Extended safety follow-up contact "Safety and Immunogenicity Study of a Booster Dose of GSK Biologicals' 10-valent Pneumococcal Conjugate Vaccine" NCT00370396

Identification
Description

Identification

Alias
UMLS CUI-1
C1300638
Center number
Description

Center number

Data type

text

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0805701
Subject ID
Description

Subject ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Treatment Number
Description

Treatment Number

Data type

text

Alias
UMLS CUI [1]
C1522541
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Gender
Description

Gender

Data type

text

Alias
UMLS CUI [1]
C0079399
Study Conclusion Extended Safety Follow-Up Contact
Description

Study Conclusion Extended Safety Follow-Up Contact

Could the subject I subject's parents/guardians be contacted after the end of the active phase?
Description

Contract after active Phase

Data type

boolean

Alias
UMLS CUI [1]
C0332522
Date of last contact
Description

Date of last contact

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1705415
Has the subject received any other investigational and/or non-registered vaccine and/or drug since the end of the active phase?
Description

If yes: GlaxoSmithKline might contact you for further investigation

Data type

boolean

Alias
UMLS CUI [1,1]
C0042210
UMLS CUI [1,2]
C0949266
Reason for no successive Contract
Description

Reason for no successive Contract

Data type

text

Alias
UMLS CUI [1]
C0332522
Did the subject experience any serious adverse event(s) (SAE(s) since the end of the active phase?
Description

If yes,please complete the complete Serious Adverse Event (SAE) report.

Data type

text

Alias
UMLS CUI [1]
C1519255
Has the subject experienced any meningitis ?
Description

Meningitis

Data type

boolean

Alias
UMLS CUI [1]
C0025289
Investigator's Signature
Description

Investigator's Signature

Alias
UMLS CUI-1
C1519316
UMLS CUI-2
C2826892
Date of Signature
Description

Date of Signature

Data type

date

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C0011008
Name of Investigator
Description

Name of Investigator

Data type

text

Alias
UMLS CUI [1]
C0008961

Similar models

Extended safety follow-up contact "Safety and Immunogenicity Study of a Booster Dose of GSK Biologicals' 10-valent Pneumococcal Conjugate Vaccine" NCT00370396

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Identification
C1300638 (UMLS CUI-1)
Center number
Item
Center number
text
C1301943 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Treatment Number
Item
Treatment Number
text
C1522541 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Gender
text
C0079399 (UMLS CUI [1])
Code List
Gender
CL Item
Male (m)
CL Item
Female (f)
Item Group
Study Conclusion Extended Safety Follow-Up Contact
Contract after active Phase
Item
Could the subject I subject's parents/guardians be contacted after the end of the active phase?
boolean
C0332522 (UMLS CUI [1])
Date of last contact
Item
Date of last contact
date
C0011008 (UMLS CUI [1,1])
C1705415 (UMLS CUI [1,2])
Other investigational Vaccines after end of Study
Item
Has the subject received any other investigational and/or non-registered vaccine and/or drug since the end of the active phase?
boolean
C0042210 (UMLS CUI [1,1])
C0949266 (UMLS CUI [1,2])
Item
Reason for no successive Contract
text
C0332522 (UMLS CUI [1])
Code List
Reason for no successive Contract
CL Item
Consent withdrawal (CWS)
CL Item
Lost to follow-up (LFU)
Item
Did the subject experience any serious adverse event(s) (SAE(s) since the end of the active phase?
text
C1519255 (UMLS CUI [1])
Code List
Did the subject experience any serious adverse event(s) (SAE(s) since the end of the active phase?
CL Item
No (N)
CL Item
Yes (Y)
CL Item
Subject could not be contacted (NA)
Meningitis
Item
Has the subject experienced any meningitis ?
boolean
C0025289 (UMLS CUI [1])
Item Group
Investigator's Signature
C1519316 (UMLS CUI-1)
C2826892 (UMLS CUI-2)
Date of Signature
Item
Date of Signature
date
C1519316 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Name of Investigator
Item
Name of Investigator
text
C0008961 (UMLS CUI [1])