Source: EURLEX
Language: en
Format: md

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# 52012PC0542

**Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL on medical devices, and amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 /\* COM/2012/0542 final - 2012/0266 (COD) \*/**

  

EXPLANATORY MEMORANDUM

1.
CONTEXT OF THE PROPOSAL

The current EU regulatory framework for
medical devices, other than in vitro diagnostic medical devices,
consists of Council Directive 90/385/EEC on active implantable medical devices
(AIMDD)[1] and Council Directive
93/42/EEC on medical devices (MDD)[2] which cover a huge
spectrum of products. The MDD divides them into four classes of risk: class I
(low risk, e.g. sticking plasters, corrective glasses), class IIa (medium-low
risk, e.g. tracheal tubes, dental filling material), class IIb (medium-high
risk, e.g. X-ray machines, bone plates and screws) and class III (high risk,
e.g. heart valves, total hip replacements, breast implants). Active implantable
medical devices (e.g. pacemakers, implantable defibrillators) covered by the
AIMDD fall de facto into class III.

The two Directives, adopted in the 1990s,
are based on the ‘New Approach’ and aim to ensure the smooth functioning of the
internal market and a high level of protection of human health and safety. Medical
devices are not subject to any pre-market authorisation by a regulatory
authority but to a conformity assessment which, for medium and high risk
devices, involves an independent third party, known as ‘notified body’.
Notified bodies, of which there are around 80 across Europe, are designated and
monitored by the Member States and act under the control of the national
authorities. Once certified, devices bear the CE marking which allows them to
circulate freely in the EU/EFTA countries and Turkey.

The existing regulatory framework has
demonstrated its merits but has also come under harsh criticism, in particular
after the French health authorities found that a French manufacturer (Poly
Implant Prothèse, PIP) had for several years apparently used industrial
silicone instead of medical grade silicone for the manufacture of breast
implants contrary to the approval issued by the notified body, causing harm to thousands
of women around the world.

In an internal market with 32 participating
countries[3] and subject to constant
technological and scientific progress, substantial divergences in the
interpretation and application of the rules have emerged, thus undermining the
main objectives of the Directives, i.e. the safety of medical devices and their
free movement within the internal market. Moreover, regulatory gaps or
uncertainties exist with regard to certain products (e.g. products manufactured
utilising non-viable human tissues or cells; implantable or other invasive
products for cosmetic purposes).

This revision aims to overcome these flaws
and gaps and to further strengthen patient safety. A robust, transparent and
sustainable regulatory framework should be put in place that is ‘fit for
purpose’. This framework should be supportive of innovation and the competitiveness
of the medical device industry and should allow rapid and cost-efficient market
access for innovative medical devices, to the benefit of patients and
healthcare professionals.

This proposal is adopted alongside a
proposal for a Regulation on in vitro diagnostic medical devices (IVDs),
such as blood tests, which are covered by Directive 98/79/EC of the European
Parliament and of the Council (IVDD)[4]. The horizontal aspects
that are common to both sectors are aligned whilst the specific features of each
sector require separate legal acts.

2.
RESULTS OF CONSULTATIONS WITH INTERESTED PARTIES AND
IMPACT ASSESSMENTS

In preparation for the impact assessment on
this proposal and the proposal for a Regulation on IVDs, the Commission held
two public consultations, the first from 8 May to 2 July 2008, and the second
from 29 June to 15 September 2010. In both public consultations, the general
principles and minimum standards for consultation of interested parties by the
Commission were applied; responses received within a reasonable period after
the deadlines were taken into account. After analysing all the responses, the
Commission published a summary outcome and the individual responses on its
website[5].

The majority of respondents to the 2008
public consultation (in particular Member States and industry) considered the
proposed revision to be premature. They pointed to Directive 2007/47/EC of the
European Parliament and of the Council[6], which amended the AIMDD
and the MDD and was to be implemented by 21 March 2010, and also to the New Legislative
Framework for the Marketing of Products which was due to enter into force with
effect from 1 January 2010, and argued that it would be advisable to wait for
these changes to be implemented, in order to assess the need for further
adjustments better.

The 2010 public consultation focussed on
aspects related to the revision of the IVDD and showed wide support for this
initiative, linked to the revision of the regulatory framework for medical
devices in general.

During 2009, 2010 and 2011, the issues to
be tackled in the revision of the regulatory framework for medical devices were
regularly discussed at meetings of the Medical Devices Expert Group (MDEG), the
Competent Authorities for Medical Devices (CAMD) and specific working groups in
the fields of notified bodies, borderline and classification, clinical
investigation and evaluation, vigilance, market surveillance, in vitro
diagnostics medical devices (IVD) and in an ad hoc working group on
Unique Device Identification (UDI). A special meeting of the MDEG was held on
31 March and 1 April 2011 to discuss issues related to the impact assessment.
Moreover, the Heads of Medicines Agencies (HMA) and the CAMD organised joint
workshops on the development of the legal framework for medical devices on 27
April and 28 September 2011.

A further special meeting of the MDEG was
held on 6 and 13 February 2012 to discuss issues related to the two legislative
proposals, based on working documents containing initial drafting proposals. Written
comments made on these working documents were taken in account for the further development
of the proposals.

In addition, the Commission’s
representatives regularly participated in conferences to present ongoing work
on the legislative initiative and hold discussions with stakeholders. Targeted
meetings took place at senior level with representatives from associations
representing industry, notified bodies, healthcare professionals and patients.

Aspects linked to the appropriate
regulatory framework were also discussed in the course of the ‘Exploratory
Process on the Future of the Medical Device Sector’ organised by the Commission
from November 2009 to January 2010. On 22 March 2011, the Commission and the
Hungarian Presidency organised a high-level conference on innovation in medical
technology, the role of the medical device sector in addressing the healthcare
challenges facing Europe and the appropriate regulatory framework for this
sector to meet the needs of tomorrow. This conference was followed by
Conclusions of the Council of the European Union on innovation in the medical
device sector adopted on 6 June 2011[7]. In its Conclusions, the
Council requested the Commission to adapt the EU medical device legislation to
the needs of tomorrow so as to achieve a suitable, robust, transparent and
sustainable regulatory framework, which is central to fostering the development
of safe, effective and innovative medical devices for the benefit of European
patients and healthcare professionals.

Triggered by the PIP breast implants
scandal, the European Parliament adopted on 14 June 2012 a Resolution on
defective silicone gel breast implants made by the French company PIP[8]
also calling on the Commission to develop an adequate legal framework to
guarantee the safety of medical technology.

3.
LEGAL ELEMENTS OF THE PROPOSAL
3.1.
Scope and definitions (Chapter I)

The scope of the proposed Regulation
corresponds to a large extent to the combined scopes of Council Directives
90/385/EEC and 93/42/EEC, i.e. it covers all medical devices other than in
vitro diagnostic medical devices. On the one hand, however, the scope is
extended to some products currently not covered by the AIMDD/MDD. And on the
other hand, some products which, in some Member States, are placed on the
market as medical devices are excluded from its scope.

The extension of the scope concerns:

·
products manufactured utilising non-viable human
tissues or cells, or their derivatives, that have undergone substantial
manipulation (e.g. syringes prefilled with human collagen), unless they are
covered by Regulation (EC) No 1394/2007 on advanced therapy medicinal products[9].
Human tissues and cells, or products derived from human tissues or cells, that are
not substantially manipulated and that are regulated by Directive 2004/23/EC of
the European Parliament and of the Council of 31 March 2004 on setting
standards of quality and safety for the donation, procurement, testing,
processing, preservation, storage and distribution of human tissues and cells[10]
are not covered by the proposal;

·
certain implantable or other invasive products
without a medical purpose that are similar to medical devices in terms of
characteristics and risk profile (e.g. non-corrective contact lenses, implants
for aesthetic purposes);

Additional provisions as regards products
that are not covered by the Regulation have been included, more to clarify the
scope with a view to ensuring harmonised implementation than to substantially
change the scope of the EU legislation. They concern:

·
products that contain or consist of viable
biological substances (e.g. living micro-organisms);

·
food covered by Regulation (EC) No 178/2002 on general principles and requirements of food law[11]
(e.g. this may affect certain slimming products); in return, medical devices
are excluded from the scope of Regulation 178/2002 (diagnostic probes or
cameras, even when introduced orally, are therefore clearly excluded from the
food legislation).

As regards products composed of substances
or combinations of substances that are intended to be ingested, inhaled or
administered rectally or vaginally and that are absorbed by or dispersed in the
human body, the borderline between medicinal products and medical devices is
difficult to draw. To ensure a high level of safety of those products regardless
of their qualification, those products which fall under the definition of a
medical device are classified in the highest risk class and should comply with
the relevant requirements of Annex I of Directive 2001/83/EC of the European
Parliament and of the Council of 6 November 2001 on the Community code relating
to medicinal products for human use[12].

To support Member States and the Commission
in determining the regulatory status of products, the Commission may set up, in
accordance with its internal rules[13], a group of experts from
various sectors (such as medical devices, IVDs, medicinal products, human
tissues and cells, cosmetics and biocides).

The definitions section has been
significantly extended, aligning the definitions in the field of medical devices
with well established European and international practice, such as the New
Legislative Framework for the Marketing of Products[14] and guidance documents produced by the
Global Harmonization Task Force (GHTF) for medical devices[15].

3.2.
Making available of devices, obligations of
economic operators, reprocessing, CE marking, free movement (Chapter II)

This chapter contains provisions that are
typical for product-related internal market legislation and sets out the
obligations of the relevant economic operators (manufacturers, authorised
representatives of non-EU manufacturers, importers and distributors). The
regulatory instrument of ‘common technical specification’ (CTS), which has proven
useful in the context of the IVDD, has been introduced in the broader field of
medical devices to allow the Commission to further specify the general safety
and performance requirements (laid down in Annex I) and the requirements on
clinical evaluation and post-market clinical follow-up (laid down in Annex
XIII). Such requirements however, leave manufacturers the possibility of adopting
other solutions that ensure at least an equivalent level of safety and
performance.

The legal obligations on manufacturers are
proportionate to the risk class of the devices they produce. For example, this
means that even though all manufacturers should have a quality management
system (QMS) in place to ensure that their products consistently meet the
regulatory requirements, the QMS-related responsibilities are stricter for
manufacturers of high risk devices than for manufacturers of low risk devices.
Manufacturers of medical devices for an individual patient, so called
‘custom-made devices’, must ensure that their devices are safe and perform as
intended, but their regulatory burden remains low.

Key documents for the manufacturer to
demonstrate compliance with the legal requirements are the technical
documentation and the EU declaration of conformity to be drawn up in respect of
devices placed on the market. Their minimum contents are laid down in Annexes
II and III.

The following concepts are also new in the
field of medical devices:

·
A requirement has been introduced that within
the manufacturer’s organisation a 'qualified person' should be responsible for
regulatory compliance. Similar requirements exist in EU legislation on
medicinal products and in the national laws transposing the AIMDD/MDD in some
Member States.

·
Since in the case of 'parallel trade' with
medical devices application of the principle of free movement of goods varies considerably
from one Member State to another and, in many cases, de facto prohibits
this practice, clear conditions are set for enterprises involved in relabelling
and/or repackaging medical devices.

·
Patients who are implanted with a device should be
given essential information on the implanted device allowing it to be
identified and containing any necessary warnings or precautions to be taken,
for example indication as to whether or not it is compatible with certain
diagnostic devices or with scanners used for security controls.

·
In accordance with Article 12a of the MDD,
introduced by Directive 2007/47/EC, the Commission had to prepare a report on
the reprocessing of medical devices and submit, where appropriate, a
legislative proposal on this issue. On the basis of the Commission's findings set
out in its report of 27 August 2010[16], which took into account
the opinion of the Scientific Committee on Emerging and Newly Identified Health
Risks (SCENIHR) of 15 April 2010, the proposal contains strict rules on the
reprocessing of single-use devices in order to ensure a high level of
protection of health and safety whilst allowing this practice to further
develop under clear conditions. Reprocessing of single-use devices is
considered as manufacture of new devices so that the reprocessors must satisfy
the obligations incumbent on manufacturers. The reprocessing of single-use
devices for critical use (e.g. devices for surgically invasive procedures) should,
as a general rule, be prohibited. Since certain Member States may have
particular concerns in terms of safety regarding the reprocessing of single-use
devices, they retain their right to maintain or impose a general ban on this
practice including the transfer of single-use devices to another Member State
or to a third country with a view to their reprocessing and on the access of
reprocessed single-use devices to their market.

3.3.
Identification and traceability of devices,
registration of devices and economic operators, summary of safety and clinical
performance, Eudamed (Chapter III)

This chapter addresses one of the main
shortcomings of the current system: its lack of transparency. It consists of:

·
a requirement that economic operators must be
able to identify who supplied them and to whom they have supplied medical
devices;

·
a requirement that manufacturers fit their
devices with a Unique Device Identification (UDI) which allows traceability.
The UDI system will be implemented gradually and proportionate to the risk
class of the devices;

·
a requirement that manufacturers/authorised
representatives and importers must register themselves and the devices they
place on the EU market in a central European database;

·
an obligation for manufacturers of high-risk
devices to make publicly available a summary of safety and performance with key
elements of the supporting clinical data;

·
and the further development of the European
databank on medical devices (Eudamed), set up by Commission Decision 2010/227/EU[17], which will contain integrated electronic systems on a European UDI, on
registration of devices, relevant economic operators and certificates issued by
notified bodies, on clinical investigations, on vigilance and on market
surveillance. A large part of the information in Eudamed will become publicly
available in accordance with the provisions regarding each electronic system.

The establishment of a central registration
database will not only provide a high level of transparency but also do away
with diverging national registration requirements which have emerged over
recent years and which have significantly increased compliance costs for
economic operators. It will therefore also contribute to reducing the
administrative burden on manufacturers.

3.4.
Notified bodies (Chapter IV)

Proper functioning of notified bodies is crucial for ensuring a high level of health and safety protection
and citizens' confidence in the system which has come
under severe criticism in recent years due to significant differences as
regards, on the one hand, the designation and monitoring of notified bodies
and, on the other, the quality and depth of the conformity assessment performed
by them, in particular in their assessment of the manufacturers' clinical
evaluation.

In line with the New Legislative Framework
for the Marketing of Products, the proposal sets out requirements for national
authorities responsible for notified bodies. It leaves the ultimate
responsibility for designating and monitoring notified
bodies, based on stricter and detailed criteria laid down in Annex VI, with the individual Member State. The proposal thus builds on
existing structures already available in most Member States instead of lifting
the responsibility to the Union level which might have caused concerns in terms
of subsidiarity. But any new designation and, in regular intervals, the
monitoring of notified bodies are made subject to ‘joint assessments’ with
experts from other Member States and the Commission, thus ensuring an effective control at Union level.

At the same time, the position of notified
bodies vis-à-vis manufacturers will be significantly strengthened, including
their right and duty to carry out unannounced factory inspections and to conduct
physical or laboratory tests on devices. The proposal also requires rotation of
the notified body's personnel involved in the assessment of medical devices at
appropriate intervals to strike a reasonable balance between the knowledge and
experience required to carry out thorough assessments and the need to ensure
continuous objectivity and neutrality in relation to the manufacturer subject
to those assessments.

3.5.
Classification and conformity assessment
(Chapter V)

The proposal keeps to the well established approach
(in Europe and internationally) of dividing medical devices into four classes,
taking account of the potential risks associated with the technical design and
manufacture. The classification rules (laid down in Annex VII) have been
adapted to technical progress and experience gained from vigilance and market
surveillance. For example, further to incidents that had occurred to blood plasma
donors and a request submitted by France, aphaeresis machines have been moved
from class IIb to class III. Active implantable medical devices and their
accessories have been classified in the highest risk class (class III) to
maintain the same level of safety as provided by Council Directive 90/385/EEC.

The classification of a medical device
determines the applicable conformity assessment procedure for which the
proposal follows the general lines of the AIMDD/MDD. The conformity assessment
procedure for class I devices can be carried out, as a general rule, under the
sole responsibility of the manufacturer in view of the low level of
vulnerability associated with these products. However, when class I devices
have a measuring function or are sold sterile, a notified body must verify the
aspects related to the measuring function or to the sterilisation process. For
devices of classes IIa, IIb and III, an appropriate level of involvement of a
notified body is compulsory proportionate to the risk class, with devices of
class III requiring explicit prior approval of the design or of the type of the
device and of the quality management system before they may be placed on the
market. In the case of class IIa and IIb devices, the notified body checks the
quality management system and, for representative samples, the technical
documentation. After initial certification, notified bodies must regularly
conduct surveillance assessments in the post-market phase.

The different conformity assessment procedures
during which the notified body audits the manufacturer's quality management
system, checks the technical documentation, examines the design dossier or approves
the type of a device are laid down in Annexes VIII to X. They have been tightened
and streamlined. The proposal reinforces the powers and responsibilities of
notified bodies and specifies the rules according to which notified bodies
perform their assessments, both in the pre-market and the post-market phase (e.g.
documentation to be submitted, scope of the audit, unannounced factory
inspections, sample checks) to ensure a level playing field and avoid notified
bodies being overly lenient. Manufacturers of custom-made devices continue to be
subject to a specific procedure (laid down in Annex XI) which does not involve
a notified body.

In addition, the proposal introduces the
obligation for notified bodies to notify an expert committee (see below under
3.8.) of new applications for conformity assessment of high-risk devices. On
scientifically valid health grounds, the expert committee will have the power
to request the notified body to submit a preliminary assessment on which the
committee can issue comments within a deadline of 60 days[18],
before the notified body can issue a certificate. This scrutiny mechanism
empowers the authorities to have a 'second look' at individual assessments and
make their views heard before a device is placed on the market. A similar
procedure is currently already applied for medical devices manufactured
utilising animal tissues (Commission Directive 2003/32/EC[19]).
Its use should be the exception rather than the rule and should follow clear
and transparent criteria.

3.6.
Clinical evaluation and clinical investigations
(Chapter VI)

Building on the current Annex X of the MDD,
this chapter lays down the key obligations of manufacturers as regards the
performance of the clinical evaluation needed to demonstrate the safety and
performance of their devices. More detailed requirements are set out in Annex
XIII which addresses the pre-market clinical evaluation and post-market
clinical follow-up that together constitute a continuous process during the
life cycle of a medical device.

The process for conducting clinical
investigations (the equivalent of clinical trials in the field of medicinal
products), which is currently described in basic terms in Article 15 of the MDD,
is further developed. First of all, the concept of ‘sponsor’ is introduced and
aligned with the definition used in the recent Commission's Proposal for a
Regulation of the European Parliament and of the Council on clinical trials on
medicinal products for human use which aims at repealing Directive 2001/20/EC[20].

The sponsor can be the manufacturer, his
authorised representative or another organisation, in practice often a ‘contract
research organisation’ conducting clinical investigations for the manufacturers.
The scope of the proposal, however, remains restricted to clinical
investigations carried out for regulatory purposes, i.e. for obtaining or
confirming regulatory approval for market access. Non-commercial clinical
investigations that do not pursue a regulatory purpose are not covered by this
Regulation.

In accordance with recognised international
ethical principles, every clinical investigation must be registered in a
publicly accessible electronic system which the Commission will set up. To
ensure synergies with the area of clinical trials on medicinal products, the electronic
system on clinical investigations on medical devices should be interoperable
with the future EU database to be set up in accordance with the future Regulation
on clinical trials on medicinal products for human use.

Before commencing a clinical investigation,
the sponsor must submit an application to confirm that there are no health and
safety or ethical aspects which would oppose it. A new possibility will be
opened up for sponsors of clinical investigations to be
conducted in more than one Member State: in future, they may submit a single
application through the electronic system to be set up by the Commission. As a
consequence, the health and safety aspects regarding the device intended for
clinical investigation will be assessed by the Member States concerned under
the direction of a coordinating Member State. The assessment of intrinsically
national, local and ethical aspects (e.g. liability, suitability of the
investigators and investigation sites, informed consent) will, however, need to
be carried out at the level of each Member State concerned which will retain
the ultimate responsibility for deciding whether the clinical investigation may
be conducted on its territory. In line with the above-mentioned Commission's Proposal
for a Regulation on clinical trials on medicinal products, also this proposal
leaves it to the Member States to define the organisational set-up at national
level for the approval of clinical investigations. In other words, it moves
away from a legally required dualism of two distinct bodies, i.e. a national
competent authority and an ethics committee.

3.7.
Vigilance and market surveillance (Chapter VII)

A well functioning vigilance system is the
'backbone' of a robust regulatory framework in this sector because
complications with medical devices that are designed to be implanted or to operate
for many years or even decades might come to light only after a certain period
of time. The main progress which the proposal will bring in this field is the
introduction of an EU portal where manufacturers must report serious incidents and
corrective actions they have taken to reduce the risk of recurrence. The
information will be automatically forwarded to the national authorities
concerned. Where the same or similar incidents have occurred, or where a
corrective action has to be taken, in more than one Member State, a
coordinating authority will take the direction in coordinating the analysis of
the case. The emphasis is placed on work- and expertise-sharing to avoid
inefficient duplication of procedures.

As regards market surveillance, the main
objectives of the proposal are to reinforce the rights and obligations of the
national competent authorities, to ensure effective coordination of their
market surveillance activities and to clarify the applicable procedures.

3.8.
Governance (Chapters VIII and IX)

The Member States will be responsible for
implementation of the future Regulation. A central role in achieving harmonised
interpretation and practice will be assigned to an expert committee (the Medical
Device Coordination Group or MDCG) made up of members appointed by the Member
States due to their role and experience in the field of medical devices and
chaired by the Commission. The MDCG and its subgroups will allow to build a
forum for discussions with stakeholders. The proposal creates the legal basis
that for specific hazards or technologies EU reference laboratories, a concept
that has proven successful in the food sector, may in the future be designated
by the Commission.

As regards the management at EU level, the impact
assessment identified as preferred policy options either the extension of the
responsibility of the European Medicines Agency (EMA) to medical devices or the
management of the medical devices regulatory system by the Commission. Taking
into account the clear preference expressed by stakeholders, including many
Member States, the proposal mandates the Commission to provide technical, scientific
and logistic support to the MDCG.

3.9.
Final provisions (Chapter X)

The proposal empowers the Commission to
adopt, where appropriate, either implementing acts to ensure uniform
application of the Regulation or delegated acts to complement the regulatory
framework for medical devices over time.

With this proposal, other Union legislation
is amended where a link exists with medical devices. In the case of medicinal product/medical device combination products that are
regulated under Directive 2001/83/EC, the AIMDD and MDD already require the
device part to comply with the applicable essential requirements set out in the
medical device legislation. However, compliance with this requirement is not currently
verified as part of the authorisation process for the medicinal product. Annex
I of Directive 2001/83/EC, which lays down the content of an application for marketing
authorisation, is therefore amended to require the applicant to submit evidence
(e.g. an EU declaration of conformity or a certificate issued by a notified
body) that the device part is in conformity with the applicable general safety
and performance requirements of the future Regulation on medical devices.

Regulation (EC) No 1223/2009 of the
European Parliament and of the Council of 30 November 2009 on cosmetic products[21]
is amended to empower the Commission to determine whether or not a product
falls within the definition of a cosmetic product. Such possibility already
exists in the AIMDD and the MDD and is kept in this proposal. It also exists in
the new Regulation (EU) No 528/2012 of the European Parliament and of the
Council of 22 May 2012 concerning the making available on the market and use of
biocidal products[22]. This will facilitate
the adoption of EU-wide decisions regarding 'borderline' cases where the
regulatory status of a product needs to be clarified.

The Food Regulation 178/2002 is amended to
exclude medical devices from its scope (see 3.1. above).

The new Regulation will become applicable
three years after its entry into force to allow manufacturers, notified bodies
and Member States time to adapt to the new requirements. The Commission needs
time to put in place the IT infrastructure and the organisational arrangements necessary
for the functioning of the new regulatory system. The designation of notified
bodies pursuant to the new requirements and process needs to start shortly
after the entry into force of the Regulation in order to ensure that by the
date of its application, sufficient notified bodies are designated in
accordance with the new rules to avoid any shortage of medical devices on the
market. Special transitional provisions are foreseen for the registration of
medical devices, relevant economic operators and certificates issued by
notified bodies to allow for a smooth transition from registration requirements
at national level to a central registration at EU level.

The future Regulation replaces and repeals Council
Directives 90/385/EEC and 93/42/EEC.

3.10.
Union competence, subsidiarity and legal form

The proposal has a ‘double legal basis‘,
i.e. Article 114 and Article 168(4)(c) of the Treaty on the Functioning of the
European Union (TFEU). With the entry into force of the Lisbon Treaty, the
legal base for the establishment and functioning of the internal market, on
which the current Medical Devices Directives were adopted, has been
complemented by a specific legal basis to set high standards for the quality
and safety of devices for medical use. In regulating medical devices, the Union
is exercising its shared powers under Article 4(2) of the TFEU.

Under the current Medical Devices Directives,
devices that bear the CE marking can, in principle, move freely within the EU.
The proposed revision of the existing directives, which will integrate the changes
introduced by the Lisbon Treaty regarding public health, can be achieved only at
Union level. This is necessary in order to improve the level of protection of
public health for all European patients and users, and also to prevent Member
States from adopting diverging product regulations which would result in
further fragmentation of the internal market. Harmonised rules and procedures
allow manufacturers, especially SMEs which make up more than 80% of the sector,
to reduce costs related to national regulatory differences, while ensuring a
high and equal level of safety throughout the Union. In
accordance with the principles of proportionality and subsidiarity, as set out
in Article 5 of the Treaty on European Union, this proposal does not go beyond
what is necessary in order to achieve those objectives.

The proposal takes the form of a Regulation.
This is the appropriate legal instrument as it imposes clear and detailed rules
which will become applicable in a uniform manner and at the same time
throughout the Union. Diverging transposition of the AIMDD
and MDD by Member States has led to different levels of
health and safety protection and created obstacles to the internal market which
only a Regulation can avoid. Replacing the national
transposition measures also has a strong simplification effect since it allows
economic operators to conduct their business on the basis of a single regulatory
framework, rather than a 'patchwork' of 27 national laws.

The choice of a Regulation, however, does
not mean that decision-making is centralised. Member States retain their
competence for implementing the harmonised rules, e.g. as regards approval of
clinical investigations, the designation of notified bodies, the assessment of vigilance
cases, the conduct of market surveillance and enforcement action (e.g.
penalties).

3.11.
Fundamental Rights

In line with the Charter of Fundamental
Rights of the EU, this proposal seeks to ensure a high level of human health
protection (Article 35 of the Charter) and consumer protection (Article 38) by
assuring a high level of safety of medical devices made available on the Union
market. The proposal affects the freedom of economic operators to conduct
business (Article 16) but the obligations imposed on manufacturers, authorised
representatives, importers and distributors of medical devices are necessary to
guarantee a high level of safety of those products.

The proposal sets guarantees for the
protection of personal data. In respect to medical research, the proposal
requires that any clinical investigation with participation of human subjects
is conducted respecting the human dignity, the right to physical and mental
integrity of the persons concerned and the principle of free and informed
consent, as required by Articles 1, 3(1) and 3(2)(a) of the Charter.

4.
BUDGETARY IMPLICATIONS

The budgetary implications of this proposal
are as follows:

·
Costs for the further development of the Eudamed
databank (one-off costs and maintenance);

·
Commission staff to organise and participate in
'joint assessments' of notified bodies;

·
Costs for national assessors participating in
'joint assessments' of notified bodies in accordance with the Commission's
rules on the reimbursement of expenses incurred by experts;

·
Commission staff to provide scientific,
technical and logistic support to the MDCG, to its sub-groups and to the
coordinating Member States in the fields of clinical investigations and
vigilance;

·
Commission staff to manage and further develop
the EU regulatory framework for medical devices (functioning of this Regulation
and preparation of delegated/implementing acts) and to support Member States in
ensuring its effective and efficient implementation;

·
Costs for organising meetings of the MDCG and
its sub-groups and of the Committee under Regulation 182/2011, including
reimbursement of their members, appointed by the Member States, to ensure a
high level of coordination between Member States;

·
Costs for the establishment and management of the
scrutiny mechanism in respect of conformity assessments by notified bodies for
high risk devices, including the technical infrastructure for data-exchange;

·
Costs for running EU reference laboratories when
these are designated;

·
Costs for participation in international
regulatory cooperation.

Details of the costs are set out in the
legislative financial statement. A thorough discussion on the costs is
contained in the impact assessment report.

2012/0266 (COD)

Proposal for a

REGULATION OF THE EUROPEAN PARLIAMENT
AND OF THE COUNCIL

on medical devices, and amending Directive
2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009

(Text with EEA relevance)

THE EUROPEAN PARLIAMENT AND THE
COUNCIL OF THE EUROPEAN UNION,

Having regard to the Treaty on the
Functioning of the European Union, and in particular Article 114 and Article 168(4)(c)
thereof,

Having regard to the proposal from the
European Commission,

After transmission of the draft legislative
act to the national Parliaments,

Having regard to the opinion of the European
Economic and Social Committee[23],

Having regard to the opinion of the
Committee of the Regions[24],

After consulting the
European Data Protection Supervisor[25],

Acting in accordance with the ordinary
legislative procedure,

Whereas:

(1)
Council Directive 90/385/EEC of 20 June 1990 on
the approximation of the laws of the Member States relating to active
implantable medical devices[26] and Council Directive
93/42/EEC of 14 June 1993 concerning medical devices[27]
constitute the Union regulatory framework for medical devices, other than in
vitro diagnostic medical devices. However, a fundamental revision of those
Directives is needed to establish a robust, transparent, predictable and sustainable regulatory framework for
medical devices which ensures a high level of safety and health whilst supporting
innovation.

(2)
This Regulation aims to ensure the functioning
of the internal market as regards medical devices, taking as a base a high
level of protection of health. At the same time, this Regulation sets high
standards of quality and safety for medical devices to meet common safety
concerns as regards these products. Both objectives are being pursued
simultaneously and are inseparably linked whilst one not being secondary to the
other. As regards Article 114 TFEU, this Regulation harmonises the rules for
the placing on the market and putting into service of medical devices and their
accessories on the Union market which may then benefit from the principle of
free movement of goods. As regards Article 168(4)(c) TFEU, this Regulation sets
high standards of quality and safety for those medical devices by ensuring,
among other things, that data generated in clinical investigations is reliable
and robust and that the safety of the subjects participating in a clinical
investigation is protected.

(3)
Key elements of the existing regulatory
approach, such as the supervision of notified bodies, conformity assessment
procedures, clinical investigations and clinical evaluation, vigilance and
market surveillance should be significantly reinforced, whilst provisions
ensuring transparency and traceability regarding devices should be introduced,
to improve health and safety.

(4)
To the extent possible, guidance developed for
medical devices at international level, in particular in the context of the Global
Harmonization Task Force (GHTF) and its follow-up initiative the International
Medical Devices Regulators Forum, should be taken into account to promote the
global convergence of regulations which contributes to a high level of safety
protection worldwide and to facilitate trade, in particular in the provisions
on Unique Device Identification, general safety and performance requirements,
technical documentation, classification criteria, conformity assessment
procedures and clinical investigations.

(5)
For historic reasons active implantable medical
devices, covered by Directive 90/385/EEC, and other medical devices, covered by
Directive 93/42/EEC, were regulated in two separate legal instruments. In the
interest of simplification, both directives, which have been amended several
times, should be replaced by a single legislative act applicable to all medical
devices other than in vitro diagnostic medical devices.

(6)
A Regulation is the appropriate legal instrument
as it imposes clear and detailed rules which do not give room for divergent
transposition by Member States. Moreover, a Regulation ensures that legal
requirements are implemented at the same time throughout the Union.

(7)
The scope of application of this Regulation
should be clearly delimited from other Union harmonisation legislation
concerning products, such as in vitro diagnostic medical devices,
medicinal products, cosmetics and food. Therefore,
Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28
January 2002 laying down the general principles and
requirements of food law, establishing the European Food Safety Authority and
laying down procedures in matters of food safety[28]
should be amended to exclude medical devices from its scope.

(8)
It should be the responsibility of the Member
States to decide on a case-by-case basis whether or not a product falls within
the scope of this Regulation. If necessary, the Commission may decide, on a
case-by-case basis, whether or not a product falls within the definition of a
medical device or of an accessory to a medical device. Since in some cases it
is difficult to distinguish between medical devices and cosmetic products, the
possibility to take an EU-wide decision regarding the regulatory status of a
product should also be introduced in Regulation No 1223/2009 of the European
Parliament and of the Council of 30 November 2009 on cosmetic products[29].

(9)
Products which combine a medicinal product or
substance and a medical device, are regulated either under this Regulation or
under Directive 2001/83/EC of the European Parliament and of the Council of 6
November 2001 on the Community code relating to medicinal products for human
use[30]. It should be ensured
that appropriate interaction exists between the two legislative acts in terms
of consultations during the pre-market assessment and exchange of information
on vigilance cases occurring with combination products. For medicinal products
that integrate a medical device part, compliance with the general safety and
performance requirements of the device part should be adequately assessed in
the context of the marketing authorisation. Directive 2001/83/EC should
therefore be amended.

(10)
Union legislation is incomplete in respect of certain products manufactured utilising non-viable human tissues or cells
that have undergone substantial manipulation and that are not covered by
Regulation (EC) No 1394/2007 of the European Parliament and of the Council of
13 November 2007 on advanced therapy medicinal products and amending Directive
2001/83/EC and Regulation (EC) No 726/2004[31]. Whilst
donation, procurement and testing of the human tissues and cells used for the
manufacture of those products should remain within the scope of Directive
2004/23/EC of the European Parliament and of the Council of 31 March 2004 on
setting standards of quality and safety for the donation, procurement, testing,
processing, preservation, storage and distribution of human tissues and cells[32],
the finished product should come under the scope of this Regulation. Human
tissues and cells that are not substantially manipulated, such as human
demineralised bone matrix, and products derived from such tissues and cells, should
not be covered by this Regulation.

(11)
Certain implantable and
other invasive products for which the manufacturer claims only an aesthetic or
another non-medical purpose but which are similar to medical devices in terms
of functioning and risks profile should be covered by this Regulation.

(12)
Like for products that contain viable tissues or
cells of human or animal origin, that are explicitly excluded from Directives
90/385/EEC and 93/42/EEC and hence from this Regulation, it should be clarified
that products that contain living biological substances of other origin are
also not covered by this Regulation.

(13)
There is scientific uncertainty about the risks
and benefits of nanomaterials used for medical devices. In order to ensure a
high level of health protection, free movement of goods and legal certainty for
manufacturers, it is necessary to introduce a uniform definition for
nanomaterials based on Commission Recommendation 2011/696/EU of 18 October 2011
on the definition of nanomaterial[33], with the necessary
flexibility to adapt this definition to scientific and technical progress and
subsequent regulatory development at Union and international level. In the
design and manufacture of medical devices, the manufacturers should take
special care when using nanoparticles that can be released to the human body
and those devices should be subject to the most severe conformity assessment
procedure.

(14)
Aspects addressed by Directive 2004/108/EC of
the European Parliament and of the Council of 15 December 2004 on the
approximation of the laws of the Member States relating to electromagnetic
compatibility and repealing Directive 89/336/EEC[34]
and aspects addressed by Directive 2006/42/EC of the European Parliament and of
the Council of 17 May 2006 on machinery and amending Directive 95/16/EC[35]
are an integral part of the general safety and performance requirements for
medical devices. Consequently, this Regulation should be considered a lex
specialis in relation to those Directives.

(15)
This Regulation should include requirements
regarding the design and manufacture of medical devices emitting ionizing
radiation without affecting the application of Council Directive 96/29/Euratom
of 13 May 1996 laying down basic safety standards for the protection of the
health of workers and the general public against the dangers arising from ionising
radiation[36] nor of Council Directive
97/43/Euratom of 30 June 1997 on health protection of individuals against the
dangers of ionizing radiation in relation to medical exposure and repealing
Directive 84/466/Euratom[37] which pursue other
objectives.

(16)
It should be made clear that the requirements of
this Regulation also apply to the countries that have entered into international
agreements with the Union which confer on that country the same status as a
Member State for the purpose of application of this Regulation, as it is
currently the case with the Agreement on the European Economic Area[38],
the Agreement between the European Community and the Swiss Confederation on mutual
recognition in relation to conformity assessment[39]
and the Agreement of 12 September 1963 establishing an association between the
European Economic Community and Turkey[40].

(17)
It should be made clear that medical devices
offered to persons in the Union by means of information society services within
the meaning of Directive 98/34/EC of the European Parliament and of the Council
of 22 June 1998 laying down a procedure for the provision of information in the
field of technical standards and regulations[41] as well as
devices used in the context of a commercial activity to provide a diagnostic or
therapeutic service to persons within the Union must comply with the
requirements of this Regulation at the latest when the product is placed on the
market or the service is provided in the Union.

(18)
It is appropriate to adapt the general safety
and performance requirements to technical and scientific progress, for example
for software that is specifically intended by the
manufacturer to be used for one or more of the medical purposes set out in the
definition of a medical device.

(19)
To recognise the important role of
standardisation in the field of medical devices, compliance with harmonised standards
as defined in Regulation (EU) No […/…] on European standardisation[42]
should be a means for manufacturers to demonstrate conformity with the general
safety and performance requirements and other legal requirements, such as
quality and risk management.

(20)
Directive 98/79/EC of the European Parliament
and of the Council of 27 October 1998 on in vitro diagnostic medical
devices[43] allows the Commission to
adopt common technical specifications for specific categories of in vitro
diagnostic medical devices. In areas where no harmonised standards exist or
where they are not sufficient, the Commission should be empowered to lay down
technical specifications which provide a means to comply with general safety
and performance requirements and requirements for clinical evaluation and/or
post-market clinical follow-up.

(21)
The definitions in the field of medical devices,
for example regarding economic operators, clinical investigations and
vigilance, should be aligned with well-established practice at Union and
international level in order to enhance legal certainty.

(22)
The rules applicable to medical devices should
be aligned, where appropriate, with the New Legislative Framework for the
Marketing of Products, which consists of Regulation (EC)
No 765/2008 of the European Parliament and of the Council of 9 July 2008 setting out the requirements for
accreditation and market surveillance relating to the marketing of products and
repealing Regulation (EEC) No 339/93[44] and Decision No 768/2008/EC of the European Parliament and of the
Council of 9 July 2008 on a
common framework for the marketing of products, and repealing Council Decision
93/465/EEC[45].

(23)
The rules on Union market surveillance and
control of products entering the Union market provided for in Regulation (EC) No 765/2008 apply to medical devices and their accessories
covered by this Regulation which does not prevent Member States from choosing
the competent authorities to carry out those tasks.

(24)
It is appropriate to set out clearly the general
obligations of the different economic operators, including importers and
distributors as laid down in the New Legislative Framework for the Marketing of
Products, without prejudice to the specific obligations laid down in the
different parts of this Regulation, to enhance understanding of the legal
requirements and thus to improve regulatory compliance by the relevant
operators.

(25)
Several of the obligations on manufacturers,
such as clinical evaluation or vigilance reporting, that were set out only in
the annexes of Directives 90/385/EEC and 93/42/EEC should be incorporated into
the enacting provisions of this Regulation to enhance legal certainty.

(26)
To ensure that medical devices manufactured in
series production continue to be in conformity with the requirements of this
Regulation and that experience from the use of their medical devices is taken
into account for the production process, all manufacturers should have a
quality management system and a post-market surveillance plan in place which
should be proportionate to the risk class and the type of the medical device.

(27)
It should be ensured that supervision and
control of the manufacture of medical devices is carried out within the
manufacturer's organisation by
a person who fulfils minimum conditions of
qualification.

(28)
For manufacturers who are not established in the
Union, the authorised representative plays a pivotal role in ensuring the
compliance of the medical devices produced by those manufacturers and in
serving as their contact person established in the Union. The tasks of an authorised
representative should be defined in a written mandate with the manufacturer
which for example may allow the authorised representative to lodge an
application for a conformity assessment procedure, to report events under the
vigilance system or to register devices placed on the Union market. The mandate
should empower the authorised representative to duly fulfil certain defined tasks.
Considering the role of authorised representatives, the minimum requirements to
be met by them should be clearly defined, including the requirement of having
available a person who fulfils minimum conditions of qualification which should
be similar to those for a manufacturer's qualified person but, with a view to
the authorised representative's tasks, could also be satisfied by a person with qualification in law.

(29)
To ensure legal certainty in respect of the
obligations incumbent on economic operators, it is necessary to clarify when a
distributor, importer or other person is to be considered the manufacturer of a
medical device.

(30)
Parallel trade in products already placed on the
market is a lawful form of trade within the internal market on the basis of
Article 34 TFEU subject to the limitations set by the protection of health and
safety and by the protection of intellectual property rights provided by
Article 36 TFEU. Application of this principle is, however, subject to
different interpretations in the Member States. The conditions, in particular
the requirements for relabelling and repackaging, should therefore be specified
in this Regulation, taking into account the case-law of the European Court of
Justice[46] in other relevant
sectors and existing good practices in the field of medical devices.

(31)
The findings of the Scientific Committee on
Emerging and Newly Identified Health Risks (SCENIHR), established
by Commission Decision 2008/721/EC of 5 August 2008 setting up an advisory
structure of Scientific Committees and experts in the field of consumer safety,
public health and the environment and repealing Decision 2004/210/EC[47], in its scientific opinion of 15 April 2010 on the safety of
reprocessed medical devices marketed for single-use, and of the Commission in
its report of 27 August 2010 to the European Parliament and the Council on the
issue of reprocessing of medical devices in the European Union, in accordance
with Article 12a of Directive 93/42/EEC[48], call for
regulation of the reprocessing of single-use devices in order to ensure a high
level of protection of health and safety whilst allowing this practice to
further develop under clear conditions. By reprocessing a single-use device its intended purpose is modified and the reprocessor should
therefore be considered the manufacturer of the reprocessed device.

(32)
Patients who are implanted with a device should be
given essential information related to the implanted device allowing it to be
identified and containing any necessary warnings or precautions to be taken,
for example indications as to whether or not it is compatible with certain
diagnostic devices or with scanners used for security controls.

(33)
Medical devices should, as a general rule, bear
the CE marking to indicate their conformity with this Regulation so that they
can move freely within the Union and be put into service in accordance with
their intended purpose. Member States should not create obstacles to their
placing on the market or putting into service for reasons related to the
requirements laid down in this Regulation.

(34)
The traceability of medical devices by means of
a Unique Device Identification (UDI) system based on international guidance should
significantly enhance the effectiveness of the post-market safety of medical
devices due to improved incident reporting, targeted field safety corrective
actions and better monitoring by competent authorities. It should also help to
reduce medical errors and to fight against counterfeit devices. Use of the UDI
system should also improve purchase-policy and stock-management by hospitals.

(35)
Transparency and better information are essential
to empower patients and healthcare professionals and to enable them to make
informed decisions, to provide a sound basis for regulatory decision-making and
to build confidence in the regulatory system.

(36)
One key aspect is the creation of a central
database that should integrate different electronic systems, with the UDI as an
integral part of it, to collate and process information regarding medical
devices on the market and the relevant economic operators, certificates,
clinical investigations, vigilance and market surveillance. The objectives of
the database are to enhance overall transparency, to streamline
and facilitate the flow of information between economic operators, notified
bodies or sponsors and Member States as well as between Member States among
themselves and with the Commission, to avoid multiple reporting requirements
and to enhance the coordination between Member States. Within
an internal market, this can be ensured effectively only at Union level and the
Commission should therefore further develop and manage the European databank on
medical devices (Eudamed) set up by Commission Decision 2010/227/EU of 19 April
2010 on the European Databank for Medical Devices[49].

