Category: First-in-Human

Short answer: Most avoidable delays in a first-in-human (FIH) device study in Latin America come from treating the region like a US study with a Spanish consent form. The ten mistakes below are the ones that most often send a dossier back or hold a shipment: planning the US Food and Drug Administration (FDA) use of the data too late, assuming every country follows the same sequence, incomplete or untranslated dossiers, missing manufacturing and sterility evidence, chasing marketing documents the trial does not need, leaving import to the end, insurance that does not match local rules, paying participants the US way, underestimating amendments, and forgetting post-trial obligations. Each one has a primary source and a deeper guide on this blog.

As one founder put it, it would be a pity to be delayed by something nobody told them to prepare. This list is meant to be that warning. It is general; the exact requirement in each country should be confirmed for each study.

1. Planning the FDA use of the data after the study

If the FIH data will support an investigational device exemption (IDE) or a US marketing submission, FDA’s rule for foreign data applies from day one. Under 21 CFR 812.28 (Code of Federal Regulations, CFR), FDA accepts data from a study outside the United States if it is well designed and well conducted and the sponsor provides a statement that it followed good clinical practice (GCP), which includes independent ethics committee review before the study starts and documented informed consent. FDA must also be able to validate the data “through an onsite inspection, or through other appropriate means, if the agency deems it necessary.” Retrofitting that file after the last participant is much harder than building it as you go.

Go deeper: 21 CFR 812.28 inspectability · Building an inspectable ISO 14155 file · FDA acceptance of Latin American data · What to send in a Q-Submission

2. Assuming every country runs the same sequence

The order of approvals differs. In Costa Rica, the institution or investigator submits the study to a scientific ethics committee (CEC, comité ético científico) of its choice before any interventional research starts (Reglamento 39061-S as amended by DE 44033-S, Art. 44). In Panama, a protocol run at an institution first needs a no-objection note from the institution (Decreto Ejecutivo 21 of 2026, Art. 47), and import of investigational products depends on registration of the project in the RESEGIS platform, ethics approval and authorization by the National Directorate of Pharmacy and Drugs (DNFD, Dirección Nacional de Farmacia y Drogas) (Art. 99). In El Salvador the Superintendencia de Regulación Sanitaria (SRS) authorizes the trial (SRS authorization guide). In Chile, device trials need special authorization from the Instituto de Salud Pública (ISP) (Código Sanitario, Art. 111 A). Build the calendar country by country, not from a template.

Go deeper: Rapid startup archetypes by country · Chile vs Panama decision framework · Costa Rica activation calendar · FIH device trials in Chile

3. Submitting an incomplete or untranslated dossier

Ethics committees review what is in front of them, and a missing item usually means another review cycle. Costa Rica’s list for interventional studies is long and specific. It includes the protocol in its original language with an official Spanish translation, the consent form in plain Spanish with date and version, and each team member’s CV, license and a recent GCP course certificate endorsed by the National Health Research Council (CONIS, Consejo Nacional de Investigación en Salud) (Art. 44(b), (d) and (z)). Panama’s institutional no-objection note is a prerequisite for ethics review, not an afterthought (Art. 47). Work from each country’s checklist and translate early.

Go deeper: Latin America FIH submission package checklist · Qualifying sites and investigators

4. Arriving without manufacturing and sterility evidence

Startups often have a prototype line, not a certified plant, and assume that is a problem only for later. It comes up at the first review. Costa Rica asks for evidence that the device was made under good manufacturing practice (GMP), and sterile devices also need a sterility certification (Art. 44(r)). El Salvador’s device requirements include a GMP certificate or a declaration of conformity from the manufacturer, safety and performance test evidence, a description of the manufacturing process and a sterility certificate describing the method, validation and final verification (SRS guide, section 7.2). Assemble this package before you choose a submission date.

Go deeper: GMP attestation vs ISO 13485 certificate · GLP, GMP and sterility requirements · Preclinical testing before FIH

5. Chasing marketing documents the trial does not need

An investigational device is, by definition, not yet on the market, and trial dossiers are built around that. Costa Rica, for example, asks for registration certificates for the device only “si ya se encuentran registrados” (Art. 44(j)). Teams sometimes lose time trying to obtain commercial documents, such as a certificate of free sale, that belong to market registration rather than to the clinical trial pathway. Check which documents the trial route actually asks for before requesting anything from a manufacturer or a foreign authority.

Go deeper: The certificate of free sale trap

6. Leaving import and the importer of record to the end

The device has to reach the site legally, and that has its own approvals. Panama ties import to RESEGIS registration, ethics approval and DNFD authorization (Art. 99). El Salvador’s application lists the establishments associated with the research center, “incluido el establecimiento importador” (SRS guide, section 6.1.1.5). Decide early who the importer of record is in each country, and plan shipping, customs, storage conditions and returns as part of the startup calendar, not after approval.

Go deeper: Investigational device import calendar · Importing investigational devices · Importer of record for trial devices · Multi-country importer of record playbook

7. Buying insurance that does not match local rules

A global policy is not automatically acceptable locally. Costa Rica asks for the sponsor’s commitment to compensate participants for study-related injury “con copia de la póliza vigente por al menos dos años después de finalizado el estudio”, and for insurance covering the investigator and team for claims arising from the study (Art. 44(jj) and (kk)). In Chile, once harm is proven, the law presumes it arose from the research (Código Sanitario, Art. 111 E). Check the policy’s territory, named insureds, duration and certificate wording against each country’s requirements before you submit.

Go deeper: Clinical trial insurance in Latin America · Buying trial liability before the first site · Site insurance vs sponsor policy · Panama FIH insurance · Subject injury vs third-party liability

8. Paying participants the US way

US-style stipends do not travel well. Costa Rica’s Ley 9234 says participants are not paid and only expenses may be reimbursed, with an exception for bioequivalence studies (Ley 9234, Art. 5). Panama allows FIH participants to receive compensation in proportion to time, effort and discomfort, with prior bioethics committee approval (DE 21 of 2026, Art. 62). A compensation plan copied from a US budget can trigger a rejection or a consent rewrite. Set it country by country.

Go deeper: Healthy volunteers in Phase 1 studies in Latin America

9. Underestimating protocol amendments

Every substantive change goes back through review. Chile’s device guide says the principal investigator must obtain written, dated ethics committee approval before enrolling and before implementing later modifications, where requested (ISP / ANDIM guide, section 10.4(c)). (ANDIM is the ISP’s Agencia Nacional de Dispositivos Médicos department.) Each amendment also has to be reflected in translations, consent versions and, sometimes, the import file. Freeze the protocol as far as you can before submission and group unavoidable changes.

Go deeper: Ethics committee amendment cycles · Protocol amendments and regulatory rework

10. Forgetting post-trial obligations

What happens after the last visit is part of the approval. Chile gives the trial participant the right to continued treatment at no cost “por todo el tiempo que persista su utilidad terapéutica, conforme al protocolo de investigación respectivo” (Código Sanitario, Art. 111 C). Costa Rica’s dossier includes the sponsor’s commitment to provide the study device free of charge if it has proven beneficial to the participant’s health (Art. 44(ll)). Decide your post-trial position before submission and write it into the protocol and consent.

Go deeper: Compassionate use vs post-trial access

One more: decide the product category first

Borderline products such as drug-coated devices or skin-contact patches can be combination products under 21 CFR 3.2(e) or can sit near the cosmetic line. If the category is wrong, the whole dossier is wrong. Settle it with the regulators before writing the protocol.

Go deeper: Combination products tutorial · FIH quote checklist for sponsors

Where bioaccess® fits

bioaccess® runs first-in-human and early feasibility medical device studies in Latin America. Most of what we do before a study starts is catching the items on this list early: building the country sequence, assembling the dossier and manufacturing evidence, lining up import and insurance, and setting participant compensation and post-trial terms that each committee will accept.

Related reading

• Microneedle Patches: Device, Combination Product, or Cosmetic? Planning Your First Human Study
• Running a First-in-Human Dermatology or Aesthetic Device Trial in Latin America: Sites, PIs and Outpatient Clinics
• Healthy Volunteers in Device FIH Studies: What Ethics Committees Allow on Compensation in Costa Rica, El Salvador, Panama and Chile

FAQ

What is the most common avoidable delay in a Latin American FIH device study?

An incomplete dossier. Ethics committees and health authorities review what is submitted, and a missing translation, certificate or commitment usually means another review cycle. Working from each country’s own checklist avoids most of it.

Do I need to plan for FDA before the study starts?

Yes, if the data will support a US filing. Under 21 CFR 812.28, FDA accepts foreign device data from well-designed, well-conducted studies that follow good clinical practice, including ethics committee review and informed consent, and FDA must be able to validate the data, for example by inspection.

Is the approval sequence the same in every Latin American country?

