ID

26195

Descrição

Phase III, open, randomized study, in two centres, to demonstrate the equivalence of the 0, 12 month schedule to the 0, 6 month schedule with respect to the immunogenicity and to evaluate the safety and reactogenicity of GlaxoSmithKline Biologicals’ combined hepatitis A/ hepatitis B vaccine TWINRIX™ ADULT (720 EL. U. of hepatitis A antigen/ 20 μg of recombinant hepatitis B surface antigen) in healthy volunteers aged from 12 to 15 years inclusive. NCT00197171

Palavras-chave

  1. 11/10/2017 11/10/2017 -
Titular dos direitos

Glaxo Smith Kline

Transferido a

11 de outubro de 2017

DOI

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Licença

Creative Commons BY-NC 3.0

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GSK Study ID 100386 & 100387 Persistence of immune response to TWINRIX™ ADULT Long Term Follow up Year 5

Long Term Follow up Year 5

Long Term Follow up Visit 7
Descrição

Long Term Follow up Visit 7

Alias
UMLS CUI-1
C1517942
Center
Descrição

Study site identifier

Tipo de dados

text

Alias
UMLS CUI [1]
C2826692
Subject number
Descrição

Subject number

Tipo de dados

text

Alias
UMLS CUI [1]
C2348585
Date of visit
Descrição

Date of visit

Tipo de dados

date

Alias
UMLS CUI [1]
C1320303
I certify that Informed Consent has been obtained prior to any study procedure.
Descrição

Informed consent

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0021430
Informed Consent Date
Descrição

Informed Consent Date

Tipo de dados

date

Alias
UMLS CUI [1]
C2985782
Previous Studies
Descrição

Subject number will be the same as in the previous study.

Tipo de dados

integer

Alias
UMLS CUI [1]
C2242969
Demographics
Descrição

Demographics

Alias
UMLS CUI-1
C0011298
Date of birth
Descrição

Date of birth

Tipo de dados

date

Alias
UMLS CUI [1]
C0421451
Gender
Descrição

Gender

Tipo de dados

integer

Alias
UMLS CUI [1]
C0079399
Race
Descrição

Race

Tipo de dados

integer

Alias
UMLS CUI [1]
C0034510
Race, if other please specify
Descrição

Race

Tipo de dados

text

Alias
UMLS CUI [1]
C0034510
Laboratory Tests
Descrição

Laboratory Tests

Alias
UMLS CUI-1
C0022885
Has a blood sample been taken for testing anti-HAV and anti-HBs antibodies?
Descrição

Blood sample

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0005834
Sample Collection Date
Descrição

Please complete only if different from visit date

Tipo de dados

date

Alias
UMLS CUI [1]
C1302413
Has the subject received a dose of monovalent or combined Hepatitis A or Hepatitis B vaccine?
Descrição

Vaccination since last visit

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C3543421
UMLS CUI [1,2]
C0589121
If yes, please specify vaccine
Descrição

Hepatitis vaccines

Tipo de dados

integer

Alias
UMLS CUI [1]
C3543421
Has the subject received a dose of Hepatitis A and/or Hepatitis B immunoglobulins within 6 months prior to bleeding?
Descrição

Hepatitis A and/or Hepatitis B immunoglobulins past 6 months

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C3652495
UMLS CUI [1,2]
C0062525
UMLS CUI [1,3]
C3828652
If yes, please specify
Descrição

Hepatitis A and/or Hepatitis B immunoglobulins

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C3652495
UMLS CUI [1,2]
C0062525
Follow up Studies
Descrição

Follow up Studies

Alias
UMLS CUI-1
C0016441
Would the subject be willing to participate in a follow-up study?
Descrição

Follow-up studies

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0016441
If No, please specify the most appropriate reason
Descrição

Follow up Studies reason for withdrawal

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0016441
UMLS CUI [1,2]
C2349954
UMLS CUI [1,3]
C0392360
Please specify Adverse event,Serious adverse event or other reason
Descrição

Specify Reason for withdrawal

Tipo de dados

text

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C1521902
Investigator Signature
Descrição

Investigator 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 Signature
Descrição

Investigator Signature

Tipo de dados

text

Alias
UMLS CUI [1]
C2346576
Investigator name
Descrição

Investigator name

Tipo de dados

text

Alias
UMLS CUI [1]
C2826892
Date
Descrição

Date of completion

Tipo de dados

date

Alias
UMLS CUI [1]
C1549507
Tracking Document Reason for non participation
Descrição

Tracking Document Reason for non participation

Alias
UMLS CUI-1
C3889409
Previous subject number
Descrição

Previous subject number

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C0205156
Previous Protocol number
Descrição

Previous Protocol number

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C0600091
UMLS CUI [1,3]
C0205156
Date of birth
Descrição

Date of birth

Tipo de dados

date

Alias
UMLS CUI [1]
C0421451
Reason for non participation
Descrição

Reason for non participation

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0558080
UMLS CUI [1,2]
C0679823
UMLS CUI [1,3]
C0392360
Please specify criteria that are not fullfilled
Descrição

Reason for non participation

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1516637
UMLS CUI [1,2]
C0679823
UMLS CUI [1,3]
C0392360
Please specify adverse events,serious adverse event or other reason for subject withdrawal
Descrição

Reason for non participation

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0558080
UMLS CUI [1,2]
C0679823
UMLS CUI [1,3]
C0392360
Date of death
Descrição