(37)
Eudamed's electronic systems regarding devices
on the market, the relevant economic operators and certificates should enable
the public to be adequately informed about devices on the Union market. The
electronic system on clinical investigations should serve as tool for the
cooperation between Member States and for enabling sponsors to submit, on a
voluntary basis, a single application for several Member States and, in this
case, to report serious adverse events. The electronic system on vigilance
should enable manufacturers to report serious incidents and other reportable
events and to support the coordination of their assessment by national
competent authorities. The electronic system regarding market surveillance
should be a tool for the exchange of information between competent authorities.

(38)
In respect of data collated and processed
through the electronic systems of Eudamed, Directive 95/46/EC of the European
Parliament and of the Council of 24 October 1995 on the protection of
individuals with regard to the processing of personal data and on the free
movement of such data[50] applies to the
processing of personal data carried out in the Member States, under the
supervision of the Member States competent authorities, in particular the
public independent authorities designated by the Member States. Regulation (EC)
No 45/2001 of the European Parliament and of the Council of 18 December 2000 on
the protection of individuals with regard to the processing of personal data by
the Community institutions and bodies and on the free movement of such data[51]
applies to the processing of personal data carried out by the Commission within
the framework of this Regulation, under the supervision of the European Data
Protection Supervisor. In
accordance with Article 2(d) of Regulation (EC) No 45/2001, the Commission
should be designated as the controller of Eudamed and its electronic systems.

(39)
For high-risk medical devices, manufacturers
should summarise the main
safety and performance aspects of the device and the outcome of the clinical
evaluation in a document that should be publicly available.

(40)
The proper functioning of notified bodies is crucial
for ensuring a high level of health and safety protection and citizens'
confidence in the system. Designation and monitoring of notified bodies by the
Member States, in accordance with detailed and strict criteria, should
therefore be subject to controls at Union level.

(41)
The position of notified bodies vis-à-vis
manufacturers should be strengthened, including their right and duty to carry
out unannounced factory inspections and to conduct physical or laboratory tests
on medical devices to ensure continuous compliance by manufacturers after
receipt of the original certification.

(42)
For high risk medical devices, authorities
should be informed at an early stage about devices which are subject to
conformity assessment and be given the right, on scientifically valid grounds, to
scrutinise the preliminary
assessment conducted by notified bodies, in particular
regarding novel devices, devices for which a novel technology is being used,
devices belonging to a category of devices with increased serious incident rates,
or devices for which significant discrepancies in the conformity assessments by
different notified bodies have been identified in respect of substantially similar
devices. The process foreseen in this Regulation does
not prevent a manufacturer from informing voluntarily a competent authority of his
intention to file an application for conformity assessment for a high risk
medical device before submitting the application to the notified body.

(43)
It is necessary, in particular for the purpose
of the conformity assessment procedures, to maintain the division of medical devices
into four product classes in line with international practice. The
classification rules, which are based on the vulnerability of the human body
taking into account the potential risks associated with the technical design
and manufacture of the devices, need to be adapted to technical progress and
experience gained from vigilance and market surveillance. To maintain the same
level of safety as provided by Directive 90/385/EEC, active implantable medical
devices and their accessories should be in the highest risk class.

(44)
The conformity assessment procedure for class I
devices should be carried out, as a general rule, under the sole responsibility
of the manufacturers in view of the low level of vulnerability associated with
these products. For medical devices in classes IIa, IIb and III, an appropriate
level of involvement of a notified body should be compulsory, with medical devices
in class III requiring explicit prior approval of their design and manufacture before
they can be placed on the market.

(45)
The conformity assessment procedures should be
simplified and streamlined whilst the requirements for notified bodies as
regards the performance of their assessments should be clearly specified to
ensure a level playing field.

(46)
To ensure a high level of safety and
performance, demonstration of compliance with the general safety and
performance requirements should be based on clinical data that, for class III medical
devices and implantable medical devices should, as a general rule, be sourced
from clinical investigations to be carried out under the responsibility of a
sponsor who can be the manufacturer or another legal or natural person taking
responsibility for the clinical investigation.

(47)
The rules on clinical investigations should be in
line with major international guidance in this field, such as the international
standard ISO 14155:2011 on good clinical practice for clinical investigations
of medical devices for human subjects and the most recent (2008) version of the
World Medical Association Declaration of Helsinki on Ethical Principles for
Medical Research Involving Human Subjects to ensure that clinical
investigations conducted in the Union are accepted elsewhere and that clinical
investigations conducted outside the Union in accordance with international
guidelines can be accepted under this Regulation.

(48)
An electronic system should be set up at Union
level to ensure that every clinical investigation is registered in a publicly
accessible database. To protect the right to the protection of personal data,
recognised by Article 8 of the Charter of Fundamental Rights of the European
Union, no personal data of subjects participating in a clinical investigation
should be recorded in the electronic system. To ensure synergies with the area
of clinical trials on medicinal products, the electronic system on clinical
investigations on medical devices should be interoperable with the EU database
to be set up for clinical trials on medicinal products for human use.

(49)
Sponsors of clinical investigations to be
conducted in more than one Member State should be given the possibility to
submit a single application in order to reduce administrative burden. In order
to allow for resource-sharing and to ensure consistency regarding the
assessment of the health and safety related aspects of the investigational
device and of the scientific design of the clinical investigation to be
conducted in several Member Stats, such single application should facilitate
the coordination between the Member States under the direction of a
coordinating Member State. The coordinated assessment should not include the
assessment of intrinsically national, local and ethical aspects of a clinical
investigation, including informed consent. Each Member State should retain the
ultimate responsibility for deciding whether the clinical investigation may be
conducted on its territory.

(50)
Sponsors should report certain adverse events
occurring during clinical investigations to the Member States concerned, which
should have the possibility to terminate or suspend the investigations if
considered necessary to ensure a high level of protection of the subjects
enrolled in a clinical investigation. Such information should be communicated
to the other Member States.

(51)
This Regulation should only cover clinical
investigations which pursue regulatory purposes laid down in this Regulation.

(52)
In order to better protect health and safety
regarding devices on the market, the vigilance system for medical devices should
be made more effective by creating a central portal at Union level for
reporting serious incidents and field safety corrective actions.

(53)
Healthcare professionals and patients should be
empowered to report suspected serious incidents at national level using
harmonised formats. The national competent authorities should inform
manufacturers and share the information with their peers when they confirm that
a serious incident has occurred in order to minimise recurrence of those
incidents.

(54)
The assessment of reported serious incidents and field safety corrective actions should be conducted
at national level but coordination should be ensured where similar incidents
have occurred or field safety corrective actions have to be carried out in more
than one Member State with the objective of sharing resources and ensuring
consistency regarding the corrective action.

(55)
The reporting of serious adverse events during clinical
investigations and the reporting of serious incidents occurring after a medical
device has been placed on the market should be clearly distinguished to avoid
double reporting.

(56)
Rules on market surveillance should be included
in this Regulation to reinforce the rights and obligations of the national
competent authorities, to ensure effective coordination of their market
surveillance activities and to clarify the applicable procedures.

(57)
The Member States shall levy fees for the
designation and monitoring of notified bodies to ensure sustainability of the
monitoring of those bodies by Member States and to establish a level playing
field for notified bodies.

(58)
Whilst this Regulation should not affect the
right of Member States to levy fees for activities at national level, Member
States should inform the Commission and the other Member States before they
adopt the level and structure of the fees to ensure transparency.

(59)
An expert committee, the Medical Device
Coordination Group (MDCG), composed of persons designated by the Member States
based on their role and expertise in the field of medical devices and in
vitro diagnostic medical devices should be established to fulfil the tasks
conferred on it by this Regulation and by Regulation
(EU) […/…] on in vitro diagnostic medical devices[52], to provide advice to the Commission and to assist the Commission
and the Member States in ensuring a harmonised implementation of this Regulation.

(60)
Closer coordination between national competent
authorities through information exchange and coordinated assessments under the
direction of a coordinating authority is fundamental for ensuring a consistently
high level of health and safety within the internal market, in particular in
the areas of clinical investigations and vigilance. This should also lead to
more efficient use of scarce resources at national level.

(61)
The Commission should provide scientific,
technical and corresponding logistic support to the coordinating national
authority and ensure that the regulatory system for medical devices is
effectively implemented at Union level based on sound scientific evidence.

(62)
The Union should actively participate in
international regulatory cooperation in the field of medical devices to
facilitate the exchange of safety-related information regarding medical devices
and to foster the further development of international regulatory guidelines promoting
the adoption of regulations in other jurisdictions with a level of health and
safety protection equivalent to that set by this Regulation.

(63)
This Regulation respects the fundamental rights
and observes the principles recognised in particular by the Charter of
Fundamental Rights of the European Union and notably human dignity, the
integrity of the person, the protection of personal data, the freedom of art
and science, the freedom to conduct business and the right to property. This
Regulation should be applied by the Member States in accordance with those
rights and principles.

(64)
In order to maintain a high level of health and
safety, the power to adopt acts in accordance with
Article 290 TFEU should be delegated to the Commission in respect of the
products subject to this Regulation that are similar to medical devices but do
not necessarily have a medical purpose; adaptation of the definition of
nanomaterial to technical progress and to developments at Union and
international level; adaptation to technical progress of the general safety and
performance requirements, of the elements to be addressed in the technical
documentation, of the minimum content of the EU declaration of conformity and
of the certificates issued by notified bodies, of the minimum requirements to
be met by notified bodies, of the classification rules, of the conformity
assessment procedures, and of the documentation to be submitted for the
approval of clinical investigations; the establishment of the UDI system; the
information to be submitted for the registration of medical devices and certain
economic operators; the level and structure of fees for the designation and
monitoring of notified bodies; the publicly available information in respect of
clinical investigations; the adoption of preventive health protection measures
at EU level; and the tasks of and criteria for European Union reference
laboratories and the level and structure of fees for scientific opinions
delivered by them.

It is of particular
importance that the Commission carry out appropriate consultations during its
preparatory work, including at expert level. The Commission, when preparing and
drawing up delegated acts, should ensure a simultaneous, timely and appropriate
transmission of relevant documents to the European Parliament and to the
Council.

(65)
In order to ensure uniform conditions for the
implementation of this Regulation, implementing powers should be conferred on
the Commission. Those powers should be exercised in accordance with
Regulation (EU) No 182/2011 of the European Parliament and of the Council of 16
February 2011 laying down the rules and general principles concerning
mechanisms for control by Member States of the Commission's exercise of
implementing powers[53].

(66)
The advisory procedure should be used for the adoption
of the form and presentation of the data elements of the manufacturers' summary
of safety and clinical performance; of the codes defining the notified bodies' scopes
of designation; and of the model for certificates of
free sale, given that those acts have a procedural
character and do not directly impact the health and safety at Union level.

(67)
The Commission should adopt immediately
applicable implementing acts where, in duly justified cases relating to the extension to the territory of the Union of a national derogation
from the applicable conformity assessment procedures in exceptional cases; relating to the Commission's position whether
a provisional national measure against a medical device presenting a risk or a
provisional national preventive health protection measure is justified or not;
and relating to the adoption of a Union measure against a medical device
presenting a risk, imperative grounds of urgency so
require.

(68)
To allow economic operators, notified bodies, Member
States and the Commission to adapt to the changes introduced by this
Regulation, it is appropriate to provide for a sufficient transitional period
for that adaptation and for the organisational
arrangements to be taken for its proper application. It is particularly important that by the date of application, a
sufficient number of notified bodies are designated in accordance with the new
requirements to avoid any shortage of medical devices on the market.

(69)
In order to ensure a smooth transition to the
registration of medical devices, of relevant economic operators and of
certificates, the obligation to submit the relevant information to the
electronic systems put in place by this Regulation at Union level should become
fully effective only 18 months after the date of application of this Regulation.
During this transitional period, Article 10a and point (a) of Article 10b(1) of
Directive 90/385/EEC and Article 14(1) and (2) and points (a) and (b) of
Article 14a(1) of Directive 93/42/EEC should remain in force. However, economic
operators and notified bodies who register in the relevant electronic systems provided
for at Union level should be considered in compliance with the registration
requirements adopted by the Member States pursuant to those provisions of the
Directives to avoid multiple registrations.

(70)
Directives 90/385/EEC and 93/42/EEC should be
repealed to ensure that only one set of rules applies to the placing of medical
devices on the market and the related aspects covered by this Regulation.

(71)
Since the objective of this Regulation, namely
to ensure high standards of quality and safety for medical
devices, thus ensuring a high
level of protection of health and safety of patients, users and other persons, cannot sufficiently be achieved by the Member States and can, by
reason of the scale of the measure, be better achieved at Union level, the
Union may adopt measures, in accordance with the principle of subsidiarity as
set out in Article 5 of the Treaty on European Union. In accordance with the
principle of proportionality, as set out in that Article, this Regulation does
not go beyond what is necessary in order to achieve that objective.

HAVE ADOPTED THIS REGULATION:

Chapter I
Scope and definitions

Article 1
Scope

1.
This Regulation establishes rules to be complied
with by medical devices and accessories to medical devices that are placed on
the market or put into service in the Union for human use.

For the purposes of this Regulation, medical
devices and accessories to medical devices shall hereinafter be referred to as ‘devices’.

2.
This Regulation shall not apply to:

(a)
in vitro
diagnostic medical devices covered by Regulation (EU) […/…];

(b)
medicinal products covered by Directive
2001/83/EC and advanced therapy medicinal products covered by Regulation (EC)
No 1394/2007. In deciding whether a product falls under Directive 2001/83/EC or
Regulation (EC) No 1394/2007 or under this Regulation, particular account shall
be taken of the principal mode of action of the product;

(c)
human blood, blood products, plasma or blood
cells of human origin or devices which incorporate, when placed on the market
or used in accordance with the manufacturer's instructions, such blood
products, plasma or cells, except for devices referred to in paragraph 4;

(d)
cosmetic products covered by Regulation (EC) No
1223/2009;

(e)
transplants, tissues or cells of human or animal
origin or their derivatives, or products containing or consisting of them,
unless a device is manufactured utilising tissues or cells of human or animal
origin, or their derivatives, which are non-viable or are rendered non-viable.

However, human tissues and cells that are
non-viable or are rendered non-viable and that have undergone only
non-substantial manipulation, in particular those listed in Annex I of
Regulation (EC) No 1394/2007, and products derived from such tissues and cells,
shall not be considered devices manufactured utilising tissues or cells of
human origin or their derivatives;

(f)
products that contain or consist of biological
substances or organisms other than those referred to in points (c) and (e) that
are viable, including living micro-organisms, bacteria, fungi or virus;

(g)
food covered by Regulation (EC) No 178/2002.

3.
Any device which, when placed on the market or
used in accordance with the manufacturer's instructions, incorporates as an integral
part an in vitro diagnostic medical device as defined in Article 2 of
Regulation (EU) […/...] [on in vitro diagnostic medical devices] shall
be governed by this Regulation, unless it is covered by Article 1(3) of that
Regulation. The relevant general safety and performance requirements set out in
Annex I of that Regulation shall apply as far as the safety and performance of
the in vitro diagnostic medical device part are concerned.

4.
Where a device, when placed on the market or
used in accordance with the manufacturer's instructions, incorporates, as an
integral part, a substance which, if used separately, would be considered to be
a medicinal product as defined in Article 1(2) of Directive 2001/83/EC,
including a medicinal product derived from human blood or human plasma as
defined in Article 1(10) of that Directive, with action ancillary to that of
the device, that device shall be assessed and authorised in accordance
with this Regulation.

However, if the action of the medicinal
substance is not ancillary to that of the device, the product shall be governed
by Directive 2001/83/EC. In this case, the relevant general safety and
performance requirements set out in Annex I of this Regulation shall apply as
far as the safety and performance of the device part are concerned.

5.
Where a device is intended to administer a
medicinal product as defined in Article 1(2) of Directive 2001/83/EC, that
device shall be governed by this Regulation, without prejudice to the
provisions of Directive 2001/83/EC with regard to the medicinal product.

However, if the device intended to administer a
medicinal product and the medicinal product are placed on the market in such a
way that they form a single integral product which is intended exclusively for
use in the given combination and which is not reusable, the product shall be
governed by Directive 2001/83/EC. In this case, the relevant general safety and
performance requirements set out in Annex I of this Regulation shall apply as
far as the safety and performance of the device part are concerned.

6.
This Regulation is a specific Union legislation
within the meaning of Article 1(4) of Directive 2004/108/EC and within the
meaning of Article 3 of Directive 2006/42/EC.

7.
This Regulation shall not affect the application
of Council Directive 96/29/Euratom nor of Council Directive 97/43/Euratom.

8.
This Regulation shall not affect national laws
which require that certain devices may only be supplied on a medical
prescription.

9.
References to a Member State in this Regulation
shall be understood as including any other country with which the Union has
concluded an agreement which confers on that country the same status as a
Member State for the purpose of application of this Regulation.

Article 2
Definitions

1.
For the purposes of this Regulation, the
following definitions shall apply:

Definitions related to devices:

(1)
‘medical device’ means any instrument,
apparatus, appliance, software, implant, reagent, material or other article,
intended by the manufacturer to be used, alone or in combination, for human
beings for one or more of the specific medical purposes of:

–
diagnosis, prevention, monitoring, treatment or
alleviation of disease,

–
diagnosis, monitoring, treatment, alleviation of
or compensation for an injury or disability,

–
investigation, replacement or modification of
the anatomy or of a physiological process or state,

–
control or support of conception,

–
disinfection or sterilisation of any of the
above-mentioned products,

and which does not achieve its principal
intended action by pharmacological, immunological or metabolic means, in or on
the human body, but which may be assisted in its function by such means.

The implantable or other invasive products,
intended to be used for human beings, which are listed in Annex XV shall be
considered medical devices, regardless of whether or not they are intended by
the manufacturer to be used for a medical purpose.

(2)
‘accessory to a medical device’ means an article
which, whilst not being a medical device, is intended by its manufacturer to be
used together with one or several particular medical device(s) to specifically
enable or assist the device(s) to be used in accordance with its/their intended
purpose(s);

(3)
‘custom-made device’ means any device
specifically made in accordance with a written prescription of a doctor of
medicine, of a dental practitioner or of any other person authorised by
national law by virtue of this person's professional qualifications which
gives, under his responsibility, specific design characteristics, and is
intended for the sole use of a particular patient.

However, mass-produced devices which need to
be adapted to meet the specific requirements of a doctor of medicine, a dental
practitioner or any other professional user and devices which are mass-produced
by means of industrial manufacturing processes in accordance with the written
prescriptions of doctors of medicine, dental practitioners or any other authorised
person shall not be considered to be custom-made devices;

(4)
‘active device’ means any device, the operation
of which depends on a source of electrical energy or any source of power other
than that directly generated by gravity and which acts by changing the density
of or converting this energy. Devices intended to transmit energy, substances
or other elements between an active device and the patient, without any
significant change, shall not be considered to be active devices.

Stand alone software shall be considered an
active device;

(5)
‘implantable device’ means any device, including
those that are partially or wholly absorbed, which is intended

–
to be totally introduced into the human body or

–
to replace an epithelial surface or the surface
of the eye,

by clinical intervention and which is intended
to remain in place after the procedure.

Any device intended to be partially introduced
into the human body by clinical intervention and intended to remain in place
after the procedure for at least 30 days shall also be considered an
implantable device;

(6)
‘invasive device’ means any device which, in
whole or in part, penetrates inside the body, either through a body orifice or
through the surface of the body;

(7)
‘generic device group’ means a set of devices
having the same or similar intended purposes or commonality of technology
allowing them to be classified in a generic manner not reflecting specific
characteristics;

(8)
‘single-use device’ means a device that is
intended to be used on an individual patient during a single procedure.

The single procedure may involve several uses
or prolonged use on the same patient;

(9)
‘single-use device for critical use’ means a
single-use device intended to be used for surgically invasive medical
procedures;

(10)
‘intended purpose’ means the use for which the
device is intended according to the data supplied by the manufacturer on the
label, in the instructions for use or in promotional or sales materials or
statements;

(11)
‘label’ means the written, printed, or graphic
information appearing either on the device itself, or on the packaging of each
unit or on the packaging of multiple devices;

(12)
‘instructions for use’ means the information
provided by the manufacturer to inform the user of the device’s intended
purpose and proper use and of any precautions to be taken;

(13)
‘Unique Device Identification’ (‘UDI’) means a
series of numeric or alphanumeric characters that is created through
internationally accepted device identification and coding standards and that
allows unambiguous identification of specific devices on the market;

(14)
‘non-viable’ means having no potential for
metabolism or multiplication;

(15)
‘nanomaterial’ means a natural, incidental or
manufactured material containing particles, in an unbound state or as an
aggregate or as an agglomerate and where, for 50 % or more of the particles in
the number size distribution, one or more external dimensions is in the size range
1-100 nm.

Fullerenes, graphene flakes and single-wall
carbon nanotubes with one or more external dimensions below 1 nm shall be
considered as nanomaterials.

For the purposes of the definition of
nanomaterial, ‘particle’, ‘agglomerate’ and ‘aggregate’ are defined as follows:

–
‘particle’ means a minute piece of matter with
defined physical boundaries;

–
‘agglomerate’ means a collection of weakly bound
particles or aggregates where the resulting external surface area is similar to
the sum of the surface areas of the individual components;

–
‘aggregate’ means a particle comprising of
strongly bound or fused particles;

Definitions related to the making available of
devices:

(16)
‘making available on the market’ means any
supply of a device, other than an investigational device, for distribution,
consumption or use on the Union market in the course of a commercial activity,
whether in return for payment or free of charge;

(17)
‘placing on the market’ means the first making
available of a device, other than an investigational device, on the Union
market;

(18)
‘putting into service’ means the stage at which
a device, other than an investigational device, has been made available to the
final user as being ready for use on the Union market for the first time for
its intended purpose;

Definitions related to economic operators,
users and specific processes:

(19)
‘manufacturer’ means the natural or legal person
who manufactures or fully refurbishes a device or has a device designed,
manufactured or fully refurbished, and markets that device under his name or
trademark.

For the purposes of the definition of
manufacturer, fully refurbishing is defined as the complete rebuilding of a
device already placed on the market or put into service, or the making of a new
device from used devices, to bring it in conformity with this Regulation,
combined with the assignment of a new lifetime to the refurbished device;

(20)
‘authorised representative’ means any natural or
legal person established within the Union who has received and accepted a
written mandate from a manufacturer to act on his behalf in relation to
specified tasks with regard to the latter's obligations under this Regulation;

(21)
‘importer’ means any natural or legal person
established within the Union who places a device from a third country on the
Union market;

(22)
‘distributor’ means any natural or legal person
in the supply chain, other than the manufacturer or the importer, who makes a
device available on the market;

(23)
‘economic operators’ means the manufacturer, the
authorised representative, the importer and the distributor;

(24)
‘health institution’ means an organisation whose
primary purpose is the care or treatment of patients or the promotion of public
health;

(25)
‘user’ means any healthcare professional or lay
person who uses a device;

(26)
‘lay person’ means an individual who does not
have formal education in a relevant field of healthcare or medical discipline;

(27)
‘reprocessing’ means the
process carried out on a used device in order to allow its safe reuse including
cleaning, disinfection, sterilisation and related procedures, as well as
testing and restoration of the technical and functional safety of the used
device;

Definitions related to conformity assessment:

(28)
‘conformity assessment’ means the process
demonstrating whether the requirements of this Regulation relating to a device
have been fulfilled;

(29)
‘conformity assessment body’ means a body that
performs third-party conformity assessment activities including calibration,
testing, certification and inspection;

(30)
‘notified body’ means a conformity assessment
body designated in accordance with this Regulation;

(31)
‘CE marking of conformity’ or ‘CE marking’ means
a marking by which the manufacturer indicates that the device is in conformity
with the applicable requirements set out in this Regulation and other
applicable Union harmonisation legislation providing for its affixing;

Definitions related to clinical evaluation and
clinical investigations:

(32)
‘clinical evaluation’ means the assessment and
analysis of clinical data pertaining to a device in order to verify the safety
and performance of the device when used as intended by the manufacturer;

(33)
‘clinical investigation’ means any systematic
investigation in one or more human subjects, undertaken to assess the safety or
performance of a device;

(34)
‘investigational device’ means any device being
assessed for safety and/or performance in a clinical investigation;

(35)
‘clinical investigation plan’ means the
document(s) setting out the rationale, objectives, design and proposed
analysis, methodology, monitoring, conduct and record-keeping of the clinical
investigation;

(36)
‘clinical data’ means the information concerning
the safety or performance that is generated from the use of a device and that are
sourced from the following:

–
clinical investigation(s) of the device
concerned,

–
clinical investigation(s) or other studies
reported in the scientific literature, of a similar device for which
equivalence to the device in question can be demonstrated,

–
published and/or unpublished reports on other
clinical experience of either the device in question or a similar device for
which equivalence to the device in question can be demonstrated;

(37)
‘sponsor’ means an individual, company,
institution or organisation which takes responsibility for the initiation and management
of a clinical investigation;

(38)
‘adverse event’ means any untoward medical
occurrence, unintended disease or injury or any untoward clinical signs,
including an abnormal laboratory finding, in subjects, users or other persons,
in the context of a clinical investigation, whether or not related to the
investigational device;

(39)
‘serious adverse event’
means any adverse event that led
to any of the following:

–
death,

–
serious deterioration in the health of the
subject, that resulted in any of the following:

(i)      life-threatening illness or injury,

(ii)      permanent impairment of a body
structure or a body function,

(iii)     hospitalisation or extending the
duration of hospitalisation,

(iv)     medical or surgical intervention to
prevent life-threatening illness or injury or permanent impairment to a body
structure or a body function,

–
foetal distress, foetal death or a congenital
abnormality or birth defect;

(40)
‘device deficiency’ means any inadequacy in the identity,
quality, durability, reliability, safety or performance of an investigational
device, including malfunction, use errors or inadequacy in the information
supplied by the manufacturer;

Definitions related to vigilance and market
surveillance:

(41)
‘recall’ means any measure aimed at achieving
the return of a device that has already been made available to the end user;

(42)
‘withdrawal’ means any measure aimed at
preventing a device in the supply chain from further being made available on
the market;

(43)
‘incident’ means any malfunction or
deterioration in the characteristics or performance of a device made available
on the market, any inadequacy in the information supplied by the manufacturer
and any unexpected undesirable side-effect;

(44)
‘serious incident’ means any incident that
directly or indirectly led, might have led or might lead to any of the following:

–
death of a patient, user or other person,

–
temporary or permanent serious deterioration of
the patient's, user's or other person's state of health,

–
serious public health threat;

(45)
‘corrective action’ means action taken to
eliminate the cause of a potential or real non-conformity or other undesirable
situation;

(46)
‘field safety corrective action’ means
corrective action taken by the manufacturer for technical or medical reasons to
prevent or reduce the risk of a serious incident in relation to a device made available
on the market;

(47)
‘field safety notice’ means the communication
sent by the manufacturer to users or customers in relation to a field safety
corrective action;

(48)
‘market surveillance’ means the activities
carried out and measures taken by public authorities to ensure that products
comply with the requirements set out in the relevant Union harmonisation
legislation and do not endanger health, safety or any other aspect of public
interest protection;

Definitions related to standards and other
technical specifications:

(49)
‘harmonised standard’ means a European standard
as defined in Article 2(1)(c) of Regulation (EU) No […/…];

(50)
‘common technical specifications’ means a
document other than a standard that prescribes technical requirements that
provide a means to comply with the legal obligation applicable to a device,
process or system.

2.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 to amend the list in Annex XV
referred to in the last subparagraph of number (1) of paragraph 1, in the light
of technical progress and taking into account the similarity between a medical
device and a product without a medical purpose in respect of their
characteristics and risks.

3.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 in order to adapt the definition
of nanomaterial set out in number (15) of paragraph 1 in view of technical and
scientific progress and taking into account definitions agreed at Union and
international level.

Article 3
Regulatory status of products

1.
The Commission may, at the request of a Member
State or on its own initiative, by means of implementing acts, determine
whether or not a specific product, or category or group of products, falls
within the definitions of 'medical device' or 'accessory to a medical device'.
Those implementing acts shall be adopted in accordance with the examination
procedure referred to in Article 88(3).

2.
The Commission shall ensure the sharing of expertise
between Member States in the fields of medical devices, in vitro
diagnostic medical devices, medicinal products, human tissues and cells,
cosmetics, biocides, food and, if necessary, other products in order to
determine the appropriate regulatory status of a product, or category or group
of products.

Chapter II
Making available of devices, obligations of economic operators, reprocessing,
CE marking, free movement

Article 4
Placing on the market and putting into service

1.
A device may be placed on the market or put into
service only if it complies with this Regulation when duly supplied and
properly installed, maintained and used in accordance with its intended
purpose.

2.
A device shall meet the general safety and
performance requirements which apply to it, taking into account its intended
purpose. General safety and performance requirements are set out in Annex I.

3.
Demonstration of conformity with the general safety
and performance requirements shall include a clinical evaluation in accordance
with Article 49.

4.
Devices that are manufactured and used within a
single health institution shall be considered as being put into service. The
provisions regarding CE marking referred to in Article 18 and the obligations
laid down in Articles 23 to 27 shall not apply to those devices, provided that
manufacture and use of those devices occur under the health institution's
single quality management system.

5.
The Commission shall be empowered to adopt delegated
acts in accordance with Article 89 amending or supplementing, in the light of
technical progress and considering the intended users or patients, the general safety
and performance requirements set out in Annex I, including the information
supplied by the manufacturer.

Article 5
Distance sales

1.
A device offered by means of information society
services as defined in Article 1(2) of Directive 98/34/EC to a natural or legal
person established in the Union shall comply with this Regulation at the latest
when the device is placed on the market.

2.
Without prejudice to national legislation
regarding the exercise of the medical profession, a device that is not placed
on the market but used in the context of a commercial activity for the
provision of a diagnostic or therapeutic service offered by means of
information society services as defined in Article 1(2) of Directive 98/34/EC
or by other means of communication to a natural or legal person established in
the Union shall comply with this Regulation.

Article 6
Harmonised standards

1.
Devices which are in conformity with the
relevant harmonised standards, or parts thereof, the references of which have
been published in the Official Journal of the European Union shall be presumed
to be in conformity with the requirements of this Regulation covered by those
standards or parts thereof.

The first subparagraph shall also apply to system
or process requirements to be fulfilled by economic operators or sponsors in
accordance with this Regulation, including those related to the quality
management system, risk management, the post-market surveillance plan, clinical
investigations, clinical evaluation or post-market clinical follow-up.

2.
Reference to harmonised standards also includes
the monographs of the European Pharmacopoeia adopted in accordance with the
Convention on the Elaboration of a European Pharmacopoeia, notably on surgical
sutures and on interaction between medicinal products and materials used in
devices containing such medicinal products.

Article 7
Common technical specifications

1.
Where no harmonised standards exist or where
relevant harmonised standards are not sufficient, the Commission shall be
empowered to adopt common technical specifications (CTS) in respect of the general
safety and performance requirements set out in Annex I, the technical
documentation set out in Annex II or the clinical evaluation and post-market
clinical follow-up set out in Annex XIII. The CTS shall be adopted by means of
implementing acts in accordance with the examination procedure referred to in
Article 88(3).

2.
Devices which are in conformity with the CTS
referred to in paragraph 1 shall be presumed to be in conformity with the requirements
of this Regulation covered by those CTS or parts thereof.

3.
Manufacturers shall comply with the CTS unless
they can duly justify that they have adopted solutions ensuring a level of
safety and performance that is at least equivalent thereto.

Article 8
General obligations of the manufacturer

1.
When placing their devices on the market or
putting them into service, manufacturers shall ensure that they have been
designed and manufactured in accordance with the requirements of this Regulation.

2.
Manufacturers shall draw up the technical
documentation which shall allow assessment of the conformity of the device with
the requirements of this Regulation. The technical documentation shall include
the elements set out in Annex II.

The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 amending or supplementing, in the
light of technical progress, the elements in the technical documentation set
out in Annex II.

3.
Where compliance of a device with the applicable
requirements has been demonstrated following the applicable conformity
assessment procedure, manufacturers of devices, other than custom-made or
investigational devices, shall draw up an EU declaration of conformity in
accordance with Article 17 and affix the CE marking of conformity in accordance
with Article 18.

4.
Manufacturers shall keep the technical
documentation, the EU declaration of conformity and, if applicable, a copy of
the relevant certificate including any supplement, issued in accordance with Article
45, available to the competent authorities for a period of at least five years
after the last device covered by the declaration of conformity has been placed
on the market. In the case of implantable devices, the period shall be at least
15 years after the last device has been placed on the market.

Where the technical documentation is voluminous
or held in different locations, the manufacturer shall provide, upon request by
a competent authority, a summary technical documentation (STED) and grant access
to the full technical documentation upon request.

5.
Manufacturers shall ensure that procedures are
in place to keep series production in conformity with the requirements of this
Regulation. Changes in product design or characteristics and changes in the harmonised
standards or CTS by reference to which conformity of a product is declared
shall be adequately taken into account. Proportionate to the risk class and the
type of device, manufacturers of devices, other than custom-made or
investigational devices, shall institute and keep up to date a quality
management system that shall address at least the following aspects:

(a)
the responsibility of the management;

(b)
resource management, including selection and
control of suppliers and sub-contractors;

(c)
product realisation;

(d)
processes for monitoring and measurement of
output, data analysis and product improvement.

6.
Proportionate to the risk class and the type of
device, manufacturers of devices, other than custom-made devices, shall
institute and keep up to date a systematic procedure to collect and review
experience gained from their devices placed on the market or put into service
and to apply any necessary corrective action, hereinafter referred to as ‘post-market
surveillance plan’. The post-market surveillance plan shall set out the process
for collecting, recording and investigating complaints and reports from healthcare
professionals, patients or users on suspected incidents related to a device,
keeping a register of non-conforming products and product recalls or
withdrawals, and if deemed appropriate due to the nature of the device, sample
testing of marketed devices. Part of the post-market surveillance plan shall be
a plan for post-market clinical follow-up in accordance with Part B of Annex
XIII. Where post-market clinical follow-up is not deemed necessary, this shall
be duly justified and documented in the post-market surveillance plan.

If in the course of the post-market
surveillance a need for corrective action is identified, the manufacturer shall
implement the appropriate measures.

7.
Manufacturers shall ensure that the device is
accompanied by the information to be supplied in accordance with Section 19 of
Annex I in an official Union language which can be easily understood by the
intended user or patient. The language(s) of the information to be supplied by
the manufacturer may be determined by the law of the Member State where the
device is made available to the user or patient.

8.
Manufacturers who consider or have reason to
believe that a device which they have placed on the market is not in conformity
with this Regulation shall immediately take the necessary corrective action to
bring that product into conformity, withdraw it or recall it, as appropriate.
They shall inform the distributors and, where applicable, the authorised
representative accordingly.

9.
Manufacturers shall, in response to a reasoned
request from a competent authority, provide it with all the information and
documentation necessary to demonstrate the conformity of the device, in an
official Union language which can be easily understood by that authority. They
shall cooperate with that authority, at its request, on any corrective action
taken to eliminate the risks posed by devices which they have placed on the
market or put into service.

10.
Where manufacturers have their devices designed
and manufactured by another legal or natural person the information on the
identity of that person shall be part of the information to be submitted in
accordance with Article 25.

Article 9
Authorised representative

1.
A manufacturer of a device that is placed on the
Union market, or bears the CE marking without being placed on the Union market,
who does not have a registered place of business in a Member State or does not
carry out relevant activities at a registered place of business in a Member
State, shall designate a single authorised representative.

2.
The designation shall be valid only when
accepted in writing by the authorised representative and shall be effective at
least for all devices of the same generic device group.

3.
The authorised representative shall perform the
tasks specified in the mandate agreed between the manufacturer and the
authorised representative.

The mandate shall allow and require the
authorised representative to perform at least the following tasks in relation
to the devices that it covers:

(a)
keep the technical documentation, the EU
declaration of conformity and, if applicable, a copy of the relevant
certificate including any supplement issued in accordance with Article 45 at
the disposal of competent authorities for the period referred to in Article 8(4);

(b)
in response to a reasoned request from a
competent authority, provide that competent authority with all the information
and documentation necessary to demonstrate the conformity of a device;

(c)
cooperate with the competent authorities on any corrective
action taken to eliminate the risks posed by devices;

(d)
immediately inform the manufacturer about
complaints and reports from healthcare professionals, patients and users about
suspected incidents related to a device for which they have been designated;

(e)
terminate the mandate if the manufacturer acts
contrary to his obligations under this Regulation.

To allow the authorised representative to
fulfil the tasks mentioned in this paragraph, the manufacturer shall at least
ensure that the authorised representative has permanent immediate access to the
necessary documentation in one of the official Union languages.

4.
The mandate referred to in paragraph 3 shall not
include the delegation of the manufacturer's obligations laid down in Article 8(1), (2), (5), (6), (7) and (8).

5.
An authorised representative who terminates the
mandate on the grounds referred to in point (e) of paragraph 3 shall
immediately inform the competent authority of the Member State in which he is
established and, where applicable, the notified body that was involved in the
conformity assessment for the device of the termination of the mandate and the
reasons therefor.

6.
Any reference in this Regulation to the
competent authority of the Member State where the manufacturer has his
registered place of business shall be understood as a reference to the
competent authority of the Member State where the authorised representative, designated
by a manufacturer referred to in paragraph 1, has his registered place of
business.

Article 10
Change of authorised representative

The modalities of a change of authorised
representative shall be clearly defined in an agreement between the
manufacturer, the outgoing authorised representative and the incoming authorised
representative. This agreement shall address at least the following aspects:

(a)
the date of termination of the mandate with the
outgoing authorised representative and date of beginning of the mandate with
the incoming authorised representative;

(b)
the date until which the outgoing authorised
representative may be indicated in the information supplied by the
manufacturer, including any promotional material;

(c)
the transfer of documents, including
confidentiality aspects and property rights;

(d)
the obligation of the outgoing authorised
representative after the end of the mandate to forward to the manufacturer or
incoming authorised representative any complaints or
reports from healthcare professionals, patients or
users about suspected incidents related to a device for
which he had been designated as authorised representative.

Article 11
General obligations of importers

1.
Importers shall place on the Union market only
devices that are in conformity with this Regulation.

2.
Before placing a device on the market importers
shall ensure the following:

(a)
that the appropriate conformity assessment
procedure has been carried out by the manufacturer;

(b)
that an authorised representative in accordance
with Article 9 has been designated by the manufacturer;

(c)
that the EU declaration of conformity and the technical
documentation has been drawn up by the manufacturer;

(d)
that the device bears the required CE marking of
conformity;

(e)
that the device is labelled in accordance with
this Regulation and accompanied by the required instructions for use and EU declaration
of conformity;

(f)
that, where applicable, a Unique Device
Identification has been assigned by the manufacturer in accordance with Article
24.

Where an importer considers or has reason to
believe that a device is not in conformity with the requirements of this
Regulation, he shall not place the device on the market until it has been
brought into conformity. Where the device presents a risk, the importer shall
inform the manufacturer and his authorised representative to that effect, as
well as the competent authority of the Member State in which he is established.

3.
Importers shall indicate their name, registered
trade name or registered trade mark and the address of their registered place
of business at which they can be contacted and their location can be
established on the device or on its packaging or in a document accompanying the
device. They shall ensure that any additional label does not obscure any
information on the label provided by the manufacturer.

4.
Importers shall ensure that the device is
registered in the electronic system in accordance with Article 25(2).

5.
Importers shall ensure that, while a device is
under their responsibility, storage or transport conditions do not jeopardise
its compliance with the general safety and performance requirements set out in
Annex I.

6.
When deemed appropriate with regard to the risks
presented by a device, importers shall, in order to protect the health and
safety of patients and users, carry out sample testing of marketed products,
investigate complaints and keep a register of complaints, of non-conforming
products and of product recalls and withdrawals, and shall keep the
manufacturer, authorised representative and distributors informed of such
monitoring.

7.
Importers who consider or have reason to believe
that a device which they have placed on the market is not in conformity with
this Regulation shall immediately inform the manufacturer and his authorised
representative and, if appropriate, take the necessary corrective action to
bring that device into conformity, withdraw or recall it. Where the device
presents a risk, they shall also immediately inform the competent authorities
of the Member States in which they made the device available and, if
applicable, the notified body that issued a certificate in accordance with
Article 45 for the device in question, giving details, in particular, of the
non-compliance and of any corrective action taken.

8.
Importers who have received complaints or
reports from healthcare professionals, patients or users about suspected
incidents related to a device which they have placed on the market shall
immediately forward this information to the manufacturer and his authorised
representative.

9.
Importers shall, for the period referred to in
Article 8(4), keep a copy of the EU declaration of conformity at the disposal
of the market surveillance authorities and ensure that the technical
documentation and, if applicable, a copy of the relevant certificate including
any supplement, issued in accordance with Article 45, can be made available to
those authorities, upon request. By written mandate, the importer and the
authorised representative for the device in question may agree that this
obligation is delegated to the authorised representative.

10.
Importers shall, in response to a request from a
competent national authority, provide it with all the information and
documentation necessary to demonstrate the conformity of a product. This
obligation shall be considered fulfilled when the authorised representative for
the device in question provides the required information. Importers shall
cooperate with a competent national authority, at its request, on any action
taken to eliminate the risks posed by products which they have placed on the
market.

Article 12
General obligations of distributors

1.
When making a device available on the market,
distributors shall act with due care in relation to the requirements
applicable.

2.
Before making a device available on the market
distributors shall verify that the following requirements are met:

(a)
the product bears the required CE marking of
conformity;

(b)
the product is accompanied by the information to be supplied by the manufacturer in accordance with Article
8(7);

(c)
the manufacturer and, where applicable, the
importer have complied with the requirements set out in Article 24 and Article
11(3) respectively.

Where a distributor considers or has reason to
believe that a device is not in conformity with the requirements of this
Regulation, he shall not make the device available on the market until it has
been brought into conformity. Where the device presents a risk, the distributor
shall inform the manufacturer and, where applicable, his authorised
representative and the importer to that effect, as well as the competent
authority of the Member State in which he is established.

3.
Distributors shall ensure that, while a device
is under their responsibility, storage or transport conditions do not
jeopardise its compliance with the general safety and performance requirements
set out in Annex I.

4.
Distributors who consider or have reason to
believe that a device which they have made available on the market is not in
conformity with this Regulation shall immediately inform the manufacturer and,
where applicable, his authorised representative and the importer and make sure
that the necessary corrective action to bring that device into conformity,
withdraw or recall it, if appropriate, is taken. Where the device presents a
risk, they shall also immediately inform the competent authorities of the
Member States in which they made the device available, giving details, in
particular, of the non-compliance and of any corrective action taken.

5.
Distributors who have received complaints or
reports from healthcare professionals, patients or users about suspected
incidents related to a device they have made available, shall immediately
forward this information to the manufacturer and, where applicable, his
authorised representative.

6.
Distributors shall, in response to a request
from a competent authority, provide it with all the information and
documentation necessary to demonstrate the conformity of a device. This
obligation shall be considered fulfilled when the authorised representative for
the device in question, where applicable, provides the required information.
Distributors shall cooperate with competent national authorities, at their
request, on any action taken to eliminate the risks posed by devices which they
have made available on the market.

Article 13
Person responsible for regulatory compliance

1.
Manufacturers shall have available within their
organisation at least one qualified person who possesses expert knowledge in
the field of medical devices. The expert knowledge shall be demonstrated by either
of the following qualifications:

(a)
a diploma, certificate or other evidence of
formal qualification awarded on completion of a university degree or of an
equivalent course of study, in natural sciences, medicine, pharmacy,
engineering or another relevant discipline, and at least two years of
professional experience in regulatory affairs or in quality management systems
relating to medical devices;

(b)
five years of professional experience in
regulatory affairs or in quality management systems relating to medical
devices.

Without prejudice to national provisions
regarding professional qualifications, manufacturers of custom-made devices may
demonstrate their expert knowledge referred to in the first subparagraph by at
least two years of professional experience within the relevant field of
manufacture.

This paragraph shall not apply to manufacturers
of custom-made devices who are micro-enterprises as defined by Commission
Recommendation 2003/361/EC[54].

2.
The qualified person shall at least be
responsible for ensuring the following matters:

(a)
that the conformity of the devices is
appropriately assessed before a batch is released;

(b)
that the technical documentation and the
declaration of conformity are drawn up and kept up-to-date;

(c)
that the reporting obligations in accordance
with Articles 61 to 66 are fulfilled;

(d)
in the case of investigational devices, that the
statement referred to in point 4.1 of Chapter II of Annex XIV is issued.

3.
The qualified person shall suffer no disadvantage
within the manufacturer's organisation in relation to the proper fulfilment of
his duties.

4.
Authorised representatives shall have available
within their organisation at least one qualified person who possesses expert
knowledge regarding the regulatory requirements for medical devices in the
Union. The expert knowledge shall be demonstrated by either of the following qualifications:

(a)
a diploma, certificate or other evidence of
formal qualification awarded on completion of a university degree or of an
equivalent course of study, in law, natural sciences, medicine, pharmacy,
engineering or another relevant discipline, and at least two years of
professional experience in regulatory affairs or in quality management systems
relating to medical devices;

(b)
five years of professional experience in
regulatory affairs or in quality management systems relating to medical
devices.

Article 14
Cases in which obligations of manufacturers apply to importers, distributors or
other persons

1.
A distributor, importer or other natural or
legal person shall assume the obligations incumbent on manufacturers if he does
any of the following:

(a)
makes available on the market a device under his
name, registered trade name or registered trade mark;

(b)
changes the intended purpose of a device already placed on the market or put into
service;

(c)
modifies a device already placed on the market or put into service in such a way that
compliance with the applicable requirements may be affected.

The first subparagraph shall not apply to any person
who, while not considered a manufacturer as defined in number (19) of Article
2(1), assembles or adapts a device already on the market to its intended
purpose for an individual patient.

2.
For the purposes of point (c) of paragraph 1, the
following shall not be considered to be a modification of a device that could affect
its compliance with the applicable requirements:

(a)
provision, including translation, of the
information supplied by the manufacturer in accordance with Section 19 of Annex
I relating to a device already placed on the market and of further information
which is necessary in order to market the product in the relevant Member State;

(b)
changes to the outer packaging of a device
already placed on the market, including a change of pack size, if the
repackaging is necessary in order to market the product in the relevant Member
State and if it is carried out in such conditions that the original condition
of the device cannot be affected by it. In the case of devices placed on the
market in sterile condition, it shall be presumed that the original condition
of the device is adversely affected if the package that shall ensure the sterile
condition is opened, damaged or otherwise negatively affected by the
repackaging.

3.
A distributor or importer who carries out any of
the activities mentioned in points (a) and (b) of paragraph 2 shall indicate
the activity carried out together with his name, registered trade name or
registered trade mark and the address at which he can be contacted and his
location can be established on the device or, where that is not possible, on
its packaging or in a document accompanying the device.

He shall ensure that he has in place a quality
management system that includes procedures which ensure that the translation of
information is accurate and up-to-date, and that the activities mentioned in
points (a) and (b) of paragraph 2 are performed by means and under conditions
that preserve the original condition of the device and that the packaging of
the repackaged device is not defective, of poor quality or untidy. Part of the
quality management system shall be procedures ensuring that the distributor or
importer is informed of any corrective action taken by the manufacturer in
relation to the device in question in order to respond to safety issues or to
bring it in conformity with this Regulation.

4.
Prior to making the relabelled or repackaged
device available, the distributor or importer referred to in paragraph 3 shall
inform the manufacturer and the competent authority of the Member State where he
plans to make the device available and, upon request, shall provide them with a
sample or a mock-up of the relabelled or repackaged device, including any
translated label and instructions for use. He shall submit to the competent
authority a certificate, issued by a notified body referred to in Article 29,
designated for the type of devices that are subject to activities mentioned in
points (a) and (b) of paragraph 2, attesting that the quality management system
complies with the requirements laid down in paragraph 3.

Article 15
Single-use devices and their reprocessing

1.
Any natural or legal person who reprocesses a
single-use device to make it suitable for further use within the Union shall be
considered to be the manufacturer of the reprocessed device and shall assume
the obligations incumbent on manufacturers laid down in this Regulation.

2.
Only single-use devices that have been placed on
the Union market in accordance with this Regulation, or prior to [date of
application of this Regulation] in accordance with Directive 90/385/EEC or
Directive 93/42/EEC may be reprocessed.

3.
In the case of reprocessing of single-use
devices for critical use, only reprocessing that is considered safe according to
the latest scientific evidence may be carried out.

4.
The Commission, by means of implementing acts,
shall establish and regularly update a list of categories or groups of single-use
devices for critical use which may be reprocessed in accordance with paragraph
3. Those implementing acts shall be adopted in accordance with the examination
procedure referred to in Article 88(3).

5.
The name and address of the legal or natural
person referred to in paragraph 1 and the other relevant information in
accordance with Section 19 of Annex I shall be indicated on the label and,
where applicable, in the instructions for use of the reprocessed device.

The name and address of the manufacturer of the
original single-use device shall no longer appear on the label, but shall be
mentioned in the instructions for use of the reprocessed device.

6.
A Member State may maintain or introduce
national provisions prohibiting, within its territory, on grounds of protection
of public health specific to that Member State the following:

(a)
the reprocessing of single-use devices and the
transfer of single-use devices to another Member State or to a third country
with a view to their reprocessing;

(b)
the making available of reprocessed single-use
devices.

Member States shall notify the Commission and
the other Member States of the national provisions and the grounds for
introducing them. The Commission shall keep the information publicly available.

Article 16
Implant card

1.
The manufacturer of an implantable device shall
provide together with the device an implant card which shall be made available
to the particular patient who has been implanted with the device.

2.
This card shall contain the following:

(a)
the information allowing identification of the
device, including the Unique Device Identification;

(b)
any warnings, precautions or measures to be
taken by the patient or a healthcare professional with regard to reciprocal
interference with reasonably foreseeable external influences or environmental
conditions;

(c)
any information about the expected lifetime of
the device and any necessary follow-up.

The information shall be written in a way that
is readily understood by a lay person.

Article 17
EU declaration of conformity

1.
The EU declaration of conformity shall state
that fulfilment of the requirements specified in this Regulation has been
demonstrated. It shall be continuously updated. The minimum content of the EU
declaration of conformity is set out in Annex III. It shall be translated into
the official Union language or languages required by the Member State(s) in
which the device is made available.

2.
Where, concerning aspects not covered by this
Regulation, devices are subject to other Union legislation which also requires
a declaration of conformity by the manufacturer that fulfilment of the
requirements of that legislation has been demonstrated, a single EU declaration
of conformity shall be drawn up in respect of all Union acts applicable to the
device containing all information required for identification of the Union
legislation to which the declaration relates.

3.
By drawing up the EU declaration of conformity,
the manufacturer shall assume responsibility for compliance with the
requirements of this Regulation and all other Union legislation applicable to
the device.

4.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 amending or supplementing the
minimum content of the EU declaration of conformity set out in Annex III in the
light of technical progress.

Article 18
CE marking of conformity

1.
Devices, other than custom-made or
investigational devices, considered to be in conformity with the requirements
of this Regulation shall bear the CE marking of conformity, as presented in
Annex IV.

2.
The CE marking shall be subject to the general
principles set out in Article 30 of Regulation (EC) No 765/2008.

3.
The CE marking shall be affixed visibly, legibly
and indelibly to the device or its sterile pack. Where that is not possible or
not warranted on account of the nature of the device, it shall be affixed to
the packaging. The CE marking shall also appear in the instructions for use and
on the sales packaging where those are provided.

4.
The CE marking shall be affixed before the
device is placed on the market. It may be followed by a pictogram or any other
mark indicating a special risk or use.

5.
Where applicable, the CE marking shall be
followed by the identification number of the notified body responsible for the
conformity assessment procedures set out in Article 42. The identification
number shall also be indicated in any promotional material which mentions that
a device fulfils the legal requirements for CE marking.

6.
Where devices are subject to other Union
legislation concerning other aspects which also provide for the affixing of the
CE marking, the CE marking shall indicate that the devices also fulfil the
provisions of the other legislation.

Article 19
Devices for special purposes

1.
Member States shall not create any obstacle to
the following devices:

(a)
investigational devices which are supplied to a
doctor of medicine, a dental practitioner or an authorised person for the
purpose of clinical investigation if they meet the conditions laid down in Articles
50 to 60 and in Annex XIV;

(b)
custom-made devices which are made available on
the market if they comply with Article 42(7) and Annex XI.

Those devices shall not bear the CE marking,
with the exception of the devices referred to in Article 54.

2.
Custom-made devices shall be accompanied by the
statement referred to in Annex XI which shall be made available to the
particular patient or user identified by name, an acronym or a numerical code.

Member States may require that the manufacturer
of a custom-made device submit to the competent authority a list of such
devices which have been made available in their territory.

3.
At trade fairs, exhibitions, demonstrations or
similar events, Member States shall not create any obstacle to the showing of
devices which do not comply with this Regulation, provided a visible sign
clearly indicates that such devices are intended for presentation or
demonstration purposes only and cannot be made available until they have been
made to comply with this Regulation.

Article 20
Systems and procedure packs

1.
Any natural or legal person shall draw up a statement
referred to in paragraph 2 if he puts devices bearing the CE marking together
with the following other devices or products, in accordance with the intended
purpose of the devices or other products and within the limits of use specified
by their manufacturers, in order to place them on the market as a system or
procedure pack:

–
other devices bearing the CE marking;

–
in vitro
diagnostic medical devices bearing the CE marking in conformity with Regulation
(EU) […/…];

–
other products which are in conformity with the
legislation applicable to those products.

2.
In the statement, the person referred to in
paragraph 1 shall declare the following:

(a)
that he verified the mutual compatibility of the
devices and, if applicable other products, in accordance with the
manufacturers' instructions and has carried out his operations in accordance
with those instructions;

(b)
that he packaged the system or procedure pack
and supplied relevant information to users incorporating the information to be
supplied by the manufacturers of the devices or other products which have been
put together;

(c)
that the activity of putting devices and, if
applicable, other products together as a system or procedure pack was subject
to appropriate methods of internal monitoring, verification and validation.

3.
Any natural or legal person who sterilises
systems or procedure packs referred to in paragraph 1 for the purpose of
placing them on the market shall, at his choice, follow one of the procedures
referred to in Annex VIII or in Part A of Annex X. The application of those Annexes
and the involvement of the notified body shall be limited to the aspects of the
procedure relating to ensuring sterility until the sterile package is opened or
damaged. The person shall draw up a statement declaring that sterilisation has
been carried out in accordance with the manufacturer's instructions.

4.
Where the system or procedure pack incorporate
devices which do not bear the CE marking or where the chosen combination of
devices is not compatible in view of their original intended purpose, the
system or procedure pack shall be treated as a device in its own right and shall
be subjected to the relevant conformity assessment procedure pursuant to
Article 42.

5.
The systems or procedure packs referred to in
paragraph 1 shall not themselves bear an additional CE marking but they shall
bear the name, registered trade name or registered trade mark of the person referred
to in paragraph 1 as well as the address at which he can be contacted and his
location can be established. Systems or procedure packs shall be accompanied by
the information referred to in Section 19 of Annex I. The statement referred to
in paragraph 2 of this Article shall be kept at the disposal of the competent
authorities, after the system or procedure pack has been put together, for the
period that is applicable to the devices put together in accordance with
Article 8(4). Where these periods differ, the longest period shall apply.

Article 21
Parts and components

1.
Any natural or legal person who makes available
on the market an article intended specifically to replace an identical or
similar integral part or component of a device that is defective or worn in
order to maintain or re-establish the function of the device without
significantly changing its performance or safety characteristics, shall ensure
that the article does not adversely affect the safety and performance of the
device. Substantiating evidence shall be kept available to the competent
authorities of the Member States.

2.
An article that is intended specifically to replace
a part or component of a device and that significantly changes the performance
or safety characteristics of the device shall be considered a device.

Article 22
Free movement

Member States shall not refuse, prohibit or
restrict the making available or putting into service within their territory of
devices which comply with the requirements of this Regulation.

Chapter III

Identification
and traceability of devices, registration of devices and of economic operators,
summary of safety and clinical performance, European databank on medical
devices

Article 23
Identification within the supply chain

For devices, other than custom-made or
investigational devices, economic operators shall be able to identify the
following, for the period referred to in Article 8(4):

(a)
any economic operator to whom they have supplied
a device;

(b)
any economic operator who has supplied them with
a device;

(c)
any health institution or healthcare
professional to whom they have supplied a device.

Upon request, they shall inform the
competent authorities thereof.

Article 24
Unique Device Identification system

1.
For devices, other than custom-made and
investigational devices, a system for Unique Device Identification shall be put
in place in the Union. The UDI system shall allow the identification and
traceability of devices and shall consist of the following:

(a)
production of a UDI that comprises the
following:

(i)      a device identifier specific to a
manufacturer and a device model, providing access to the information laid down
in Part B of Annex V;

(ii)      a production identifier that
identifies data related to the unit of device production;

(b)
placement of the UDI on the label of the device;

(c)
storage of the UDI by the economic operators and
the health institutions through electronic means;

(d)
establishment of an electronic system on UDI.

2.
The Commission shall designate one or several entities
that operate a system for assignment of UDIs pursuant to this Regulation and that
satisfy all of the following criteria:

(a)
the entity is an organisation with legal
personality;

(b)
its system for the assignment of UDIs is
adequate to identify a device through its distribution and use in accordance
with the requirements of this Regulation;

(c)
its system for the assignment of UDIs conforms
to the relevant international standards;

(d)
the entity gives access to its system for the
assignment of UDIs to all interested users according to a set of predetermined
and transparent terms and conditions;

(e)
the entity undertakes the following:

(i)      to operate its system for the
assignment of UDIs for the period to be determined in the designation which
shall at least be three years after its designation;

(ii)      to make available to the Commission
and to the Member States, upon request, information concerning its system for
the assignment of UDIs and concerning manufacturers that place an UDI on the
label of their device in accordance with the entity's system;

(iii)     to remain in compliance with the
criteria for designation and the terms of designation during the period for
which it is designated.

3.
Before placing a device on the market, the
manufacturer shall assign to the device a UDI provided by an entity designated
by the Commission in accordance with paragraph 2, if that device belongs to the
devices, categories or groups of devices determined by a measure referred to in
point (a) of paragraph 7.

4.
The UDI shall be placed on the label of the
device, in accordance with the conditions laid down by a measure referred to in
point (c) of paragraph 7. It shall be used for reporting serious incidents and
field safety corrective actions in accordance with Article 61 and shall be
included in the implant card referred to in Article 16. The device identifier
shall appear on the EU declaration of conformity referred to in Article 17 and
in the technical documentation referred to in Annex II.

5.
Economic operators and health institutions shall
store and keep, by electronic means, the device identifier and the production
identifier of the devices which they have supplied or they have been supplied
with, if they belong to the devices, categories or groups of devices determined
by a measure referred to in point (a) of paragraph 7.

6.
The Commission, in cooperation with the Member
States, shall set up and manage an electronic system on UDI to collate and
process the information mentioned in Part B of Annex V. This information shall
be accessible to the public.

7.
The Commission shall be empowered to adopt delegated
acts in accordance with Article 89:

(a)
determining the devices, categories or groups of
devices whose identification shall be based on the UDI system as set out in
paragraphs 1 to 6, and the timelines for implementing this. Following a risk-based
approach, implementation of the UDI system shall be gradual, starting with
devices falling in the highest risk class;

(b)
specifying the data to be included in the
production identifier which, following a risk based approach, may vary depending
on the risk class of the device;

(c)
defining the obligations of economic operators,
of health institutions and of professional users, in particular regarding
allocation of the numeric or alphanumeric characters, placement of the UDI on
the label, storage of information in the electronic system on UDI and use of
the UDI in documentation and reporting related to the device provided for in this
Regulation;

(d)
amending or supplementing the list of
information set out in Part B of Annex V in the light of technical progress.

8.
When adopting the measures referred to in
paragraph 7, the Commission shall take into account the following:

(a)
the protection of personal data;

(b)
the legitimate interest in protecting
commercially sensitive information;

(c)
the risk-based approach;

(d)
the cost-effectiveness of the measures;

(e)
the convergence of UDI systems developed at
international level.

Article 25
Electronic system on registration of devices and economic operators

1.
The Commission, in collaboration with the Member
States, shall set up and manage an electronic system to collate and process
information that is necessary and proportionate to describe and identify the
device and to identify the manufacturer and, where applicable, the authorised
representative and the importer. The details regarding the information to be
submitted by the economic operators are laid down in Part A of Annex V.

2.
Before a device, other than a custom-made or
investigational device, is placed on the market the manufacturer or his
authorised representative shall submit to the electronic system the information
referred to in paragraph 1.

3.
Within one week after placing a device, other
than a custom-made or investigational device, on the market, importers shall
submit to the electronic system the information referred to in paragraph 1.

4.
Within one week of any change occurring in
relation to the information referred to in paragraph 1, the relevant economic
operator shall update the data in the electronic system.

5.
Not later than two years after submission of the
information in accordance with paragraphs 2 and 3, and then every second year,
the relevant economic operator shall confirm the accuracy of the data. In the
event of failure to confirm within six months of the due date, any Member State
may take measures to suspend or otherwise restrict the making available of the
device in question within its territory until the obligation referred to in
this paragraph is complied with.

6.
The data contained in the electronic system
shall be accessible to the public.

7.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 amending the list of information
to be submitted as set out in Part A of Annex V in the light of technical
progress.

Article 26
Summary of safety and clinical performance

1.
In the case of devices classified as class III
and implantable devices, other than custom-made or investigational devices, the
manufacturer shall draw up a summary of safety and clinical performance. It
shall be written in a way that is clear to the intended user. The draft of this
summary shall be part of the documentation to be submitted to the notified body
involved in the conformity assessment in accordance with Article 42 and shall
be validated by that body.

2.
The Commission may, by means of implementing
acts, set out the form and the presentation of the data elements to be included
in the summary of safety and clinical performance. Those implementing acts shall be adopted in accordance with the
advisory procedure referred to in Article 88(2).

Article 27
European databank

1.
The Commission shall develop and manage the
European databank on medical devices (Eudamed) for the following purposes:

(a)
to enable the public to be adequately informed
about devices placed on the market, about the corresponding certificates issued
by notified bodies and about the relevant economic operators;

(b)
to enable traceability of devices within the
internal market;

(c)
to enable the public to be adequately informed
about clinical investigations and to enable sponsors of clinical investigations
to be conducted in more than one Member State to comply with information
obligations under Articles 50 to 60;

(d)
to enable manufacturers to comply with information
obligations under Articles 61 to 66;

(e)
to enable the competent authorities of the
Member States and the Commission to carry out their tasks relating to this
Regulation on a well informed basis and to enhance the cooperation between them.

2.
Eudamed shall include the following as integral
parts:

(a)
the electronic system on UDI referred to in
Article 24;

(b)
the electronic system on registration of devices
and economic operators referred to in Article 25;

(c)
the electronic system on information on
certificates referred to in Article 45(4);

(d)
the electronic system on clinical investigations
referred to in Article 53,

(e)
the electronic system on vigilance referred to
in Article 62;

(f)
the electronic system on market surveillance referred
to in Article 68.

3.
The data shall be entered into Eudamed by the
Member States, notified bodies, economic operators and sponsors as specified in
the provisions concerning the electronic systems referred to in paragraph 2.

4.
All the information collated and processed by
Eudamed shall be accessible to the Member States and to the Commission. The
information shall be accessible to notified bodies, economic operators,
sponsors and the public to the extent defined in the provisions referred to in
paragraph 2.

5.
Eudamed shall contain personal data only insofar
as this is necessary for the electronic systems referred to in paragraph 2 to
collate and process the information in accordance with this Regulation. Personal
data shall be kept in a form which permits identification of the data subjects
for no longer than the periods referred to in Article 8(4).

6.
The Commission and the Member States shall
ensure that the data subjects may effectively exercise their rights to
information, to access, to rectify and to object in accordance with Regulation
(EC) No 45/2001 and Directive 95/46/EC, respectively. They shall ensure that
the data subjects may effectively exercise the right of access to data relating
to them, and the right to have inaccurate or incomplete data corrected and
erased. Within their respective responsibilities, the Commission and the Member
States shall ensure that inaccurate and unlawfully processed data is deleted,
in accordance with the applicable legislation. Corrections and deletions shall
be carried out as soon as possible, but no later than within 60 days after a
request is made by a data subject.

7.
The Commission shall, by means of implementing
acts, lay down the modalities necessary for the development and management of
Eudamed. Those implementing acts shall be adopted in accordance with the
examination procedure referred to in Article 88(3).

8.
In relation to its responsibilities under this
Article and the processing of personal data involved therein, the Commission
shall be considered controller of Eudamed and its electronic systems.

Chapter IV

Notified bodies

Article 28
National authorities responsible for notified bodies

1.
A Member State that intends to designate a
conformity assessment body as a notified body, or has designated a notified
body, to carry out third-party conformity assessment tasks under this
Regulation shall designate an authority that shall be responsible for setting
up and carrying out the necessary procedures for the assessment, designation
and notification of conformity assessment bodies and for the monitoring of
notified bodies, including subcontractors or subsidiaries of those bodies, hereinafter
referred to as the ‘national authority responsible for notified bodies’.

2.
The national authority responsible for notified
bodies shall be established, organised and operated so as to safeguard the
objectivity and impartiality of its activities and to avoid any conflicts of
interests with conformity assessment bodies.

3.
It shall be organised so that each decision
relating to notification of a conformity assessment body is taken by personnel
different from those who carried out the assessment of the conformity
assessment body.

4.
It shall not perform any activities that
conformity assessment bodies perform nor provide consultancy services on a
commercial or competitive basis.

5.
The national authority responsible for notified
bodies shall safeguard the confidentiality of the information it obtains.
However, it shall exchange information on a notified body with other Member
States and the Commission.

6.
The national authority responsible for notified
bodies shall have a sufficient number of competent personnel at its disposal
for the proper performance of its tasks.

Without prejudice to Article 33(3), where a
national authority is responsible for the designation of notified bodies in the
field of products other than medical devices, the competent authority for
medical devices shall be consulted on all aspects specifically related to
medical devices.

7.
Member States shall provide the Commission and
the other Member States with information on their procedures for the
assessment, designation and notification of conformity assessment bodies and
for the monitoring of notified bodies, and of any changes thereto.

8.
The national authority responsible for notified
bodies shall be peer-reviewed every second year. The peer-review shall include
an on-site visit to a conformity assessment body or a notified body under the
responsibility of the reviewed authority. In the case referred to in the second
subparagraph of paragraph 6, the competent authority for medical devices shall
participate in the peer-review.

The Member States shall draw up the annual plan
for the peer-review, ensuring an appropriate rotation in respect of reviewing
and reviewed authorities, and submit it to the Commission. The Commission may
participate in the review. The outcome of the peer-review shall be communicated
to all Member States and to the Commission and a summary of the outcome shall
be made publicly available.

Article 29
Requirements relating to notified bodies

1.
Notified bodies shall satisfy the organisational
and general requirements and the quality management, resource and process
requirements that are necessary to fulfil their tasks for which they are
designated in accordance with this Regulation. Minimum requirements to be met
by notified bodies are set out in Annex VI.

2.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 amending or supplementing the
minimum requirements in Annex VI, in the light of technical progress and
considering the minimum requirements needed for the assessment of specific
devices, or categories or groups of devices.

Article 30
Subsidiaries and subcontracting

1.
Where a notified body subcontracts specific
tasks connected with conformity assessment or has recourse to a subsidiary for
specific tasks connected with conformity assessment, it shall verify that the
subcontractor or the subsidiary meets the relevant requirements set out in
Annex VI and shall inform the national authority responsible for notified
bodies accordingly.

2.
Notified bodies shall take full responsibility
for the tasks performed on their behalf by subcontractors or subsidiaries.

3.
Conformity assessment activities may be
subcontracted or carried out by a subsidiary only with the agreement of the
legal or natural person that applied for conformity assessment.

4.
Notified bodies shall keep at the disposal of
the national authority responsible for notified bodies the relevant documents
concerning the verification of the qualifications of the subcontractor or the
subsidiary and the work carried out by them under this Regulation.

Article 31
Application by a conformity assessment body for notification

1.
A conformity assessment body shall submit an
application for notification to the national authority responsible for notified
bodies of the Member State in which it is established.

2.
The application shall specify the conformity
assessment activities, the conformity assessment procedures and the devices for
which the body claims to be competent, supported by documentation proving compliance
with all the requirements set out in Annex VI.

In respect of the organisational and general
requirements and the quality management requirements set out in Sections 1 and
2 of Annex VI, the relevant documentation may be submitted in form of a valid certificate and the corresponding evaluation report delivered by
a national accreditation body in accordance with Regulation
(EC) No 765/2008. The conformity assessment body shall be presumed to be in
conformity with the requirements covered by the certificate delivered by such
accreditation body.

3.
After being designated, the notified body shall
update the documentation referred to in paragraph 2 whenever relevant changes
occur in order to enable the national authority responsible for notified bodies
to monitor and verify continuous compliance with all the requirements set out
in Annex VI.

Article 32
Assessment of the application

1.
The national authority responsible for notified
bodies shall check that the application referred to in Article 31 is complete and
draw up a preliminary assessment report.

2.
It shall submit the preliminary assessment
report to the Commission which shall immediately transmit it to the Medical
Device Coordination Group established by Article 78 (‘MDCG’). Upon request by the
Commission, the report shall be submitted by the authority in up to three
official Union languages.

3.
Within 14 days of the submission referred to in
paragraph 2, the Commission shall designate a joint assessment team made up of at
least two experts chosen from a list of experts who are qualified in the
assessment of conformity assessment bodies. The list shall be drawn up by the
Commission in cooperation with the MDCG. At least one of these experts shall be
a representative of the Commission who shall lead the joint assessment team.

4.
Within 90 days after designation of the joint
assessment team, the national authority responsible for notified bodies and the
joint assessment team shall review the documentation submitted with the
application in accordance with Article 31 and conduct an on-site assessment of
the applicant conformity assessment body and, where relevant, of any subsidiary
or sub-contractor, located inside or outside the Union, to be involved in the
conformity assessment process. Such on-site assessment shall not cover
requirements for which the applicant conformity assessment body has received a
certificate delivered by the
national accreditation body as referred to in Article 31(2), unless the
Commission representative mentioned in Article 32(3) requests the on-site assessment.

Findings regarding non-compliance of a body
with the requirements set out in Annex VI shall be raised during the assessment
process and discussed between the national authority responsible for notified
bodies and the joint assessment team with a view to finding common agreement
with respect to the assessment of the application. Divergent opinions shall be
identified in the assessment report of the national authority responsible.

5.
The national authority responsible for notified
bodies shall submit its assessment report and its draft notification to the
Commission which shall immediately transmit those documents to the MDCG and to
the members of the joint assessment team. Upon request by the Commission, those
documents shall be submitted by the authority in up to three official Union
languages.

6.
The joint assessment team shall provide its
opinion regarding the assessment report and the draft notification within 21
days of receipt of those documents and the Commission shall immediately submit this
opinion to the MDCG. Within 21 days after receipt of the opinion of the joint
assessment team, the MDCG shall issue a recommendation with regard to the draft
notification which the relevant national authority shall duly take into consideration
for its decision on the designation of the notified body.

7.
The Commission may, by means of implementing
acts, adopt measures setting out the modalities for the application for
notification referred to in Article 31 and the assessment of the application
set out in this Article. Those implementing acts shall be adopted in accordance
with the examination procedure referred to in Article 88(3).

Article 33
Notification procedure

1.
Member States shall notify the Commission and
the other Member States of the conformity assessment bodies they have designated,
using the electronic notification tool developed and managed by the Commission.

2.
Member States may notify only conformity
assessment bodies which satisfy the requirements set out in Annex VI.

3.
Where a national authority responsible for
notified bodies is responsible for designation of notified bodies in the field
of products other than medical devices, the competent authority for medical
devices shall provide, prior to the notification, a positive opinion on the
notification and its scope.

4.
The notification shall clearly specify the scope
of the designation indicating the conformity assessment activities, the
conformity assessment procedures and the type of devices which the notified
body is authorised to assess.

The Commission may, by means of implementing
acts, set up a list of codes and the corresponding types of devices to define
the scope of the designation of notified bodies which the Member States shall
indicate in their notification. Those implementing acts shall be adopted in
accordance with the advisory procedure referred to in Article 88(2).

5.
The notification shall be accompanied by the
final assessment report of the national authority responsible for notified
bodies, the opinion of the joint assessment team and the recommendation of the MDCG.
Where the notifying Member State does not follow the recommendation of the MDCG,
it shall provide a duly substantiated justification.

6.
The notifying Member State shall provide the
Commission and the other Member States with documentary evidence regarding the
arrangements in place to ensure that the notified body will be monitored
regularly and will continue to satisfy the requirements set out in Annex VI. It
shall furthermore submit evidence of the availability of competent personnel for
monitoring the notified body in accordance with Article 28(6).

7.
Within 28 days of a notification, a Member State
or the Commission may raise written objections, setting out its arguments, with
regard either to the notified body or to its monitoring by the national
authority responsible for notified bodies.

8.
When a Member State or the Commission raises
objections in accordance with paragraph 7, the effect of the notification shall
be suspended. In this case, the Commission shall bring the matter before the MDCG
within 15 days after expiry of the period referred to in paragraph 7. After
consulting the parties involved, the MDCG shall give its opinion at the latest within
28 days after the matter has been brought before it. If the notifying Member
State does not agree with the opinion of the MDCG, it may request the
Commission to give its opinion.

9.
Where no objection is raised in accordance with
paragraph 7 or where the MDCG or the Commission, after having been consulted in
accordance with paragraph 8, is of the opinion that the notification may be
accepted fully or partially, the Commission shall publish the notification
accordingly.

10.
The notification shall become valid the day
after its publication in the database of notified bodies developed and managed
by the Commission. The published notification shall determine the scope of
lawful activity of the notified body.

Article 34
Identification number and list of notified bodies

1.
The Commission shall assign an identification
number to each notified body for which the notification is accepted in
accordance with Article 33. It shall assign a single identification number even
when the body is notified under several Union acts.

2.
The Commission shall make the list of the bodies
notified under this Regulation, including the identification numbers that have
been assigned to them and the activities for which they have been notified,
accessible to the public. The Commission shall ensure that the list is kept up
to date.

Article 35
Monitoring of notified bodies

1.
The national authority
responsible for notified bodies shall continuously
monitor the notified bodies to ensure ongoing compliance with the requirements set out in Annex VI. The notified bodies shall, on request, supply all relevant
information and documents, required to enable the authority to verify
compliance with those criteria.

Notified bodies shall, without delay, inform
the national authority responsible for notified bodies of any changes, in
particular regarding their personnel, facilities, subsidiaries or subcontractors,
which may affect compliance with the requirements set out in Annex VI or their
ability to conduct the conformity assessment procedures relating to the devices
for which they have been designated.

2.
Notified bodies shall respond without delay to
requests relating to conformity assessments they have carried out, submitted by
their or another Member State's authority or by the Commission. The national
authority responsible for notified bodies of the Member State in which the body
is established shall enforce requests submitted by authorities of any other
Member State or by the Commission unless there is a legitimate reason for not
doing so in which case both sides may consult the MDCG. The notified body or
their national authority responsible for notified bodies may request that any
information transmitted to the authorities of another Member State or to the
Commission shall be treated confidential.

3.
At least once a year, the national authority
responsible for notified bodies shall assess whether each notified body under
its responsibility still satisfies the requirements set out in Annex VI. This
assessment shall include an on-site visit to each notified body.

4.
Three years after notification of a notified
body, and again every third year thereafter, the assessment to determine whether
the notified body still satisfies the requirements set out in Annex VI shall be
conducted by the national authority responsible for notified bodies of the
Member State in which the body is established and a joint assessment team
designated in accordance with the procedure described in Article 32(3) and (4).
At the request of the Commission or of a Member State, the MDCG may initiate
the assessment process described in this paragraph at any time when there is
reasonable concern about the ongoing compliance of a
notified body with the requirements set out in Annex VI.

5.
The Member States shall report to the Commission
and to the other Member States, at least once a year, on their monitoring
activities. This report shall contain a summary which shall be made publicly available.

Article 36
Changes to notifications

1.
The Commission and the other Member States shall
be notified of any subsequent relevant changes to the notification. The
procedures described in Article 32(2) to (6) and in Article 33 shall apply to
changes where they entail an extension of the scope of the notification. In all
other cases, the Commission shall immediately publish the amended notification
in the electronic notification tool referred to in Article 33(10).

2.
Where a national authority responsible for
notified bodies has ascertained that a notified body no longer meets the
requirements set out in Annex VI, or that it is failing to fulfil its
obligations, the authority shall suspend, restrict, or fully or partially withdraw
the notification, depending on the seriousness of the failure to meet those
requirements or fulfil those obligations. A suspension shall not exceed a
period of one year, renewable once for the same period. Where the notified body
has ceased its activity, the national authority responsible for notified bodies
shall withdraw the notification.

The national authority responsible for notified
bodies shall immediately inform the Commission and the other Member States of
any suspension, restriction or withdrawal of a notification.

3.
In the event of restriction, suspension or
withdrawal of a notification, the Member State shall take appropriate steps to
ensure that the files of the notified body concerned are either processed by
another notified body or kept available for the national authorities responsible
for notified bodies and for market surveillance at their request.

4.
The national authority responsible for notified
bodies shall assess whether the reasons which gave rise to the change to the
notification have an impact on the certificates issued by the notified body
and, within three months after having notified the changes to the notification,
shall submit a report on its findings to the Commission and the other Member
States. Where necessary to ensure the safety of devices on the market, that
authority shall instruct the notified body to suspend or withdraw, within a
reasonable period of time determined by the authority, any certificates which were
unduly issued. If the notified body fails to do so within the determined period
of time, or has ceased its activity, the national authority responsible for
notified bodies itself shall suspend or withdraw the certificates unduly
issued.

5.
The certificates, other than those unduly
issued, which were issued by the notified body for which the notification has
been suspended, restricted or withdrawn shall remain valid in the following
circumstances:

(a)
in the case of suspension of a notification: on
condition that, within three months of the suspension, either the competent
authority for medical devices of the Member State in which the manufacturer of
the device covered by the certificate is established, or another notified body
confirm in writing that it is assuming the functions of the notified body
during the period of suspension;

(b)
in the case of restriction or withdrawal of a
notification: for a period of three months after the restriction or withdrawal.
The competent authority for medical devices of the Member State in which the
manufacturer of the device covered by the certificate is established may extend
the validity of the certificates for further periods of three months, which
altogether may not exceed twelve months, provided it is assuming the functions
of the notified body during this period.

The authority or the notified body assuming the
functions of the notified body affected by the change of notification shall
immediately inform the Commission, the other Member States and the other
notified bodies thereof.

Article 37
Challenge to the competence of notified bodies

1.
The Commission shall investigate all cases where
concerns have been brought to its attention regarding the continued fulfilment
by a notified body of the requirements set out in Annex VI or the obligations to
which it is subject. It may also commence such investigations on its own
initiative.

2.
The notifying Member State shall provide the
Commission, on request, with all information regarding the notification of the notified
body concerned.

3.
Where the Commission ascertains that a notified
body no longer meets the requirements for its notification, it shall inform the
notifying Member State accordingly and request it to take the necessary
corrective measures, including the suspension, restriction or withdrawal of the
notification if necessary.

Where the Member State fails to take the
necessary corrective measures, the Commission may, by means of implementing
acts, suspend, restrict or withdraw the notification. Those implementing acts
shall be adopted in accordance with the examination procedure referred to in
Article 88(3). It shall notify the Member State concerned of its decision and
update the database and list of notified bodies.

Article 38
Exchange of experience between national authorities responsible for notified
bodies

The Commission shall provide for the
organisation of exchange of experience and coordination of administrative
practice between the national authorities responsible for notified bodies under
this Regulation.

Article 39
Coordination of notified bodies

The Commission shall ensure that
appropriate coordination and cooperation between notified bodies is put in
place and operated in the form of a coordination group of notified bodies in
the field of medical devices, including in vitro diagnostic medical
devices.

The bodies notified under this Regulation
shall participate in the work of that group.

Article 40
Fees

1.
The Member State where the bodies are
established shall levy fees on applicant conformity assessment bodies and on
notified bodies. These fees shall, wholly or partly, cover the costs relating
to the activities exercised by the national authorities responsible for
notified bodies in accordance with this Regulation.

2.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 setting out the structure and the
level of the fees referred to in paragraph 1, taking into account the
objectives of protection of human health and safety, support of innovation and
cost-effectiveness. Particular attention shall be paid to the interests of notified
bodies that submitted a valid certificate delivered by the national accreditation body as referred to in Article 31(2) and
notified bodies that are small and medium-sized enterprises as defined by Commission
Recommendation 2003/361/EC.

Chapter V

Classification and conformity assessment

Section 1 – Classification

Article 41
Classification of medical devices

1.
Devices shall be divided into classes I, IIa,
IIb and III, taking into account their intended purpose
and inherent risks. Classification shall be carried out
in accordance with the classification criteria set out in Annex VII.

2.
Any dispute between the manufacturer and the
notified body concerned, arising from the application of the classification criteria,
shall be referred for a decision to the competent authority of the Member State
where the manufacturer has his registered place of business. In cases where the
manufacturer has no registered place of business in the Union and has not yet
designated an authorised representative, the matter shall be referred to the
competent authority of the Member State where the authorised representative
referred to in the last indent of point (b) of Section 3.2. of Annex VIII has
his registered place of business.

At least 14 days prior to any decision, the
competent authority shall notify the MDCG and the Commission of its envisaged
decision.

3.
The Commission may, at the request of a Member
State or on its own initiative, by means of implementing acts, decide on the application
of the classification criteria set out in Annex VII to a given device, or
category or group of devices, with a view to determining their classification.

Those implementing acts shall be adopted in
accordance with the examination procedure referred to in Article 88(3).

4.
In the light of technical progress and any information
which becomes available in the course of the vigilance and market surveillance
activities described in Articles 61 to 75, the Commission shall be empowered to
adopt delegated acts in accordance with Article 89 as regards the following:

(a)
deciding that a device, or category or group of
devices, should, by way of derogation from the classification criteria set out
in Annex VII, be classified in another class;

(b)
amending or supplementing the classification criteria
set out in Annex VII.

Section 2 – Conformity assessment

Article 42
Conformity assessment procedures

1.
Prior to placing a device on the market,
manufacturers shall undertake an assessment of the conformity of that device. The
conformity assessment procedures are set out in Annexes VIII to XI.

2.
Manufacturers of devices classified as class
III, other than custom-made or investigational devices, shall be subject to a
conformity assessment based on full quality assurance and design dossier
examination as specified in Annex VIII. Alternatively,
the manufacturer may choose to apply a conformity assessment based on type
examination as specified in Annex IX coupled with a conformity assessment based
on product conformity verification as specified in Annex X.

In the case of devices referred to in the first
subparagraph of Article 1(4), the notified body shall follow the consultation
procedure as specified in Section 6.1 of Chapter II of Annex VIII or Section 6
of Annex IX, as applicable.

In the case of devices that are covered by this
Regulation in accordance with point (e) of Article 1(2), the notified body
shall follow the consultation procedure as specified in Section 6.2 of Chapter
II of Annex VIII or Section 6 of Annex IX, as applicable.

3.
Manufacturers of devices classified as class
IIb, other than custom-made or investigational devices, shall be subject to a
conformity assessment based on full quality assurance as specified in Annex
VIII, except for its Chapter II, with assessment of the design documentation
within the technical documentation on a representative basis. Alternatively,
the manufacturer may choose to apply a conformity assessment based on type
examination as specified in Annex IX coupled with a conformity assessment based
on product conformity verification as specified in Annex X.

4.
Manufacturers of devices classified as class
IIa, other than custom-made or investigational devices, shall be subject to a
conformity assessment based on full quality assurance as specified in Annex
VIII, except for its Chapter II, with assessment of the design documentation
within the technical documentation on a representative basis. Alternatively,
the manufacturer may choose to draw up the technical documentation set out in
Annex II coupled with a conformity assessment based on product conformity
verification as specified in Section 7 of Part A or Section 8 of Part B of Annex
X.

5.
Manufacturers of devices classified as class I,
other than custom-made or investigational devices, shall declare the conformity
of their products by issuing the EU declaration of conformity referred to in
Article 17 after drawing up the technical documentation set out in Annex II. If
the devices are placed on the market in sterile condition or have a measuring
function, the manufacturer shall apply the procedures set out in Annex VIII,
except for its Chapter II, or in Part A of Annex X. However, involvement of the
notified body shall be limited:

(a)
in the case of devices placed on the market in
sterile condition, to the aspects of manufacture concerned with securing and
maintaining sterile conditions,

(b)
in the case of devices with a measuring
function, to the aspects of manufacture concerned with the conformity of the
devices with the metrological requirements.

6.
Manufacturers may choose to apply a conformity
assessment procedure applicable to devices of a higher class than the device in
question.

7.
Manufacturers of custom-made devices shall
follow the procedure set out in Annex XI and draw up the statement set out in
that Annex before placing the device on the market.

8.
The Member State in which the notified body is
established may determine that all or certain documents, including the
technical documentation, audit, assessment and inspection reports, relating to the
procedures referred to in paragraphs 1 to 6 shall be available in an official
Union language. Otherwise they shall be available in an official Union language
acceptable to the notified body.

9.
Investigational devices shall be subject to the requirements
set out in Articles 50 to 60.

10.
The Commission may, by means of implementing
acts, specify the modalities and the procedural aspects with a view to ensuring
harmonised application of the conformity assessment procedures by the notified
bodies for any of the following aspects:

–
the frequency and the sampling basis of the
assessment of the design documentation within the technical documentation on a
representative basis as set out in Sections 3.3(c) and 4.5 of Annex VIII in the
case of devices of classes IIa and IIb, and in Section 7.2 of Part A of Annex X
in the case of devices of class IIa;

–
the minimum frequency of unannounced factory
inspections and sample checks to be conducted by notified bodies in accordance
with Section 4.4 of Annex VIII, taking into account the risk-class and the type
of device;

–
the physical, laboratory or other tests to be carried
out by notified bodies in the context of sample checks, design dossier
examination and type examination in accordance with Sections 4.4 and 5.3 of
Annex VIII, Section 3 of Annex IX and Section 5 of Part B of Annex X.

Those implementing acts shall be adopted in
accordance with the examination procedure referred to in Article 88(3).

11.
In the light of technical progress and any
information which becomes available in the course of the designation or
monitoring of notified bodies set out in Articles 28 to 40, or of the vigilance
and market surveillance activities described in Articles 61 to 75, the
Commission shall be empowered to adopt delegated acts in accordance with
Article 89 amending or supplementing the conformity assessment procedures set
out in Annexes VIII to XI.