No. Costa Rica starts with a scientific ethics committee, Panama requires an institutional no-objection note before ethics review and links import to RESEGIS registration, ethics approval and DNFD authorization, El Salvador’s SRS authorizes trials, and Chile requires ISP special authorization for device trials.

Does a startup need GMP certification before a first-in-human study?

Not always a certificate, but it needs manufacturing evidence. Costa Rica asks for evidence of manufacture under good manufacturing practice and a sterility certification for sterile devices, and El Salvador accepts a GMP certificate or a manufacturer’s declaration of conformity together with sterility and test evidence.

Can I pay participants in Latin America the way I would in the US?

Not everywhere. Costa Rica’s law allows reimbursement of expenses but not payment, except for bioequivalence studies. Panama allows proportional compensation for first-in-human participants with bioethics committee approval. Set the plan country by country.

What post-trial obligations should a sponsor plan for?

In Chile, trial participants have a legal right to continued treatment at no cost while it remains therapeutically useful, according to the protocol. In Costa Rica, the sponsor commits to provide the study device free of charge if it has proven beneficial. Decide your position before submission.

Short answer: A first-in-human (FIH) dermatology or aesthetic device study can run in an outpatient clinic in Latin America, but the clinic has to qualify as a research site under each country’s rules. In Costa Rica the site needs the health permit (habilitación) for its activity and the ethics dossier must describe the site and the emergency plan. In Panama an institution must issue a no-objection note before ethics review. El Salvador’s authorization guide asks for the research center’s establishment registration and technical director. Chile’s device-trial guide from the public health institute expects a documented site selection report and facilities that match the device’s intended setting. Pick the principal investigator (PI) and the clinic together, and plan the emergency pathway before you submit.

Why dermatology and aesthetic studies are different

Most device FIH guidance assumes a hospital: an operating room, an interventional suite, an intensive care unit down the hall. Many dermatology and aesthetic devices are used in a very different place. The intended setting is a private dermatology practice or an aesthetic clinic, the procedure is short, and the main endpoints are often visual: investigator grading scales, standardized photographs, participant-reported outcomes. The best investigators for these products are often dermatologists or plastic surgeons in private practice, not hospital department heads.

That is a good fit for an early study, because the study setting should look like the setting the device is designed for. It also means the ethics committee and health authority will look harder at things a hospital provides by default: the permit, the equipment, the emergency backup and the storage of the investigational device.

Can an outpatient clinic be an FIH site? Country by country

Country	What the rules ask about the site	Primary source
Costa Rica	A research site (“sitio de investigación”) is any place where research activities happen or where investigational products are stored or dispensed, and it “deben contar con la habilitación sanitaria por actividad que les corresponda según la categoría de establecimiento.” The submission to the scientific ethics committee (CEC, comité ético científico) for interventional research includes a description of the site and facilities (Art. 44(p)), current permits and accreditation for laboratories and other facilities (Art. 44(dd)) and an explanation of how medical emergencies and serious adverse events will be handled, including which centers participants should go to (Art. 44(pp)).	Reglamento 39061-S as amended by DE 44033-S, Art. 3 def. 58 and Art. 44, La Gaceta Alcance 111, 14 Jun 2023
Panama	“Todo protocolo de investigación a realizarse en una institución deberá contar previamente con una nota de conformidad o no objeción de la autoridad administrativa competente de la institución” before ethics review (Art. 47). A multicenter study is approved by a single accredited institutional bioethics committee (CBI, comité de bioética de la investigación), and each additional center then submits its documents for inclusion (Art. 46).	Decreto Ejecutivo 21 of 23 Apr 2026, Arts. 46 and 47
El Salvador	The trial authorization application to the Superintendencia de Regulación Sanitaria (SRS) asks for the research center’s name, address, “Número de registro de establecimiento ante la SRS” and technical director, plus the associated establishments, including the importer (section 6.1.1.5). It also asks for the contract between the research center and associated centers.	SRS, Guía para la Autorización del Proyecto de Investigación del Ensayo Clínico
Chile	The sponsor defines the facilities and the type of setting (“por ejemplo, hospitalario frente al domiciliario”). Facilities “deberían ser similares a las instalaciones requeridas para el uso previsto” of the device, with extra equipment where needed for safety. Investigator qualifications and site suitability are verified and documented in a site selection report before the study starts (section 6.8). The PI must show the site has enough eligible subjects, a qualified team and adequate facilities (section 10.3).	Instituto de Salud Pública (ISP), Agencia Nacional de Dispositivos Médicos (ANDIM) department, Guía de Investigación Clínica de Dispositivos Médicos, May 2026

In short, none of these sources says a device FIH study has to be in a hospital. What they require is that the site is properly permitted for what it does, described accurately in the dossier, and backed by a credible plan for emergencies. Whether a particular private clinic’s permit category covers research activity, and which documents a given ethics committee wants for it, should be confirmed per study.

Choosing the PI: dermatologist or plastic surgeon

The right specialty follows the device and the procedure. A topical or energy-based skin device usually points to a dermatologist; a device used in a surgical or minimally invasive aesthetic procedure may point to a plastic surgeon. Either way, the paperwork is the same kind of evidence:

• Costa Rica: the CEC dossier includes each team member’s curriculum vitae, ID, current professional license or college registration, and a Good Clinical Practice (GCP) course certificate less than three years old endorsed by the National Health Research Council (CONIS, Consejo Nacional de Investigación en Salud), plus investigator accreditation (Reglamento 39061-S, Art. 44(z) and (aa)).
• Chile: the PI must be able to show a team with “la cualificación académica y la experiencia” for the study, documented with current CVs (ISP guide, section 10.3(b)).
• Panama and El Salvador: investigator documents go to the ethics committee and, in El Salvador, the SRS application lists investigator details. Specific credential requirements should be confirmed per study (Panama DE 21; SRS guide).

Beyond the documents, ask practical questions: has the investigator run a device study before, can the clinic see the target population in the recruitment window you need, who covers when the PI is in surgery, and does the team have time for study visits on top of a busy private practice? Our guide to qualifying FIH sites and investigators in Latin America covers the general checklist.

Confirming the clinic has the equipment

Sponsors often ask how to confirm that a clinic really has the imaging and procedure equipment the protocol needs. The answer is to verify it in person and write it down. Chile’s guide makes the site selection report an explicit document (section 6.8), and Costa Rica’s dossier asks for a description of the site and facilities (Art. 44(p)). A practical site qualification visit for a dermatology study checks:

• the procedure room and the equipment the device needs (power, ventilation, any accessories), against the instructions for use;
• the photography setup: the same camera and settings, fixed lighting, fixed participant positioning and a written procedure, so images are comparable across visits and sites;
• maintenance and calibration records for any measuring equipment used for endpoints;
• a locked, access-controlled place to store the investigational device under the manufacturer’s conditions. Costa Rica requires the product to be kept “bajo las condiciones ambientales especificadas por el fabricante o patrocinador, en un lugar limpio, seguro y con restricción de acceso” (Reglamento 39061-S, Art. 58(a));
• where source documents and photographs will be kept, so the file is ready for monitoring and for review by the US Food and Drug Administration (FDA) under 21 CFR 812.28 (Code of Federal Regulations, CFR) if the data will support a US submission.

If the protocol uses photographs taken by participants at home, treat that as a separate method to describe and justify in the protocol, and check with the ethics committee how it wants consent, privacy and image transfer handled.

The emergency pathway is the question committees ask first

An outpatient clinic does not have a hospital’s emergency backup on site, so the dossier has to show one. Costa Rica asks the sponsor to explain how emergencies and serious adverse events will be handled and “a cuáles centros debe acudir el participante” (Art. 44(pp)). Chile’s guide notes that sites may need “equipos y capacidades adicionales” to make sure the necessary safety precautions are present (section 6.8). In practice, that means a named referral hospital, a written transfer procedure, emergency equipment and trained staff at the clinic, and a 24-hour contact for participants. It also means insurance that covers the study at that site; see site insurance vs sponsor policy.

Skin types, ages and the US label

If the FIH data will feed a US submission, think early about which skin types and ages the device is meant for. Recruiting across a range of Fitzpatrick skin types at the first study gives you safety data in the population you plan to treat, rather than finding out later. No source reviewed for this post sets a skin-type quota for an FIH study; it is a design decision to discuss with FDA. See Fitzpatrick skin type diversity in clinical trials.

Device category still comes first

Before you choose a clinic, confirm that the product is regulated as a device in each country and in the US. Aesthetic products can sit near the cosmetic line. FDA’s microneedling guidance, for example, treats penetration beyond the stratum corneum into living skin as evidence of device status (FDA guidance). In Chile, ISP special authorization applies to trials of a “producto farmacéutico o dispositivo médico” (Código Sanitario, Art. 111 A).

