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  • 1.  Patient/User Involvement and MDR's

    This message was posted by a user wishing to remain anonymous
    Posted 16-Jan-2023 10:33
    This message was posted by a user wishing to remain anonymous

    RAPS Community,

    My company decided to update the way in which we assess complaints for MDR Reportability. We initially were assessing complaints regardless of patient/user involvement however we now only assess malfunctions if a patient or use was involved. I have verbally communicated to Executive Management this is not correct, but they have asked for specific references showing what I stated to be accurate. Besides having them read 21 CFR 820.198 and 21 CFR 803 I have no good way to show them what isnt there; the regulation does not say "only assess malfunctions for reportability if there is patient involvement." I am trying to my job in ensuring we have compliant processes.  How would you go about approaching this situation?

    Thanks you in advance for your insight!


  • 2.  RE: Patient/User Involvement and MDR's

    Posted 16-Jan-2023 10:58
      |   view attached
    Hi,
    "Malfunction" means the failure of a device to meet its performance specifications or
    otherwise perform as intended [21 CFR 803.3]. Performance specifications include all
    claims made in the labeling for the device.

    The link here shows all possible scenarios reportable and hope this helps.
    https://www.fda.gov/media/86420/download


    Thanks
    Kind regards,
    Raje 

    Raje Devanathan
    rdevanathan@tpireg.com

    Amerisource Bergen

    TPIreg, Innomar Strategies

    Senior Manager - Regulatory Affairs, Medical Devices



    ------------------------------
    RAJESWARI DEVANATHAN
    Senior Manager
    Oakville ON
    Canada
    ------------------------------



  • 3.  RE: Patient/User Involvement and MDR's

    Posted 16-Jan-2023 12:52

    Your company needs to be careful about language here. The correct word, from 820.198 is "evaluate" not "assess".

    820.198(a)(3) requires evaluation of every complaint for reportability under Part 803. Presumably you evaluation criteria now says something like:
    1. Is the compliant a malfunction? Y/N
    2. If a malfunction, is there patient or user involvement? Y/N
    3 If Yes to both 1 and 2 report as a Part 803 MDR, otherwise do not report.

    I infer that you think that question 2 should not be part of the evaluation.

    To analyze this, start with the definition of malfunction in 803.3(k) which says, in part, "Malfunction means the failure of a device to meet its performance specifications or otherwise perform as intended". Notice that this is silent about patient or user involvement.

    To determine reportability look at 803.3(o)(2)(ii) which says, the device has "malfunctioned and that the device or a similar device marketed by the manufacturer or importer would be likely to cause or contribute to a death or serious injury if the malfunction were to recur". Notice that this is silent about patient or user involvement.

    To test this, make a plausible scenario. Before the start of the day, the technician tests each device expected for use that day. When she tests your company's device it fails. She notes in the record that if it had failed on a patient it likely contribute to a serious injury. She repairs the device and puts it into service. Her health care organization files a complain with your company alleging a deficiency in reliability.

    Your company evaluates the complaint using the new criteria and concludes that a malfunction occurred, since there was no patient involvement, the malfunction is not reportable.

    Now apply the evaluation criteria in the regulations.
    1 Is the compliant a malfunction? Y/N
    2 If a malfunction were to recur could it cause or contribute to death or serious injury? Y/N
    3 If Yes to both 1 and 2 report as a Part 803 MDR, otherwise do not report.

    Your company evaluates the complaint using the regulation-based criteria and concludes that a malfunction occurred and it could have contributed to a serious injury so it is reportable.

    As an aside, it is hard to imagine a complaint without, at least, user involvement. Perhaps the device conducts a periodic self test and reports a malfunction to the manufacturer using the Internet of Things.

    In my experience, companies, incorrectly, look for ways to minimize MDR reporting. I suspect that management thinks it is a public admission of bad products. However, these minimization efforts often result in under reporting and, as part of an FDA Investigation, leads to a Warning Letter. A Warning Letter has a far more serious impact on the firm.

    Consider searching the FDA Warning Letter database for cases of malfunctions so you help management understand the serious consequences from under reporting.