Article 43
Involvement of notified bodies

1.
Where the conformity assessment procedure
requires the involvement of a notified body, the manufacturer may apply to a notified
body of his choice, provided that the body is notified for the conformity
assessment activities, the conformity assessment procedures and the devices concerned.
An application may not be lodged in parallel with more than one notified body
for the same conformity assessment activity.

2.
The notified body concerned shall inform the
other notified bodies of any manufacturer who withdraws his application prior
to the notified body's decision regarding the conformity assessment.

3.
The notified body may require any information or
data from the manufacturer which is necessary in order to properly conduct the
chosen conformity assessment procedure.

4.
Notified bodies and the personnel of notified
bodies shall carry out their conformity assessment activities with the highest
degree of professional integrity and the requisite technical competence in the
specific field and shall be free from all pressures and inducements,
particularly financial, which might influence their judgement or the results of
their conformity assessment activities, especially as regards persons or groups
with an interest in the results of those activities.

Article 44
Mechanism for scrutiny of certain conformity assessments

1.
Notified bodies shall notify the Commission of
applications for conformity assessments for devices classified as class III,
with the exception of applications to supplement or renew existing
certificates. The notification shall be accompanied by the draft instructions
for use referred to in Section 19.3 of Annex I and the draft summary of safety
and clinical performance referred to in Article 26. In its notification the
notified body shall indicate the estimated date by which the conformity
assessment is to be completed. The Commission shall immediately transmit the
notification and the accompanying documents to the MDCG.

2.
Within 28 days of receipt of the information
referred to in paragraph 1, the MDCG may request the notified body to submit a
summary of the preliminary conformity assessment prior to issuing a
certificate. Upon suggestion by any of its members or by the Commission, the MDCG
shall decide on making such request in accordance with the procedure set out in
Article 78(4). In its request the MDCG shall indicate the scientifically valid
health reason for having selected the specific file for submission of a summary
of the preliminary conformity assessment. When selecting a specific file for
submission, the principle of equal treatment shall be duly taken into account.

Within 5 days after receipt of the request by
the MDCG, the notified body shall inform the manufacturer thereof.

3.
The MDCG may submit comments on the summary of
the preliminary conformity assessment at the latest 60 days after submission of
this summary. Within that period and at the latest 30 days after submission,
the MDCG may request the submission of additional information that for
scientifically valid grounds are necessary for the analysis of the notified
body's preliminary conformity assessment. This may include a request for
samples or an on-site visit to the manufacturer's premises. Until submission of
the additional information requested, the period for comments referred to in
the first sentence of this subparagraph shall be suspended. Subsequent requests
for additional information from the MDCG shall not suspend the period for the
submission of comments.

4.
The notified body shall give due consideration
to any comments received in accordance with paragraph 3. It shall convey to the
Commission an explanation of how they have been taken into consideration,
including any due justification for not following the comments received, and
its final decision regarding the conformity assessment in question. The
Commission shall immediately transmit this information to the MDCG.

5.
Where deemed necessary for the protection of
patient safety and public health, the Commission, may determine, by means of
implementing acts, specific categories or groups of devices, other than devices
of class III, to which paragraphs 1 to 4 shall apply during a predefined period
of time. Those implementing acts shall be adopted in accordance with the
examination procedure referred to in Article 88(3).

Measures pursuant to this paragraph may be
justified only by one or more of the following criteria:

(a)
the novelty of the device or of the technology
on which it is based and the significant clinical or public health impact thereof;

(b)
an adverse change in the risk-benefit profile of
a specific category or group of devices due to scientifically valid health
concerns in respect of components or source material or in respect of the
impact on health in case of failure;

(c)
an increased rate of serious incidents reported
in accordance with Article 61 in respect of a specific category or group of
devices;

(d)
significant discrepancies in the conformity
assessments carried out by different notified bodies on substantially similar
devices;

(e)
public health concerns regarding a specific
category or group of devices or the technology on which they are based.

6.
The Commission shall make a summary of the
comments submitted in accordance with paragraph 3 and the outcome of the
conformity assessment procedure accessible to the public. It shall not disclose
any personal data or information of commercially confidential nature.

7.
The Commission shall set up the technical
infrastructure for the data-exchange by an electronic means between notified
bodies and MDCG for the purposes of this Article.

8.
The Commission, by means of implementing acts,
may adopt the modalities and the procedural aspects concerning the submission
and analysis of the summary of the preliminary conformity assessment in
accordance with paragraphs 2 and 3. Those implementing acts shall be adopted in
accordance with the examination procedure referred to in Article 88(3).

Article 45
Certificates

1.
The certificates issued by the notified bodies
in accordance with Annexes VIII, IX and X shall be in an official Union language
determined by the Member State in which the notified body is established or otherwise
in an official Union language acceptable to the notified body. The minimum
content of the certificates is set out in Annex XII.

2.
The certificates shall be valid for the period
they indicate, which shall not exceed five years. On application by the
manufacturer, the validity of the certificate may be extended for further
periods, each not exceeding five years, based on a re-assessment in accordance
with the applicable conformity assessment procedures. Any supplement to a
certificate shall remain valid as long as the certificate which it supplements
is valid.

3.
Where a notified body finds that requirements of
this Regulation are no longer met by the manufacturer, it shall, taking account
of the principle of proportionality, suspend or withdraw the certificate issued
or impose any restrictions on it unless compliance with such requirements is
ensured by appropriate corrective action taken by the manufacturer within an
appropriate deadline set by the notified body. The notified body shall give the
reasons for its decision.

4.
The Commission, in collaboration with the Member
States, shall set up and manage an electronic system to collate and process
information on certificates issued by notified bodies. The notified body shall
enter into this electronic system information regarding certificates issued,
including amendments and supplements, and regarding suspended, reinstated,
withdrawn or refused certificates and restrictions imposed on certificates.
This information shall be accessible to the public.

5.
In the light of technical progress, the
Commission shall be empowered to adopt delegated acts in accordance with
Article 89 amending or supplementing the minimum content of the certificates
set out in Annex XII.

Article 46
Voluntary change of notified body

1.
In cases where a manufacturer terminates his contract
with a notified body and enters into a contract with another notified body in
respect of the conformity assessment of the same device, the modalities of the change
of notified body shall be clearly defined in an agreement between the
manufacturer, the outgoing notified body and the incoming notified body. This
agreement shall address at least the following aspects:

(a)
the date of invalidity of certificates issued by
the outgoing notified body;

(b)
the date until which the identification number
of the outgoing notified body may be indicated in the information supplied by
the manufacturer, including any promotional material;

(c)
the transfer of documents, including
confidentiality aspects and property rights;

(d)
the date as of which the incoming notified body
assumes full responsibility for the conformity assessment tasks.

2.
On their date of invalidity, the outgoing
notified body shall withdraw the certificates it has issued for the device
concerned.

Article 47
Derogation from the conformity assessment procedures

1.
By way of derogation from Article 42, any
competent authority may authorise, on duly justified request, the placing on
the market or putting into service within the territory of the Member State
concerned, of a specific device for which the procedures referred to in Article
42 have not been carried out and use of which is in the interest of public
health or patient safety.

2.
The Member State shall inform the Commission and
the other Member States of any decision to authorise the placing on the market
or putting into service of a device in accordance with paragraph 1 where such
authorisation is granted for use other than for a single patient.

3.
Upon request by a Member State and where this is
in the interest of public health or patient safety in more than one Member
State, the Commission may, by means of implementing acts, extend for a
determined period of time the validity of an authorisation granted by a Member
State in accordance with paragraph 1 to the territory of the Union and set the
conditions under which the device may be placed on the market or put into
service. Those implementing acts shall be adopted in accordance with the
examination procedure referred to in Article 88(3).

On duly justified imperative grounds of urgency
relating to the health and safety of humans, the Commission shall adopt
immediately applicable implementing acts in accordance with the procedure
referred to in Article 88(4).

Article 48
Certificate of free sale

1.
For the purpose of export and upon request by a
manufacturer, the Member State in which the manufacturer has its registered
place of business shall issue a certificate of free sale declaring that the
manufacturer is properly established and that the device in question bearing
the CE-marking in accordance with this Regulation may be legally marketed in
the Union. The certificate of free sale shall be valid for the period indicated
on it which shall not exceed five years and shall not exceed the validity of
the certificate referred to in Article 45 issued for the device in question.

2.
The Commission may, by means of implementing
acts, establish a model for certificates of free sale taking into account
international practice as regards the use of certificates of free sale. Those implementing
acts shall be adopted in accordance with the advisory procedure referred to in
Article 88(2).

Chapter VI

Clinical
evaluation and clinical investigations

Article 49
Clinical evaluation

1.
Manufacturers shall conduct a clinical
evaluation in accordance with the principles set out in this Article and Part A
of Annex XIII.

2.
A clinical evaluation shall follow a defined and
methodologically sound procedure based on either of the following:

(a)
a critical evaluation of the relevant scientific
literature currently available relating to the safety, performance, design
characteristics and intended purpose of the device, where the following
conditions are satisfied:

–
it is demonstrated that the device subject to
clinical evaluation and the device to which the data relate are equivalent,

–
the data adequately demonstrate compliance with
the relevant general safety and performance requirements;

(b)
a critical evaluation of the results of all
clinical investigations performed in accordance with Articles 50 to 60 and
Annex XIV;

(c)
a critical evaluation of the combined clinical
data referred to in points (a) and (b).

3.
Where demonstration of conformity with general
safety and performance requirements based on clinical data is not deemed
appropriate, adequate justification for any such exception shall be given based
on the results of the manufacturer's risk management and on consideration of
the specifics of the interaction between the device and the human body, the
clinical performances intended and the claims of the manufacturer. The adequacy
of demonstration of conformity with the general safety and performance requirements
based on the results of non-clinical testing methods alone, including performance evaluation, bench testing and
pre-clinical evaluation, has to be duly substantiated in the technical
documentation referred to in Annex II.

4.
The clinical evaluation and its documentation
shall be updated throughout the life cycle of the device concerned with data
obtained from the implementation of the manufacturer's post-market surveillance
plan referred to in Article 8(6).

5.
The clinical evaluation and its outcome shall be
documented in a clinical evaluation report referred to in Section 6 of Part A
of Annex XIII which shall be included or fully referenced in the technical
documentation referred to in Annex II relating to the device concerned.

Article 50
General requirements regarding clinical investigations

1.
Clinical investigations shall be subject to
Articles 50-60 and Annex XIV if they are conducted for one or more of the
following purposes:

(a)
to verify that, under normal conditions of use,
devices are designed, manufactured and packaged in such a way that they are
suitable for one or more of the specific purposes of a medical device referred
to in number (1) of Article 2(1), and achieve the performances intended as
specified by the manufacturer;

(b)
to verify that devices achieve the intended
benefits to the patient as specified by the manufacturer;

(c)
to determine any undesirable side-effects, under
normal conditions of use, and assess whether they constitute acceptable risks
when weighed against the benefits to be achieved by the device.

2.
Where the sponsor is not established in the
Union, he shall ensure that a contact person is established in the Union. That
contact person shall be the addressee for all communications with the sponsor provided
for in this Regulation. Any communication to that contact person shall be
considered as communication to the sponsor.

3.
Clinical investigations shall be designed and
conducted in a way that the rights, safety and well-being of the subjects participating
in a clinical investigation are protected and that the clinical data generated in
the clinical investigation are going to be reliable and robust.

4.
Clinical investigations shall be designed,
conducted, recorded and reported in accordance with the provisions of Articles
50 to 60 and of Annex XIV.

Article 51
Application for clinical investigations

1.
Before making the first application, the sponsor
shall procure from the electronic system referred to in Article 53 a single
identification number for a clinical investigation conducted in one site or
multiple sites, in one or more than one Member State. The sponsor shall use this
single identification number when registering the clinical investigation in
accordance with Article 52.

2.
The sponsor of a clinical investigation shall submit an application to the
Member State(s) in which the investigation is to be conducted accompanied by
the documentation referred to in Chapter II of Annex XIV. Within six days after
receipt of the application, the Member State concerned shall notify the sponsor
whether the clinical investigation falls within the scope of this Regulation
and whether the application is complete.

Where the Member State has not notified the
sponsor within the time period referred to in the first subparagraph, the
clinical investigation shall be considered as falling within the scope of this
Regulation and the application shall be considered complete.

3.
Where the Member State finds that the clinical
investigation applied for does not fall within the scope of this Regulation or
that the application is not complete, it shall inform the sponsor thereof and
shall set a maximum of six days for the sponsor to comment or to complete the
application.

Where the sponsor has not provided comments nor
completed the application within the time-period referred to in the first subparagraph,
the application shall be considered as withdrawn.

Where the Member State has not notified the
sponsor according to paragraph 2 within three days following receipt of the
comments or of the completed application, the clinical investigation shall be
considered as falling within the scope of this Regulation and the application
shall be considered complete.

4.
For the purposes of this Chapter, the date on
which the sponsor is notified in accordance with paragraph 2 shall be the
validation date of the application. Where the sponsor is not notified, the
validation date shall be the last day of the time periods referred to in
paragraphs 2 and 3.

5.
The sponsor may start the clinical investigation
in the following circumstances:

(a)
in the case of investigational devices classified
as class III and implantable or long-term invasive devices classified as class
IIa or IIb, as soon as the Member State concerned has notified the sponsor of
its approval;

(b)
in the case of investigational devices other
than those referred to in point (a) immediately after the date of application
provided that the Member State concerned has so decided and that evidence is
provided that the rights, safety and well-being of the subjects to the clinical
investigation are protected;

(c)
after the expiry of 35 days after the validation
date referred to in paragraph 4, unless the Member State concerned has notified
the sponsor within that period of its refusal based on considerations of public
health, patient safety or public policy.

6.
Member States shall ensure that the persons
assessing the application do not have conflicts of interest and that they are
independent of the sponsor, the institution of the investigation site(s) and
the investigators involved, as well as free of any other undue influence.

Member States shall ensure that the assessment
is done jointly by a reasonable number of persons who collectively have the
necessary qualifications and experience. In the assessment, the view of at
least one person whose primary area of interest is non-scientific shall be
taken into account. The view of at least one patient shall be taken into
account.

7.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 amending or supplementing, in the
light of technical progress and global regulatory developments, the
requirements for the documentation to be submitted with the application for the
clinical investigation that is laid down in Chapter II of Annex XIV.

Article 52
Registration of clinical investigations

1.
Before commencing the clinical investigation,
the sponsor shall enter in the electronic system referred to in Article 53 the
following information regarding the clinical investigation:

(a)
the single identification number of the clinical
investigation;

(b)
the name and contact details of the sponsor and,
if applicable, his contact person established in the Union;

(c)
the name and contact details of the natural or
legal person responsible for the manufacture of the investigational device, if
different from the sponsor;

(d)
the description of the investigational device;

(e)
the description of the comparator(s), if
applicable;

(f)
the purpose of the clinical investigation;

(g)
the status of the clinical investigation.

2.
Within one week of any change occurring in
relation to the information referred to in paragraph 1, the sponsor shall
update the relevant data in the electronic system referred to in Article 53.

3.
The information shall be accessible to the
public, through the electronic system referred to in Article 53, unless, for
all or parts of that information, confidentiality of the information is
justified on any of the following grounds:

(a)
protection of personal data in accordance with Regulation
(EC) No 45/2001;

(b)
protection of commercially sensitive information;

(c)
effective supervision of the conduct of the
clinical investigation by the Member State(s) concerned.

4.
No personal data of subjects participating in clinical
investigations shall be publicly available.

Article 53
Electronic system on clinical investigations

1.
The Commission shall, in collaboration with the
Member States, set up and manage an electronic system to create the single
identification numbers for clinical investigations referred to in Article 51(1)
and to collate and process the following information:

(a)
the registration of clinical investigations in
accordance with Article 52;

(b)
the exchange of information between the Member
States and between them and the Commission in accordance with Article 56;

(c)
the information related to clinical
investigations conducted in more than one Member State in case of a single
application in accordance with Article 58;

(d)
reports on serious adverse events and device
deficiencies referred to in Article 59(2) in case of a single application in
accordance with Article 58.

2.
When setting up the electronic system referred
in paragraph 1, the Commission shall ensure that it is interoperable with the
EU database for clinical trials on medicinal products for human use set up in
accordance with Article […] of Regulation (EU) No […/…]. With the exception of the
information referred to in Article 52, the information collated and processed
in the electronic system shall be accessible only to the Member States and to
the Commission.

3.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 determining which other
information regarding clinical investigations collated and processed in the
electronic system shall be publicly accessible to allow interoperability with
the EU database for clinical trials on medicinal products for human use set up
by Regulation (EU) No […/…]. Article 52(3) and (4) shall apply.

Article 54
Clinical investigations with devices authorised to bear the CE marking

1.
Where a clinical investigation is to be
conducted to further assess a device which is authorised in accordance with
Article 42 to bear the CE marking and within its intended purpose referred to in
the relevant conformity assessment procedure, hereinafter referred to as ‘post-market
clinical follow-up investigation’, the sponsor shall notify the Member States
concerned at least 30 days prior to their commencement if the investigation
would submit subjects to additionally invasive or burdensome procedures.
Article 50(1) to (3), Article 52, Article 55, Article 56(1), Article 57(1), the
first subparagraph of Article 57(2) and the relevant provisions of Annex XIV shall
apply.

2.
If the aim of the clinical investigation
regarding a device which is authorised in accordance with Article 42 to bear
the CE marking is to assess such device for a purpose other than that referred
to in the information supplied by the manufacturer in accordance with Section
19 of Annex I and in the relevant conformity assessment procedure, Articles 50
to 60 shall apply.

Article 55
Substantial modifications to a clinical investigation

1.
If the sponsor introduces modifications to a
clinical investigation that are likely to have a substantial impact on the
safety or rights of the subjects or on the robustness or reliability of the
clinical data generated by the investigation, he shall notify the Member
State(s) concerned of the reasons for and the content of those modifications.
The notification shall be accompanied by an updated version of the relevant
documentation referred to in Chapter II of Annex XIV.

2.
The sponsor may implement the modifications
referred to in paragraph 1 at the earliest 30 days after notification, unless
the Member State concerned has notified the sponsor of its refusal based on
considerations of public health, patient safety or public policy.

Article 56
Information exchange between Member States

1.
Where a Member State has refused, suspended or
terminated a clinical investigation, or has called for a substantial
modification or temporary halt of a clinical investigation, or has been
notified by the sponsor of the early termination of a clinical investigation on
safety grounds, that Member State shall communicate its decision and the
grounds therefor to all Member States and the Commission by means of the
electronic system referred to in Article 53.

2.
Where an application is withdrawn by the sponsor
prior to a decision by a Member State, that Member State shall inform all the other
Member States and the Commission of that fact, by means of the electronic
system referred to in Article 53.

Article 57
Information by the sponsor in the event of temporary halt or termination of a
clinical investigation

1.
If the sponsor has temporarily halted a clinical
investigation on safety grounds, he shall inform the Member States concerned
within 15 days of the temporary halt.

2.
The sponsor shall notify each Member State
concerned of the end of a clinical investigation in relation to that Member State,
providing a justification in the event of early termination. That notification
shall be made within 15 days from the end of the clinical investigation in
relation to that Member State.

If the investigation is conducted in more than
one Member State the sponsor shall notify all Member States concerned of the overall
end of the clinical investigation. That notification shall be made within 15
days from the overall end of the clinical investigation.

3.
Within one year from the end of the clinical
investigation, the sponsor shall submit to the Member States concerned a summary
of the results of the clinical investigation in form of a clinical
investigation report referred to in Section 2.7 of Chapter I of Annex XIV. Where,
for scientific reasons, it is not possible to submit the clinical investigation
report within one year, it shall be submitted as soon as it is available. In
this case, the clinical investigation plan referred to in Section 3 of Chapter
II of Annex XIV shall specify when the results of the clinical investigation
are going to be submitted, together with an explanation.

Article 58
Clinical investigations conducted in more than one Member State

1.
By means of the electronic system referred to in
Article 53, the sponsor of a clinical investigation to be conducted in more
than one Member State may submit, for the purpose of Article 51, a single
application that, upon receipt, is transmitted electronically to the Member
States concerned.

2.
In the single application, the sponsor shall
propose one of the Member States concerned as coordinating Member State. If
that Member State does not wish to be the coordinating Member State, it shall
agree, within six days of submission of the single application, with another
Member State concerned that the latter shall be the coordinating Member State. If
no other Member State accepts to be the coordinating Member State, the Member
State proposed by the sponsor shall be the coordinating Member State. If
another Member State than the one proposed by the sponsor becomes coordinating
Member State, the deadline referred to in Article 51(2) shall start on the day
following the acceptance.

3.
Under the direction of the coordinating Member
State referred to in paragraph 2, the Member States concerned shall coordinate
their assessment of the application, in particular of the documentation
submitted in accordance with Chapter II of Annex XIV, except for Sections 3.1.3,
4.2, 4.3 and 4.4 thereof which shall be assessed separately by each Member
State concerned.

The coordinating Member State shall:

(a)
within 6 days of receipt of the single
application notify the sponsor whether the clinical investigation falls within
the scope of this Regulation and whether the application is complete, except
for the documentation submitted in accordance with Sections 3.1.3, 4.2, 4.3 and
4.4 of Chapter II of Annex XIV for which each Member State shall verify the
completeness. Article 51(2) to (4) shall apply to the coordinating Member State
in relation to the verification that the clinical investigation falls within
the scope of this Regulation and that the application is complete, except for
the documentation submitted in accordance with Sections 3.1.3, 4.2, 4.3 and 4.4
of Chapter II of Annex XIV. Article 51(2) to (4) shall apply to each Member
State in relation to the verification that the documentation submitted in
accordance with Sections 3.1.3, 4.2, 4.3 and 4.4 of Chapter II of Annex XIV is
complete;

(b)
establish the results of the coordinated assessment
in a report to be taken into account by the other Member States concerned when
deciding on the sponsor’s application in accordance with Article 51(5).

4.
The substantial modifications referred to in
Article 55 shall be notified to the Member States concerned by means of the electronic
system referred to in Article 53. Any assessment as to whether there are
grounds for refusal as referred to in Article 55 shall be carried out under the
direction of the coordinating Member State.

5.
For the purpose of Article 57(3), the sponsor
shall submit the clinical investigation report to the Member States concerned
by means of the electronic system referred to in Article 53.

6.
The Commission shall provide secretarial support
to the coordinating Member State in the accomplishment of its tasks provided
for in this Chapter.

Article 59
Recording and reporting of events occurring during clinical investigations

1.
The sponsor shall fully record any of the
following:

(a)
an adverse event identified in the clinical
investigation plan as critical to the evaluation of the results of the clinical
investigation in view of the purposes referred to in Article 50(1);

(b)
a serious adverse event;

(c)
a device deficiency that might have led to a
serious adverse event if suitable action had not been taken, intervention had
not occurred, or circumstances had been less fortunate;

(d)
new findings in relation to any event referred
to in points (a) to (c).

2.
The sponsor shall report to all Member States
where a clinical investigation is conducted without delay any of the following:

(a)
a serious adverse event that has a causal
relationship with the investigational device, the comparator or the
investigation procedure or where such causal relationship is reasonably
possible;

(b)
a device deficiency that might have led to a
serious adverse event if suitable action had not been taken, intervention had
not occurred, or circumstances had been less fortunate;

(c)
new findings in relation to any event referred
to in points (a) to (b).

The time period for reporting shall take
account of the severity of the event. Where necessary to ensure timely
reporting, the sponsor may submit an initial incomplete report followed up by a
complete report.

3.
The sponsor shall also report to the Member
States concerned any event referred to in paragraph 2 occurring in third
countries in which a clinical investigation is performed under the same
clinical investigation plan as the one applying to a clinical investigation
covered by this Regulation.

4.
In the case of a clinical investigation for
which the sponsor has used the single application referred to in Article 58,
the sponsor shall report any event as referred to in paragraph 2 by means of
the electronic system referred to in Article 53. Upon receipt, this report shall
be transmitted electronically to all Member States concerned.

Under the direction of the coordinating Member
State referred to in Article 58(2), the Member States shall coordinate their
assessment of serious adverse events and device deficiencies to determine
whether a clinical investigation needs to be terminated, suspended, temporarily
halted or modified.

This paragraph shall not affect the rights of
the other Member States to perform their own evaluation and to adopt measures
in accordance with this Regulation in order to ensure the protection of public
health and patient safety. The coordinating Member State and the Commission
shall be kept informed of the outcome of any such evaluation and the adoption
of any such measures.

5.
In the case of post-market clinical follow-up
investigations referred to in Article 54(1), the provisions on vigilance contained
in Articles 61 to 66 shall apply instead of this Article.

Article 60
Implementing acts

The Commission may, by means of
implementing acts, adopt the modalities and procedural aspects necessary for
the implementation of this Chapter as regards the following:

(a)
harmonised forms for the application for
clinical investigations and their assessment as referred to in Articles 51 and
58, taking into account specific categories or groups of devices;

(b)
the functioning of the electronic system
referred to in Article 53;

(c)
harmonised forms for the notification of
post-market clinical follow-up investigations as referred to in Article 54(1),
and of substantial modifications as referred to in Article 55;

(d)
the exchange of information between Member
States as referred to in Article 56;

(e)
harmonised forms for the reporting of serious
adverse events and device deficiencies as referred to in Article 59;

(f)
the timelines for the reporting of serious
adverse events and device deficiencies, taking into account the severity of the
event to be reported as referred to in Article 59.

Those implementing acts shall be adopted in
accordance with the examination procedure referred to in Article 88(3).

Chapter
VII

Vigilance and market surveillance

Section 1 – Vigilance

Article 61
Reporting of incidents and field safety corrective actions

1.
Manufacturers of devices other than custom-made
or investigational devices, shall report through the electronic system referred
to in Article 62 the following:

(a)
any serious incident in respect of devices made available
on the Union market;

(b)
any field safety corrective action in respect of
devices made available on the Union market, including any field safety
corrective action undertaken in a third country in relation to a device which
is also legally made available on the Union market if the reason for the field
safety corrective action is not limited to the device made available in the
third country.

Manufacturers shall make the report referred to
in the first subparagraph without delay, and no later than 15 days after they have
become aware of the event and the causal relationship with their device or that
such causal relationship is reasonably possible. The time period for reporting
shall take account of the severity of the incident. Where necessary to ensure timely
reporting, the manufacturer may submit an initial incomplete report followed up
by a complete report.

2.
For similar serious incidents occurring with the
same device or device type and for which the root cause has been identified or
the field safety corrective action implemented, manufacturers may provide
periodic summary reports instead of individual incident reports, on condition that
the competent authorities referred to in points (a), (b) and (c) of Article
62(5) have agreed with the manufacturer on the format, content and frequency of
the periodic summary reporting.

3.
The Member States shall take all appropriate
measures to encourage healthcare professionals, users and patients to report to
their competent authorities suspected serious incidents referred to in point (a)
of paragraph 1. They shall record such reports centrally at national level.
Where a competent authority of a Member State obtains such reports, it shall
take the necessary steps to ensure that the manufacturer of the device
concerned is informed of the incident. The manufacturer shall ensure the
appropriate follow-up.

The Member States shall coordinate between them
the development of standard web-based structured forms for reporting of serious
incidents by healthcare professionals, users and patients.

4.
Manufacturers of custom-made devices shall
report any serious incidents and field safety corrective actions referred to in
paragraph 1 to the competent authority of the Member State in which the device
in question has been made available.

Article 62
Electronic system on vigilance

1.
The Commission shall, in collaboration with the
Member States, set up and manage an electronic system to collate and process
the following information:

(a)
the reports by manufacturers on serious
incidents and field safety corrective actions referred to in Article 61(1);

(b)
the periodic summary reports by manufacturers referred
to in Article 61(2);

(c)
the reports by competent authorities on serious
incidents referred to in the second subparagraph of Article 63(1);

(d)
the reports by manufacturers on trends referred
to in Article 64;

(e)
the field safety notices by manufacturers referred
to in Article 63(5);

(f)
the information to be exchanged between the
competent authorities of the Member States and between them and the Commission
in accordance with Article 63(4) and (7).

2.
The information collated and processed by the
electronic system shall be accessible to the competent authorities of the
Member States, to the Commission and to the notified bodies.

3.
The Commission shall ensure that healthcare
professionals and the public have appropriate levels of access to the
electronic system.

4.
On the basis of arrangements between the
Commission and competent authorities of third countries or international
organisations, the Commission may grant those competent authorities or
international organisations access to the database at the appropriate level.
Those arrangements shall be based on reciprocity and make provision for
confidentiality and data protection equivalent to those applicable in the Union.

5.
The reports on serious incidents and field
safety corrective actions referred to in points (a) and (b) of Article 61(1),
the periodic summary reports referred to in Article 61(2), the reports on
serious incidents referred to in the second subparagraph of Article 63(1) and
the trend reports referred to in Article 64 shall be automatically transmitted
upon receipt via the electronic system to the competent authorities of the following
Member States:

(a)
the Member State where the incident occurred;

(b)
the Member State where the field safety
corrective action is being or is to be undertaken;

(c)
the Member State where the manufacturer has his
registered place of business;

(d)
where applicable, the Member State where the
notified body, that issued a certificate in accordance with Article 45 for the
device in question, is established.

Article 63
Analysis of serious incidents and field safety corrective actions

1.
Member States shall take the necessary steps to
ensure that any information regarding a serious incident that has occurred
within their territory or a field safety corrective action that has been or is
to be undertaken within their territory, and that is brought to their knowledge
in accordance with Article 61 is, at national level, evaluated centrally by
their competent authority, if possible together with the manufacturer.

If in the case of reports received in
accordance with Article 61(3) the competent authority ascertains that the reports
relate to a serious incident it shall notify without delay those reports to the
electronic system referred to in Article 62, unless the same incident has
already been reported by the manufacturer.

2.
The national competent authorities shall carry
out a risk assessment with regard to reported serious incidents or field safety
corrective actions, taking into account criteria such as causality,
detectability and probability of recurrence of the problem, frequency of use of
the device, probability of occurrence of harm and severity of harm, clinical
benefit of the device, intended and potential users, and population affected.
They shall also evaluate the adequacy of the field safety corrective action
envisaged or undertaken by the manufacturer and the need for and kind of any
other corrective action. They shall monitor the manufacturer’s investigation of
the incident.

3.
In the case of devices referred to in the first
subparagraph of Article 1(4) and where the serious incident or field safety
corrective action may be related to a substance which, if used separately, would
be considered to be a medicinal product, the evaluating competent authority or the
coordinating competent authority referred to in paragraph 6 shall inform the relevant
competent authority for medicinal products, or the European Medicines Agency
(EMA), that was consulted by the notified body in accordance with the second
subparagraph of Article 42(2).

In the case of devices covered by this
Regulation in accordance with point (e) of Article 1(2) and where the serious
incident or field safety corrective action may be related to the tissues or
cells of human origin utilised for the manufacture of the device, the competent
authority or the coordinating competent authority referred to in paragraph 6 shall
inform the relevant competent authority for human tissues and cells that was consulted
by the notified body in accordance with the third subparagraph of Article 42(2).

4.
After carrying out the assessment, the
evaluating competent authority shall, through the electronic system referred to
in Article 62, inform without delay the other competent authorities of the
corrective action taken or envisaged by the manufacturer or imposed on him to
minimise the risk of recurrence of a serious incident, including information on
the underlying events and the outcome of its assessment.

5.
The manufacturer shall ensure that the users of
the device in question are informed without delay of the corrective action
taken by means of a field safety notice. Except in case of urgency, the content
of the draft field safety notice shall be submitted to the evaluating competent
authority or, in cases referred to in paragraph 6 of this Article, the
coordinating competent authority to allow them to make comments. Unless duly
justified by the situation of the individual Member State, the content of the
field safety notice shall be consistent in all Member States.

The manufacturer shall enter the field safety
notice in the electronic system referred to in Article 62 through which that
notice shall be accessible to the public.

6.
The competent authorities shall designate a coordinating
competent authority to coordinate their assessments referred to in paragraph 2 in
the following cases:

(a)
where similar serious incidents related to the
same device or type of device of the same manufacturer occur in more than one
Member State;

(b)
where the field safety corrective action is being
or is to be undertaken in more than one Member State.

Unless otherwise agreed between the competent
authorities, the coordinating competent authority shall be the one of the
Member State where the manufacturer has his registered place of business.

The coordinating competent authority shall
inform the manufacturer, the other competent authorities and the Commission
that it has assumed the role of coordinating authority.

7.
The coordinating competent authority shall carry
out the following tasks:

(a)
to monitor the investigation of the serious
incident by the manufacturer and the corrective action to be taken;

(b)
to consult with the notified body that issued a
certificate in accordance with Article 45 for the device in question regarding
the impact of the serious incident on the certificate;

(c)
to agree with the manufacturer and the other
competent authorities referred to in points (a) to (c) of Article 62(5) on the
format, content and frequency of periodic summary reports in accordance with
Article 61(2);

(d)
to agree with the manufacturer and other
competent authorities concerned on the implementation of the appropriate field
safety corrective action;

(e)
to inform the other competent authorities and
the Commission, through the electronic system referred to in Article 62, of the
progress in and the outcome of its assessment.

The designation of a coordinating competent
authority shall not affect the rights of the other competent authorities to
perform their own assessment and to adopt measures in accordance with this
Regulation in order to ensure the protection of public health and patient
safety. The coordinating competent authority and the Commission shall be kept
informed of the outcome of any such assessment and the adoption of any such
measures.

8.
The Commission shall provide secretarial support
to the coordinating competent authority in the accomplishment of its tasks
under this Chapter.

Article 64
Trend reporting

Manufacturers of devices classified in
class IIb and III shall report to the electronic system referred to in Article
62 any statistically significant increase in the frequency or severity of incidents
that are not serious incidents or of expected undesirable side-effects that
have a significant impact on the risk-benefit analysis referred to in Sections
1 and 5 of Annex I and which have led or may lead to unacceptable risks to the
health or safety of patients, users or other persons when weighted against the intended
benefits. The significant increase shall be established in comparison to the
foreseeable frequency or severity of such incidents or expected undesirable
side-effects in respect of the device, or category or group of devices, in
question during a specific time period as established in the manufacturer’s
conformity assessment. Article 63 shall apply.

Article 65
Documentation of vigilance data

Manufacturers shall update their technical
documentation with information on incidents received from healthcare
professionals, patients and users, serious incidents, field safety corrective
actions, periodic summary reports referred to in Article 61, trend reports
referred to in Article 64 and field safety notices referred to in Article
63(5). They shall make this documentation available to their notified bodies,
which shall assess the impact of the vigilance data on the conformity
assessment and the certificate issued.

Article 66
Implementing acts

The Commission may, by means of
implementing acts, adopt the modalities and procedural aspects necessary for
the implementation of Articles 61 to 65 as regards the following:

(a)
typology of serious incidents and field safety
corrective actions in relation to specific devices, or categories or groups of
devices;

(b)
harmonised forms for the reporting of serious incidents
and field safety corrective actions, periodic summary reports and trend reports
by manufacturers as referred to in Articles 61 and 64;

(c)
timelines for the reporting of serious incidents
and field safety corrective actions, periodic summary reports and trend reports
by manufacturers, taking into account the severity of the event to be reported
as referred to in Articles 61 and 64;

(d)
harmonised forms for the exchange of information
between competent authorities as referred to in Article 63.

Those implementing acts shall be adopted in
accordance with the examination procedure referred to in Article 88(3).

Section 2 – Market surveillance

Article 67
Market surveillance activities

1.
The competent authorities shall perform
appropriate checks on the characteristics and performance of devices including,
where appropriate, review of documentation and physical or laboratory checks on
the basis of adequate samples. They shall take account of established
principles regarding risk assessment and risk management, vigilance data and
complaints. The competent authorities may require economic operators to make available
the documentation and information necessary for the purpose of carrying out
their activities and, where necessary and justified, enter the premises of
economic operators and take the necessary samples of devices. They may destroy
or otherwise render inoperable devices presenting a serious risk where they
deem it necessary.

2.
The Member States shall periodically review and
assess the functioning of their surveillance activities. Such reviews and
assessments shall be carried out at least every four years and the results
thereof shall be communicated to the other Member States and the Commission. The
Member State concerned shall make a summary of the results accessible to the public.

3.
The competent authorities of the Member States
shall coordinate their market surveillance activities, cooperate with each
other and share with each other and with the Commission the results thereof. Where
appropriate, the competent authorities of the Member States shall agree on work-sharing
and specialisation.

4.
Where more than one authority in a Member State is
responsible for market surveillance and external border controls, those
authorities shall cooperate with each other, by sharing information relevant to
their role and functions.

5.
The competent authorities of the Member States shall
cooperate with the competent authorities of third countries with a view to
exchanging information and technical support and promoting activities relating
to market surveillance.

Article 68
Electronic system on market surveillance

1.
The Commission, in collaboration with the Member
States, shall set up and manage an electronic system to collate and process the
following information:

(a)
information in relation to non-compliant devices
presenting a risk to health and safety referred to in Article 70(2), (4) and
(6);

(b)
information in relation to compliant devices presenting
a risk to health and safety referred to in Article 72(2);

(c)
information in relation to formal non-compliance
of products referred to in Article 73(2);

(d)
information in relation to preventive health
protection measures referred to in Article 74(2).

2.
The information mentioned in paragraph 1 shall
be immediately transmitted through the electronic system to all competent
authorities concerned and be accessible to the Member States and to the
Commission.

Article 69
Evaluation regarding devices presenting a risk to health and safety at national
level

Where the
competent authorities of a Member State, based on vigilance data or other information,
have sufficient reason to believe that a device presents a risk to the health
or safety of patients, users or other persons, they shall carry out an
evaluation in relation to the device concerned covering all the requirements
laid down in this Regulation that are relevant to the risk presented by the
device. The relevant economic operators shall cooperate as necessary with the
competent authorities.

Article 70
Procedure for dealing with non-compliant devices presenting a risk to health
and safety

1.
Where, having performed an evaluation pursuant
to Article 69, the competent authorities find that the device, which presents a
risk to the health or safety of patients, users or other persons, does not
comply with the requirements laid down in this Regulation, they shall without
delay require the relevant economic operator to take all appropriate and duly
justified corrective action to bring the device into compliance with those
requirements, to prohibit or restrict the making available of the device on the
market, to subject the making available of the device
to specific requirements, to withdraw the device from
the market, or to recall it within a reasonable period, proportionate to the
nature of the risk.

2.
Where the competent authorities consider that
non-compliance is not restricted to their national territory, they shall inform
the Commission and the other Member States of the results of the evaluation and
of the actions which they have required the economic operators to take, by
means of the electronic system referred to in Article 68.

3.
The economic operators shall ensure that all
appropriate corrective action is taken in respect of all the devices concerned
that they have made available on the market throughout the Union.

4.
Where the relevant economic operator does not
take adequate corrective action within the period referred to in paragraph 1,
the competent authorities shall take all appropriate provisional measures to
prohibit or restrict the device’s being made available on their national
market, to withdraw the device from that market or to recall it.

They shall notify the Commission and the other
Member States, without delay, of those measures, by means of the electronic
system referred to in Article 68.

5.
The notification referred to in paragraph 4 shall
include all available details, in particular the data necessary for the
identification of the non-compliant device, the origin of the device, the
nature of and the reasons for the non-compliance alleged and the risk involved,
the nature and duration of the national measures taken and the arguments put
forward by the relevant economic operator.

6.
Member States other than the Member State
initiating the procedure shall without delay inform the Commission and the
other Member States of any additional information at their disposal relating to
the non-compliance of the device concerned and of any measures adopted by them
in relation to the device concerned. In the event of disagreement with the
notified national measure, they shall without delay inform the Commission and
the other Member States of their objections, by means of the electronic system referred
to in Article 68.

7.
Where, within two months of receipt of the notification
referred to in paragraph 4, no objection has been raised by either a Member
State or the Commission in respect of a provisional measure taken by a Member
State, that measure shall be deemed justified.

8.
All Member States shall ensure that appropriate
restrictive measures are taken without delay in respect of the device
concerned.

Article 71
Procedure at Union level

1.
Where, within two months of receipt of the notification
referred to in Article 70(4), objections are raised by a Member State against a
provisional measure taken by another Member State, or where the Commission
considers the measure to be contrary to Union legislation, the Commission shall
evaluate the national measure. On the basis of the results of that evaluation,
the Commission shall decide, by means of implementing acts, whether or not the
national measure is justified. Those implementing acts
shall be adopted in accordance with the examination procedure referred to in
Article 88(3).

2.
If the national measure is considered justified,
Article 70(8) shall apply. If the national measure is considered unjustified,
the Member State concerned shall withdraw the measure. Where, in the situations
referred to in Articles 70 and 72, a Member State or the Commission consider
that the risk to health and safety emanating from a device cannot be contained
satisfactorily by means of measures taken by the Member State(s) concerned, the Commission, at
the request of a Member State or on its own initiative, may take, by means of implementing
acts, the necessary and duly justified measures to ensure the protection of
health and safety, including measures restricting or prohibiting the placing on
the market and putting into service of the device concerned. Those implementing
acts shall be adopted in accordance with the examination procedure referred to
in Article 88(3).

3.
On duly justified imperative grounds of urgency
relating to the health and safety of humans, the Commission shall adopt
immediately applicable implementing acts referred to in paragraphs 1 and 2 in
accordance with the procedure referred to in Article 88(4).

Article 72
Procedure for dealing with compliant devices presenting a risk to health and
safety

1.
Where, having performed an evaluation pursuant
to Article 69, a Member State finds that although a device has been legally
placed on the market or put into service, it presents a risk to the health or
safety of patients, users or other persons or to other aspects of the protection
of public health, it shall require the relevant economic operator or operators
to take all appropriate provisional measures to ensure that the device
concerned, when placed on the market or put into service, no longer presents
that risk, to withdraw the device from the market or to recall it within a
reasonable period, proportionate to the nature of the risk.

2.
The Member State shall immediately notify the
Commission and the other Member States of the measures taken, by means of the
electronic system referred to in Article 68. That information shall include the
data necessary for the identification of the device concerned, the origin and
the supply chain of the device, the findings of the Member State's evaluation
specifying the nature of the risk involved and the nature and duration of the
national measures taken.

3.
The Commission shall evaluate the provisional
national measures taken. On the basis of the results of that evaluation, the
Commission shall decide, by means of implementing acts, whether or not the
measure is justified. Those implementing acts shall be
adopted in accordance with the examination procedure referred to in Article 88(3).
On duly justified imperative grounds of urgency relating to the health and
safety of humans, the Commission shall adopt immediately applicable
implementing acts in accordance with the procedure referred to in Article 88(4).

4.
Where the national measure is considered
justified, Article 70(8) shall apply. If the national measure is considered unjustified, the Member State
concerned shall withdraw the measure.

Article 73
Formal non-compliance

1.
Without prejudice to Article 70, a Member State shall
require the relevant economic operator to put an end to the non-compliance
concerned within a reasonable period that is proportionate to the
non-compliance where it makes one of the following findings:

(a)
that the CE marking has been affixed in
violation of the formal requirements laid down in Article 18;

(b)
that the CE marking has not been affixed to a
device contrary to Article 18;

(c)
that the CE marking has been inappropriately affixed
in accordance with procedures in this Regulation on a product that is not
covered by this Regulation;

(d)
that the EU declaration of conformity has not
been drawn up or is not complete;

(e)
that the information to be supplied by the
manufacturer on the label or in the instructions for use is not available, not
complete or not provided in the language(s) required;

(f)
that the technical documentation, including the
clinical evaluation, is not available or not complete.

2.
Where the economic operator does not put an end
to the non-compliance within the period referred to in paragraph 1, the Member
State concerned shall take all appropriate measures to restrict or prohibit the
product being made available on the market or to ensure that it is recalled or
withdrawn from the market. That Member State shall inform the Commission and
the other Member States without delay of those measures, by means of the
electronic system referred to in Article 68.

Article 74
Preventive health protection measures

1.
Where a Member State, after having performed an
evaluation which indicates a potential risk related to a device or a specific
category or group of devices considers that the making available on the market
or putting into service of such device or specific category or group of devices
should be prohibited, restricted or made subject to particular requirements or
that such device or category or group of devices should be withdrawn from the
market or recalled in order to protect the health and safety of patients, users
or other persons or other aspects of public health, it may take any necessary
and justified provisional measures.

2.
The Member State shall immediately notify the
Commission and all other Member States, giving the reasons for its decision, by means of the electronic system referred to in Article 68.

3.
The Commission shall
assess the provisional national measures taken. The Commission shall decide, by means of implementing acts,
whether the national measures are justified or not. Those
implementing acts shall be adopted in accordance with the examination procedure
referred to in Article 88(3).

On duly justified imperative grounds of urgency
relating to the health and safety of humans, the Commission may adopt
immediately applicable implementing acts in accordance with the procedure
referred to in Article 88(4).

4.
Where the assessment referred to in paragraph 3 demonstrates
that the making available on the market or putting into service of a device,
specific category or group of devices should be prohibited, restricted or made subject
to particular requirements or that such device or category or group of devices
should be withdrawn from the market or recalled in all Member States in order
to protect the health and safety of patients, users or
other persons or other aspects of public health, the
Commission shall be empowered to adopt delegated acts in accordance with
Article 89 to take the necessary and duly justified measures.

Where in this case imperative grounds of
urgency so require, the procedure provided for in Article 90 shall apply to
delegated acts adopted pursuant to this paragraph.

Article 75
Good administrative practice

1.
Any measure adopted by the competent authorities
of the Member States pursuant to Articles 70 to 74 shall state the exact
grounds on which it is based. Where it is addressed to a specific economic
operator, it shall be notified without delay to the economic operator concerned,
who shall at the same time be informed of the remedies available to him under
the law of the Member State concerned and of the time limits to which such
remedies are subject. Where the measure is of general scope, it shall be
appropriately published.

2.
Except in cases where immediate action is
necessary for reasons of serious risk to human health or safety, the economic
operator concerned shall be given the opportunity to make submissions to the
competent authority within an appropriate period of time before any measure is
adopted. If action has been taken without the economic operator’s being heard,
he shall be given the opportunity to make submissions as soon as possible and
the action taken shall be reviewed promptly thereafter.

3.
Any measure adopted shall be immediately
withdrawn or amended upon the economic operator’s demonstrating that he has
taken effective corrective action.

4.
Where a measure adopted pursuant to Articles 70
to 74 concerns a product for which a notified body has been involved in the
conformity assessment, the competent authorities shall inform the relevant
notified body of the measure taken.

Chapter VIII

Cooperation
between Member States, Medical Device Coordination Group, EU reference
laboratories, device registers

Article 76
Competent authorities

1.
The Member States shall designate the competent authority
or authorities responsible for the implementation of this Regulation. They
shall entrust their authorities with the powers, resources, equipment and
knowledge necessary for the proper performance of their tasks pursuant to this
Regulation. The Member States shall communicate the competent authorities to
the Commission which shall publish a list of competent authorities.

2.
For the implementation of Articles 50 to 60, the
Member States may designate a national contact point other than a national
authority. In this case, references to a competent authority in this Regulation
shall be understood as including the national contact point.

Article 77
Cooperation

1.
The competent authorities of the Member States
shall cooperate with each other and with the Commission and exchange with each
other the information necessary to enable this Regulation to be applied
uniformly.

2.
Member States and the Commission shall
participate in initiatives developed at international level with the aim of
ensuring cooperation between regulatory authorities in the field of medical
devices.

Article 78
Medical Device Coordination Group

1.
A Medical Device Coordination Group (MDCG) is
hereby established.

2.
Each Member State shall appoint, for a
three-year term which may be renewed, one member and one alternate providing
expertise in the field of this Regulation, and one member and one alternate
providing expertise in the field of Regulation (EU) No […/…] [on in vitro
diagnostic medical devices]. A Member State may choose to appoint only one
member and one alternate providing expertise in both fields.

The members of the MDCG shall be chosen for
their competence and experience in the field of medical devices and in vitro
diagnostic medical devices. They shall represent the competent authorities of
the Member States. The names and affiliation of members shall be made public by
the Commission.

The alternates shall represent and vote for the
members in their absence.

3.
The MDCG shall meet at regular intervals and,
where the situation requires, on a request from the Commission or a Member
State. The meetings shall be attended either by the members appointed for their
role and expertise in the field of this Regulation, or by the members appointed
for their expertise in the field of Regulation (EU) No […/…] [on in vitro
diagnostic medical devices], or by the members appointed for both Regulations,
as appropriate.

4.
The MDCG shall use its best endeavours to reach consensus.
If such consensus cannot be reached, the MDCG shall decide by the majority of
its members. Members with diverging positions may request that their positions
and the grounds on which they are based are recorded in the MDCG's position.

5.
The MDCG shall be chaired by a representative of
the Commission. The chair shall not take part in votes of the MDCG.

6.
The MDCG may invite, on a case-by-case basis,
experts and other third parties to attend meetings or provide written
contributions.

7.
The MDCG may establish standing or temporary
sub-groups. Where appropriate, organisations representing the interests of the
medical device industry, healthcare professionals, laboratories, patients and
consumers at Union level shall be invited in such sub-groups in the capacity of
observers.

8.
The MDCG shall establish its rules of procedure
which shall, in particular, lay down procedures for the following:

–
the adoption of opinions or recommendations or
other positions by the MDCG, including in cases of urgency;

–
the delegation of tasks to reporting and
co-reporting members;

–
the functioning of sub-groups.

The rules of procedure shall enter into force
after receiving a favourable opinion from the Commission.

Article 79
Support by the Commission

The Commission shall support the
functioning of the cooperation between national competent authorities and
provide technical, scientific and logistic support to the MDCG and its
sub-groups. It shall organise the meetings of the MDCG and its sub-groups,
participate in those meetings and ensure the appropriate follow-up.

Article 80
Tasks of the MDCG

The MDCG shall have the following tasks:

(a)
to contribute to the assessment of applicant
conformity assessment bodies and notified bodies pursuant to the provisions set
out in Chapter IV;

(b)
to contribute to the scrutiny of certain conformity
assessments pursuant to Article 44;

(c)
to contribute to the development of guidance aimed
at ensuring effective and harmonised implementation of this Regulation, in
particular regarding the designation and monitoring of notified bodies,
application of the general safety and performance requirements and conduct of
the clinical evaluation by manufacturers and the assessment by notified bodies;

(d)
to assist the competent authorities of the
Member States in their coordination activities in the fields of clinical
investigations, vigilance and market surveillance;

(e)
to provide advice and assist the Commission, at
its request, in its assessment of any issue related to the implementation of
this Regulation;

(f)
to contribute to harmonised administrative
practice with regard to medical devices in the Member States.

Article 81
European Union reference laboratories

1.
For specific devices, or a category or group of
devices, or for specific hazards related to a category or group of devices, the
Commission may designate, by means of implementing acts, one or more European
Union reference laboratories, hereinafter referred to as 'EU reference
laboratories', that satisfy the criteria set out in paragraph 3. The Commission
shall only designate laboratories for which a Member State or the Commission's
Joint Research Centre have submitted an application for designation.

2.
Within the scope of their designation, the EU
reference laboratories shall, where appropriate, have the following tasks:

(a)
to provide scientific and technical assistance
to the Commission, the Member States and notified bodies in relation to the
implementation of this Regulation;

(b)
to provide scientific advice regarding the state
of the art in relation to specific devices, or a category or group of devices;

(c)
to set up and manage a network of national
reference laboratories and publish a list of the participating national
reference laboratories and their respective tasks;

(d)
to contribute to the development of appropriate
testing and analysis methods to be applied for conformity assessment procedures
and market surveillance;

(e)
to collaborate with notified bodies in the development
of best practices for the performance of conformity assessment procedures;

(f)
to contribute to the development of standards at
international level;

(g)
to provide scientific opinions in response to consultations
by notified bodies in accordance with this Regulation.

3.
EU reference laboratories shall satisfy the
following criteria:

(a)
to have appropriately qualified staff with
adequate knowledge and experience in the field of the medical devices for which
they are designated;

(b)
to possess the necessary equipment and reference
material to carry out the tasks assigned to them;

(c)
to have the necessary knowledge of international
standards and best practices;

(d)
to have an appropriate administrative
organisation and structure;

(e)
to ensure that their staff observe the
confidentiality of the information and data obtained in carrying out their
tasks.

4.
EU reference laboratories may be granted a Union
financial contribution.

The Commission may adopt, by means of
implementing acts, the modalities and the amount of the grant of a Union financial contribution to EU reference laboratories, taking
into account the objectives of protection of health and safety, support of
innovation and cost-effectiveness. Those implementing acts shall be adopted in
accordance with the examination procedure referred to in Article 88(3).

5.
Where notified bodies or Member States request scientific
or technical assistance or a scientific opinion from an EU reference laboratory,
they may be required to pay fees to wholly or partially cover the costs incurred
by that laboratory in carrying out the requested task according to a set of predetermined
and transparent terms and conditions.

6.
The Commission shall be empowered to adopt
delegated acts in accordance with Article 89 for the following purposes:

(a)
amending or supplementing the tasks of EU
reference laboratories referred to in paragraph 2 and the criteria to be satisfied
by EU reference laboratories referred to in paragraph 3.

(b)
setting out the structure and the level of the
fees referred to in paragraph 5 which may be levied by an EU Reference
Laboratory for providing scientific opinions in response to consultations by
notified bodies in accordance with this Regulation, taking into account the
objectives of protection of human health and safety, support of innovation and
cost-effectiveness.

7.
EU reference laboratories shall be subject to
controls, including on-site visits and audits, by the Commission to verify
compliance with the requirements of this Regulation. If these controls find
that a laboratory is not complying with those requirements for which they have
been designated, the Commission, by means of implementing acts, shall take
appropriate measures, including the withdrawal of the designation.

Article 82
Conflict of interests

1.
Members of the MDCG and staff of the EU
reference laboratories shall not have financial or other interests in the
medical device industry which could affect their impartiality. They shall
undertake to act in the public interest and in an independent manner. They
shall declare any direct and indirect interests they may have in the medical
device industry and update this declaration whenever a relevant change occurs.
Upon request, the declaration of interests shall be accessible to the public.
This Article shall not apply to the representatives of stakeholder
organisations participating in the sub-groups of the MDCG.

2.
Experts and other third parties invited by the MDCG
on a case-by-case basis shall be requested to declare their interests in the
issue in question.

Article 83
Device registers

The Commission and the Member States shall take
all appropriate measures to encourage the establishment of registers for
specific types of devices to gather post-market experience related to the use
of such devices. Such registers shall contribute to the independent evaluation
of the long-term safety and performance of devices.

Chapter IX

Confidentiality, data
protection, funding, penalties

Article 84
Confidentiality

1.
Unless otherwise provided in this Regulation and
without prejudice to existing national provisions and practices in the Member
States on medical confidentiality, all parties involved in the application of
this Regulation shall respect the confidentiality of information and data
obtained in carrying out their tasks in order to protect the following:

(a)
personal data in compliance with Directive
95/46/EC and Regulation (EC) No 45/2001;

(b)
commercial interests of a natural or legal
person, including intellectual property rights;

(c)
the effective implementation of this Regulation,
in particular for the purpose of inspections, investigations or audits.

2.
Without prejudice to paragraph 1, information
exchanged between competent authorities and between competent authorities and
the Commission on condition of confidentiality shall remain confidential unless
the originating authority has agreed to its disclosure.

3.
Paragraphs 1 and 2 shall not affect the rights
and obligations of the Commission, Member States and notified bodies with
regard to exchange of information and the dissemination of warnings, nor the
obligations of the persons concerned to provide information under criminal law.

4.
The Commission and Member States may exchange
confidential information with regulatory authorities of third countries with
which they have concluded bilateral or multilateral confidentiality
arrangements.

Article 85
Data protection

1.
Member States shall apply Directive 95/46/EC to
the processing of personal data carried out in the
Member States pursuant to this Regulation.

2.
Regulation (EC) No 45/2001 shall apply to the
processing of personal data carried out by the Commission pursuant to this
Regulation.

Article 86
Levy of fees

This Regulation shall be without prejudice
to the possibility for Member States to levy fees for the activities set out in
this Regulation, provided that the level of the fees is set in a transparent
manner and on the basis of cost recovery principles. They shall inform the
Commission and the other Member States at least three months before the
structure and level of fees is to be adopted.

Article 87
Penalties

The Member States shall lay down the
provisions on penalties applicable for infringement of the provisions of this
Regulation and shall take all measures necessary to ensure that they are
implemented. The penalties provided for must be effective, proportionate, and
dissuasive. The Member States shall notify those provisions to the Commission
by [3 months prior to the date of application of the Regulation] and shall
notify it without delay of any subsequent amendment affecting them.

Chapter X
Final provisions

Article 88
Committee procedure

1.
The Commission shall be assisted by a Committee
on Medical Devices. That Committee shall be a committee within the meaning of
Regulation (EU) No 182/2011.

2.
Where reference is made to this paragraph,
Article 4 of Regulation (EU) No 182/2011 shall apply.

3.
Where reference is made to this paragraph,
Article 5 of Regulation (EU) No 182/2011 shall apply.

4.
Where reference is made to this paragraph, Article
8 of Regulation (EU) No 182/2011, in conjunction with Article 4 or Article 5, as
appropriate, shall apply.

Article 89
Exercise of the delegation

1.
The power to adopt the delegated acts referred
to in Articles 2(2) and (3), 4(5), 8(2), 17(4), 24(7), 25(7), 29(2), 40(2), 41(4),
42(11), 45(5), 51(7), 53(3), 74(4) and 81(6) is conferred on the Commission
subject to the conditions laid down in this Article.

2.
The delegation of power referred to in Articles 2(2)
and (3), 4(5), 8(2), 17(4), 24(7), 25(7), 29(2), 40(2), 41(4), 42(11), 45(5),
51(7), 53(3), 74(4) and 81(6) shall be conferred on the Commission for an
indeterminate period of time from the date of entry into force of this
Regulation.

3.
The delegation of power referred to in Articles 2(2)
and (3), 4(5), 8(2), 17(4), 24(7), 25(7), 29(2), 40(2), 41(4), 42(11), 45(5),
51(7), 53(3), 74(4) and 81(6) may be revoked at any time by the European
Parliament or by the Council. A decision of revocation shall put an end to the
delegation of the power specified in that decision. It shall take effect the
day following its publication in the Official Journal of the European Union or
at a later date specified therein. It shall not affect the validity of any
delegated acts already in force.

4.
As soon as it adopts a delegated act, the
Commission shall notify it simultaneously to the European Parliament and to the
Council.

5.
A delegated act adopted pursuant to any of the
Articles listed in paragraph 1 shall enter into force only if no objection has
been expressed either by the European Parliament or by the Council within a
period of two months of notification of that act to the European Parliament and
the Council or if, before the expiry of that period, the European Parliament
and the Council have both informed the Commission that they will not object.
That period may be extended by two months at the initiative of the European
Parliament or the Council.

Article 90
Urgency procedure for delegated acts

1.
Delegated acts adopted under this Article shall
enter into force without delay and shall apply as long as no objection is
expressed in accordance with paragraph 2. The notification of a delegated act
to the European Parliament and to the Council shall state the reasons for the
use of the urgency procedure.

2.
Either the European Parliament or the Council
may object to a delegated act in accordance with the procedure referred to in
Article 89. In such a case, the Commission shall repeal the act without delay
following the notification of the decision to object by the European Parliament
or the Council.

Article 91
Amendments to Directive 2001/83/EC

In Annex I of Directive 2001/83/EC, point
12 of Section 3.2. is replaced by the following:

‘(12) Where a product is governed by this
Directive in accordance with the second subparagraph of Article 1(4) or the
second subparagraph of Article 1(5) of Regulation (EU) […/…] on medical devices[55],
the marketing authorisation dossier shall include, where available, the results
of the assessment of the conformity of the device part with the relevant general
safety and performance requirements of Annex I of that Regulation contained in
the manufacturer’s EU declaration of conformity or the relevant certificate
issued by a notified body allowing the manufacturer to affix a CE marking to
the medical device.

If the dossier does not include the results
of the conformity assessment referred to in the first subparagraph and where
for the conformity assessment of the device, if used separately, the
involvement of a notified body is required in accordance with Regulation (EU)
[…/…], the authority shall require the applicant to provide an opinion on the
conformity of the device part with the relevant general safety and performance requirements
of Annex I of that Regulation issued by a notified body designated in accordance
with that Regulation for the type of device in question, unless the authority
is advised by its experts for medical devices that involvement of a notified
body is not required.’

Article 92
Amendments to Regulation (EC) No 178/2002

In the third subparagraph of Article 2 of
Regulation (EC) No 178/2002, the following point (i) is added:

‘(i) medical devices within the meaning of
Regulation (EU) […/…][56].’

Article 93
Amendments to Regulation (EC) No 1223/2009

In Article 2 of Regulation (EC) No
1223/2009, the following paragraph is added:

‘4. In accordance with the regulatory
procedure referred to in Article 32(2), the Commission may, at the request of a
Member State or on its own initiative, adopt the necessary measures to determine
whether or not a specific product or group of products falls within the definition
‘cosmetic product’.’

Article 94
Transitional provisions

1.
From the date of application of this Regulation
any publication of a notification in respect of a notified body in accordance
with Directives 90/385/EEC and 93/42/EEC shall become void.

2.
Certificates issued by notified bodies in
accordance with Directives 90/385/EEC and 93/42/EEC prior to the entry into
force of this Regulation shall remain valid until the end of the period
indicated on the certificate, except for certificates issued in accordance with
Annex 4 of Directive 90/385/EEC or Annex IV of Directive 93/42/EEC which shall
become void at the latest two years after the date of application of this
Regulation.

Certificates issued by notified bodies in
accordance with Directives 90/385/EEC and 93/42/EEC after the entry into force
of this Regulation shall become void at the latest two years after the date of application
of this Regulation.

3.
By way of derogation from Directives 90/385/EEC
and 93/42/EEC, devices which comply with this Regulation may be placed on the
market before its date of application.

4.
By way of derogation from Directives 90/385/EEC
and 93/42/EEC, conformity assessment bodies which comply with this Regulation
may be designated and notified before its date of application. Notified bodies
which are designated and notified in accordance with this Regulation may apply
the conformity assessment procedures laid down in this Regulation and issue
certificates in accordance with this Regulation before its date of application.

5.
By way of derogation from Article 10a and point
(a) of Article 10b(1) of Directive 90/385/EEC and Article 14(1) and (2) and
points (a) and (b) of Article 14a(1) of Directive 93/42/EEC, manufacturers,
authorised representatives, importers and notified bodies who, during the
period from [date of application] until [18 months after date of application], comply
with Article 25(2) and (3) and Article 45(4) of this Regulation shall be
considered to comply with the laws and regulations adopted by Member States in
accordance with, respectively, Article 10a of Directive 90/385/EEC or Article
14(1) and (2) of Directive 93/42/EEC and with, respectively, point (a) of
Article 10b(1) of Directive 90/385/EEC or points (a) and (b) of Article 14a(1)
of Directive 93/42/EEC as specified in Commission Decision 2010/227/EU.

6.
Authorisations granted by competent authorities
of the Member States in accordance with Article 9(9) of Directive 90/385/EEC or
Article 11(13) of Directive 93/42/EEC shall keep the validity indicated in the
authorisation.

7.
Devices falling within the scope of this
Regulation in accordance with point (e) of Article 1(2) which have been legally
placed on the market or put into service in accordance with the rules in force
in the Member States prior to the application of this Regulation may continue
to be placed on the market and put into service in the Member States concerned.

8.
Clinical investigations which have started to be
conducted in accordance with Article 10 of Directive 90/385/EEC or Article 15
of Directive 93/42/EEC prior to the application of this Regulation may continue
to be conducted. As of the application of this Regulation, however, the
reporting of serious adverse events and device deficiencies shall be carried
out in accordance with this Regulation.

Article 95
Evaluation

No later than seven years after the date of
application, the Commission shall assess the application of this Regulation and
establish an evaluation report on the progress towards achievement of the
objectives of the Regulation including an assessment of resources required to
implement this Regulation.

Article 96
Repeal

Council Directives 90/385/EEC and 93/42/EEC
are repealed with effect from [date of application of this Regulation], with
the exception of Article 10a and point (a) of Article
10b(1) of Directive 90/385/EEC and Article 14(1) and (2) and points (a) and (b)
of Article 14a(1) of Directive 93/42/EEC which are repealed with effect from [18 months after date of application].

References to the repealed Council
Directives shall be understood as reference to this Regulation and shall be
read in accordance with the correlation table laid down in Annex XVI.

Article 97
Entry into force and date of application

1.
This Regulation shall enter into force on the
twentieth day after its publication in the Official
Journal of the European Union.

2.
It shall apply from [three years after entry
into force].

3.
By way of derogation from paragraph 2 the
following shall apply:

(a)
Article 25(2) and (3) and Article 45(4) shall
apply from [18 months after date of application referred to in paragraph 2];

(b)
Articles 28 to 40 and Article 78 shall apply from
[six months after entry into force]. However, prior to [date of application as
referred to in paragraph 2], the obligations on notified bodies emanating from
the provisions in Articles 28 to 40 shall apply only to those bodies which submit
an application for notification in accordance with Article 31 of this
Regulation.

This Regulation shall be binding
in its entirety and directly applicable in all Member States.

Done at Brussels, 26.9.2012

For the European Parliament                       For
the Council

The President                                                 The
President

ANNEX I

GENERAL SAFETY AND PERFORMANCE REQUIREMENTS

I.            General requirements

1.
Devices shall achieve the performance intended
by the manufacturer and be designed and manufactured in such a way that, during
normal conditions of use, they are suitable for their intended purpose, taking
into account the generally acknowledged state of the art. They shall not compromise the clinical
condition or the safety of patients, or the safety and health of users or,
where applicable, other persons, provided that any risks which may be
associated with their use constitute acceptable risks when weighed against the
benefits to the patient and are compatible with a high level of protection of
health and safety.

This shall include:

–
reducing as far as possible the risk of use
error due to ergonomic features of the device and the environment in which the
device is intended to be used (design for patient safety), and

–
consideration of the technical knowledge,
experience, education and training, and the medical and physical conditions of
intended users (design for lay, professional, disabled or other users).

2.
The solutions adopted by the manufacturer for
the design and manufacture of the devices shall conform to safety principles,
taking account of the generally acknowledged state of the art. To reduce risks,
the manufacturer shall manage the risks so that the residual risk associated
with each hazard as well as the overall residual risk is judged acceptable. The
manufacturer shall apply the following principles in the priority order listed:

(a)
identify known or foreseeable hazards and
estimate the associated risks arising from the intended use and foreseeable
misuse;

(b)
eliminate risks as far as possible through
inherently safe design and manufacture;

(c)
reduce as far as possible the remaining risks by
taking adequate protection measures, including alarms; and

(d)
provide training to users and/or inform users of
any residual risks.

3.
The characteristics and performances of the
device shall not be adversely affected to such a degree that the health or
safety of the patient or the user and, where applicable, of other persons are
compromised during the lifetime of the device, as indicated by the
manufacturer, when the device is subjected to the stresses which can occur
during normal conditions of use and has been properly maintained in accordance
with the manufacturer’s instructions. When no lifetime is stated, the same
applies for the lifetime reasonably to be expected of a device of that kind,
having regard to the intended purpose and the anticipated use of the device.

4.
Devices shall be designed, manufactured and
packaged in such a way that their characteristics and performances during their
intended use will not be adversely affected by transport and storage conditions
(for example, fluctuations of temperature and humidity) taking account of the
instructions and information provided by the manufacturer.

5.
All known and foreseeable risks, and any
undesirable side-effects, shall be minimised and be acceptable when weighed
against the benefits to the patient of the achieved performance of the device
during normal conditions of use.

6.
For devices listed in Annex XV for which the
manufacturer does not claim a medical purpose, the general requirements set out
in Sections 1 and 5 shall be understood that the device, when used under the
conditions and for the purposes intended, shall not present any risk or only
the minimum acceptable risks related to the product’s use which is consistent
with a high level of protection for the safety and health of persons.

II.          Requirements regarding design
and construction

7.
Chemical, physical and biological
properties

7.1.
The devices shall be designed and manufactured
in such a way as to ensure the characteristics and performance referred to in
Chapter I ‘General Requirements’. Particular attention shall be paid to:

(a)
the choice of materials used, particularly as
regards toxicity and, where appropriate, flammability;

(b)
the compatibility between the materials used and
biological tissues, cells, and body fluids taking account of the intended
purpose of the device;

(c)
where appropriate, the results of biophysical or
modelling research whose validity has been demonstrated beforehand;

(d)
the choice of materials used, reflecting, where
appropriate, matters such as hardness, wear and fatigue strength.

7.2.
The devices shall be designed, manufactured and
packaged in such a way as to minimise the risk posed by contaminants and
residues to patients, taking account of the intended purpose of the device, and
to the persons involved in the transport, storage and use of the devices.
Particular attention shall be paid to tissues exposed and to the duration and
frequency of exposure.

7.3.
The devices shall be designed and manufactured
in such a way that they can be used safely with the materials and substances,
including gases, with which they enter into contact during their normal use or
during routine procedures; if the devices are intended to administer medicinal
products they shall be designed and manufactured in such a way as to be
compatible with the medicinal products concerned according to the provisions
and restrictions governing these medicinal products and that both the performance
of the medicinal products and of the devices are maintained in accordance with
their respective indications and intended use.

7.4.
The devices shall be designed and manufactured
in such a way as to reduce as far as possible and appropriate the risks posed by
substances that may leach or leak from the device. Special attention shall be
given to substances which are carcinogenic, mutagenic or toxic to reproduction,
in accordance with Part 3 of Annex VI to Regulation (EC) No 1272/2008 of the
European Parliament and of the Council of 16 December 2008 on classification,
labelling and packaging of substances and mixtures, amending and repealing
Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006[57],
and to substances having endocrine disrupting
properties for which there is scientific evidence of probable serious effects
to human health and which are identified in accordance with the procedure set
out in Article 59 of Regulation (EC) No 1907/2006 of the European Parliament
and of the Council of 18 December 2006 concerning the Registration, Evaluation,
Authorisation and Restriction of Chemicals (REACH)[58].

If devices, or parts thereof, that are intended

–
to be invasive devices and to come into contact
with the body of the patient for short- or long-term, or

–
to (re)administer medicines, body liquids or
other substances, including gases, to/from the body, or

–
to transport or store such medicines, body
fluids or substances, including gases, to be (re)administered to the body

contain, in a concentration of 0.1% by mass of
the plasticised material or above, phthalates which are classified as
carcinogenic, mutagenic or toxic to reproduction of category 1A or 1B in
accordance with Part 3 of Annex VI to Regulation (EC) No 1272/2008, these
devices shall be labelled on the device itself and/or on the packaging for each
unit or, where appropriate, on the sales packaging as devices containing
phthalates. If the intended use of such devices includes treatment of children
or treatment of pregnant or nursing women, the manufacturer shall provide a
specific justification for the use of these substances with regard to
compliance with the general safety and performance requirements, in particular
of this paragraph, within the technical documentation and, within the
instructions for use, information on residual risks for these patient groups
and, if applicable, on appropriate precautionary measures.

7.5.
Devices shall be designed and manufactured in
such a way as to reduce as far as possible and appropriate risks posed by the
unintentional ingress or egress of substances into or from the device taking
into account the device and the nature of the environment in which it is
intended to be used.

7.6.
The devices shall be designed and manufactured
in such a way as to reduce to a minimum the risks linked to the size and the
properties of particles used. Special care shall be applied when devices
contain or consist of nanomaterial that can be released into the patient’s or
user's body.

8.
Infection and microbial contamination

8.1.
The devices and manufacturing processes shall be
designed in such a way as to eliminate or to reduce as far as possible the risk
of infection to patients, users and, where applicable, other persons. The
design shall:

(a)
allow easy handling,

and, where necessary,

(b)
reduce as far as possible and appropriate any
microbial leakage from the device and/or microbial exposure during use,

(c)
prevent microbial contamination of the device or
specimen.

8.2.
Devices labelled as having a special
microbiological state shall be designed, manufactured and packaged to ensure
that they remain so when placed on the market and remain so under the transport
and storage conditions specified by the manufacturer.

8.3.
Devices delivered in a sterile state shall be
designed, manufactured and packaged in a non-reusable pack, and/or according to
appropriate procedures, to ensure that they are sterile when placed on the
market and remain sterile, under the transport and storage conditions indicated
by the manufacturer, until the protective packaging is damaged or opened.

8.4.
Devices labelled either as sterile or as having
a special microbiological state shall have been processed, manufactured and, if
applicable, sterilised by appropriate, validated methods.

8.5.
Devices intended to be sterilised shall be
manufactured in appropriately controlled (e.g. environmental) conditions.

8.6.
Packaging systems for non‑sterile devices shall
maintain the integrity and cleanliness of the product and, if the devices are
to be sterilised prior to use, minimise the risk of microbial contamination;
the packaging system shall be suitable taking account of the method of sterilisation
indicated by the manufacturer.

8.7.
The labelling of the device shall distinguish
between identical or similar products placed on the market in both sterile and
non‑sterile condition.

9.
Devices incorporating a substance
considered to be a medicinal product and
devices composed of substances or combination of substances intended to be
ingested, inhaled or administered rectally or vaginally

9.1.
In the case of devices referred to in the first
subparagraph of Article 1(4), the quality, safety and usefulness of the
substance which, if used separately, would be considered to be a medicinal
product within the meaning of Article 1 of Directive 2001/83/EC, shall be
verified by analogy with the methods specified in Annex I to Directive
2001/83/EC, as laid down in the applicable conformity assessment procedure in
this Regulation.

9.2.
Devices that are composed of substances or
combination of substances intended to be ingested, inhaled or administered
rectally or vaginally and that are absorbed by or dispersed in the human body
shall comply, by analogy, with the relevant requirements laid down in Annex I
to Directive 2001/83/EC.

10.
Devices incorporating materials of
biological origin

10.1.
For devices manufactured utilising tissues or
cells, or their derivatives, of human origin which are covered by this
Regulation in accordance with point (e) of Article 1(2) the following applies:

(a)
Donation, procurement and testing of tissues and
cells of human origin used for the manufacture of devices shall be made in
accordance with Directive 2004/23/EC.

(b)
The processing, preservation and any other
handling of those tissues and cells shall be carried out so as to provide
optimal safety for patients, users and, where applicable, other persons. In
particular, safety with regard to viruses and other transmissible agents shall
be addressed by implementation of validated methods of elimination or
inactivation in the course of the manufacturing process.

(c)
It shall be ensured that the traceability system
for devices manufactured utilising those human tissues or cells is
complementary and compatible with the traceability and data protection
requirements laid down in Directive 2004/23/EC and in Directive 2002/98/EC of
the European Parliament and of the Council of 27 January 2003 setting standards
of quality and safety for the collection, testing, processing, storage and
distribution of human blood and blood components and amending Directive
2001/83/EC[59].

10.2.
For devices manufactured utilising tissues or
cells, or their derivatives, of animal origin which are non-viable or rendered
non-viable the following applies:

(a)
Where feasible taking into account the animal
species, tissues and cells of animal origin shall originate from animals that
have been subjected to veterinary controls that are adapted to the intended use
of the tissues. Information on the geographical origin of the animals shall be
retained.

(b)
Processing, preservation, testing and handling
of tissues, cells and substances of animal origin shall be carried out so as to
provide optimal safety for patients, users and, where applicable, other
persons. In particular safety with regard to viruses and other
transmissible agents shall be addressed by implementation of validated
methods of elimination or viral inactivation in the course of the manufacturing
process.

(c)
In the case of devices manufactured utilising
tissues or cells of animal origin as referred to in Commission Regulation (EU)
No 722/2012 of 8 August 2012 concerning particular requirements as regards the
requirements laid down in Council Directives 90/385/EEC and 93/42/EEC with
respect to active implantable medical devices and medical devices manufactured
utilising tissues of animal origin[60], the particular
requirements laid down in that Regulation shall apply.

10.3.
For devices manufactured utilising other
non-viable biological substances the following applies:

In the case of biological substances other than
those referred to in Sections 10.1. and 10.2., the processing, preservation,
testing and handling of those substances shall be carried out so as to provide
optimal safety for patients, users and, where applicable, other persons. In
particular, safety with regard to viruses and other transmissible agents shall
be addressed by implementation of validated methods of elimination or
inactivation in the course of the manufacturing process.

11.
Interaction of devices with their
environment

11.1.
If the device is intended for use in combination
with other devices or equipment the whole combination, including the connection
system shall be safe and shall not impair the specified performance of the
devices. Any restrictions on use applying to such combinations shall be
indicated on the label and/or in the instructions for use. Connections which
the user has to handle, such as fluid, gas transfer or mechanical coupling,
shall be designed and constructed in such a way as to minimize all possible
risks from incorrect connection.

11.2.
Devices shall be designed and manufactured in
such a way as to remove or reduce as far as possible and appropriate:

(a)
the risk of injury to the patient, user or other
persons in connection with their physical and ergonomic features;

(b)
the risk of use error due to the ergonomic
features, human factors and the environment in which the device is intended to
be used;

(c)
risks connected with reasonably foreseeable
external influences or environmental conditions, such as magnetic fields,
external electrical and electromagnetic effects, electrostatic discharge,
radiation associated with diagnostic or therapeutic procedures, pressure,
humidity, temperature, variations in pressure and acceleration or radio signal
interferences;

(d)
the risks associated with the use of the device
when it comes into contact with materials, liquids, and substances, including
gases, to which it is exposed during normal conditions of use;

(e)
the risk associated with the possible negative
interaction between software and the environment within which it operates and
interacts;

(f)
the risks of accidental ingress of substances
into the device;

(g)
the risks of reciprocal interference with other
devices normally used in the investigations or for the treatment given;

(h)
risks arising where maintenance or calibration
are not possible (as with implants), from ageing of materials used or loss of
accuracy of any measuring or control mechanism.

11.3.
Devices shall be designed and manufactured in
such a way as to minimise the risks of fire or explosion during normal use and
in single fault condition. Particular attention shall be paid to devices whose
intended purpose includes exposure to or use in association with flammable
substances or substances which could cause combustion.

11.4.
Devices shall be designed and manufactured in
such a way that adjustment, calibration, and maintenance, where such is
necessary to achieve the performances intended, can be done safely.

11.5.
Devices that are intended to be operated
together with other devices or products shall be designed and manufactured in
such as way that the interoperability is reliable and safe.

11.6.
Any measurement, monitoring or display scale
shall be designed in line with ergonomic principles, taking account of the
intended purpose of the device.

11.7.
Devices shall be designed and manufactured in
such a way as to facilitate the safe disposal of the device and/or of any waste
substances by the user, patient or other person.

12.
Devices with a diagnostic or measuring
function

12.1.
Diagnostic devices and devices with a measuring
function, shall be designed and manufactured in such a way as to provide
sufficient accuracy, precision and stability for their intended purpose, based
on appropriate scientific and technical methods. The limits of accuracy shall
be indicated by the manufacturer.

12.2.
The measurements made by devices with a
measuring function and expressed in legal units shall conform to the provisions
of Council Directive 80/181/EEC[61].

13.
Protection against radiation

13.1.
General

(a)
Devices shall be designed and manufactured and
packaged in such a way that exposure of patients, users and other persons to
any emitted radiation shall be reduced as far as possible and appropriate,
compatible with the intended purpose, whilst not restricting the application of
appropriate specified levels for therapeutic and diagnostic purposes.

(b)
The operating instructions for devices emitting
radiation shall give detailed information as to the nature of the emitted
radiation, means of protecting the patient and the user and on ways of avoiding
misuse and of eliminating the risks inherent in installation.

13.2.
Intended radiation

(a)
Where devices are designed to emit hazardous, or
potentially hazardous, levels of visible and/or invisible radiation necessary
for a specific medical purpose the benefit of which is considered to outweigh
the risks inherent in the emission, it shall be possible for the user to
control the emissions. Such devices shall be designed and manufactured to
ensure reproducibility of relevant variable parameters within an acceptable
tolerance.

(b)
Where devices are intended to emit potentially
hazardous, visible and/or invisible radiation, they shall be fitted, where
possible, with visual displays and/or audible warnings of such emissions.

13.3.
Unintended radiation

Devices shall be designed and manufactured in
such a way that exposure of patients, users and other persons to the emission
of unintended, stray or scattered radiation is reduced as far as possible and
appropriate.

13.4.
Ionising radiation

(a)
Devices intended to emit ionising radiation
shall be designed and manufactured in such a way as to ensure that, where
possible, the quantity, geometry and energy distribution (or quality) of radiation
emitted can be varied and controlled taking into account the intended use.

(b)
Devices emitting ionising radiation intended for
diagnostic radiology shall be designed and manufactured in such a way as to
achieve appropriate image and/or output quality for the intended medical
purpose whilst minimising radiation exposure of the patient and user.

(c)
Devices emitting ionising radiation, intended
for therapeutic radiology shall be designed and manufactured in such a way as
to enable reliable monitoring and control of the delivered dose, the beam characteristics
in terms of type of radiations, energy and, where appropriate, energy
distribution.

14.
Software incorporated in devices and
standalone software

14.1.
Devices that incorporate electronic programmable
systems, including software, or standalone software that are devices in
themselves, shall be designed to ensure repeatability, reliability and
performance according to the intended use. In the event of a single fault
condition, appropriate means shall be adopted to eliminate or reduce as far as
possible and appropriate consequent risks.

14.2.
For devices that incorporate software or for
standalone software that are devices in themselves, the software shall be developed
and manufactured according to the state of the art taking into account the
principles of development life cycle, risk management, verification and
validation.

14.3.
Software referred to in this Section that are
intended to be used in combination with mobile computing platforms shall be
designed and manufactured taking into account the specific features of the
mobile platform (e.g. size and contrast ratio of the screen) and the external
factors related to their use (varying environment as regards to level of light
or noise).

15.
Active devices and devices connected to
them

15.1.
For active devices, in the event of a single
fault condition, appropriate means shall be adopted to eliminate or reduce as
far as possible and appropriate consequent risks.

15.2.
Devices where the safety of the patients depends
on an internal power supply shall be equipped with a means of determining the
state of the power supply.

15.3.
Devices where the safety of the patients depends
on an external power supply shall include an alarm system to signal any power
failure.

15.4.
Devices intended to monitor one or more clinical
parameters of a patient shall be equipped with appropriate alarm systems to
alert the user of situations which could lead to death or severe deterioration
of the patient's state of health.

15.5.
Devices shall be designed and manufactured in
such a way as to reduce as far as possible and appropriate the risks of
creating electromagnetic interference which could impair the operation of this
or other devices or equipment in the intended environment.

15.6.
Devices shall be designed and manufactured in
such a way as to provide an adequate level of intrinsic immunity to
electromagnetic disturbance to enable them to operate as intended.

15.7.
Devices shall be designed and manufactured in
such a way as to avoid, as far as possible, the risk of accidental electric
shocks to the patient, user or any other person, both during normal use of the
device and in the event of a single fault condition in the device, provided the
device is installed and maintained as indicated by the manufacturer.

16.
Protection against mechanical and thermal
risks

16.1.
Devices shall be designed and manufactured in
such a way as to protect the patient and user against mechanical risks
connected with, for example, resistance to movement,
instability and moving parts.

16.2.
Devices shall be designed and manufactured in
such a way as to reduce to the lowest possible level the risks arising from
vibration generated by the devices, taking account of technical progress and of
the means available for limiting vibrations, particularly at source, unless the
vibrations are part of the specified performance.

16.3.
Devices shall be designed and manufactured in
such a way as to reduce to the lowest possible level the risks arising from the
noise emitted, taking account of technical progress and of the means available
to reduce noise, particularly at source, unless the noise emitted is part of
the specified performance.

16.4.
Terminals and connectors to the electricity, gas
or hydraulic and pneumatic energy supplies which the user or other person has
to handle shall be designed and constructed in such a way as to minimise all
possible risks.

16.5.
Errors likely to be made when fitting or
refitting, or connecting or reconnecting, certain parts before or during use which could be a source
of risk must be made impossible by the design and construction of such parts
or, failing this, by information given on the parts themselves and/or their
housings.

The same information must be given on moving
parts and/or their housings where the direction of movement needs to be known
in order to avoid a risk.

16.6.
Accessible parts of the devices (excluding the
parts or areas intended to supply heat or reach given temperatures) and their
surroundings shall not attain potentially dangerous temperatures under normal
conditions of use.

17.
Protection against the risks posed to the
patient or user by supplied energy or substances

17.1.
Devices for supplying the patient with energy or
substances shall be designed and constructed in such a way that the delivered
amount can be set and maintained accurately enough to assure the safety of the
patient and of the user.

17.2.
Devices shall be fitted with the means of
preventing and/or indicating any inadequacies in the delivered amount which
could pose a danger. Devices shall incorporate suitable means to prevent, as
far as possible, the accidental release of dangerous levels of energy or
substances from an energy and/or substance source.

17.3.
The function of the controls and indicators
shall be clearly specified on the devices. Where a device bears instructions
required for its operation or indicates operating or adjustment parameters by
means of a visual system, such information shall be understandable to the user
and, as appropriate, the patient.

18.
Protection against the risks posed by
medical devices intended by the manufacturer for use by lay persons

18.1.
Devices for use by lay persons shall be
designed and manufactured in such a way that they perform appropriately for
their intended purpose taking into account the skills and the means available
to lay persons and the influence resulting from variation that can reasonably
be anticipated in the lay person’s technique and environment. The information
and instructions provided by the manufacturer shall be easy for the lay person
to understand and apply.

18.2.
Devices for use by lay persons shall be
designed and manufactured in such a way as to

–
ensure that the device is easy to use by the
intended user at all stages of the procedure, and

–
reduce as far as possible the risk of error by
the intended user in the handling of the device and, if applicable, in the
interpretation of the results.

18.3.
Devices for use by lay persons shall,
where reasonably possible, include a procedure by which the lay person

–
can verify that, at the time of use, the device
will perform as intended by the manufacturer, and

–
if applicable, is warned if the device has failed
to provide a valid result.

III.         Requirements regarding the
information supplied with the device

19.
Label and instructions for use

19.1.
General requirements regarding the
information supplied by the manufacturer

Each device shall be accompanied by the
information needed to identify the device and its manufacturer, and communicate
safety and performance related information to the user, professional or lay, or
other person, as appropriate. Such information may appear on the device itself,
on the packaging or in the instructions for use, taking into account the
following:

(a)
The medium, format, content, legibility, and
location of the label and instructions for use shall be appropriate to the
particular device, its intended purpose and the technical knowledge, experience,
education or training of the intended user(s). In particular, instructions for
use shall be written in terms readily understood by the intended user and,
where appropriate, supplemented with drawings and diagrams. Some devices may
include separate information for the professional user and the lay person.

(b)
The information required on the label shall be
provided on the device itself. If this is not practicable or appropriate, some
or all of the information may appear on the packaging for each unit, and/or on
the packaging of multiple devices.

Where multiple devices are supplied to a single
user and/or location, a single copy of the instructions for use may be provided
if so agreed by the purchaser who in any case may request further copies to be
provided.

(c)
For devices of class I and IIa, instructions for
use are not needed or may be abbreviated if the device can be used safely and
as intended by the manufacturer without any such instructions for use.