Where bioaccess® fits

bioaccess® runs first-in-human and early feasibility medical device studies in Latin America. For dermatology and aesthetic sponsors, we help shortlist investigators, qualify outpatient clinics in person, and assemble the site, emergency and storage documents each ethics committee and health authority expects.

Related reading

• Microneedle Patches: Device, Combination Product, or Cosmetic? Planning Your First Human Study
• Healthy Volunteers in Device FIH Studies: What Ethics Committees Allow on Compensation in Costa Rica, El Salvador, Panama and Chile
• 10 Startup Mistakes That Delay a Latin America FIH Study (and How to Avoid Them)
• How to qualify FIH sites and investigators in Latin America
• Latin America FIH patient recruitment and feasibility
• Fitzpatrick skin type diversity in clinical trials
• Costa Rica FIH activation calendar: CONIS and CEC
• Rapid startup archetypes: Chile, Costa Rica, Panama, El Salvador
• Building an inspectable ISO 14155 file for a Latin America device FIH study
• Investigational device import calendar for Latin America FIH studies
• Site profile: Clínica Dermacross, Santiago

FAQ

Can a first-in-human device study run in an outpatient dermatology clinic in Latin America?

Yes, if the clinic qualifies as a research site under local rules. None of the sources reviewed requires a hospital, but they require proper permits, an accurate description of the site, and a credible plan for emergencies. Confirm per study that the clinic’s permit category covers the research activity.

What does Costa Rica require of a research site?

Costa Rica’s research regulation defines a research site as any place where research activities happen or investigational products are stored or dispensed, and says it must hold the health permit for its activity. The ethics dossier includes a site description, current permits for laboratories and facilities, and an explanation of how emergencies will be handled and where participants should go.

What does Panama require before ethics review at an institution?

Executive Decree 21 of 2026 says any protocol carried out in an institution needs a prior note of conformity or no objection from the institution’s competent administrative authority before ethics review. A multicenter study is approved by one accredited bioethics committee, and each additional center submits documents for inclusion.

Should the PI be a dermatologist or a plastic surgeon?

It depends on the device and the procedure. Topical and energy-based skin devices usually fit a dermatologist, while devices used in surgical or minimally invasive aesthetic procedures may fit a plastic surgeon. In both cases the ethics dossier needs current CVs, licenses and GCP training records.

How do you confirm that a clinic has the right equipment and imaging?

Through an in-person site qualification visit documented in writing. Check the procedure room and equipment against the instructions for use, the photography setup and written imaging procedure, calibration records, secure storage for the investigational device, and where source documents will be kept.

What emergency arrangements does an outpatient FIH site need?

A named referral hospital, a written transfer procedure, emergency equipment and trained staff at the clinic, and a round-the-clock contact for participants. Costa Rica’s ethics dossier explicitly asks which centers participants should go to in an emergency.

Short answer: The four countries take different positions. Costa Rica’s research law says participants are not paid and only their expenses may be reimbursed; the one payment exception is for bioequivalence studies, which the regulation defines around pharmaceutical products. Panama’s 2026 research decree allows first-in-human (FIH) participants to receive compensation in proportion to time, effort and discomfort, with prior approval from the bioethics committee. El Salvador’s national ethics committee reviews the amount and method of any payment and requires that payments not depend on finishing the study. Chile’s device-trial guide allows reimbursement of direct expenses such as transport, as long as it is not an undue incentive; we found no Chilean rule on paying for time. In every country, what you plan to pay goes in the consent form and needs ethics committee approval.

Why healthy volunteers come up in device FIH studies

Some device FIH studies enroll healthy volunteers rather than patients. Examples include skin-contact and wearable devices, sensors, and products where the first question is tolerability or usability rather than treatment effect. Healthy volunteers get no therapeutic benefit, so ethics committees look closely at two things: whether the risk is justified, and whether the payment could push someone to accept a risk they otherwise would not.

The international reference point is Guideline 13 of the Council for International Organizations of Medical Sciences (CIOMS). It says participants “should be reasonably reimbursed for costs directly incurred during the research, such as travel costs, and compensated reasonably for their inconvenience and time spent,” that compensation “must not be so large as to induce potential participants to consent to participate in the research against their better judgment,” and that “a local research ethics committee must approve reimbursement and compensation” (CIOMS International Ethical Guidelines, 2016, Guideline 13). National law can be stricter than CIOMS, and in Latin America it sometimes is.

Costa Rica: reimbursement only, with a narrow exception

Article 5 of Ley 9234, the Biomedical Research Regulation Law, is titled “Gratuidad”. It says participation “siempre deberá ser voluntaria, por lo que no se remunerará a los participantes. Solo podrán reintegrarse los gastos en que eventualmente incurra un sujeto por su participación en la investigación.” It then makes one exception: “En el caso de los estudios de bioequivalencia, además del reconocimiento de gastos, se permitirá la remuneración al participante por su participación voluntaria,” with payment approved in advance by the scientific ethics committee (CEC, comité ético científico) (Ley 9234, Art. 5, La Gaceta, 25 Apr 2014).

Has that changed? The legislation index of the National Health Research Council (CONIS, Consejo Nacional de Investigación en Salud) lists one amendment to the law: the repeal of Article 18, published in La Gaceta in September 2020 (CONIS legislation page). Article 5 was not touched.

The implementing regulation, as amended in 2023, defines bioequivalence studies as studies in healthy volunteers “a los que se les administra un producto farmacéutico” and says that, because they lack therapeutic benefit, use healthy volunteers and are paid, they are classified as Phase I (Reglamento 39061-S as amended by DE 44033-S, Art. 3 def. 31, La Gaceta Alcance 111, 2023). The same regulation defines medical devices separately, as equipo y material biomédico (EMB) (def. 28). Our reading is that a device study does not fall under the bioequivalence exception, so healthy volunteers in a Costa Rican device study can have their expenses reimbursed but cannot be paid for participating. Confirm the treatment of any specific item with the CEC that will review the study.

Practical consequences: budget for documented expenses (transport, meals during long visits, and similar costs), describe exactly what will be reimbursed in the consent form, and do not advertise the study as a “paid” trial in Costa Rica.

Panama: compensation allowed for FIH studies, with committee approval

Panama’s Executive Decree 21 of 23 April 2026 regulates health research under Ley 84 of 2019. Article 61 says participants and their companions “no deben incurrir en ningún gasto por participar en un estudio de investigación”, and that any planned compensation must be in the informed consent and in the documents approved by the bioethics committee. Article 62 is specific to FIH studies: “Los participantes de los estudios clínicos por primera vez en humanos podrán recibir una compensación en proporción al tiempo, esfuerzo e incomodidad, previa aprobación del comité de bioética. El comité de bioética en el proceso de revisión deberá velar por que no se convierta en un incentivo indebido para la participación” (Decreto Ejecutivo 21 of 2026, Arts. 61 and 62, Gaceta Oficial Digital 30510 C).

Article 62 does not distinguish between drug and device FIH studies, and it does not set an amount. The bioethics committee decides whether the proposed compensation is proportionate. Build the proposal around the actual burden of the protocol: number and length of visits, procedures and any discomfort.

El Salvador: the national ethics committee reviews amount and method

The operating manual of the National Health Research Ethics Committee (CNEIS, Comité Nacional de Ética de la Investigación en Salud) does not ban payment. It requires review. The CNEIS “debe revisar tanto la cantidad como el método de pago a las personas para asegurarse que no existan problemas de coerción o mal influencia”, and “los pagos a la persona deberán ser asignados y no depender de que el sujeto termine el estudio.” The CNEIS must also make sure the methods, amounts and schedule of payment are set out in the written consent form (Manual de funcionamiento del CNEIS, Acuerdo 382 of 2017, section on functions, items (j) and (k)). A March 2026 reform of the manual changed the committee’s composition and removal rules, not these provisions (Acuerdo 838 BIS, 3 Mar 2026).

The key design point is proration. A schedule that pays only at the final visit conflicts with the manual. Pay per completed visit or per study phase.

Chile: reimbursement of direct expenses

The clinical investigation guide for medical devices issued by the Instituto de Salud Pública (ISP) through its Agencia Nacional de Dispositivos Médicos (ANDIM) department addresses this directly. It says it is appropriate to reimburse participants for “los gastos directos derivados de su participación (ej. transporte), bajo la figura de asignación por gastos de traslado”, and that this allowance must not be so large that it becomes an undue incentive or affects the participant’s right to withdraw early (ISP / ANDIM, Guía de Investigación Clínica de Dispositivos Médicos, May 2026, section 5.3).

We did not find a provision in Chilean law or regulation that addresses payment for time or inconvenience in device studies. Device trials in Chile also need ISP special authorization (Código Sanitario, Art. 111 A). Whether a CEC will accept compensation beyond the travel allowance should be confirmed per study.

Side by side

Country	Reimbursement of expenses	Payment for time or participation	Primary source
Costa Rica	Allowed	Not allowed, except bioequivalence studies (defined around pharmaceutical products). Our reading: not available for device studies; confirm with the CEC	Ley 9234, Art. 5; Reglamento 39061-S, Art. 3 def. 31
Panama	Participants must incur no expenses	FIH participants may receive compensation proportional to time, effort and discomfort, with prior bioethics committee approval	DE 21 of 2026, Arts. 61 and 62
El Salvador	Reviewed by the CNEIS	Not prohibited. The CNEIS reviews amount and method; payments must not depend on completion	CNEIS Manual, items (j) and (k)
Chile	Direct expenses (for example transport) as a travel allowance	No legal provision found; confirm per study	ISP / ANDIM guide, section 5.3

If the data will support a US submission

Sponsors planning a US submission sometimes ask whether FDA expects payment. It does not require it. The US Food and Drug Administration (FDA) guidance on payment says paying research subjects “is a common and, in general, acceptable practice”, that payment “is not considered a benefit” in the risk-benefit assessment, that credit “should accrue as the study progresses and not be contingent upon the subject completing the entire study”, and that the amount and schedule should be in the consent document (FDA, Payment and Reimbursement to Research Subjects, January 2018). That guidance is written for US institutional review boards; in each Latin American country the local law and ethics committee decide.

Building a compensation plan that passes review

1. Start from the local rule, not from a US or European template. In Costa Rica that means reimbursement only.
2. List every participant cost the protocol creates, visit by visit, and decide which will be reimbursed and how receipts or allowances will work.
3. Where payment for time is allowed, tie it to the burden of the protocol and explain the reasoning to the committee.
4. Prorate. Pay per visit or per phase so a participant who withdraws is not penalized, as El Salvador’s manual and FDA’s guidance both expect.
5. Put the amounts, method and schedule in the consent form in plain language, and keep recruitment materials consistent with it.
6. Keep compensation separate from compensation for research-related injury, which is a different obligation covered by insurance and by Article 61 in Panama.

Where bioaccess® fits

bioaccess® runs first-in-human and early feasibility medical device studies in Latin America. We help sponsors build participant reimbursement and compensation plans that match each country’s rules and the reviewing committee’s expectations, and keep the consent form, budget and recruitment materials aligned.

Related reading

• Microneedle Patches: Device, Combination Product, or Cosmetic? Planning Your First Human Study
• Running a First-in-Human Dermatology or Aesthetic Device Trial in Latin America: Sites, PIs and Outpatient Clinics
• 10 Startup Mistakes That Delay a Latin America FIH Study (and How to Avoid Them)
• Healthy volunteers in Phase 1 drug studies in Latin America
• Costa Rica FIH activation calendar: CONIS and CEC
• Subject injury vs third-party liability in FIH studies
• Clinical trial insurance for FIH studies in Panama
• First-in-human medical device trials in Chile
• Latin America FIH patient recruitment and feasibility

FAQ

Can healthy volunteers be paid in a device study in Costa Rica?

Ley 9234 says participants are not paid and only their expenses may be reimbursed. The only payment exception is for bioequivalence studies, which the regulation defines around pharmaceutical products. Our reading is that device studies are not covered by the exception, so plan for reimbursement only and confirm details with the reviewing ethics committee.

Does Panama allow compensation for first-in-human participants?

Yes. Article 62 of Executive Decree 21 of 2026 says first-in-human participants may receive compensation in proportion to time, effort and discomfort, with prior approval from the bioethics committee, which must make sure it does not become an undue incentive.

What does El Salvador require for participant payments?

The national ethics committee manual says the committee reviews both the amount and the method of payment, that payments must not depend on the participant finishing the study, and that methods, amounts and schedule must appear in the written consent form.

Can participants in a Chilean device trial be reimbursed?

Yes. The ISP device clinical investigation guide says direct expenses such as transport can be reimbursed as a travel allowance, as long as the amount is not an undue incentive and does not affect the right to withdraw. We found no Chilean rule on paying for time, so confirm per study.

Should payment depend on completing the study?

No. El Salvador’s ethics committee manual says payments must not depend on completion, and FDA guidance says credit for payment should accrue as the study progresses. Paying per visit or per phase is the safer design in every country.

Where should compensation be described?

In the informed consent form, with the amounts, method and schedule, and in the documents submitted to the ethics committee. Panama, El Salvador and CIOMS all expect the committee to review and approve it.

Short answer: It depends on three things: what you claim the patch does, how far the needles are designed to go into the skin, and whether a drug or biologic is part of the product. Under guidance from the US Food and Drug Administration (FDA), a microneedle product that claims or is designed to penetrate past the stratum corneum into living skin generally meets the device definition. Once a drug or biologic is coated on, loaded into or packaged with the patch, it may be a combination product, and FDA decides which center leads. The registered-cosmetic route fits only a product that stays on the skin surface and makes appearance claims. The cosmetic definitions in Central America, Panama and Chile are all written around superficial or external application. Settle the category before you write the protocol for your first-in-human (FIH) study, because it decides which dossier the ethics committee and health authority will expect.

Why the category question comes first

Microneedle patches sit on three regulatory borders at once: device and drug, device and biologic, and device and cosmetic. For a startup, the category drives almost everything that follows: which FDA center reviews the product, which investigational application applies in the US, what manufacturing evidence an ethics committee asks for, and whether a polymer-only version and a later drug-loaded version can be treated as the same product.

The rest of this post walks through the US framework first, because most sponsors plan to use FIH data from Latin America in an FDA submission. It then covers the cosmetic and device definitions in Central America, Panama and Chile.

How FDA draws the device line for microneedling products

FDA’s guidance Regulatory Considerations for Microneedling Products (FDA guidance page; PDF) is the clearest US statement. It defines the stratum corneum as “a dead cell layer of skin, as opposed to living layers of skin.” It then says FDA considers claims or statements “that indicate penetration or some effect beyond the stratum corneum into living layers of skin” to be evidence of intent to affect the structure or function of the body. That intent is what makes a product a device under section 201(h) of the Federal Food, Drug, and Cosmetic Act (FD&C Act).

Claims are not the only test. The same guidance says FDA considers “needle penetration beyond the stratum corneum as a result of the design or technology” of a product as evidence that it may be a device. FDA lists what it may look at: needle length and arrangement, needle sharpness, and the degree of control over “depth of penetration into living layers of skin” (FDA microneedling guidance, section IV). In practice, your design specifications and directions for use can classify the product even if your marketing copy is careful.

The guidance also describes products that are generally not devices: microneedling products “that do not penetrate living skin” and claim only to facilitate exfoliation, improve the appearance of skin, give skin a smoother look and feel, or give skin a luminous look. FDA adds that such products “may still be subject to other requirements of the FD&C Act” (FDA microneedling guidance, section V).

For devices, aesthetic microneedling is classified at 21 CFR 878.4430 (Code of Federal Regulations, CFR) as Class II with special controls. The identification text matters for patch developers: it “does not include devices intended for transdermal delivery of topical products such as cosmetics, drugs, or biologics.” A patch built to deliver an active ingredient is therefore outside that classification by its own terms.

When a drug-loaded patch becomes a combination product

FDA’s microneedling guidance excludes products used with topically applied substances such as “creams, ointments, gels, vitamin solutions, drugs, or blood products.” It says these “may be combination products under 21 CFR 3.2(e)”, that they are “outside the scope of this guidance”, and that manufacturers should contact the Office of Combination Products (OCP) (FDA microneedling guidance, section III).

The definition at 21 CFR 3.2(e) covers several configurations that map onto patch programs:

• Single entity. Two or more regulated components “physically, chemically, or otherwise combined or mixed and produced as a single entity” (3.2(e)(1)). Coated, drug-loaded or dissolving microneedles usually raise this question.
• Co-packaged. “Two or more separate products packaged together in a single package or as a unit” (3.2(e)(2)), such as a needle array sold in a kit with a serum.
• Cross-labeled. Separately packaged products whose labeling or investigational plan says they are for use only with a specified drug, device or biologic, where both are required for the intended effect (3.2(e)(3) and (4)).

FDA’s page on combination product types lists a microneedle “patch” as a common example of a prefilled drug delivery system, and a “microneedle patch pre-loaded with biological product” as an example of a prefilled biologic delivery system.

Which FDA center leads depends on the primary mode of action (PMOA). Under 21 CFR 3.2(m), the PMOA is “the single mode of action of a combination product that provides the most important therapeutic action.” Depending on the answer, the lead is the Center for Devices and Radiological Health (CDRH), the Center for Drug Evaluation and Research (CDER) or the Center for Biologics Evaluation and Research (CBER). If the answer is unclear, 21 CFR 3.7 provides a formal request for designation (RFD) and says “a sponsor should file a request for designation before filing any application for premarket review, whether an application for marketing approval or a required investigational notice.” For an FIH plan, that means the jurisdiction question belongs before the US investigational filing, not after the first human data are in.

