R-TF-015-004 Clinical Investigation Plan

Scope

The purpose of this Clinical Investigation Plan (CIP) is to set out the rationale, objectives, design, methodology, conduct, implementation, record-keeping and the method of analysis for the clinical investigation.

CIP Identification

	CIP
Title of the clinical investigation	Legit.Health Medical Device: Prospective Validation and Optimization of Teledermatology Referrals in a Pilot Study
Device under investigation	Legit.Health Plus version 1.1.0.0
Protocol version	Version 4.0
Date	22/10/2025
Protocol code	Legit.Health_clinical_VH_2025
Sponsor	AI LABS GROUP, S.L (Legit.Health)
Coordinating Investigator	Dr. Álvaro Gómez Tomás
Principal Investigator(s)	Dr. Álvaro Gómez Tomás
Collaborating Investigator(s)	Dr. Jordi Mollet, Dr. Vicente García-Patos, Alfonso Medela, Andy Aguilar, Taig Mac Carthy, Dr. Jordi Barrachina
Investigational site(s)	Hospital Universitari Vall d'Hebron
Ethics Committee	Hospital Universitari Vall d'Hebron

Table of contents

• Scope
• CIP Identification
• Compliance statement
• Abbreviations and Definitions
• CIP or protocol specifications
  • Principal Investigator
  • Coordinating Investigator(s)
  • Collaborating Investigator(s)
  • Investigational sites
  • Funding
• Product Identification and Description
  • Device accountability
• Justification of the design
  • Background and rationale
  • Evaluation of preclinical and clinical data
• Hypothesis
• Objectives
  • Primary objetive(s)
  • Secondary objective(s)
• Summary of the study
• Design and Methods
  • Type of clinical research
  • Population
  • Duration
  • Acceptance criteria
  • Inclusion and exclusion criteria
  • Variables
  • Condition of interest
  • Quality control
  • Limitations of clinical research
• Ethical considerations
  • Data confidentiality
  • Information to subjects and informed consent
  • Bias minimization measures
  • Calendar
  • Monitoring plan
  • Subject follow-up procedures
  • Completition of the investigation
  • Statistical analysis
  • Procedures
  • Data management
• CIP Modification
• CIP Deviations
• Start, follow-up and end reports
• Statements of compliance
• Informed Consent process
• Adverse events, adverse product reactions and product deficiencies
  • Adverse Events (AE) and Adverse Event to Product (AEP)
  • Product deficencies
  • Serious Adverse Events, serios adverse events to product and serious and unexpected adverse event to the product
  • Non-reportable Adverse Events
  • Notification Process
  • Foreseeable adverse events and adverse events to product
  • Emergency contact
  • Data Monitoring Committee (DMC)
• Vulnerable population (if applicable)
• Suspension or early termination of clinical research
• Publication policy
• Bibliography

Compliance statement

The clinical investigation will be conducted according to the Clinical Investigation Plan (CIP) and other applicable guidances and regulations. This includes compliance with:

• The ethical principles originating from the World Medical Association's Declaration of Helsinki
• Harmonized standard UNE-EN ISO 14155:2020
• Regulation (EU) 2017/745 on medical devices (MDR), including the applicable General Safety and Performance Requirements (GSPR) as outlined in Annex I, and the requirements of Annex XV (Chapter I and Chapter II, Section 3)
• Harmonized standard UNE-EN ISO 13485:2016
• MDCG 2024-3 for its structural and content expectations, MDCG 2021-8 concerning application requirements, and MDCG 2020-10/1 Rev 1 for safety reporting timelines and definitions
• Regulation (EU) 2016/679 (GDPR)
• Spanish Organic Law 3/2018 on the Protection of Personal Data and guarantee of digital rights.

All data processing within the device is carried out in accordance with the highest standards of data protection and privacy. Patient information is managed in an encrypted manner to ensure confidentiality and security.

The research team assumes the role of Data Controller, responsible for the collection and management of study data. Legit.Health acts as the Data Processor and is not involved in the processing of patient data.

The storage and transfer of data comply with European data protection regulations. At the conclusion of the study, all information stored in the device will be permanently and securely deleted.

The device employs robust technical and organizational security measures to safeguard personal data against unauthorized access, alteration, loss, or processing.

