CE MARKING PROCESS & NOTIFIED BODIES

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CE MARKING PROCESS & NOTIFIED BODIES Ellis Garai Ramin Miri Spring 2011 GLOBAL BIODESIGN STANFORD UNIVERSITY

Machinery 9% Others 49% Construction 11% Notified Bodies Industrial and Medical Devices 8% NAWI 23% Geographical Distribution NB*Directive (~1500) 5% 2% AI 1% EU 27 (Others), 11 Germany, 6 UK, 1 Italy, 1 AI UK 21% Italy 18% Germany 21% NBs (969) France 8% Other 32% EU 27 (Others) 28% EFTA, 2% MRA-PECA MRA-PECA, 1 EFTA, 7 EU 27 (Others), 36 Germany, 16 UK, 6 Italy, 10

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Class I devices require registration Translation of Documentation: User Manuals & Labels (23 languages) Place Product on the European Market Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Place Product on the European Market Technical File- Class II There are three medical device directives. The manufacturer must prove that Design Dossier- Class III their product complies with the appropriate directive. : Medical Devices Directive (90/42/EEC & 2007/47/EC) AI: Active Implantable Medical Devices Directive (90/385/EEC & 2007/47/EC) : In Vitro Diagnostic Device Directive (98/79/EC) Essential Requirements (Annex I) Translation of Documentation: User Manuals & Labels (23 languages) Clinical Evaluation (Annex X) Class I devices require registration Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Appoint Authorized Representative (a.k.a. EC Rep) Notified Body Issues CE Mark Certificate Place Product on the European Market Technical File- Class II Medical devices are grouped by classification depending on the level of Design Dossier- Class III risk to the patient. Essential Requirements (Annex I) The major factors in determining the class of a medical device is the primary mode of action and operation. Translation of Documentation: User Manuals & Labels (23 languages) Clinical Evaluation (Annex X) It is the responsibility of the manufacturer to indentify which class their Formal Notified Body Audit product fall under, but ultimately confirmed by the Notified body There are 18 rules found in Annex IX of the that helps the Declaration of Conformity (Annex VII) manufacturer determined the appropriate classification for a particular product. Class I devices require registration Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) ISO 13845:2003 Appoint Authorized Representative (a.k.a. EC Rep) Medical devices Formal -- Quality Notified Body management Audit systems -- Requirements for regulatory purposes Notified Body Issues CE Mark Certificate Main sections of ISO 13485: Section 4.0: Declaration Quality of Management Conformity (Annex System VII) Requirements Section Translation 5.0: of Management Documentation: Responsibility User Manuals & Labels Section 6.0: Resource (23 languages) Management Section 7.0: Product Realization Place Product on the European Market Section 8.0: Measurement, Analysis, and Improvement Class I devices require registration Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Can take up to 3-9 months to implement Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) Components of the Technical File: Product Description Intended Use Technical Drawings Standards Used Product Specification Design Requirements Product performance testing Packaging & Labeling Transportation and storage Construction requirements Annual Notified Body Audits to maintain CE Mark certification Manufacturing Documentation Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Translation of Documentation: User Manuals & Labels (23 languages) Place Product on the European Market Post Market Surveillance System must be in place Pre-clinical testing: Bench & Animal Clinical Evaluation Biocompatibility (ISO 10993) - Systemic toxicity - EtO sterilization residuals - Potential degradation products Risk Management: (ISO 14971) - Risk analysis, evaluation, & control - Production & post-production info Incident Reports must be filed Class I devices require registration Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) Forms of Clinical Evaluation: Scientific Review of the Literature Preclinical Testing: - Bench Testing - Animal Testing Annual Notified Body Audits to maintain CE Mark certification Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Post Market Surveillance System must be in place Incident Reports must be filed Class I devices require registration Human Clinical Evaluation: Translation of Documentation: User Manuals & Labels -ISO 14155-1:2009 Clinical Investigation (23 languages) of Medical Devices for Human Subjects, General Requirements Place Product on the European Market -ISO 14155-2:2009 Clinical Investigation of Medical Devices for Human Subjects, Investigation Plan - Clinical Evaluation Reports (CER) section of the MEDDEV 2.7.1 Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Place Product on the European Market Class IIa Class IIb Class III /AI/ BSI Group, UK TÜV SÜD, Germany NSAI, Ireland Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) AI/ General TÜV Nord, Germany AI Specific EMKI, Hungary - Implantable heart pacemakers POLSKIE C BI, Poland - AI auditive prosthesis (Cochlear Imp) Translation of Documentation: User Manuals & Labels (23 languages) Clinical Evaluation (Annex X) Class I devices require registration Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