The “blank patch first” plan

A common development plan is to run the first human study with a polymer-only patch and add an active ingredient later. The sources above support a few cautious points:

• A polymer-only patch is assessed on its own claims and design. If its needles are designed to reach living epidermis or dermis, FDA’s guidance points toward the device definition.
• Once an active is added, the product has to be assessed again under 21 CFR 3.2(e). The loaded patch may be a different regulated product with a different lead center.
• How far data from the blank patch can support the loaded product is a question for FDA, not an assumption. Put it to the agency early, either to OCP or in a Q-Submission (Q-Sub) meeting request.

Write both versions into your regulatory plan from the start, and keep the FIH protocol’s claims about the blank patch consistent with the later program. A safety claim written loosely for the first study can complicate the classification of the second.

The registered-cosmetic route: what it covers in Latin America

Some sponsors ask whether a patch can be registered as a cosmetic and tested that way. The answer turns on the local cosmetic definition, and those definitions are narrow.

Costa Rica and El Salvador: the Central American cosmetics regulation

Central American cosmetic registration follows the Central American Technical Regulation (RTCA, Reglamento Técnico Centroamericano) RTCA 71.03.35:21, adopted by the Council of Ministers of Economic Integration (COMIECO) in Resolución No. 474-2023 (COMIECO-EX). The Secretariat for Central American Economic Integration (SIECA) lists the resolution as in force (SIECA). The resolution states that it entered into force on 5 February 2024.

Its definition (section 4.11) covers products “destinado a ser puesto en contacto con las diversas partes superficiales del cuerpo humano (epidermis, sistemas piloso y capilar, uñas, labios y órganos genitales externos)” for cleaning, perfuming, changing appearance, correcting body odor or protecting them. El Salvador published the regulation in its Diario Oficial (copy hosted by the Superintendencia de Regulación Sanitaria, SRS). Costa Rica’s Ministerio de Salud links the resolution from its cosmetic registration page.

Panama

Panama’s Ministry of Health (MINSA, Ministerio de Salud) states that Ley 419 of 1 February 2024 replaced (“subroga”) Ley 1 of 2001, and that Executive Decree 27 of 10 May 2024 regulates it. According to the same MINSA document, Article 192 of that decree says cosmetic registration and labeling follow the RTCA for cosmetic products (MINSA, DNFD presentation, May 2024). The National Directorate of Pharmacy and Drugs (DNFD, Dirección Nacional de Farmacia y Drogas) puts the line plainly: “Los productos cosméticos solo están indicados para uso tópico. No se ingieren, inhalan o inyectan dentro del cuerpo humano.” It adds that a cosmetic attributed therapeutic properties “debe registrarse como medicamento” (DNFD explainer). The exact definition article in Ley 419 should be confirmed per study.

Chile

Chile’s cosmetics regulation, Decreto Supremo (DS) 239 of 2002 (BCN), defines a cosmetic as a preparation “que se destine a ser aplicado externamente al cuerpo humano”, with only local action or, if absorbed, “carezca de efecto sistémico”. The Instituto de Salud Pública (ISP) repeats that definition in its technical guide on borderline medical devices (Guía Técnica sobre Dispositivos Médicos Frontera, October 2022). The same guide sets the device condition that the product does not achieve “su acción principal en o sobre el cuerpo humano por mecanismos farmacológicos, inmunológicos o metabólicos.” Where a sponsor is unsure, the guide says to seek a ruling (“pronunciamiento”) from the ISP’s Comité de Régimen de Control Sanitario. See also the ISP cosmetics page.

What this means for a patch

A patch whose needles are designed to reach living tissue, or that delivers an active for a therapeutic or structure-or-function effect, is hard to fit inside any of these definitions. Cosmetic registration is a marketing authorization for a cosmetic. It does not authorize a clinical investigation of a device, drug or combination product, and it will not help an FDA submission that depends on device or drug data. Whether consumer-use or claims testing of a genuinely cosmetic product needs ethics review differs by country and should be confirmed per study.

How the category changes your FIH study

Category	US anchor	What it means for an FIH study in Latin America
Device (no active)	FDA device test (FD&C Act 201(h)); foreign data under 21 CFR 812.28	Run as a device clinical investigation. In Costa Rica the device category is “equipo y material biomédico” (EMB) under Reglamento 39061-S as amended by Decree 44033-S (La Gaceta, Alcance 111, 2023). In Chile, ISP special authorization applies to trials of a “producto farmacéutico o dispositivo médico” (Código Sanitario, Art. 111 A).
Combination product	21 CFR 3.2(e); PMOA; RFD under 21 CFR 3.7	Confirm per study which pathway (drug or device) each health authority and ethics committee will apply, and expect questions on both the drug and the device constituents.
Cosmetic	Not a device if it does not penetrate living skin and makes appearance-only claims (FDA guidance, section V)	Registration under RTCA 71.03.35:21, Panama’s Ley 419 framework or Chile’s DS 239. Not a substitute for a clinical trial authorization.

Practical steps before you write the protocol

1. Write down the intended use and every claim you plan to make, including in the consent form and instructions for use.
2. Document the design facts FDA says it may weigh: needle length, arrangement, sharpness and control of penetration depth.
3. If any active ingredient is involved, map the product against 21 CFR 3.2(e), state your PMOA reasoning and decide whether to contact OCP or file an RFD before any US investigational filing.
4. Ask FDA how it will view FIH data generated in Latin America. For a device study, plan to meet 21 CFR 812.28.
5. Check the category in each target country. In Chile, the ISP categorization route is in the borderline-device guide; elsewhere, confirm per study with the health authority.
6. Keep the category consistent across protocol, investigator brochure, labeling and consent. Ethics committees notice when documents describe the product differently.

Where bioaccess® fits

bioaccess® runs first-in-human and early feasibility medical device studies in Latin America. For borderline products such as microneedle patches, we work through the category question country by country with the sponsor’s regulatory team before anything is submitted, so the protocol, the ethics dossier and the later FDA plan tell the same story.

Related reading

• Running a First-in-Human Dermatology or Aesthetic Device Trial in Latin America: Sites, PIs and Outpatient Clinics
• Healthy Volunteers in Device FIH Studies: What Ethics Committees Allow on Compensation in Costa Rica, El Salvador, Panama and Chile
• 10 Startup Mistakes That Delay a Latin America FIH Study (and How to Avoid Them)
• Medical device combination products: a tutorial on regulations and compliance
• FDA Q-Submission: what to send before your IDE filing
• FDA foreign clinical data and 21 CFR 812.28 for Latin America studies
• Early feasibility vs pivotal trial
• Preclinical testing before a device FIH study in Latin America
• Fitzpatrick skin type diversity in clinical trials

FAQ

Is a microneedle patch a medical device?

Often, but not always. FDA guidance treats claims or design features that indicate penetration beyond the stratum corneum into living layers of skin as evidence that a microneedling product is a device. A product that does not penetrate living skin and makes only appearance or exfoliation claims would generally not be a device.

When does a microneedle patch become a combination product?

When a drug or biologic is combined with it as a single entity, packaged with it, or cross-labeled for use only with it, as described in 21 CFR 3.2(e). FDA lists a microneedle patch as a common example of a prefilled drug delivery system and of a prefilled biologic delivery system.

Who decides which FDA center reviews a drug-loaded patch?

FDA assigns the lead center based on the primary mode of action. If the answer is unclear, a sponsor can file a request for designation under 21 CFR 3.7, which says the request should be filed before any premarket application or required investigational notice.

Can a microneedle patch be registered as a cosmetic in Central America, Panama or Chile?

Only if it genuinely fits the cosmetic definition. RTCA 71.03.35:21 covers products in contact with superficial parts of the body, Panama’s DNFD says cosmetics are not injected into the body, and Chile’s DS 239 covers products applied externally. A patch designed to reach living tissue or deliver an active is hard to fit inside these definitions.

Does cosmetic registration let me run a clinical study of my patch?

No. Cosmetic registration is a marketing authorization for a cosmetic. A clinical investigation of a device, drug or combination product needs ethics committee approval and, where required, health authority authorization in each country. Whether claims testing of a true cosmetic needs ethics review should be confirmed per study.

Can I run my first study with a polymer-only patch and add the drug later?

Many teams plan it that way, but the loaded patch has to be assessed again as a possible combination product. How far data from the blank patch can support the loaded product is a question to put to FDA early, through the Office of Combination Products or a Q-Submission.

