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ID

35054

Beskrivning

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"

Länk

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

Nyckelord

  1. 2019-02-12 2019-02-12 -
Rättsinnehavare

GlaxoSmithKline

Uppladdad den

12 februari 2019

DOI

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Licens

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
    Beskrivning

    Administrative data

    Alias
    UMLS CUI-1
    C1320722
    Subject Number
    Beskrivning

    Subject Number

    Datatyp

    integer

    Alias
    UMLS CUI [1]
    C2348585
    Workbook number
    Beskrivning

    Workbook number

    Datatyp

    integer

    Alias
    UMLS CUI [1]
    C2986015
    Visit type
    Beskrivning

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

    Datatyp

    integer

    Alias
    UMLS CUI [1,1]
    C0332307
    UMLS CUI [1,2]
    C0545082
    Visit Date
    Beskrivning

    Visit Date

    Datatyp

    date

    Alias
    UMLS CUI [1]
    C1320303
    Physical Examination, Medical history
    Beskrivning

    Physical Examination, Medical history

    Alias
    UMLS CUI-1
    C0031809
    UMLS CUI-2
    C0262926
    Are you aware of any pre-existing conditions, signs or symptoms present prior to the start of the study?
    Beskrivning

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

    Datatyp

    text

    Alias
    UMLS CUI [1]
    C0521987
    UMLS CUI [2,1]
    C2347662
    UMLS CUI [2,2]
    C0037088
    MedDRA System Organ Class
    Beskrivning

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

    Datatyp

    integer

    Alias
    UMLS CUI [1]
    C2347091
    Diagnosis
    Beskrivning

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

    Datatyp

    text

    Alias
    UMLS CUI [1]
    C0011900
    Disease status
    Beskrivning

    Disease status

    Datatyp

    integer

    Alias
    UMLS CUI [1,1]
    C0012634
    UMLS CUI [1,2]
    C0449438

    Similar models

    Medical history/ physical examination

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    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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