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product, the manufacturer must docu- ucts are formed from natural rubber ment and provide, upon request, an ap- latex by dipping, extruding, or coating. propriate justification for the applica- (2) The term "dry natural rubber" tion of the testing data to the vari means rubber that is produced by the ation of the tested product.

dry natural rubber process that in(h) If a latex condom contains a volves the use of coagulated natural spermicide, and the expiration date latex in the form of dried or milled based on spermicidal stability testing sheets. Products are formed from dry is different from the expiration date natural rubber by compression moldbased upon latex integrity testing, the ing, extrusion, or by converting the product shall bear only the earlier ex

sheets into a solution for dipping. piration date.

(3) The term “contacts humans" (i) The time period upon which the

means that the natural rubber conexpiration date is based shall start

tained in a device is intended to conwith the date of packaging.

tact or is likely to contact the user or (j) As provided in part 820 of this

patient. This includes contact when chapter, all testing data must be re

the device that contains natural rubber tained in each company's files, and

is connected to the patient by a liquid shall be made available upon request

path or an enclosed gas path; or the de

vice containing the natural rubber is for inspection by the Food and Drug

fully or partially coated with a powder, Administration.

and such powder may carry natural (k) Any latex condom not labeled

rubber proteins that may contaminate with an expiration date as required by

the environment of the user or patient. paragraph (c) of this section, and ini

(c) Devices containing natural rubber tially delivered for introduction into

shall be labeled as set forth in parainterstate commerce after the effective

graphs (d) through (h) of this section. date of this regulation is misbranded

Each required labeling statement shall under sections 201(n) and 502(a) and (f)

be prominently and legibly displayed of Federal Food, Drug, and Cosmetic

in conformance with section 502(c) of Act (21 U.S.C. 321(n) and 352(a) and (f)).

the Federal Food, Drug, and Cosmetic [62 FR 50501, Sept. 26, 1997]

Act (the act) (21 U.S.C. 352(c)).

(d) Devices containing natural rubber 8801.437 User labeling for devices that latex that contacts humans, as decontain natural rubber.

scribed in paragraph (b) of this section, (a) Data in the Medical Device Re shall bear the following statement in porting System and the scientific lit bold print on the device labeling: erature indicate that some individuals

“Caution: This Product Contains are at risk of severe anaphylactic reac

Natural Rubber Latex Which May tions to natural latex proteins. This la

Cause Allergic Reactions." beling regulation is intended to mini This statement shall appear on all demize the risk to individuals sensitive vice labels, and other labeling, and to natural latex proteins and protect shall appear on the principal display the public health.

panel of the device packaging, the out(b) This section applies to all devices side package, container or wrapper, composed of or containing, or having and the immediate device package, packaging or components that are container, or wrapper. composed of, or contain, natural rubber (e) Devices containing dry natural that contacts humans. The term "nat rubber that contacts humans, as deural rubber" includes natural rubber scribed in paragraph (b) of this section, latex, dry natural rubber, and syn that are not already subject to parathetic latex or synthetic rubber that graph (d) of this section, shall bear the contains natural rubber in its formula following statement in bold print on tion.

the device labeling: (1) The term "natural rubber latex"

"This Product Contains Dry Natural means rubber that is produced by the Rubber." natural rubber latex process that in- This statement shall appear on all devolves the use of natural latex in a con- vice labels, and other labeling, and centrated colloidal suspension. Prod- shall appear on the principal display

(a) Use of the hearing aid.

(6) Maintenance and care of the hearing aid, including the procedure to follow in washing the earmold, when replacing tubing on those hearing aids that use tubing, and in storing the hearing aid when it will not be used for an extended period of time.

(c) Replacing or recharging the batteries, including a generic designation of replacement batteries.

(v) Information on how and where to obtain repair service, including at least one specific address where the user can go, or send the hearing aid to, to obtain such repair service.

(vi) A description of commonly occurring avoidable conditions that could adversely affect'or damage the hearing aid, such as dropping, immersing, or exposing the hearing aid to excessive heat.

(vii) Identification of any known side effects associated with the use of a hearing aid that may warrant consultation with a physician, e.g., skin irritation and accelerated accumulation of cerumen (ear wax).

(viii) A statement that a hearing aid will not restore normal hearing and will not prevent or improve a hearing impairment resulting from organic conditions.

