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How to find updated FDA forms for a 510k

Before you complete FDA forms for your 510k submission, you need to made sure you have the most updated FDA forms.

How do you know if the FDA form you are using is current?

The FDA assigns numbers to each FDA form and the document control number is found in the bottom left footer of the document. In addition, the top right-hand header of the document will have an expiration date for the form (see the picture below). Often the changes to FDA forms are minor, but you should only submit the current version of the FDA form which has not expired.

FDA Form 3881 screen capture How to find updated FDA forms for a 510k

What happens if you are using an expired FDA form?

In the past, if you included an obsolete document in your submission the FDA would often ignore this an proceed with the review of your submission anyway. Now FDA reviewers will identify the obsolete form and require you to resubmit the document on the current version of the form. If the reviewer is conducting an initial Refusal to Accept (RTA) screening, and one of the required items in the RTA screening are identified, then you will receive an RTA Hold letter and the RTA checklist will include a comment that you have used an obsolete version of an FDA Form.

If there are no deficiencies identified in the RTA checklist, the reviewer may still send you an email asking you to submit the document on the correct form. This could be a formal amendment (e.g. K123456/A001) or it could be as an informal email of the corrected document. This type of request could also be identified after the substantive review is complete in the form of a comment in an Additional Information (AI) Request or as part of an Interactive Review Request. An AI Request must be responded to with a formal supplement submitted to the Document Control Center (DCC) as a supplement to the original submission (e.g. K123456/S001) or as an informal ammendment submitted by email.

Examples of updated FDA forms for your 510k submission

Expired forms are frequently submitted to the FDA because submitters are using templates that have not been properly maintained or the submitter modified a form that was submitted in a previous 510k submission. The most common examples include: FDA Form 3514 (i.e. Submission Coversheet), FDA Form 3881 (i.e. Indications for Use), and the RTA Checklist.

Where can you find updated FDA forms?

Recently one of our clients noticed that the 510k template folder we share with people that have purchased our 510k course included obsolete templates for Financial Disclosure. There are three financial disclosure forms that can be used for a 510k submission or De Novo Classification Request:

  1. FDA Form 3454, Certification: Financial Interest and Arrangements of Clinical Investigator (PDF)
  2. FDA Form 3455, Disclosure: Financial Interest and Arrangements of Clinical Investigators (PDF)
  3. FDA Form 3674, Certification of Compliance, under 42 U.S.C. , 282(j)(5)(B), with Requirements of ClinicalTrials.gov (PDF)

We normally update these FDA forms as soon as the new form is released, but this financial disclosure forms are only used in about 10-15% of 510k submissions.

The current version of most FDA forms can usually be found by simply conducting an internet search for the form using your favorite browser. However, sometimes you may find a copy of the document that was editted by a consultant to facilitate completion of the document as an unsecured PDF or Word document. Although this is convenient, you should not use these “bastardized” forms. You should use the original secured form provided by the FDA. These native forms require Adobe Acrobat to complete the form and save the content. The most current version of the FDA form can be found using the FDA’s Form search tool.

Editing and Signing FDA Forms

Most of the FDA forms are secured and you can only enter information in specific locations. If there is a location for a signature, usually the signature cannot be added in Adobe to the secured form. In these situations, our team will save the document as a “Microsoft Print PDF” format. Once the document has been saved in this “non-native” format, you can manipulate almost anything in the document. Then we will add signatures using the “Fill and Sign” tool in Adobe Acrobat or we will use the “Edit” tool. Editing also gives us ability to make corrections when the document has incorrect information filled in the form somewhere.

Another option for adding dates and signatures is for you to save the document as a non-secure PDF. Then using an electronic signature software tool like Docusign, you can request that another person add their electronic signature or you can add your own electronic signature. Some companies prefer to do this to ensure the electronic signature meets 21 CFR Part 11 requirements, but the FDA accepts scanned images of a signature that was added to the document without certification in a 510k submission. This is even true for the Truthful and Accuracy Statement for a 510k. That document can be attached as a PDF in an FDA eSTAR template or you can electronically sign the eSTAR template if the person preparing the eSTAR is also the person signing the Truthful and Accuracy Statement.

Tips and Tricks for maintaining templates

Our company is a consulting firm, and we do not have a formal document control process that would be typical of our clients. However, we do have a shared Dropbox folder where we maintain the most current version of 510k templates. Any obsolete versions we move to an archive folder. However, there are ways to improve this informal system. You can include a date of the document in the file name. For example, “Vol 4 001_Indications for Use (FDA Form 3881) rvp 2-7-2022.” This indicates that this file is the FDA Form 3881 which is the indications for use form used in Volume 4 of the 510k submission. The document is the first document in that volume. The date the form was revised and saved is February 7, 2022 and the author’s initials are “rvp.”

If you are saving 510k templates you might consider adding an expiration date to the file name. For example, “Vol 4 001_Indications for Use (FDA Form 3881) exp 06-30-2023.” This file name indicates that the form’s expiration date is June 30, 2023. The inclusion of an expiration date in the file name is a visual reminder of when you will need to search for an updated FDA form.

A third way to manage your FDA Forms is to include them in your documents of external origin. ISO 13485:2016, Clause 4.2.4, requires that you maintain control of documents of external origin. Therefore, if your company has a formal quality system, a list or log of documents of external origin is the best way to manage FDA forms. Your log should indicate the date the updated FDA form was created, any parent guidance documents should be cross-referenced, and the expiration date of the FDA form should be identified. By using a log of this type, you can sort the list by expiration date or by the date of creation if there is no expiration date identified. Sorting the list will help your team prioritize which documents need to be reviewed next for new and revised versions.

Additional 510k submission resources

The FDA will be updating the 510k guidance for the new FDA eSTAR template by September 2022. Medical Device Academy will be systematically updating all of our templates and training webinars related to preparation of 510k submissions. We will also be preparing for the transition from FDA eCopy submissions to electronic submissions via a Webtrader Account.

You can keep up-to-date on template revisions in one of two ways:

  1. Purchase our 510k course, and you will receive access to the updated templates as they are created. We will send email notifications each time a template is updated.
  2. Register for our New Blog email subscription for automated email notifications of when a new blog is released about updated FDA forms, templates, and webinars.
  3. Register for our New Webinar email subscription for automated email notifications of when a new or revised webinar is scheduled and for email notification of our newest live streaming YouTube videos.

Posted in: 510(k)

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Individual process audits or one full quality system audit, which is better?

 

You can conduct multiple individual process audits or you can conduct one full quality system audit, but which solution is better?

What are individual process audits?

There are 25 processes that require procedures for compliance with the US FDA quality system regulations and ISO 13485:2016 has 28 required procedures. Individual process audits focus on one of these procedures, the process it controls, the equipment and software used by that process, the work environment where the process is performed, the people responsible for the process, the records resulting from that process, and any metrics or quality objectives associated with that process. An individual process audit can be completed in remotely or on-site, and these audits will be much shorter in duration than a full quality system audit. Another way to think of an individual process audit is to realize that a full quality system audit is comprised of many individual process audits scheduled back-to-back. Auditing one process might be as short in duration as 30 minutes (e.g. control of records) but individual process audits can take as long as four hours (e.g. design controls and technical file audits).

What is a full quality system audit?

A full quality system audit is typically a single audit conducted annually to address all the requirements for conducting an internal audit of your quality system. In this type of audit, all of the procedures and processes should be covered. Therefore, full quality system audits are necessarily longer. If the person assigned to conduct the full quality system audit is an employee, that person cannot audit their own work. This can be addressed in two ways: 1) the audit can be a team audit, and the other team members can audit areas the lead auditor was responsible for; and 2) the process(es) that the lead auditor is responsible for can be audited as individual process audits by another auditor at another time.

If the person assigned to conduct the full quality system audit is a consultant from outside the company, there is still potential for conflicts regarding independence. If the consultant audited the company in the previous year, then the auditor cannot audit last year’s internal audit. In our consulting firm we address this issue in two ways: 1) we rotate who is assigned to audits so that the same auditor does not conduct a full quality system audit two years in a row, or 2) we assign another auditor in our company to conduct the audit of internal auditing as a team member.

How do you evaluate auditing effectiveness?

Some companies perceive that auditing is a necessary evil and they want to put as little effort and resources into the audit as possible. In this situation, auditing might be evaluated based upon whether it was completed on-time, by how much the audit cost the company, and the fewer nonconformities identified the better the perceived outcome. This perspective typically results in a single full quality system audit that is three days in duration or shorter if an auditor can manage to complete the audit in less time. Of course the shorter the audit is, the fewer records that an auditor has time to review. Therefore, shorter audits typically have fewer findings and management is pleased at the outcome because the audit required fewer resources and had little or no nonconformities.

The better approach is to look at auditing as a method for identifying areas that need improvement. Identifying areas where your quality system needs improvement is the intent of requiring internal audits. Therefore, the amount of time your company allocates to auditing should reflect the benefits for improvement that are identified. Top management of your company needs to identify which process areas they feel needs improvement. Only then can the audit program manager design an audit schedule that will focus on identifying opportunities for improvement and nonconformities in the process areas where management feels improvement is most needed. Ideally, this approach to auditing will focus on looking for inefficiency and metrics with negative trends. These findings result in preventive actions instead of corrective actions, because the process is not yet nonconforming. In general, the more opportunities for CAPAs that are identified the more valuable the audit was.

What advantages do one full quality system audit present?

Sometimes a single full quality system audit is easier to schedule, because it is only once per year. The rest of the year your company will not need to spend much time discussing audits or even thinking about them. If your company perceives audits as a necessary evil, then the less disruption caused by scheduling an audit the better.

