ID
29749
Beschreibung
https://clinicaltrials.gov/show/NCT00197028 Visit 1 Case Report Form Study ID: 103967 Clinical Study ID: 103967 Study Title: A Phase I/IIb randomized, double-blind, controlled study of the safety, immunogenicity and proof-of-concept of RTS,S/AS02D, a candidate malaria vaccine in infants living in a malaria-endemic region Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00197028 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: SB257049 Trade Name: BIO MALARIA; SB257049 Study Indication: Malaria
Link
https://clinicaltrials.gov/show/NCT00197028
Stichworte
Versionen (1)
- 18.04.18 18.04.18 -
Rechteinhaber
GlaxoSmithKline (GSK)
Hochgeladen am
18. April 2018
DOI
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Lizenz
Creative Commons BY-NC 3.0
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RTS,S/AS02D, a candidate malaria vaccine in infants living in a malaria-endemic region, Study ID: 103967, NCT00197028
Case Report Form, Screening, Visit 1
- StudyEvent: ODM
Beschreibung
Informed Consent and Demographics
Alias
- UMLS CUI-1
- C0021430
- UMLS CUI-2
- C0011298
Beschreibung
Informed Consent Date
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0021430
Beschreibung
Center Number
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C1301943
- UMLS CUI [1,2]
- C0600091
Beschreibung
Date of birth
Datentyp
date
Alias
- UMLS CUI [1]
- C0421451
Beschreibung
Gender
Datentyp
text
Alias
- UMLS CUI [1]
- C0079399
Beschreibung
Race
Datentyp
integer
Alias
- UMLS CUI [1]
- C0034510
Beschreibung
Geographical area
Datentyp
integer
Alias
- UMLS CUI [1]
- C0681784
Beschreibung
Eligibility Check
Alias
- UMLS CUI-1
- C0013893
Beschreibung
Do not enter the subject into the study if he/she failed any inclusion or exclusion criteria below.
Datentyp
integer
Alias
- UMLS CUI [1]
- C0013893
Beschreibung
Inclusion criteria
Datentyp
integer
Beschreibung
Exclusion Criteria
Datentyp
integer
Beschreibung
Screening conclusion
Alias
- UMLS CUI-1
- C1707478
- UMLS CUI-2
- C0008976
- UMLS CUI-3
- C0042210
Beschreibung
Serious Adverse Event
Datentyp
integer
Alias
- UMLS CUI [1]
- C1519255
Beschreibung
Number of SAEs
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0449788
- UMLS CUI [1,2]
- C1519255
Beschreibung
Screening failure
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1710477
- UMLS CUI [1,2]
- C0231175
Beschreibung
Screening failure
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C1710477
- UMLS CUI [1,2]
- C0231175
Beschreibung
Decision maker
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422727
- UMLS CUI [1,2]
- C0679006
Beschreibung
Administative data
Alias
- UMLS CUI-1
- C1320722
Beschreibung
I confirm that I have reviewed the data in these screening forms 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.
Datentyp
text
Alias
- UMLS CUI [1]
- C2346576
Beschreibung
Date
Datentyp
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Beschreibung
Printed name
Datentyp
text
Alias
- UMLS CUI [1]
- C2826892
Ähnliche Modelle
Case Report Form, Screening, Visit 1
- StudyEvent: ODM
C0011298 (UMLS CUI-2)
C0021430 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,2])
C0008976 (UMLS CUI-2)
C0042210 (UMLS CUI-3)
C1519255 (UMLS CUI [1,2])
C0231175 (UMLS CUI [1,2])
C0231175 (UMLS CUI [1,2])
C0679006 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])