ID

33463

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

  1. 10-12-18 10-12-18 -
Houder van rechten

GSK group of companies

Geüploaded op

10 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

Visit 4: Concomitant Medications

Administrative data
Beschrijving

Administrative data

Subject Number
Beschrijving

Subject Number

Datatype

integer

Date of Visit
Beschrijving

Visit Date

Datatype

date

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

Have any medications/treatments been administered during study period?

Datatype

boolean

Medication
Beschrijving

Medication

Trade Name/Generic Name
Beschrijving

Trade Name/Generic Name

Datatype

text

Total Daily Dose
Beschrijving

Total Daily Dose

Datatype

text

Start Date
Beschrijving

Start Date

Datatype

date

End Date
Beschrijving

End Date

Datatype

date

Ongoing?
Beschrijving

Ongoing?

Datatype

boolean

Medical Indication
Beschrijving

Medical Indication

Datatype

text

If Other, specify
Beschrijving

If Other, specify

Datatype

text

Route
Beschrijving

Route

Datatype

text

Reminder
Beschrijving

Reminder

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

fill the date below

Datatype

date

In case of hospitalisation, please inform
Beschrijving

fill the name below

Datatype

text

Similar models

Visit 4: Concomitant Medications

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Visit Date
Item
Date of Visit
date
Have any medications/treatments been administered during study period?
Item
Have any medications/treatments been administered during study period?
boolean
Item Group
Medication
Trade Name/Generic Name
Item
Trade Name/Generic Name
text
Total Daily Dose
Item
Total Daily Dose
text
Start Date
Item
Start Date
date
End Date
Item
End Date
date
Ongoing?
Item
Ongoing?
boolean
Item
Medical Indication
text
Code List
Medical Indication
CL Item
Prophylactic (1)
CL Item
Other (2)
If Other, specify
Item
If Other, specify
text
Item
Route
text
Code List
Route
CL Item
External (1)
CL Item
Intradermal (2)
CL Item
Inhalation (3)
CL Item
Intramuscular (4)
CL Item
Intraarticular (5)
CL Item
Intrathecal (6)
CL Item
Intravenous (7)
CL Item
Intranasal (8)
CL Item
Other (9)
CL Item
Parenteral (10)
CL Item
Oral (11)
CL Item
Rectal (12)
CL Item
Subcutaneous (13)
CL Item
Sublingual (14)
CL Item
Transdermal (15)
CL Item
Topical (16)
CL Item
Unknown (17)
CL Item
Vaginal (18)
Item Group
Reminder
Please do not forget to bring back the diary card on
Item
Please do not forget to bring back the diary card on
date
In case of hospitalisation, please inform
Item
In case of hospitalisation, please inform
text

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