ID
35161
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 Solicited adverse events - local and general symptoms and Unsolicited AE form. It has to be filled in for screening for all workbooks (WB1-4). It also has to be filled in for: WB 1: Visit Month 6 WB 2: Visit Month 12 WB 3: Visit Day 21 and Visit Month 6 WB 4: Visit Day 21 and Visit Month 12
Link
https://clinicaltrials.gov/ct2/show/NCT00430521
Keywords
Versions (2)
- 2/18/19 2/18/19 -
- 2/20/19 2/20/19 -
Copyright Holder
GlaxoSmithKline
Uploaded on
February 20, 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
Solicited adverse events - local and general symptoms, Unsolicited AE
Description
Solicited adverse events - local symptoms
Alias
- UMLS CUI-1
- C1457887
- UMLS CUI-2
- C0205276
- UMLS CUI-3
- C0042196
Description
Signs/symptoms after vaccination
Data type
text
Alias
- UMLS CUI [1,1]
- C0037088
- UMLS CUI [1,2]
- C0042196
Description
Local Symptoms
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205276
Description
Please tick No/Yes for each symptom
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0150312
Description
Day of symptom
Data type
integer
Alias
- UMLS CUI [1,1]
- C0439228
- UMLS CUI [1,2]
- C1457887
Description
Note for: Redness, Swelling, Ecchymosis and Induration
Data type
integer
Measurement units
- mm
Alias
- UMLS CUI [1,1]
- C0456389
- UMLS CUI [1,2]
- C0518690
Description
Intensity of symptom
Data type
integer
Alias
- UMLS CUI [1]
- C0518690
Description
Symptom's ongoing
Data type
text
Alias
- UMLS CUI [1,1]
- C0549178
- UMLS CUI [1,2]
- C1457887
Description
day month year
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C1457887
Description
Medically attended visit
Data type
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
Description
Type of medically attended visit
Data type
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C0332307
- UMLS CUI [1,3]
- C1386497
Description
Solicited adverse events - general symptoms
Alias
- UMLS CUI-1
- C0159028
- UMLS CUI-2
- C0042196
Description
Signs/symptoms after vaccination
Data type
text
Alias
- UMLS CUI [1,1]
- C0037088
- UMLS CUI [1,2]
- C0042196
Description
General symptoms
Data type
text
Alias
- UMLS CUI [1]
- C0159028
Description
Please tick No/Yes for each symptom
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0150312
Description
Day of symptom
Data type
integer
Alias
- UMLS CUI [1,1]
- C0439228
- UMLS CUI [1,2]
- C1457887
Description
Measurement of body temperature
Data type
text
Alias
- UMLS CUI [1,1]
- C0886414
- UMLS CUI [1,2]
- C0449444
Description
Definition of Fever: Axillary >= 37.5°C, Oral >= 37.5°C, Rectal >= 38° C
Data type
float
Measurement units
- °C
Alias
- UMLS CUI [1]
- C0005903
Description
Body temperature not taken
Data type
boolean
Alias
- UMLS CUI [1]
- C0437722
Description
For Fatigue, Headache, Myalgia, Shivering, Arthralgia, Sweating increase
Data type
integer
Alias
- UMLS CUI [1]
- C0518690
Description
Symptom's ongoing
Data type
text
Alias
- UMLS CUI [1,1]
- C0549178
- UMLS CUI [1,2]
- C1457887
Description
day month year
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C1457887
Description
Causality of symptoms
Data type
text
Alias
- UMLS CUI [1]
- C0015127
Description
Medically attended visit
Data type
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
Description
Type of medically attended visit
Data type
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C0332307
- UMLS CUI [1,3]
- C1386497
Description
Unsolicited Adverse events
Alias
- UMLS CUI-1
- C0877248
- UMLS CUI-2
- C0042196
Description
If you tick yes, please fill in the Non-Serious Adverse Event section or Serious Adverse Event report, as appropriate. Time specification: For WB1: 1) between Visit Day 0 and Telephone contact Day 30, 2) between Visit Month 6 and Telephone contact Month 6 + 30 days. For WB2: 1) between Visit Day 0 and Telephone contact Day 30, 2) between Visit Month 12 and Telephone contact Month 12 + 30 days. For WB3: 1) between Visit Day 0 and Visit Day 21, 2) between Visit Day 21 and Telephone contact Day 51, 3) between Visit Month 6 and Telephone contact Month 6 + 30 days. For WB4: 1) between Visit Day 0 and Visit Day 21, 2) between Visit Day 21 and Telephone contact Day 51, 3) between Visit Month 12 and Telephone contact Month 12 + 30 days.
Data type
text
Alias
- UMLS CUI [1,1]
- C0042196
- UMLS CUI [1,2]
- C0877248
- UMLS CUI [1,3]
- C4055646
Similar models
Solicited adverse events - local and general symptoms, Unsolicited AE
C0205276 (UMLS CUI-2)
C0042196 (UMLS CUI-3)
C0042196 (UMLS CUI [1,2])
C0150312 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
C1386497 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,2])
C1386497 (UMLS CUI [1,3])
C0042196 (UMLS CUI-2)
C0042196 (UMLS CUI [1,2])
C0150312 (UMLS CUI [1,2])
C0449444 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
C1386497 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,2])
C1386497 (UMLS CUI [1,3])
C0042196 (UMLS CUI-2)
C0877248 (UMLS CUI [1,2])
C4055646 (UMLS CUI [1,3])