(d)
Labels shall be provided in a human-readable
format but may be supplemented by machine-readable forms, such as
radio-frequency identification (RFID) or bar codes.

(e)
Instructions for use may be provided to the user
in non-paper format (e.g. electronic) to the extent and under the conditions
set out in Commission Regulation (EU) No 207/2012 on electronic instructions
for use of medical devices[62].

(f)
Residual risks which are required to be
communicated to the user and/or other person shall be included as limitations,
contraindications, precautions or warnings in the information supplied by the
manufacturer.

(g)
Where appropriate, this information should take
the form of internationally recognised symbols. Any symbol or identification
colour used shall conform to the harmonised standards or CTS. In areas for
which no standards or CTS exist, the symbols and colours shall be described in
the documentation supplied with the device.

19.2.
Information on the label

The label shall bear the following particulars:

(a)
The name or trade name of the device.

(b)
The details strictly necessary for a user to
identify the device, the contents of the packaging and, where it is not obvious
for the user, the intended purpose of the device.

(c)
The name, registered trade name or registered
trade mark of the manufacturer and the address of his registered place of
business at which he can be contacted and his location be established.

(d)
For imported devices, the name, registered trade
name or registered trade mark of the authorised representative established
within the Union and the address of his registered place of business at which
he can be contacted and his location be established.

(e)
Where applicable, an indication that the device
contains or incorporates

–
a medicinal substance, including a human blood or
plasma derivative, or

–
tissues or cells, or their derivatives, of human
origin, or

–
tissues or cells, or their derivatives, of
animal origin as referred to in Commission Regulation (EU) No 722/2012.

(f)
Where applicable, an indication that the device
incorporates or consists of nanomaterial unless the nanomaterial is encapsulated
or bound in such a manner that it cannot be released into the patient’s or
user's body when the device is used within its intended purpose.

(g)
The batch code/lot number or the serial number
of the device preceded by the word LOT or SERIAL NUMBER or an equivalent
symbol, as appropriate.

(h)
Where applicable, the unique device
identification (UDI).

(i)
An unambiguous indication of the date until when
the device may be used safely, expressed at least as the year and month, where
this is relevant.

(j)
Where there is no indication of the date until
when it may be used safely, the year of manufacture. This year of manufacture
may be included as part of the batch or serial number, provided the date is
clearly identifiable.

(k)
An indication of any special storage and/or handling
condition that applies.

(l)
If the device is supplied sterile, an indication
of its sterile state and the sterilisation method.

(m)
Warnings or precautions to be taken that need to
be brought to the immediate attention of the user of the device as relevant,
and to any other person where appropriate. This information may be kept to a
minimum in which case more detailed information should appear in the
instructions for use.

(n)
If the device is intended for single use, an
indication of that fact. A manufacturer's indication of single use shall be
consistent across the Union.

(o)
If the device is a single use device that has
been reprocessed, an indication of that fact, the number of reprocessing cycles
already performed, and any limitation as regards the number of reprocessing
cycles.

(p)
If the device is custom made, an indication of
that fact.

(q)
If the device is intended for clinical
investigation only, an indication of that fact.

19.3.
Information in the instructions for use

The instructions for use shall contain the
following particulars:

(a)
The particulars referred to in points 19.2. a),
c), e), f), k), l) and n).

(b)
The device’s intended purpose including the
intended user (e.g. professional or lay person), as appropriate.

(c)
The performance of the device intended by the
manufacturer.

(d)
Any residual risks, contraindications and any
expected and foreseeable undesirable side-effects, including information to be
conveyed to the patient in this regard.

(e)
Specifications the user requires to use the
device appropriately, e.g. if the device has a measuring function, the degree
of accuracy claimed for it.

(f)
Details of any preparatory treatment or handling
of the device before it is ready for use (e.g. sterilisation, final assembly,
calibration, etc.).

(g)
Any requirements for special facilities, or special
training, or particular qualifications of the device user and/or other persons.

(h)
The information needed to verify whether the
device is properly installed and is ready to perform safely and as intended by
the manufacturer, together with, where relevant:

–
details of the nature, and frequency, of
preventative and regular maintenance, and of any preparatory cleaning or
disinfection;

–
identification of any consumable components and
how to replace them;

–
information on any necessary calibration to
ensure that the device operates properly and safely during its intended lifetime;

–
methods of eliminating the risks encountered by
persons involved in installing, calibrating or servicing devices.

(i)
If the device is supplied sterile, instructions
in the event of the sterile packaging being damaged before use.

(j)
If the device is supplied non-sterile with the
intention that it is sterilised before use, the appropriate instructions for
sterilisation.

(k)
If the device is reusable, information on the
appropriate processes to allow reuse, including cleaning, disinfection,
decontamination, packaging and, where appropriate, the validated method of
re-sterilisation. Information should be provided to identify when the device
should no longer be reused, e.g. signs of material degradation or the maximum
number of allowable reuses.

(l)
If the device bears an indication that the
device is for single use, information on known characteristics and technical
factors known to the manufacturer that could pose a risk if the device were to
be re-used. If in accordance with point c) of Section 19.1 no instructions for
use are needed, the information shall be made available to the user upon
request.

(m)
For devices intended for use together with other
devices and/or general purpose equipment:

–
information to identify such devices or
equipment, in order to obtain a safe combination, and/or

–
information on any known restrictions to
combinations of devices and equipment.

(n)
If the device emits hazardous, or potentially
hazardous levels of radiation for medical purposes:

–
detailed information as to the nature, type and
where appropriate, the intensity and distribution of the emitted radiation;

–
the means of protecting the patient, user, or
other person from unintended radiation during use of the device.

(o)
Information that allows the user and/or patient
to be informed of any warnings, precautions, measures to be taken and
limitations of use regarding the device. This information should cover, where
appropriate:

–
warnings, precautions and/or measures to be
taken in the event of malfunction of the device or changes in its performance
that may affect safety;

–
warnings, precautions and/or measures to be
taken in regards to the exposure to reasonably foreseeable external influences
or environmental conditions, such as magnetic fields, external electrical and
electromagnetic effects, electrostatic discharge, radiation associated with
diagnostic or therapeutic procedures, pressure, humidity, or temperature;

–
warnings, precautions and/or measures to be
taken in regards to the risks of interference posed by the reasonably
foreseeable presence of the device during specific diagnostic investigations,
evaluations, or therapeutic treatment or other procedures (e.g. electromagnetic
interference emitted by the device affecting other equipment);

–
if the device is intended to administer
medicinal products, tissues or cells, or their derivatives, of human or animal
origin or biological substances, any limitations or incompatibility in the
choice of substances to be delivered;

–
warnings, precautions and/or limitations related
to the medicinal substance or biological material that is incorporated into the
device as an integral part of the device;

–
precautions related to materials incorporated
into the device that are carcinogenic, mutagenic or toxic, or that have
endocrine disrupting properties or that could result in sensitisation or
allergic reaction of the patient or user.

(p)
Warnings or precautions to be taken in order to
facilitate the safe disposal of the device, its accessories and the consumables
used with it, if any. This information should cover, where appropriate:

–
infection or microbial hazards (e.g. explants,
needles or surgical equipment contaminated with potentially infectious
substances of human origin);

–
physical hazards (e.g. from sharps).

(q)
For devices intended for use by lay persons, the
circumstances when the user should consult with a healthcare professional.

(r)
For devices listed in Annex XV for which the
manufacturer does not claim a medical purpose, information regarding the
absence of a clinical benefit and the risks related to the use of the device.

(s)
Date of issue of the instructions for use or, if
they have been revised, date of issue and identifier of the latest revision of
the instructions for use.

(t)
A notice to the user and/or patient that any
serious incident that has occurred in relation to the device should be reported
to the manufacturer and the competent authority of the Member State where the
user and/or patient is established.

ANNEX II

TECHNICAL DOCUMENTATION

The technical documentation and, if
applicable, the summary technical documentation (STED) to be drawn up by the
manufacturer shall include in particular the following elements:

1.
Device description and specification, including
variants and accessories
1.1.
Device description and
specification

(a)
product or trade name and a general description
of the device including its intended purpose,

(b)
the UDI device identifier as referred to in item
(i) of point (a) of Article 24(1) attributed by the manufacturer to the device
in question, as soon as identification of this device shall be based on a UDI
system, or otherwise clear identification by means of product code, catalogue
number or other unambiguous reference allowing traceability;

(c)
the intended patient population and medical
condition to be diagnosed and/or treated and other considerations such as
patient selection criteria;

(d)
principles of operation of the device;

(e)
risk class and the applicable classification
rule according to Annex VII;

(f)
an explanation of any novel features;

(g)
a description of the accessories, other medical
devices and other products that are not medical devices, which are intended to
be used in combination with it;

(h)
a description or complete list of the various
configurations/variants of the device that will be made available;

(i)
a general description of the key functional
elements, e.g. its parts/components (including software if appropriate), its
formulation, its composition, its functionality. Where appropriate, this shall
include labelled pictorial representations (e.g. diagrams, photographs, and
drawings), clearly indicating key parts/components, including sufficient
explanation to understand the drawings and diagrams;

(j)
a description of the (raw) materials
incorporated into key functional elements and those making either direct contact
with the human body or indirect contact with the body, e.g., during extracorporeal
circulation of body fluids;

(k)
technical specifications (features, dimensions
and performance attributes) of the medical device and any variants and
accessories that would typically appear in the product specification made
available to the user, e.g. in brochures, catalogues and the like.

1.2.
Reference to previous and similar generations of
the device

(a)
an overview of the manufacturer’s previous
generation(s) of the device, if such exist;

(b)
an overview of the manufacturer’s similar
devices available on the EU or international markets, if such exist.

2.
Information supplied by the manufacturer

(a)
a complete set of

–
the label(s) on the device and on its packaging;

–
the instructions for use;

(b)
a list of the language variants for the Member
States where the device is envisaged to be marketed.

3.
Design and manufacturing information

(a)
Information to allow a general understanding of
the design stages applied to the device and the manufacturing processes such as
production, assembly, final product testing, and packaging of the finished
device. More detailed information needs to be provided for the audit of the
quality management system or other applicable conformity assessment procedures;

(b)
identification of all sites, including suppliers
and sub-contractors, where design and manufacturing activities are performed.

4.
General safety and performance requirements

The documentation shall contain information
regarding the solutions adopted to meet the general safety and performance requirements
laid down in Annex I. This information may take the form of a checklist
identifying

(a)
the general safety and performance requirements
that apply to the device and why others do not apply;

(b)
the method(s) used to demonstrate conformity
with each applicable general safety and performance requirement;

(c)
the harmonised standards or CTS applied or other
method(s) employed;

(d)
the precise identity of the controlled documents
offering evidence of conformity with each harmonised standard, CTS or other
method employed to demonstrate conformity with the general safety and
performance requirements. This information shall incorporate a cross-reference
to the location of such evidence within the full technical documentation and,
if applicable, the summary technical documentation.

5.
Risk/benefit analysis and risk management

The documentation shall contain a summary of

(a)
the risk/benefit analysis referred to in
Sections 1 and 5 of Annex I, and

(b)
the solutions adopted and the results of the
risk management referred to in Section 2 of Annex I.

6.
Product verification and validation

The documentation shall contain the results of
verification and validation testing and/or studies undertaken to demonstrate
conformity of the device with the requirements of this Regulation and in
particular the applicable general safety and performance requirements.

6.1.
Pre-clinical and clinical data

(a)
results of (engineering, laboratory, simulated
use, animal) tests and evaluation of published literature applicable to the
device or substantially similar devices regarding the pre-clinical safety of
the device and its conformity with the specifications;

(b)
detailed information regarding test design,
complete test or study protocols, methods of data analysis, in addition to data
summaries and test conclusions regarding

–
biocompatibility (identifying all materials in direct or indirect contact with the patient or user);

–
physical, chemical and microbiological
characterisation;

–
electrical safety and electromagnetic
compatibility;

–
software verification and validation (describing
the software design and development process and
evidence of the validation of the software, as used in the finished device.
This information should typically include the summary results of all
verification, validation and testing performed both in-house and in a simulated
or actual user environment prior to final release. It should also address all
of the different hardware configurations and, where applicable, operating
systems identified in the information supplied by the manufacturer);

–
stability/shelf life.

Where applicable, conformity with the provisions
of Directive 2004/10/EC of the European Parliament and
of the Council of 11 February 2004 on the harmonisation of laws, regulations
and administrative provisions relating to the application of the principles of
good laboratory practice and the verification of their applications for tests
on chemical substances[63] shall
be demonstrated.

Where no new testing has been undertaken, the
documentation shall incorporate a rationale for that decision, e.g.
biocompatibility testing on the identical materials was conducted when these
were incorporated in a previous version of the device that has been legally
placed on the market or put into service;

(c)
the report on the clinical evaluation in
accordance with Article 49(5) and Part A of Annex XIII;

(d)
the PMCF plan and PMCF evaluation report in
accordance with Part B of Annex XIII or any justification why a PMCF is not
deemed necessary or appropriate.

6.2.
Additional information in specific cases

(a)
Where a device incorporates, as an integral
part, a substance which, if used separately, may be considered to be a
medicinal product within the meaning of Article 1 of Directive 2001/83/EC,
including a medicinal product derived from human blood or human plasma,
referred to in the first subparagraph of Article 1(4), a statement indicating
this fact. In this case, the documentation shall identify the source of that
substance and contain the data of the tests conducted to assess its safety,
quality and usefulness, taking account of the intended purpose of the device.

(b)
Where a device is manufactured utilising tissues
or cells of human or animal origin, or their derivatives, that are covered by
this Regulation in accordance with point (e) of Article 1(2), a statement
indicating this fact. In this case, the documentation shall identify all
materials of human or animal origin used and provide detailed information
concerning the conformity with Sections 10.1. or 10.2., respectively, of Annex
I.

(c)
In the case of devices placed on the market in a
sterile or defined microbiological condition a description of the environmental
conditions for the relevant manufacturing steps. In the case of devices placed
on the market in a sterile condition, a description of the methods used,
including the validation reports, with respect to packaging, sterilisation and
maintenance of sterility. The validation report shall address bioburden
testing, pyrogen testing and, if applicable, testing for sterilant residues.

(d)
In the case of devices placed on the market with
a measuring function, a description of the methods used in order to ensure the
accuracy as given in the specifications.

(e)
If the device is to be connected to other
device(s) in order to operate as intended, a description of this combination
including proof that it conforms to the general safety and performance
requirements when connected to any such device(s) having regard to the
characteristics specified by the manufacturer.

ANNEX III

EU DECLARATION OF CONFORMITY

1.
Name, registered trade name or registered trade
mark of the manufacturer and, if applicable, his authorised representative, and
the address of their registered place of business where they can be contacted
and their location be established;

2.
A statement that the declaration of conformity
is issued under the sole responsibility of the manufacturer;

3.
The UDI device identifier as referred to in item
(i) of point (a) of Article 24(1) as soon as identification of the device that
is covered by the declaration shall be based on a UDI system;

4.
Product or trade name, product code, catalogue
number or other unambiguous reference allowing identification and traceability
of the device that is covered by the declaration (it may include a photograph,
where appropriate). Except for the product or trade name, the information
allowing identification and traceability may be provided by the device
identifier referred to in point 3;

5.
Risk class of the device in accordance with
Annex VII;

6.
A statement that the device that is covered by
the present declaration is in conformity with this Regulation and, if
applicable, with other relevant Union legislation that make provision for the
issuing of a declaration of conformity;

7.
References to the relevant harmonised standards or
CTS used in relation to which conformity is declared;

8.
Where applicable, name and identification number
of the notified body, description of the conformity assessment procedure
performed and identification of the certificate(s) issued;

9.
Where applicable, additional information;

10.
Place and date of issue, name and function of
the person who signs as well as indication for and on behalf of whom he/she
signs, signature.

ANNEX IV

CE MARKING OF CONFORMITY

1.
The CE marking shall consist of the initials
‘CE’ taking the following form:

2.
If the CE marking is reduced or enlarged the
proportions given in the above graduated drawing shall be respected.

3.
The various components of the CE marking shall
have substantially the same vertical dimension, which may not be less than 5
mm. This minimum dimension may be waived for small-scale devices.

ANNEX V

INFORMATION TO BE SUBMITTED WITH THE REGISTRATION OF
DEVICES AND ECONOMIC OPERATORS IN ACCORDANCE WITH ARTICLE 25

AND

DATA ELEMENTS OF THE UDI DEVICE IDENTIFIER IN
ACCORDANCE
WITH ARTICLE 24

Part A
Information to be submitted with the registration of devices in accordance with
Article 25

Manufacturers
or, when applicable, authorised representatives, and, when applicable,
importers shall submit the following information:

1.
economic operator's role (manufacturer,
authorised representative, or importer),

2.
name, address and contact details of the
economic operator,

3.
where submission of information is completed by
another person on behalf of any of the economic operators mentioned under point
1, the name, address and contact details of this person,

4.
UDI device identifier, or where identification
of the device is not yet based on a UDI system, the data elements laid down in
points 5 to 21 of Part B of this Annex,

5.
type, number and expiry date of certificate and
name or identification number of the notified body that has issued the
certificate (and link to the information on the certificate entered by the
notified body in the electronic system on certificates),

6.
Member State where the device shall or has been
placed on the market in the Union,

7.
in case of devices classified as classes IIa,
IIb or III: Member States where the device is or shall be made available,

8.
in case of imported device: country of origin,

9.
risk class of the device,

10.
reprocessed single use device (y/n),

11.
presence of a substance which, if used
separately, may be considered to be a medicinal product and name of this
substance,

12.
presence of a substance which, if used
separately, may be considered a medicinal product derived from human blood or
human plasma and name of this substance,

13.
presence of human tissues or cells, or their
derivatives (y/n),

14.
presence of animal tissues or cells, or their
derivatives, as referred to in Commission Regulation (EU) No 722/2012 (y/n),

15.
where applicable, single identification number
of the clinical investigation(s) conducted in relation to the device (or link
to the clinical investigation registration in the electronic system regarding
clinical investigations),

16.
in case of devices listed in Annex XV,
specification whether the intended purpose of the device is other than a
medical purpose,

17.
in case of devices designed and manufactured by
another legal or natural person as referred in Article 8(10), the name, address
and contact details of that legal or natural person,

18.
in case of devices classified as class III or
implantable devices, the summary of safety and clinical performance,

19.
status of the device (on the market, no longer
manufactured, withdrawn from the market, recalled).

Part B
Data elements of the UDI device identifier in accordance with Article 24

The UDI device identifier shall provide
access to the following information related to the manufacturer and the device
model:

1.
quantity per package configuration,

2.
if
applicable, alternative or additional identifier(s),

3.
the way how the device
production is controlled (expiration date or manufacturing date, lot or batch
number, serialisation number),

4.
if applicable, the unit
of use device identifier (when a UDI is not assigned to the device at the level
of its unit of use, a 'unit of use' device identifier shall be assigned to
associate the use of a device with a patient),

5.
name and address of the manufacturer (as
indicated on the label),

6.
if applicable, name and address of the
authorised representative (as indicated on the label),

7.
Global Medical Device Nomenclature (GMDN) code
or internationally recognised nomenclature code,

8.
if applicable, trade/brand name,

9.
if applicable, device model, reference, or
catalogue number,

10.
if applicable, clinical size (including volume,
length, gauge, diameter),

11.
additional product description (optional),

12.
if applicable, storage and/or handling
conditions (as indicated on the label or in the instructions for use),

13.
if applicable, additional trade names of the
device,

14.
labelled as single use device (y/n),

15.
if applicable, restricted number of reuses,

16.
device packaged sterile (y/n),

17.
need for sterilisation before use (y/n),

18.
labelled as containing latex (y/n),

19.
labelled as containing DEHP (y/n),

20.
URL for additional information, e.g. electronic
instructions for use (optional),

21.
if applicable, critical warnings or
contraindications.

ANNEX VI

MINIMUM REQUIREMENTS TO BE MET BY NOTIFIED BODIES

1.
Organisational and general requirements
1.1.
Legal status and organisational structure
1.1.1.
A notified body shall be established under the national law of a
Member State, or under the law of a third country with which the Union has
concluded an agreement in this respect, and shall have full documentation of
its legal personality and status. This shall include information about ownership and the legal or natural
persons exercising control over the notified body.
1.1.2.
If the notified body
is a legal entity that is part of a larger organisation, the activities of this
organisation as well as its organisational structure and governance, and the
relationship with the notified body shall be clearly documented.
1.1.3.
If the notified body
wholly or partly owns legal entities established in a Member State or in a
third country, the activities and responsibilities of those entities, as well
as their legal and operational relationships with the notified body, shall be
clearly defined and documented.
1.1.4.
The organisational
structure, distribution of responsibilities and operation of the notified body
shall be such that it assures confidence in the performance and results of the
conformity assessment activities conducted.

The organisational structure and the functions,
responsibilities and authority of its top-level management and of other
personnel with influence upon the performance and results of the conformity
assessment activities shall be clearly documented.

1.2.
Independence and impartiality
1.2.1.
The notified body shall be a third-party body that is
independent of the manufacturer of the product in relation to which it performs
conformity assessment activities. The notified body shall also be independent
of any other economic operator having an interest in the product as well as of
any competitor of the manufacturer.
1.2.2.
The notified body
shall be organised and operated so as to safeguard the independence,
objectivity and impartiality of its activities. The notified body shall have
procedures in place that effectively ensure identification, investigation and
resolution of any case in which a conflict of interests may arise, including
involvement in consultancy services in the field of medical devices prior to
taking up employment with the notified body.
1.2.3.
The notified body, its
top-level management and the personnel responsible for carrying out the
conformity assessment tasks shall not

–
be the designer, manufacturer, supplier,
installer, purchaser, owner, user or maintainer of the products, nor the
authorised representative of any of those parties. This shall not preclude the purchase
and use of assessed products that are necessary for the operations of the
notified body (e.g. measuring equipment), the conduct of the conformity
assessment or the use of such products for personal purposes;

–
be directly involved in the design, manufacture
or construction, the marketing, installation, use or maintenance of the products
which they assess, or represent the parties engaged in those activities. They
shall not engage in any activity that may conflict with their independence of
judgement or integrity in relation to conformity assessment activities for
which they are notified;

–
offer or provide any service which may
jeopardise the confidence in their independence, impartiality or objectivity.
In particular, they shall not offer or provide consultancy services to the
manufacturer, his authorised representative, a supplier or a commercial
competitor as regards the design, construction, marketing or maintenance of the
products or processes under assessment. This does not preclude general training
activities relating to medical device regulations or related standards that are
not client specific.

1.2.4.
The impartiality of
the notified bodies, of their top level management and of the assessment
personnel shall be guaranteed. The remuneration of the top level management and
assessment personnel of a notified body shall not depend on the results of the
assessments.
1.2.5.
If a notified body is
owned by a public entity or institution, independence and absence of any
conflict of interests must be ensured and documented between, on the one hand,
the national authority responsible for notified bodies and/or competent
authority and, on the other hand, the notified body.
1.2.6.
The notified body
shall ensure and document that the activities of its subsidiaries or
subcontractors, or of any associated body, do not affect its independence,
impartiality or objectivity of its conformity assessment activities.
1.2.7.
The notified body
shall operate in accordance with a set of consistent, fair and reasonable terms and conditions, taking
into account the interests of small and medium-sized enterprises as defined by
Commission Recommendation 2003/361/EC.
1.2.8.
The requirements of
this section in no way preclude exchanges of technical information and
regulatory guidance between a notified body and a manufacturer seeking their
conformity assessment.
1.3.
Confidentiality

The personnel of a notified body shall observe
professional secrecy with regard to all information obtained in carrying out
their tasks under this Regulation, except in relation to the national
authorities responsible for notified bodies, competent authorities or the
Commission. Proprietary rights shall be protected. To this end, the notified
body shall have documented procedures in place.

1.4.
Liability

The notified body shall take out appropriate liability
insurance that corresponds to the conformity assessment activities for which it
is notified, including the possible suspension, restriction or withdrawal of
certificates, and the geographic scope of its activities, unless liability is
assumed by the State in accordance with national law, or the Member State
itself is directly responsible for the conformity assessment.

1.5.
Financial requirements

The notified body shall have at its disposal
the financial resources required to conduct its conformity assessment
activities and related business operations. It shall document and provide
evidence of its financial capacity and its sustainable economic viability,
taking into account specific circumstances during an initial start-up phase.

1.6.
Participation in coordination activities
1.6.1.
The notified body
shall participate in, or ensure that its assessment personnel is informed of
the relevant standardisation activities and the activities of the notified body
coordination group and that its assessment and decision making personnel are
informed of all relevant legislation, guidance and best practice documents
adopted in the framework of this Regulation.
1.6.2.
The notified body
shall adhere to a code of conduct, addressing among other things, ethical
business practices for notified bodies in the field of medical devices that is
accepted by the national authorities responsible for notified bodies. The code
of conduct shall provide for a mechanism of monitoring and verification of its
implementation by notified bodies.
2.
Quality management requirements
2.1.
The notified body
shall establish, document, implement, maintain and operate a quality management
system that is appropriate to the nature, area and scale of its conformity
assessment activities and capable of supporting and demonstrating the
consistent achievement of the requirements of this Regulation.
2.2.
The quality
management system of the notified body shall at least address the following:

–
policies for assignment of personnel to
activities and their responsibilities;

–
decision-making process in accordance with the tasks, responsibilities and role of the top-level management and
other notified body personnel;

–
control of documents;

–
control of records;

–
management review;

–
internal audits;

–
corrective and preventive actions;

–
complaints and appeals.

3.
Resource requirements
3.1.
General
3.1.1.
A notified body shall
be capable of carrying out all the tasks assigned to it by this Regulation with
the highest degree of professional integrity and the requisite technical
competence in the specific field, whether those tasks are carried out by the
notified body itself or on its behalf and under its responsibility.

In particular, it shall have the necessary personnel
and shall possess or have access to all equipment and facilities needed to
perform properly the technical and administrative tasks entailed in the
conformity assessment activities in relation to which it has been notified.

This presupposes the availability within its
organisation of sufficient scientific personnel who possess experience and
knowledge sufficient to assess the medical functionality and performance of
devices for which it has been notified, having regard to the requirements of
this Regulation and, in particular, those set out in Annex I.

3.1.2.
At all times and for
each conformity assessment procedure and each kind or category of products in
relation to which it has been notified, a notified body shall have within its
organisation the necessary administrative, technical and scientific personnel
with technical knowledge and sufficient and appropriate experience relating to
medical devices and the corresponding technologies to perform the conformity
assessment tasks, including the assessment of clinical data.
3.1.3.
The notified body
shall clearly document the extent and the limits of the duties,
responsibilities and authorities in relation of the personnel involved in
conformity assessment activities and inform the personnel concerned about it.
3.2.
Qualification criteria in relation to personnel
3.2.1.
The Notified Body
shall establish and document qualification criteria and procedures for
selection and authorisation of persons involved in conformity assessment
activities (knowledge, experience and other competence required) and the
required training (initial and ongoing training). The qualification criteria
shall address the various functions within the conformity assessment process
(e.g. auditing, product evaluation/testing, design dossier/file review,
decision-making) as well as the devices, technologies and areas (e.g.
biocompatibility, sterilisation, tissues and cells of human and animal origin,
clinical evaluation) covered by the scope of designation.
3.2.2.
The qualification criteria
shall refer to the scope of the notified body's designation in accordance with
the scope description used by the Member State for the notification referred to
in Article 33, providing sufficient level of detail for the required
qualification within the subdivisions of the scope description.

Specific qualification criteria shall be
defined for the assessment of biocompatibility aspects, clinical evaluation and
the different types of sterilisation processes.

3.2.3.
The personnel
responsible for authorising other personnel to perform specific conformity
assessment activities and the personnel with overall responsibility for the
final review and decision-making on certification shall be employed by the notified body itself and shall
not be subcontracted. These personnel altogether shall have proven knowledge and experience in the
following:

–
Union medical devices legislation and relevant
guidance documents;

–
the conformity assessment procedures in
accordance with this Regulation;

–
a broad base of medical device technologies, the
medical device industry and the design and manufacture of medical devices;

–
the notified body’s quality management system
and related procedures;

–
the types of qualifications (knowledge,
experience and other competence) required for carrying out conformity
assessments in relation to medical devices as well as the relevant
qualification criteria;

–
training relevant to personnel involved in
conformity assessment activities in relation to medical devices;

–
the ability to draw up certificates, records and
reports demonstrating that the conformity assessments have been appropriately
carried out.

3.2.4.
Notified bodies shall
have available personnel with
clinical expertise. This personnel shall be integrated in the notified body's
decision-making process in a steady way in order to:

–
identify when specialist input is required for
the assessment of the clinical evaluation conducted by the manufacturer and
identify appropriately qualified experts;

–
appropriately train external clinical experts in
the relevant requirements of this Regulation, delegated and/or implementing
acts, harmonised standards, CTS and guidance documents and ensure that the
external clinical experts are fully aware of the context and implication of
their assessment and advice provided;

–
be able to discuss the clinical data contained
within the manufacturer's clinical evaluation with the manufacturer and with
external clinical experts and to appropriately guide external clinical experts
in the assessment of the clinical evaluation;

–
be able to scientifically challenge the clinical
data presented, and the results of the external clinical experts' assessment of
the manufacturer's clinical evaluation;

–
be able to ascertain the comparability and
consistency of the clinical assessments conducted by clinical experts;

–
be able to make an objective clinical judgement
about the assessment of the manufacturer's clinical evaluation and make a
recommendation to the notified body's decision maker.

3.2.5.
The personnel
responsible for carrying out product related review (e.g. design dossier
review, technical documentation review or type examination including aspects
such as clinical evaluation, biological safety, sterilisation, software
validation) shall have the following proven qualification:

–
successful completion of a university or a
technical college degree or equivalent qualification in relevant studies, e.g.
medicine, natural science or engineering;

–
four years professional experience in the field
of healthcare products or related sectors (e.g. industry, audit, healthcare,
research experience) whilst two years of this experience shall be in the
design, manufacture, testing or use of the device or technology to be assessed or
related to the scientific aspects to be assessed;

–
appropriate knowledge of the general safety and
performance requirements laid down in Annex I as well as related delegated
and/or implementing acts, harmonised standards, CTS and guidance documents;

–
appropriate knowledge and experience of risk
management and related medical device standards and guidance documents;

–
appropriate knowledge and experience of the
conformity assessment procedures laid down in Annexes VIII to X, in particular
of those aspects for which they are authorised, and adequate authority to carry
out those assessments.

3.2.6.
The personnel responsible
for carrying out audits of the manufacturer's quality management system shall
have the following proven qualification:

–
successful completion of a university or a
technical college degree or equivalent qualification in relevant studies, e.g.
medicine, natural science or engineering;

–
four years professional experience in the field
of healthcare products or related sectors (e.g. industry, audit, healthcare,
research experience) whilst two years of this experience shall be in the area
of quality management;

–
appropriate knowledge of the medical devices
legislation as well as related delegated and/or implementing acts, harmonised
standards, CTS and guidance documents;

–
appropriate knowledge and experience of risk
management and related medical device standards and guidance documents;

–
appropriate knowledge of quality management
systems and related standards and guidance documents

–
appropriate knowledge and experience of the
conformity assessment procedures laid down in Annexes VIII to X, in particular
of those aspects for which they are authorised, and adequate authority to carry
out the audits;

–
training in auditing techniques enabling them to
challenge quality management systems.

3.3.
Documentation of qualification, training and
authorisation of personnel
3.3.1.
The notified body
shall have a process in place to fully document the qualification of each
personnel involved in conformity assessment activities and the satisfaction of
the qualification criteria referred to in Section 3.2. Where in exceptional
circumstances the fulfilment of the qualification criteria set out in Section
3.2 cannot be fully demonstrated, the notified body shall appropriately justify
the authorisation of these personnel to carry out specific conformity
assessment activities.
3.3.2.
For its personnel referred
to in Sections 3.2.3 to 3.2.6, the notified body shall establish and maintain
up to date:

–
a matrix detailing the responsibilities of the personnel
in respect of the conformity assessment activities;

–
records demonstrating the required knowledge and
experience for the conformity assessment activity for which they are
authorised.

3.4.
Subcontractors and external experts
3.4.1.
Without prejudice to
the limitations emanating from Section 3.2., notified bodies may subcontract
clearly defined parts of the conformity assessment activities. The
subcontracting of the auditing of quality management systems or of product
related reviews as a whole is not allowed.
3.4.2.
Where a notified body
subcontracts conformity assessment activities either to an organisation or an
individual, it shall have a policy describing the conditions under which
subcontracting may take place. Any subcontracting or consultation of external
experts shall be properly documented and be subject to a written agreement
covering, among others, confidentiality and conflict of interests.
3.4.3.
Where subcontractors
or external experts are used in the context of the conformity assessment, in
particular regarding novel, invasive and implantable medical devices or
technologies, the notified body shall have adequate own competence in each
product area for which it is designated to lead the conformity assessment, to
verify the appropriateness and validity of expert opinions and make the
decision on the certification.
3.4.4.
The notified body
shall establish procedures for assessing and monitoring the competence of all
subcontractors and external experts used.
3.5.
Monitoring of competences and training
3.5.1.
The notified body
shall appropriately monitor the satisfactory performance of the conformity
assessment activities by its personnel.
3.5.2.
It shall review the
competence of its personnel and identify training needs in order to maintain
the required level of qualification and knowledge.
4.
Process requirements
4.1.
The notified body's
decision-making process shall be clearly documented, including the process for the
issue, suspension, reinstatement, withdrawal or refusal of conformity
assessment certificates, their modification or restriction and the issue of
supplements.
4.2.
The notified body
shall have in place a documented process for the conduct of the conformity
assessment procedures for which it is designated taking into account their
respective specificities, including legally required consultations, in respect
of the different categories
of devices covered by the scope of notification, ensuring transparency and the ability of
reproduction of those procedures.
4.3.
The notified body
shall have in place documented procedures covering at least:

–
the application for conformity assessment by a
manufacturer or by an authorised representative,

–
the processing of the application, including the
verification of the completeness of the documentation, the qualification of the
product as device and its classification,

–
the language of the application, of the
correspondence and of the documentation to be submitted,

–
the terms of the agreement with the manufacturer
or authorised representative,

–
the fees to be charged for conformity assessment
activities,

–
the assessment of relevant changes to be
submitted for prior approval,

–
the planning of surveillance,

–
the renewal of certificates.

ANNEX VII

CLASSIFICATION Criteria

I. Specific definitions for the classification rules

1.
Duration of use
1.1.
‘Transient’ means normally
intended for continuous use for less than 60 minutes.
1.2.
‘Short term’ means normally
intended for continuous use for between 60 minutes and 30 days.
1.3.
‘Long term’ means normally
intended for continuous use for more than 30 days.
2.
Invasive and active devices
2.1.
‘Body orifice’ means
any natural opening in the body, as well as the external surface of the
eyeball, or any permanent artificial opening, such as a stoma or permanent
tracheotomy.
2.2.
‘Surgically invasive
device’ means

(a)
an invasive device which penetrates inside the
body through the surface of the body, with the aid or in the context of a
surgical operation;

(b)
a device which produces penetration other than
through a body orifice.

2.3.
‘Reusable surgical
instrument’ means an instrument intended for surgical use by cutting, drilling,
sawing, scratching, scraping, clamping, retracting, clipping or similar
procedures, without connection to any active medical device and which are
intended by the manufacturer to be reused after appropriate procedures for
cleaning and/or sterilization have been carried out.
2.4.
‘Active therapeutic
device’ means any active medical device, whether used alone or in combination
with other medical devices, to support, modify, replace or restore biological
functions or structures with a view to treatment or alleviation of an illness,
injury or disability.
2.5.
‘Active device
intended for diagnosis’ means any active medical device, whether used alone or
in combination with other medical devices, to supply information for detecting,
diagnosing, monitoring or treating physiological conditions, states of health,
illnesses or congenital deformities.
2.6.
‘Central circulatory
system’ means the following blood vessels: arteriae pulmonales, aorta
ascendens, arcus aorta, aorta descendens to the bifurcatio aortae, arteriae
coronariae, arteria carotis communis, arteria carotis externa, arteria carotis
interna, arteriae cerebrales, truncus brachiocephalicus, venae cordis, venae
pulmonales, vena cava superior, vena cava inferior.
2.7.
‘Central nervous
system’ means the brain, meninges and spinal cord.

II.
Implementing rules for the classification rules

1.
Application of the classification rules shall be
governed by the intended purpose of the devices.

2.
If the device is intended to be used in
combination with another device, the classification rules shall apply
separately to each of the devices. Accessories are classified in their own
right separately from the device with which they are used.

3.
Stand alone software, which drives a device or
influences the use of a device, falls automatically in the same class as the
device. If stand alone software is independent of any other device, it is
classified in its own right.

4.
If the device is not intended to be used solely
or principally in a specific part of the body, it shall be considered and
classified on the basis of the most critical specified use.

5.
If several rules, or within the same rule
several sub-rules, apply to the same device based on the device’s intended
purpose, the strictest rule and/or sub-rule resulting in the higher
classification shall apply.

6.
In calculating the duration referred to in
Chapter I, Section 1 continuous use means:

(a)
The entire duration of use of the same device
without regard to temporary interruption of use during a procedure or temporary
removal for purposes such as cleaning or disinfection of the device. Whether
the interruption of use or the removal is temporary shall be established in
relation to the duration of the use prior and after the period when the use is
interrupted or the device removed.

(b)
The accumulated use of a device that is intended
by the manufacturer to be replaced immediately with another of the same type.

7.
A device is considered to allow direct diagnosis
when it provides the diagnosis of the disease or condition by itself or when it
provides decisive information for the diagnosis.

III.
Classification rules

3.
Non-invasive devices
3.1.
Rule 1

All non-invasive devices are in class I, unless
one of the rules set out hereinafter applies.

3.2.
Rule 2

All non-invasive devices intended for
channelling or storing blood, body liquids or tissues, liquids or gases for the
purpose of eventual infusion, administration or introduction into the body are
in class IIa:

–
if they may be connected to an active medical
device in class IIa or a higher class,

–
if they are intended for use for storing or
channelling blood or other body liquids or for storing organs, parts of organs
or body tissues.

In all other cases they are in class I.

3.3.
Rule 3

All non-invasive devices intended for modifying
the biological or chemical composition of human tissues or cells, blood, other
body liquids or other liquids intended for implantation or infusion into the
body are in class IIb, unless the treatment consists of filtration,
centrifugation or exchanges of gas, heat, in which case they are in class IIa.

All non-invasive devices intended to be used
for in vitro fertilisation (IVF) or assisted reproduction technologies (ART)
which are liable to act with close contact on the inner or outer cells during
the IVF/ART, such as washing, separating, sperm immobilising, cryoprotecting
solutions, are in class IIb.

3.4.
Rule 4

All non-invasive devices which come into
contact with injured skin:

–
are in class I if they are intended to be used
as a mechanical barrier, for compression or for absorption of exudates,

–
are in class IIb if they are intended to be used
principally with wounds which have breached the dermis and can only heal by
secondary intent,

–
are in class IIa in all other cases, including
devices principally intended to manage the micro-environment of a wound.

4.
Invasive
devices
4.1.
Rule 5

All invasive devices with respect to body
orifices, other than surgically invasive devices and which are not intended for
connection to an active medical device or which are intended for connection to
an active medical device classified as class I:

–
are in class I if they are intended for
transient use,

–
are in class IIa if they are intended for
short-term use, except if they are used in the oral cavity as far as the
pharynx, in an ear canal up to the ear drum or in a nasal cavity, in which case
they are in class I,

–
are in class IIb if they are intended for
long-term use, except if they are used in the oral cavity as far as the
pharynx, in an ear canal up to the ear drum or in a nasal cavity and are not
liable to be absorbed by the mucous membrane, in which case they are in class
IIa.

All invasive devices with respect to body
orifices, other than surgically invasive devices, intended for connection to an
active medical device in class IIa or a higher class, are in class IIa.

4.2.
Rule 6

All surgically invasive devices intended for
transient use are in class IIa unless they:

–
are intended to control, diagnose, monitor or
correct a defect of the heart or of the central circulatory system through
direct contact with these parts of the body, in which case they are in class
III,

–
are reusable surgical instruments, in which case
they are in class I,

–
are intended specifically for use in direct
contact with the central nervous system, in which case they are in class III,

–
are intended to supply energy in the form of
ionising radiation in which case they are in class IIb,

–
have a biological effect or are wholly or mainly
absorbed in which case they are in class IIb,

–
are intended to administer medicines by means of
a delivery system, if this is done in a manner that is potentially hazardous
taking account of the mode of application, in which case they are in class IIb.

4.3.
Rule 7

All surgically invasive devices intended for
short-term use are in class IIa unless they:

–
are intended specifically to control, diagnose,
monitor or correct a defect of the heart or of the central circulatory system
through direct contact with these parts of the body, in which case they are in
class III,

–
are intended specifically for use in direct
contact with the central nervous system, in which case they are in class III,

–
are intended to supply energy in the form of
ionizing radiation in which case they are in class IIb,

–
have a biological effect or are wholly or mainly
absorbed in which case they are in class III,

–
are intended to undergo chemical change in the
body, except if the devices are placed in the teeth, or to administer
medicines, in which case they are in class IIb.

4.4.
Rule 8

All implantable devices and long-term
surgically invasive devices are in class IIb unless they:

–
are intended to be placed in the teeth, in which case they are in class IIa,

–
are intended to be used in direct contact with
the heart, the central circulatory system or the central nervous system, in
which case they are in class III,

–
have a biological effect or are wholly or mainly
absorbed, in which case they are in class III,

–
are intended to undergo chemical change in the
body, except if the devices are placed in the teeth, or to administer
medicines, in which case they are in class III,

–
are active implantable medical devices or
implantable accessories to active implantable medical devices, in which case
they are in class III,

–
are breast implants, in which case they are in
class III,

–
are hip, knee or shoulder total and partial
joint replacements, in which case they are in class III, with the exception of
ancillary components such as screws, wedges, plates and instruments,

–
are spinal disc replacement implants and
implantable devices that come into contact with the spinal column, in which
case they are in class III.

5.
Active
devices
5.1.
Rule 9

All active therapeutic devices intended to
administer or exchange energy are in class IIa unless their characteristics are
such that they may administer or exchange energy to or from the human body in a
potentially hazardous way, taking account of the nature, the density and site
of application of the energy, in which case they are in class IIb.

All active devices intended to control or
monitor the performance of active therapeutic devices in class IIb, or intended
directly to influence the performance of such devices are in class IIb.

All active devices that are intended for
controlling, monitoring or directly influencing the performance of active
implantable medical devices are in class III.

5.2.
Rule 10

Active devices intended for diagnosis are in
class IIa:

–
if they are intended to supply energy which will
be absorbed by the human body, except for devices used to illuminate the
patient's body, in the visible spectrum,

–
if they are intended to image in vivo
distribution of radiopharmaceuticals,

–
if they are intended to allow direct diagnosis
or monitoring of vital physiological processes, unless they are specifically
intended for monitoring of vital physiological parameters, where the nature of
variations is such that it could result in immediate danger to the patient, for
instance variations in cardiac performance, respiration, activity of central
nervous system in which case they are in class IIb.

Active devices intended to emit ionizing
radiation and intended for diagnostic or therapeutic interventional radiology
including devices which control or monitor such devices, or which directly
influence their performance, are in class IIb.

5.3.
Rule 11

All active devices intended to administer
and/or remove medicines, body liquids or other substances to or from the body
are in class IIa, unless this is done in a manner that is potentially
hazardous, taking account of the nature of the substances involved, of the part
of the body concerned and of the mode of application in which case they are in
class IIb.

