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ID

35167

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 Concomitant medication form. It has to be filled in for all Visits/contacts (except screening) for each workbook. All concomitant medication, with the exception of vitamins and/or dietary supplements, administered at ANY time during the period starting with administration of each dose of study vaccine and ending 21 days after each vaccination after each dose of study vaccine are to be recorded with generic name of the medication (trade names are allowed for combination drugs, i.e. multi-component drugs), medical indication, total daily dose, route of administration, start and end dates of treatment. Any treatments and/or medications specifically contraindicated, e.g., any immunoglobulins, other blood products and any immune modifying drugs administered within three months preceding the vaccination or at any time during the study period are to be recorded with generic name of the medication (trade names are allowed for combination drugs only), medical indication, total daily dose, route of administration, start and end dates of treatment. Concomitant medication administered for the treatment of an AE or SAE within the follow-up period for adverse events must be recorded in the CRF with generic name of the medication (trade names are allowed for combination drugs only), medical indication (including which AE/SAE), total daily dose, route of administration,start and end dates of treatment. Similarly, concomitant medication administered for the treatment of an SAE, at any time, must be recorded on the SAE Report Form.

Link

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

Keywords

  1. 2/18/19 2/18/19 -
  2. 2/20/19 2/20/19 -
  3. 2/20/19 2/20/19 - Sarah Riepenhausen
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

    Concomitant Medication

    1. StudyEvent: ODM
      1. Concomitant Medication
    Administrative data
    Description

    Administrative data

    Alias
    UMLS CUI-1
    C1320722 (Administrative documentation)
    SNOMED
    405624007
    Subject Number
    Description

    Subject Number

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2348585 (Clinical Trial Subject Unique Identifier)
    Workbook number
    Description

    Workbook number

    Data type

    integer

    Alias
    UMLS CUI [1]
    C2986015 (Document Version Number Text)
    Visit type
    Description

    Check/update for each study visit

    Data type

    integer

    Alias
    UMLS CUI [1,1]
    C0332307 (Type - attribute)
    SNOMED
    261664005
    UMLS CUI [1,2]
    C0545082 (Visit)
    Concomitant medication
    Description

    Concomitant medication

    Alias
    UMLS CUI-1
    C2347852 (Concomitant Agent)
    Collection Date
    Description

    day month year

    Data type

    date

    Alias
    UMLS CUI [1]
    C1317250 (Collection Date)
    Have any medications/treatments been administered during the timeframe as specified by the protocol?
    Description

    If you tick "yes" please fill in following items. At each study visit/contact, the investigator should question the subject about any medication(s) taken.

    Data type

    text

    Alias
    UMLS CUI [1]
    C2347852 (Concomitant Agent)
    Trade/ (Generic) Name
    Description

    Trade/ (Generic) Name

    Data type

    text

    Alias
    UMLS CUI [1,1]
    C0027365 (Name)
    SNOMED
    703503000
    LOINC
    LP72974-6
    UMLS CUI [1,2]
    C2347852 (Concomitant Agent)
    Medical Indication: prophylactic
    Description

    A prophylactic medication is a medication administered in the absence of ANY symptom and in anticipation of a reaction to the vaccination (e.g. an anti-pyretic is considered to be prophylactic when it is given in the absence of fever [rectal temperature < 38°C] and any other symptom, to prevent fever from occurring). Any concomitant medication administered prophylactically in anticipation of reaction to the vaccination must be recorded in the CRF with generic name of the medication (trade names are allowed for combination drugs only), total daily dose, route of administration, start and end dates of treatment and coded as ‘Prophylactic’.