     



    ------------------------------
    Dan O'Leary CQA, CQE
    Swanzey NH
    United States
    ------------------------------



  • 4.  RE: Patient/User Involvement and MDR's

    Posted 17-Jan-2023 04:16
    Hello there,

    I agree with Dan that companies try to minimise their reporting, believing this is some type of admission ... and all it does is result in under-reporting.  One of the highest, if not the top from year-to-year, FDA Form 483 observations is related to Medical Device Reporting (MDR) procedure and not properly reporting.  Do not let the company mince words or use words to "exempt" themselves from reporting.

    The regulation is silent on patient use or use of device, because a malfunction could occur during installation, servicing, checking of a device, or anytime during the life cycle ... then if it were to happen during patient use could cause a serious injury.  Evaluating malfunctions of a device during the life cycle of a device is important, because this evaluation allows the organisation to see emerging risks, potential risks, or other issues which may require reporting.  Also agree, show your management FDA Warning Letters of companies not reporting and ask them if they would rather be noise in the MAUDE database or front-page headlines on the Pink Sheet for a FDA Warning Letter issuance?

    ------------------------------
    Richard Vincins ASQ-CQA, MTOPRA, RAC
    Vice President Global Regulatory Affairs
    ------------------------------



  • 5.  RE: Patient/User Involvement and MDR's

    Posted 18-Jan-2023 09:15
    I agree with Richard on this one that relying only on patient or user association for need to report is bad.

    Back in the day, a service person told me when they went to perform routine service on a CT machine, when they opened the access panel, they observed all the components were burned up, melted PCBs, wires.  Clearly evidence of spark/ fire.   What if that had happened and started a larger fire?  Something that triggered a reinspection of all installed units and further investigation into manufacturing operations and original design layout of the electronics.

    At the time, the customer only said "oh yeah, we see smoke from time to time", but never reported it to the company. 🙄🙄🙄.  At least we had trained the installers/service personnel to check the "notify QA/RA/Safety box" in the service database for certain types of issues found. That feature was custom add and sent us all an e-mail immediately so we could evaluate and report on time if necessary.


    ------------------------------
    Ginger Cantor, MBA, RAC
    Founder/Principal Consultant
    Centaur Consulting LLC
    River Falls, Wisconsin 54022 USA
    715-307-1850
    centaurconsultingllc@gmail.com
    ------------------------------



  • 6.  RE: Patient/User Involvement and MDR's

    Posted 17-Jan-2023 10:29
    Edited by Charley Ford 17-Jan-2023 10:42
    I agree with Dan's clear explanation with the examples given. What he has provided is a great distillation of the issue. Not to beat a dead horse, but if Executive Management is not willing or cannot understand the intent of the regs as Richard explained, then I would recommend following both Dan's and Richard's advice on looking at Warning Letters to demonstrate to Executive Management the consequences of non-compliance.




  • 7.  RE: Patient/User Involvement and MDR's

    Posted 17-Jan-2023 03:52
    Dear Anonymous,
    The Article and definition should help to get the procedures right for the EU.

    Vigilance Article 87

    Reporting of serious incidents and field safety corrective actions

    1.  Manufacturers of devices made available on the Union market, other than investigational devices, shall report, to the relevant competent authorities, in accordance with Articles 92(5) and (7), the following:

    (a) any serious incident involving devices made available on the Union market, ...

    Article 2 Definitions:
    (64) 'incident' means any malfunction or deterioration in the characteristics or performance of a device made available on the market, including use-error due to ergonomic features, as well as any inadequacy in the information supplied by the manufacturer and any undesirable side-effect;
    (65) serious incident' means any incident that directly or indirectly led, might have led or might lead to any of the following:

    It clearly states "directly or indirectly led, might have led or might lead".  This may be the case in particular if there are not patient involvement but in the next time somebody could get hurt.  The current procedure in your company may miss those events.

    Please let me know whether the above in helpful.

    ------------------------------
    Ludger Moeller
    President, MDSS GmbH
    l.moeller@mdssar.com
    ------------------------------



  • 8.  RE: Patient/User Involvement and MDR's

    This message was posted by a user wishing to remain anonymous
    Posted 17-Jan-2023 15:10
    This message was posted by a user wishing to remain anonymous

    Not to repeat what has already been explained so well by Dan and Richard, this is a classic example of Executive Management not understanding various elements of quality and regulatory. Based on my experience this seems symptomatic of other issues in the culture at the Exec level. I am always concerned when Exec management with no background in regulations "get into the weeds" rather than trusting the judgement of experienced regulatory professionals like yourself. Reportability issue aside, I would suggest keeping an eye out for other factors at play here.