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ID

33098

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. 11/27/18 11/27/18 -
Copyright Holder

GSK group of companies

Uploaded on

November 27, 2018

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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

    Diary Card: Unsolicited Symptoms (All Groups) - Dose 2

    1 forms  
    Administrative data
    Description

    Administrative data

    Dose Number
    Description

    Dose Number

    Data type

    text

    Subject Number
    Description

    Subject Number

    Data type

    integer

    Please do not forget to bring back the diary card on
    Description

    fill the date below

    Data type

    date

    Other Symptoms (Day 0-42)
    Description

    Other Symptoms (Day 0-42)

    Symptom
    Description

    Symptom

    Data type

    integer

    Description
    Description

    Description

    Data type

    text

    Intensity
    Description

    Intensity

    Data type

    text

    Start day
    Description

    Start day

    Data type

    date

    End date
    Description

    End date

    Data type

    date

    Ongoing?
    Description

    Ongoing?

    Data type

    boolean

    Medication
    Description

    Medication

    Trade/Generic name
    Description

    Please fill in below if any medication has been taken since the vaccination

    Data type

    text

    Reason
    Description

    Reason

    Data type

    text

    Total daily dose
    Description

    Total daily dose

    Data type

    text

    Start date
    Description

    Start date

    Data type

    date

    End date
    Description

    End date

    Data type

    date

    Still taking medication?
    Description

    Still taking medication?

    Data type

    boolean

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    Similar models

    Diary Card: Unsolicited Symptoms (All Groups) - Dose 2

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Administrative data
    Item
    Dose Number
    text
    Dose Number
    Code List
    Dose Number
    CL Item
    Dose 2 (1)
    Subject Number
    Item
    Subject Number
    integer
    Please do not forget to bring back the diary card on
    Item
    Please do not forget to bring back the diary card on
    date
    Item Group
    Other Symptoms (Day 0-42)
    Symptom
    Item
    Symptom
    integer
    Description
    Item
    Description
    text
    Item
    Intensity
    text
    Intensity
    Code List
    Intensity
    CL Item
    Mild (1)
    CL Item
    Moderate (2)
    CL Item
    Severe (3)
    Start day
    Item
    Start day
    date
    End date
    Item
    End date
    date
    Ongoing?
    Item
    Ongoing?
    boolean
    Item Group
    Medication
    Trade/Generic name
    Item
    Trade/Generic name
    text
    Reason
    Item
    Reason
    text
    Total daily dose
    Item
    Total daily dose
    text
    Start date
    Item
    Start date
    date
    End date
    Item
    End date
    date
    Still taking medication?
    Item
    Still taking medication?
    boolean
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