Gravitate Health FHIR Implementation Guide
0.1.0 - CI Build
Gravitate Health FHIR Implementation Guide
0.1.0 - CI Build
Gravitate Health FHIR Implementation Guide, published by Gravitate Health Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/joofio/test-epi-composition/ and changes regularly. See the Directory of published versions
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<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><a name="Composition_composition-en-1ab1f974f728f0d2d09ca9306f1ffe2d"> </a><p class="res-header-id"><b>Generated Narrative: Composition composition-en-1ab1f974f728f0d2d09ca9306f1ffe2d</b></p><a name="composition-en-1ab1f974f728f0d2d09ca9306f1ffe2d"> </a><a name="hccomposition-en-1ab1f974f728f0d2d09ca9306f1ffe2d"> </a><a name="composition-en-1ab1f974f728f0d2d09ca9306f1ffe2d-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/HL7/emedicinal-product-info/StructureDefinition-Composition-uv-epi.html">Composition (ePI)</a></p></div><p><b>identifier</b>: <code>http://ema.europa.eu/identifier</code>/EU/1/23/1779/001</p><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{https://spor.ema.europa.eu/rmswi/ 100000155538}">Package Leaflet</span></p><p><b>category</b>: <span title="Codes:{http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/epicategory-cs R}">Raw</span></p><p><b>date</b>: 2022-02-16 13:28:17+0000</p><p><b>author</b>: <a href="Organization-mah-ema.html">Organization ACME industry</a></p><p><b>title</b>: TEST PURPOSES ONLY - rimmyrah</p><h3>Attesters</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Mode</b></td><td><b>Time</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://hl7.org/fhir/composition-attestation-mode official}">Official</span></td><td>2022-02-16 13:28:17+0000</td></tr></table></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>What is in this leaflet</p><ol type="1"><li>What Rimmyrah is and what it is used for</li><li>What you need to know before you are given Rimmyrah</li><li>How Rimmyrah is given</li><li>Possible side effects</li><li>How to store Rimmyrah</li><li>Contents of the pack and other information</li></ol></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>What Rimmyrah is Rimmyrah is a solution which is injected into the eye. Rimmyrah belongs to a group of medicines called antineovascularisation agents. It contains the active substance called ranibizumab.</p><p>What Rimmyrah is used for Rimmyrah is used in adults to treat several eye diseases causing vision impairment.</p><p>These diseases result from damage to the retina (light-sensitive layer at the back of the eye) caused by:</p><ul><li>Growth of leaky, abnormal blood vessels. This is observed in diseases such as age-related macular degeneration (AMD) and proliferative diabetic retinopathy (PDR, a disease caused by diabetes). It may also be associated with choroidal neovascularisation (CNV) due to pathologic myopia (PM), angioid streaks, central serous chorioretinopathy or inflammatory CNV.</li><li>Macular oedema (swelling of the centre of the retina). This swelling can be caused by diabetes (a disease called diabetic macular oedema (DME)) or by the blockage of retinal veins of the retina (a disease called retinal vein occlusion (RVO)).</li></ul><p>How Rimmyrah works Rimmyrah specifically recognises and binds to a protein called human vascular endothelial growth factor A (VEGF-A) present in the eye. In excess, VEGF-A causes abnormal blood vessel growth and swelling in the eye which can lead to impairment of vision in diseases like AMD, DME, PDR, RVO, PM and CNV. By binding to VEGF-A, Rimmyrah can block its actions and prevent this abnormal growth and swelling.</p><p>In these diseases, Rimmyrah can help to stabilise and in many cases improve your vision.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>You must not receive Rimmyrah</p><ul><li>If you are allergic to ranibizumab or any of the other ingredients of this medicine (listed in section 6).</li><li>If you have an infection in or around your eye.</li><li>If you have pain or redness (severe intraocular inflammation) in your eye.</li></ul><p>Warnings and precautions Talk to your doctor before you are given Rimmyrah.</p><ul><li>Rimmyrah is given as an injection into the eye. Occasionally, an infection in the internal portion of the eye, pain or redness (inflammation), detachment or tear of one of the layers in the back of the eye (retinal detachment or tear and retinal pigment epithelial detachment or tear), or clouding of the lens (cataract) may occur after Rimmyrah treatment. It is important to identify and treat such an infection or retinal detachment as soon as possible. Please tell your doctor immediately if you develop signs such as eye pain or increased discomfort, worsening eye redness, blurred or decreased vision, an increased number of small particles in your vision or increased sensitivity to light.