ID

23899

Descrição

Study part: Study Conclusion. A phase 2 study to assess safety, reactogenicity and immunogenicity of a booster dose of an investigational vaccination regimen and GSK Biologicals Hib-MenC vaccine (co-administered with Infanrix penta) compared to a booster dose of Menjugate (co-administered with Infanrix hexa).Patient Level Data: Study Listed on ClinicalStudyDataRequest.com. Study ID: 100381, Clinical Study ID: 100381

Palavras-chave

  1. 17/07/2017 17/07/2017 -
Titular dos direitos

GlaxoSmithKline

Transferido a

17 de julho de 2017

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

Study Conclusion Hib-MenCY-TT-004 BST 003 Neisseria Meningitidis-Haemophilus influenzae type b Vaccine 100381

Study Conclusion

  1. StudyEvent: ODM
    1. Study Conclusion
OCCURRENCE OF SERIOUS ADVERSE EVENT
Descrição

OCCURRENCE OF SERIOUS ADVERSE EVENT

Alias
UMLS CUI-1
C1519255
Subject number
Descrição

Subject number

Tipo de dados

integer

Alias
UMLS CUI [1]
C2348585
Did the subject experience any Serious Adverse Event during the study period?
Descrição

Serious Adverse Event

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1519255
If yes, please give the total number of SAE's:
Descrição

total number SAE

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C4288115
UMLS CUI [1,2]
C1519255
STATUS OF TREATMENT BLIND
Descrição

STATUS OF TREATMENT BLIND

Alias
UMLS CUI-1
C2347797
UMLS CUI-2
C0039798
UMLS CUI-3
C2347038
Was the treatment blind broken during the study?
Descrição

Blinded Clinical Study

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2347038
Date
Descrição

date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Reason
Descrição

reason

Tipo de dados

text

Alias
UMLS CUI [1]
C0392360
If other, please specify
Descrição

Other

Tipo de dados

text

Alias
UMLS CUI [1]
C0205394
ELIMINATION CRITERIA
Descrição

ELIMINATION CRITERIA

Alias
UMLS CUI-1
C0680251
Did any elimination criteria become applicable during the study?
Descrição

Elimination criteria

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0680251
If Yes, please specify:
Descrição

Elimination criteria

Tipo de dados

text

Alias
UMLS CUI [1]
C0680251
STUDY CONCLUSION
Descrição

STUDY CONCLUSION

Alias
UMLS CUI-1
C1707478
UMLS CUI-2
C0008972
Was the subject withdrawn from study?
Descrição

study subject participation status

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2348568
Reason
Descrição

Reason

Tipo de dados

integer

Alias
UMLS CUI [1]
C0392360
If SAE, please specify SAE N° :
Descrição

SAE

Tipo de dados

text

Alias
UMLS CUI [1]
C1519255
If AEX, please specify AE N° (Unsol.) or code (Solicited) :
Descrição

Non-Serious adverse event

Tipo de dados

text

Alias
UMLS CUI [1]
C1518404
If (PTV) Protocol violation, please specify:
Descrição

Protocol violation

Tipo de dados

text

Alias
UMLS CUI [1]
C1709750
If (OTH) Other, please specify :
Descrição

(e.g. : consent withdrawal, Protocol violation, …)

Tipo de dados

text

Alias
UMLS CUI [1]
C0205394
Investigator's decision
Descrição

Investigator desicion study discontinuation

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0008961
UMLS CUI [1,2]
C0679006
UMLS CUI [1,3]
C2826233
Parents/Guardian’s decision
Descrição

Parents desicion study discontinuation

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0030551
UMLS CUI [1,2]
C0679006
UMLS CUI [1,3]
C2826233
Date of last contact:
Descrição

Date of last contact

Tipo de dados

date

Alias
UMLS CUI [1]
C0805839
Was the subject in good condition at date of last contact?
Descrição

medical condition contact last

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0332158
UMLS CUI [1,3]
C1517741
INVESTIGATOR'S SIGNATURE
Descrição

INVESTIGATOR'S SIGNATURE

Alias
UMLS CUI-1
C2346576
I confirm that I have reviewed the data in this Case Report Form for this subject. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date below.
Descrição

confirmation

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0750484
Investigator's signature:
Descrição

