ID
35084
Description
Study ID: 100478 Clinical Study ID: 100478 Study Title: Study to show non-inferiority of Tritanrix™-HepB/Hib-MenAC (+/- hepatitis B vaccine at birth) versus Tritanrix™-HepB/Hiberix™ without hepatitis B vacc. at birth for antibody response to all vaccine antigens given in healthy infants Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00290303 Sponsor: GlaxoSmithKline Phase: phase 3 Study Recruitment Status: Completed Generic Name: Combined Diphtheria, Tetanus, Whole Cell Pertussis, Hepatitis B, Haemophilus influenzae Type b Vaccine Trade Name: Tritanrix HepB/Hiberix Study Indication: Diphtheria; Haemophilus influenzae type b; Hepatitis B; Tetanus; Whole Cell Pertussis This form contains the Diary Card and has to be filled in for every dose of vaccination (1-3).
Mots-clés
Versions (1)
- 14/02/2019 14/02/2019 -
Détendeur de droits
GlaxoSmithKline
Téléchargé le
14 février 2019
DOI
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Licence
Creative Commons BY-NC 3.0
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Evaluation of immunogenicity and safety of GSK Biologicals' HPV-16/18 L1 VLP AS04 vaccine in healthy females NCT00290277
Diary Card
- StudyEvent: ODM
Description
Local Symptoms
Alias
- UMLS CUI-1
- C1457887
- UMLS CUI-2
- C0205276
Description
The itemgroup has to be completed for every symptom one after the other.
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205276
Description
Day 0 = Day of vaccination. This item has to be filled in for every day for every symptom one after the other.
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0439228
- UMLS CUI [1,2]
- C1457887
- UMLS CUI [1,3]
- C0205276
Description
This item has to be filled in only for Redness and for Swelling for every day. Please measure the greatest diameter (in mm).
Type de données
integer
Unités de mesure
- mm
Alias
- UMLS CUI [1,1]
- C0456389
- UMLS CUI [1,2]
- C0332575
- UMLS CUI [1,3]
- C2700396
- UMLS CUI [2,1]
- C0456389
- UMLS CUI [2,2]
- C0038999
- UMLS CUI [2,3]
- C2700396
Description
This item has to be filled in only for pain for every day.
Type de données
text
Alias
- UMLS CUI [1,1]
- C0030193
- UMLS CUI [1,2]
- C0522510
- UMLS CUI [1,3]
- C2700396
Description
This item has to be filled in for every symptom. If YES, please enter date of last day of symptoms below.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205276
- UMLS CUI [1,3]
- C0549178
Description
Date of last Day of Symptoms
Type de données
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C1457887
- UMLS CUI [1,3]
- C0205276
Description
This item has to be filled in for every symptom.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
- UMLS CUI [1,3]
- C1457887
- UMLS CUI [1,4]
- C0205276
Description
Other local symptoms
Alias
- UMLS CUI-1
- C1457887
- UMLS CUI-2
- C0205276
- UMLS CUI-3
- C0205394
Description
Other local symptoms Description
Type de données
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205276
- UMLS CUI [1,3]
- C1521902
Description
This item has to be filled in for every 'other local symptom'. Mild = easily tolerated by the subject, causing minimal discomfort and not interfering with everyday activities. Moderate = sufficiently discomforting to interfere with normal everyday activities. Severe = prevents normal, everyday activities. (In adults/ adolescents, such an adverse event would, forexample, prevent attendance at work/ school and would necessitate the administration ofcorrective therapy).
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205276
- UMLS CUI [1,3]
- C0518690
Description
This item has to be filled in for every 'other local symptom'.
Type de données
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C1457887
- UMLS CUI [1,3]
- C0205276
Description
This item has to be filled in for every 'other local symptom'.
Type de données
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C1457887
- UMLS CUI [1,3]
- C0205276
Description
This item has to be filled in for every 'other local symptom'.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
- UMLS CUI [1,3]
- C1457887
- UMLS CUI [1,4]
- C0205276
Description
Medication
Alias
- UMLS CUI-1
- C0013227
Description
Trade Generic name
Type de données
text
Alias
- UMLS CUI [1]
- C0592502
Description
This item has to be filled in for every Medication.
Type de données
text
Alias
- UMLS CUI [1,1]
- C0392360
- UMLS CUI [1,2]
- C0013227
Description
This item has to be filled in for every Medication.
Type de données
text
Alias
- UMLS CUI [1]
- C0013153
Description
This item has to be filled in for every Medication.