Abbreviations and Definitions

• AE: Adverse Event
• AEMPS: Spanish Agency of Medicines and Medical Devices
• AEP: Adverse Reaction to Product
• AUC: Area Under the ROC Curve
• CAD: Computer-Aided Diagnosis
• CMD: Data Monitoring Committee
• CIP: Clinical Investigation Plan
• CUS: Clinical Utility Questionnaire
• DLQI: Dermatology Quality of Life Index
• GCP: Standards of Good Clinical Practice
• ICH: International Conference of Harmonization
• IFU: Instructions For Use
• IRB: Institutional Review Board
• N/A: Not Applicable
• NCA: National Competent Authority
• PI: Principal Investigator
• PPV: Positive Predictive Value
• NPV: Negative Predictive Value
• SAE: Serious Adverse Events
• SAEP: Serious Adverse Event to Product
• SUAEP: Serious and Unexpected Adverse Event to the Product
• SUS: System Usability Scale

CIP or protocol specifications

Principal Investigator

Dr. Álvaro Gómez Tomás Servei de Dermatologia, Hospital Universitari Vall d'Hebron Pg. de la Vall d'Hebron, 119, Horta-Guinardó, 08035 Barcelona

Coordinating Investigator(s)

Dr. Álvaro Gómez Tomás Servei de Dermatologia, Hospital Universitari Vall d'Hebron

Collaborating Investigator(s)

• Dr. Jordi Mollet (Servei de Dermatologia)
• Dr. Vicente García-Patos (Servei de Dermatologia)
• Alfonso Medela (AI LABS GROUP, S.L.)
• Andy Aguilar (AI LABS GROUP, S.L.)
• Taig Mac Carthy (AI LABS GROUP, S.L.)
• Dr. Jordi Barrachina (AI LABS GROUP, S.L.)

Investigational sites

Hospital Universitari Vall d'Hebron Pg. de la Vall d'Hebron, 119, Horta-Guinardó, 08035 Barcelona

Funding

Sponsor: AI LABS GROUP, S.L. No external funding sources are anticipated.

Product Identification and Description

	Information
Device name	Legit.Health Plus (hereinafter, the device)
Model and type	NA
Version	1.1.0.0
Basic UDI-DI	8437025550LegitCADx6X
Certificate number (if available)	MDR 792790
EMDN code(s)	Z12040192 (General medicine diagnosis and monitoring instruments - Medical device software)
GMDN code	65975
EU MDR 2017/745	Class IIb
EU MDR Classification rule	Rule 11
Novel product (True/False)	TRUE
Novel related clinical procedure (True/False)	TRUE
SRN	ES-MF-000025345

Device accountability

Given that the investigational device is a Software as a Medical Device (SaMD), product accountability is managed through strict access control to the platform. Access to the software is granted exclusively to authorized investigators and registered patients during the clinical investigation through secure credentials (username and password). The sponsor will maintain a log of all active accounts and usage metrics associated with the clinical investigation. Upon completion, early termination, or temporary halt of the study, or if a user withdraws consent, their access credentials will be immediately revoked to prevent further use. Malfunctioning software versions or "expired" access rights are similarly managed by restricting access and disabling accounts, ensuring no unauthorized or obsolete product use occurs.

Justification of the design

Background and rationale

Access for the general population to a dermatology specialist is complicated due to the low number of professionals (3 dermatologists per 100,000 inhabitants), making it even more difficult in small population centers. Consequently, the detection and diagnosis of dermatological lesions must be carried out by a primary care physician, whose diagnostic capacity is usually lower, increasing the risk of incorrect diagnoses. Literature shows a discrepancy of between 55% and 65% between the primary care physician and the specialist.

In recent years, the demand has grown for the development of Computer-Aided Diagnosis (CAD) systems. Artificial intelligence algorithms can classify photographs of lesions with a level of competence comparable to an expert doctor. Thus, the use of computer vision applications provides not only reliability but also greater accuracy in measuring visual signs and quantifying the severity of the pathology.

This study aims to clinically validate an artificial intelligence tool to optimize referrals to Dermatology from Primary Care, both in number and in prioritization. Additionally, it analyzes its impact on healthcare system efficiency: reducing costs associated with unnecessary referrals, optimizing resources, and decreasing waiting times for severe patients.

Evaluation of preclinical and clinical data

These evaluations can be consulted in the T-015-005 Investigator's brochure.

Hypothesis

The hypothesis guiding this study is that the implementation of the device can improve the appropriateness of patient referrals to dermatology consultations.