Investigators signature

Tipo de dados

text

Alias
UMLS CUI [1]
C2346576
Printed Investigator's name:
Descrição

Investigator name

Tipo de dados

text

Alias
UMLS CUI [1]
C2826892
Date:
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008

Similar models

Study Conclusion

  1. StudyEvent: ODM
    1. Study Conclusion
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
OCCURRENCE OF SERIOUS ADVERSE EVENT
C1519255 (UMLS CUI-1)
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Serious Adverse Event
Item
Did the subject experience any Serious Adverse Event during the study period?
boolean
C1519255 (UMLS CUI [1])
total number SAE
Item
If yes, please give the total number of SAE's:
integer
C4288115 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
STATUS OF TREATMENT BLIND
C2347797 (UMLS CUI-1)
C0039798 (UMLS CUI-2)
C2347038 (UMLS CUI-3)
Blinded Clinical Study
Item
Was the treatment blind broken during the study?
boolean
C2347038 (UMLS CUI [1])
date
Item
Date
date
C0011008 (UMLS CUI [1])
Item
Reason
text
C0392360 (UMLS CUI [1])
Code List
Reason
CL Item
Medical emergency requiring identification of investigational product for further treatments (Medical emergency requiring identification of investigational product for further treatments)
CL Item
Other (Other)
Other
Item
If other, please specify
text
C0205394 (UMLS CUI [1])
Item Group
ELIMINATION CRITERIA
C0680251 (UMLS CUI-1)
Elimination criteria
Item
Did any elimination criteria become applicable during the study?
boolean
C0680251 (UMLS CUI [1])
Elimination criteria
Item
If Yes, please specify:
text
C0680251 (UMLS CUI [1])
Item Group
STUDY CONCLUSION
C1707478 (UMLS CUI-1)
C0008972 (UMLS CUI-2)
study subject participation status
Item
Was the subject withdrawn from study?
boolean
C2348568 (UMLS CUI [1])
Item
Reason
integer
C0392360 (UMLS CUI [1])
Code List
Reason
CL Item
SAE Serious adverse event (complete the Serious Adverse Event form) (1)
CL Item
AEX Non-Serious adverse event (complete the Non-serious Adverse Event page) (2)
CL Item
PTV Protocol violation (3)
CL Item
CWS Consent withdrawal, not due to an adverse event. (4)
CL Item
MIG Migrated / moved from the study area (5)
CL Item
LFU Lost to follow-up. (6)
CL Item
OTH Other (7)
SAE
Item
If SAE, please specify SAE N° :
text
C1519255 (UMLS CUI [1])
Non-Serious adverse event
Item
If AEX, please specify AE N° (Unsol.) or code (Solicited) :
text
C1518404 (UMLS CUI [1])
Protocol violation
Item
If (PTV) Protocol violation, please specify:
text
C1709750 (UMLS CUI [1])
other
Item
If (OTH) Other, please specify :
text
C0205394 (UMLS CUI [1])
Investigator desicion study discontinuation
Item
Investigator's decision
boolean
C0008961 (UMLS CUI [1,1])
C0679006 (UMLS CUI [1,2])
C2826233 (UMLS CUI [1,3])
Parents desicion study discontinuation
Item
Parents/Guardian’s decision
boolean
C0030551 (UMLS CUI [1,1])
C0679006 (UMLS CUI [1,2])
C2826233 (UMLS CUI [1,3])
Date of last contact
Item
Date of last contact:
date
C0805839 (UMLS CUI [1])
Item
Was the subject in good condition at date of last contact?
text
C0012634 (UMLS CUI [1,1])
C0332158 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,3])
Code List
Was the subject in good condition at date of last contact?
CL Item
No, please give details within the Adverse Events section (No, please give details within the Adverse Events section)
CL Item
Yes (Yes)
Item Group
INVESTIGATOR'S SIGNATURE
C2346576 (UMLS CUI-1)
confirmation
Item
I confirm that I have reviewed the data in this Case Report Form for this subject. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date below.
boolean
C0750484 (UMLS CUI [1])
Investigators signature
Item
Investigator's signature:
text
C2346576 (UMLS CUI [1])
Investigator name
Item
Printed Investigator's name:
text
C2826892 (UMLS CUI [1])
Date
Item
Date:
date
C0011008 (UMLS CUI [1])

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial