ID

24461

Description

Visit 2 General Medical History - Physical Examination Findings form Study ID: 208127/125 Clinical Study ID: 208127/125 (Ext-HAB-038 Month 90) Study Title: A double-blind, randomized study to evaluate the immunogenicity and reactogenicity of two different lots of GlaxoSmithKline Biologicals' combined hepatitis A / hepatitis B vaccine in healthy children between 6 and 15 years of age. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor:GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Hepatitis A (Inactivated), Hepatitis B (Recombinant) Vaccine Trade Name: Twinrix Study Indication: Hepatitis A; Hepatitis B

Keywords

Versions (1)
  1. 8/1/17 8/1/17 -
Copyright Holder

GlaxoSmithKline

Uploaded on

August 1, 2017

DOI

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License

Creative Commons BY-NC 3.0
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Visit 2 General Medical History Biologicals HepA/HepB vaccine 208127/125

English

Visit 2 General Medical History Biologicals HepA/HepB vaccine 208127/125

1 forms  
Header
Description

Header

Alias
UMLS CUI-1
C1320722
Protocol
Description

Protocol

Data type

text

Alias
UMLS CUI [1]
C1507394
Activity
Description

Activity

Data type

text

Alias
UMLS CUI [1]
C1512346
Subject number
Description

Subject number

Data type

text

Alias
UMLS CUI [1]
C2348585
General Medical History
Description

General Medical History

Alias
UMLS CUI-1
C0262926
Has the subject taken any medication in the past 4 weeks ?
Description

if Yes, please complete the medication section

Data type

boolean

Alias
UMLS CUI [1]
C0013216
Is the subject suffering from or has he/she ever suffered from any SIGNIFICANT medical condition or undergone surgery ?
Description

If Yes, provide one diagnosis per line. In case of unclear diagnosis provide the significant signs or symptoms on separate lines.

Data type

boolean

Alias
UMLS CUI [1]
C0973444
UMLS CUI [2]
C0543467
DIAGNOSIS / SIGNS AND SYMPTOMS
Description

DIAGNOSIS / SIGNS AND SYMPTOMS

Alias
UMLS CUI-1
C0011900
UMLS CUI-3
C0037088
PAST
Description

past

Data type

boolean

Alias
UMLS CUI [1]
C0455458
CURRENT/ACTIVE
Description

current/active

Data type

boolean

Alias
UMLS CUI [1]
C2707252
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Similar models

Visit 2 General Medical History Biologicals HepA/HepB vaccine 208127/125

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol
Item
Protocol
text
C1507394 (UMLS CUI [1])
Activity
Item
Activity
text
C1512346 (UMLS CUI [1])
Subject number
Item
Subject number
text
C2348585 (UMLS CUI [1])
Item Group
General Medical History
C0262926 (UMLS CUI-1)
Medication in the past 4 weeks
Item
Has the subject taken any medication in the past 4 weeks ?
boolean
C0013216 (UMLS CUI [1])
Significant disease or undergone surgery
Item
Is the subject suffering from or has he/she ever suffered from any SIGNIFICANT medical condition or undergone surgery ?
boolean
C0973444 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Item Group
DIAGNOSIS / SIGNS AND SYMPTOMS
C0011900 (UMLS CUI-1)
C0037088 (UMLS CUI-3)
past
Item
PAST
boolean
C0455458 (UMLS CUI [1])
current/active
Item
CURRENT/ACTIVE
boolean
C2707252 (UMLS CUI [1])
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