This is based on the notion that artificial intelligence introduces significant changes in the diagnosis and monitoring process:

1. Higher sensitivity and specificity than a primary care physician in diagnosing skin pathologies, especially in differentiating malignant and benign lesions.
2. Provides a clinically validated second medical opinion.
3. The identification and subsequent prioritization of malignant lesions will reduce waiting times in this pathology.

Objectives

Primary objetive(s)

To evaluate if the medical device with artificial intelligence can be a suitable tool to prioritize referrals from Primary Care to Dermatology.

Secondary objective(s)

• Evaluate if the implementation of the device reduces the number of days until care is provided for more severe cases.
• Evaluate if the device would reduce dermatology waiting lists by reducing potentially avoidable referrals and prioritizing severe cases.
• Evaluate if the use of the device improves the diagnostic capacity of Primary Care physicians.
• Evaluate the quality of images sent via teledermatology.

Summary of the study

The study will include a minimum of 50 adult patients (≥ 18 years) with skin pathologies seen in primary care at the health centers of the SAP Muntanya area, the reference area for the Vall d'Hebron University Hospital.

Design and Methods

Type of clinical research

Cross-sectional observational validation study of a medical device as well as evaluation and improvement of healthcare quality.

Population

Adult patients (≥ 18 years) with skin pathologies seen in primary care at the reference health centers of the Vall d'Hebron University Hospital.

Duration

Recruitment period: 6 months. Total study duration: 12 months, including the time necessary after the recruitment of the last subject for database closure, data analysis, and preparation of the final report. Participation duration of each patient: The patient will only be surveyed on the day of their visit with their primary care physician; no longitudinal follow-up is planned.

Acceptance criteria

• Diagnostic accuracy: Top-1 $\ge 50\%$, Top-3 $\ge 70\%$, Top-5 $\ge 80\%$.
• Agreement between device and dermatologist diagnosis: $\kappa > 0.8$.
• Statistically significant reduction of unnecessary referrals: $\ge 20\%$.
• Malignancy detection: AUC $\ge 0.8$, sensitivity $\ge 75\%$, specificity $\ge 80\%$.
• Increase in correctly identified and referred "preferent" cases: $\ge 20\%$.
• Reduction of cumulative waiting time for consultations: $\ge 30\%$.

Inclusion and exclusion criteria

Inclusion Criteria:

• Patients with dermatological pathologies to be referred via teleconsultation.
• Patients aged 18 or older with the capacity to give consent.
• Patients who have signed the study's informed consent.

Exclusion Criteria:

• Patient who, in the investigator's opinion, will not comply with the study procedures.
• Lesions on genitals, close to tattoos, or that upon taking the photograph allow unequivocal identification of the person.

Variables

Primary Variable: The appropriateness of referrals from Primary Care to Dermatology before and after using Legit.Health support. This is established by comparing the concordance between diagnostic classes and prioritization degrees (no referral / normal / preferential) before and after using the tool.

Secondary Variables:

• Clinical data: PC dates of assistance, sex, age, time of evolution, diagnostic orientation (DO) before Legit.Health, request priority before Legit.Health, DO after Legit.Health, request priority after Legit.Health.
• Dermatology data: recommended request priority, CIE-10 diagnosis, diagnostic superfamily (benign/premalignant/malignant/infectious/inflammatory/other).
• Legit.Health perceived usefulness (Likert 1-5) and ease of use (Likert 1-5).
• Image quality received (DIQA).
• Cost reduction: Computed as the product of a dermatology consultation cost and the number of consultations the algorithm would have avoided.
• Waiting list reduction.
• Improvement in diagnostic capacity of Primary Care physicians.
• Tool usability evaluated via System Usability Scale (SUS).

Condition of interest

Dermatological conditions and optimization of referrals in primary care teledermatology.

Quality control

The Principal Investigator is responsible for reviewing and approving the study protocol and ensuring data quality. Data will be entered into an electronic Database using double data entry. Validation processes using computerized filters based on validation rules will be executed to identify missing or incongruent values.

Limitations of clinical research

The main limitation regarding machine learning is the quantity and quality of the collected images. Variability in illumination, color, shape, size, and focus is determinant. Another potential limitation is the "Hawthorne effect", meaning observers might change their judgments knowing they are being evaluated. To minimize this, the evaluation of images by the Dermatology team will be blinded to the Primary Care physician's diagnosis and the Legit.Health algorithm.

