai Truthful Information Technology Co., Ltd. Room 1801, No. 161 East Lujiazui Rd., Pudong Shanghai, 200120 China Tel: [phone] Email: [e-mail]

Date of Preparation: Mar.28, 2024

#### 2.0 Device information

Trade name: Powered Wheelchair Common name: Powered Wheelchair Classification name: Powered Wheelchair Model(s): NXN20-208, NXN20-211

#### 3.0 Classification

Production code: ITI Regulation number: 21 CFR 890.3860 Classification: Class II Panel: Physical Medicine

#### 4.0 Predicate device information

Manufacturer: Kunshan Aoshida Electric Technology Co., Ltd. Trade/Device: A08 Power Wheelchair

{5}------------------------------------------------

#### 510(k) number: K163204

#### 5.0 Indication for Use Statement

The device is a motor driven, indoor and outdoor transportation vehicle with the intended use to provide mobility to a disabled or elderly person limited to a seated position.

#### 6.0 Device description

The subject device, Powered Wheelchair, mainly powered by battery, motivated by DC motor, driven by user controlling joystick and adjusting speed. The Powered Wheelchairs consist of two foldable armrests, a backrest, a seat cushion, a safety belt, a foldable frame, two rear driving wheels with hub motor/electromagnetic brake assemblies, two pivoting casters, two Li-ion batteries, an off-board battery charger, a control panel, and an electric motor controller.

The NXN20-208 and NXN20-211 Powered Wheelchair is intended to provide mobility to a disabled or elderly person limited to a seated position.

The Powered Wheelchair has 7 inch front wheel and 11 inch rear tire.

The motor of electric wheelchair is DC24V 200W; the battery is 24V 12AH, Li-ion battery; the charger is 24V/3A.

Max. loading can not be over than 110Kgs.

Max. distance of travel on the fully charged battery is 16 km and Max. speed forward is 6km/h.

The braking time is about 2s, and the braking distance is ≤1.77m.

#### 7.0 Summary of Non-Clinical Testing .

Non clinical tests were conducted to verify that the proposed device met all design specifications as was Substantially Equivalent (SE) to the predicate device. The test results demonstrated that the proposed device complies with the following standards:

ISO 7176-1:2014 Wheelchairs - Part 1: Determination of static stability

ISO 7176-2:2017 Wheelchairs - Part 2: Determination of dynamic stability of electrically powered wheelchairs

ISO 7176-3:2012 Wheelchairs - Part 3: Determination of effectiveness of brakes

ISO 7176-4:2008 Wheelchairs - Part 4: Energy consumption of electric wheelchairs and scooters for determination of theoretical distance range

ISO 7176-5:2008 Wheelchairs - Part 5: Determination of overall dimensions, mass and manoeuvring space

ISO 7176-6:2018 Wheelchairs - Part 6: Determination of maximum speed,

acceleration and deceleration of electric wheelchairs

ISO 7176-7:1998 Wheelchairs - Part 7: Measurement of seating and wheel dimensions

{6}------------------------------------------------

ISO 7176-8:2014 Wheelchairs - Part 8: Requirements and test methods for static, impact and fatique strengths

ISO 7176-9:2009 Wheelchairs - Part 9: Climatic tests for electric wheelchairs

ISO 7176-10:2008 Wheelchairs - Part 10: Determination of obstacle-climbing ability of electrically powered wheelchairs

ISO 7176-11:2012 Wheelchairs - Part 11: Test dummies

ISO 7176-13:1989 Wheelchairs - Part 13: Determination of coefficient of friction of test surfaces

ISO 7176-14:2008 Wheelchairs - Part 14: Power and control systems for electrically powered wheelchairs and scooters - Requirements and test methods

ISO 7176-15:1996 Wheelchairs - Part 15: Requirements for information disclosure, documentation and labeling

ISO 7176-21:2009 Wheelchairs - Part 21: Requirements and test methods for electromagnetic compatibility of electrically powered wheelchairs and scooters, and battery chargers

ISO 7176-22:2014 Wheelchairs - Part 22: Set-up procedures

ISO 7176-25:2013 Wheelchairs - Part 25: Batteries and chargers for powered wheelchairs

ISO 16840-10:2021 Wheelchair seating - Part 10: Resistance to ignition of postural support devices - Requirements and test method

IEC 60601-1-2:2020 Medical electrical equipment - Part 1-2: General requirements for safety - Collateral standard: Electromagnetic compatibility - Requirements and tests

#### Software Verification and Validation Testing

Software documentation including verification & validation was provided in accordance with FDA Guidance: Content of Premarket Submissions for Device Software Functions for software.