5.4.
Rule 12

All other active devices are in class I.

6.
Special
Rules
6.1.
Rule 13

All devices incorporating, as an integral part,
a substance which, if used separately, can be considered to be a medicinal
product, as defined in Article 1 of Directive 2001/83/EC, including a medicinal
product derived from human blood or human plasma, with action ancillary to that
of the devices, are in class III.

6.2.
Rule 14

All devices used for contraception or the
prevention of the transmission of sexually transmitted diseases are in class
IIb, unless they are implantable or long term invasive devices, in which case
they are in class III.

6.3.
Rule 15

All devices intended specifically to be used
for disinfecting, cleaning, rinsing or, when appropriate, hydrating contact
lenses are in class IIb.

All devices intended specifically to be used
for disinfecting or sterilising medical devices are in class IIa, unless they
are disinfecting solutions or washer-disinfectors intended specifically to be
used for disinfecting invasive devices, as the end point of processing, in
which case they are in class IIb.

This rule does not apply to devices that are
intended to clean medical devices other than contact lenses by means of
physical action only.

6.4.
Rule 16

Devices specifically intended for recording of
diagnostic images generated by X-ray, MRI, ultra-sound or other diagnostic
devices are in class IIa.

6.5.
Rule 17

All devices manufactured utilising tissues or
cells of human or animal origin, or their derivatives, which are non-viable or
rendered non-viable are in class III, unless such devices are manufactured
utilising tissues or cells of animal origin, or their derivatives, which are
non-viable or rendered non-viable that are intended to come into contact with
intact skin only.

6.6.
Rule 18

By derogation from other rules, blood bags are
in class IIb.

6.7.
Rule 19

All devices incorporating or consisting of
nanomaterial are in class III unless the nanomaterial is encapsulated or bound
in such a manner that it cannot be released into the patient’s or user's body
when the device is used within its intended purpose.

6.8.
Rule 20

All devices intended to be used for aphaeresis,
such as aphaeresis machines, sets, connectors and solutions, are in class III.

6.9.
Rule 21

Devices that are composed of substances or
combination of substances intended to be ingested, inhaled or administered
rectally or vaginally and that are absorbed by or dispersed in the human body
are in class III.

ANNEX VIII

Conformity assessment based on full quality assurance
AND design examination

Chapter
I: Full Quality Assurance System

1.
The manufacturer shall ensure application of the
quality management system approved for the design, manufacture and final
inspection of the products concerned, as specified in Section 3 and is subject
to audit as laid down in Sections 3.3 and 3.4 and to the surveillance as
specified in Section 4.

2.
The manufacturer who fulfils the obligations
imposed by Section 1 shall draw up and keep an EU declaration of conformity in
accordance with Article 17 and Annex III for the device model covered by the
conformity assessment procedure. By issuing a declaration of conformity the
manufacturer ensures and declares that the devices concerned meet the
provisions of this Regulation which apply to them.

3.
Quality management system

3.1.
The manufacturer shall lodge an application for
assessment of his quality management system with a notified body. The
application shall include:

–
the name and address of the manufacturer and any
additional manufacturing site covered by the quality management system, and, if
the application is lodged by the authorised representative, his name and
address as well,

–
all the relevant information on the device or
device category covered by the procedure,

–
a written declaration that no application has
been lodged with any other notified body for the same device-related quality
management system, or information about any previous application for the same
device-related quality management system that has been refused by another
notified body,

–
the documentation on the quality management
system,

–
a description of the procedures in place to
fulfil the obligations imposed by the quality management system approved and
the undertaking by the manufacturer to apply these procedures,

–
a description of the procedures in place to keep
the approved quality management system adequate and efficacious and the
undertaking by the manufacturer to apply these procedures,

–
the documentation on the post-market
surveillance plan, including, when applicable, a plan for the post-market
clinical follow-up, and the procedures put in place to ensure compliance with
the obligations emanating from the provisions on vigilance set out in Articles
61 to 66,

–
a description of the procedures in place to keep
up to date the post-market surveillance plan, including, when applicable, a
plan for the post-market clinical follow-up, and the procedures ensuring
compliance with the obligations emanating from the provisions on vigilance set
out in Articles 61 to 66 as well as the undertaking by the manufacturer to
apply these procedures.

3.2.
Application of the quality management system
shall ensure that the devices conform to the provisions of this Regulation
which apply to them at every stage, from design to final inspection. All the
elements, requirements and provisions adopted by the manufacturer for his
quality management system shall be documented in a systematic and orderly
manner in the form of written policies and procedures such as quality
programmes, quality plans, quality manuals and quality records.

Moreover, the documentation to be submitted for
the assessment of the quality management system shall include an adequate
description of, in particular:

(a)
the manufacturer’s quality objectives;

(b)
the organisation of the business and in
particular:

–
the organisational structures, the
responsibilities of the managerial staff and their organisational authority
where quality of design and manufacture of the products is concerned,

–
the methods of monitoring the efficient
operation of the quality management system and in particular its ability to
achieve the desired quality of design and of product, including control of
products which fail to conform,

–
where the design, manufacture and/or final
inspection and testing of the products, or elements thereof, is carried out by
another party, the methods of monitoring the efficient operation of the quality
management system and in particular the type and extent of control applied to
the other party,

–
where the manufacturer does not have a
registered place of business in a Member State, the draft mandate for the
designation of an authorised representative and a letter of intention of the
authorised representative to accept the mandate;

(c)
the procedures and techniques for monitoring,
verifying, validating and controlling the design of the devices, including the
corresponding documentation as well as the data and records arising from those
procedures and techniques;

(d)
the inspection and quality assurance techniques
at the manufacturing stage and in particular:

–
the processes and procedures which will be used,
particularly as regards sterilisation, purchasing and the relevant documents,

–
the product identification procedures drawn up
and kept up to date from drawings, specifications or other relevant documents
at every stage of manufacture;

(e)
the appropriate tests and trials which will be
carried out before, during and after manufacture, the frequency with which they
will take place, and the test equipment used; it shall be possible to trace
back the calibration of the test equipment adequately.

In addition, the manufacturer shall grant the
notified body access to the technical documentation referred to in Annex II.

3.3.
Audit

(a)
The notified body shall audit the quality
management system to determine whether it meets the requirements referred to in
Section 3.2. Unless duly substantiated, it shall presume that quality
management systems which satisfy the relevant harmonised standards or CTS
conform to the requirements covered by the standards or CTS.

(b)
The assessment team shall include at least one
member with past experience of assessments of the technology concerned. The
assessment procedure shall include an audit on the manufacturer's premises and,
if appropriate, on the premises of the manufacturer's suppliers and/or
subcontractors to inspect the manufacturing and other relevant processes.

(c)
Moreover, in the case of devices falling into
class IIa or IIb the audit procedure shall include an assessment, on a
representative basis, of the design documentation within the technical
documentation as referred to in Annex II of the device(s) concerned. In
choosing representative sample(s) the notified body shall take into account the
novelty of the technology, similarities in design, technology, manufacturing
and sterilisation methods, the intended use and the results of any previous
relevant assessments (e.g. with regard to physical, chemical or biological
properties) that have been carried out in accordance with this Regulation. The
notified body shall document its rationale for the sample(s) taken.

(d)
If the quality management system conforms to the
relevant provisions of this Regulation, the notified body shall issue an EU
full quality assurance certificate. The decision shall be notified to the
manufacturer. It shall contain the conclusions of the audit and a reasoned
assessment.

3.4.
The manufacturer shall inform the notified body
which approved the quality management system of any plan for substantial
changes to the quality management system or the product-range covered. The
notified body shall assess the changes proposed and verify whether after these
changes the quality management system still meets the requirements referred to
in Section 3.2. It shall notify the manufacturer of its decision which shall
contain the conclusions of the audit and a reasoned assessment. The approval of
any substantial change to the quality management system or the product-range
covered shall take the form of a supplement to the EU full quality assurance
certificate.

4.
Surveillance assessment

4.1.
The aim of surveillance is to ensure that the
manufacturer duly fulfils the obligations imposed by the approved quality
management system.

4.2.
The manufacturer shall authorise the notified
body to carry out all the necessary audits, including inspections, and supply
it with all relevant information, in particular:

–
the documentation on the quality management
system,

–
the documentation on the post-market
surveillance plan, including a post-market clinical follow-up, as well as, if
applicable, any findings resulting from the application of the post-market
surveillance plan, including the post-market clinical follow-up, and of the
provisions on vigilance set out in Articles 61 to 66,

–
the data stipulated in the part of the quality
management system relating to design, such as the results of analyses,
calculations, tests, the solutions adopted regarding the risk-management as
referred to in Section 2 of Annex I , pre-clinical and clinical evaluation,

–
the data stipulated in the part of the quality
management system relating to manufacture, such as inspection reports and test
data, calibration data, qualification reports of the personnel concerned, etc.

4.3.
The notified body shall periodically, at least
once every 12 months, carry out appropriate audits and assessments to make sure
that the manufacturer applies the approved quality management system and the
post-market surveillance plan, and shall supply the manufacturer with an
assessment report. This shall include inspections on the premises of the
manufacturer and, if appropriate, of the manufacturer's suppliers and/or
subcontractors. At the time of such inspections, the notified body shall, where
necessary, carry out or ask for tests in order to check that the quality
management system is working properly. It shall provide the manufacturer with
an inspection report and, if a test has been carried out, with a test report.

4.4.
The notified body shall randomly perform
unannounced factory inspections to the manufacturer and, if appropriate, of the
manufacturer's suppliers and/or subcontractors, which may be combined with the
periodic surveillance assessment referred to in Section 4.3. or be performed in
addition to this surveillance assessment. The notified body shall establish a
plan for the unannounced inspections which must not be disclosed to the
manufacturer.

Within the context of such unannounced
inspections, the notified body shall check an adequate sample from the
production or the manufacturing process to verify that the manufactured device
is in conformity with the technical documentation and/or design dossier. Prior
to the unannounced inspection, the notified body shall specify the relevant
sampling criteria and testing procedure.

Instead of, or in addition to, the sampling
from the production, the notified body shall take samples of devices from the
market to verify that the manufactured device is in conformity with the
technical documentation and/or design dossier. Prior to the sampling, the
notified body shall specify the relevant sampling criteria and testing
procedure.

The notified body shall provide the
manufacturer with an inspection report which shall include, if applicable, the
result of the sample check.

4.5.
In the case of devices classified as class IIa
or class IIb, the surveillance assessment shall also include the assessment of
the design documentation within the technical documentation of the device(s)
concerned on the basis of further representative sample(s) chosen in accordance
with the rationale documented by the notified body in accordance with point (c)
of Section 3.3.

In the case of devices classified as class III,
the surveillance assessment shall also include a check of the approved parts
and/or materials that are essential for the integrity of the device, including,
where appropriate, the coherence between the quantities of produced or
purchased parts and/or materials and the quantities of finished products.

4.6.
The notified body shall ensure that the
composition of the assessment team assures experience with the technology
concerned, continuous objectivity and neutrality; this shall include a rotation
of the members of the assessment team at appropriate intervals. As a general
rule, a lead auditor shall not lead and attend an audit for more than three
consecutive years in respect to the same manufacturer.

4.7.
If the notified body establishes a divergence
between the sample taken from the production or from the market and the
specifications laid down in the technical documentation or the approved design,
it shall suspend or withdraw the relevant certificate or impose restrictions on
it.

Chapter
II: Design dossier examination

5.
Examination of the design of the device,
applicable to devices classified as
class III

5.1.
In addition to the obligations imposed by
Section 3, the manufacturer shall lodge with the notified body referred to in
Section 3.1 an application for examination of the design dossier relating to
the device which he plans to manufacture and which falls into the device
category covered by the quality management system referred to in Section 3.

5.2.
The application shall describe the design,
manufacture and performances of the device in question. It shall include the
technical documentation as referred to in Annex II; where the technical
documentation is voluminous and/or held in different locations, the
manufacturer shall submit a summary technical documentation (STED) and grant
access to the full technical documentation upon request.

5.3.
The notified body shall examine the application
employing staff with proven knowledge and experience regarding the technology
concerned. The notified body may require the application to be completed by
further tests or other evidence to allow assessment of conformity with the
requirements of the Regulation. The notified body shall carry out adequate
physical or laboratory tests in relation to the device or request the
manufacturer to carry out such tests.

The notified body shall provide the
manufacturer with an EU design-examination report.

5.4.
If the device conforms to the relevant
provisions of this Regulation, the notified body shall issue an EU
design-examination certificate. The certificate shall contain the conclusions
of the examination, the conditions of validity, the data needed for
identification of the approved design, where appropriate, a description of the
intended purpose of the device.

5.5.
Changes to the approved design shall receive
further approval from the notified body which issued the EU design-examination
certificate wherever the changes could affect conformity with the general
safety and performance requirements of the Regulation or with the conditions
prescribed for use of the device. The applicant shall inform the notified body
which issued the EU design-examination certificate of any planned changes to
the approved design. The notified body shall examine the planned changes,
notify the manufacturer of its decision and provide him with a supplement to
the EU design-examination report. The approval of any change to the approved
design shall take the form of a supplement to the EU design-examination
certificate.

6.
Specific procedures

6.1.
Procedure in the case of devices
incorporating a medicinal substance

(a)
Where a device incorporates, as an integral
part, a substance which, if used separately, may be considered to be a
medicinal product within the meaning of Article 1 of Directive 2001/83/EC,
including a medicinal product derived from human blood or human plasma, with
action ancillary to that of the device, the quality, safety and usefulness of
the substance shall be verified by analogy with the methods specified in Annex
I to Directive 2001/83/EC.

(b)
Before issuing an EU design-examination
certificate, the notified body shall, having verified the usefulness of the
substance as part of the device and taking account of the intended purpose of
the device, seek a scientific opinion from one of the competent authorities
designated by the Member States in accordance with Directive 2001/83/EC (hereinafter
referred to as 'medicinal products competent authority') or the European
Medicines Agency (hereinafter referred to as ‘EMA’), acting particularly
through its Committee on Human Medicinal Products in accordance with Regulation
(EC) No 726/2004, on the quality and safety of the substance including the
benefit/risk of the incorporation of the substance into the device. Where the
device incorporates a human blood or plasma derivative or a substance that, if
used separately may be considered to be a medicinal product falling exclusively
within the scope of the Annex of Regulation (EC) No 726/2004, the notified body
shall consult the EMA.

(c)
When issuing its opinion, the medicinal products
competent authority or the EMA shall take into account the manufacturing
process and the data related to the usefulness of incorporation of the
substance into the device as determined by the notified body.

(d)
The opinion of the medicinal products competent
authority or the EMA shall be drawn up

–
within 150 days after receipt of valid
documentation if the substance subject to the consultation is authorised in
accordance with Directive 2001/83/EC; or

–
within 210 days after receipt of valid
documentation in other cases.

(e)
The scientific opinion of the medicinal products
competent authority or the EMA, and any possible update, shall be included in
the documentation of the notified body concerning the device. The notified body
shall give due consideration to the views expressed in the scientific opinion
when making its decision. The notified body shall not deliver the certificate
if the scientific opinion is unfavourable. It shall convey its final decision
to the medicinal products competent authority concerned or to the EMA.

(f)
Before changes are made with respect to an
ancillary substance incorporated in a device, in particular related to its
manufacturing process, the manufacturer shall inform the notified body of the
changes which shall consult the medicinal products competent authority that was
involved in the initial consultation, in order to confirm that the quality and
safety of the ancillary substance are maintained. The medicinal products
competent authority shall take into account the data related to the usefulness
of incorporation of the substance into the device as determined by the notified
body, in order to ensure that the changes have no negative impact on the
established benefit/risk of the addition of the substance in the device. It
shall provide its opinion within 30 days after receipt of the valid
documentation regarding the changes.

(g)
When the medicinal products competent authority
that was involved in the initial consultation has obtained information on the
ancillary substance, which could have an impact on the established benefit/risk
of the addition of the substance in the device, it shall provide the notified
body with advice whether this information has an impact on the established
benefit/risk of the addition of the substance in the device or not. The
notified body shall take the updated scientific opinion into account in
reconsidering its assessment of the conformity assessment procedure.

6.2.
Procedure in the case of devices manufactured
utilising tissues or cells of human or animal origin, or their derivatives,
that are non-viable or rendered non-viable

(a)
For devices manufactured utilising tissues or
cells of human origin, or their derivatives, that are covered by this Regulation
in accordance with point (e) of Article 1(2), the notified body shall, prior to
issuing an EU design-examination certificate, submit to the competent authority
designated by the Member State in accordance with Directive 2004/23/EC
(hereinafter referred to as 'human tissues and cells competent authority') in
which it is established a summary of the preliminary conformity assessment
which shall, among others, provide information about the non-viability of the
human tissues or cells, their donation, procurement and testing and the
benefit/risk of the incorporation of the human tissues or cells into the
device.

(b)
Within 90 days after receipt of valid
documentation, the human tissues and cells competent authority may submit
comments on aspects related to the donation, procurement and testing and/or the
benefit/risk of the incorporation of the human tissues or cells into the
device.

(c)
The notified body shall give due consideration
to any comments received in accordance with point (b). It shall convey to the human
tissues and cells competent authority an explanation as regards this
consideration, including any due justification not to follow the comment
received, and its final decision regarding the conformity assessment in
question. The comments of the human tissues and cells competent authority shall
be included in the documentation of the notified body concerning the device.

7.
Batch verification in the case of devices
incorporating a medicinal substance which, if used separately, may be
considered to be a medicinal product derived from human blood or human plasma
referred to in Article 1(4)

Upon completing the manufacture of each batch
of devices that incorporate a medicinal substance which, if used separately,
may be considered to be a medicinal product derived from human blood or human
plasma referred to in the first subparagraph of Article 1(4), the manufacturer
shall inform the notified body of the release of the batch of devices and send
to it the official certificate concerning the release of the batch of human blood
or plasma derivative used in the device, issued by a State laboratory or a
laboratory designated for that purpose by a Member State in accordance with
Article 114(2) of Directive 2001/83/EC.

Chapter
III: Administrative provisions

8.
The manufacturer or his authorised
representative shall, for a period ending at least five years, and in the case
of implantable devices at least 15 years, after the last device has been placed
on the market, keep at the disposal of the competent authorities:

–
the declaration of conformity,

–
the documentation referred to in the fourth
indent of Section 3.1 and in particular the data and records arising from the
procedures referred to in point (c) of Section 3.2,

–
the changes referred to in Section 3.4,

–
the documentation referred to in Section 5.2,
and

–
the decisions and reports from the notified body
as referred to in Sections 3.3, 4.3, 4.4. 5.3, 5.4. and 5.5.

9.
Each Member State shall make provision that this
documentation is kept at the disposal of the competent authorities for the
period indicated in the first sentence of the preceding paragraph in case the
manufacturer, or his authorised representative, established within its
territory goes bankrupt or ceases its business activity prior to the end of
this period.

ANNEX IX

CONFORMITY ASSESSEMENT BASED ON TYPE EXAMINATION

1.
EU type-examination is the procedure whereby a
notified body ascertains and certifies that a representative sample of the
production covered fulfils the relevant provisions of this Regulation.

2.
Application

The application shall include:

–
the name and address of the manufacturer and, if
the application is lodged by the authorised representative, the name and
address of the authorised representative,

–
the technical documentation referred to in Annex
II needed to assess the conformity of the representative sample of the
production in question, hereinafter referred to as the ‘type’, with the
requirements of this Regulation; where the technical documentation is voluminous and/or held in different locations, the manufacturer
shall submit a summary technical documentation (STED) and
grant access to the full technical documentation upon request. The applicant
shall make a ‘type’ available to the notified body. The notified body may
request other samples as necessary,

–
a written declaration that no application has
been lodged with any other notified body for the same type, or information
about any previous application for the same type that has been refused by
another notified body.

3.
Assessment

The notified body shall:

3.1.
examine and assess the technical documentation
and verify that the type has been manufactured in conformity with that
documentation; it shall also record the items designed in conformity with the
applicable specifications of the standards referred to in Article 6 or CTS , as
well as the items not designed on the basis of the relevant provisions of the
abovementioned standards;

3.2.
carry out or arrange for the appropriate
assessments and the physical or laboratory tests necessary to verify whether
the solutions adopted by the manufacturer meet the general safety and
performance requirements of this Regulation if the standards referred to in
Article 6 or CTS have not been applied; if the device is to be connected to
other device(s) in order to operate as intended, proof shall be provided that
it conforms to the general safety and performance requirements when connected
to any such device(s) having the characteristics specified by the manufacturer;

3.3.
carry out or arrange for the appropriate
assessments and the physical or laboratory tests necessary to verify whether,
if the manufacturer has chosen to apply the relevant standards, these have
actually been applied;

3.4.
agree with the applicant on the place where the
necessary assessments and tests will be carried out.

4.
Certificate

If the type conforms to the provisions of this
Regulation, the notified body shall issue an EU type-examination certificate.
The certificate shall contain the name and address of the manufacturer, the
conclusions of the assessment, the conditions of validity and the data needed
for identification of the type approved. The relevant parts of the
documentation shall be annexed to the certificate and a copy kept by the
notified body.

5.
Changes to the type

5.1.
The applicant shall inform the notified body
which issued the EU type-examination certificate of any planned change to the
approved type.

5.2.
Changes to the approved product shall receive
further approval from the notified body which issued the EU type-examination
certificate wherever the changes may affect conformity with the general safety
and performance requirements or with the conditions prescribed for use of the
product. The notified body shall examine the planned changes, notify the
manufacturer of its decision and provide him with a supplement to the EU
type-examination report. The approval of any change to the approved type shall
take the form of a supplement to the initial EU type-examination certificate.

6.
Specific procedures

The provisions regarding the specific
procedures in the case of devices incorporating a medicinal substance, or
devices manufactured utilising tissues or cells of human or animal origin, or
their derivatives, that are non-viable or rendered non-viable set out in Annex VIII,
Section 6, apply with the proviso that any reference to an EU design-examination
certificate shall be understood as reference to an EU type-examination
certificate.

7.
Administrative provisions

The manufacturer or his authorised
representative shall, for a period ending at least five years, and in the case
of implantable devices at least 15 years, after the last device has been placed
on the market, keep at the disposal of the competent authorities:

–
the documentation referred to in the second
indent of Section 2,

–
the changes referred to in Section 5,

–
copies of EU type-examination certificates and
their additions.

Section 9 of Annex VIII shall apply.

ANNEX X

CONFORMITY ASSESSEMENT BASED ON PRODUCT CONFORMITY VERIFICATION

1.
The objective of the conformity assessment based
on product conformity verification is to ensure that devices conform to the
type for which an EU type-examination certificate has been issued and meet the
provisions of this Regulation which apply to them.

2.
Where an EU type-examination certificate has
been issued in accordance with Annex IX, the manufacturer can either apply the
procedure set out in part A (production quality assurance) or the procedure set
out in part B (product verification).

3.
By way of derogation from Sections 1 and 2, this
Annex can also be applied by manufacturers of devices classified as class IIa
coupled with the drawing up of a technical documentation as set out in Annex
II.

Part A: Production quality
assurance

1.
The manufacturer shall ensure application of the
quality management system approved for the manufacture of the devices concerned
and carry out the final inspection, as specified in Section 3, and is subject
to the surveillance referred to in Section 4.

2.
The manufacturer who fulfils the obligations
imposed by Section 1 shall draw up and keep an EU declaration of conformity in
accordance with Article 17 and Annex III for the device model covered by the
conformity assessment procedure. By issuing an EU declaration of conformity the
manufacturer ensures and declares that the devices concerned conform to the
type described in the EU type-examination certificate and meet the provisions
of this Regulation which apply to them.

3.
Quality management system

3.1.
The manufacturer shall lodge an application for
assessment of his quality management system with a notified body. The
application shall include:

–
all elements listed in Section 3.1 of Annex
VIII,

–
the technical documentation as referred to in
Annex II for the types approved; where the technical documentation is voluminous and/or held in different locations, the manufacturer
shall submit a summary technical documentation (STED) and
grant access to the full technical documentation upon request;

–
a copy of the EU-type examination certificates
referred to in Section 4 of Annex IX; if the EU-type examination certificates
have been issued by the same notified body with which the application is
lodged, a reference to the technical documentation and the certificates issued
is sufficient.

3.2.
Application of the quality management system
shall ensure that the devices conform to the type described in the EU type-examination
certificate and to the provisions of this Regulation which apply to them at
every stage. All the elements, requirements and provisions adopted by the
manufacturer for his quality management system shall be documented in a
systematic and orderly manner in the form of written policies and procedures
such as quality programmes, quality plans, quality manuals and quality records.

It shall, in particular, include an adequate
description of all elements listed in points (a), (b), (d) and (e) of Section
3.2 of Annex VIII.

3.3.
The provisions of points (a) and (b) of Section
3.3 of Annex VIII apply.

If the quality management system ensures that
the devices conform to the type described in the EU type-examination
certificate and conforms to the relevant provisions of this Regulation, the
notified body shall issue an EU quality assurance certificate. The decision
shall be notified to the manufacturer. It shall contain the conclusions of the
inspection and a reasoned assessment.

3.4.
The provisions of Section 3.4 Annex VIII apply.

4.
Surveillance

The provisions of Section 4.1, the first,
second and fourth indents of Section 4.2, Section 4.3, Section 4.4, Section 4.6
and Section 4.7 of Annex VIII apply.

In the case of devices classified as class III,
the surveillance shall also include a check of the coherence between the
quantity of produced or purchased raw material or crucial components approved
for the type and the quantity of finished products.

5.
Batch verification in the case of devices
incorporating a medicinal substance which, if used separately, may be
considered to be a medicinal product derived from human blood or human plasma
referred to in Article 1(4)

Upon completing the manufacture of each batch
of devices that incorporate a medicinal substance which, if used separately,
may be considered to be a medicinal product derived from human blood or human
plasma referred to in the first subparagraph of Article 1(4), the manufacturer
shall inform the notified body of the release of the batch of devices and send
to it the official certificate concerning the release of the batch of human
blood or plasma derivative used in the device, issued by a State laboratory or
a laboratory designated for that purpose by a Member State in accordance with
Article 114(2) of Directive 2001/83/EC.

6.
Administrative provisions

The manufacturer or his authorised
representative shall, for a period ending at least five years, and in the case
of implantable devices at least 15 years, after the last device has been placed
on the market, keep at the disposal of the competent authorities:

–
the declaration of conformity,

–
the documentation referred to in the fourth
indent of Section 3.1 of Annex VIII,

–
the documentation referred to in the seventh
indent of Section 3.1 of Annex VIII, including the EU type-examination
certificate referred to in Annex IX,

–
the changes referred to in Section 3.4 of Annex
VIII, and

–
the decisions and reports from the notified body
as referred to in Sections 3.3, 4.3 and 4.4 of Annex VIII.

Section 9 of Annex VIII shall apply.

7.
Application to devices classified as
class IIa

7.1.
By way of derogation from Section 2, by virtue
of the EU declaration of conformity the manufacturer ensures and declares that
the devices in class IIa are manufactured in conformity with the technical
documentation referred to in Annex II and meet the requirements of this
Regulation which apply to them.

7.2.
For devices in class IIa the notified body shall
assess, as part of the assessment in Section 3.3, on a representative basis,
the technical documentation as referred in Annex II for compliance with the
provisions of this Regulation; where the technical documentation is voluminous
and/or held in different locations, the manufacturer shall submit a summary
technical documentation (STED) and grant access to the full technical
documentation upon request.

In choosing representative sample(s) the
notified body shall take into account the novelty of the technology,
similarities in design, technology, manufacturing and sterilisation methods,
the intended use and the results of any previous relevant assessments (e.g.
with regard to physical, chemical or biological properties) that have been
carried out in accordance with this Regulation. The notified body shall
document its rationale for the sample(s) taken.

7.3.
If the assessment in accordance with Section
7.2. confirms that the devices in class IIa conform to the technical
documentation referred to in Annex II and meet the requirements of this
Regulation which apply to them, the notified body shall issue a certificate
pursuant to this section of this Annex.

7.4.
Further samples shall be assessed by the
notified body as part of the surveillance assessment referred to in Section 4.

7.5.
By way of derogation from Section 6, the
manufacturer or his authorised representative shall, for a period ending at
least five years after the last device has been placed on the market, keep at
the disposal of the competent authorities:

–
the declaration of conformity,

–
the technical documentation referred to in Annex
II,

–
the certificate referred to in Section 7.3.

Section 9 of Annex VIII shall apply.

Part B: Product verification

1.
Product verification is the procedure whereby
after examination of every manufactured device the manufacturer, by issuing a
EU declaration of conformity in accordance with Article 17 and Annex III,
ensures and declares that the devices which have been subject to the procedure
set out in Sections 4 and 5 conform to the type described in the EU
type-examination certificate and meet the requirements of this Regulation which
apply to them.

2.
The manufacturer shall take all the measures
necessary to ensure that the manufacturing process produces devices which
conform to the type described in the EU type-examination certificate and to the
requirements of the Regulation which apply to them. Before the start of
manufacture, the manufacturer shall prepare documents defining the
manufacturing process, in particular as regards sterilisation where necessary,
together with all the routine, pre-established provisions to be implemented to
ensure homogeneous production and, where appropriate, conformity of the
products with the type described in the EU type-examination certificate and
with the requirements of this Regulation which apply to them.

In addition, for devices placed on the market
in sterile condition, and only for those aspects of the manufacturing process
designed to secure and maintain sterility, the manufacturer shall apply the
provisions of Sections 3 and 4 of Part A of this Annex.

3.
The manufacturer shall undertake to institute
and keep up to date a post-market surveillance plan, including a post-market
clinical follow-up, and the procedures ensuring compliance with the obligations
emanating from the provisions on vigilance set out in Articles 61 to 66.

4.
The notified body shall carry out the
appropriate examinations and tests in order to verify the conformity of the
device with the requirements of the Regulation by examining and testing every
product as specified in Section 5.

The aforementioned checks do not apply to those
aspects of the manufacturing process designed to secure sterility.

5.
Verification by examination and testing
of every product

5.1.
Every device is examined individually and the
appropriate physical or laboratory tests defined in the relevant standard(s)
referred to in Article 6 or equivalent tests shall be carried out in order to
verify, where appropriate, the conformity of the devices with the type
described in the EU type-examination certificate and with the requirements of
this Regulation which apply to them.

5.2.
The notified body shall affix, or have affixed
its identification number to each approved device and shall draw up an EU
product verification certificate relating to the tests carried out.

6.
Batch verification in the case of devices
incorporating a medicinal substance which, if used separately, may be
considered to be a medicinal product derived from human blood or human plasma
referred to in Article 1(4)

Upon completing the manufacture of each batch
of devices that incorporate a medicinal substance which, if used separately, may
be considered to be a medicinal product derived from human blood or human
plasma referred to in the first subparagraph of Article 1(4), the manufacturer
shall inform the notified body of the release of the batch of devices and send
to it the official certificate concerning the release of the batch of human
blood or plasma derivative used in the device, issued by a State laboratory or
a laboratory designated for that purpose by a Member State in accordance with
Article 114(2) of Directive 2001/83/EC.

7.
Administrative provisions

The manufacturer or his authorised
representative shall, for a period ending at least five years, and in the case
of implantable devices at least 15 years, after the last device has been placed
on the market, keep at the disposal of the competent authorities:

–
the declaration of conformity,

–
the documentation referred to in Section 2,

–
the certificate referred to in Section 5.2,

–
the EU type-examination certificate referred to
in Annex IX.

Section 9 of Annex VIII shall apply.

8.
Application to devices classified as
class IIa

8.1.
By way of derogation from Section 1, by virtue
of the EU declaration of conformity the manufacturer ensures and declares that
the devices in class IIa are manufactured in conformity with the technical
documentation referred to in Annex II and meet the requirements of this
Regulation which apply to them.

8.2.
The verification conducted by the notified body
in accordance with Section 4 is intended to confirm the conformity of the
devices in class IIa with the technical documentation referred to in Annex II
and with the requirements of this Regulation which apply to them.

8.3.
If the verification in accordance with Section
8.2. confirms that the devices in class IIa conform to the technical
documentation referred to in Annex II and meet the requirements of this
Regulation which apply to them, the notified body shall issue a certificate
pursuant to this section of this Annex.

8.4.
By way of derogation from Section 7, the
manufacturer or his authorised representative shall, for a period ending at
least five years after the last device has been placed on the market, keep at
the disposal of the competent authorities:

–
the declaration of conformity,

–
the technical documentation referred to in Annex
II,

–
the certificate referred to in Section 8.3.

Section 9 of Annex VIII shall apply.

ANNEX XI

Conformity assessment procedure for custom-made
devices

1.
For custom-made devices the manufacturer or his
authorised representative shall draw up the statement containing the following
information:

–
the name and address of the manufacturer, and of
any additional manufacturing sites,

–
if applicable, the name and address of the
authorised representative,

–
data allowing identification of the device in
question,

–
a statement that the device is intended for
exclusive use by a particular patient or user, identified by name, an acronym
or a numerical code,

–
the name of the doctor of medicine, dental
practitioner or any other person authorised by national law by virtue of this
person's professional qualifications who made out the prescription and, where
applicable, the name of the health institution concerned,

–
the specific characteristics of the product as
indicated by the prescription,

–
a statement that the device in question conforms
to the general safety and performance requirements set out in Annex I and,
where applicable, indicating which general safety and performance requirements
have not been fully met, together with the grounds,

–
where applicable, an indication that the device
contains or incorporates a medicinal substance, including a human blood or
plasma derivative, or tissues or cells of human origin, or of animal origin as
referred to in Commission Regulation (EU) No 722/2012.

2.
The manufacturer shall undertake to keep
available for the competent national authorities the documentation, indicating
manufacturing site(s) and allowing an understanding of the design, manufacture
and performances of the product, including the expected performances, so as to
allow assessment of conformity with the requirements of this Regulation.

The manufacturer shall take all the measures
necessary to ensure that the manufacturing process produces products which are
manufactured in accordance with the documentation mentioned in the first
paragraph;

3.
The information contained in the declaration concerned
by this Annex shall be kept for a period of time of at least five years after
the device has been placed on the market. In the case of implantable devices
the period shall be at least 15 years.

Section 9 of Annex VIII shall apply.

4.
The manufacturer shall undertake to review and
document experience gained in the post-production phase, including a PMCF
referred to in Part B of Annex XIII, and to implement appropriate means to
apply any necessary corrective action. This undertaking shall include an obligation
for the manufacturer to notify, in accordance with Article 61(4) the competent
authorities of any serious incidents and/or field safety corrective actions
immediately on learning of them.

ANNEX XII

MINIMUM CONTENT OF CERTIFICATES ISSUED BY A NOTIFIED BODY

1.
Name, address and identification number of the
notified body;

2.
name and address of the manufacturer and, if
applicable, of the authorised representative;

3.
unique number identifying the certificate;

4.
date of issue;

5.
date of expiry;

6.
data needed for the identification of the
device(s) or categories of devices covered by the certificate, including the
intended purpose of the device(s) and the GMDN code(s) or internationally
recognised nomenclature code(s);

7.
if applicable, the manufacturing facilities covered
by the certificate;

8.
reference to this Regulation and the relevant
Annex according to which the conformity assessment has been carried out;

9.
examinations and tests performed, e.g. reference
to relevant standards / test reports / audit report(s);

10.
if applicable, reference to the relevant parts
of the technical documentation or other certificates required for the placing
on the market of the device(s) covered;

11.
if applicable, information about the
surveillance by the notified body;

12.
conclusions of the notified body’s assessment,
examination or inspection;

13.
conditions for or limitations to the validity of
the certificate;

14.
legally binding signature of the notified body
according to the applicable national law.

ANNEX XIII

CLINICAL EVALUATION AND POST-MARKET CLINICAL
FOLLOW-UP

Part A: Clinical evaluation

1.
To conduct a clinical evaluation, a manufacturer
shall:

–
identify the general safety and performance
requirements that require support from relevant clinical data;

–
identify available clinical data relevant to the
device and its intended use generated through scientific literature search,
clinical experience and/or clinical investigations;

–
appraise the clinical data sets by evaluating
their suitability for establishing the safety and performance of the device;

–
generate any new or additional clinical data
needed to address outstanding issues;

–
analyse all relevant clinical data to reach
conclusions about the safety and performance of the device.

2.
Confirmation of conformity with the requirements
concerning the characteristics and performances referred to in Section 1 of
Annex I, under the normal conditions of use of the device, and the evaluation
of the undesirable side-effects and of the acceptability of the benefit/risk
ratio referred to in Sections 1 and 5 of Annex I, shall be based on clinical
data.

3.
The clinical evaluation shall be thorough and
objective, considering both favourable and unfavourable data. Its depth and
extent shall be proportionate and appropriate to the nature, classification,
intended use, manufacturer’s claims and risks of the device in question.

4.
Clinical data relating to another device may be
relevant where equivalence is demonstrated of the device subject to clinical
evaluation to the device to which the data relates. Equivalence can only be demonstrated
when the device that is subject to clinical evaluation and the device to which
the existing clinical data relates have the same intended purpose and when the
technical and biological characteristics of the devices and the medical
procedures applied are similar to such an extent that there would be not a
clinically significant difference in the safety and performance of the devices.

5.
In the case of implantable devices and devices
falling within class III, clinical investigations shall be performed unless it
is duly justified to rely on existing clinical data alone. Demonstration of
equivalence in accordance with Section 4 shall generally not be considered as
sufficient justification within the meaning of the first sentence of this
paragraph.

6.
The results of the clinical evaluation and the
clinical data on which it is based shall be documented in the clinical
evaluation report which shall support the assessment of the conformity of the
device.

The clinical data together with non-clinical
data generated from non-clinical testing methods and other relevant
documentation shall allow the manufacturer to demonstrate conformity with the general
safety and performance requirements and shall be part of the technical
documentation of the device in question.

Part B: Post-market clinical
follow-up

1.
Post-market clinical follow-up, hereinafter:
PMCF, is a continuous process to update the clinical evaluation referred to in
Article 49 and Part A of this Annex and shall be part of the manufacturer's
post-market surveillance plan. To this end, the manufacturer shall proactively
collect and evaluate clinical data from the use in or on humans of a device
which is authorised to bear the CE marking, within its intended purpose as
referred to in the relevant conformity assessment procedure, with the aim of
confirming the safety and performance throughout the expected lifetime of the
device, the continued acceptability of identified risks and to detect emerging
risks on the basis of factual evidence.

2.
The PMCF shall be performed pursuant to a
documented method laid down in a PMCF plan.

2.1.
The PMCF plan shall specify the methods and
procedures to proactively collect and evaluate clinical data with the aim of

(a)
confirming the safety and performance of the
device throughout its expected lifetime,

(b)
identifying previously unknown side-effects and
monitoring the identified side-effects and contra-indications,

(c)
identifying and analysing emergent risks on the
basis of factual evidence,

(d)
assuring the continued acceptability of the
benefit/risk ratio referred to in Sections 1 and 5 of Annex I, and

(e)
identifying possible systematic misuse or
off-label use of the device with a view to verify the correctness of its
intended purpose.

2.2.
The PMCF plan shall lay down, in particular

(a)
the general methods and procedures of the PMCF
to be applied, such as gathering of clinical experience gained, feedback from
users, screening of scientific literature and of other sources of clinical data;

(b)
the specific methods and procedures of PMCF to
be applied, such as evaluation of suitable registers or PMCF studies;

(c)
a rationale for the appropriateness of the
methods and procedures referred to in points (a) and (b);

(d)
a reference to the relevant parts of the
clinical evaluation report referred to in Section 6 of Part A of this Annex and
to the risk management referred to in Section 2 of Annex I;

(e)
the specific objectives to be addressed by the
PMCF;

(f)
an evaluation of the clinical data related to
equivalent or similar devices,

(g)
reference to relevant standards and guidance on PMCF.

3.
The manufacturer shall analyse the findings of
the PMCF and document the results in a PMCF evaluation report that shall be
part of the technical documentation.

4.
The conclusions of the PMCF evaluation report
shall be taken into account for the clinical evaluation referred to in Article
49 and Part A of this Annex and in the risk management referred to in Section 2
of Annex I. If through the PMCF the need for corrective measures has been
identified, the manufacturer shall implement them.

ANNEX XIV

CLINICAL INVESTIGATIONS

I. General requirements

1.
Ethical considerations

Every step in the clinical investigation, from
first consideration of the need and justification of the study to the
publication of the results, shall be carried out in accordance with recognised
ethical principles, as for example those laid down in the World Medical
Association Declaration of Helsinki on Ethical Principles for Medical Research
Involving Human Subjects, adopted by the 18th World Medical Association General
Assembly in Helsinki, Finland, in 1964, and last amended by the 59th World
Medical Association General Assembly in Seoul, Korea, in 2008.

2.
Methods

2.1.
Clinical investigations shall be performed on
the basis of an appropriate plan of investigation reflecting the latest
scientific and technical knowledge and defined in such a way as to confirm or
refute the manufacturer's claims for the device as well as the safety,
performance and benefit/risk related aspects referred to in Article 50(1);
these investigations shall include an adequate number of observations to
guarantee the scientific validity of the conclusions.

2.2.
The procedures used to perform the
investigations shall be appropriate to the device under examination.

2.3.
Clinical investigations shall be performed in
circumstances similar to the normal conditions of use of the device.

2.4.
All the appropriate features, including those
involving the safety and performances of the device, and its effect on patients
shall be examined.

2.5.
The investigations shall be performed under the
responsibility of a medical practitioner or another authorised qualified person
in an appropriate environment.

2.6.
The medical practitioner or other authorised
person shall have access to the technical and clinical data regarding the
device.

2.7.
The clinical investigation report, signed by the
medical practitioner or other authorised person responsible, shall contain a
critical evaluation of all the data collected during the clinical investigation,
including negative findings.

II. Documentation regarding the application
for clinical investigation

For investigational devices covered by
Article 50 the sponsor shall draw up and submit the application in accordance
with Article 51 accompanied by the documentation as laid down below:

1.
Application form

The application form shall be duly filled in, containing
information regarding:

1.1.
Name, address and contact details of the sponsor
and, if applicable, name, address and contact details of his contact person
established in the Union.

1.2.
If different from the Section 1.1., name,
address and contact details of the manufacturer of the device intended for
clinical investigation and, if applicable, of his authorised representative.

1.3.
Title of the clinical investigation.

1.4.
Single identification number in accordance with
Article 51(1).

1.5.
Status of the clinical investigation (e.g. first
submission, resubmission, significant amendment).

1.6.
If resubmission with regard to same device,
previous date(s) and reference number(s) of earlier submission(s) or in the
case of significant amendment, reference to the original submission.

1.7.
If parallel submission for a clinical trial on a
medicinal product in accordance with Regulation (EU) No […/…] [on clinical
trials on medicinal products for human use], reference to the official
registration number of the clinical trial.

1.8.
Identification of the Member States, EFTA
countries, Turkey and third countries in which the clinical investigation shall
be conducted as part of a multicentre/multinational study at the time of
application.

1.9.
Brief description of the investigational device
(e.g. name, GMDN code or internationally recognised nomenclature code, intended
purpose, risk class and applicable classification rule according to Annex VII).

1.10.
Information as to whether the device
incorporates a medicinal substance, including a human blood or plasma derivative,
or whether it is manufactured utilising non-viable tissues or cells of human or
animal origin, or their derivatives.

1.11.
Summary of the clinical investigation plan
(objective(s) of the clinical investigation, number and gender of subjects,
criteria for subject selection, subjects under 18 years of age, design of the
investigation such as controlled and/or randomised studies, planned dates of
commencement and of completion of the clinical investigation).

