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ID

35054

Description

Study ID: 107495 Clinical Study ID: 107495 Study Title: A phase II, open, randomized study in adults aged between 18 and 60 years designed to evaluate the reactogenicity and immunogenicity of a 1- and 2-dose prime-boost concept of pandemic monovalent (H5N1) influenza vaccine (split virus formulation) adjuvanted with AS03, administered according to different vaccination schedules. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00430521 https://clinicaltrials.gov/ct2/show/NCT00430521 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: Pandemic influenza vaccine (GSK1119711A)-formulation 1, Pandemic influenza vaccine (GSK1119711A)-formulation 2 Trade Name: N/A Study Indication: Influenza There are 4 workbooks (WB): WB 1: Protocol 107495, (H5N1-012), Groups: VT/VT/6Mo, VT/IN/6Mo WB 2: Protocol 107495, (H5N1-012), Groups: VT/VT/12Mo, VT/IN/12Mo WB 3: Protocol 107495 (H5N1-012) GROUPS: 2VT/VT/6MO, 2VT/IN/6MO WB 4: Protocol 107495 (H5N1-012) Groups: 2VT/VT/12Mo, 2VT/IN/12Mo Every Workbook has the following visits: Visit Day 0 (Screening, Dose 1), Visit Day 21, Visit Month 6, Visit Month 12 and Visit Month 18. After Month 6 (+30 days, if applicable) and Month 12 (+30 days, if applicable) there is a Core Analysis section, followed by a final study conclusion after Month 18. Workbook 1 schedules a vaccination at screening and Month 6 each, Workbook 2 at Screening and Month 12. 30 days after the first vaccination there is an additional telephone contact. After the second vaccination additional visits/contacts are necessary in both workbooks: a visit at Month 6/12 + 7 and 21 days and a telephone contact on Month 6/12 + 30 days. Workbook 3 schedules a vaccination at screening, Day 21 and Month 6 and Workbook 4 at screening, Day 21 and Month 12. After the second vaccination there is an additional visit on Day 42 and a telephone contact on day 51. After the third vaccination there are additional visits/contacts: visits at Month 6/12 + 7 and 21 days and a telephone contact at Month 6/12 + 30 days. After Month 6 (+30 days, if applicable) and Month 12 (+30 days, if applicable) there is a Core Analysis section. This document contains the general medical history/ physical examination form. It has to be filled in for screening for all workbooks (wb1-4). If deemed necessary by the investigator fill in this document for: WB 1 for "Visit Month 6" WB 2 for "Visit Month 12" WB 3 for "Visit Day 21" and "Visit Month 6" WB 4 for "Visit Day 21" and "Visit Month 12"

Link

https://clinicaltrials.gov/ct2/show/NCT00430521

Keywords

  1. 2/12/19 2/12/19 -
Copyright Holder

GlaxoSmithKline

Uploaded on

February 12, 2019

DOI

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License

Creative Commons BY-NC 3.0

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    Evaluation of reactogenicity and immunogenicity of pandemic monovalent (H5N1) influenza vaccine in adults, NCT00430521

    Medical history/ physical examination

    Administrative data
    Description

    Administrative data

    Alias
    UMLS CUI-1
    C1320722 (Administrative documentation)
    SNOMED
    405624007
    Subject Number
    Description

    Subject Number

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2348585 (Clinical Trial Subject Unique Identifier)
    Workbook number
    Description

    Workbook number

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2986015 (Document Version Number Text)
    Visit type
    Description

    For Screening it's necessary. The others are optional if deemed necessary by the investigator.

    Data type

    integer

    Alias
    UMLS CUI [1,1]
    C0332307 (Type - attribute)
    SNOMED
    261664005
    UMLS CUI [1,2]
    C0545082 (Visit)
    Visit Date
    Description

    Visit Date

    Data type

    date

    Alias
    UMLS CUI [1]
    C1320303 (Date of visit)
    SNOMED
    406543005
    Physical Examination, Medical history
    Description

    Physical Examination, Medical history

    Alias
    UMLS CUI-1
    C0031809 (Physical Examination)
    SNOMED
    5880005
    LOINC
    MTHU028014
    UMLS CUI-2
    C0262926 (Medical History)
    SNOMED
    392521001
    LOINC
    LP6817-3
    Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
    Description

    If you tick yes, please give diagnosis and tick following Past/Current box(es).

