ID

33346

Beschrijving

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

Trefwoorden

Versies (2)
  1. 06-12-18 06-12-18 -
  2. 10-12-18 10-12-18 -
Houder van rechten

GSK group of companies

Geüploaded op

6 december 2018

DOI

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Licentie

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

Engels

Visit 4: Study Continuation Check

1 Formulieren  
Administrative data
Beschrijving

Administrative data

Subject Number
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Subject Number

Datatype

integer

Date of Visit
Beschrijving

Date of Visit

Datatype

date

Protocol Number
Beschrijving

Protocol Number

Datatype

integer

Check for Study Continuation
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Check for Study Continuation

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Did the subject come for Visit 4?

Datatype

boolean

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text

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text

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integer

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integer

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Visit 4: Study Continuation Check

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Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Date of Visit
Item
Date of Visit
date
Protocol Number
Item
Protocol Number
integer
Item Group
Check for Study Continuation
Did the subject come for Visit 4?
Item
Did the subject come for Visit 4?
boolean
Item
If no, please choose the reason
text
If no, please choose the reason
Code List
If no, please choose the reason
CL Item
same reason or decision as previous visit (1)
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Serious Adverse Event (2)
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Non-Serious Adverse Event (3)
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Other (4)
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Item
If Other, please specify
text
If SAE, please record the number
Item
If SAE, please record the number
integer
If Non-SAE, please record the number
Item
If Non-SAE, please record the number
integer
Item
Please tick who took the decision
text
Please tick who took the decision
Code List
Please tick who took the decision
CL Item
Investigator (1)
CL Item
Parents/Guardians (2)
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