</li><li>In some patients the eye pressure may increase for a short period directly after the injection.</li><li>This is something you may not notice, therefore your doctor may monitor this after each injection.</li><li>Inform your doctor if you have a prior history of eye conditions or eye treatments, or if you have had a stroke or experienced transient signs of stroke (weakness or paralysis of limbs or face, difficulty speaking or understanding). This information will be taken into account to evaluate if Rimmyrah is the appropriate treatment for you.</li></ul><p>Please see section 4 ( Possible side effects ) for more detailed information on side effects that could occur during Rimmyrah therapy.</p><p>Children and adolescents (below 18 years of age) The use of Rimmyrah in children and adolescents has not been established and is therefore not recommended.</p><p>Other medicines and Rimmyrah Tell your doctor if you are using, have recently used or might use any other medicines.</p><p>Pregnancy and breast-feeding</p><ul><li>Women who could become pregnant must use effective contraception during treatment and for at least three further months after the last injection of Rimmyrah.</li><li>There is no experience of using Rimmyrah in pregnant women. Rimmyrah should not be used during pregnancy unless the potential benefit outweighs the potential risk to the unborn child. If you are pregnant, think you may be pregnant or planning to become pregnant, discuss this with your doctor before treatment with Rimmyrah.</li><li>Small amounts of ranibizumab may pass into breast milk, therefore Rimmyrah is not recommended during breast-feeding. Ask your doctor or pharmacist for advice before Rimmyrah treatment.</li></ul><p>Driving and using machines After Rimmyrah treatment you may experience some temporary vision blurring. If this happens, do not drive or use machines until this resolves.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Rimmyrah is administered as a single injection into your eye by your eye doctor under a local anaesthetic. The usual dose of an injection is 0.05 ml (which contains 0.5 mg of ranibizumab). The interval between two doses injected into the same eye should be at least four weeks. All injections will be administered by your eye doctor.</p><p>Before the injection, your doctor will wash your eye carefully to prevent infection. Your doctor will also give you a local anaesthetic to reduce or prevent any pain you might have with the injection.</p><p>The treatment is started with one injection of Rimmyrah per month. Your doctor will monitor the condition of your eye and, depending on how you respond to the treatment, will decide if and when you need to receive further treatment.</p><p>Detailed instructions for use are given at the end of the leaflet.</p><p>Elderly (age 65 years and over) Rimmyrah can be used for people of 65 years of age and over without dose adjustment.</p><p>Before stopping Rimmyrah treatment If you are considering stopping Rimmyrah treatment, please go to your next appointment and discuss this with your doctor. Your doctor will advise you and decide how long you should be treated with Rimmyrah.</p><p>If you have any further questions on the use of this medicine, ask your doctor.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>Like all medicines, this medicine can cause side effects, although not everybody gets them.</p><p>The side effects associated with the administration of Rimmyrah are either due to the medicine itself or the injection procedure and mostly affect the eye.</p><p>The most serious side effects are described below:</p><p>Common serious side effects (may affect up to 1 in 10 people):</p><ul><li>Detachment or tear of the layer in the back of the eye (retinal detachment or tear), resulting in flashes of light with floaters progressing to a temporary loss of sight, or a clouding of the lens (cataract).</li></ul><p>Uncommon serious side effects (may affect up to 1 in 100 people):</p><ul><li>Blindness, infection of the eyeball (endophthalmitis) with inflammation of the inside of the eye.</li></ul><p>The symptoms you might experience are pain or increased discomfort in your eye, worsening eye redness, blurred or decreased vision, an increased number of small particles in your vision or increased<br/>sensitivity to light.</p><p>Please tell your doctor immediately if you develop any of these side effects.