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ID

33080

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 Medication Form

    1 forms  
    Administrative data
    Description

    Administrative data

    Subject Number
    Description

    Subject Number

    Data type

    integer

    Concomitant Medication
    Description

    Concomitant Medication

    Have any medications/treatments been administered during study period?
    Description

    Have any medications/treatments been administered during study period?

    Data type

    boolean

    If Yes, please complete the following table
    Description

    If Yes, please complete the following table

    Data type

    text

    List of Medications
    Description

    List of Medications

    Trade/Generic Name
    Description

    Trade/Generic Name

    Data type

    text

    Medical Indication
    Description

    Medical Indication

    Data type

    text

    Total daily dose
    Description

    Total daily dose

    Data type

    text

    Route
    Description

    Route

    Data type

    text

    Start date
    Description

    Start date

    Data type

    date

    End date
    Description

    End date

    Data type

    date

    Ongoing at the end of study?
    Description

    Ongoing at the end of study?

    Data type

    boolean

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    Similar models

    Concomitant Medication 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 Medication
    Have any medications/treatments been administered during study period?
    Item
    Have any medications/treatments been administered during study period?
    boolean
    If Yes, please complete the following table
    Item
    If Yes, please complete the following table
    text
    Item Group
    List of Medications
    Trade/Generic Name
    Item
    Trade/Generic Name
    text
    Item
    Medical Indication
    text
    Medical Indication
    Code List
    Medical Indication
    CL Item
    Prophylactic (1)
    Total daily dose
    Item
    Total daily dose
    text
    Route
    Item
    Route
    text
    Start date
    Item
    Start date
    date
    End date
    Item
    End date
    date
    Ongoing at the end of study?
    Item
    Ongoing at the end of study?
    boolean
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