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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

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

GSK group of companies

Uploaded on

November 26, 2018

DOI

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License

Creative Commons BY-NC 3.0
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    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

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    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
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