Ethical considerations

This study adhered to international Good Clinical Practice (GCP) guidelines, the Declaration of Helsinki in its latest amendment, and applicable international and national regulations. As applicable, approval from the relevant Ethics Committee was obtained prior to the initiation of the study. When applicable, modifications to the protocol were reviewed and approved by the Principal Investigator (PI) and subsequently evaluated by the Ethics Committee before subjects were enrolled under a modified protocol.

This study was conducted in compliance with European Regulation 2016/679, of 27 April, concerning the protection of natural persons with regard to the processing of personal data and the free movement of such data (General Data Protection Regulation, GDPR), and Organic Law 3/2018, of 5 December, on the Protection of Personal Data and the guarantee of digital rights. In accordance with these regulations, no data enabling the personal identification of participants was collected, and all information was managed securely in an encrypted format.

Participants were informed both orally and in writing about all relevant aspects of the study, with the information being tailored to their level of understanding. They were provided with a copy of the informed consent form and the accompanying patient information sheet. Adequate time was given to patients to ask questions and fully comprehend the details of the study before providing their consent.

The PI was responsible for the preparation of the informed consent form, ensuring it included all elements required by the International Conference on Harmonisation (ICH), adhered to current regulatory guidelines, and complied with the ethical principles of GCP and the Declaration of Helsinki.

The original signed informed consent forms were securely stored in a restricted access area under the custody of the PI. These documents remained at the research site at all times. Participants were provided with a copy of their signed consent form for their records.

Data confidentiality

Current legislation will be complied with in terms of data confidentiality protection (European Regulation 2016/679, of 27 April, on the protection of natural persons with regard to the processing of personal data and the free movement of such data and Organic Law 3/2018, of 5 December, on Personal Data Protection and guarantee of digital rights). For this purpose, when applicable, each participant will receive an alphanumeric identification code in the study that will not include any data allowing personal identification (coded CRD). The Principal Investigator will have an independent list that will allow the connection of the identification codes of the patients participating in the study with their clinical and personal data. This document will be filed in a secure area with restricted access, under the custody of the Principal Investigator and will never leave the centre.

Once the paper CRDs are completed and closed by the Principal Investigator, the data will be transferred to a database.

As in the CRDs, the Database will comply with current legislation in terms of data confidentiality protection (European Regulation 2016/679, of 27 April, on the protection of natural persons about the processing of personal data and the free movement of such data and Organic Law 3/2018, of 5 December, on the Protection of Personal Data and guarantee of digital rights) in which no data allowing personal identification of patients will be included.

Information to subjects and informed consent

The primary care physician will explain the study to the patient using the Patient Information Sheet. If the patient wishes to participate, they will sign the Informed Consent, and a study code will be assigned.

Bias minimization measures

To minimize the Hawthorne effect and ensure objective prioritization evaluation, the dermatology team's assessment of the images will be conducted blinded, without knowing the primary care physician's diagnosis or the Legit.Health algorithm output.

Calendar

Recruitment period of 6 months. Total study duration estimated at 12 months.

Monitoring plan

A clinical monitoring plan has been established to oversee the progress of the clinical investigation, ensuring that it is conducted, recorded, and reported in accordance with the protocol, Good Clinical Practice, and the applicable regulatory requirements. This pilot study will rely on internal validation processes, database closure, and independent principal investigator responsibilities. Every 3 months a monitoring meeting will be held between the investigational team and the monitor designated by the sponsor (Jordi Barrachina) to review the study's development and address possible questions.

Subject follow-up procedures

In the event of early termination, temporary suspension, or completion of the clinical investigation, subjects will continue to receive the standard of care as determined by their treating physician. If a subject withdraws their consent, no further data will be collected, but previously collected data will be processed according to data protection regulations, and the patient's routine medical care will not be affected. For subjects lost to follow-up, the investigating site will make reasonable attempts to contact the subject before officially recording them as lost. After the clinical investigation, subjects will return to their regular clinical care pathways without any alteration to their healthcare provision caused by the study.

Completition of the investigation

The database will be considered closed after completing all data management processes and resolving discrepancies. Following this, the statistical analysis and final study report will be executed.

Statistical analysis

Variables will be characterized using frequency distributions for qualitative variables and measures of central tendency and variability for quantitative ones. Concordance analysis between the AI tool, dermatologists, and primary care physicians will be performed (using Cohen's kappa and McNemar test). Sensitivity, specificity, PPV, NPV, LR+, and LR- will be calculated comparing Legit.Health results to dermatologists' diagnoses as the gold standard. Analyses will be performed using R software, with p < 0.05 considered significant.