General NBs in Medical Devices

Full Spectrum NB Japan PAL Mexico & Brazil Canada CMDCAS Health USA FDA BSI group UK Founded in 1901 Non-Profit under Royal Chapter 235.3m Revenue 2591 Employees Australia MRA-CE KiteMark - Medical Devices QMS (ISO 13485) CE Marking 16 Direc., all 3 s

AI NBOG Codes AIMDs Product Categorization 0100: General AIs 0101: AIMDs for stimulation / inhibition 0102: AIMDs delivering drugs or other substances 0103: AIMDs substituting or replacing organ functions & AI SCOPE EXPRESSIONS, ADDITIONS MDS 7000: / AI Specifics MDS 7004: s referencing the Directive 2006/42/EC on machinery MDS 7005: s referencing the Directive 89/686/EEC on personal protective equipment (PPE) MDS 7006: s in sterile condition

AI (90/385/EEC) Products Implantable active monitoring devices Implantable Nerve Stimulators Stimulators Implantable active drug administration Implantable cardiac Programmers, software, transmitters Cochlear implants Bladder Sphincter Diaphragm Devices Catheters Sensors Pacemakers Defibrillators Leads, electrodes, adaptors

Specific AI NB Preparation and exchange information, and Preevaluating group EMKI Hungary /AI/ But only implantable heart pacemakers in AI directive Specialized in pacemakers Classification of C.A. scope (NBGO), and Calculating the time interval of C.A. procedures Designating the members of C.A. group, and making a bid Planning, performing, & Closure of C.A. procedure, and Decision about Conformity Issuing, modifying, or supplementing certificates Suspending, withdrawing, or constraining certificates Transparency and reproducibility of C.A. procedure Conformity Assessment

Specific AI NB EMKI Hungary /AI/ But only implantable heart pacemakers in AI directive Specialized in pacemakers Preparation and exchange information, and Preevaluating group In case of sole Classification of C.A. scope (NBGO), and Calculating the time interval of C.A. procedures product line of implantable heart Designating the members of C.A. group, and making a bid pacemaker, and Planning, performing, & Closure of C.A. procedure, and Decision about Conformity being a start-up, or Issuing, modifying, or supplementing certificates prior strategic Suspending, withdrawing, or constraining certificates partnership with Transparency and reproducibility of C.A. procedure EMKI C.A. Conformity Assessment

Identify Appropriate Directive AI Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Actively Functioning Quality Management System Identify Appropriate Classification within Directive (Annex IX) The Authorize Representative acts as a regulatory liaison between each Class I (non-sterile/ non-measuring) country's ministry of health (aka Competent Authorities) and the company. Class I (sterile/measuring) Class IIa Class IIb Class III Authorized Representative Function: Has access to technical files if review is requested by Competent Authorities Aids in Product Establish Registration Quality process Management Sys. Technical File- Class II Aids in Incident Reporting (Annex II, V, VII; ISO 13485:2003) Design Dossier- Class III Recall Notification Change Notification Essential Requirements (Annex I) Clinical Evaluation (Annex X) Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Class I devices require registration Translation of Documentation: User Manuals & Labels (23 languages) Place Product on the European Market Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Technical File Audit : $10-15k Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Quality System Audit: $3.5-4k Actively Functioning Quality Management System TOTAL Cost: ~$20,000 Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) Declaration of Conformity (Annex VII) Class I devices require registration Translation of Documentation: User Manuals & Labels (23 languages) Place Product on the European Market Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Conformity Assessment Procedure Options Based on Directive A Aa B C D E F G H Internal production control Intervention of a Notified Body EC type-examination Conformity to type Production quality assurance Product quality assurance Product verification Unit verification Full quality assurance