(ix) A statement that in most cases infrequent use of a hearing aid does not permit a user to attain full benefit from it.

(x) A statement that the use of a hearing aid is only part of hearing habilitation and may need to be supplemented by auditory training and instruction in lipreading.

(xi) The warning statement required by paragraph (c)(2) of this section.

(xii) The notice for prospective hearing aid users required by paragraph (c)(3) of this section.

(xiii) The technical data required by paragraph (c)(4) of this section, unless such data is provided in separate labeling accompanying the device.

(2) Warning statement. The User Instructional Brochure shall contain the following warning statement: , WARNING TO HEARING AID DISPENSERS

A hearing aid dispenser should advise a prospective hearing aid user to consult promptly with a licensed physician (preferably an ear specialist) before dispensing a

hearing aid if the hearing aid dispenser determines through inquiry, actual observation, or review of any other available information concerning the prospective user, that the prospective user has any of the following conditions:

(i) Visible congenital or traumatic deformity of the ear.

(ii) History of active drainage from the ear within the previous 90 days.

(iii) History of sudden or rapidly progressive hearing loss within the previous 90 days.

(iv) Acute or chronic dizziness.

(v) Unilateral hearing loss of sudden or recent onset within the previous 90 days.

(vi) Audiometric air-bone gap equal to or greater than 15 decibels at 500 hertz (Hz), 1,000 Hz, and 2,000 Hz.

(vii) Visible evidence of significant cerumen accumulation or a foreign body in the ear canal.

(viii) Pain or discomfort in the ear.

Special care should be exercised in selecting and fitting a hearing aid whose maximum sound pressure level exceeds 132 decibels because there may be risk of impairing the remaining hearing of the hearing aid user. (This provision is required only for those hearing aids with a maximum sound pressure capability greater than 132 decibels (dB).)

(3) Notice for prospective hearing aid users. The User Instructional Brochure shall contain the following notice:

IMPORTANT NOTICE FOR PROSPECTIVE HEARING

AID USERS Good health practice requires that a person with a hearing loss have a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid. Licensed physicians who specialize in diseases of the ear are often referred to as otolaryngologists, otologists or otorhinolaryngologists. The purpose of medical evaluation is to assure that all medically treatable conditions that may affect hearing are identified and treated before the hearing aid is purchased.

Following the medical evaluation, the physician will give you a written statement that states that your hearing loss has been medically evaluated and that you may be considered a candidate for a hearing aid. The physician will refer you to an audiologist or a hearing aid dispenser, as appropriate, for a hearing aid evaluation.

The audiologist or hearing aid dispenser will conduct a hearing aid evaluation to assess your ability to hear with and without a hearing aid. The hearing aid evaluation will enable the audiologist or dispenser to select and fit a hearing aid to your individual needs.

If you have reservations about your ability to adapt to amplification, you should inquire about the availability of a trial-rental or purchase-option program. Many hearing aid dispensers now offer programs that permit you to wear a hearing aid for a period of time for a nominal fee after which you may decide if you want to purchase the hearing aid.

Federal law restricts the sale of hearing aids to those individuals who have obtained a medical evaluation from a licensed physician. Federal law permits a fully informed adult to sign a waiver statement declining the medical evaluation for religious or personal beliefs that preclude consultation with a physician. The exercise of such a waiver is not in your best health interest and its use is strongly discouraged.

CHILDREN WITH HEARING LOSS In addition to seeing a physician for a medical evaluation, a child with a hearing loss should be directed to an audiologist for evaluation and rehabilitation since hearing loss may cause problems in language development and the educational and social growth of a child. An audiologist is qualified by training and experience to assist in the evaluation and rehabilitation of a child with a hearing loss.

(4) Technical data. Technical data useful in selecting, fitting, and checking the performance of a hearing aid shall be provided in the User Instructional Brochure or in separate labeling that accompanies the device. The determination of technical data values for the hearing aid labeling shall be conducted in accordance with the test procedures of the American National Standard "Specification of Hearing Aid Characteristics,” ANSI S3.22–1996 (ASA 70-1996) (Revision of ANSI S3.22–1987), which is incorporated by reference in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies are available from the Standards Secretariat of the Acoustical Society of America, 120 Wall St., New York, NY 10005–3993, or are available for inspection at the Regulations Staff, CDRH (HFZ-215), FDA, 1350 Piccard Dr., rm. 240, Rockville, MD 20850, and at the Office of the Federal Register, 800 North Capitol St. NW., Suite 700, Washington, DC. As a minimum, the User Instructional Brochure or such other labeling shall include the appropriate values or information for the following technical data elements as these elements are defined or used in such standard:

(i) Saturation output curve (SSPL 90 curve).

