ID

33506

Beschrijving

Study ID: 104297 Clinical Study ID: 104297 Study Title: An open study for a 2-year period to confirm the safety and immunogenicity of the candidate malaria vaccine RTS,S/AS02A in Mozambican children aged 1 to 4 years at the time of first vaccine dose. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00323622 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: SB257049 Trade Name: SB257049 Study Indication: Malaria CRF Seiten: 378-420

Trefwoorden

Versies (3)
  1. 11-12-18 11-12-18 -
  2. 11-12-18 11-12-18 -
  3. 06-06-19 06-06-19 -
Houder van rechten

GSK group of companies

Geüploaded op

11 december 2018

DOI

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Licentie

Creative Commons BY-NC 3.0
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Immunogenicity of malaria vaccine candidate in Mozambican children (1 to 4 y.o) - 104297 (Malaria039)

Engels

Reason for Non Participation - Tracking Form

1 Formulieren  
Administrative data
Beschrijving

Administrative data

Protocol Number
Beschrijving

Protocol Number

Datatype

text

Previous study
Beschrijving

Previous study

Datatype

text

Center Number
Beschrijving

Center number

Datatype

integer

Reason for non participation
Beschrijving

Reason for non participation

Subject Number
Beschrijving

Subject Number

Datatype

integer

Subject could not be reached due to
Beschrijving

Subject could not be reached due to

Datatype

text

Subject could be contacted
Beschrijving

Subject could be contacted

Datatype

text

Record eligibility criteria that was failed
Beschrijving

if applies

Datatype

text

Subject is eligible but not willing to participate due to
Beschrijving

if applies

Datatype

text

Day of contact
Beschrijving

Day of contact

Datatype

date

In case of death, date of contact not requested
Beschrijving

In case of death, date of contact not requested

Investigator's Signature
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Investigator's Signature

Investigator's name (in Print)
Beschrijving

Investigator's name (in Print)

Datatype

text

Investigator's Signature
Beschrijving

Investigator's Signature

Datatype

text

Date
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Date

Datatype

date

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Reason for Non Participation - Tracking Form

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
Protocol Number
Item
Protocol Number
text
Item
Previous study
text
Previous study
Code List
Previous study
CL Item
257049/026 (Malaria-026) (1)
Center number
Item
Center Number
integer
Item Group
Reason for non participation
Subject Number
Item
Subject Number
integer
Item
Subject could not be reached due to
text
Subject could not be reached due to
Code List
Subject could not be reached due to
CL Item
Lost to follow-up (1)
CL Item
Migrated/moved from study area (2)
CL Item
Death (3)
Item
Subject could be contacted
text
Subject could be contacted
Code List
Subject could be contacted
CL Item
Not eligible (record criteria) (1)
CL Item
Eligible but not willing to participate (record reason for it) (2)
Record eligibility criteria that was failed
Item
Record eligibility criteria that was failed
text
Item
Subject is eligible but not willing to participate due to
text
Subject is eligible but not willing to participate due to
Code List
Subject is eligible but not willing to participate due to
CL Item
Consent withdrawal not due to an AE (1)
CL Item
Serious adverse event (2)
CL Item
Adverse event (3)
CL Item
Other (4)
Day of contact
Item
Day of contact
date
Item Group
In case of death, date of contact not requested
Item Group
Investigator's Signature
Investigator's name (in Print)
Item
Investigator's name (in Print)
text
Investigator's Signature
Item
Investigator's Signature
text
Date
Item
Date
date
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