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. 26/11/2018 26/11/2018 -
Détendeur de droits

GSK group of companies

Téléchargé le

26 novembre 2018

DOI

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Licence

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

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Concomitant Vaccination Form

1 Formulaires  
Administrative data
Description

Administrative data

Subject Number
Description

Subject Number

Type de données

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?

Type de données

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

Type de données

text

Trade Name / Generic Name
Description

Trade Name / Generic Name

Trade / Generic Name
Description

Trade / Generic Name

Type de données

text

Route
Description

Route

Type de données

text

Administration Date
Description

Administration Date

Type de données

date

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Similar models

Concomitant Vaccination Form

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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