(ii) Frequency response curve.

(iii) Average saturation output (HFAverage SSPL 90).

(iv) Average full-on gain (HF-Average fullsongai full-on gain).

(v) Reference test gain.
(vi) Frequency range.
(vii) Total harmonic distortion.
(viii) Equivalent input noise.
(ix) Battery current drain.

(x) Induction coil sensitivity (telephone coil aids only).

(xi) Input-output curve (ACG aids only).

(xii) Attack and release times (ACG aids only).

(5) Statement if hearing aid is used or rebuilt. If a hearing aid has been used or rebuilt, this fact shall be declared on the container in which the hearing aid is packaged and on a tag that is physically attached to such hearing aid. Such fact may also be stated in the User Instructional Brochure.

(6) Statements in User Instructional Brochure other than those required. A User Instructional Brochure may contain statements or illustrations in addition to those required by paragraph (c) of this section if the additional statements:

(i) Are not false or misleading in any particular, e.g., diminishing the impact of the required statements; and

(ii) Are not prohibited by this chapter or by regulations of the Federal Trade Commission.

(d) Submission of all labeling for each type of hearing aid. Any manufacturer of a hearing aid described in paragraph (a) of this section shall submit to the

of Medical Devices and Diagnostic Products, Division of Compliance, HFK-116, 8757 Georgia Ave., Silver Spring, MD 20910, a copy of the User Instructional Brochure described in paragraph (c) of this section and all other labeling for each type of hearing aid on or before August 15, 1977. [42 FR 9294, Feb. 15, 1977, as amended at 47 FR 9398, Mar. 5, 1982; 50 FR 30154, July 24, 1985; 54 FR 52396, Dec. 21, 1989; 64 FR 59620, Nov. 3, 1999)

PART 803–MEDICAL DEVICE

REPORTING

Subpart A-General Provisions

Sec. 803.1 Scope. 803.3 Definitions. 803.9 Public availability of reports. 803.10 General description of reports re

quired from user facilities, importers,

and manufacturers. 803.11 Obtaining the forms. 803.12 Where to submit reports. 803.13 English reporting requirement. 803.14 Electronic reporting. 803.15 Requests for additional information. 803.16 Disclaimers. 803.17 Written MDR procedures. 803.18 Files and distributor records. 803.19 Exemptions, variances, and alter

native reporting requirements.

Subpart B-Generally Applicable Require

ments for Individual Adverse Event Reports

803.20 How to report. 803.21 Reporting codes. 803.22 When not to file.

panel of the device packaging, the outside package, container or wrapper, and the immediate device package, container, or wrapper.

(f) Devices that have packaging containing natural rubber latex that contacts humans, as described in paragraph (b) of this section, shall bear the following statement in bold print on the device labeling:

“Caution: The Packaging of This Product Contains Natural Rubber Latex Which May Cause Allergic Reactions.” This statement shall appear on the packaging that contains the natural rubber, and the outside package, container, or wrapper.

(g) Devices that have packaging containing dry natural rubber that contacts humans, as described in paragraph (b) of this section, shall bear the following statement in bold print on the device labeling:

“The Packaging of This Product Contains Dry Natural Rubber." This statement shall appear on the packaging that contains the natural rubber, and the outside package, container, or wrapper.

(h) Devices that contain natural rubber that contacts humans, as described in paragraph (b) of this section, shall not contain the term “hypoallergenic" on their labeling.

(i) Any affected person may request an exemption or variance from the requirements of this section by submitting a citizen petition in accordance with $10.30 of this chapter.

(j) Any device subject to this section that is not labeled in accordance with paragraphs (d) through (h) of this section and that is initially introduced or initially delivered for introduction into interstate commerce after the effective date of this regulation is misbranded under sections 201(n) and 502(a), (c), and (f) of the act (21 U.S.C. 321(n) and 352(a), (c), and (f)).