</p><p>The most frequently reported side effects are described below:</p><p>Very common side effects (may affect more than 1 in 10 people) Visual side effects include:</p><ul><li>Inflammation of the eye,</li><li>Bleeding in the back of the eye (retinal bleeding),</li><li>Visual disturbances,</li><li>Eye pain,</li><li>Small particles or spots in your vision (floaters),</li><li>Bloodshot eye, eye irritation,</li><li>A feeling of having something in the eye,</li><li>Increased tear production,</li><li>Inflammation or infection of the eyelid margins,</li><li>Dry eye,</li><li>Redness or itching of the eye,</li><li>Increased eye pressure.</li></ul><p>Non-visual side effects include:</p><ul><li>Sore throat,</li><li>Nasal congestion,</li><li>Runny nose,</li><li>Headache,</li><li>Joint pain.</li></ul><p>Other side effects which may occur following Rimmyrah treatment are described below:</p><p>Common side effects (may affect up to 1 in 10 people) Visual side effects include:</p><ul><li>Decreased sharpness of vision,</li><li>Swelling of a section of the eye (uvea, cornea),</li><li>Inflammation of the cornea (front part of eye),</li><li>Small marks on the surface of the eye,</li><li>Blurred vision,</li><li>Bleeding at the site of injection,</li><li>Bleeding in the eye,</li><li>Discharge from the eye with itching,</li><li>Redness and swelling (conjunctivitis),</li><li>Light sensitivity,</li><li>Eye discomfort,</li><li>Swelling of the eyelid,</li><li>Eyelid pain.</li></ul><p>Non-visual side effects include:</p><ul><li>Urinary tract infection,</li><li>Low red blood cells count (with symptoms such as tiredness, breathlessness, dizziness, pale skin),</li><li>Anxiety,</li><li>Cough,</li><li>Nausea (feeling sick),</li><li>Allergic reactions like rash, hives, itching and skin reddening.</li></ul><p>Uncommon side effects (may affect up to 1 in 100 people) Visual side effects include:</p><ul><li>Inflammation and bleeding in the front part of the eye,</li><li>Sac of pus on the eye,</li><li>Changes of the central part of the eye surface,</li><li>Pain or irritation at the site of injection,</li><li>Abnormal sensation in the eye,</li><li>Irritation of the eyelid.</li></ul><p>Reporting of side effects If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in Appendix V.<br/>By reporting side effects you can help provide more information on the safety of this medicine.</p></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><ul><li>Keep this medicine out of the sight and reach of children.</li><li>Do not use this medicine after the expiry date which is stated on the carton and vial label after EXP. The expiry date refers to the last day of that month.</li><li>Store in a refrigerator (2 C - 8 C). Do not freeze.</li><li>Prior to use, the unopened vial may be kept at room temperature (25 C) for up to 24 hours.</li><li>Keep the vial in the outer carton in order to protect from light.</li><li>Do not use any pack that is damaged.</li></ul></div>
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<div xmlns="http://www.w3.org/1999/xhtml"><p>What Rimmyrah contains</p><ul><li>The active substance is ranibizumab. Each ml contains 10 mg ranibizumab. Each vial contains 2,3 mg ranibizumab in 0.23 ml solution. This provides a suitable amount to deliver a single dose of 0.05 ml containing 0.5 mg ranibizumab.</li><li>The other ingredients are trehalose dihydrate, histidine hydrochloride monohydrate, histidine, polysorbate 20 (E432), water for injections.</li></ul><p>What Rimmyrah looks like and contents of the pack Rimmyrah is a solution for injection in a vial (0.23 ml). The solution is clear to slightly opalescent, colourless to brownish and aqueous.</p><p>Two different pack types are available:</p><p>Vial-only pack Pack containing one glass vial of ranibizumab with chlorobutyl rubber stopper. The vial is for single use only.</p><p>Vial + filter needle pack Pack containing one glass vial of ranibizumab with chlorobutyl rubber stopper and one blunt filter needle (18G 1 nches, 1.2 mm 40 mm, 5 micrometres) for withdrawal of the vial contents. All components are for single use only.</p><p>Marketing Authorisation Holder QILU PHARMA SPAIN S.L. Paseo de la Castellana 40, planta 8 28046 Madrid Spain</p><p>Manufacturer KYMOS, S.L. Ronda De Can Fatjo 7 B Parc Tecnologic Del Valles Cerdanyola Del Valles Barcelona 08Spain</p><p>For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:</p><p>Belgi /Belgique/Belgien Qilu Pharma Spain S.L. T l/Tel: + 34 911 841 Lietuva Qilu Pharma Spain S.L. Tel: + 34 911 841<br/>Qilu Pharma Spain S.L. Te .: + 34 911 841 Luxembourg/Luxemburg Qilu Pharma Spain S.L. T l/Tel: + 34 911 841 esk republika Qilu Pharma Spain S.L. Tel: +34 911 841 Magyarorsz g Qilu Pharma Spain S.L. Tel: +34 911 841 Danmark Qilu Pharma Spain S.L. Tlf: + 34 911 841 Malta Qilu Pharma Spain S.L. Tel: +34 911 841 Deutschland Orion Pharma GmbH Tel: +49 40 899 689-0</p><p>Nederland Qilu Pharma Spain S.L. Tel: +34 911 841 Eesti Qilu Pharma Spain S.L. Tel: +34 911 841 Norge Qilu Pharma Spain S.L. Tlf: + 34 911 841<br/>Orion Pharma Hellas . . .