Short answer: The rules do not ask for “a doctor”. They ask for an investigator qualified by education, training and experience, and Chile’s device guide adds experience in the device’s field of application. Costa Rica’s regulation goes further: a device study must run under a principal investigator suited to the product. For devices used on the skin and soft tissue, that field of application is the daily work of dermatologists and plastic surgeons. That is why they are often the strongest choice of principal investigator for aesthetic and dermatology device first-in-human (FIH) trials, provided their site, credentials and time also meet the local rules.

bioaccess® is a contract research organization (CRO) that runs FIH and early feasibility medical device studies in Latin America. We identify and qualify investigators, and the investigators conduct the clinical work at their sites. This article explains what the regulations ask of an investigator, why these two specialties fit, and what to check before you choose one.

What the rules ask of an investigator

Source	What it requires
International Council for Harmonisation (ICH), E6(R3) Good Clinical Practice (GCP) guideline, sections 2.1–2.2	Investigators “should be qualified by education, training and experience to assume responsibility for the proper conduct of the trial” and provide evidence of it (2.1.1). They should be familiar with the investigational product (2.1.2), able to show they can recruit the agreed number of eligible participants (2.2.1), and have enough time, qualified staff and facilities (2.2.2).
Chile, Instituto de Salud Pública (ISP), device clinical investigation guide (Resolución Exenta 2.050 of 2026), section 10.2	The responsible investigator must have the academic qualification, training and experience to run the investigation, “tener experiencia en el campo de aplicación y poseer formación en la utilización del DM” (DM is dispositivo médico, medical device; experience in the field of application and training in use of the device), disclose conflicts of interest, and know how informed consent is obtained.
Costa Rica, Reglamento 39061-S as amended in 2023, Art. 72(c)	Device studies must be carried out “bajo la responsabilidad de un profesional acorde al producto a investigar; como investigador principal” (under the responsibility of a professional suited to the product, as principal investigator).
Costa Rica, Ley 9234, Art. 51	The investigator must have the academic training, practical training and experience to conduct the research (d), make sure the team is suitably qualified (f), and be fully familiar with the protocol, consent, investigator’s brochure and the investigational device (h).
US, Code of Federal Regulations (CFR), 21 CFR 812.43 (relevant if the data will support a US Food and Drug Administration filing)	“A sponsor shall select investigators qualified by training and experience to investigate the device.” The signed investigator agreement includes the curriculum vitae (CV) and, where applicable, a statement of relevant experience.

ICH E6(R3) is written for drugs and biological products. For device trials, El Salvador’s Superintendencia de Regulación Sanitaria (SRS) applies ISO 14155, the International Organization for Standardization (ISO) GCP standard for devices (SRS clinical-trial guide, section 5), and Chile’s ISP guide refers to the Chilean adoption of ISO 14155. Panama’s Decreto Ejecutivo (DE) 21 of 2026 lists ICH GCP among the reference documents for ethics review (Art. 71).

Why these two specialties fit aesthetic and dermatology devices

1. They already work in the field of application

Chile’s guide asks for experience in the device’s field of application, and Costa Rica’s asks for a principal investigator (PI) suited to the product. When a device acts on the skin, scars, wounds or subcutaneous tissue, the specialists who diagnose and treat those tissues every day meet that test directly. A PI from another specialty can still qualify, but the ethics committee will expect the CV to show why.

2. Endpoint assessment is part of their routine

Many aesthetic and dermatology endpoints depend on a clinician’s assessment of the skin, often supported by standardized photography and grading scales defined in the protocol. An investigator who makes those judgments in daily practice is better placed to apply a scale the same way at every visit. Rater training is still needed, and the protocol should define it.

3. They can manage the adverse events these devices tend to cause

ICH E6(R3) places trial-related medical care and decisions with a qualified physician who is an investigator or sub-investigator (2.7.1), and Chile’s guide says medical care of participants must always be the responsibility of a qualified physician. Whatever the protocol lists as anticipated adverse events for a skin or soft-tissue device, the specialist who treats that tissue in practice is best placed to recognize, grade and manage them.

4. Device technique transfers quickly

Investigators must be trained in using the investigational device (Chile guide 10.2(b); ICH E6(R3) 2.1.2), and Chile’s guide makes the sponsor responsible for documenting that training (9.2.1(h)). A clinician who already performs comparable procedures usually has less to learn, which lets training focus on what is new about the device.

5. Their practices see the target population

The investigator should be able to show a realistic potential to recruit eligible participants (ICH E6(R3) 2.2.1). Aesthetic and dermatology practices see the people these devices are designed for. Ask for evidence, such as anonymized counts of relevant patients, rather than an estimate.

Dermatologist or plastic surgeon?

Choose by the procedure the protocol requires, not by the device label. As a rule of thumb:

• Dermatologist as PI: devices that treat skin conditions or the skin surface, where the main endpoints are dermatological assessments.
• Plastic surgeon as PI: devices that involve incision, implantation, wound closure, scar revision or reconstruction.
• Both: many aesthetic devices sit between the two. One model is a PI from one specialty with a sub-investigator from the other. Under ICH E6(R3) 2.3, the PI can delegate tasks to qualified team members but keeps overall responsibility and must keep a delegation record.

What to check before you choose

The site, not only the doctor

Aesthetic and dermatology studies may be proposed at private outpatient clinics. Each country sets its own site rules:

• Costa Rica: description of the site and facilities, valid habilitation certificates, and an emergency plan stating which centers participants go to (Reglamento 39061-S Art. 44(p), (dd), (pp)).
• Chile: research centers must be accredited by the ISP (Código Sanitario Art. 111 D). How this applies to a given clinic: confirm per study.
• El Salvador: the SRS application form asks for the research center’s SRS establishment registration number (SRS guide §6.1.1.5).
• Panama: registration on the Registro y Seguimiento de la Investigación para la Salud (RESEGIS) platform needs a no-objection from the entity where the study will run (DE 21 Art. 84(1)).
• Peru: each research center must hold a valid registration as a center authorized for clinical trials (Decreto Supremo (DS) 021-2017-SA Art. 67(b)).

Credentials and training

• Costa Rica: CV with identity document, current professional license or medical college registration, a GCP course under three years old endorsed by the Consejo Nacional de Investigación en Salud (CONIS), and CONIS investigator accreditation (Art. 44(z)–(aa); Ley 9234 Art. 43(c)).
• Panama: at least one PI resident in the country (DE 21 Art. 69), and GCP courses approved by the national bioethics committee at least every three years (Art. 67).
• El Salvador: GCP certificates for investigators, sub-investigators and coordinators, and a PI declaration of compliance with GCP and the Declaration of Helsinki (SRS guide §6.4(6), (10)).
• Peru: GCP and research ethics training no more than three years old for the whole team (Art. 67(q)).
• Chile: current CV or equivalent evidence, device training, and a conflict-of-interest disclosure (ISP guide 10.2).

Time

Specialists in private practice may work across several clinics. El Salvador’s application form asks for the PI’s current trial workload and whether they practice in other establishments (SRS guide §6.1.1.10), and ICH E6(R3) 2.2.2 asks for enough time for the full trial. Agree on protected study time and a named backup sub-investigator before you file.

Conflicts of interest

Costa Rica requires conflict-of-interest declarations from the whole team (Art. 44(cc)), and Chile’s guide requires the investigator to disclose conflicts, including financial ones (10.2(c)). Disclose consulting, equity or royalty links to the device or a competitor early.

Common mistakes

• Choosing a PI on reputation alone, without checking site authorization and GCP certificate dates
• Running the study in a clinic with no documented emergency pathway
• Naming a PI who has no protected time for visits and safety follow-up
• Leaving device training undocumented
• Choosing a specialty that does not match the procedure in the protocol

How bioaccess® works with investigators

bioaccess® is the CRO. We build the qualification questionnaire for the device, check the investigator’s and the site’s documents against each country’s rules, and support training, monitoring and filings. The investigators and their sites conduct the study and keep the responsibilities the rules assign to them. For our method, see how we qualify FIH sites and investigators in Latin America.

Related reading: Pre-study document checklist by country for device FIH studies · Good Manufacturing Practice attestation or ISO 13485 certificate? · Costa Rica FIH activation calendar · Chile ISP clinical trial approval for medical devices · Clinical trial insurance in Latin America

Frequently asked questions (FAQ)

Does a dermatology device first-in-human trial need a dermatologist as principal investigator?

No regulation reviewed here names a specialty. Chile’s ISP guide asks for experience in the device’s field of application, and Costa Rica asks for a principal investigator suited to the product. For a skin device, a dermatologist or plastic surgeon usually meets that test most directly.

What does ICH E6(R3) require of an investigator?

Section 2.1 says investigators should be qualified by education, training and experience, provide evidence of those qualifications, and be familiar with the investigational product. Section 2.2 asks them to show recruitment potential and to have enough time, staff and facilities. ICH E6(R3) is written for drugs and biological products; device trials use ISO 14155.

Can a private aesthetic clinic be a trial site?

