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
Versions (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
- StudyEvent: ODM
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
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
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)
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
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
- StudyEvent: ODM
C0262926 (UMLS CUI-2)
C2347662 (UMLS CUI [2,1])
C0037088 (UMLS CUI [2,2])
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