Another advantage of conducting full quality system audits is that you can more easily afford to use external consultant auditors, because the travel costs for auditing are limited to one trip per year. If you had more than twenty individual process audits each year, and external consultant auditors conducted all of the audits, then you would have to pay for travel costs twenty times each year. Unless the consultant lives locally, these travel costs can be substantial.

What advantages exist for individual process audits?

Individual process audits are much easier for the auditor to complete within the time established in the audit agenda, because the auditor does not have another audit process immediately proceeding or immediately after the process they are auditing. There are also fewer people that need to attend an opening or closing meeting for an individual process audit, because only one process is being audited. Managers from other departments are seldom needed for participation in the opening or closing meeting.  The combined benefits result in the auditor being more likely to start the opening meeting on-time and to start the closing meeting on-time.

The shorter duration of individual process audits is also an advantage. There are very few times in a year when none of your department managers will be traveling, sick, or on vacation. These rare weeks only happen a few times each year, and sometimes auditors must proceed with an audit even if someone is absent because they have no alternative. If you are preparing for an audit remotely, you face-to-face audit time is only 90 minutes, and your report writing time is also conducted remotely, then finding 90-minutes of available time in an department manager’s schedule is usually quite easy.

Can both approaches to internal audit scheduling coexist?

You can combine both approaches to audit scheduling in several possible ways. First you can schedule one full quality system audit each year in order to make sure that the minimum audit requirements are met, and then top management can review the results of the full quality system audit to decide which processes would benefit from individual process audits.

A second strategy would include conducting individual process audits for each process that resulted in a nonconformity during 3rd party certification audits or during the one full quality system audit. In this scenario, you might have a 3rd party audit in November, a full quality system audit in May, and top management might select 10 other individual processes to audit during the other 10 months of the year.

A third strategy would be to alternate between individual process audits and single full quality system audits each year. During “odd” years the audit program manager would only schedule one full quality system audit, and during “even” years the audit program manager would schedule multiple individual process audits.

A fourth strategy would be for top management to select a few processes that they would like the audit program manager to focus on with individual process audits, and all of the remaining processes would be incorporated into a single audit that covers the remaining 70% of the quality system.

Each of these four strategies for combining the two approaches to audit scheduling is viable and may result in multiple opportunities for improvement being identified. There is no regulation that favors one approach over another, but all four strategies require more time an effort on the part of the audit program manager and top management to discuss and plan the annual audit schedule.

Next steps if you would like to try individual process audits

If your company has always scheduled a single full quality system audit each year, you can test the concept of conducting an individual process audit by selecting just one process to audit. The best choice for this approach is to pick a process that has one or more CAPAs that are in progress or to select a process that top management feels is performing efficiently. The more frustration that top management experiences with a process, the greater the need is to identify opportunities for improvement. If the company has not already identified CAPAs to initiate for that process, you might just need an outsider to state the obvious: “I think we need a CAPA in this department.” The outsider might be a consultant, but it could also be a person from another department. If you would like a quote for an individual process audit, please visit our audit quote webpage.

About the Author

Rob Packard 150x150 Individual process audits or one full quality system audit, which is better?

Rob Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certification. From 2009-2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone 802.258.1881 or email. You can also follow him on Google+LinkedIn or Twitter.

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eSTAR draft guidance is here, and wicked eSubmitter is dead.

I hated the the FDA eSubmitter template which was discontinued May 30, 2021. Finally we have eSTAR draft guidance for the new eSTAR template.

eSTAR draft guidance button eSTAR draft guidance is here, and wicked eSubmitter is dead.

History of 510k electronic submissions

The FDA has experimented with a multitude of pilot 510k submission programs over the years to streamline and improve the 510k submission content, formatting, and to facilitate a faster review process. The Turbo 510k program was one of the first successful pilot programs. In 2012 I wrote one of my first blogs about how to improve the 510k process. In September 2018, the FDA launched the “Quality in 510k Review Program Pilot” for certain devices using the eSubmitter electronic submission template. The goal of the this pilot program was to enable electronic submissions instead of requiring manufacturers to deliver USB flash drives to the FDA Document Control Center (DCC). I hated the eSubmitter template, and the FDA finally discontinued availability of the eSubmitter template on May 30, 2021. During the past 15 years, the FDA gradually streamlined the eCopy process too. Originally we had to submit one complete hardcopy, averaging 1,200 pages per submission, and one CD containing an electronic “eCopy.” Today, the current process involves a single USB flash drive and a 2-page printed cover letter, but today’s eCopy must still be shipped by mail or courier to the DCC.

eSTAR Pilot Program is Launched

During the 15-year evolution of the FDA eCopy, CDRH was trying to develop a reliable process for electronic submissions of a 510k. CBER, the biologics division of the FDA, has already eliminated the submission of eCopy submissions and now 100% of biologics submissions must be submitted through an electronic submissions gateway (ESG). In February 2020, CDRH launched a new and improved 510k template through the electronic Submission Template And Resource (eSTAR) Pilot Program. The eSTAR templates include benefits of the deceased eSubmitter template, but CDRH has incorporated additional benefits:

  • the templates use Adobe Acrobat Pro instead of a proprietary application requiring training;
  • support for images and messages with hyperlinks;
  • support for creation of Supplements and Amendments;
  • availability for use on mobile devices as a dynamic PDF;
  • ability to add comments to the PDF; and
  • the content and logic mirrors checklists used by CDRH reviewers.

Medical Device Academy’s experience with the eSTAR Templates

Every time the FDA has released a new template for electronic submissions we have obtained a copy and tried populating the template with content from one of our 510k submissions. Unfortunately, all of the templates have been slower to populate that the Word document templates that our company uses every day. On May 16 we conducted an internal training for our team on the eSTAR submission templates, and we published that training as a YouTube Video (see embedded video below). Then nine days later the FDA released updates to the eSTAR templates (version 0.7). The new eSTAR templates are available for non-IVD and IVD products (ver 0.7 updated May 27, 2021).

Sharon Morrow submitted our first eSTAR template to the FDA in August and we experienced no delays with the 510k submission during the initial uploading to the CDHR database, there was no RTA screening process, and CDRH did not identify any issues during their technical screening process. Shoron’s first eSTAR submission is now in interactive review, which is a better outcome than 95%+ of our 510k submissions. I have several other eSTAR submissions that are almost ready to submit as well. The other 510k consultants on our team are also working on their first eSTAR submissions.

Finally the CDRH releases an FDA eSTAR draft guidance

On September 29, 2021 the FDA released the new eSTAR draft Guidance for 510k submissions. This is a huge milestone because there have not been any draft guidance documents created for pilot programs. The draft indicates that the comment period will last 60 days (i.e. until November 28, 2021). However, the draft also states that the guidance will not be finalized until a date for requiring electronic submissions (i.e. submission via an ESG) is identified. The draft indicates that this will be no later than September 30, 2022. Once the guidance is finalized, there will be a transition period of at least one year where companies may submit via an ESG or by physical delivery to the FDA DCC.

Are there any new format or content requirements in the FDA eSTAR draft guidance?

There are no new format or content requirements in the eSTAR draft guidance, but the eSTAR template itself has several text boxes that must be filled in with summary information that is not specified in the guidance for format and content of a 510k. The information requested for the text boxes is a brief summary of non-confidential information contained in the attachments of the submission. Therefore, these boxes can information that would normally be in the overview summary documentst that are typically included at the beginning of each section of a 510k. If your overview documents do not already have this information, then you may have some additional work to do in order to complete the eSTAR templates. An example of one of these text boxes is provided below:

Summary of electrical mechanical and thermal testing eSTAR draft guidance is here, and wicked eSubmitter is dead.

Another example of additional content required by the eSTAR templates is references to page numbers. Normally the FDA reviewer has to search the submission for information that is required in their regulatory review checklist. In the new templates the submitter is now asked to enter the page numbers of each attachment where specific information can be found. The following is an example of this type of request for a symbols glossary:

Reference to symbols glossary in labeling eSTAR draft guidance is here, and wicked eSubmitter is dead.

Are there any changes to the review timelines for a 510k in the eSTAR draft guidance?

The eSTAR draft guidance indicates that a technical screening will be completed in 15 calendar days instead of conducting a RTA screening. I believe that the technical screening is less challenging than the RTA screening, but the FDA has not released a draft of the technical screening criteria or a draft checklist. I would imagine that the intent was to streamline the process and reduce the workload of reviewers performing a technical screening, but we only have guesses regarding the substance of the technical review and so far our performance is 100% passing (i.e. 1 of 1). The next step in the 510k review process is a substantive review. Timelines for the substantive review are not even mentioned in the new draft guidance, but the FDA usually has the review clock details in Table 1 (MDUFA III performance goals) and Table 2 (MDUFA IV performance goals) of the FDA guidance specific to “Effect on FDA Review Clock and Goals.” In both tables, the goal is 60 calendar days, and our first eSTAR submission completed the substantive review in 60 days successfully. The 180-day deadline for responding to an additional information (AI) request has not changed in the eSTAR draft guidance, but our first submission is now interactive review. I believe this suggests that companies may have a higher likelihood of having an interactive review with their CDRH lead reviewer instead of being placed upon AI Hold, but we won’t have enough submissions reviewed by the FDA to be sure until the end of Q1 2022.

Register for our new webinar on the FDA eSTAR draft guidance

We hosted a live webinar on Thursday, October 21, 2021 @ Noon EDT. The webinar was approximatley 37 minutes in duration. In this webinar we shared the lessons learned from our initial work with the eSTAR template. Anyone that registers for our webinar will also receive a copy of our table of contents template that we updated for use with the eSTAR templates. Unlike a 510k eCopy, an eSTAR template does not require a table of contents but we still use a table of contents to communicate the status of the 510(k) project with our clients. Finally, we reviewed the eSTAR draft guidance in detail. If you would like to receive our new eSTAR table of content template and an invitation to our live webinar, please complete the registration form below.