1.12.
If applicable, information regarding a
comparator (e.g. identification of the comparator device or medicinal product).

2.
Investigator’s Brochure

The investigator's brochure (IB) shall contain
the clinical and non-clinical information on the investigational device that is
relevant for the investigation and available at the time of application. It
shall be clearly identified and contain in particular the following
information:

2.1.
Identification and description of the device,
including information on the intended purpose, the risk classification and
applicable classification rule according to Annex VII, design and manufacturing
of the device and reference to previous and similar generations of the device.

2.2.
Manufacturer's instructions for installation,
and use, including storage and handling requirements, as well as the label and
instructions for use to the extent that this information is available.

2.3.
Pre-clinical testing and experimental data, in
particular regarding in design calculations, in vitro tests, ex vivo
tests, animal tests, mechanical or electrical tests, reliability tests,
software verification and validation, performance tests, evaluation of
biocompatibility and biological safety.

2.4.
Existing clinical data, in particular

–
of the relevant scientific literature available
relating to the safety, performance, design characteristics and intended
purpose of the device and/or of equivalent or similar devices;

–
of other relevant clinical data available
relating to the safety, performance, design characteristics and intended
purpose of equivalent or similar devices of the same manufacturer, including
length of time on the market and a review of performance and safety related
issues and any corrective actions taken;

2.5.
Summary of the risk/benefit analysis and the
risk management, including information regarding known or foreseeable risks,
any undesirable effects, contra-indications and warnings.

2.6.
In the case of devices that incorporates a
medicinal substance, including a human blood or plasma derivative, or devices
manufactured utilising non-viable tissues or cells of human or animal origin,
or their derivatives, detailed information on the medicinal substance or on the
tissues or cells, and on the compliance with the relevant general safety and
performance requirements and the specific risk management in relation to the
substance or tissues or cells.

2.7.
Reference to harmonised or other internationally
recognised standards complied with in full or in part.

2.8.
A clause that any updates to the IB or any other
relevant information that is newly available shall be brought to the attention
of the investigators.

3.
Clinical Investigation Plan

The clinical investigation plan (CIP) shall
define the rationale, objectives, design and proposed analysis, methodology,
monitoring, conduct and record-keeping of the clinical investigation. It shall
contain in particular the information as laid down below. If part of this
information is submitted in a separate document, it shall be referenced in the
CIP.

3.1.
General

3.1.1.
Identification of the clinical investigation and
the CIP.

3.1.2.
Identification of the sponsor.

3.1.3.
Information on the principal investigator,
coordinating investigator, including their qualifications, and on the
investigation site(s).

3.1.4.
Overall synopsis of the clinical investigation.

3.2.
Identification and description of the device,
including its intended purpose, its manufacturer, its traceability, the target
population, materials coming into contact with the human body, the medical or
surgical procedures involved in its use and the necessary training and
experience for its use.

3.3.
Justification for the design of the clinical
investigation.

3.4.
Risks and benefits of the device and of the
clinical investigation.

3.5.
Objectives and hypotheses of the clinical
investigation.

3.6.
Design of the clinical investigation

3.6.1.
General information such as type of investigation
with rationale for choice, endpoints, variables.

3.6.2.
Information on the device to be used for the
clinical investigation, on any comparator and on any other device or
medication.

3.6.3.
Information on subjects, including size of
investigation population and, if applicable, information on vulnerable
populations.

3.6.4.
Description of the procedures related to the
clinical investigation.

3.6.5.
Monitoring plan.

3.7.
Statistical considerations.

3.8.
Data management.

3.9.
Information about any amendments to the CIP.

3.10.
Policy regarding deviations from the CIP.

3.11.
Accountability regarding the device, in
particular control of access to the device, follow-up in relation to the device
used in the clinical investigation and the return of unused, expired or
malfunctioning devices.

3.12.
Statement of compliance with the recognised
ethical principles for medical research involving humans and the principles of
good clinical practice in the field of clinical investigations of medical
devices as well as with the applicable regulatory requirements.

3.13.
Informed consent process.

3.14.
Safety reporting, including definitions of
adverse events and serious adverse events, procedures and timelines for
reporting.

3.15.
Criteria and procedures for suspension or early
termination of the clinical investigation.

3.16.
Policy as regards the establishment of the
clinical investigation report and publication of results in accordance with the
legal requirements and the ethical principles referred to in Section 1 of
Chapter I.

3.17.
Bibliography.

4.
Other information

4.1.
A signed statement by the natural or legal person
responsible for the manufacture of the investigational device that the device
in question conforms to the general safety and performance requirements apart
from the aspects covered by the clinical investigation and that, with regard to
these aspects, every precaution has been taken to protect the health and safety
of the subject.

This statement may be supported by an
attestation issued by a notified body.

4.2.
Where applicable according to national law, copy
of the opinion(s) of the ethics committee(s) concerned as soon as available.

4.3.
Proof of insurance cover or indemnification of
subjects in case of injury, according to the national law.

4.4.
Documents and procedures to be used to obtain
informed consent.

4.5.
Description of the arrangements to comply with
the applicable rules on the protection and confidentiality of personal data, in
particular:

–
organisational and technical arrangements that
will be implemented to avoid unauthorised access, disclosure, dissemination,
alteration or loss of information and personal data processed;

–
a description of measures that will be
implemented to ensure confidentiality of records and personal data of subjects
concerned in clinical investigations;

–
a description of measures that will be
implemented in case of data security breach in order to mitigate the possible
adverse effects.

III. Other sponsor’s obligations

1.
The sponsor shall undertake to keep available
for the competent national authorities any documentation necessary to provide
evidence for the documentation referred to in Chapter II of this Annex. If the
sponsor is not the natural or legal person responsible for the manufacture of
the investigational device, this obligation may be fulfilled by that person on
behalf of the sponsor.

2.
The reportable events shall be provided by the
investigator(s) in timely conditions.

3.
The documentation mentioned in this Annex shall
be kept for a period of time of at least five years after the clinical
investigation with the device in question has ended, or, when the device is
subsequently placed on the market, at least five years after the last device
has been placed on the market. In the case of implantable devices the period
shall be at least 15 years.

Each Member State shall make provision that
this documentation is kept at the disposal of the competent authorities for the
period indicated in the first sentence of the preceding paragraph in case the
sponsor, or his contact person, established within its territory goes bankrupt
or ceases its activity prior to the end of this period.

ANNEX XV

List of products covered by the last subparagrpah of
the definition of ‘medical device’ referred to in number (1) of Article 2(1)

1.
Contact lenses;

2.
Implants for modification or fixation of body
parts;

3.
Facial or other dermal or mucous membrane fillers;

4.
Equipment for liposuction;

5.
Invasive laser equipment intended to be used on
the human body;

6.
Intense pulsed light equipment.

ANNEX XVI

CORRELATION TABLE

Council Directive 90/385/EEC || Council Directive 93/42/EEC || This Regulation

Article 1(1) || Article 1(1) || Article 1(1)

Article 1(2) || Article 1(2) || Article 2(1)

Article 1(3) || Article 1(3) 1st subparagraph || Article 1(5)1st subparagraph

- || Article 1(3) 2nd subparagraph || Article 1(5)2nd subparagraph

Article 1(4) and (4a) || Article 1(4) and (4a) || Article 1(4)1st subparagraph

Article 1(5) || Article 1(7) || Article 1(6)

Article 1(6) || Article 1(5) || Article 1(2)

- || Article 1(6) || -

|| Article 1(8) || Article 1(7)

Article 2 || Article 2 || Article 4(1)

Article 3 1st subparagraph || Article 3 1st subparagraph || Article 4(2)

Article 3 2nd subparagraph || Article 3 2nd subparagraph || -

Article 4(1) || Article 4(1) || Article 22

Article 4(2) || Article 4(2) || Article 19(1) and (2)

Article 4(3) || Article 4(3) || Article 19(3)

Article 4(4) || Article 4(4) || Article 8(7)

Article 4(5) point (a) || Article 4(5) 1st subparagraph || Article 18(6)

Article 4(5) point (b) || Article 4(5) 2nd subparagraph || -

Article 5(1) || Article 5(1) || Article 6(1)

Article 5(2) || Article 5(2) || Article 6(2)

Article 6(1) || Article 5(3), Article 6 || -

Article 6(2) || Article 7(1) || Article 88

Article 7 || Article 8 || Articles 69 to 72

- || Article 9 || Article 41

Article 8(1) || Article 10(1) || Number (43) and (44) of Article 2(1), Article 61(1), Article 63(1)

Article 8(2) || Article 10(2) || Article 61(3) and Article 63(1)2nd subparagraph

Article 8(3) || Article 10(3) || Article 63(2) and (4)

Article 8(4) || Article 10(4) || Article 66

Article 9(1) || Article 11(1) || Article 42(2)

- || Article 11(2) || Article 42(4)

- || Article 11(3) || Article 42(3)

- || Article 11(4) || -

- || Article 11(5) || Article 42(5)

Article 9(2) || Article 11 (6) || Article 42(7)

Article 9(3) || Article 11(8) || Article 9(3)

Article 9(4) || Article 11(12) || Article 42(8)

Article 9(5) || Article 11(7) || -

Article 9(6) || Article 11(9) || Article 43(1)

Article 9(7) || Article 11(10) || Article 43(3)

Article 9(8) || Article 11(11) || Article 45(2)

Article 9(9) || Article 11(13) || Article 47(1)

Article 9(10) || Article 11(14) || -

- || Article 12 || Article 20

- || Article 12a || Article 15

Article 9a(1) 1st indent || Article 13(1) point (c) || -

Article 9a(1) 2nd indent || Article 13(1) point (d) || Article 3(1)

- || Article 13(1) point (a) || Article 41(3)

- || Article 13(1) point (b) || Article 41(4) point (a)

Article 10 || Article 15 || Articles 50 to 60

Article 10a || Article 14 || Article 25

Article 10b || Article 14a || Article 27

Article 10c || Article 14b || Article 74

Article 11(1) || Article 16(1) || Articles 33 and 34

Article 11(2) || Article 16(2) || Article 29

Article 11(3) || Article 16(3) || Article 36(2)

Article 11(4) || Article 16(4) || -

Article 11(5) || Article 16(5) || Article 45(4)

Article 11(6) || Article 16(6) || Article 45(3)

Article 11(7) || Article 16(7) || Articles 31(2) and 35(1)

Article 12 || Article 17 || Article 18

Article 13 || Article 18 || Article 73

Article 14 || Article 19 || Article 75

Article 15 || Article 20 || Article 84

Article 15a || Article 20a || Article 77

Article 16 || Article 22 || -

Article 17 || Article 23 || -

- || Article 21 || -

LEGISLATIVE FINANCIAL STATEMENT

1.           FRAMEWORK OF THE PROPOSAL/INITIATIVE

              1.1.    Title of the proposal/initiative

              1.2.    Policy
area(s) concerned in the ABM/ABB structure

              1.3.    Nature
of the proposal/initiative

              1.4.    Objective(s)

              1.5.    Grounds
for the proposal/initiative

              1.6.    Duration
and financial impact

              1.7.    Management
method(s) envisaged

2.           MANAGEMENT MEASURES

              2.1.    Monitoring
and reporting rules

              2.2.    Management
and control system

              2.3.    Measures
to prevent fraud and irregularities

3.           ESTIMATED FINANCIAL IMPACT OF THE
PROPOSAL/INITIATIVE

              3.1.    Heading(s)
of the multiannual financial framework and expenditure budget line(s) affected

              3.2.    Estimated
impact on expenditure

              3.2.1. Summary of
estimated impact on expenditure

              3.2.2. Estimated impact
on operational appropriations

              3.2.3. Estimated impact
on appropriations of an administrative nature

              3.2.4. Compatibility
with the current multiannual financial framework

              3.2.5. Third-party
participation in financing

              3.3.    Estimated impact on revenue

LEGISLATIVE FINANCIAL STATEMENT

1.
FRAMEWORK OF THE PROPOSAL/INITIATIVE
1.1.
Title of the proposal/initiative

Proposal for a Regulation of the European Parliament and of the
Council on medical devices, and amending Directive 2001/83/EC, Regulation (EC)
No 178/2002 and Regulation (EC) No 1223/2009.

This financial statement also includes the costs related to the
Proposal for a Regulation of the European Parliament and of the Council on in
vitro diagnostic medical devices which is based on the same organisational
and IT infrastructure established by this Proposal.

1.2.
Policy area(s) concerned in the ABM/ABB
structure[64]

Health for Growth

1.3.
Nature of the proposal/initiative

X The proposal/initiative relates to a new action

¨ The
proposal/initiative relates to a new action following a pilot
project/preparatory action[65]

¨ The proposal/initiative relates to the
extension of an existing action

¨ The
proposal/initiative relates to an action redirected towards a new action

1.4.
Objectives
1.4.1.
The Commission’s multiannual strategic
objective(s) targeted by the proposal/initiative

In the field of medical devices, the proposals aim

1) to ensure a high level of human health and safety,

2) to ensure the functioning of the internal market, and

3) to promote innovation in medical technology for the
benefit of patients and healthcare professionals.

1.4.2.
Specific objective(s) and ABM/ABB activity(ies)
concerned

Specific objective 1: Establish
mechanisms to ensure harmonised implementation of the rules on medical devices
by all Member States with a sustainable, efficient and credible management at
EU level with access to internal and external technical, scientific and
clinical expertise, allowing improved coordination and resource-sharing between
Member States.

Specific objective 2: Enhance
transparency regarding medical devices on the EU market, including their
traceability.

ABM/ABB activity(ies) concerned

Health for Growth

The Commission's Proposal for a Regulation of the European
Parliament and of the Council on establishing a Health for Growth Programme for
the period 2014-2020 (COM[2011]709) lists contribution to the objectives of the
EU legislation in the field of medical devices as one of the eligible actions
to be financed by the programme.

1.4.3.
Expected result(s) and impact

Specify the effects
which the proposal/initiative should have on the beneficiaries/groups targeted.

On patients and healthcare professionals: High level of human health
and safety; cases of deliberate circumvention of the legal requirements (e.g.
PIP case) are prevented or quickly identified. High level of transparency and
traceability regarding medical devices on the market (e.g. publicly accessible
Eudamed; UDI; implant card; summary of safety and performance) allowing better
informed decision-making and follow-up. High level of confidence in the EU
regulations.

On manufacturers of medical devices: Level playing field due to
clearer rules and obligations, benefiting in particular the large majority of
manufacturers which already comply with the spirit of the current legislation.
Benefits from smoother functioning of the internal market. Support to
innovation due to predictable regulatory framework conditions (e.g. early
scientific advice). Lower overall administrative burdens due to central
registration of devices and reporting of serious incidents.

On notified bodies: Safeguard their role in pre-market medical
device assessment. Level playing field due to clearer rules and obligations,
benefiting in particular those notified bodies which already comply with the
spirit of the current legislation. Reinforcement of their position vis-à-vis
manufacturers.

On national authorities: Reinforcement of their enforcement powers.
Clear legal framework for coordination between them and resource- and
work-sharing.

1.4.4.
Indicators of results and impact

Specify the
indicators for monitoring implementation of the proposal/initiative.

Number of patients harmed by unsafe medical devices.

Number of designated notified bodies, their areas of competence and
the level of diversification.

Number of registrations (medical devices, economic operators,
certificates), incident reports, single applications for clinical
investigations and market surveillance measures in the Eudamed databank with
its several new electronic systems.

Number of preliminary conformity assessments "called up"
under the scrutiny mechanism and number of comments emitted by MDCG.

Number of coordinated actions between national competent authorities
regarding post-market safety issues (vigilance and market surveillance).

Number of 'borderline cases' solved.

Number of devices fitted with an UDI system that is aligned with
international practice.

1.5.
Grounds for the proposal/initiative
1.5.1.
Requirement(s) to be met in the short or long
term

The existing regulatory framework is being criticised for not
sufficiently ensuring patient safety within the internal market and for being
intransparent. The criticism has become even louder after findings of the
French health authorities that a French manufacturer (Poly Implant Prothèse,
PIP) over several years apparently used industrial silicone instead of medical
grade silicone for the manufacture of breast implants contrary to the approval
provided by the notified body, causing harm to thousands of women around the
world.

In an internal market with currently 32 participating countries (EU,
EFTA, Turkey) and subject to constant technological and scientific progress,
important divergences in the interpretation and application of the rules have
emerged, thus undermining the directives' main objectives, i.e. the safety of
medical devices and their free circulation within the internal market.
Moreover, regulatory gaps or uncertainties exist with regard to certain
products (e.g. products manufactured utilising non-viable human tissues or
cells; implantable or other invasive products for cosmetic purposes).

The present revision aims to overcome these flaws and gaps and to
put in place a robust, transparent and sustainable regulatory framework that is
'fit for purpose'.

1.5.2.
Added value of EU involvement

The proposed revision of the existing directives concerning medical
devices, which will integrate the modification of the Lisbon Treaty regarding
public health, can only be achieved at Union level. The proposals are based on
Article 114 and Article 168(4)(c) of the Treaty on the Functioning of the
European Union (TFEU).

EU action is necessary to improve the level of protection of public
health for all European patients and users, as well as to prevent Member States
from adopting varying product regulations which would result in a further
fragmentation of the internal market. Harmonised rules and procedures allow
manufacturers, especially SMEs that represent more than 80% of the sector, to
reduce costs related to national regulatory differences, while ensuring a high
and equal level of safety for all European patients and users. In accordance with the principles of proportionality and
subsidiarity, as set out in Article 5 of the Treaty on European Union, this
proposal does not go beyond what is necessary to achieve those objectives.

1.5.3.
Lessons learned from similar experiences in the
past

The existing directives concerning medical devices, which date back
to the 1990ies, have set harmonised requirements to be met by medical devices
placed on the EU market. But they have not provided for mechanisms that ensure
a harmonised implementation. As mentioned under 1.5.1., important divergences
in the interpretation and application of the rules have emerged, thus
undermining the directives' main objectives, i.e. the safety of medical devices
and their free circulation within the internal market.

In addition, lessons drawn from an analysis of the shortcomings
brought to light by the PIP case have been taken into account for the drafting
of these proposals.

1.5.4.
Coherence and possible synergy with other
relevant instruments

Enhanced coherence is expected with other legislations (e.g.
concerning medicinal products, food, biocides, cosmetics) in terms of better
delimitation of the respective scopes of application and/or in terms of
solution of 'borderline cases'.

Synergies are expected with the legislation regarding medicinal
products, in particular as regards the assessment of drug-device combination
products and as regards clinical research regarding medicinal products (in the
context of the revised Clinical Trials Directive) and regarding medical devices
(in the context of this proposal) and/or performance evaluation studies with
IVDs (in the context of the proposal for a Regulation on IVDs).

1.6.
Duration and financial impact

¨ Proposal/initiative of limited
duration

–
¨  Proposal/initiative in effect from [DD/MM]YYYY to [DD/MM]YYYY

–
¨  Financial impact from YYYY to YYYY

X Proposal/initiative
of unlimited duration

–
Implementation with a start-up period from 2014
to 2017,

–
followed by full-scale operation.

1.7.
Management mode(s) envisaged[66]

X Centralised direct management by the
Commission

¨ Centralised indirect management with the delegation of implementation tasks to:

–
¨  executive agencies

–
¨  bodies set up by the Communities[67]

–
¨  national public-sector bodies/bodies with public-service mission

–
¨  persons entrusted with the implementation of specific actions
pursuant to Title V of the Treaty on European Union and identified in the
relevant basic act within the meaning of Article 49 of the Financial Regulation

¨ Shared management with the Member States

¨ Decentralised management with third countries

¨ Joint management with international organisations (to be specified)

If more than one
management mode is indicated, please provide details in the
"Comments" section.

Comments

The
Commission intends to ensure the services concerned via centralised direct
management through its own services, in particular via the JRC for the
technical, scientific and logistic support.

The
centralised direct management by the Commission also applies to the further
development and management of Eudamed (electronic systems regarding UDI;
central registration of medical devices, economic operators and certificates;
central reporting of vigilance cases; market surveillance measures; clinical
investigations) and the IT tool for the notification of information regarding
new applications for conformity assessment concerning high risk devices by
notified bodies and 'called up' preliminary assessments by them in the context
of the scrutiny mechanism.

It should
be highlighted that the four EFTA countries (via EEA Agreement and MRA
with CH) and Turkey (via Customs Union Agreement) will participate in
the management.

2.
MANAGEMENT MEASURES
2.1.
Monitoring and reporting rules

Specify frequency
and conditions.

The future Medical Device Coordination Group (MDCG), set up by this
Regulation, and its special working groups will provide a regular platform to
discuss issues related to the implementation of the new regulatory framework.

Ten years after entry into force, the Commission should report to
the European Parliament and to the Council about the achievements of the
'medical device package'. The report should address the impact of the new rules
in respect of public health and patient safety, internal market, innovativeness
and competitiveness of the medical device industry (with special attention to
SMEs). The Commission should consult competent authorities and stakeholders
(healthcare professionals, patients, manufacturers, notified bodies) when
preparing its report.

2.2.
Management and control system
2.2.1.
Risk(s) identified

Risks related to Eudamed:

The development of the future Eudamed database would become too
complex and would not meet the needs of the national competent authorities, the
notified bodies, economic operators and the public at large.

The IT infrastructure would not support the registration of all
medical devices placed on the EU market (several hundreds of thousands), or the
reporting of serious incidents and field safety corrective actions (several
thousands a years), the reporting of market surveillance measures, or the
single submission of applications for clinical investigations and the reporting
of related serious adverse events.

The non-public parts of the Eudamed database with sensitive personal
and commercial information would disclose confidential information, e.g. due to
hacking or software failure.

Risks related to the conformity assessment of medical devices:

By the date of application of the new Regulations, an insufficient
number of notified bodies would be designated in accordance with the new
requirements which would lead to a delay for manufacturers to get their devices
approved.

The scrutiny mechanism would be used in a way that would delay, in a
disproportionate manner, access to market of innovative medical devices.

The IT tool for the notification of information regarding new
applications and/or submission of preliminary assessments by notified bodies,
which contains commercially sensitive information, would disclose confidential
information, e.g. due to hacking or software failure.

2.2.2.
Control method(s) envisaged

Control methods regarding risks related to Eudamed:

The development of Eudamed is given high priority with a high level
of sensitivity as regards its functioning.

Close and regular contacts between the Commission services
responsible for the management of the regulatory framework and the IT
developers.

Close and regular contacts between the Commission services/IT
developers and the future users of the IT infrastructure.

Control methods regarding risks related to the conformity assessment
of medical devices:

The reinforced and coordinated supervision of notified bodies in the
context of the 'immediate action' initiated after the PIP scandal already takes
account of the future requirements laid down in the proposal and thus supports
a smooth transition.

The Commission shall create guidance to ensure a proportionate and
workable operation of the new scrutiny mechanism.

The development of the IT tool is given high priority with a high
level of sensitivity as regards its functioning.

2.3.
Measures to prevent fraud and irregularities

Specify existing or
envisaged prevention and protection measures.

In addition to the application of all regulatory control mechanisms,
the responsible Commission's services will devise an anti-fraud strategy in
line with the Commission's new anti-fraud strategy (CAFS) adopted on 24 June
2011 in order to ensure inter alia that its internal anti-fraud related
controls are fully aligned with the CASF and that its fraud risk management
approach is geared to identify fraud risk areas and adequate responses. Where
necessary, networking groups and adequate IT tools dedicated to analysing fraud
cases related to the financing implementing activities of the Medical Devices
Regulations will be set up. In particular a series of measures will be put in
place such as:

- decisions, agreements and contracts resulting from the financing
implementing activities of the Medical Devices Regulations will expressly
entitle the Commission, including OLAF, and the Court of Auditors to conduct
audits, on-the-spot checks and inspections;

- during the evaluation phase of a call for proposals/tender, the
proposers and tenderers are checked against the published exclusion criteria
based on declarations and the Early Warning System (EWS);

- the rules governing the eligibility of costs will be simplified in
accordance with the provisions of the Financial Regulation;

- regular training on issues related to fraud and irregularities is
given to all staff involved in contract management as well as to auditors and
controllers who verify the beneficiaries' declarations on the spot.

Moreover, the Commission will control a strict application of the
rules on conflict of interests provided in the proposal.

3.
ESTIMATED FINANCIAL IMPACT OF THE PROPOSAL/INITIATIVE
3.1.
Heading(s) of the multiannual financial
framework and expenditure budget line(s) affected

· Existing expenditure budget lines

In order of multiannual financial framework
headings and budget lines.

Operational resources which are necessary
for implementation of this initiative will be covered by the allocations
proposed under the Health for Growth Programme 2014-2020.

Heading of multiannual financial framework || Budget line || Type of expenditure || Contribution

Number [Description: Health for Growth Programme] || Diff./non-diff. ([68]) || from EFTA[69] countries || from candidate countries[70] || from third countries || within the meaning of Article 18(1)(aa) of the Financial Regulation

3 || 17.03.XX. || Diff/non-diff. || YES/NO || YES/NO (to be determined whether Turkey – in the context of the Customs Union and as candidate country – should contribute.) || YES/NO || YES/NO

3.2.
Estimated impact on expenditure
3.2.1.
Summary of estimated impact on expenditure
(in current prices)

EUR million (to 3 decimal places)

Heading of multiannual financial framework: || Number 3 || Citizenship (Health for Growth Programme)

DG SANCO || || || Year 2014 || Year 2015 || Year 2016 || Year 2017 || Year 2018 || 2019 et sq years || TOTAL

 Operational appropriations[71] || || || || || || || ||

Number of budget line: 17.03.XX[72] || Commitments || (1) || 5,296 || 5,677 || 6,667 || 7,662 || 7,590 || 7,742 || 7,742 || 48,376

Payments || (2) || 2,648 || 5,486 || 6,172 || 7,165 || 7,626 || 7,666 || 7,742 + 3,871 || 48,376

|| || || || || || || || || ||

|| || || || || || || || ||

Appropriations of an administrative nature financed  from the envelope for specific programmes[73] || || || || || || || ||

Number of budget line: || || (3) || || || || || || || ||

TOTAL appropriations for DG SANCO || Commitments || =1+1a +3 || 5,296 || 5,677 || 6,667 || 7,662 || 7,590 || 7,742 || 7,742 || 48,376

Payments || =2+2a +3 || 2,648 || 5,486 || 6,172 || 7,165 || 7,626 || 7,666 || 7,742 + 3,871 || 48,376

 TOTAL operational appropriations || Commitments || (4) || 5,296 || 5,677 || 6,667 || 7,662 || 7,590 || 7,742 || 7,742 || 48,376

Payments || (5) || 2,648 || 5,486 || 6,172 || 7,165 || 7,626 || 7,666 || 7,742 + 3,871 || 48,376

 TOTAL appropriations of an administrative nature financed from the envelope for specific programmes || (6) || || || || || || || ||

TOTAL appropriations under HEADING 3B of the multiannual financial framework || Commitments || =4+ 6 || 5,296 || 5,677 || 6,667 || 7,662 || 7,590 || 7,742 || 7,742 || 48,376

Payments || =5+ 6 || 2,648 || 5,486 || 6,172 || 7,165 || 7,626 || 7,666 || 7,742 + 3,871 || 48,376

If more
than one heading is affected by the proposal / initiative:

 TOTAL operational appropriations || Commitments || (4) || || || || || || || ||

Payments || (5) || || || || || || || ||

 TOTAL appropriations of an administrative nature financed from the envelope for specific programmes || (6) || || || || || || || ||

TOTAL appropriations under HEADINGS 1 to 4 of the multiannual financial framework (Reference amount) || Commitments || =4+ 6 || || || || || || || ||

Payments || =5+ 6 || || || || || || || ||

Heading of multiannual financial framework: || 5 || " Administrative expenditure "

EUR million (to 3 decimal places)

|| || || Year 2014 || Year 2015 || Year 2016 || Year 2017 || Year 2018 || 2019 et sq years || TOTAL

DG SANCO ||

 Human resources || 2,413 || 2,413 || 2,413 || 2,413 || 2,413 || 2,413 || 2,413 || 16,891

 Other administrative expenditure || 0,469 || 0,478 || 0,488 || 0,497 || 0,508 || 0,519 || 0,519 || 3,478

TOTAL DG SANCO || Appropriations || 2,882 || 2,891 || 2,901 || 2,910 || 2,921 || 2,932 || 2,932 || 20,369

TOTAL appropriations under HEADING 5 of the multiannual financial framework || (Total commitments = Total payments) || 2,882 || 2,891 || 2,901 || 2,910 || 2,921 || 2,932 || 2,932 || 20,369

EUR million (to 3 decimal places)

|| || || Year 2014 || Year 2015 || Year 2016 || Year 2017 || Year 2018 || 2019 et sq years || TOTAL

TOTAL appropriations under HEADINGS 1 to 5 of the multiannual financial framework || Commitments || 8,178 || 8,568 || 9,568 || 10,572 || 10,511 || 10,674 || 10,674 || 68,745

Payments || 5,530 || 8,377 || 9,073 || 10,075 || 10,547 || 10,598 || 10,674+ 3,871 || 68,745

3.2.2.
Estimated impact on operational appropriations

–
¨  The proposal/initiative does not require the use of operational
appropriations

–
X  The
proposal/initiative requires the use of operational appropriations, as explained
below:

Commitment appropriations in EUR million (to 3 decimal
places)

Indicate objectives and outputs ò || || || Year 2014 || Year 2015 || Year 2016 || Year 2017 || Year 2018 || 2019 et sq years || TOTAL

OUTPUTS

Type of output[74] || Average cost of the output || Number of outputs || Cost || Number of outputs || Cost || Number of outputs || Cost || Number of outputs || Cost || Number of outputs || Cost || Number of outputs || Cost || Number of outputs || Cost || Total number of outputs || Total cost

SPECIFIC OBJECTIVE No 1 || Establish mechanisms to ensure harmonised implementation of the rules by all Member States with a sustainable, efficient and credible management at EU level with access to internal and external technical, scientific and clinical expertise, allowing improved coordination and resource-sharing between Member States

- Output || Meetings of MDCG || || 80 meeting days || 1,873 || 80 meeting days || 1,910 || 80 meeting days || 1,948 || 80 meeting days || 1,987 || 80 meeting days || 2,027 || 80 meeting days || 2,068 || 80 meeting days || 2,068 || || 13,881

- Output || Technical and scientific opinions and advice || || || 0,406 || || 0,690 || || 1,580 || || 2,473 || || 2,523 || || 2,573 || || 2,573 || || 12,818

- Output || Audits / 'joint assessments' of 80 notified bodies || || || 0,416 || || 0,424 || || 0,433 || || 0,442 || || 0,450 || || 0,459 || || 0,459 || || 3,083

Sub-total for specific objective N°1 || || 2,695 || || 3,024 || || 3,961 || || 4,902 || || 5,000 || || 5,100 || || 5100 || || 29,782

SPECIFIC OBJECTIVE No 2 || Enhance transparency regarding medical devices on the EU market, including their traceability

- Output || Eudamed (with 6 electronic systems: UDI, registration, certificates, clinical inv., vigilance, market surv.), as of 2018 with statistical analysis / business intelligence) for signal detection || || 1 || 2,081 || 1 || 2,122 || 1 || 2,165 || 1 || 2,208 || 1 || 2,027 || 1 || 2,068 || 1 || 2,068 || || 14,739

- Output || Translations, info campaigns, publications etc. || || tbd || 0,520 || tbd || 0,531 || tbd || 0,541 || tbd || 0,552 || tbd || 0,563 || tbd || 0,574 || tbd || 0,574 || || 3,855

Sub-total for specific objective N°2 || || 2,601 || || 2,653 || || 2,706 || || 2,760 || || 2,590 || || 2,642 || || 2,642 || || 18,594

Total costs || || 5,296 || || 5,677 || || 6,667 || || 7,662 || || 7,590 || || 7,742 || || 7,742 || || 48,376

3.2.3.
Estimated impact on appropriations of an
administrative nature
3.2.3.1. Summary

–
¨  The proposal/initiative does not require the use of administrative
appropriations

–
X  The
proposal/initiative requires the use of administrative appropriations, as
explained below:

EUR million (to 3
decimal places)

|| Year 2014 || Year 2015 || Year 2016 || Year 2017 || Year 2018 || 2019 et sq years || TOTAL

HEADING 5 of the multiannual financial framework || || || || || || || ||

Human resources || 2,413 || 2,413 || 2,413 || 2,413 || 2,413 || 2,413 || 2,413 || 16,891

Other administrative expenditure || 0,469 || 0,478 || 0,488 || 0,497 || 0,508 || 0,519 || 0,519 || 3,478

Subtotal HEADING 5 of the multiannual financial framework || 2,882 || 2,891 || 2,901 || 2,910 || 2,921 || 2,932 || 2,932 || 20,369

Outside HEADING 5[75] of the multiannual financial framework || || || || || || || ||

Human resources || || || || || || || ||

Other expenditure of an administrative nature || || || || || || || ||

Subtotal outside HEADING 5 of the multiannual financial framework || || || || || || || ||

TOTAL || 2,882 || 2,891 || 2,901 || 2,910 || 2,921 || 2,932 || 2,932 || 20,369

3.2.3.2.
 Estimated requirements of human resources

–
¨  The proposal/initiative does not require the use of human
resources

–
X  The
proposal/initiative requires the use of human resources, as explained below:

Estimate to be expressed in full amounts
(or at most to one decimal place)

|| Year 2014 || Year 2015 || Year 2016 || Year 2017 || Year 2018 || Year 2019 || Year >2019

 Establishment plan posts (officials and temporary agents)

17 01 01 01 (Headquarters and Commission’s Representation Offices) || 19 || 19 || 19 || 19 || 19 || 19 || 19

XX 01 01 02 (Delegations) || || || || || || ||

XX 01 05 01 (Indirect research) || || || || || || ||

10 01 05 01 (Direct research) || || || || || || ||

 External personnel (in Full Time Equivalent unit: FTE)[76]

XX 01 02 01 (CA, INT, SNE from the "global envelope") || || || || || || ||

XX 01 02 02 (CA, INT, JED, LA and SNE in the delegations) || || || || || || ||

XX 01 04 yy [77] || - at Headquarters[78] || || || || || || ||

- in delegations || || || || || || ||

XX 01 05 02 (CA, INT, SNE - Indirect research) || || || || || || ||

10 01 05 02 (CA, INT, SNE - Direct research) || || || || || || ||

Other budget lines (specify) || || || || || || ||

TOTAL || 19 || 19 || 19 || 19 || 19 || 19 || 19

XX is the
policy area or budget title concerned.

The human resources
required will be met by staff from DG SANCO who are already assigned to the
management of the action and who will be redeployed within DG SANCO, together
if necessary with any additional allocation which may be granted to the
managing DG under the annual allocation procedure and in the light of budgetary
constraints (estimated needs: 16 AD/FTE and 3 AST/FTE).

Description of
tasks to be carried out:

Officials and temporary agents || Control of appropriate implementation of this Regulation; development of delegated/implementing acts and guidance; development of new electronic systems for Eudamed (in cooperation with IT staff); organisation and direction of 'joint assessments' of notified bodies and control of designation and monitoring process by Member States; coordination of market surveillance activities with EU wide impact; follow-up of national safeguard and preventive health protection measures; international regulatory cooperation; management of Medical Device Committee (committee within the meaning of Reg. 182/2011).

External personnel ||

3.2.4.
Compatibility with the current multiannual
financial framework

–
X  Proposal/initiative
is compatible with the new multiannual financial framework 2014-2020.

–
¨  Proposal/initiative will entail reprogramming of the relevant
heading in the multiannual financial framework.

Explain what reprogramming is required,
specifying the budget lines concerned and the corresponding amounts.

–
¨  Proposal/initiative requires application of the flexibility
instrument or revision of the multiannual financial framework[79].

Explain what is required, specifying the
headings and budget lines concerned and the corresponding amounts.

3.2.5.
Third-party contributions

–
The proposal/initiative does not provide for
co-financing by third parties

–
The proposal/initiative provides for the
co-financing estimated below:

Appropriations in EUR million (to 3 decimal places)

|| Year N || Year N+1 || Year N+2 || Year N+3 || … enter as many years as necessary to show the duration of the impact (see point 1.6) || Total

Specify the co-financing body || || || || || || || ||

TOTAL appropriations cofinanced || || || || || || || ||

3.3.
Estimated impact on revenue

–
¨  Proposal/initiative has no financial impact on revenue.

–
¨  Proposal/initiative has the following financial impact:

–
1.  on own resources

–
2.  on miscellaneous revenue

EUR million (to 3 decimal places)

Budget revenue line: || Appropriations available for the ongoing budget year || Impact of the proposal/initiative[80]

2014 || 2015 || 2016 || 2017 || Subsequent years

Article …………. || || 0 || 0 || 0 || 0 || 0 || 0 || 0

For miscellaneous
assigned revenue, specify the budget expenditure line(s) affected.

Specify the method for
calculating the impact on revenue.

[1]               OJ L 189, 20.7.1990, p. 17.

[2]               OJ L 169, 12.7.1993, p. 1.

[3]               EU Member States, EFTA countries and Turkey.

[4]               OJ L 331, 7.12.1998, p. 1.

[5]               See http://ec.europa.eu/health/medical-devices/documents/revision/index\_en.htm.

[6]               OJ L 247, 21.9.2007, p. 21.

[7]               OJ C 202, 8.7.2011, p. 7.

[8]               Resolution of 14 June 2012 (2012/2621(RSP));
P7\_TA-PROV(2012)0262, http://www.europarl.europa.eu/plenary/en/texts-adopted.html.

[9]               OJ L 324, 10.12.2007, p. 121.

[10]             OJ L 102, 7.4.2004, p. 48.

[11]             OJ L 31, 1.2.2002, p. 1.

[12]             OJ L 311, 28.11.2001, p. 67.

[13]             Communication from the President to the Commission of
10.11.2010, Framework for Commission Expert Groups: Horizontal Rules and Public
Registers, C(2010)7649 final.

[14]             Consisting of Regulation (EC)
No 765/2008 of the European Parliament and of the Council setting out the requirements for accreditation and market
surveillance relating to the marketing of products and repealing Regulation
(EEC) No 339/93, OJ L 218, 13.8.2008, p. 30, and
Decision No 768/2008/EC of the European Parliament and of the Council on a
common framework for the marketing of products, and repealing Council Decision
93/465/EEC, OJ L 218, 13.8.2008, p. 82.

[15]             http://www.ghtf.org/

[16]             Report from the Commission to the
European Parliament and the Council on the issue of reprocessing of medical
devices in the European Union, in accordance with Article 12a of Directive
93/42/EEC, COM(2010)443 final.

[17]             OJ L 102, 23.4.2010, p. 45.

[18]             In accordance with Article 3(3) of Regulation (EEC,
EURATOM) No 1182/71 of the Council of 3 June 1971 determining the rules applicable
to periods, dates and time limits, OJ L 124, 8.6.1971, p. 1) days referred to
in this Regulation mean calendar days.

[19]             OJ L 105, 26.4.2003, p. 18. This directive will be
replaced by Commission Regulation (EU) No 722/2012 (OJ L 212, 9.8.2012, p. 3)
with effect from 29 August 2013.

[20]             COM(2012)369.

[21]             OJ L 342, 22.12.2009, p. 59.

[22]             OJ L 167, 27.6.2012, p.1.

[23]             OJ C […], […], p. […].

[24]             OJ C […], […], p. […].

[25]             OJ C […], […], p. […].

[26]             OJ L 189, 20.7.1990, p. 17.

[27]             OJ L 169, 12.7.1993, p. 1.

[28]         OJ L 31, 1.2.2002, p.1.

[29]             OJ L 342, 22.12.2009, p. 59.

[30]             OJ L 311, 28.11.2001, p. 67.

[31]         OJ L 324, 10.12.2007, p. 121.

[32]             OJ L 102, 7.4.2004, p. 48.

[33]             OJ L 275, 20.10.2011, p. 38.

[34]             OJ L 390, 31.12.2004, p. 24

[35]             OJ L 157, 9.6.2006, p. 24.

[36]             OJ L 159, 29.6.1996, p. 1.

[37]             OJ L 180, 9.7.1997, p. 22.

[38]             OJ L 1, 3.1.1994, p. 3.

[39]             OJ L 114, 30.4.2002, p. 369.

[40]             OJ 217, 29.12.1964, p. 3687.

[41]             OJ L 204, 21.7.1998, p. 37, as amended by Directive
98/48/EC of the European Parliament and of the Council of 20 July 1998, OJ L
217, 5.8.1998, p. 18.

[42]             OJ L […], […], p. […].

[43]             OJ L 331, 7.12.1998, p. 1.

[44]             OJ L 218, 13.8.2008, p. 30.

[45]             OJ L 218, 13.8.2008, p. 82.

[46]             Judgment of the Court of 28 July 2011 in joined cases
C-400/09 and C-207/10.

[47]             OJ L 241, 10.9.2008, p. 21.

[48]             COM(2010)443 final.

[49]             OJ L 102, 23.4.2010, p. 45.

[50]             OJ L 281, 23.11.1995, p. 31.

[51]             OJ L 8, 12.1.2001, p. 1.

[52]         OJ L […], […], p. […].

[53]             OJ L 55, 28.2.2011, p. 13.

[54]             OJ L 124, 20.5.2003, p. 36

[55]             OJ L […], […], p. […].

[56]             OJ L […], […], p. […].

[57]             OJ L 353, 31.12.2008, p. 1.

[58]             OJ L 136, 29.5.2007, p.3.

[59]             OJ L 33, 8.2.2003, p. 30.

[60]             OJ L 212, 9.8.2012, p. 3.

[61]             OJ L 39, 15.2.1980.

[62]             OJ L 72, 10.3.2012, p. 28.

[63]             OJ L 50, 20.2.2004, p. 44.

[64]             ABM: Activity-Based Management – ABB: Activity-Based
Budgeting.

[65]             As referred to in Article 49(6)(a) or (b) of the
Financial Regulation.

[66]             Details of management modes and references to the
Financial Regulation may be found on the BudgWeb site: http://www.cc.cec/budg/man/budgmanag/budgmanag\_en.html

[67]             As referred to in Article 185 of the Financial
Regulation.

[68]             Diff. = Differentiated appropriations / Non-diff. =
Non-Differentiated Appropriations

[69]             EFTA: European Free Trade Association.

[70]             Candidate countries and, where applicable, potential
candidate countries from the Western Balkans.

[71]             Costs for development of IT and for
technical/scientific support.

[72]             The cost of the action will be entirely covered by the
envelope of the Health for Growth programme under the budgetary line
related to the relevant objective of the programme.

[73]             Technical and/or administrative assistance and
expenditure in support of the implementation of EU programmes and/or actions
(former "BA" lines), indirect research, direct research.

[74]             Outputs are products and services to be supplied (e.g.:
number of student exchanges financed, number of km of roads built, etc.).

[75]             Technical and/or administrative assistance and expenditure
in support of the implementation of EU programmes and/or actions (former
"BA" lines), indirect research, direct research.

[76]             CA= Contract Agent; INT= agency staff ("Intérimaire");
JED= "Jeune Expert en Délégation" (Young Experts in
Delegations); LA= Local Agent; SNE= Seconded National Expert;

[77]             Under
the ceiling for external personnel from operational
appropriations (former "BA" lines).

[78]             Essentially for Structural Funds, European Agricultural
Fund for Rural Development (EAFRD) and European Fisheries Fund (EFF).

[79]             See points 19 and 24 of the Interinstitutional
Agreement.

[80]             As regards traditional own resources (customs duties,
sugar levies), the amounts indicated must be net amounts, i.e. gross amounts
after deduction of 25% for collection costs.

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