Procedures

The primary care physician will assess the patient, record their diagnostic orientation and referral criteria before and after using the device. The physician will take photographs of the affected areas using a smartphone/dermatoscope, which will be uploaded to an encrypted storage platform. Dermatologists will later review the photographs, recording their final diagnosis and priority to evaluate concordance.

Data management

The data will be managed and tabulated with consistency rules and logical ranges to control inconsistencies during data tabulation. A validation process of the clinical data will be carried out by running computer filters based on validation rules, which will automatically identify missing values or inconsistencies of clinical data according to the protocol. Additionally, manual editing and validation will be performed using descriptive and exploratory statistical techniques to complement the detection of logical errors and inconsistent values.

The database will be considered closed upon completion of all data management processes and satisfactory resolution of discrepancies and errors in the data. Any changes in the database after its closure can only be made after written agreement between the Principal Investigator and the technical coordinators of the project.

AI Labs Group, S.L. (hereinafter, the manufacturer) is the owner of the device. During the period of validity of this study, the manufacturer will grant a license to use the device by the research team free of charge. The research team will be the administrator of the account. Both patients and members of the medical team will have login credentials. The manufacturer will not have access to the account or patient information.

According to the definitions and roles set out in Regulation (EU) 2016/679 (GDPR), the Data Controller is the research team and the manufacturer is the Data Processor.

The storage of data and photographs will be in line with the European Regulation 2016/679 (GDPR) and the Organic Law 3/2018 of 5 December on the Protection of Personal Data and guarantee of digital rights. At the end of the study, all information stored in the device will be totally and permanently deleted.

The device complies with current legislation on the protection and confidentiality of personal data European Regulation 2016/679 (GDPR). Appropriate technical and organizational security measures are adopted to ensure the security of personal data and prevent its alteration, loss, unauthorized processing or access, given the state of technology, the nature of the data and the risks to which they are exposed, whether from human action or the natural physical environment.

CIP Modification

As indicated in the UNE-EN ISO 14155:2021 standard, the Clinical Investigation Plan (CIP) may be modified as necessary during the clinical investigation. The changes made must be described, along with their justification, potential impact on clinical performance, efficacy, safety, or other evaluation criteria, and identification of other affected documents.

CIP modifications will be prepared by the sponsor and agreed upon and accepted between the sponsor and the principal investigator. The modifications will be recorded with a justification for each one in the form of an amendment or addendum.

The required regulatory authority (AEMPS) and the Ethics Committee or Institutional Review Board (IRB) will be notified, if necessary. Modifications to the clinical investigation may only be implemented once favourable feedback and the corresponding approval have been obtained.

In accordance with Article 75 of Regulation (EU) 2017/745, substantial modifications to the clinical investigation must be approved by both the Ethics Committee for investigation with medicines (CEIm) and the Competent Authority (AEMPS) prior to their implementation.

• In the case of substantial modifications to authorized clinical investigations, a request must be submitted to the AEMPS and the CEIm.
• For non-substantial modifications to authorized clinical investigations, until the corresponding module is available in the EUDAMED database, the updated documentation will be sent to the AEMPS for inclusion in their file.

CIP Deviations

As indicated in the UNE-EN ISO 14155:2021 standard, the investigator may not deviate from the Clinical Investigation Plan (CIP), except in emergencies (section 4.5.4.b of the standard). In such cases, the investigator may proceed without prior approval from the sponsor and the Ethics Committee to protect the rights, safety, and well-being of human subjects. The use of waivers from the Clinical Investigation Plan is strictly prohibited.

These deviations must be documented by the principal investigator and notified to the sponsor and the IRB as soon as possible, and always within a maximum of 15 days. Immediately after receiving the notification, the sponsor will record and analyze the deviations carried out and their potential impact. Depending on the findings, the sponsor will take the necessary corrective and/or preventive measures.

In other circumstances, when deviations affect the rights, safety, and well-being of the subject or the scientific integrity of the clinical investigation, deviation requests and reports must be provided to the IRB if required.

Start, follow-up and end reports

The start of the study will be notified to the ethics committee (CEIm). Any required follow-ups will be provided as established by national regulations. At the end of the study, a final report (T-015-006 Clinical Investigation Report (CIR)) will be generated.