About the Author

Rob Packard 150x150 eSTAR draft guidance is here, and wicked eSubmitter is dead.
Robert Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certification. From 2009-2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone 802.258.1881 or email. You can also follow him on Google+LinkedIn or Twitter.

Posted in: 510(k), eSTAR

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How can you encourage more customer feedback and exciting engagement?

How can you encourage more customer feedback and exciting engagement?

We desperately need to find a way to get more customer feedback and suggestions for product improvement, but what is the best way to do that?

Surveys rarely have a high response rate, but we need to gather customer feedback. Therefore, we created this blog posting as a living document of how we are trying to gather customer feedback. Specifically, we are looking for more customer feedback and better engagement with us. We don’t just want YouTube subscribers to like our videos, we want you to share our videos with other people in your company so they can learn about quality and regulatory too. We don’t just want you to register for a free webinar and watch the recording when you get a chance. We want to you to add a question when you register and please interrupt us during our live webinars to clarify anything you don’t understand. Finally, we want you to give us suggestions for improving our procedures, writing new blogs, and recording new training webinars and videos. Tell us what you want.

Using the headline analyzer to attract more customer feedback

We have a page on our website for a “suggestion box” where we are asking people to provide suggestions for new and improved procedures, blogs, webinars, and videos. But the last time someone filled in the form on that page is October 16, 2019. We desperately need to find a way to get more engagement from you in the form of suggestions. The first approach to gathering feedback is to send out email notification to our current 1,057 blog subscribers by posting this blog. To improve our chances for you to open an email about this blog, we optimized the headline using the CoSchedule Headline Analyzer. The first version of the headline scored a 75, while 70 is the minimum threshold for a worthy title. Our second attempt included the emotional word “exciting” and the new result scored an 83 (see below). Normally it requires 20+ tries before we achieve a headline score higher than 80, but today was a good day. We decided to stop at 83 and focus on other elements of this posting.

  1. How can you encourage more customer feedback? (75)
  2. How can you encourage more customer feedback and exciting engagement? (83)

Screen capture of headline analyzer How can you encourage more customer feedback and exciting engagement?

A picture says 1,000 words

A great thumbnail or featured picture often helps improve click through rates for video, but pictures also communicate more information than words alone. Pictures can communicate the temperature, directions, speed you are moving, and even emotions. Ideally, a combination of a picture with a short caption does the most. The layout of your picture matters too. For example, the featured image above originally had just 6 images grouped together. To communicate that we were trying to decide which icon best communicated the concept of a suggestion box, we separated each icon image with a blue border. To help people identify the different images, we used letters under each icon image. We could have used numbers, but then people might have replied with phrases like “#2 was my 1st choice,” instead of “B was my 1st choice.” To make it clear that the far right icon image was our current icon, we used the word “current” instead of a letter. Finally, we used a bright yello text box at the top of the featured image to communicate instructions for polling of the various icon images.

In the end, we didn’t feel that the suggestion box icons were very attractive. In fact, icons in general are boring. Therefore, we hired an artist to create some concept sketches for other ideas that would communicate “please take the opportunity to give us your suggestion.” The three concepts we liked most were a wishing well, a coffee filter, and an open door with a suggestion doormat that opens into space. We selected the door as our favorite and added some details to create the final image you see now on our webpage. Specifically, we wanted the doormat to appear more three-dimensional, we wanted to incorporate Medical Device Academy’s logo, and we wanted a better focal point in the space beyond the door. Therefore, the artist created three different versions of a moon (crescent, partial, and full). The partial moon was our final choice.

A video is 1,000+ pictures

Full-frame video typically ranges from 24-60 frames per second (FPS). Therefore, there are at least 1,000 pictures in 42 seconds of video. Therefore, the five-and-half-minute video below is giving you much more information than you read above in a lot less time. The video walks you through the evolution of our suggestion box (all 24 versions). This is why we recommend recording a training video to every single medical device company we work with. This is also why our website has steadily been increasing the number of videos we procedure and publish on our YouTube channel.

A call to action increases customer feedback and engagement

Gathering customer feedback requires just as much marketing as selling a medical device. Typically, near the end of your presentation you will include a call to action. The call to action is intended to persuade customers to take immediate action. The call to action will create a sense of urgency. Sometimes a series of small calls to action will precede a final larger call to action. In our case, we are just trying to get suggestions from you regarding what quality and regulatory training materials we should develop next. We are asking you for advice on what our customers want to learn. In return we will develop the training materials you want. The better your questions are, the better our training materials will become. This strategy of offering valuable information to customers develops trust, and this has been our company’s primary marketing strategy since the beginning.

Button Art 1 How can you encourage more customer feedback and exciting engagement?

Click on the button above.

Try using a call-to-action button

If you want more engagement, you need to increase your click-through rate (CTR) first. Campaign Monitor conducted a test to which call-to-action performs best. They found a call-to-action button helped increase the CTR by 28%. We took this concept one step further, we used the headline analyzer tool to optimize the wording of the call-to-action button. The wording we used in the call-to-action button above scored an 86, while “click here” scored a dismal 28 and “click the button” only scored 31. We are also trying a contrarion approach to the design of the button. Instead of using bright colors that modern advertisers have trained us to ignore, we used a light grey background with Palatino Linotype font to optimize readability. We also used a small caption to make sure your subconscious knows what to do.

Campaign Monitor How can you encourage more customer feedback and exciting engagement?

Posted in: Customer Feedback

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How much does a 510k cost?

How much does a 510k cost is the most common question I receive from customers, and there are three parts to the cost of a 510k.

If you want to save $9,559 on your 510k cost of submission to the FDA, you need to listen to ALL of this video and follow every single step in the process. Most of our clients forget one of the steps and end up paying full price for their 510k.

There are three parts to the 510k cost of submission:

  1. Testing
  2. Submission Preparation
  3. FDA User Fees

The highest cost is testing

The testing cost is the biggest cost, but I think the average is around $100K for our clients. For devices that only consist of software (i.e. software as a medical device or SaMD), the testing costs are less, but the cost of documenting your software validation and cybersecurity will be more extensive than the cost of preparing your 510k and the FDA user fee. The more you can do in-house, the lower the testing costs will be. Biocompatibility testing for a non-invasive device might be only $13,000, but a long-term implant can cost as much as $100,000 for the implantation studies. Sterilization validation testing depends upon the method of sterilization and whether you are doing a single-lot method or a full validation. Typical costs for EO sterilization validation are around $15,000, and then you should add several thousand more for the shelf-life testing.

For devices that are powered and/or have software, you will need to perform software validation in accordance with IEC 62304 ed 1.1 (2015). There are also five FDA guidance documents that apply:

  1. General Principles of Software Validation; Final Guidance for Industry and FDA Staff (January 2002)
  2. Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices (May 2005)
  3. Guidance for Industry, FDA Reviewers and Compliance on Off-The-Shelf Software Use in Medical Devices (September 2019)
  4. Guidance for Industry and Food and Drug Administration Staff Content of Premarket Submissions for Management of Cybersecurity in Medical Devices (October 2014)
  5. Guidance for Industry, FDA Reviewers and Compliance on Postmarket Management of Cybersecurity in Medical Devices (December 2016)

You can do all of the software validation in-house, but some firms choose to outsource the validation of software. In the long-term, you need to learn this, and it pays to hire an expert in IEC 62304 to help your team learn how to document software validation if you have not done this before. Typically, software validation documentation will be between 300 and 1,000 pages in length.

Electrical safety and EMC testing are often the most expensive part of the testing process for our customers. EMC testing should always be done first to make sure that you can pass the immunity and emissions testing. If you have to modify the device to pass the EMC testing, then you will need to repeat any electrical safety testing. The total cost of this testing is typically $50-60K.

Performance testing is the last part of the testing process. Performance testing should be performed on sterile and aged products if your product requires sterility and you are claiming a shelf-life. Most of the testing is benchtop testing only to demonstrate performance. This includes simulated use testing (e.g. summative usability testing), cadaver testing, and computer modeling. Benchtop performance testing is typically tens of thousands of dollars to complete, but you might be able to do the testing in-house. If animal testing is required, this typically costs around $100K. Finally, if a human clinical study is required (i.e. ~10% of 510k submissions). Then you should expect to spend between $250K and $2.5 million. Some simple clinical studies (e.g. IR thermometers) cost less than $100K, but these resemble benchtop performance testing in many ways.

The second highest cost is the cost of submission preparation

Medical Device Academy has two different options for preparation consulting fees. Your first option is hourly consulting fees. The second option is a flat fee. As of September 2021, we are charging $3,850 for pre-submission preparation and $14,410 for 510(k) submission preparation. Therefore, the total cost is $18,260 if you need to request a pre-submission meeting.

510k cost #3 is the cost of the FDA user fee

You have three options for your FDA user fees. The first option is to avoid the FDA altogether and submit to a third-party reviewer. We only recommend one third-party reviewer, because the other companies do not have sufficient experience to have predictable review times and positive outcomes. The quote we received recently was $13,600. If you submit directly to the FDA, the standard user fee is $12,745. If you apply for small business status, and the FDA grants you that status for the fiscal year you are submitting, then the user fee is $3,186.

FY 2022 FDA User Fees for the 510k cost How much does a 510k cost?

Reduce 510k cost by applying for small business status

Every medical device company that has revenues of less than $100 million annually can apply, but you must apply each year. There is no application fee, but you need to complete FDA Form 3602 if you are a US firm. The form must be completed for each subsidiary too. FDA Form 3602A must be completed for foreign firms, and the national tax authority must verify the accuracy of your income statement on the form in order to submit it to the FDA. If your national tax authority refuses to sign the form you can provide a justification, but I don’t know anyone that has successfully done this yet. The qualification review by the FDA requires 60 days. Therefore, you should apply every year in August for the next fiscal year (October 1, 2021 – September 30, 2022, is FY 2022). The form will request that you include your Organization ID #. A Dun & Bradstreet Number (DUNS #) is also required if your firm is located outside the USA. Finally, you need to attach a copy of your tax return. Therefore, you must file your tax return–even if your firm had a loss or had no revenues. You can also take advantage of R&D tax credits in the USA or Canada if you are a start-up device company developing a new device.