    Data type

    boolean

    Alias
    UMLS CUI [1,1]
    C3146298 (Indication)
    UMLS CUI [1,2]
    C2347852 (Concomitant Agent)
    UMLS CUI [1,3]
    C0199176 (Prophylactic treatment)
    SNOMED
    360271000
    Medical Indication
    Description

    Medical Indication

    Data type

    text

    Alias
    UMLS CUI [1,1]
    C3146298 (Indication)
    UMLS CUI [1,2]
    C2347852 (Concomitant Agent)
    Total daily dose
    Description

    Total daily dose

    Data type

    text

    Alias
    UMLS CUI [1]
    C2826638 (Concomitant Medication Daily Dose)
    Route of administration
    Description

    Route of administration

    Data type

    text

    Alias
    UMLS CUI [1,1]
    C0013153 (Drug Administration Routes)
    SNOMED
    410675002
    LOINC
    LP40261-7
    UMLS CUI [1,2]
    C2347852 (Concomitant Agent)
    Start date of medication
    Description

    day month year

    Data type

    date

    Alias
    UMLS CUI [1]
    C2826734 (Concomitant Medication Start Date)
    End date of medication
    Description

    day month year

    Data type

    date

    Alias
    UMLS CUI [1]
    C2826744 (Concomitant Medication End Date)
    Continuation of medication
    Description

    Tick if medication is continuing

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C2826666 (Concomitant Medication Ongoing)
    Comment
    Description

    For GSK

    Data type

    text

    Alias
    UMLS CUI [1]
    C0947611 (Comment)
    LOINC
    LP72293-1

    Similar models

    Concomitant Medication

    1. StudyEvent: ODM
      1. Concomitant Medication
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    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
    Core Analysis 1 (1)
    CL Item
    Core Analysis 2 (2)
    CL Item
    Study conclusion  (3)
    Item Group
    Concomitant medication
    C2347852 (UMLS CUI-1)
    Collection Date
    Item
    Collection Date
    date
    C1317250 (UMLS CUI [1])
    Item
    Have any medications/treatments been administered during the timeframe as specified by the protocol?
    text
    C2347852 (UMLS CUI [1])
    Code List
    Have any medications/treatments been administered during the timeframe as specified by the protocol?
    CL Item
    Yes (Y)
    CL Item
    No (N)
    Trade/ (Generic) Name
    Item
    Trade/ (Generic) Name
    text
    C0027365 (UMLS CUI [1,1])
    C2347852 (UMLS CUI [1,2])
    Medical Indication: prophylactic
    Item
    Medical Indication: prophylactic
    boolean
    C3146298 (UMLS CUI [1,1])
    C2347852 (UMLS CUI [1,2])
    C0199176 (UMLS CUI [1,3])
    Medical Indication
    Item
    Medical Indication
    text
    C3146298 (UMLS CUI [1,1])
    C2347852 (UMLS CUI [1,2])
    Total daily dose
    Item
    Total daily dose
    text
    C2826638 (UMLS CUI [1])
    Item
    Route of administration
    text
    C0013153 (UMLS CUI [1,1])
    C2347852 (UMLS CUI [1,2])
    Code List
    Route of administration
    CL Item
    Intradermal (ID)
    CL Item
    Inhalation (IH)
    CL Item
    Intramuscular (IM)
    CL Item
    Intravenous (IV)
    CL Item
    Intranasal (NA)
    CL Item
    Parenteral (PE)
    CL Item
    Oral (PO)
    CL Item
    Subcutaneous (SC)
    CL Item
    Sublingual (SL)
    CL Item
    Transdermal (TD)
    CL Item
    Other (OTH)
    CL Item
    Unknown (UNK)
    CL Item
    External (EXT)
    CL Item
    Intraarticular (IR)
    CL Item
    Intrathecal (IT)
    CL Item
    Rectal (PR)
    CL Item
    Topical (TO)
    CL Item
    Vaginal (VA)
    Start date
    Item
    Start date of medication
    date
    C2826734 (UMLS CUI [1])
    End date
    Item
    End date of medication
    date
    C2826744 (UMLS CUI [1])
    Continuation of medication
    Item
    Continuation of medication
    boolean
    C2826666 (UMLS CUI [1])
    Comment
    Item
    Comment
    text
    C0947611 (UMLS CUI [1])

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