Statements of compliance

The present clinical investigation will be conducted following the ethical principles originating from the Declaration of Helsinki.

Additionally, the clinical investigation will comply with the harmonized standard UNE-EN ISO 14155:2021 and the European Regulation MDR 2017/745. The statement specifying compliance with the general safety and performance requirements in accordance with MDR can be found in the document Manufacturer's Declaration of Compliance with Requirements.

As appropiate, clinical investigation will not commence until approval/favourable opinion has been obtained from the Clinical Research Ethics Committee (CREC) and the required regulatory authority (Spanish Agency for Medicines and Medical Devices, AEMPS), and it must comply with any additional requirements imposed by the CREC and/or AEMPS.

The statement regarding the funding of the clinical investigation, along with the description of the agreement between the sponsor and the research centers and between the sponsor and the principal investigator, can be found in the Clinical Trial Agreement (CTA) and can be accessed upon request.

Informed Consent process

The primary care physician will explain the study to the patient via the Patient Information Sheet. The patient can ask questions to clarify any doubts. If they agree to participate, they will sign the Informed Consent and receive a study code. The original signed consent will be kept in a secure, restricted-access area at the center, and a copy will be provided to the patient.

The patient information form (or family member or legally authorized representative), as well as the informed consent document, can be found in the Patient Information Sheet and Informed Consent Form (PIS/ICF).

Adverse events, adverse product reactions and product deficiencies

Adverse Events (AE) and Adverse Event to Product (AEP)

An AE is any unintended medical event, unanticipated illness or injury, or unintended clinical signs (including abnormal laboratory findings) in subjects, users, or other persons, whether or not related to the investigational product and whether intended or unintended.

A AEP is an adverse event related to the use of an investigational medical device.

Given these definitions, potential AEPs or AEs are documented in the product's IFU.

Product deficencies

Possible inadequacies of a medical device may relate to its identity, quality, durability, reliability, safety, or performance.

Considering this definition, the following issues could arise:

• Malfunctions, such as application crashes or failure to process images.
• Use errors, such as capturing poor quality photographs or incorrect data entry.
• Inadequate information provided by the manufacturer, such as a complex IFU and/or labeling.

Product deficiencies in the investigation will be managed by the sponsor according to non-conforming product control procedures. When appropriate, corrective and/or preventive actions will be taken to protect the safety of subjects, users, and other individuals.

Serious Adverse Events, serios adverse events to product and serious and unexpected adverse event to the product

According to UNE-EN ISO 14155:2021:

• A Serious Adverse Product Reaction (SAEP) is a SAE that has produced any consequence characteristic of a serious adverse event.
• A Serious Adverse Event (SAE) is an AE that resulted in any of the following events: death, serious deterioration of the health status of the subject, users or other persons, or fetal distress, fetal death, congenital anomaly or birth defect.
• A Serious Unexpected Adverse Event to the Product (SUAEP) is a SAE that, due to its nature, incidence, intensity or consequences, has not been identified in the updated risk assessment.

Taking into account these definitions, there are no SAEP, SAEs or SUAEPs related to the use of the product.

Non-reportable Adverse Events

note

List non-reportable adverse events, if applicable, including justification.

There are no specific non-reportable adverse events defined for this study, as the device intervention involves no physical risk to patients and acts as a clinical decision support tool.

Notification Process

Any SAEP, product deficiency or finding related to the above will be duly documented and reported in accordance with the provisions of document MDCG 2020-10/1 “Safety reporting in clinical investigations of medical devices under the Regulation (EU) 2017/745”

In the situations detailed in the previous paragraph, the principal investigator must notify the sponsor immediately (but no later than 3 days after becoming aware of the event). The sponsor will then use the form published as an annex to said document, MDCG 2020-10/2 “Guidance safety report form”.

This form must be completed or updated for each reportable event or for new findings or updates of events already reported. It will be transmitted to all National Competent Authorities (NCA) where the clinical investigation is being conducted. In this case, the AEMPS. Once EUDAMED is available and fully operational, the obligations and requirements related to the preparation of safety reports through EUDAMED will apply from six months after the date of publication of the notice in the Official Journal of the European Union.

The notification period of the sponsor to the NCA(s) will be immediately (but no later than 2 days after becoming aware of the event) for reportable events that involve an imminent risk of death, serious injury or serious illness and that require immediate corrective action, or new findings or updates of related events. For the rest of reportable events or new findings or updates, the notification period will be immediately (but no later than 7 days after becoming aware of the event).