About the Author

Rob Packard 150x150 How much does a 510k cost?

Rob Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certifications. From 2009 to 2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone at 802.258.1881 or by email. You can also follow him on Google+LinkedIn, or Twitter.

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Does your FDA inspection plan need to be proactive first?

Does your FDA inspection plan need to be proactive first?

Maybe you need an FDA inspection plan. Does everyone in your company know what they need to do when FDA inspectors arrive at your facility?

Be proactive and don’t just let FDA inspections happen. You need to have an FDA inspection plan, and that plan needs to cover the roles and responsbilities for everyone. Below we have a list of 15 items that are in our FDA inspection work instruction (WI-009). If you already have a plan, try using the following checklist to assess your readiness for the next next inspection:

  1. What will you ask and do when your FDA inspector calls the Friday before the inspection?
  2. Who should be contacted by the FDA inspector if you are on vacation?
  3. How will you communicate to the rest of your company that an FDA inspection is planned for Monday morning?
  4. Who will greet the FDA inspector upon arrival, and what should they do?
  5. Which conference room will the FDA inspector spend most of their time in?
  6. Who will be in the conference room with you and the FDA inspector?
  7. How will you track document and records requests, and how will you communicate that information to others?
  8. How will you retrieve documents and records requested by the FDA inspector?
  9. Who will conduct a tour of the facility with the FDA inspector and how will the tour be managed?
  10. When quality issues are identified, how will you respond?
  11. What will you do for lunches during the inspection?
  12. Who will attend the closing meeting with the FDA inspector?
  13. Should you “promise to correct” 483 inspection observations identified by the FDA?
  14. How and when will you repsond to the inspector with corrective action plans?
  15. If your company is outside of the USA, what should you do differently to prepare?

What will you ask and do when your FDA inspector calls the Friday before the inspection?

Most people begin their FDA inspection plan with the arrival of the inspector. However, you should consider including earlier events in your plan. Such as closure of previous 483 inspection observations, scheduling of mock-FDA inspections in your annual audit schedule, and details of how to interact with the inspector when they contact you just before an inspection. Most inspections will be conducted by a single inspector, but occasionally inspectors will be training another inspector. In this situation you can count on them following the QSIT manual more carefully, and you are more likely to receive an FDA 483 inspection observation. In the worst-case scenario, the lead inspector will split up from the trainee, and they will “tag-team” your company. This is not proper FDA procedure, but you should be prepared for that possibility. Therefore, make sure you ask the inspector if they are going to be alone or with another inspector when you speak with them on the phone. You should also get their name and phone number. You may even want to consider reviewing FDAZilla Store for details about your FDA inspector’s past inspection 483s and warning letters. Immediately after the call with the inspector, you should reserve a conference room(s) for the inspection and cancel your other meetings for the week. You should also verify that the person that contacted you is really from the FDA. You can do this by looking up their contact information on the Health and Human Services Directory. Your inspector should have a phone number and email you can verify on that directory.

Who should be contacted by the FDA inspector if you are on vacation?

You should always have a back-up designated for speaking with FDA inspectors, handling MDR reporting, and initiating recalls when you are on vacation. These are critical tasks that require timely actions. You can’t expect inspectors, MDRs, or recalls to wait you to get back in the office. It doesn’t matter what the reason is. Weddings, funerals, and ski trips should not be rescheduled. You need a back-up, and often that person is the CEO or President of your company. Make sure you have a strong systems in place (i.e. an FDA inspection plan, an MDR procedure, and a recall procedure). Whomever is your back-up needs to be trained and ready for action. This is also the purpose of conducting a mock-FDA inspection, including examples of MDRs in your medical device reporting procedure, and conducting mock recalls. This ensures you and your back-up are trained effectively. 

How will you communicate to the rest of your company that an FDA inspection is planned for Monday morning?

Most companies have an emergeny call list as part of their business continuity planning, and after the past 18 months of living with a Covid-19 pandemic your firm should certainly have a business continuity plan. Your FDA inspection plan should leverage that process. Contact the same people and notify them of when the FDA inspector is coming. If you are unable to find a conference room available for the inspection (i.e. see below), then ask the manager(s) that reserved the designated room for FDA inspections to relocate to another conference room for the week. Make sure you tell them who the inspector will be, and you might even be able to provide a photo of the inspector (try seraching LinkedIn). Make sure that you remind everyone to smile, and to listen carefully to the question asked. Everyone should be trained to answer only the questions asked, and nobody should run and hide. There should also be no need to stop your operations just because an inspector is visiting. You might even include the name of the inspector on a “Welcome Board” if your company has one at the entryway or in public areas. The more an FDA inspection appears as “routine” the better your outcome will be.

Who will greet the FDA inspector upon arrival, and what should they do?

By the time an FDA inspector(s) actually arrives at your company, all of the managers in your company should already been notified of the inspection and a conference room should be reserved for the inspection. Therefore, when the person that is greeting people in the lobby comes to work on Monday morning, you (or their supervisor) need to communicate with them and make sure that they are prepared for arrival. There are four things that should be communicated:

  1. the name of the inspector(s) that are arriving
  2. the list of managers that should be notified when the inspector(s) arrives (possibly identical to the buisness continuity call list)
  3. the conference room that is reserved for the inspection

If the person greeting the inspector(s) is also going to escort them to the conference room and help them get set-up, then they will need additional instructions. If that escorting inspectors to the conference room and helping them get set-up is delegated to a different person, then the following considerations should be included in that person’s instructions:

  1. the location of bathrooms and emergency exit instructions in case of a fire
  2. the information for wireless connectivity
  3. recommendations for seating in the conference room based upon the expected participants (see below)

It is important that an escort for the inspectors is able to bring the inspector(s) to the conference room as quickly as possible. They should not be expected to wait more than a few minutes for an escort.

Does your FDA inspection plan identify a specific room for the inspector? Is there a back-up?

Some companies have a specific room that is designated for inspections and 3rd party certification audits. If your comapny can do that, it will be very helpful because it reduces the decision making that is required immediatley prior to the inspection. Having a specific room for the inspection also eliminates the need to tell everyone else in the company where the inspector will be. Instead the location of the inspection can be in the work instruction or written FDA inspection plan. You shouldn’t need a back-up plan if there is a specific room designated for an FDA inspection, but our firm has a client that will be hosting three notified body auditors simultaneouly for three days. In that situation, you might need more than one room. 

Does your FDA inspection plan have assigned seating?

You might think that it really doesn’t matter where people sit in a conference room, but you will probably want consider the layout of charging cords and the flow of interviewees requested by the inspector. In your conference room, you will need room for at least the following people:

  1. the inspector(s)
  2. the management representative (i.e. you)
  3. a scribe
  4. an interviewee

If there is an inspector and a trainee, you will probably want to seat them together to facilitate them working together. You as the Management Representative also need to be in the room, and it may help for you to sit next to the scribe to facilitate communication between you and to make it easier for them to hand you documents after the scribe logs the documents into their notes. The scribe should probably sit closest to the door, because they will be receiving documents, logs, and records that are brought to the room. You will also need one more seat next to you, and probaby accross from the inspector(s), for interviewees. This person will rotate as different processes are reviewed. I also recommend having a location in the middle of the table for an “in box” where documents, logs, and records for the inspector are placed after being logged in. A second location in the middle of the table can be used for a “discard pile” as you finish using your copy of each document, log, and record. You may refer back to these copies later. The “discard pile” should be 100% copies rather than originals. Originals should never be brought into the room with the inspector.

Who is the scribe in your FDA inspection plan?

The perfect scribe would know the quality system well and they would have the typing skills of a professional stenographer. You might have someone that is an executive assistant in your company or a paralegal that could do this job, but you might also have a document control specialist that fits this requirement. Some companies will even hire a temp for the duration of the inspection that has this type of skill, but a temp is unlikely to know the jargon and quality system requirements well. I have taken on the role of scribe many times for my clients, because I type fast and know their quality system. I also don’t want to interferre with the inspection process. As scribe I can answer questions and offer suggestions when appropriate, but most of my time is spent taking notes and communicating by instant messenger with company members that are outside of the inspection room.

You should seriously consider using an application such as Slack as a tool for communication during the inspection. Then anyone in your company that needs to know the status of the inspection can be provided access to the Slack channel for the inspection. This can also act as your record of requests from the inspector. It’s even possible for people on the Slack channel to share pictures of documents to confirm that they have identified the document being requested. You could even invite someone to speak remotely with the inspector via Slack with Zoom integration. All the scribe needs to do is share the Zoom app with a larger display in the same conference room so the inspector can see it too.

Does your FDA inspection plan include provisions for  document and record retrieval?

The most important part of document and record retrieval during an FDA inspection is to remember that inspectors should never receive the original document. Ideally, a copier would be located immediately outside of the conference room and three copies would be made of every document before it enters the inspection room. The originals can be stored next to the copier until someone has time to return them to the proper storage location. The three copies should all be stamped “uncontrolled documents” to differentiate them from the originals. When the three copies are brought into the room, they should be handed to the scribe. The scribe should log the time the copies were delivered in the Slack channel. Then the copies should be handed to you, the Management Representative. You should skim the document to make sure that the correct document was received. Then one copy would be given to the inspector and another copy would be made available to the interviewee. If only two copies are needed, the extra copy can be placed in the “discard pile.”  Even if your system is 100% electronic, I recommend printing copies for the inspection. The paper copies are easier for inspectors to review, and it eliminates the ability for the inspector to hunt around your electronic document system. In this situation, the scribe may do all of the printing.

