ID

33336

Beskrivning

Study ID: 104065 Clinical Study ID: 104065 Study Title: Immune memory of GSK's DTPw-HBV/Hib vaccine by giving Plain PRP polysaccharide at 10 mths. Immuno & reacto of a booster dose of DTPw-HBV/Hib or DTPw-HBV or DTPw-HBV+Hib at 15-18 mths in infants previously primed with DTPw-HBV/Hib Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00169442  Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completet Generic Name: Combined Diphtheria, Tetanus, Whole Cell Pertussis, Hepatitis B, Haemophilus influenzae Type b Vaccine (KFT) Trade Name: Zilbrix/Hib Study Indication: Diphtheria; Haemophilus influenzae type b; Hepatitis B; Tetanus; Whole Cell Pertussis

Nyckelord

Versioner (1)
  1. 2018-12-06 2018-12-06 -
Rättsinnehavare

GSK group of companies

Uppladdad den

6 december 2018

DOI

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Licens

Creative Commons BY-NC 3.0
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mmune memory of Combined Diphtheria, Tetanus, Whole Cell Pertussis, Hepatitis B, Haemophilus influenzae Type b Vaccine at infants (15 to 18 mths) - 104065

Engelsk

Visit 2: Study Continuation Check

1 Formulär  
Administrative data
Beskrivning

Administrative data

Subject Number
Beskrivning

Subject Number

Datatyp

integer

Protocol Number
Beskrivning

Protocol Number

Datatyp

integer

Check for Study Continuation
Beskrivning

Check for Study Continuation

Did the subject return for visit 2?
Beskrivning

Did the subject return for visit 2?

Datatyp

boolean

If yes, please complete all forms for Visit 2
Beskrivning

If yes, please complete all forms for Visit 2

Datatyp

text

If No, record ONE most appropriate reason and skip the following pages of this visit
Beskrivning

If No, record ONE most appropriate reason and skip the following pages of this visit

Datatyp

text

If SAE, record the SAE number
Beskrivning

If SAE, record the SAE number

Datatyp

integer

If Non-SAE, record the unsolicited AE number
Beskrivning

If Non-SAE, record the unsolicited AE number

Datatyp

integer

If Other, specify
Beskrivning

e.g., consent withdrawal, protocol violation, etc.

Datatyp

text

Who took the decision?
Beskrivning

Who took the decision?

Datatyp

text

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Similar models

Visit 2: Study Continuation Check

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Protocol Number
Item
Protocol Number
integer
Item Group
Check for Study Continuation
Did the subject return for visit 2?
Item
Did the subject return for visit 2?
boolean
If yes, please complete all forms for Visit 2
Item
If yes, please complete all forms for Visit 2
text
Item
If No, record ONE most appropriate reason and skip the following pages of this visit
text
If No, record ONE most appropriate reason and skip the following pages of this visit
Code List
If No, record ONE most appropriate reason and skip the following pages of this visit
CL Item
Serious Adverse Event (1)
CL Item
Non-Serious adverse event (2)
CL Item
Other (3)
If SAE, record the SAE number
Item
If SAE, record the SAE number
integer
If Non-SAE, record the unsolicited AE number
Item
If Non-SAE, record the unsolicited AE number
integer
If Other, specify
Item
If Other, specify
text
Item
Who took the decision?
text
Who took the decision?
Code List
Who took the decision?
CL Item
Investigator (1)
CL Item
Parents/Guardians (2)
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