ID
35161
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 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
Länk
https://clinicaltrials.gov/ct2/show/NCT00430521
Nyckelord
Versioner (2)
- 2019-02-18 2019-02-18 -
- 2019-02-20 2019-02-20 -
Rättsinnehavare
GlaxoSmithKline
Uppladdad den
20 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 :
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
Solicited adverse events - local and general symptoms, Unsolicited AE
Beskrivning
Solicited adverse events - local symptoms
Alias
- UMLS CUI-1
- C1457887
- UMLS CUI-2
- C0205276
- UMLS CUI-3
- C0042196
Beskrivning
Signs/symptoms after vaccination
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0037088
- UMLS CUI [1,2]
- C0042196
Beskrivning
Local Symptoms
Datatyp
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205276
Beskrivning
Please tick No/Yes for each symptom
Datatyp
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0150312
Beskrivning
Day of symptom
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0439228
- UMLS CUI [1,2]
- C1457887
Beskrivning
Note for: Redness, Swelling, Ecchymosis and Induration
Datatyp
integer
Måttenheter
- mm
Alias
- UMLS CUI [1,1]
- C0456389
- UMLS CUI [1,2]
- C0518690
Beskrivning
Intensity of symptom
Datatyp
integer
Alias
- UMLS CUI [1]
- C0518690
Beskrivning
Symptom's ongoing
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0549178
- UMLS CUI [1,2]
- C1457887
Beskrivning
day month year
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C1457887
Beskrivning
Medically attended visit
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
Beskrivning
Type of medically attended visit
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C0332307
- UMLS CUI [1,3]
- C1386497
Beskrivning
Solicited adverse events - general symptoms
Alias
- UMLS CUI-1
- C0159028
- UMLS CUI-2
- C0042196
Beskrivning
Signs/symptoms after vaccination
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0037088
- UMLS CUI [1,2]
- C0042196
Beskrivning
General symptoms
Datatyp
text
Alias
- UMLS CUI [1]
- C0159028
Beskrivning
Please tick No/Yes for each symptom
Datatyp
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0150312
Beskrivning
Day of symptom
Datatyp
integer
Alias
- UMLS CUI [1,1]
- C0439228
- UMLS CUI [1,2]
- C1457887
Beskrivning
Measurement of body temperature
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0886414
- UMLS CUI [1,2]
- C0449444
Beskrivning
Definition of Fever: Axillary >= 37.5°C, Oral >= 37.5°C, Rectal >= 38° C
Datatyp
float
Måttenheter
- °C
Alias
- UMLS CUI [1]
- C0005903
Beskrivning
Body temperature not taken
Datatyp
boolean
Alias
- UMLS CUI [1]
- C0437722
Beskrivning
For Fatigue, Headache, Myalgia, Shivering, Arthralgia, Sweating increase
Datatyp
integer
Alias
- UMLS CUI [1]
- C0518690
Beskrivning
Symptom's ongoing
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0549178
- UMLS CUI [1,2]
- C1457887
Beskrivning
day month year
Datatyp
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C1457887
Beskrivning
Causality of symptoms
Datatyp
text
Alias
- UMLS CUI [1]
- C0015127
Beskrivning
Medically attended visit
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
Beskrivning
Type of medically attended visit
Datatyp
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C0332307
- UMLS CUI [1,3]
- C1386497
Beskrivning
Unsolicited Adverse events
Alias
- UMLS CUI-1
- C0877248
- UMLS CUI-2
- C0042196
Beskrivning
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.
Datatyp
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])