<br/>: + 30 210 980 3 sterreich Qilu Pharma Spain S.L. Tel: +34 911 841 Espa a Orion Pharma SL Tel: +349 159 9 86 Polska Orion Pharma Poland Sp. z o. o. Tel.: + 48 22 833 31 France Orion Pharma T l: +33 (0) 1 85 18 00 Portugal Qilu Pharma Spain S.L. Tel: +34 911 841 Hrvatska Qilu Pharma Spain S.L. Tel: +34 911 841 Ireland Qilu Pharma Spain S.L. Tel: +34 911 841 Rom nia Qilu Pharma Spain S.L. Tel: +34 911 841 Slovenija Qilu Pharma Spain S.L. Tel: +34 911 841 sland Qilu Pharma Spain S.L. S mi: + 34 911 841 Slovensk republika Qilu Pharma Spain S.L. Tel: + 34 911 841 Italia Orion Pharma S.r.l. Tel: + 39 02 67876Suomi/Finland Qilu Pharma Spain S.L. Puh/Tel: + 34 911 841<br/>Qilu Pharma Spain S.L. : + 34 911 841 Sverige Qilu Pharma Spain S.L. Tel: +34 911 841 Latvija Qilu Pharma Spain S.L. Tel: +34 911 841 United Kingdom (Northern Ireland) Orion Pharma (Ireland) Limited<br/>Tel: +353 1 428 7This leaflet was last revised in</p><p>Other sources of information Detailed information on this medicine is available on the European Medicines Agency website: <a href="http://www.ema.europa.eu">http://www.ema.europa.eu</a></p><p>THE FOLLOWING INFORMATION IS INTENDED FOR HEALTHCARE<br/>PROFESSIONALS ONLY:</p><p>Please also refer to section 3 How Rimmyrah is given .</p><p>Single-use vial for intravitreal use only</p><p>Rimmyrah must be administered by a qualified ophthalmologist experienced in intravitreal injections.</p><p>In wet AMD, in CNV, in PDR and in visual impairment due to DME or to macular oedema secondary to RVO the recommended dose for Rimmyrah is 0.5 mg given as a single intravitreal injection. This corresponds to an injection volume of 0.05 ml. The interval between two doses injected into the same eye should be at least four weeks.</p><p>Treatment is initiated with one injection per month until maximum visual acuity is achieved and/or there are no signs of disease activity i.e., no change in visual acuity and in other signs and symptoms of the disease under continued treatment. In patients with wet AMD, DME, PDR and RVO, initially, three or more consecutive, monthly injections may be needed.</p><p>Thereafter, monitoring and treatment intervals should be determined by the physician and should be based on disease activity, as assessed by visual acuity and/or anatomical parameters.</p><p>If, in the physician s opinion, visual and anatomical parameters indicate that the patient is not benefiting from continued treatment, Rimmyrah should be discontinued.</p><p>Monitoring for disease activity may include clinical examination, functional testing or imaging techniques (e.g. optical coherence tomography or fluorescein angiography).</p><p>If patients are being treated according to a treat-and-extend regimen, once maximum visual acuity is achieved and/or there are no signs of disease activity, the treatment intervals can be extended stepwise until signs of disease activity or visual impairment recur. The treatment interval should be extended by no more than two weeks at a time for wet AMD and may be extended by up to one month at a time for DME. For PDR and RVO, treatment intervals may also be gradually extended, however there are insufficient data to conclude on the length of these intervals. If disease activity recurs, the treatment interval should be shortened accordingly.</p><p>The treatment of visual impairment due to CNV should be determined individually per patient based on disease activity. Some patients may only need one injection during the first 12 months; others may need more frequent treatment, including a monthly injection. For CNV secondary to pathologic myopia (PM), many patients may only need one or two injections during the first year.</p><p>Ranibizumab and laser photocoagulation in DME and macular oedema secondary to BRVO There is some experience of ranibizumab administered concomitantly with laser photocoagulation. When given on the same day, ranibizumab should be administered at least 30 minutes after laser photocoagulation. ranibizumab can be administered in patients who have received previous laser photocoagulation.</p><p>Ranibizumab and verteporfin photodynamic therapy in CNV secondary to PM There is no experience of concomitant administration of ranibizumab and verteporfin.