Notified Body s Roles within CEM Certification Identify the Directive (s) applicable to product Full Quality Assurance Examination of the Design Type Examination Verification Production and Product Quality Assurance Identify the conformity assessment procedure based on product & Directive Determine key milestones and actionable schedule Identify if there are any Harmonized European Standards Ensure product compliance with all the essential requirements of the Directive(s)

Notified Body s Roles within CEM Certification Full Quality Assurance Examination of the Design Type Examination Verification Production and Product Quality Assurance Identify whether independent assessment of conformity is required by NBs Maintain Technical Documentation required by the Directive(s) Prepare the Declaration of Conformity and the required supporting evidence Check that no other purely national requirements exist in the market country Affix CE marking on the product and/or packaging

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) Actively Functioning Quality Management System Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Class I devices require registration Translation of Documentation: User Manuals & Labels (23 languages) Place Product on the European Market Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Components: Class IIa Class IIb Class III Product identification Establish Quality Management Sys. Product classification (Annex II, V, VII; ISO 13485:2003) EU directives with which the product complies Standards used Actively Functioning Quality Management System Name of the Notified Body used The manufacturer's name and address Appoint Authorized Representative CE Mark certificate number (a.k.a. EC Rep) Signature on behalf of the manufacturer or EC Rep. Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Formal Notified Body Audit Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Clinical Evaluation (Annex X) Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Class I devices require registration Translation of Documentation: User Manuals & Labels (23 languages) Place Product on the European Market Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

Identify Appropriate Directive Identify Appropriate Classification within Directive (Annex IX) Class I (non-sterile/ non-measuring) Class I (sterile/measuring) AI Class IIa Class IIb Class III Strategically Select appropriate Notified Body - NB s area of expertise - Strategic partner s history with specific NBs Establish Quality Management Sys. (Annex II, V, VII; ISO 13485:2003) CE Mark is recognized by all 27 countries within the European Union (EU) as well as others in the region that are not necessarily part of the EU plus Canada, Australia, etc. around the globe Actively Functioning Quality Management System Appoint Authorized Representative (a.k.a. EC Rep) Formal Notified Body Audit Notified Body Issues CE Mark Certificate Declaration of Conformity (Annex VII) Place Product on the European Market Technical File- Class II Design Dossier- Class III Essential Requirements (Annex I) Translation of Documentation: User Manuals & Labels (23 languages) Clinical Evaluation (Annex X) Class I devices require registration Annual Notified Body Audits to maintain CE Mark certification Post Market Surveillance System must be in place Incident Reports must be filed Corrective & Preventative Action (CAPA)- part of QMS

EU Medical Device Classification & CE Mark Requirements Summary EU Class Class I (nonsterile/ nonmeasuring) Class I (sterile/ measuring) Class IIa Class IIb Class III Device Risk Low Low Medium Medium High Type of devices examination gloves surgical gloves, patient scales Natural Orifice Access; wound management; hearing devices, EKG, etc. Partial/Total Implantable; surgical lasers, ventilators Devices that affect vital organs; Life Support; heart valves Technical File Required Yes Yes, in the form of a Design Dossier Requires Full Quality System No Yes Requires NB Auditing No; Self declaration of conformity by manufacturer is acceptable Yes Requires Authorized Representative Yes Form of Clinical Evaluation Possible Scientific Literature Review Scientific Literature Review; Preclinical Work; Possible clinical trial Highly Likely that clinical trial is required Requires device to be Registered Yes No ; Notified Body conducts annual audits