ID

33348

Descrição

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

Palavras-chave

  1. 06/12/2018 06/12/2018 -
Titular dos direitos

GSK group of companies

Transferido a

6 de dezembro de 2018

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

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

Large Swelling Reaction

Administrative data
Descrição

Administrative data

Subject Number
Descrição

Subject Number

Tipo de dados

integer

Protocol Number
Descrição

Protocol Number

Tipo de dados

integer

Date of Birth
Descrição

Date of Birth

Tipo de dados

date

Vaccine - possible cause of swelling reaction
Descrição

Vaccine - possible cause of swelling reaction

Tipo de dados

text

Report of Physical Examination
Descrição

Report of Physical Examination

Date of physical examination
Descrição

Please complete this section for: any local swelling with diameter >50mm, any noticeable diffuse injection site swelling (diameter not measurable), any noticeable increased circumference of the injected limb.

Tipo de dados

date

Was the examination performed by a member of study personnel during the large swelling reaction period?
Descrição

Was the examination performed by a member of study personnel during the large swelling reaction period?

Tipo de dados

boolean

Date when the swelling was first considered to be a large swelling reaction
Descrição

Date when the swelling was first considered to be a large swelling reaction

Tipo de dados

date

If occurring within 24 hrs after vaccination, please specify how long after vaccination
Descrição

If occurring within 24 hrs after vaccination, please specify how long after vaccination

Tipo de dados

integer

Unidades de medida
  • hrs
hrs
Size of swelling
Descrição

measurement of the greatest diameter

Tipo de dados

integer

Unidades de medida
  • mm
mm
Type of swelling
Descrição

please specify in section "clinical case description"

Tipo de dados

text

Circumference of swollen limb (at the site of maximum swelling)
Descrição

Circumference of swollen limb (at the site of maximum swelling)

Tipo de dados

integer

Unidades de medida
  • mm
mm
Circumference of the opposite limb (at the same level)
Descrição

Circumference of the opposite limb (at the same level)

Tipo de dados

integer

Unidades de medida
  • mm
mm
Associated signs
Descrição

Associated signs

Temperature
Descrição

Please report t°; if the t° has been taken more than once a day, please report the highest value.

Tipo de dados

integer

Unidades de medida
  • °C
°C
Route
Descrição

Route

Tipo de dados

text

Redness
Descrição

Redness

Tipo de dados

boolean

Redness - largest diameter
Descrição

Redness - largest diameter

Tipo de dados

integer

Unidades de medida
  • mm
mm
Induration
Descrição

Induration

Tipo de dados

boolean

Induration - largest diameter
Descrição

Induration - largest diameter

Tipo de dados

integer

Unidades de medida
  • mm
mm
Pain
Descrição

at administration site

Tipo de dados

boolean

Pain intensity
Descrição

Pain intensity

Tipo de dados

text

Functional impairment
Descrição

Functional impairment

Tipo de dados

boolean

Functional impairment intensity
Descrição

Functional impairment intensity

Tipo de dados

text

If hospitalisation is required, please also complete a Serious Adverse Event Form
Descrição

If hospitalisation is required, please also complete a Serious Adverse Event Form

Clinical Case Description
Descrição

Clinical Case Description

Please give a clinical description of the observed large swelling reaction.
Descrição

Includes a description of the joint involved and specific associated symptoms. Please mention also eventual diagnostic(s) procedures and therapeutic interventions.

Tipo de dados

text

Last date when the swelling was still considered to be a large swelling reaction
Descrição

Last date when the swelling was still considered to be a large swelling reaction

Tipo de dados

date

Outcome of the large swelling reaction
Descrição

Outcome of the large swelling reaction

Tipo de dados

text

Follow-up information
Descrição

Follow-up information

Tipo de dados

text

Is there an alternative explanation for the swelling?
Descrição

e.g., allergy, infection, trauma, underlying conditions

Tipo de dados

boolean

If Yes, please specify below
Descrição

If Yes, please specify below

Tipo de dados

text

Similar models

Large Swelling Reaction

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Protocol Number
Item
Protocol Number
integer
Date of Birth
Item
Date of Birth
date
Item
Vaccine - possible cause of swelling reaction
text
Code List
Vaccine - possible cause of swelling reaction
CL Item
Plain PRP Vaccine (1)
CL Item
DTPw-HBV Kft Vaccine (2)
Item Group
Report of Physical Examination
Date of physical examination
Item
Date of physical examination
date
Was the examination performed by a member of study personnel during the large swelling reaction period?
Item
Was the examination performed by a member of study personnel during the large swelling reaction period?
boolean
Date when the swelling was first considered to be a large swelling reaction
Item
Date when the swelling was first considered to be a large swelling reaction
date
If occurring within 24 hrs after vaccination, please specify how long after vaccination
Item
If occurring within 24 hrs after vaccination, please specify how long after vaccination
integer
Size of swelling
Item
Size of swelling
integer
Item
Type of swelling
text
Code List
Type of swelling
CL Item
Local swelling around injection site, not involving adjacent joint (1)
CL Item
Diffuse swelling, not involving adjacent joint (2)
CL Item
Swelling, involving adjacent joint (3)
Circumference of swollen limb (at the site of maximum swelling)
Item
Circumference of swollen limb (at the site of maximum swelling)
integer
Circumference of the opposite limb (at the same level)
Item
Circumference of the opposite limb (at the same level)
integer
Item Group
Associated signs
Temperature
Item
Temperature
integer
Item
Route
text
Code List
Route
CL Item
Axillary (1)
CL Item
Oral (2)
CL Item
Tympanic oral (3)
CL Item
Tympanic rectal (4)
CL Item
Rectal (5)
Redness
Item
Redness
boolean
Redness - largest diameter
Item
Redness - largest diameter
integer
Induration
Item
Induration
boolean
Induration - largest diameter
Item
Induration - largest diameter
integer
Pain
Item
Pain
boolean
Item
Pain intensity
text
Code List
Pain intensity
CL Item
Minor reaction to touch (1)
CL Item
Cries/protest on touch (2)
CL Item
Cries when limb is moved/spontaneously painful (3)
Functional impairment
Item
Functional impairment
boolean
Item
Functional impairment intensity
text
Code List
Functional impairment intensity
CL Item
grade 1 (easily tolerated, causing minimal discomfort and not interfering with everyday activities) (1)
CL Item
grade 2 (sufficiently discomforting to interfere with normal everyday activities) (2)
CL Item
grade 3 (prevents normal everyday activities) (3)
Item Group
If hospitalisation is required, please also complete a Serious Adverse Event Form
Item Group
Clinical Case Description
Please give a clinical description of the observed large swelling reaction.
Item
Please give a clinical description of the observed large swelling reaction.
text
Last date when the swelling was still considered to be a large swelling reaction
Item
Last date when the swelling was still considered to be a large swelling reaction
date
Item
Outcome of the large swelling reaction
text
Code List
Outcome of the large swelling reaction
CL Item
Recovered/resolved (1)
CL Item
Recovering/resolving (2)
CL Item
Not recovered/not resolved (please provide further follow-up data) (3)
CL Item
Recovered with sequelae/resolved with sequelae (please specify under section "clinical case description") (4)
Follow-up information
Item
Follow-up information
text
Is there an alternative explanation for the swelling?
Item
Is there an alternative explanation for the swelling?
boolean
If Yes, please specify below
Item
If Yes, please specify below
text

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial