ID

35056

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 HCG urine pregnancy test form. It has to be filed in for screening (for all workbooks). It also has to be filled in for: Visit Month 6 (WB1+3), Visit Month 12 (WB2+4), Visit Day 21 (WB3+4).

Länk

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

Nyckelord

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

GlaxoSmithKline

Uppladdad den

12 februari 2019

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0

Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Itemgroup-kommentar för :

Item-kommentar för :


Inga kommentarer

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

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

HCG urine pregnancy test

Administrative data
Beskrivning

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Number
Beskrivning

Subject Number

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Visit Date
Beskrivning

day month year

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Workbook number
Beskrivning

Workbook number

Datatyp

integer

Alias
UMLS CUI [1]
C2986015
Visit type
Beskrivning

Visit type

Datatyp

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0545082
HCG urine pregnancy test
Beskrivning

HCG urine pregnancy test

Alias
UMLS CUI-1
C1141639
UMLS CUI-2
C0430056
UMLS CUI-3
C0428402
Has a urine sample been taken?
Beskrivning

Urine sample

Datatyp

text

Alias
UMLS CUI [1]
C0200354
If urine sample has been taken, please complete date (only if different from visit date)
Beskrivning

day month year

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0200354
Result of HCG urine pregnancy test
Beskrivning

Result of HCG urine pregnancy test

Datatyp

text

Alias
UMLS CUI [1,1]
C1141639
UMLS CUI [1,2]
C0430056
UMLS CUI [1,3]
C1274040

Similar models

HCG urine pregnancy test

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Visit Date
Item
Visit Date
date
C1320303 (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)
Item Group
HCG urine pregnancy test
C1141639 (UMLS CUI-1)
C0430056 (UMLS CUI-2)
C0428402 (UMLS CUI-3)
Item
Has a urine sample been taken?
text
C0200354 (UMLS CUI [1])
Code List
Has a urine sample been taken?
CL Item
Yes (Y)
CL Item
No (N)
CL Item
Not of childbearing potential or male (NA)
Date of urine sample
Item
If urine sample has been taken, please complete date (only if different from visit date)
date
C0011008 (UMLS CUI [1,1])
C0200354 (UMLS CUI [1,2])
Item
Result of HCG urine pregnancy test
text
C1141639 (UMLS CUI [1,1])
C0430056 (UMLS CUI [1,2])
C1274040 (UMLS CUI [1,3])
Code List
Result of HCG urine pregnancy test
CL Item
Negative (N)
CL Item
Positive (P)

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial