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ID

33473

Beschreibung

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

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  1. 10.12.18 10.12.18 -
Rechteinhaber

GSK group of companies

Hochgeladen am

10. Dezember 2018

DOI

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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

    Diary Card: Local Symptoms (DTPwHBV Kft + HiberixTM)

    Administrative data
    Beschreibung

    Administrative data

    Subject Number
    Beschreibung

    Subject Number

    Datentyp

    integer

    Visit
    Beschreibung

    Visit

    Datentyp

    text

    Protocol Number
    Beschreibung

    Protocol Number

    Datentyp

    integer

    Local Symptoms - Redness (at injection site) DTPw-HBV Kft Vaccine
    Beschreibung

    Local Symptoms - Redness (at injection site) DTPw-HBV Kft Vaccine

    Day
    Beschreibung

    Day

    Datentyp

    integer

    Side
    Beschreibung

    Side

    Datentyp

    text

    Site
    Beschreibung

    Site

    Datentyp

    text

    Size
    Beschreibung

    please measure the greatest diameter

    Datentyp

    integer

    Maßeinheiten
    • mm
    mm
    Ongoing after Day 3?
    Beschreibung

    Ongoing after Day 3?

    Datentyp

    boolean

    If Yes, record date of last day of symptoms
    Beschreibung

    If Yes, record date of last day of symptoms

    Datentyp

    date

    Medically attended visit?
    Beschreibung

    Medicalyl attended visit?

    Datentyp

    boolean

    Local Symptoms - Swelling (at injection site)
    Beschreibung

    Local Symptoms - Swelling (at injection site)

    Day
    Beschreibung

    Day

    Datentyp

    integer

    Side
    Beschreibung

    Side

    Datentyp

    text

    Site
    Beschreibung

    Site

    Datentyp

    text

    Size
    Beschreibung

    please measure the greatest diameter

    Datentyp

    integer

    Maßeinheiten
    • mm
    mm
    Ongoing after Day 3?
    Beschreibung

    Ongoing after Day 3?

    Datentyp

    boolean

    If Yes, record date of last day of symptoms
    Beschreibung

    If Yes, record date of last day of symptoms

    Datentyp

    date

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Local Symptoms - Pain (at injection site)
    Beschreibung

    Local Symptoms - Pain (at injection site)

    Day
    Beschreibung

    Day

    Datentyp

    integer

    Side
    Beschreibung

    Side

    Datentyp

    text

    Site
    Beschreibung

    Site

    Datentyp

    text

    Intensity
    Beschreibung

    Intensity

    Datentyp

    integer

    Ongoing after day 3?
    Beschreibung

    Ongoing after day 3?

    Datentyp

    boolean

    If Yes, record date of last day of symptoms
    Beschreibung

    If Yes, record date of last day of symptoms

    Datentyp

    date

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Other Local Symptoms
    Beschreibung

    Other Local Symptoms

    Description
    Beschreibung

    please specify side(s) and site(s)

    Datentyp

    text

    Intensity
    Beschreibung

    Intensity

    Datentyp

    text

    Start date
    Beschreibung

    Start date

    Datentyp

    date

    End date
    Beschreibung

    End date

    Datentyp

    date

    Ongoing?
    Beschreibung

    Ongoing?

    Datentyp

    boolean

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Local Symptoms - Redness (at injection site) HiberixTM Vaccine
    Beschreibung

    Local Symptoms - Redness (at injection site) HiberixTM Vaccine

    Day
    Beschreibung

    Day

    Datentyp

    text

    Side
    Beschreibung

    Side

    Datentyp

    text

    Site
    Beschreibung

    Site

    Datentyp

    text

    Size
    Beschreibung

    please measure the greatest diameter

    Datentyp

    integer

    Maßeinheiten
    • mm
    mm
    Ongoing after Day 3?
    Beschreibung

    Ongoing after Day 3?

    Datentyp

    boolean

    If Yes, record date of last day of symptoms
    Beschreibung

    If Yes, record date of last day of symptoms

    Datentyp

    date

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Local Symptoms - Swelling (at injection site) HiberixTM Vaccine
    Beschreibung

    Local Symptoms - Swelling (at injection site) HiberixTM Vaccine

    Day
    Beschreibung

    Day

    Datentyp

    text

    Side
    Beschreibung

    Side

    Datentyp

    text

    Site
    Beschreibung

    Site

    Datentyp

    text

    Size
    Beschreibung

    please measure the greatest diameter

    Datentyp

    integer

    Maßeinheiten
    • mm
    mm
    Ongoing after Day 3?
    Beschreibung

    Ongoing after Day 3?