Reason for non participation

Tipo de dados

date

Alias
UMLS CUI [1,1]
C1148348
UMLS CUI [1,2]
C0679823
UMLS CUI [1,3]
C0392360
Date of Contact
Descrição

Last seen

Tipo de dados

date

Alias
UMLS CUI [1]
C0805839

Similar models

Long Term Follow up Year 5

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Long Term Follow up Visit 7
C1517942 (UMLS CUI-1)
Study site identifier
Item
Center
text
C2826692 (UMLS CUI [1])
Subject number
Item
Subject number
text
C2348585 (UMLS CUI [1])
Date of visit
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Informed consent
Item
I certify that Informed Consent has been obtained prior to any study procedure.
boolean
C0021430 (UMLS CUI [1])
Informed Consent Date
Item
Informed Consent Date
date
C2985782 (UMLS CUI [1])
Item
Previous Studies
integer
C2242969 (UMLS CUI [1])
Code List
Previous Studies
CL Item
208127/082 (HAB-082) (1)
CL Item
208127/103 (HAB-082 Y2) (2)
CL Item
208127/104 (HAB-082 Y3) (3)
Item Group
Demographics
C0011298 (UMLS CUI-1)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Code List
Gender
CL Item
Male (1)
CL Item
Female (2)
Item
Race
integer
C0034510 (UMLS CUI [1])
Code List
Race
CL Item
Black (1)
CL Item
Arabic/North African (4)
CL Item
White/Caucasian (2)
CL Item
East & South East Asian (5)
CL Item
South Asian (6)
CL Item
Other,please specify (9)
Race
Item
Race, if other please specify
text
C0034510 (UMLS CUI [1])
Item Group
Laboratory Tests
C0022885 (UMLS CUI-1)
Blood sample
Item
Has a blood sample been taken for testing anti-HAV and anti-HBs antibodies?
boolean
C0005834 (UMLS CUI [1])
Sample Collection Date
Item
Sample Collection Date
date
C1302413 (UMLS CUI [1])
Vaccination since last visit
Item
Has the subject received a dose of monovalent or combined Hepatitis A or Hepatitis B vaccine?
boolean
C3543421 (UMLS CUI [1,1])
C0589121 (UMLS CUI [1,2])
Item
If yes, please specify vaccine
integer
C3543421 (UMLS CUI [1])
Code List
If yes, please specify vaccine
CL Item
Hepatitis A vaccine (1)
CL Item
Hepatitis B vaccine (2)
CL Item
Combined Hepatitis A and B vaccine (3)
Hepatitis A and/or Hepatitis B immunoglobulins past 6 months
Item
Has the subject received a dose of Hepatitis A and/or Hepatitis B immunoglobulins within 6 months prior to bleeding?
boolean
C3652495 (UMLS CUI [1,1])
C0062525 (UMLS CUI [1,2])
C3828652 (UMLS CUI [1,3])
Item
If yes, please specify
integer
C3652495 (UMLS CUI [1,1])
C0062525 (UMLS CUI [1,2])
Code List
If yes, please specify
CL Item
Hepatitis A immunoglobulins (1)
CL Item
Hepatitis B immunoglobulins (2)
Item Group
Follow up Studies
C0016441 (UMLS CUI-1)
Follow-up studies
Item
Would the subject be willing to participate in a follow-up study?
boolean
C0016441 (UMLS CUI [1])
Item
If No, please specify the most appropriate reason
integer
C0016441 (UMLS CUI [1,1])
C2349954 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Code List
If No, please specify the most appropriate reason
CL Item
Adverse Events or Serious Adverse Events (1)
CL Item
Other (2)
Specify Reason for withdrawal
Item
Please specify Adverse event,Serious adverse event or other reason
text
C2349954 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item Group
Investigator 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])
Investigator Signature
Item
Investigator Signature
text
C2346576 (UMLS CUI [1])
Investigator name
Item
Investigator name
text
C2826892 (UMLS CUI [1])
Date of completion
Item
Date
date
C1549507 (UMLS CUI [1])
Item Group
Tracking Document Reason for non participation
C3889409 (UMLS CUI-1)
Previous subject number
Item
Previous subject number
integer
C2348585 (UMLS CUI [1,1])
C0205156 (UMLS CUI [1,2])
Item
Previous Protocol number
integer
C2348563 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
C0205156 (UMLS CUI [1,3])
Code List
Previous Protocol number
CL Item
208127/082 (HAB-082) (1)
CL Item
208127/103 (HAB-082 Y2) (2)
CL Item
208127/104 (HAB-082 Y3) (3)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Reason for non participation
integer
C0558080 (UMLS CUI [1,1])
C0679823 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Code List
Reason for non participation
CL Item
Subject not eligible? - please specify criteria that are not fulfilled (1)
CL Item
Subject lost to follow-up or not reached (2)
CL Item
Subject eligible but not willing to participate due to AE,SAE or other reason (3)
CL Item
Subject died on: (4)
Reason for non participation
Item
Please specify criteria that are not fullfilled
text
C1516637 (UMLS CUI [1,1])
C0679823 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Reason for non participation
Item
Please specify adverse events,serious adverse event or other reason for subject withdrawal
text
C0558080 (UMLS CUI [1,1])
C0679823 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Reason for non participation
Item
Date of death
date
C1148348 (UMLS CUI [1,1])
C0679823 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Last seen
Item
Date of Contact
date
C0805839 (UMLS CUI [1])

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