The Software Validation is in compliance with FDA Guidance.

#### 8.0 Summary of Clinical Testing .

No clinical study implemented for the electric wheelchair.

#### 9.0 Technological Characteristic Comparison Table

{7}------------------------------------------------

| Item | Proposed device | Predicate device | Remark |
|----------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|
| Product Code | ITI | ITI | Same |
| Regulation No. | 21 CFR 890.3860 | 21 CFR 890.3860 | Same |
| Class | II | II | Same |
| Product name | Powered Wheelchair | A08 Power Wheelchair | - |
| 510(k) No. | K241603 | K163204 | - |
| Models | NXN20-208<br>NXN20-211 | A08 | - |
| Intended Use | The device is a motor driven,<br>indoor and outdoor<br>transportation vehicle with the<br>intended use to provide<br>mobility to a disabled or<br>elderly person limited to a<br>seated position. | It is a motor driven, indoor and<br>outdoor transportation vehicle<br>with the intended use to<br>provide mobility to a disabled<br>or elderly person limited to a<br>seated position. | Same |
| Use environment | Indoor and outdoor use | Indoor and outdoor use | Same |
| Patient<br>Population | This product is suitable for<br>disabled people with mobility<br>difficulties and elderly people. | This product is suitable for<br>disabled people with mobility<br>difficulties and elderly people. | Same |
| Product structure | Consist of two foldable<br>armrests, a backrest, a seat<br>cushion, a safety belt, a<br>foldable frame, two rear<br>driving wheels with hub<br>motor/electromagnetic brake<br>assemblies, two pivoting<br>casters, two Li-ion batteries,<br>an off-board battery charger, a<br>control panel, and an electric<br>motor controller. | Consists primarily of a<br>foldable welded-aluminum<br>frames, two sealed transaxle<br>motors drive system,<br>electromagnetic braking<br>system, electric motor<br>controller and two Li-ion<br>batteries with an off-board<br>battery charger. | Similar |
| Driving system | Direct drive on the rear wheels | Direct drive on the rear wheels | Same |
| Movement control<br>method | By Joystick control | By Joystick control | Same |
| Number of<br>wheels | 4 | 4 | Same |
| Brake system | Automatic electromagnetic<br>brake system | Electromagnetic<br>brake system | Same |
| Main frame<br>material | Model NXN20-208 consists of<br>Aluminum alloy, and model<br>NXN20-211 consist with<br>Aluminum alloy+Carbon fiber. | Welded-aluminum | Different<br>The differences in the<br>main frame material will<br>not impact the safety and<br>effectiveness of the<br>substantial equivalence. |
| Motor | Brushless motor,<br>DC24V* 200W*2pcs | Brushless motor,<br>24 VDC *250W * 2 pcs | Minor differences in the<br>dimensions will not<br>impact the safety and<br>effectiveness of the<br>substantial equivalence. |
| Battery | DC 24V 12Ah Lithium-ion,<br>2 pcs | Lithium-ion<br>20 Ah x 24 VDC | |
| Battery charger | Off-board charger<br>Input: 100-240 VAC<br>Output: DC 24V, 3A | Off-board charger<br>Input: 110-240 VAC<br>Output: DC 24V, 2 Amp | |