    Datentyp

    boolean

    If Yes, record date of last day of symptoms
    Beschreibung

    If Yes, record date of last day of symptoms

    Datentyp

    date

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Local Symptoms - Pain (at injection site) HiberixTM Vaccine
    Beschreibung

    Local Symptoms - Pain (at injection site) HiberixTM Vaccine

    Day
    Beschreibung

    Day

    Datentyp

    integer

    Side
    Beschreibung

    Side

    Datentyp

    text

    Site
    Beschreibung

    Site

    Datentyp

    text

    Intensity
    Beschreibung

    Intensity

    Datentyp

    text

    Ongoing after day 3?
    Beschreibung

    Ongoing after day 3?

    Datentyp

    boolean

    If Yes, record date of last day of symptoms
    Beschreibung

    If Yes, record date of last day of symptoms

    Datentyp

    date

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Other Local Symptoms
    Beschreibung

    Other Local Symptoms

    Description
    Beschreibung

    please specify side(s) and site(s)

    Datentyp

    text

    Intensity
    Beschreibung

    Intensity

    Datentyp

    text

    Start date
    Beschreibung

    Start date

    Datentyp

    date

    End date
    Beschreibung

    End date

    Datentyp

    date

    Ongoing?
    Beschreibung

    Ongoing?

    Datentyp

    boolean

    Medically attended visit?
    Beschreibung

    Medically attended visit?

    Datentyp

    boolean

    Ähnliche Modelle

    Diary Card: Local Symptoms (DTPwHBV Kft + HiberixTM)

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Administrative data
    Subject Number
    Item
    Subject Number
    integer
    Item
    Visit
    text
    Code List
    Visit
    CL Item
    Vaccination 1 (1)
    Protocol Number
    Item
    Protocol Number
    integer
    Item Group
    Local Symptoms - Redness (at injection site) DTPw-HBV Kft Vaccine
    Item
    Day
    integer
    Code List
    Day
    CL Item
    Day 0 (1)
    CL Item
    Day 1 (evening) (2)
    CL Item
    Day 2 (evening) (3)
    CL Item
    Day 3 (evening) (4)
    Item
    Side
    text
    Code List
    Side
    CL Item
    Upper left (1)
    CL Item
    Lower left (2)
    CL Item
    Upper right (3)
    CL Item
    Lower right (4)
    Item
    Site
    text
    Code List
    Site
    CL Item
    Arm (1)
    CL Item
    Thigh (2)
    CL Item
    Buttock (3)
    Size
    Item
    Size
    integer
    Ongoing after Day 3?
    Item
    Ongoing after Day 3?
    boolean
    If Yes, record date of last day of symptoms
    Item
    If Yes, record date of last day of symptoms
    date
    Medicalyl attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Local Symptoms - Swelling (at injection site)
    Item
    Day
    integer
    Code List
    Day
    CL Item
    Day 0 (1)
    CL Item
    Day 1 (evening) (2)
    CL Item
    Day 2 (evening) (3)
    CL Item
    Day 3 (evening) (4)
    Item
    Side
    text
    Code List
    Side
    CL Item
    Upper left (1)
    CL Item
    Lower left (2)
    CL Item
    Upper right (3)
    CL Item
    Lower right (4)
    Item
    Site
    text
    Code List
    Site
    CL Item
    Arm (1)
    CL Item
    Thigh (2)
    CL Item
    Buttock (3)
    Size
    Item
    Size
    integer
    Ongoing after Day 3?
    Item
    Ongoing after Day 3?
    boolean
    If Yes, record date of last day of symptoms
    Item
    If Yes, record date of last day of symptoms
    date
    Medically attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Local Symptoms - Pain (at injection site)
    Item
    Day
    integer
    Code List
    Day
    CL Item
    Day 0 (1)
    CL Item
    Day 1 (evening) (2)
    CL Item
    Day 2 (evening) (3)
    CL Item
    Day 3 (evening) (4)
    Item
    Side
    text
    Code List
    Side
    CL Item
    Upper left (1)
    CL Item
    Lower left (2)
    CL Item
    Upper right (3)
    CL Item
    Lower right (4)
    Item
    Site
    text
    Code List
    Site
    CL Item
    Arm (1)
    CL Item
    Thigh (2)
    CL Item
    Buttock (3)
    Item
    Intensity
    integer
    Code List
    Intensity
    CL Item
    Absent (1)
    CL Item
    Minor reaction to touch (2)
    CL Item
    Cries/protests on touch (3)
    CL Item
    Cries when limb is moved/spontaneously painful (4)
    Ongoing after day 3?
    Item
    Ongoing after day 3?
    boolean
    If Yes, record date of last day of symptoms
    Item
    If Yes, record date of last day of symptoms
    date
    Medically attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Other Local Symptoms
    Description
    Item
    Description
    text
    Item
    Intensity
    text
    Code List
    Intensity
    CL Item
    Mild (1)
    CL Item
    Moderate (2)
    CL Item
    Severe (3)
    Start date
    Item
    Start date
    date
    End date
    Item
    End date
    date
    Ongoing?
    Item
    Ongoing?
    boolean
    Medically attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Local Symptoms - Redness (at injection site) HiberixTM Vaccine
    Item
    Day
    text
    Code List
    Day
    CL Item
    Day 0 (1)
    CL Item
    Day 1 (evening) (2)
    CL Item
    Day 2 (evening) (3)
    CL Item
    Day 3 (evening) (4)
    Item
    Side
    text
    Code List
    Side
    CL Item
    Upper left (1)
    CL Item
    Lower left (2)
    CL Item
    Upper right (3)
    CL Item
    Lower right (4)
    Item
    Site
    text
    Code List
    Site
    CL Item
    Arm (1)
    CL Item
    Thigh (2)
    CL Item
    Buttock (3)
    Size
    Item
    Size
    integer
    Ongoing after Day 3?
    Item
    Ongoing after Day 3?
    boolean
    If Yes, record date of last day of symptoms
    Item
    If Yes, record date of last day of symptoms
    date
    Medically attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Local Symptoms - Swelling (at injection site) HiberixTM Vaccine
    Item
    Day
    text
    Code List
    Day
    CL Item
    Day 0 (1)
    CL Item
    Day 1 (evening) (2)
    CL Item
    Day 2 (evening) (3)
    CL Item
    Day 3 (evening) (4)
    Item
    Side
    text
    Code List
    Side
    CL Item
    Upper left (1)
    CL Item
    Lower left (2)
    CL Item
    Upper right (3)
    CL Item
    Lower right (4)
    Item
    Site
    text
    Code List
    Site
    CL Item
    Arm (1)
    CL Item
    Thigh (2)
    CL Item
    Buttock (3)
    Size
    Item
    Size
    integer
    Ongoing after Day 3?
    Item
    Ongoing after Day 3?
    boolean
    If Yes, record date of last day of symptoms
    Item
    If Yes, record date of last day of symptoms
    date
    Medically attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Local Symptoms - Pain (at injection site) HiberixTM Vaccine
    Item
    Day
    integer
    Code List
    Day
    CL Item
    Day 0 (1)
    CL Item
    Day 1 (evening) (2)
    CL Item
    Day 2 (evening) (3)
    CL Item
    Day 3 (evening) (4)
    Item
    Side
    text
    Code List
    Side
    CL Item
    Upper left (1)
    CL Item
    Lower left (2)
    CL Item
    Upper right (3)
    CL Item
    Lower right (4)
    Item
    Site
    text
    Code List
    Site
    CL Item
    Arm (1)
    CL Item
    Thigh (2)
    CL Item
    Buttock (3)
    Item
    Intensity
    text
    Code List
    Intensity
    CL Item
    Absent (1)
    CL Item
    Minor reaction to touch (2)
    CL Item
    Cries/protests on touch (3)
    CL Item
    Cries when limb is moved/spontaneously painful (4)
    Ongoing after day 3?
    Item
    Ongoing after day 3?
    boolean
    If Yes, record date of last day of symptoms
    Item
    If Yes, record date of last day of symptoms
    date
    Medically attended visit?
    Item
    Medically attended visit?
    boolean
    Item Group
    Other Local Symptoms
    Description
    Item
    Description
    text
    Item
    Intensity
    text
    Code List
    Intensity
    CL Item
    Mild (1)
    CL Item
    Moderate (2)
    CL Item
    Severe (3)
    Start date
    Item
    Start date
    date
    End date
    Item
    End date
    date
    Ongoing?
    Item
    Ongoing?
    boolean
    Medically attended visit?
    Item
    Medically attended visit?
    boolean

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