ID

34016

Descripción

Study ID: 103974 (primary study) Clinical Study ID: 103974 Study Title: Demonstrate non-inferiority of Men-C immune response of Hib-MenC with Infanrix™-IPV versus a licensed Men-C vaccine with Pediacel™ when given at 2, 3, 4 months and the immunogenicity of Hib-MenC when given as a booster dose at 12-15 months Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00258700 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Haemophilus influenzae Type b, Meningococcal C-Tetanus Toxoid Conjugate Vaccine Trade Name: BIO HIB-MENC-TT; Menitorix Study Indication: Haemophilus influenzae type b; Neisseria Meningitidis

Palabras clave

Versiones (1)
  1. 11/1/19 11/1/19 -
Titular de derechos de autor

GSK group of companies

Subido en

11 de enero de 2019

DOI

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Licencia

Creative Commons BY-NC 3.0
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Primary & Booster Immunogenicity of Hib-MenC vs a Licensed Men-C Vaccine - 103974

Inglés

Visit 6: Eligibility Check, Laboratory Test

1 formularios  
Administrative data
Descripción

Administrative data

Visit Number
Descripción

Visit Number

Tipo de datos

integer

Day
Descripción

Day

Tipo de datos

text

Subject Number
Descripción

Subject Number

Tipo de datos

integer

Date of Visit
Descripción

Date of Visit

Tipo de datos

date

Check for Study Continuation
Descripción

Check for Study Continuation

Did the subject return for Visit 6?
Descripción

Did the subject return for Visit 6?

Tipo de datos

boolean

If No, please tick ONE most appropriate reason
Descripción

If No, please tick ONE most appropriate reason

Tipo de datos

text

If Other, please specify
Descripción

If Other, please specify

Tipo de datos

text

If SAE, record the SAE number
Descripción

If SAE, record the SAE number

Tipo de datos

integer

If non-SAE, please record the AE number
Descripción

If non-SAE, please record the AE number

Tipo de datos

integer

Please tick who took the decision
Descripción

Please tick who took the decision

Tipo de datos

text

Elimination Criteria During The Study
Descripción

Elimination Criteria During The Study

The following criteria should be checked at each visit subsequent to the first visit.
Descripción

If any of the criteria become applicable during the study, it will not require withdrawal of the subject from the study but may determine a subject's evaluability in the according-to-protocol (ATP) analysis.

Tipo de datos

text

1. Use of any investigational or non-registered product (drug or vaccine) other than the study vaccine(s) during the study period
Descripción

1. Use of any investigational or non-registered product (drug or vaccine) other than the study vaccine(s) during the study period

Tipo de datos

text

2. Chronic administration (defined as more than 14 days) or immunodepressants or other imminodefying drugs during the study period.
Descripción

2. Chronic administration (defined as more than 14 days) or immunodepressants or other imminodefying drugs during the study period.

Tipo de datos

text

3. Administration of a vaccine not foreseen by the study protocol during the period starting from 30 days before each dose of vaccine(s) and ending 30 days after
Descripción

3. Administration of a vaccine not foreseen by the study protocol during the period starting from 30 days before each dose of vaccine(s) and ending 30 days after

Tipo de datos

text

4. Administration of immunoglobulins and/or any blood products during the study period
Descripción

4. Administration of immunoglobulins and/or any blood products during the study period

Tipo de datos

text

Laboratory Tests - Blood
Descripción

Laboratory Tests - Blood

Has a blood sample been taken?
Descripción

Has a blood sample been taken?

Tipo de datos

boolean

Date blood sample taken
Descripción

please fill in only if different from visit date

Tipo de datos

date

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Similar models

Visit 6: Eligibility Check, Laboratory Test

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
Item
Visit Number
integer
Visit Number
Code List
Visit Number
CL Item
Visit 6 (1)
Item
Day
text
Day
Code List
Day
CL Item
42-56 days after Visit 5 (1)
Subject Number
Item
Subject Number
integer
Date of Visit
Item
Date of Visit
date
Item Group
Check for Study Continuation
Did the subject return for Visit 6?
Item
Did the subject return for Visit 6?
boolean
Item
If No, please tick ONE most appropriate reason
text
If No, please tick ONE most appropriate reason
Code List
If No, please tick ONE most appropriate reason
CL Item
Serious Adverse Event (SAE) (1)
CL Item
Non-Serious Adverse Event (Non-SAE) (2)
CL Item
Other (e.g.withdrawal,protocol violation) (3)
If Other, please specify
Item
If Other, please specify
text
If SAE, record the SAE number
Item
If SAE, record the SAE number
integer
If non-SAE, please record the AE number
Item
If non-SAE, please record the AE number
integer
Item
Please tick who took the decision
text
Please tick who took the decision
Code List
Please tick who took the decision
CL Item
Investigator (1)
CL Item
Parents / Guardians (2)
Item Group
Elimination Criteria During The Study
Item
The following criteria should be checked at each visit subsequent to the first visit.
text
The following criteria should be checked at each visit subsequent to the first visit.
Code List
The following criteria should be checked at each visit subsequent to the first visit.
CL Item
Use of any investigational or non-registered product (drug or vaccine) other than the study vaccine(s) during the study period (1)
CL Item
Chronic administration (defined as more than 14 days) or immunodepressants or other imminodefying drugs during the study period. (For corticosteroids, this will mean prednisone, or equivalent, ≥0.5 mg/kg/day. Inhaled and topical steroids are allowed.) (2)
Item
1. Use of any investigational or non-registered product (drug or vaccine) other than the study vaccine(s) during the study period
text
1. Use of any investigational or non-registered product (drug or vaccine) other than the study vaccine(s) during the study period
Code List
1. Use of any investigational or non-registered product (drug or vaccine) other than the study vaccine(s) during the study period
CL Item
Applicable (1)
CL Item
Not applicable (2)
Item
2. Chronic administration (defined as more than 14 days) or immunodepressants or other imminodefying drugs during the study period.
text
2. Chronic administration (defined as more than 14 days) or immunodepressants or other imminodefying drugs during the study period.
Code List
2. Chronic administration (defined as more than 14 days) or immunodepressants or other imminodefying drugs during the study period.
CL Item
Applicable (1)
CL Item
Not applicable (2)
Item
3. Administration of a vaccine not foreseen by the study protocol during the period starting from 30 days before each dose of vaccine(s) and ending 30 days after
text
3. Administration of a vaccine not foreseen by the study protocol during the period starting from 30 days before each dose of vaccine(s) and ending 30 days after
Code List
3. Administration of a vaccine not foreseen by the study protocol during the period starting from 30 days before each dose of vaccine(s) and ending 30 days after
CL Item
Applicable (1)
CL Item
Not applicable (2)
Item
4. Administration of immunoglobulins and/or any blood products during the study period
text
4. Administration of immunoglobulins and/or any blood products during the study period
Code List
4. Administration of immunoglobulins and/or any blood products during the study period
CL Item
Applicable (1)
CL Item
Not applicable (2)
Item Group
Laboratory Tests - Blood
Has a blood sample been taken?
Item
Has a blood sample been taken?
boolean
Date blood sample taken
Item
Date blood sample taken
date
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