Occurrence of serious adverse event
SAEs recorded up to Visit 7, Month 21 of Malaria-026 to be recorded in Malaria-026 SAE forms; SAEs recorded 1 day after Visit 7, Month 21 to be recorded in Malaria-039 SAE forms
boolean
If Yes, specify total number of SAE's for the Malaria-039 period only
integer
Subject Withdrawal
A subject is withdrawn from interim analysis if he/she did not come for the interim analysis timepoint visit
boolean
If Yes, choose one reason for withdrawal
text
If Death, please specify SAE number
integer
Is Serious Adverse Event, please specify the SAE number
integer
If Protocol violation, please specify
text
If Other, please specify
text
Who made the decision?
text
Date of last contact
date
Was the subject in good condition at date of last contact?
boolean
If No, please give details in Adverse Event section.
text
Investigator's Signature
Investigator's confirmation
date
Investigator's signature
text
Investigator's name (in print)
text