Does your FDA inspection plan indicate who will conduct a tour of the facility with the FDA inspector and how will the tour be managed?

I’m surprised by the number of companies that don’t seem to have a map of their facility. Medical device manufacturing facilities should have two kinds of facility maps. One should identify where pest control monitoring stations are located, and the second should indicate your evacuation route to exit the building. All guests should be shown the evacuation route map, probably within the first 30 minutes of arrival. The second map will be requested by the inspector eventually if you conduct manufacturing at your facility. Therefore, it would be helpful to use one or both of these facility maps as a starting point for creating a map of the route that inspectors should be taken on during a tour. I prefer to start with where raw materials enter the facility, and then I follow the process flow of material until we reach finished goods storage and shipping. If you can do this without back-tracking multiple times, then that will probalby be the preferred route. The purpose of planning the route out in advance is to help estimate how long the tour will take, and to make sure there is consistency. If someone starts the tour, and then another person takes over the tour, the new person should be aware of what the next location is and what areas have not been observed yet. There may also be safety reasons for avoiding certain areas during a tour and asking the inspector to observe those areas from a distance. Welding processes, for example, often fall into this safety category.

When quality issues (i.e. FDA 483 inspection observations) are identified, is this covered by your FDA inspection plan?

Third party certificaton body auditors will typically make you aware of nonconformities as they are identified, but FDA inspectors often will hold off on identifying 483 inspection observations until the end of the inspection in a closing meeting. However, you can typically identify several areas that may result in a 483 inspection observation during the inspection. You and the manager of that area may want to consider initiating a draft CAPA plan for each of these quality issues before the closing meeting. This would give you an opportunity to demonstrate making immediate corrections and you might be able to get feedback from the inspector on your root cause analysis and corrective action plan before the closing meeting. Sometimes this will result in an inspector identifying low-risk quality issues verbally instead of writing them out on FDA Form 483. I find the best way to make sure CAPA plans are initiated early is to have a debrief each day after the inspector leaves. All of the managers involved in the inspection should participate, and the debrief can be done virtually or in person. Virtually may be necessary, because often managers need to leave work before the inspector ends for the day. You should consider including this in your FDA inspection plan as well.

Does your FDA inspection plan include plans for daily lunches?

If your facility is located outside the USA, skip this paragraph and go to the section below about companies located outside the USA. If your company is locagted inside the USA, you can be certain that the FDA inspector will not eat lunch at your facility. They will leave for lunch on their own, and then they will return after lunch. Therefore, you may not have control of the timing of a lunch break but you will have time to take one. Most managers use the lunch break as a time to catch-up on emails. However, I think it makes more sense to change your email settings to “out of office.” You can indicate that you are hosting an audit and you will answer questions as a batch that evening or then next morning. You might use the lunch break to take a walk and relax, you might have  short debrief meeting with other managers, and you might spend some time preparing documents, logs, and records that the inspector may have requested before they left. Most inspectors use this strategy of asking for a list of documents and records in advance. This is also a good strategy to learn as an internal auditor or supplier auditor. If you have a back-room team that is supporting you, don’t make them wait for a break. Have someone in your company take their lunch orders or arrange for a catered buffet lunch. This will keep your support team happy, and you should definitely remember to include lunch for the team and changing your email settings to “out of office” in your FDA inspection plan.

Does your FDA inspection plan state who will attend the closing meeting?

Most companies have every manager that was in the opening meeting attend the closing meeting. This is ok, but it is important for anyone that might need to initiate a CAPA to be present in the meeting so that they can ask the inspector for clarification if needed. Scheduling a closing meeting should be part of your FDA inpsection plan. However, the past 18 months of the Covid-19 pandemic has taught us that we can attend this type of meeting remotely via Zoom. Therefore, we recommend letting the managers go home early if they are no longer needed as auditees. Instead, ask them to call in for a Zoom meeting at the time the FDA inspector estimates for review of the 483 inspection observations with the company.

Should you “promise to correct” 483 inspection observations identified by the FDA?

During the closing meeting the FDA inspector will review 483 inspection observations with you and any of the other managers present at the closing meeting. The inspector will ask if you promise to correct the 483 inspection observations that were identified. You should confirm that you will, and the FDA inspector will add this to the Annotations in the Observations section of FDA Form 483 that you will recive at the closing meeting. By stating this, you are agreeing to create a corrective action plan for each of the 483 inspection observations. You could change you mind later, but the better approach is to perform a thorough investigation of the 483 inspection observation first. If you determine that corrective action is not required, you can explain this in your CAPA plan and provide data to support it. The only likely reason for not correcting an observation is that you determined the incorrect information was provided to the inspector. In that case, you may need to do some retraining or organize your records better as a corrective action to prevent recurrence in a future inspection. You might even make modifications to your work instruction for “Conducting an FDA Inspection” (i.e. FDA inspection plan).

How and when will you repsond to the inspector with corrective action plans?

Your FDA inspection plan should include details on how respond to FDA 483 inspection observations and when the response must be submitted by. The FDA inspector will give you instructions for submission of your corrective action plans by email to the applicable email address for your region of the country. This email address and contact information should be added to your work instruction as an update after the first inspection if you are not sure in advance. You should respond with a copy of your CAPAs with 15 business days. Regardless of what the inspector told you, there is always a possibility that the outcome of your inspection could be “Official Action Indicated.” This is because the inspector’s supervisor makes the final decision on whether a Warning Letter will be issued and regarding the approval of the final inspection report. You should also confirm what the 15-day deadline is, because your state’s holidays may be different from the US Federal holidays.

If your company is outside of the USA, what should you do differently to prepare?

The US FDA only has jurisdiction over companies that are located in the USA. Therefore, if your company is registered with the FDA, you can only be inspected if you agree to host the FDA inspector when they contact you. FDA inspectors will contact foreign firms 6-8 weeks in advance, and they will typically give you a couple of weeks to choose from. After you confirm the dates for the inspection, then they will make their travel plans. Therefore, you will know exactly when the FDA inspection is schedulea and you will have more than month to prepare. Therefore, you should do four things differently:

  1. You should send the FDA inspector directions from the airport to your facility and provide recommendations for potential hotels to stay at. Ideally the hotels you recommend will provide transportation from the airport and managers that are speak passable English). The hotels should be appropriate for business travel–not royalty. If it is convenient, you may even offer to pick-up the inspector at the hotel each day to ensure they have no problems with local transportation.
  2. You should offer to provide lunches for the inspector during the inspection. This should not be considered entertainment. The purpose is make sure the inspector has lunch (i.e. a light meal or snacks) and drinks (i.e. water and coffee) during the inspection so that they do not have to negotiate local traffic, struggle with ordering food in a language they don’t know, and to eliminate delays associate with having lunch off-site. Make sure you remember to ask about food allergies and dietary restrictions. You might even follow-up with a draft menu to obtain confirmation that your proposed menu is appropriate.
  3. You should schedule a mock-FDA inspection immediately to verify that everyone is prepared and to identify any CAPAs that need to initiated before the FDA inspector finds the problems.
  4. During the first day of the inspection, you may consider asking the inspector if they would like to go out for dinner one of the evenings with a couple of people from your company or if they would like any recommendations for restaurants to eat at. If you are not familiar with US customs and international travel, ask the hotel concierge for advice. When you are out to dinner, the conversation should remain professional and if you normally drink alcohol at dinner you may want to consider the “BOB” compaign in the Netherlands as a role model. 

How are you going to train everyone in your company?

You need an easy way to train everyone in your company. Why not give them a video to watch? Next Monday, July 26, 2021 @ Noon EDT, we are hosting a webinar on how to prepare for an FDA inspection. It is a live webinar where you will be able to ask questions, and we are bundling the webinar with our new work instruction for “Conducting an FDA Inspection” (WI-009). If you register for the webinar, you will receive access to the live webinar, you will receive the native slide deck, and you will receive a copy of the work instruction. You can use the work instruction as an FDA inspection plan template for your company. The webinar will be recorded for anyone that is unable to attend the live session. You will be sent a link to download the recording to watch it as many times as you wish, and we recommend that you use the webinar as training for the rest of your company.

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Smile, because you should never be scared of a surprise FDA inspector

Smile, because you should never be scared of a surprise FDA inspector

If you have a surprise FDA inspector visit, you should never be scared because there is no difference between the best and worst-case outcome.

Why are you scared of an FDA inspector?

There are a number of reasons why you might be scared of an FDA inspector, but if you keep reading you will learn why 95% of your fear is self-induced. A small percentage of device manufacturers evaluate the performance of quality managers based upon the outcome of FDA inspections, but you have no control over whom the FDA Office of Regulatory Affairs (ORA) assigns to perform your inspection. If your company belongs to this 5% minority, you need to change top management’s approach to regulators or you need to find a new employer. For the majority of us, we are scared of embarrassment, failure, or being “shut down.”

There are rare examples of where the FDA has taken action to stop the distribution of medical devices, but this is only done as a last resort. Usually companies cooperate with the FDA with the hope of being able to resolve quality issues and resume distribution after corrective actions are implemented. Not only is this type of action rare, there will be a prior visit to your facility and prior written communication from ORA before you receive a warning letter–let alone removal of your company’s device(s) from the market. You can’t pass or fail an FDA inspection. The FDA inspector is verifying compliance with the FDA Quality System Regulation (i.e. 21 CFR 820) as well as the requirements for medical device reporting (i.e. 21 CFR 803), reports of corrections and removals (i.e. 21 CFR 806), investigational device exemptions (i.e. 21 CFR 812), and unique device identification (UDI). FDA inspectors only have time to sample your records, and with any sampling plan there is always uncertainty. When you do receive an FDA 483 inspection observation you should not consider it to be a condemnation of your company. Likewise, an absence of 483 observations is not a reason to celebrate.

