ID

33079

Description

Study ID: 104020 Clinical Study ID: 104020 Study Title: Blinded, randomised study to assess the immunogenicity and safety of GlaxoSmithKline (GSK) Biologicals’ live attenuated measles-mumps-rubella-varicella candidate vaccine when given to healthy children in their second year of life Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00126997 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 4 Study Recruitment Status: Completed Generic Name: Combined Measles, Mumps, Rubella, Varicella Vaccine Trade Name: Priorix Tetra Study Indication: Measles; Mumps; Rubella; Varicella

Keywords

Versions (1)
  1. 11/26/18 11/26/18 -
Copyright Holder

GSK group of companies

Uploaded on

November 26, 2018

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Immunogenicity of Combined Measles, Mumps, Rubella, Varicella Vaccine for healthy 2 y.o children - 104020

English

Concomitant Vaccination Form

1 forms  
Administrative data
Description

Administrative data

Subject Number
Description

Subject Number

Data type

integer

Concomitant Vaccination
Description

Concomitant Vaccination

Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?
Description

Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?

Data type

boolean

If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date
Description

If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date

Data type

text

Trade Name / Generic Name
Description

Trade Name / Generic Name

Trade / Generic Name
Description

Trade / Generic Name

Data type

text

Route
Description

Route

Data type

text

Administration Date
Description

Administration Date

Data type

date

Back to the top of the page

Similar models

Concomitant Vaccination Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item Group
Concomitant Vaccination
Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?
Item
Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?
boolean
If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date
Item
If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date
text
Item Group
Trade Name / Generic Name
Trade / Generic Name
Item
Trade / Generic Name
text
Item
Route
text
Route
Code List
Route
CL Item
Intradermal (ID) (1)
CL Item
Inhalation (IH) (2)
CL Item
Intramuscular (IM) (3)
CL Item
Intravenous (IV) (4)
CL Item
Intranasal (NA) (5)
CL Item
Other (OTH) (6)
CL Item
Parenteral (PE) (7)
CL Item
Oral (PO) (8)
CL Item
Subcutaneous (SC) (9)
CL Item
Sublingual (SL) (10)
CL Item
Transdermal (TD) (11)
CL Item
Unknown (UNK) (12)
Administration Date
Item
Administration Date
date
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

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