NOTE TO $ 801.437: Paragraphs (f) and (g) are stayed until June 27, 1999, as those regulations relate to device packaging that uses “cold seal" adhesives. [62 FR 51029, Sept. 30, 1997, as amended at 63 FR 46175, Aug. 31, 1998]

Subpart C-User Facility Reporting

Requirements 803.30 Individual adverse event reports; user

facilities. 803.32 Individual adverse event report data

elements. 803.33 Annual reports.

Subpart D— Importer Reporting

Requirement

803.40 Individual adverse event reporting re

quirements; importers, 803.42 Individual adverse event report data

elements.

Subpart E-Manufacturer Reporting

Requirements 803.50 Individual adverse event reports;

manufacturers. 803.52 Individual adverse event report data

elements. 803.53 Five-day reports. 803.55 Baseline reports. 803.56 Supplemental reports. 803.58 Foreign manufacturers.

AUTHORITY: 21 U.S.C. 352, 360, 360i, 360j, 371, 374.

SOURCE: 60 FR 63597, Dec. 11, 1995, unless otherwise noted.

Subpart A-General Provisions 8803.1 Scope.

(a) This part establishes requirements for medical device reporting. Under this part, device user facilities, importers, and manufacturers, as defined in 8803.3, must report deaths and serious injuries to which a device has or may have caused or contributed, must establish and maintain adverse event files, and must submit to FDA specified followup and summary reports. Medical device distributors, as defined in $ 803.3, are also required to maintain records of incidents (files). Furthermore, manufacturers and importers are also required to report certain device malfunctions. These reports will assist FDA in protecting the public health by helping to ensure that devices are not adulterated or misbranded and are safe and effective for their intended use.

(b) This part supplements and does not supersede other provisions of this subchapter, including the provisions of part 820 of this chapter.

(c) References in this part to regulatory sections of the Code of Federal Regulations are to chapter I of title 21, unless otherwise noted. [60 FR 63597, Dec. 11, 1995, as amended at 62 FR 13306, Mar. 20, 1997; 65 FR 4118, Jan. 26, 2000

(c) Become aware means that an employee of the entity required to report has acquired information reasonably suggesting a reportable adverse event has occurred.

(1) Device user facilities are considered to have “become aware” when medical personnel, as defined in paragraph (s) of this section, who are employed by or otherwise formally affiliated with the facility, acquire such information about a reportable event.

(2) Manufacturers are considered to have become aware of an event when:

(i) Any employee becomes aware of a reportable event that is required to be reported within 30 days or that is required to be reported within 5 days under a written request from FDA under $ 803.53(b); and

(ii) Any employee, who is a person with management or supervisory responsibilities over persons with regulatory, scientific, or technical responsibilities, or a person whose duties relate to the collection and reporting of adverse events, becomes aware that a reportable MDR event or events, from any information, including any trend analysis, necessitate remedial action to prevent an unreasonable risk of substantial harm to the public health.

(3) Importers are considered to have become aware of an event when any employee becomes aware of a reportable event that is required to be reported by an importer within 30 days.

(d) Caused or contributed means that a death or serious injury was or may have been attributed to a medical device, or that a medical device was or may have been a factor in a death or serious injury, including events occurring as a result of:

(1) Failure;
(2) Malfunction;
(3) Improper or inadequate design;
(4) Manufacture;
(5) Labeling; or
(6) User error.

(e)(1) Device family means a group of one or more devices manufactured by or for the same manufacturer and having the same:

(i) Basic design and performance characteristics related to device safety and effectiveness,

(ii) Intended use and function, and

8803.3 Definitions.

(a) Act means the Federal Food, Drug, and Cosmetic Act.

(b) Ambulatory surgical facility (ASF) means a distinct entity that operates for the primary purpose of furnishing same day outpatient surgical services to patients. An ASF may be either an independent entity (i.e., not a part of a provider of services or any other facility) or operated by another medical entity (e.g., under the common ownership, licensure or control of an entity). An ASF is subject to this regulation regardless of whether it is licensed by a Federal, State, municipal, or local government or regardless of whether it is accredited by a recognized accreditation organization. If an adverse event meets the criteria for reporting, the ASF must report that event regardless of the nature or location of the medical service provided by the ASF.

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