#### Table1-General Comparison

{8}------------------------------------------------

## Table2 Performance Comparison

| Item | Subject Device | Predicate Device | Remark | |
|--------------------------------|-------------------------------------------------------------|------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Model | NXN20-208 | NXN20-211 | A08 | -- |
| Overall length | 1000mm | 950mm | 890 mm | |
| Overall width | 600mm | 600mm | 603 mm | Minor differences in<br>the dimensions will<br>not impact the safety<br>and effectiveness of<br>the substantial<br>equivalence. |
| Stowage<br>length | 340mm | 340mm | 324 mm | |
| Stowage<br>width | 600mm | 600mm | 603 mm | |
| Stowage<br>height | 775mm | 765mm | 670 mm | |
| Weight, w/<br>Battery | 42.99 lbs.<br>/19.5kg | 36.48 lbs.<br>/16.55kg | 61.7 lbs. /28 kg | The difference will<br>not raise any new<br>safety and<br>effectiveness<br>concerns. |
| Front wheel<br>(inch) | 7<br>(PU solid tire) | | 8<br>(PU solid tire) | Smaller sizes of font<br>wheels |
| Rear tire<br>(inch) | 11<br>(PU solid tire) | | 10<br>(PU solid tire) | Larger sizes of rear<br>wheels bring steadier<br>pivoting function than<br>predicate device. |
| Cruising<br>Range<br>(km) | 16 | | 20 | The subject device<br>complies with ISO<br>7176-4: 2008<br>Wheelchairs - Part 4:<br>Energy consumption<br>of electric<br>wheelchairs and<br>scooters for<br>determination of<br>theoretical distance |
| | | | | |
| Obstacle<br>climbing(mm) | 25 | | 40 | range, these<br>differences do not<br>affect safety and<br>effectiveness.<br>The smaller height in<br>the obstacle climbing<br>will not impact the<br>safety and<br>effectiveness of the<br>subject device. |
| Static stability<br>forward | 18.8° | | Not publicly available | Both of the devices<br>are evaluated<br>according to<br>standard ISO<br>7176-1:2014, so the<br>different static<br>stability will not<br>impact the safety and<br>effectiveness |
| Static stability<br>rearward | 20.4° | | | |
| Static stability<br>sideways | 20.5° | | | |
| Max. loading<br>(kg) | 242.5lbs(110kg) | | 220 lbs (100 kg) | More loading weight<br>means more<br>convenient for the<br>transportation |
| Min. Turning<br>radium | 850mm | 840mm | 800mm | Similar |
| Minimum<br>braking<br>distance | <=1.77m | | 1m | Similar |
| Max Speed<br>Forwards | 1.66 m/s (6 km/h) | | 1.94 m/s (7 km/h) | The devices are<br>evaluated according<br>to standard ISO<br>7176-6:2018, so the<br>different will not<br>impact the safety and<br>effectiveness |
| Max. Speed<br>Backward | 0.8 m/s (2.88 km/h) | | Not publicly available | The devices are<br>evaluated according<br>to standard ISO<br>7176-6:2018, so the<br>different will not<br>impact the safety and<br>effectiveness |
| Controller | Yanteon Mechanical &<br>Electronic Technology | | Yisheng Electric Co.<br>Ltd | Different<br>Although different |
| Speed control<br>method | (Shanghai) Co. Ltd.<br>Joystick Y2450M<br>Controller Y2430M | WS-1, 40A | controller is used,<br>both the control<br>system, including the<br>joystick controller,<br>the electromagnetic<br>brakes and the user<br>interface are similar.<br>The joystick controls<br>the directions and<br>speed of movement,<br>and when the joystick<br>is released, the<br>powered wheelchair<br>will slow down to<br>stop and the brakes<br>will automatically<br>re-engage. The<br>controller also<br>provides the battery<br>status displaying and<br>abnormal condition<br>displaying. Both of<br>the control systems<br>are evaluated<br>according to<br>standard ISO<br>7176-14:2008 and<br>software validation<br>requirement and<br>there are no new<br>safety and<br>effectiveness<br>concerns due to the<br>difference. | |
| Joystick control method | Joystick control method | Same | | |

{9}------------------------------------------------

{10}------------------------------------------------

### Table3 Safety Comparison

| Item | Proposed Device | Predicate Device | Remark |
|------------------------------|-------------------------------------|-----------------------------------------------------------------|---------------------------------------------------------|
| Materials<br>contacting user | Armrest: PU; | Armrest: PU; | Biocompatibility evaluation<br>has been carried out per |
| | Backrest/Seat/Seat belt: | Backrest/seat cushion: PU foam<br>covered by nylon fabric cloth | ISO 10993-1. There are no<br>new safety and |
| | Sandwich mesh fabric<br>(polyester) | | effectiveness concerns due |
| | Safety Belt: Nylon | | |

{11}------------------------------------------------

| | Controller Housing: ABS<br>Joystick/button: Silicone<br>Footplates: ABS | | to the difference. |
|-----------------------------------------------------|-------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------|
| Biocompatibility<br>of materials<br>contacting user | Comply with FDA Guidance | Comply with ISO 10993-1, FDA<br>Guidance, Tests included<br>Cytotoxicity (ISO 10993-5:2009),<br>Sensitization and Intracutaneous<br>Reactivity (ISO 10993-10:2010) | Same |

#### Summary of substantial equivalence discussion:

The technological characteristics, features, specifications, materials, mode of operation, and intended use of the device substantially equivalent to the predicate devices quoted above. The differences between the subject device and predicate devices do not raise new issues of safety or effectiveness. The differences between the subject device and predicate devices do not raise new issues of safety or effectiveness.

#### 10.0 Conclusion

The conclusions drawn from the comparison and analysis above demonstrate that the proposed device is as safe, as effective, and performs as well as the legally marketed predicated device under K163204.