Why you should not be embarrassed when you receive a 483 from an FDA inspector

The most irrational response to an FDA 483 inspection oberservation is embarrassment. Our firm specializes in helping start-up medical device companies get their first product to market. This includes providing training and helping them to implement a quality system. When our clients have their first FDA inspection, it is not uncommon to receive an FDA Form 483 inspection observation. Start-ups have limited resources, limited experience, and most of the employees have never participated in an FDA inspection before. Experience matters, and immature quality systems have only a limited number of records to sample. Any mistakes are easy for an inspector to find.

Instead of feeling embarrassed, acknowledge and embrace your inexperience. For example, during the opening meeting with an FDA inspector you might say, “We are a new company, and this is our first FDA inspection. I am also a first-time quality manager. If you find anything that we are doing incorrectly, please let us know and we will make immediate corrections and start working on our CAPA plan.” You can say this with a smile :), and you can genuinely mean what you said because it’s true.

Anticipation is always worse than reality

Another reason you are scared of an FDA inspection is because you don’t know exactly when the inspection will be. Only Class III PMA devices, and a few Class II De Novo devices with novel manufacturing processes, require a pre-approval inspection. For the rest of the Class II devices, ORA prioritizes inspections based upon risk. There are a few companies prioritized for inspection within the first six months of registration, such as reprocessors of single-use devices and contract sterilizers. For the rest of the Class II device manufacturers, your first inspection should be approximately two years after your company registers with the FDA. If you are located outside the USA (OUS), your first inspection might take three years to schedule. Finally, for Class I device manufacturers and contract manufacturers, you are unlikely to ever be inspected by the FDA. If you didn’t know what the typical timeline was for ORA to schedule your first inspection, you probably just breathed a HUGE sigh of relief when you read this paragraph.

Even if you already knew the approximate timeline and priorities for FDA inspections, it’s normal to feel a little anxiety when the date of your first visit is unknown. Your boss and the rest of top management are probably feeling just as much anxiety as you are, or even more if they have no idea what the timeline and priorities are. You should make sure that everyone in your company understands what they are supposed to do during an FDA inspection, and if you forget to tell them you might cause a lot of unneeded drama when they find out an FDA inspector is in the front lobby. Preparing for an FDA inspection is no different from conducting a firedrill. Everyone should know the procedure, and you should practice (i.e. conduct a mock-FDA inspection). Practice ensures that everyone knows what to do during the first 30 minutes of an FDA inspection, and nobody in your company will panic when an FDA inspector actually arrives.

Let’s define “surprise” visits by an FDA inspector

A surprise visit from an FDA inspector is extremely rare, but in the USA inspectors will call on Friday to confirm that your company will be open the following Monday for an inspection. The FDA has jurisdiction over medical device manufacturers located in the USA, and they are not required to give advanced notice. However, inspectors need time to prepare in advance for their inspection–just like a ISO 13485 auditor. Therefore, before an inspector will arrive on-site for a routine (Level 2) inspection, the inspector will first make a courtesy call to the official correspondent identified in your establishment registration.

What happens when an FDA inspector travels outside the USA

In the case of OUS medical device manufacturers, the FDA inspector does not have jurisdiction. Therefore, they will contact the official correspondent 6-8 weeks in advance to schedule an inspection. Inspectors will typically make contact via email, and you may be given a couple of weeks to choose from for the FDA inspection. The duration off your inspection should be 4.5 days. The inspector will arrive on Sunday, and the inspection will begin on Monday morning. The inspector has four major process areas to cover, and Friday morning will be focused on generating a preliminary report of 483 inspection observations. The reason why you can predict this OUS routine with a degree of certainty is two-fold: 1) these are government workers following a procedure, and 2) the FDA inspector needs time to get to the airport for their flight home.

What is the outcome of a FDA inspection?

FDA inspections have three possible outcomes:

  1. No action indicated – there were no FDA 483 inspection observations identified by the FDA inspector
  2. Voluntary action indicated – there was at least one FDA 483 inspection observation identified by the FDA inspector, and the FDA inspector requests submission of a CAPA plan to prevent recurrence
  3. Official action indicated – there was at least one FDA 483 inspection observation identified by the FDA inspector, and the FDA inspector requires submission of a CAPA plan to prevent recurrence; if a plan is not received in 15 business days, a warning letter will automatically be generated on the 16 day

Even in the rare instances with there is “no action indicated” (i.e. best case scenario), I have always noticed one or more things during and FDA inspection that were overlooked and we needed to be initiate a new corrective action plan(s). In the other two possible scenarios, the FDA inspector identified the need for one or more corrective action plans. Therefore, regardless of whether you FDA inspection results in the best-case scenario or the worst-case, you will always need to initiate a new corrective action plan(s).

If the outcome is always a CAPA, what should you do?

Give your FDA inspector a big smile and say, “We are a new company, and this is our first FDA inspection. I am also a first-time quality manager. If you find anything that we are doing incorrectly, please let us know and we will make immediate corrections and start working on our CAPA plan.” Making sure that you have a genuine smile is just as important as what you say. Smiling will relax you and the anxiety and stress you are feeling will gradually melt away. Smiling will encourage the FDA inspector to trust you. Maybe your smile will even be contagious.

If you need help responding to an FDA 483 inspection observation, or you want to conduct a mock-FDA inspection, please use our calendly app to schedule a call with a member of our team. We are also hosting a live webinar on FDA inspections on July 26, 2021 @ Noon EDT.

About the Author

Rob Packard 150x150 Smile, because you should never be scared of a surprise FDA inspector

Robert Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certification. From 2009-2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone 802.258.1881 or email. You can also follow him on Google+LinkedIn or Twitter.

Posted in: FDA

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How is your response to an Additional Information Request different from an RTA response?

How is your response to an Additional Information Request different from an RTA response?

A poor RTA response will cause a two-week delay, but an additional information request only gets one chance to avoid the dreaded NSE letter.

An Additional Information Request (i.e. AI Request) is typically received just before the 60th day in a 90-day 510k review, while a Refusal to Accept (RTA) Hold is typically received on the 15th day. If your response to your first RTA Hold (i.e. RTA1) is inadequate, the reviewer will issue another RTA Hold letter (i.e. RTA2) and your 510(k) review clock will be reset to 0 days. You will have another 180-days to respond to RTA2, and issues identified in an RTA Hold are usually easy to address. Most RTA Hold issues also have one or more guidance documents that are available to help you to obtain an RTA Accept letter. You can always request a submission-in-review (SIR) meeting to clarify what information the reviewer needs to address the RTA deficiencies too. If you want to learn more about responding to an RTA Hold, please read last week’s blog. The rest of this article is specific to responding to requests for additional information.

What happens after 60 days during a 510k review?

On the 60th day of the 510k review clock, or a few days prior to the 60th day, the lead reviewer must determine if they need to issue an Additional Information (AI) Request. The alternative to an AI Request is for the lead reviewer to issue a letter indicating that you have entered the Interactive Review Phase. This only happens if the reviewer believes they can make a decision regarding substantial equivalence in the next 30 days. If the decision is to issue an Interactive Review Letter, then the lead reviewer believes that only minor issues remain and there is only the need for interactive email responses between the lead reviewer and the submitter. An interactive review is the ideal outcome of the substantive review process but it rarely happens.

If you receive an Additional Information Request, what are your options?

The AI letter will indicate that you have 10 days to request a clarification meeting with the reviewer. The wording of this section of the AI letter is provided below:

“FDA is offering a teleconference within 10 calendar days from the date on this letter to address any clarification questions you may have to pertain to the deficiencies. If you are interested in a teleconference, please provide (1) proposed dates and (2) a list of your clarification questions via email at least 48 hours before the teleconference to the lead reviewer assigned to your submission. We would like to emphasize that the purpose of the meeting is to address specific clarification questions. The teleconference is not intended for the review of new information, test methods, or data; these types of questions could be better addressed via a Submission Issue Q-Submission (Q-Sub). For additional information regarding Q-Subs, please refer to the Guidance for Industry and FDA Staff on Medical Devices: Requests for Feedback and Meetings for Medical Device Submissions at https://www.fda.gov/media/114034/download.”

If you wait too long to request the teleconference, then FDA will require you to submit a formal pre-sub meeting request or “Submission in Review” (SIR) meeting request. If you request a SIR meeting within 60 days of receiving an AI Request, the FDA will schedule a SIR meeting with you within three weeks of receiving the request–assuming resources are available. If you wait longer than 60 days to request the SIR meeting, then the FDA will default to their normal target of 60-75 days for scheduling a pre-sub meeting. For example, if you submit your SIR meeting request on day 75, and the FDA takes 75 days to schedule the meeting, you will be granted your SIR meeting at 150 days and you will only have 30 days remaining to respond to the AI Request before your submission is automatically withdrawn.

Therefore, it is important to request a clarification meeting immediately after you receive the AI Request. While you are waiting for your clarification meeting, you should immediately begin preparing any draft testing protocols that you want the FDA to provide feedback on during a SIR meeting. Then after you have the clarification meeting, you should submit your SIR meeting request and include any draft testing protocols you have prepared. This may include a statistical sampling rationale, a proposed statistical analysis method, a summative usability testing protocol, or a draft protocol for some additional benchtop performance testing. The FDA can review examples of preliminary data, a protocol, or a proposed method of analysis. The FDA cannot, however, provide a determination of substantial equivalence.