    Data type

    text

    Alias
    UMLS CUI [1]
    C0521987 (Pre-existing condition)
    SNOMED
    102478008
    UMLS CUI [2,1]
    C2347662 (Pre-existing)
    UMLS CUI [2,2]
    C0037088 (Signs and Symptoms)
    SNOMED
    404684003
    LOINC
    LP185402-7
    MedDRA System Organ Class
    Description

    To immune system: incl allergies, autoimmune disorders To eoplasms benign, malignant and unspecified: incl cysts, polyps

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2347091 (MedDRA System Organ Class)
    Diagnosis
    Description

    Please report medication(s) as specified in the protocol and fill in the Medication section.

    Data type

    text

    Alias
    UMLS CUI [1]
    C0011900 (Diagnosis)
    SNOMED
    439401001
    LOINC
    LP30831-9
    Disease status
    Description

    Disease status

    Data type

    integer

    Alias
    UMLS CUI [1,1]
    C0012634 (Disease)
    SNOMED
    64572001
    LOINC
    LP21006-9
    UMLS CUI [1,2]
    C0449438 (Status)
    SNOMED
    263490005
    LOINC
    LP73412-6

    Similar models

    Medical history/ physical examination

    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Administrative data
    C1320722 (UMLS CUI-1)
    Subject Number
    Item
    Subject Number
    integer
    C2348585 (UMLS CUI [1])
    Item
    Workbook number
    integer
    C2986015 (UMLS CUI [1])
    Code List
    Workbook number
    CL Item
    WB 1 (1)
    CL Item
    WB 2 (2)
    CL Item
    WB 3 (3)
    CL Item
    WB 4 (4)
    Item
    Visit type
    integer
    C0332307 (UMLS CUI [1,1])
    C0545082 (UMLS CUI [1,2])
    Code List
    Visit type
    CL Item
    Screening (all WB's) (1)
    CL Item
    Visit Month 6 (WB1+3) (2)
    CL Item
    Visit Month 12 (WB2+4) (3)
    CL Item
    Visit Day 21 (WB3+4) (4)
    Visit Date
    Item
    Visit Date
    date
    C1320303 (UMLS CUI [1])
    Item Group
    Physical Examination, Medical history
    C0031809 (UMLS CUI-1)
    C0262926 (UMLS CUI-2)
    Item
    Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
    text
    C0521987 (UMLS CUI [1])
    C2347662 (UMLS CUI [2,1])
    C0037088 (UMLS CUI [2,2])
    Code List
    Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
    CL Item
    Yes (Y)
    CL Item
    No (N)
    Item
    MedDRA System Organ Class
    integer
    C2347091 (UMLS CUI [1])
    Code List
    MedDRA System Organ Class
    CL Item
    Skin and subcutaneous tissue (1)
    CL Item
    Musculoskeletal and connective tissue (2)
    CL Item
    Cardiac (3)
    CL Item
    Vascular (4)
    CL Item
    Respiratory, thoracic and mediastinal (5)
    CL Item
    Gastrointestinal (6)
    CL Item
    Hepatobiliary (7)
    CL Item
    Renal and urinary (8)
    CL Item
    Nervous system (9)
    CL Item
    Eye (10)
    CL Item
    Ear and labyrinth (11)
    CL Item
    Endocrine (12)
    CL Item
    Metabolism and nutrition (13)
    CL Item
    Blood and lymphatic system (14)
    CL Item
    Immune system (15)
    CL Item
    Infections and infestations (16)
    CL Item
    eoplasms benign, malignant and unspecified (17)
    CL Item
    Surgical and medical procedures (18)
    CL Item
    Other (99)
    Diagnosis
    Item
    Diagnosis
    text
    C0011900 (UMLS CUI [1])
    Item
    Disease status
    integer
    C0012634 (UMLS CUI [1,1])
    C0449438 (UMLS CUI [1,2])
    Code List
    Disease status
    CL Item
    Past (1)
    CL Item
    Current (2)

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