ID

33870

Beskrivning

Study ID:103860/269 Clinical Study ID:103860/269 (HBV-269) Study Title: Phase II study to evaluate the immunogenicity of GSK Biologicals' preservative-free Engerix-B and thiomersal-free Engerix-B vaccines compared to Engerix™-B and evaluate safety and reactogenicity of each vaccine when administered intramuscularly according to a 0, 1, 6 month schedule in healthy volunteers Patient Level Data:Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: Hepatitis B Vaccine, Recombinant Trade Name: Engerix-B Study Indication: Hepatitis B

Nyckelord

Versioner (1)
  1. 2019-01-04 2019-01-04 -
Rättsinnehavare

GlaxoSmithKline

Uppladdad den

4 januari 2019

DOI

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Licens

Creative Commons BY-NC 3.0
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Immunogenicity, safety and reactogenicity of preservative-free Engerix-B and thiomersal-free Engerix-B vaccines compared to Engerix™️-B

Engelsk

Informed Consent

1 Formulär  
  1. StudyEvent: ODM
    1. Informed Consent
Informed Consent
Beskrivning

Informed Consent

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C0030705
Subject’s first name and family name
Beskrivning

The aims and procedures of this study have been clearly explained to me and I have read the preceding information sheet and understood the information provided. I agree to be enrolled in the study. I understand that I have the right to decline to enter the study and to withdraw from it at any time for any reasons, without consequence to my present or future health care and attention which I receive from my healthcare provider. I have been made aware of my right to access and request correction of my personal data. I acknowledge that I have received a copy of this form for future reference. I hereby freely give my consent to take part in this study.

Datatyp

text

Alias
UMLS CUI [1]
C1299487
Participant’s signature
Beskrivning

Participant, Signature

Datatyp

text

Alias
UMLS CUI [1,1]
C0679646
UMLS CUI [1,2]
C1519316
Participant’s main address
Beskrivning

Patient address

Datatyp

text

Alias
UMLS CUI [1]
C0421449
Participant’s phone number
Beskrivning

Participant, Telephone Number

Datatyp

integer

Alias
UMLS CUI [1,1]
C0679646
UMLS CUI [1,2]
C1515258
Date
Beskrivning

Informed Consent, Date in time

Datatyp

date

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0011008
Time
Beskrivning

Informed Consent, Time

Datatyp

time

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0040223
Witness
Beskrivning

Informed Consent, Witnesses

Datatyp

text

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0682356
Statement by Doctor, Nurse or Project Assistant who conducted the informed consent discussion
Beskrivning

Statement by Doctor, Nurse or Project Assistant who conducted the informed consent discussion

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C0035173
Name
Beskrivning

I have carefully explained the nature, demands and foreseeable risks and benefits of the vaccination study to the person named above and witnessed the completion of the written consent form.

Datatyp

text

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0035173
UMLS CUI [1,3]
C0027365
Signature
Beskrivning

Informed Consent, Research Personnel, Signature

Datatyp

text

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0035173
UMLS CUI [1,3]
C1519316
Designation
Beskrivning

Informed Consent, Research Personnel, Occupations

Datatyp

text

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0035173
UMLS CUI [1,3]
C0028811
Date
Beskrivning

Informed Consent, Research Personnel, Date in time

Datatyp

date

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0035173
UMLS CUI [1,3]
C0011008
Time
Beskrivning

Informed Consent, Research Personnel, Time

Datatyp

time

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0035173
UMLS CUI [1,3]
C0040223
Tillbaka till toppen

Similar models

Informed Consent

1 Formulär
  1. StudyEvent: ODM
    1. Informed Consent
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Informed Consent
C0021430 (UMLS CUI-1)
C0030705 (UMLS CUI-2)
Patient Name
Item
Subject’s first name and family name
text
C1299487 (UMLS CUI [1])
Participant, Signature
Item
Participant’s signature
text
C0679646 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
Patient address
Item
Participant’s main address
text
C0421449 (UMLS CUI [1])
Participant, Telephone Number
Item
Participant’s phone number
integer
C0679646 (UMLS CUI [1,1])
C1515258 (UMLS CUI [1,2])
Informed Consent, Date in time
Item
Date
date
C0021430 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Informed Consent, Time
Item
Time
time
C0021430 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Informed Consent, Witnesses
Item
Witness
text
C0021430 (UMLS CUI [1,1])
C0682356 (UMLS CUI [1,2])
Item Group
Statement by Doctor, Nurse or Project Assistant who conducted the informed consent discussion
C0021430 (UMLS CUI-1)
C0035173 (UMLS CUI-2)
Informed Consent, Research Personnel, Name
Item
Name
text
C0021430 (UMLS CUI [1,1])
C0035173 (UMLS CUI [1,2])
C0027365 (UMLS CUI [1,3])
Informed Consent, Research Personnel, Signature
Item
Signature
text
C0021430 (UMLS CUI [1,1])
C0035173 (UMLS CUI [1,2])
C1519316 (UMLS CUI [1,3])
Informed Consent, Research Personnel, Occupations
Item
Designation
text
C0021430 (UMLS CUI [1,1])
C0035173 (UMLS CUI [1,2])
C0028811 (UMLS CUI [1,3])
Informed Consent, Research Personnel, Date in time
Item
Date
date
C0021430 (UMLS CUI [1,1])
C0035173 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Informed Consent, Research Personnel, Time
Item
Time
time
C0021430 (UMLS CUI [1,1])
C0035173 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Tillbaka till toppen 

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