Type de données
text
Alias
- UMLS CUI [1,1]
- C2348070
- UMLS CUI [1,2]
- C0013227
Description
Start Date
Type de données
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C0013227
Description
Either 'End Date' or 'Continuing' has to be entered.
Type de données
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C0013227
Description
Either 'End Date' or 'Continuing' has to be entered.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1553904
- UMLS CUI [1,2]
- C0013227
Description
General Symptoms
Alias
- UMLS CUI-1
- C0159028
Description
The itemgroup has to be completed for every symptom one after the other.
Type de données
text
Alias
- UMLS CUI [1]
- C0159028
Description
Day 0 = Day of vaccination. This item has to be filled in for every day for every symptom one after the other.
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0439228
- UMLS CUI [1,2]
- C0159028
Description
This item has to be completed only for general symptom 'temperature'. Rectal measurement is not recommended. Please record the temperature every day in the evening. If temperature has been taken more than once a day, please reportthe highest value for the day.
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0005903
- UMLS CUI [1,2]
- C0242485
- UMLS CUI [1,3]
- C0475264
Description
This item has to be completed for every general symptom (except temperature) one after the other. Please note the different meanings of intensity 0-3 depending on the symptom. Fatigue - Headache - Gastrointestinal symptoms (including nausea,vomiting, diarrhea and / or abdominal pain) - Arthralgia (joint pain: only in joints which are distalfrom the injection site) - Rash - Myalgia: 0 = Normal. 1 = Symptoms that are easily tolerated. 2 = Symptoms that interfere with normal activity. 3 = Symptoms that prevent normal activity. Urticaria: 0 = Normal. 1 = Urticaria distributed on a single body areaonly. 2 = Urticaria distributed on 2 or 3 body areas butnot more. 3 = Urticaria distributed on at least 4 bodyareas
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0159028
- UMLS CUI [1,2]
- C0518690
Description
This item has to be filled in for every symptom. If YES, please enter date of last day of symptoms below.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0159028
- UMLS CUI [1,2]
- C0549178
Description
Date of last Day of Symptoms
Type de données
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C0159028
Description
This item has to be filled in for every symptom.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
- UMLS CUI [1,3]
- C0159028
Description
Other general symptoms
Alias
- UMLS CUI-1
- C0159028
- UMLS CUI-2
- C0205394
Description
Other general symptoms Description
Type de données
text
Alias
- UMLS CUI [1,1]
- C0159028
- UMLS CUI [1,2]
- C1521902
Description
This item has to be filled in for every 'other general symptom'. Mild = easily tolerated by the subject, causing minimal discomfort and not interfering with everyday activities. Moderate = sufficiently discomforting to interfere with normal everyday activities. Severe = prevents normal, everyday activities. (In adults/ adolescents, such an adverse event would, forexample, prevent attendance at work/ school and would necessitate the administration ofcorrective therapy).
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0159028
- UMLS CUI [1,2]
- C0518690
Description
This item has to be filled in for every 'other general symptom'.
Type de données
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C0159028
Description
This item has to be filled in for every 'other general symptom'.
Type de données
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C0159028
Description
This item has to be filled in for every 'other general symptom'.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
- UMLS CUI [1,3]
- C0159028
Similar models
Diary Card
- StudyEvent: ODM
C0011008 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0332156 (UMLS CUI [1,3])
C0019993 (UMLS CUI [1,2])
C0205276 (UMLS CUI-2)
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
C0456389 (UMLS CUI [2,1])
C0038999 (UMLS CUI [2,2])
C2700396 (UMLS CUI [2,3])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
C0205276 (UMLS CUI [1,2])
C0549178 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,2])
C0205276 (UMLS CUI [1,3])
C1386497 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
C0205276 (UMLS CUI [1,4])
C0205276 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
C0205276 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
C0205276 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,2])
C0205276 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,2])
C0205276 (UMLS CUI [1,3])
C1386497 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
C0205276 (UMLS CUI [1,4])
C0013227 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C0242485 (UMLS CUI [1,2])
C0475264 (UMLS CUI [1,3])
C0518690 (UMLS CUI [1,2])
C0549178 (UMLS CUI [1,2])
C0159028 (UMLS CUI [1,2])
C1386497 (UMLS CUI [1,2])
C0159028 (UMLS CUI [1,3])
C0205394 (UMLS CUI-2)
C1521902 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,2])
C0159028 (UMLS CUI [1,2])
C0159028 (UMLS CUI [1,2])
C1386497 (UMLS CUI [1,2])
C0159028 (UMLS CUI [1,3])