Concomitant Vaccination
If yes, please record concomitant vaccination with trade name and/or generic name, route and vaccine administration date in the following itemgroup.
boolean
Concomitant Vaccination Characteristics
Trade / (Generic) Name
text
Route of Administration
text
Administration Date
date
Commentary field for GSK
text
Contraindicated Medication / Medication
All concomitant medication, with the exception of vitamins and/or dietary supplements, administered at ANY time during the period starting with administration of each dose of study vaccine (Visit 3) and ending at Visit 6 are to be recorded with generic name of the medication (trade names are allowed for combination drugs, i.e. multi-component drugs), medical indication, total daily dose, route of administration, start and end dates of treatment. Any treatments and/or medications specifically contraindicated, e.g., any immunoglobulins, other blood products and any immune modifying drugs administered since birth or at any time during the study period are to be recorded with generic name of the medication (trade names are allowed for combination drugs only), medical indication, total daily dose, route of administration, start and end dates of treatment. Concomitant medication administered for the treatment of an AE or SAE within the follow-up period for adverse events must be recorded in the CRF with generic name of the medication (trade names are allowed for combination drugs only), medical indication (including which AE/SAE), total daily dose, route of administration, start and end dates of treatment. If yes, please complete the following item group.
boolean
Medication Characteristics
Trade / (Generic) Name
text
Medical indication
text
A prophylactic medication is a medication administered in the absence of ANY symptom and in anticipation of a reaction to the vaccination (e.g. an anti-pyretic is considered to be prophylactic when it is given in the absence of fever [rectal temperature < 38°C] and any other symptom, to prevent fever from occurring). Any concomitant medication administered prophylactically in anticipation of reaction to the vaccination must be recorded in the CRF with generic name of the medication (trade names are allowed for combination drugs only), total daily dose, route of administration, start and end dates of treatment and coded as ‘Prophylactic’.
boolean
Total daily dose
text
Route of Administration
text
Administration Date
date
Start date of Administration
date
If the administration ended during the time of the study.
date
Ongoing Administration
boolean
Commentary field for GSK
text