ID

35167

Beschreibung

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

Stichworte

  1. 18.02.19 18.02.19 -
  2. 20.02.19 20.02.19 -
  3. 20.02.19 20.02.19 - Sarah Riepenhausen
Rechteinhaber

GlaxoSmithKline

Hochgeladen am

20. Februar 2019

DOI

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Lizenz

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
Beschreibung

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Number
Beschreibung

Subject Number

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
Workbook number
Beschreibung

Workbook number

Datentyp

integer

Alias
UMLS CUI [1]
C2986015
Visit type
Beschreibung

Check/update for each study visit

Datentyp

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0545082
Concomitant medication
Beschreibung

Concomitant medication

Alias
UMLS CUI-1
C2347852
Collection Date
Beschreibung

day month year

Datentyp

date

Alias
UMLS CUI [1]
C1317250
Have any medications/treatments been administered during the timeframe as specified by the protocol?
Beschreibung

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.

Datentyp

text

Alias
UMLS CUI [1]
C2347852
Trade/ (Generic) Name
Beschreibung

Trade/ (Generic) Name

Datentyp

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C2347852
Medical Indication: prophylactic
Beschreibung

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’.

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C2347852
UMLS CUI [1,3]
C0199176
Medical Indication
Beschreibung

Medical Indication

Datentyp

text

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C2347852
Total daily dose
Beschreibung

Total daily dose

Datentyp

text

Alias
UMLS CUI [1]
C2826638
Route of administration
Beschreibung

Route of administration

Datentyp

text

Alias
UMLS CUI [1,1]
C0013153
UMLS CUI [1,2]
C2347852
Start date of medication
Beschreibung

day month year

Datentyp

date

Alias
UMLS CUI [1]
C2826734
End date of medication
Beschreibung

day month year

Datentyp

date

Alias
UMLS CUI [1]
C2826744
Continuation of medication
Beschreibung

Tick if medication is continuing

Datentyp

boolean

Alias
UMLS CUI [1]
C2826666
Comment
Beschreibung

For GSK

Datentyp

text

Alias
UMLS CUI [1]
C0947611

Ähnliche Modelle

Concomitant Medication

  1. StudyEvent: ODM
    1. Concomitant Medication
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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