The Most Common Mistakes in Responding to an Additional Information Request

Most companies make the mistake of asking the lead review if they provide specific additional information, “Will this be sufficient to obtain 510(k) clearance?” Unfortunately, the FDA is not able to provide that answer until the company has submitted the additional information and the FDA review team has had time to review it thoroughly. This is done only when the submitter delivers an FDA eCopy to the Document Control Center at CDRH, and the review team is able to review the information. This new information is assigned a supplement number (e.g. S001), and it will typically require three weeks to review the information. Then the lead reviewer may request minor modifications to the labeling, instructions for use, or the 510k summary. This request is an interactive request, and the submitter must respond within a very short period (e.g. 48 hours), and the wording of the request may be “Please provide the above information by no later than COB tomorrow.”

FYI: “COB” means “close of business.” Wow. The FDA loves acronyms.

Best Practices in Responding to an Additional Information Request

If you receive an AI request on a Friday afternoon, 58 days after your initial submission, you should immediately request a clarification teleconference with the FDA reviewer for the following week. The only exception is if you only have minor deficiencies that you feel are completely understood. During the days leading up to the clarification teleconference, your team should send a list of clarification questions to the lead reviewer and begin drafting a response memo with a planned response to each deficiency. After the clarification meeting, you will have approximately 6-7 weeks to submit a SIR meeting request. However, you should not wait that long. Your team should make every effort to submit your SIR meeting request within 2-3 weeks. If the FDA takes 3 weeks to schedule your meeting, then you will have used approximately 6 weeks of your 26 weeks to respond to the AI Request.

In your SIR meeting request, you should always try to provide examples or sample calculations to make sure the FDA review team understands what you are proposing to submit in your supplement. For example, the FDA reviewers do not have enough time to review your entire use-related risk analysis (URRA) in a SIR meeting request. However, you can provide an example of how you plan to document a couple of use-related risks. Then you can show how these risks would translate into critical tasks. Finally, you could provide a draft summative usability testing protocol for FDA feedback. The FDA review team doesn’t have enough time available to review much more. You will only have one hour for your SIR meeting.

How to Prepare Your Response

In section “V” of the FDA guidance on deficiency responses, the FDA recommends that you restate the issue identified by the reviewer in your response. Next, your response should include one of the following:

  1. the information or data requested, or
  2. an explanation of why the issue is not relevant, or
  3. alternate information with an explanation of why the information you are providing addresses the issue.

Before you respond to an AI Request, you should look up any FDA guidance documents referenced in the AI Hold letter to make sure that you address each requirement in the applicable FDA guidance document(s).

The most important technique to learn when you are responding to regulators is to organize your response in a tabular format that is numbered in exactly the same order that the request was made. Typically there will also be sub-parts to certain issues. In that case, you should duplicate the numbers and/or letters of each sub-part and segregate each sub-part in a different row of the table. Personally, I like to alternate the color of the font I use in the table to make it even more obvious which information is a restatement of the reviewer’s comment and which information is the company’s response to the AI Request.

Why you don’t get a second chance to respond to an AI Request

Once you respond to an AI Request, and the DCC receives your FDA eCopy, the FDA review clock will then resume the countdown to 90 days. In our example above, you received the AIR Request on the 58th day. The FDA must review everything you submitted and make a final substantial equivalence decision before the 83rd day because they still need to submit their recommendations to senior management in their branch. If any changes to the labeling, instructions for use, or the 510k are required, you should receive those requests several days before (i.e. 76-83 days). You can respond to interactive requests via email, and then the final SE decision will be made. If you do not respond to all of the deficiencies in the AI Request, the FDA reviewer will not have enough time to request that you address the remaining gaps and finish their review. Therefore, an incomplete AI Response will certainly result in a non-substantial equivalence (NSE) letter.

If you need to respond to an additional information request from the FDA reviewer, we can review your planned response to identify potential gaps. If you need help please use our calendly app to schedule a call with a member of our team.

About the Author

Rob Packard 150x150 How is your response to an Additional Information Request different from an RTA response?

Robert Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certification. From 2009-2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone 802.258.1881 or email. You can also follow him on Google+LinkedIn or Twitter.

Posted in: 510(k)

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What are the secrets to success in responding to an FDA RTA Hold?

What are the secrets to success in responding to an FDA RTA Hold?

When an FDA reviewer places your 510k on RTA Hold, there are secrets you can learn to improve your chances of a successful response.

Test your knowledge about the FDA RTA Hold process

Did you know that approximately 50% of 510(k) submissions are placed on RTA Hold? Did you know that you can be placed on RTA Hold multiple times for the same submission? Did you know that the 90-day review clock is reset to “0” when you submit your response? Do you know how to respond to the FDA when the reviewer is incorrect? Did you know that you can avoid the RTA screening process for any 510(k) submission if you use the correct template? Every year there are more than 1,000 submissions placed on RTA Hold, but did you know there is an FDA guidance specifically telling you how to respond to deficiencies? You can learn the secrets to responding to an FDA RTA Hold just by reading this article.

What is an FDA RTA Hold?

When the FDA receives a Traditional 510k submission FDA eCopy, the eCopy is uploaded to the FDA system within hours of the submission being received. If the eCopy does not meet the eCopy format requirements, then the submission will be placed upon eCopy Hold. The official correspondent will receive an automated email indicating that the submission is on eCopy Hold, and the submitter will be asked to correct the submission format to meet the eCopy submission requirements and provide a replacement eCopy. If the FDA user fee has not cleared, then the submission will be placed on User Fee Hold. It is possible to be placed on eCopy Hold and User Fee Hold at the same time.

If your eCopy is accepted, then a reviewer is assigned to screen your submission for compliance with the FDA Refusal to Accept (RTA) policy. The reviewer has 14 days to complete this review, and on the 15th day the reviewer must do one of three things: 1) issue a RTA Hold letter to the submitter, 2) issue an RTA Acceptance letter to the submitter, or 3) issue a letter that states the RTA screening was not completed on-time and the submission was automatically accepted. If your receive an RTA Hold letter, it will be via email from the reviewer and the RTA Checklist will be attached. In the checklist, there will some items highlighted in yellow and deficiencies will be noted in those sections. The reviewer may add additional comments to the checklist, but you are only required to respond to the highlighted sections. The process that the reviewer follows for RTA screening is defined in the FDA guidance for the Refusal to Accept process, and the guidance includes a checklist for traditional, abbreviated, and special 510k submissions. Some companies will fill in these checklists themselves and submit a copy of the checklist with the 510k submission. This is intended to help the reviewer identify where all of the requirements in the RTA checklist can be found. Third-party reviewers require that the company complete the RTA checklist and provide it to them with the eCopy.

How many times can you be placed on hold for the same submission?

Technically there is no limit to the number of times a submission can be placed on RTA Hold, and our firm has seen a few submissions placed on RTA Hold twice in a row. The first RTA Hold is referred to as RTA1, and the response to that RTA Hold is referred to as the first supplement (i.e. K123456/S001). If a second RTA Hold is issued, that hold is RTA2, and the response to that RTA Hold is referred to as the second supplement (i.e. K123456/S002). A response to an eCopy Hold is referred to as an amendment (i.e. K123456/A001).

What happens to the 90-day review clock when you are placed on RTA Hold?

When the FDA reviewer places your submission on RTA Hold, the 90-day review clock is automatically reset. Therefore, even if you respond to an RTA Hold on the same day you receive the RTA Hold, and your submission is received the next day, the “real” review timeline is now 106 days instead of 90. If your submission is placed on RTA Hold twice, then the “real” review timeline is now 122 days instead of 90. If the lead reviewer of your 510k requests additional information, this is referred to as an “AI Request.” We will address this in a future blog, but an AI Request does not reset the review timeline. The AI Request, however, will increase the review timeline. Although we rarely have an RTA Hold, we almost always have an AI Request. This is why our average submission is approximately 125 days (i.e. ~30 days are required to respond to the AI Request.

How should you respond if the FDA reviewer is incorrect?

The average 510(k) submission has grown over time from 300 pages to more than 1,200 pages, but the FDA review “clock” is still 90 days and the RTA screening is limited to 15 days. Therefore, it is not reasonable for you to expect the reviewer to understand and absorb every detail of your submission. If the reviewer can’t find the information they are looking for quickly, the reviewer may state that they could not find the information in the submission or that you did not provide it. If the information is found in the submission, you should provide a reference to the section of the submission, including the document and page number, in your RTA response. You may even choose to quote the information in your response memo if it is brief.

Other times the reviewer may not understand why certain information is not relevant to your submission. In this case, you should restate why the information requested is not relevant. You may want to review relevant FDA guidance documents that explain how to justify why information is not required.  For example, if you did not provide biocompatibility testing reports for some of the endpoints that are identified in ISO 10993-1:2018, then you should either provide a detailed biological risk assessment in accordance with the FDA guidance on the use of ISO 10993-1, or you should provide a biocompatibility certification statement.

If you are not sure why the FDA reviewer stated the information you provided is not acceptable, you might try calling or emailing the reviewer to ask for clarification. If you do this, be respectful of their time and be brief. You should identify who you are (you must be the official submission correspondent to speak with the reviewer), you should identify which submission you are contacting the reviewer about (they are working on many simultaneously), you should restate the issue identified by the reviewer (it may have been an issue of another member of the review team), and then you should indicate where the information can be found in the submission. If they believe this addresses the issue, then they will instruct you to provide that information in an RTA response. If the information does not address the issue, usually they will explain why. Your chances of receiving an email response are also better than speaking to the person on the phone–especially during the Covid-19 pandemic.

FDA eSTAR submissions are not subjected to the RTA screening process

When you use the FDA eSTAR submission instead of creating an eCopy, your submission should already meet all of the RTA screening requirements. The eSTAR includes automation to validate that the submission is administratively complete and therefore the reviewer does not need to do an RTA screening of an eSTAR submission. Therefore, most companies should realize a shorter overall 510k clearance timelines, because they will only have an AI Request and the review clock will not be reset.

Does the FDA offer any guidance on how to respond to deficiencies?

When the FDA writes deficiencies, the reviewer is supposed to follow the FDA guidance for deficiency content and format. However, the RTA checklist deficiencies typically are shorter and may not be as clear as a deficiency in additional information (AI) requests or non-substantial equivalence (NSE) letters. The first part of the deficiency is a reference to the information that was provided by the submitter (i.e. section, page number, or table). In an RTA checklist, each deficiency is provided in the comments section at the end of the section of the checklist. Therefore, if you have a deficiency related to your device description, the deficiency will be written at the end of the device description section of the RTA checklist. The comment will be highlighted in yellow, and there will be a checkbox next to the specific checklist item indicating that the requirement was not met. In the far-right column of the checklist, there will be a reference to the page of the submission where the deficiency can be found.

In the comment there reviewer should explain why the current information does not meet the requirement of the RTA checklist. The reviewer should also clarify the relevance of the deficiency with regard to the substantial equivalence determination. For the example of a deficiency related to your device description, usually, the issue is that your submission has inconsistencies between the various submissions or there is insufficient detail about your device. At the end of the comment, the reviewer should provide an explicit request for the information needed to address the RTA Hold.

In section “V” of the FDA guidance on deficiency responses, the FDA recommends that you restate the issue identified by the reviewer in your response. Next, your response should include one of the following:

  1. the information or data requested, or
  2. an explanation of why the issue is not relevant, or
  3. alternate information with an explanation of why the information you are providing addresses the issue.

Before you respond to an RTA Hold, you should look up any FDA guidance documents referenced in the RTA Checklist to make sure that you address each requirement in the applicable FDA guidance document(s).

The most important technique to learn when you are responding to regulators is to organize your response in a tabular format that is numbered in exactly the same order that the request was made. Typically there will also be sub-parts to certain issues. In that case, you should duplicate the numbers and/or letters of each sub-part and segregate each sub-part in a different row of the table. Personally, I like to alternate the color of the font I use in the table to make it even more obvious which information is a restatement of the reviewer’s comment and which information is the company’s response to the RTA Hold.

Regardless of how well your response is organized, you must respond within 180 days. On the 181st day, your submission will be automatically withdrawn. The agency has granted extensions of an additional 180 days during the Covid-19 pandemic, but that will end and you should verify if you can obtain an extension from the reviewer rather than assume that this will happen. If the 180th day is on a weekend or US holiday, the Document Control Center (DCC) at the FDA will not receive your submission until the next business day. Therefore, you will need to ship your submission earlier to ensure the delivery is received on time. Since most companies are shipping their RTA response via FedEx or UPS to the FDA, you also will want to make sure you take into account customs clearance for international shipments and local holidays where you are. If you are shipping from the UK, for example, you can’t expect FedEx to ship on a British holiday. If you need help with printing and shipping your RTA response, Medical Device Academy offers an eCopy print and ship service for $99/eCopy (including the overnight FedEx fee).

If your 510k submission was placed on RTA Hold by the FDA, we can help you respond to the deficiencies identified by the FDA reviewer. We can also review your planned response to identify potential gaps. If you need help please use our calendly app to schedule a call with a member of our team.

About the Author

Rob Packard 150x150 What are the secrets to success in responding to an FDA RTA Hold?

Robert Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certification. From 2009-2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone 802.258.1881 or email. You can also follow him on Google+LinkedIn or Twitter.

Posted in: 510(k)

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Which changes are forgotten in your MDR labeling procedure?

Did you forget any of the MDR labeling procedure requirements when you were updating your device labeling for CE Marking?

Don’t forget to subscribe to our YouTube channel for more medical device quality and regulatory training. The topic of this article is how to create an MDR labeling procedure for compliance with Regulation (EU) 2017/745 (MDR) for CE Marking of medical devices. The MDR does not actually include a requirement for a labeling procedure. In fact, the MDR doesn’t even specifically require that you have ISO 13485:2016 certification. ISO 13485:2016, clause 7.5.1 states that you shall implement “defined operations for labeling and packaging,” but the standard doesn’t specifically say that “the organization shall document procedures” for labeling. In 21 CFR 820.120, the FDA states that “each manufacturer shall establish and maintain procedures to control labeling activities.” But there is no similar requirement in the MDR.

MDR Quality System Requirements

Article 10 is the section of the MDR that defines the obligations for device manufacturers to create quality system procedures, but a labeling procedure is not specifically mentioned. Article 10(9)(a) states that your quality system shall include “a strategy for regulatory compliance, including…procedures for management of modifications to the devices covered by the system,” and this would include label changes. The next paragraph states that your quality system shall include, “identification of applicable general safety and performance requirements.” The general safety and performance requirements (GSPRs) are found in Annex I of the MDR, and the very last GSPR (i.e. GSPR 23) is for your label and instructions for use.

Then, which changes do you need to make for the MDR labeling procedure?

The GSPRs in Annex I of the MDR are longer than the Essential Requirements that were in the MDD. In addition to the new requirements for UDI compliance (which you should address in a UDI Requirements Procedure), GSPR 23 has new general requirements (i.e. 23.1) and new requirements for information on the sterile packaging (i.e. 23.3). There is also a more detailed specification for the information on the label (i.e. 23.2) and the information in the instructions for use (i.e. 23.4). The approach for demonstrating compliance with the GSPRs suggested in the MDR is to provide a checklist. Therefore, most manufacturers of CE Marked devices have replaced their Essential Requirements Checklist (ERC) with a GSPR checklist. However, if you are reviewing a draft label for approval, you don’t want to review and update your entire 22-page, GSPR checklist for every label.

The more efficient approach is to create one or more labeling checklists that are specific to the requirements in GSPR 23. If you create a separate checklist for the label, the information on the sterile packaging, and for the information in the instructions for use, then you would have three shorter checklists to complete. The label checklist and the checklist of the information on the sterile packaging would be only one page each, while the checklist for the instructions for use would be approximately four pages. There may be additional labeling requirements for specific countries and types of devices. Electrical medical equipment also has specific labeling requirements in IEC 60601-1 and IEC 60601-1-2. You will also need to create a user needs specification that can be used as criteria for summative usability testing (i.e. validation that the design and risk controls implemented meet the user needs specification). You should also document a use-related risk analysis (URRA), and perform formative testing, in order to identify critical tasks which need to be in the instructions for use to prevent use errors.

Are there any other MDR requirements that you should address in a labeling procedure?

There are two other requirements that should be addressed in your labeling procedure. The first is the general labeling requirements in GSPR 23.1. Withing GSPR 23.1, there are actually nine “sub-requirements.” The first “sub-requirement” in GSPR 23.1 is to provide the identity of the device, your company, and any safety and performance information needed by the user on the packaging or the instructions for use, and on your website. Many manufacturers do not want to make this information available on their website, because it makes it easier for competitors to copy the instructions for use, but this is not optional. This requirement and the other eight requirements in GSPR 23.1 could be included in your procedure or as part of a fourth labeling checklist associated with your MDR labeling procedure.

The second requirement is the requirement to translate your instructions for use into an official Union language(s) determined by the member state where your device will be made available to the intended user or patient. Creating these translations, and verifying the accuracy of the translations, can be expensive and burdensome–especially if your device is sold in most of the member states.

You might also consider implant cards as labeling requirements and try to add them to your MDR labeling procedure. However, if the requirement for implant cards (see Article 18 of the MDR) is applicable to your company you should create an implant card procedure instead because this is a detailed and critical requirement that will not apply to most of the other labels in your company. You should make sure that the implant card procedure is compliant with MDCG 2021-11 released in May 2021 and MDCG 20201-8 v2 release in March 2020. These guidance documents also have great examples of how to design your implant cards.

Other changes in labeling requirements

The ISO 15223-1:2016 standard has been revised and was expected for release at the end of 2020. However, only draft versions are currently available (i.e. ISO/DIS 15223-1:2020). This new version of the standard for symbols to be used with labeling will also need to be updated shortly in your MDR labeling procedure. This new version is already referenced in the medical device standard for information provided by the manufacturer (i.e. EN ISO 20417:2021)–which supersedes EN 1041:2008. Consultants and chat rooms have argued over whether the requirement for identifying the importer must be on the label or if it could be presented in other documents. EN ISO 20417:2021 resolves this dispute in section 7.1: “Where necessary, the label of a medical device or accessory shall include the name or trade name and full address of the importer to which the responsible organization can refer.” In the note following that clause, it clarifies that “This can be required by the authority having jurisdiction.” There is even a new symbol referenced for importers (i.e. Symbol 5.1.8 in ISO 15223-1).

If you have specific questions about device labeling or MDR compliance, please use our calendly app to schedule a call with a member of our team. You can also purchase our labeling and translation procedure (SYS-030) to save yourself the time and effort of making your own versions of the labeling checklist described above.

About the Author

Rob Packard 150x150 Which changes are forgotten in your MDR labeling procedure?

Robert Packard is a regulatory consultant with 25+ years of experience in the medical device, pharmaceutical, and biotechnology industries. He is a graduate of UConn in Chemical Engineering. Robert was a senior manager at several medical device companies—including the President/CEO of a laparoscopic imaging company. His Quality Management System expertise covers all aspects of developing, training, implementing, and maintaining ISO 13485 and ISO 14971 certification. From 2009-2012, he was a lead auditor and instructor for one of the largest Notified Bodies. Robert’s specialty is regulatory submissions for high-risk medical devices, such as implants and drug/device combination products for CE marking applications, Canadian medical device applications, and 510(k) submissions. The most favorite part of his job is training others. He can be reached via phone 802.258.1881 or email. You can also follow him on Google+, LinkedIn or Twitter.

Posted in: CE Marking

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