It can if it meets the country’s site rules. Costa Rica asks for habilitation certificates and an emergency plan, Chile requires ISP accreditation of research centers, El Salvador asks for the center’s SRS registration number, and Peru requires a registered research center. Confirm per study.

How recent must an investigator’s GCP training be?

Costa Rica asks for a CONIS-endorsed GCP course under three years old. Panama requires GCP courses approved by the national bioethics committee at least every three years. Peru asks for GCP and research ethics training no more than three years old.

Is the investigator’s site the CRO?

No. The investigator and site conduct the clinical work and keep the responsibilities the rules assign to them. bioaccess® is the CRO and supports qualification, training, monitoring and regulatory filings.

Short answer: Before a medical device first-in-human (FIH) study can start in Latin America, three gates have to be cleared: the ethics committee, the health authority and, for imported devices, the import or customs-release step. The core dossier is largely the same in every country. The differences are in translations, who files, which quality documents are accepted and what each committee adds on top. This checklist sets out what the regulations of Costa Rica, Panama, El Salvador, Chile and Peru say, with the primary source next to each item. Anything we could not verify in a primary text is marked “confirm per study”.

bioaccess® is a contract research organization (CRO) that runs FIH and early feasibility medical device studies in Latin America. Sponsors, especially medtech startups, often ask us for one list they can work from before the protocol is final. This is that list, written for device studies in general. It is not legal advice, and committees can ask for more than the regulation lists.

How to read this checklist

• Ethics committee (EC): reviews the protocol, consent and investigator documents. The local names differ: Comité Ético Científico (CEC) in Costa Rica and Chile, Comité de Bioética de la Investigación (CBI) in Panama, and Comité Institucional de Ética en Investigación (CIEI) in Peru.
• Health authority: registers or authorizes the study and, in some countries, evaluates the investigational device.
• Import: clears each shipment of an unregistered investigational device. A document accepted at one gate does not automatically satisfy the next.
• “Confirm per study”: the item depends on the device, its classification, the committee or a rule we could not open in a primary source.

The core dossier: documents the sponsor prepares once

These items appear in the requirement lists of several countries. Prepare them once, then adapt them to each country’s format and language.

Document	Where the regulation names it
Clinical investigation plan (protocol), dated and versioned	Costa Rica Art. 44(b); El Salvador Superintendencia de Regulación Sanitaria (SRS) guide §6.4(2); Panama Decreto Ejecutivo (DE) 21/2026 Art. 84(3); Chile Instituto de Salud Pública (ISP) device guide §5.6.2(a); Peru Art. 67(l)
Investigator’s brochure (IB)	Costa Rica Art. 44(c); El Salvador §6.4(4); Chile §5.6.2(b); Peru Art. 67(n)
Informed consent form (ICF)	Costa Rica Art. 44(d); El Salvador §6.4(3); Chile §5.6.2(c) and Código Sanitario Art. 111 A; Peru Art. 67(m)
Case report form (CRF) and participant materials	Costa Rica Art. 44(f)–(g); Chile §5.6.2(f)
Curriculum vitae (CV) of the investigators and team	Costa Rica Art. 44(z); El Salvador §6.4(9); Chile §5.6.2(e) and (l); Peru Art. 67(p)
Good Clinical Practice (GCP) training evidence	Costa Rica Art. 44(z); El Salvador §6.4(10); Panama DE 21 Art. 67; Peru Art. 67(q)
Conflict-of-interest declarations	Costa Rica Art. 44(cc); Chile §5.6.2(i); Peru Art. 67(h)
Clinical trial agreement and budget	Costa Rica Art. 44(l)–(m); El Salvador §6.4(12); Chile §5.6.2(h); Peru Art. 67(r)
Participant insurance policy	Costa Rica Art. 44(jj)–(kk) and Ley 9234 Art. 31; El Salvador §6.4(14); Chile Código Sanitario Arts. 111 A and 111 F; Peru Art. 67(j)
Manufacturer Good Manufacturing Practice (GMP) or quality evidence	Costa Rica Art. 44(r); El Salvador §7.2(a); Peru Art. 67(o) and Annex 5. See our GMP attestation guide.
Sterility certificate for sterile devices	Costa Rica Art. 44(r); El Salvador §7.2(d)
Device technical file: description, manufacturing process, operating principles, test results (including biocompatibility), materials of human or animal origin	El Salvador §7.2(b)–(g); Costa Rica Art. 44(tt)
Risk management plan based on ISO 14971, the International Organization for Standardization (ISO) standard for device risk management	El Salvador §7.2(h)
Instructions for use and packaging or label artwork	Costa Rica Art. 44(s); El Salvador §6.4(16)
Prior regulatory status, such as a US Investigational Device Exemption (IDE) or an approval letter from another agency	Costa Rica Art. 44(h); El Salvador §6.4(17), when applicable. Confirm per study what an FIH device with no prior approval needs instead.
Public trial registration	Panama DE 21 Art. 79 (registered in a public registry that meets World Health Organization standards before the trial starts)

Sources: Costa Rica, Decreto Ejecutivo 44033-S amending Reglamento 39061-S (Alcance 111, La Gaceta 106, 14 June 2023). El Salvador, SRS clinical-trial authorization guide. Panama, Decreto Ejecutivo 21 of 23 April 2026. Chile, ISP Resolución Exenta 2.050 of 2026 and the Código Sanitario. Peru, Decreto Supremo (DS) 021-2017-SA.

Language, legalization and representation

• Costa Rica: the protocol and IB go in the original language plus an official Spanish translation (Art. 44(b)–(c)).
• El Salvador: all documents filed with the SRS must be in Spanish (SRS guide §5, item 6). The application form names the sponsor’s representative or attorney in El Salvador (§6.1.1.2).
• Panama: documents filed for registration on the Registro y Seguimiento de la Investigación para la Salud (RESEGIS) platform must be in Spanish and match the versions sent to the ethics committee (DE 21 Art. 85).
• Chile: the ISP guide tells a sponsor that does not reside in Chile to select a local representative who acts as the sponsor (ISP guide §9.2.1(b)). The consent must be in non-technical Spanish or the participant’s native language (§5.8.2(d)).
• Peru: the protocol and IB go in Spanish and the original language (Art. 67(l), (n)). A foreign sponsor files its delegation to a local representative with a Hague apostille (Art. 67(f)).
• Apostille or legalization of other foreign documents: Confirm per study and per document.

Costa Rica: CEC, national research council and customs release

Biomedical research is governed by Ley 9234 (La Gaceta 79, 25 April 2014) and its regulation, Decreto Ejecutivo 39061-S, as amended in 2023. The institution or investigator files the package with a CEC of their choice (Art. 44). The Consejo Nacional de Investigación en Salud (CONIS) accredits CECs, CROs and investigators (Ley 9234 Art. 43(b)–(c)).

CEC package (Art. 44), beyond the core dossier

• Investigator’s cover letter requesting review (a)
• Device classification under Costa Rica’s medical device regulation (i)
• List of countries and sites, and expected participants per site and in Costa Rica (k), (o)
• Description of the site, facilities and laboratories (p), plus valid habilitation certificates (dd)
• History of submissions to other Costa Rican CECs (q)
• Team CVs with identity document, current professional license or college registration, and a GCP course certificate under three years old endorsed by CONIS (z)
• Copy of CONIS accreditation of investigators and sub-investigators (aa), team compliance commitment (bb) and conflict-of-interest declarations (cc)
• Injury treatment and indemnity plans (ee); principal investigator (PI) commitments on serious adverse event reporting within 24 hours and periodic reports (ff)–(hh)
• Sponsor commitments: injury costs (ii), insurance for the investigator and team with a copy of the policy (jj), participant compensation with a policy valid at least two years after the study ends (kk), post-study treatment where beneficial (ll), reporting results (mm) and publication role (nn)
• Recruitment plan (oo), emergency plan (pp), signature log (qq) and participant-rights procedure (rr)
• Sworn declaration on whether a CRO (organización de investigación por contrato, OIC) or site management organization (organización de administración por contrato, OAC) takes part, with their CONIS accreditations (ss)
• Technical and medical specifications, inserts and user manuals (tt); sponsor commitment to bear all device-related costs (uu); care and monitoring plan for implantable devices (vv)

Device protocols must also cover items including the device type and regulatory class, novelty, nature and period of exposure, materials, inherent risks, the impact of device failure, expected service life and alternatives (Art. 73). Under Art. 72(c), the PI must be a professional suited to the product under investigation.

Ley 9234 Art. 31 requires a civil-liability policy that covers participants from the start of the study until at least two years after their participation ends, and that is enforceable in Costa Rica. The CEC decides within one calendar month (Art. 42). Whether a given FIH device study must go to a particular committee: Confirm per study.