</p><p>Rimmyrah should be inspected visually to ensure there is no particulate matter, discolouration or disturbance prior to the administration. If particulate matter, discolouration or disturbance is observed, the vial should be discarded per local disposal guidelines. The injection procedure should be carried out under aseptic conditions, which includes the use of surgical hand disinfection, sterile gloves, a sterile drape and a sterile eyelid speculum (or equivalent) and the availability of sterile paracentesis (if required). The patient s medical history for hypersensitivity reactions should be carefully evaluated prior to performing the intravitreal procedure. Adequate anaesthesia and a broad-spectrum topical microbicide to disinfect the periocular skin, eyelid and ocular surface should be administered prior to the injection, in accordance with local practice.</p><p>Vial-only pack The vial is for single use only. After injection any unused product must be discarded. Any vial showing signs of damage or tampering must not be used. The sterility cannot be guaranteed unless the packaging seal remains intact.</p><p>For preparation and intravitreal injection the following medical devices for single use are needed:</p><ul><li>a 5 m filter needle (18G 1 inches, 1.2 mm 40 mm)</li><li>a 1 ml sterile syringe (including a 0.05 ml mark)</li><li>an injection needle (30G inches). These medical devices are not included within the Rimmyrah pack.</li></ul><p>Vial + filter needle pack All components are sterile and for single use only. Any component with packaging showing signs of damage or tampering must not be used. The sterility cannot be guaranteed unless the component packaging seal remains intact. Re-use may lead to infection or other illness/injury.</p><p>For preparation and intravitreal injection the following medical devices for single use are needed:</p><ul><li>a 5 m filter needle (18G 1 inches, 1.2 mm 40 mm, provided)</li><li>a 1 ml sterile syringe (including a 0.05 ml mark, not included within the Rimmyrah pack)</li><li>an injection needle (30G inches; not included within the Rimmyrah pack)</li></ul><p>To prepare Rimmyrah for intravitreal administration to adult patients, please adhere to the following<br/>instructions:</p><p>Traceability In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.</p><ol type="1"><li><p>Rimmyrah should be inspected visually to ensure there is no particulate matter, discolouration or disturbance prior to the administration. If particulate matter, discolouration or disturbance is observed, the vial should be discarded per local disposal guidelines.</p></li><li><p>Before withdrawal, the outer part of the rubber stopper of the vial should be disinfected (e.g., with 75% alcohol swab).</p></li><li><p>Assemble a 5 m filter needle (18G 1 inches, 1.2 mm x 40 mm) onto a 1 ml syringe using aseptic technique. Push the blunt filter needle into the centre of the vial stopper until the needle touches the bottom edge of the vial.</p></li><li><p>Withdraw all the liquid from the vial, keeping the vial in an upright position, slightly inclined to ease complete withdrawal.</p></li><li><p>Ensure that the plunger rod is drawn sufficiently back when emptying the vial in order to completely empty the filter needle.</p></li><li><p>Leave the blunt filter needle in the vial and disconnect<br/>the syringe from the blunt filter needle. The filter needle should be discarded after withdrawal of the vial contents and should not be used for the intravitreal injection.</p></li><li><p>Aseptically and firmly assemble an injection needle<br/>(30G inches, 0.3 mm 13 mm) onto the syringe.</p></li><li><p>Carefully remove the cap from the injection needle without disconnecting the injection needle from the syringe.</p></li></ol><p>Note: Grip at the hub of the injection needle while removing the cap.</p><ol start="9" type="1"><li>Carefully expel the air along with the excess solution from the syringe and adjust the dose to the 0.05 ml mark on the syringe. The syringe is ready for injection.</li></ol><p>Note: Do not wipe the injection needle. Do not pull back on the plunger.</p><p>The injection needle should be inserted 3.5-4.0 mm posterior to the limbus into the vitreous cavity, avoiding the horizontal meridian and aiming towards the centre of the globe. The injection volume of 0.05 ml is then delivered; a different scleral site should be used for subsequent injections.</p><p>After injection, do not recap the needle or detach it from the syringe. Dispose of the used syringe together with the needle in a sharps disposal container or in accordance with local requirements.</p><p>0.05 ml</p></div>
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IG © 2021+ Gravitate Health Project. Package hl7.eu.fhir.ghepi#0.1.0 based on FHIR 5.0.0. Generated 2024-10-14
Links: Table of Contents |
QA Report
The Gravitate Health project has received funding from the IMI 2 Joint Undertaking under grant agreement No 945334.
This joint undertaking receives support from the EU H2020 research and innovation programme and EFPIA.