Likewise, as indicated in the UNE-EN ISO 14155:2021 regulation, the IRB must be notified of the SAEs, if the IRB so requires.

Foreseeable adverse events and adverse events to product

The foreseeable adverse events and expected adverse reactions to the product, as well as their incidence, mitigation and treatment are documented in the T-013-002 Risk management record of the product under study.

Emergency contact

The emergency contact person for reporting serious adverse events and serious adverse effects of the product:

• Name: Dr. Álvaro Gómez Tomás
• Professional role: Principal Investigator
• E-mail: alvaro.gomez@vallhebron.cat

Data Monitoring Committee (DMC)

Information on the DMC (Data Monitoring Committee), if established. This is an independent committee that the sponsor may establish to evaluate, at indicated intervals, the progress of the clinical investigation, the safety data or the critical clinical performance or efficacy endpoints and to recommend to the sponsor whether to continue, suspend, modify, or stop the clinical investigation.

Vulnerable population (if applicable)

N/A

Suspension or early termination of clinical research

As indicated in the UNE-EN ISO 14155:2021 regulation, the sponsor may suspend or terminate the clinical research early for significant and documented reasons. These are:

• If during the clinical research the suspicion of an unacceptable risk arises, including a serious threat to the health of the subjects. It must be suspended while the risk is determined.
• If an unacceptable risk that cannot be controlled is confirmed.
• Due to the impossibility of including a minimum number of subjects that allows the final assessment of the study within a reasonable period according to the characteristics of the study.
• When instructed by the IRB or the required regulatory authority (AEMPS).
• Due to non-compliance with the obligations assumed in the contract by any of the contracting parties.
• By mutual agreement between the parties, expressed in writing.
• By the will of one of the parties, expressed in writing at least one month in advance.

In the event of a suspension or early termination of the clinical research, the sponsor will inform the AEMPS. The sponsor must provide the resources to comply with the obligations of the CIP and with the existing agreements. The principal investigator must inform the subjects if so stipulated in the agreement between the sponsor and the research centre.

If the clinical investigation is resumed, the sponsor must inform the principal investigator and, where appropriate, the AEMPS. Approval from the IRB and, where appropriate, from the AEMPS will be required for such resumption. The principal investigator must inform the subjects.

In accordance with Article 77 of Regulation (EU) 2017/745, the sponsor must notify the Member States in which the clinical investigation is being conducted of the end of the clinical investigation, its temporary halt, or its early termination, within the deadlines specified by the regulation (within 15 days of the end, or within 24 hours in case of early termination or temporary halt for safety reasons). This notification must be accompanied by a justification in case of early termination or temporary halt.

Publication policy

Statement indicating the conditions and time periods in which the results of the clinical research will be offered for publication, including the role played by the sponsor and the criteria for authorship of the publication.

The description of the clinical research will be recorded in a publicly accessible database (e.g. ClinicalTrials.gov or EUDAMED once fully functional) before the recruitment of the first subject. Its content will be updated during the conduct of the clinical research.

In accordance with the legal requirements and ethical principles established in Section 1 of Chapter I of Annex XV of Regulation (EU) 2017/745, a Clinical Investigation Report (T-015-006 Clinical Investigation Report (CIR)) will be prepared within one year of the end of the clinical investigation or within three months of its early termination or temporary halt. The CIR will be provided to the IRB and the AEMPS.

The results of the clinical investigation will be published in the aforementioned public database. The summary of the clinical investigation report and its results (whether positive, negative, or inconclusive) will be made available to the public within 1 year from the end of the clinical investigation, or within 3 months in the event of early termination or temporary halt.

In addition, if deemed appropriate, the results obtained will be published in scientific journals. The CEIC that has approved this clinical research will be mentioned, and the funds obtained by the author for or for its conduct and the source of funding will be stated. The anonymity of the subjects participating in the clinical research will be maintained at all times.

Bibliography

References can be consulted in the original PDF protocol document.

Signature meaning

The signatures for the approval process of this document can be found in the verified commits at the repository for the QMS. As a reference, the team members who are expected to participate in this document and their roles in the approval process, as defined in Annex I Responsibility Matrix of the GP-001, are:

• Author: Team members involved
• Reviewer: JD-003 Design & Development Manager, JD-004 Quality Manager & PRRC
• Approver: JD-001 General Manager

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