Import and customs release (Art. 55)

• Import only after CEC approval and registration with CONIS (Art. 55(a))
• Before the first shipment, a CEC-endorsed request to CONIS listing the devices and supplies and their quantities (Art. 55(b))
• For each customs release: CONIS request form, CEC approval letter, commercial invoice or acquisition document, transport document, and a GMP certificate for each manufacturing establishment issued by the authority of the manufacturing country (Art. 55(g)(i)–(vi))

Fees and the current CONIS forms: Confirm per study. For sequencing, see our Costa Rica FIH activation calendar.

Panama: registration, ethics review and product evaluation

Decreto Ejecutivo 21 of 2026 regulates health research under Ley 84 of 2019. Every health research study must be registered with the Ministerio de Salud (MINSA) through the RESEGIS platform before the ethics committee certifies its decision (Arts. 79 and 82).

RESEGIS registration (Art. 84)

• No-objection or consent from the public or private entity where the study will run
• Registration request by the PI from an activated RESEGIS user account
• Protocol and annexes, in the same version that goes to the CBI or the national committee (Comité Nacional de Bioética de la Investigación, CNBI)

MINSA issues a registration receipt for the ethics review within three business days (Art. 86).

Ethics and investigator items

• At least one PI resident in Panama; the committees check this from the time of submission (Art. 69)
• The sponsor’s financial provisions for compensating research-related harm, attached to the documents for ethics review (Art. 67(2))
• GCP courses approved by the CNBI, at least every three years, for the investigator and team (Art. 67)
• Committee-specific forms, format and fees: Confirm per study. See our Panama CNBI procedure checklist.

Product evaluation and import

For high-risk research using “medicamentos o productos para la salud humana”, the Dirección Nacional de Farmacia y Drogas (DNFD) evaluates the product before the trial, using the protocol, GMP certificates or a qualified-person GMP declaration, a certificate of analysis and the IB (Art. 95). Import of research products is based on RESEGIS registration, ethics approval and DNFD authorization (Art. 99). The document list in Art. 95 names the investigational medicamento. How Arts. 88, 95 and 99 apply to an investigational device: Confirm per study.

El Salvador: SRS and the national ethics committee

The Superintendencia de Regulación Sanitaria (SRS) authorizes clinical trials of drugs and medical devices. Its guide applies ISO 14155 (clinical investigation of medical devices, good clinical practice) to device trials (SRS guide §5, item 6). The ethics approval minutes are one of the SRS requirements, so ethics review comes first (§6.4(1)).

SRS general requirements (§6.4), beyond the core dossier

• Authorization from the head of the public institution where the trial runs, if applicable (5)
• PI declaration of compliance with GCP, the Declaration of Helsinki and current rules (6); same declaration from sub-investigators and staff (8)
• Joint sponsor–PI declaration of economic capacity to finish the trial (7)
• Training certificate for staff who handle, store or dispense the investigational product, when they are outside the pharmacy or biomedical area (11)
• Contract between the research center and any associated centers (13)
• Insurance policy that applies in El Salvador (14)
• Appointment of the data safety monitoring committee and the schedule for its safety reports (15)
• Fee receipt (18). Amount: Confirm per study

The application form also asks for the PI’s current workload and the research center’s SRS establishment registration number (§6.1.1). The device-specific list in §7.2 is covered in the core dossier above.

The ethics committee’s own document list (Comité Nacional de Ética de la Investigación en Salud, CNEIS) and the import permit steps: Confirm per study. We did not open the current CNEIS manual for this guide.

Chile: CEC, site director and ISP

Under Ley 20.120 Art. 10, biomedical research needs the express authorization of the director of the establishment, after a favorable report from the CEC (Ley 20.120). Under Código Sanitario Art. 111 A, any device that is not registered, or is used differently from its registration, needs an ISP special authorization for provisional use for research. The filing comes after approval under Ley 20.120 Art. 10 and includes the protocol, the consent form, the insurance policy and any other document set by regulation. The authorization lasts up to one year and can be renewed. The Ministry of Health may exempt low-risk devices by decree. Whether any such exemption covers your device: Confirm per study.

CEC initial submission (ISP guide §5.6.2)

The ISP device guide approved by Resolución Exenta 2.050 of 2026 recommends, as a minimum: the protocol, the IB or equivalent, the consent form and other written participant information, recruitment procedures and materials, and the PI’s CV. Depending on the design and the committee, it may also be necessary to file the CRF, documents on payments and compensation to participants, the clinical investigation agreement and site payment, conflict-of-interest documents, evidence of insurance, the sponsor’s delegation of duties, and the CVs of other team members.

Other Chile items

• Local representative for a sponsor that does not reside in Chile (ISP guide §9.2.1(b))
• Civil-liability insurance held by the authorization holder (Código Sanitario Art. 111 F). The same article says a decree sets the device classes for which an insurance policy is mandatory. How that applies to your device: Confirm per study.
• Research centers must be accredited by the ISP under Art. 111 D. How this applies to your site today: Confirm per study.
• The ISP dossier list for the device provisional-use authorization: Confirm per study. ISP ran a public consultation on its filing guide in June and July 2026, and we have not confirmed the final version.

Related: Chile ISP clinical trial approval for medical devices and Chile ISP device vs drug trials.

Peru: CIEI approval and national authorization

DS 021-2017-SA sets the documents the sponsor or CRO files with the Instituto Nacional de Salud (INS) to authorize a trial (Art. 67). Beyond the core dossier, the list includes the registration of each research center, approval from the institution’s legal representative, CIEI approval of the protocol and consent, sworn declarations from the sponsor and the PI, a declaration on site conditioning, a sworn declaration of a fund for immediate care of participants until the insurance activates, a supply list and the fee receipt. Training in GCP and research ethics must be no more than three years old (Art. 67(q)).

Art. 68 limits authorization to investigational products that meet one of several conditions, such as authorization for human research by a regulator from a high-surveillance country. How Art. 68 applies to a device that has never been used in people, and whether later amendments change Art. 67: Confirm per study.

Items to confirm per study

• Device classification in each country, which drives several requirements (Costa Rica Art. 44(i))
• Panama: how DE 21 Arts. 88, 95 and 99 apply to investigational devices, and which committee reviews the study
• Chile: the ISP provisional-use dossier list, any exemption decree, and site accreditation under Art. 111 D
• El Salvador: the CNEIS document list and the import permit steps
• Peru: how Art. 68 applies to an FIH device, and any amendments to DS 021-2017-SA
• Apostille or legalization of each foreign document
• Committee forms and fees in every country
• What replaces a prior-agency approval letter when the device has none (Costa Rica Art. 44(h); El Salvador §6.4(17))

A practical order of work

1. Freeze the protocol version you will translate. Every country ties its filings to a dated version.
2. Build the device technical file to the El Salvador §7.2 list. It is the most detailed device list among the texts reviewed here.
3. Collect investigator CVs, licenses and GCP certificates early, and check their dates against the three-year limits in Costa Rica, Panama and Peru.
4. Line up the insurance policy for each country before submission. See our clinical trial insurance guide.
5. Plan the import-stage documents before ethics approval, not after. See importing investigational devices into Latin America.

Related reading: The universal Latin America FIH submission package · GMP attestation or ISO 13485 certificate? · How we qualify FIH sites and investigators · Protocol template for FIH devices

Frequently asked questions (FAQ)

What documents does every Latin American ethics committee ask for in a device first-in-human study?

In the texts reviewed for Costa Rica, El Salvador, Chile and Peru, the common items are the protocol, the investigator’s brochure, the informed consent form, investigator CVs and an insurance policy. Costa Rica, El Salvador and Peru also require GCP training evidence. Panama’s ethics committees apply their own document lists, so confirm those per study.

Do I need a GMP certificate or is a manufacturer declaration enough?

It depends on the country and the filing stage. Costa Rica accepts a manufacturer GMP statement at the ethics committee but asks for an authority-issued GMP certificate for customs release. El Salvador accepts a GMP certificate or a manufacturer declaration of conformity for devices. For other countries, confirm per study.

Does a device first-in-human study in Chile need ISP authorization?

Código Sanitario Article 111 A requires an ISP special authorization for provisional use for any device that is not registered or is used differently from its registration, after ethics approval. The Ministry of Health may exempt low-risk devices by decree, so confirm per study whether an exemption applies.

Must the investigators’ GCP training be recent?

Yes in several countries. Costa Rica asks for a CONIS-endorsed GCP course under three years old. Panama requires GCP courses approved by the national bioethics committee at least every three years. Peru asks for GCP and research ethics training no more than three years old.

Must documents be in Spanish?

Costa Rica requires an official Spanish translation of the protocol and investigator’s brochure. El Salvador requires all SRS filings in Spanish. Panama requires RESEGIS filings in Spanish. Peru asks for the protocol and brochure in Spanish and the original language. Chile requires the consent in Spanish or the participant’s native language.