ID

11804

Description

Eligibility HIV-1 HPV vaccination AMC-052 NCT00513526 Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3BAF52D2-F5E5-0D56-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3BAF52D2-F5E5-0D56-E044-0003BA3F9857

Keywords

  1. 9/19/12 9/19/12 -
  2. 5/28/15 5/28/15 -
  3. 5/28/15 5/28/15 -
  4. 6/3/15 6/3/15 -
  5. 8/4/15 8/4/15 - Martin Dugas
Uploaded on

August 4, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Eligibility HIV-1 HPV vaccination AMC-052 NCT00513526

No Instruction available.

  1. StudyEvent: AMC-052 Eligibility Checklist Segment A
    1. No Instruction available.
Inclusion Criteria
Description

Inclusion Criteria

Inclusion Criteria
Description

AIDSMalignancyConsortiumPatientInclusionClinicalTrialEligibilityCriteria052Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19707
UMLS 2011AA ObjectClass-2
C1515830
NCI Thesaurus Property
C16112
UMLS 2011AA Property
C1516637
NCI Thesaurus Property-2
C25532
UMLS 2011AA Property-2
C1512693
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Exclusion Criteria
Description

Exclusion Criteria

Age
Description

Age

Data type

integer

Measurement units
  • years
Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ValueDomain
C29848
NCI Thesaurus ValueDomain-2
C25463
NCI Thesaurus Property
C25150
UMLS CUI [1]
C0001779
years
Informed Consent Date
Description

Informed Consent Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C16468
NCI Thesaurus Property
C25679
UMLS CUI [1]
C2985782
Exclusion Criteria
Description

AIDSMalignancyConsortiumPatientExclusionClinicalTrialEligibilityCriteria052Type

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19707
UMLS 2011AA ObjectClass-2
C1515830
NCI Thesaurus Property
C16112
UMLS 2011AA Property
C1516637
NCI Thesaurus Property-2
C25370
UMLS 2011AA Property-2
C0680251
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307

Similar models

No Instruction available.

  1. StudyEvent: AMC-052 Eligibility Checklist Segment A
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Inclusion Criteria
Item
Inclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25532 (NCI Thesaurus Property-2)
C1512693 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Inclusion Criteria
CL Item
Date Of Informed Consent (Date of informed consent)
CL Item
Does The Participant Have Documentation Of Hiv-1 Infection By Any Licensed Elisa Test Kit And Confirmed By Western Blot At Any Time Prior To Study Entry (Does the participant have documentation of HIV-1 infection by any licensed ELISA test kit and confirmed by Western blot at any time prior to study entry)
CL Item
Does The Participant Have The Ability And Willingness To Give Informed Consent (Does the participant have the ability and willingness to give informed consent)
CL Item
Participant's Age (in Years) (Participant's age (in years))
Item Group
Exclusion Criteria
Age
Item
Age
integer
C16960 (NCI Thesaurus ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS CUI [1])
Informed Consent Date
Item
Informed Consent Date
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C25679 (NCI Thesaurus Property)
C2985782 (UMLS CUI [1])
Item
Exclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25370 (NCI Thesaurus Property-2)
C0680251 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Exclusion Criteria
CL Item
Does The Participant Have A History Of Anal Cytological Result With Hsil, Atypical Squamous Cells Suggestive Of Hsil, Or Suggestive Of Carcinoma (Does the participant have a history of anal cytological result with HSIL, atypical squamous cells suggestive of HSIL, or suggestive of carcinoma)
CL Item
Does The Participant Have A History Of Anal Or Perianal Carcinoma (Does the participant have a history of anal or perianal carcinoma)
CL Item
Does The Participant Have A History Of High Grade Ain (i.e. Ain 2 Or 3) Or High Grade Perianal Intraepithelial Neoplasia (Does the participant have a history of high grade AIN (i.e. AIN 2 or 3) or high grade perianal intraepithelial neoplasia)
CL Item
Does The Participant Have Active Drug Or Alcohol Use Or Dependence That, In The Opinion Of The Site Investigator, Would Interfere With Adherence To Study Requirements (Does the participant have active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements)
CL Item
Does The Participant Have An Allergy To Yeast Or Any Other Components Of Gardasil (Does the participant have an allergy to yeast or any other components of Gardasil)
CL Item
Does The Participant Have Hemophilia (Does the participant have hemophilia)
CL Item
Has The Participant Ever Received Gardasil Or Any Other Hpv Vaccine (Has the participant ever received Gardasil or any other HPV vaccine)
CL Item
Has The Participant Undergone A Splenectomy (Has the participant undergone a splenectomy)

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