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ID

35167

Descrição

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

Palavras-chave

  1. 18-02-19 18-02-19 -
  2. 20-02-19 20-02-19 -
  3. 20-02-19 20-02-19 - Sarah Riepenhausen
Titular dos direitos

GlaxoSmithKline

Transferido a

20 februari 2019

DOI

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Licença

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
    Descrição

    Administrative data

    Alias
    UMLS CUI-1
    C1320722
    Subject Number
    Descrição

    Subject Number

    Tipo de dados

    integer

    Alias
    UMLS CUI [1]
    C2348585
    Workbook number
    Descrição

    Workbook number

    Tipo de dados

    integer

    Alias
    UMLS CUI [1]
    C2986015
    Visit type
    Descrição

    Check/update for each study visit

    Tipo de dados

    integer

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

    Concomitant medication

    Alias
    UMLS CUI-1
    C2347852
    Collection Date
    Descrição

    day month year

    Tipo de dados

    date

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

    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.

    Tipo de dados

    text

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

    Trade/ (Generic) Name

    Tipo de dados

    text

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

    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’.

    Tipo de dados

    boolean

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

    Medical Indication

    Tipo de dados

    text

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

    Total daily dose

    Tipo de dados

    text

    Alias
    UMLS CUI [1]
    C2826638
    Route of administration
    Descrição

    Route of administration

    Tipo de dados

    text

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

    day month year

    Tipo de dados

    date

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

    day month year

    Tipo de dados

    date

    Alias
    UMLS CUI [1]
    C2826744
    Continuation of medication
    Descrição

    Tick if medication is continuing

    Tipo de dados

    boolean

    Alias
    UMLS CUI [1]
    C2826666
    Comment
    Descrição

    For GSK

    Tipo de dados

    text

    Alias
    UMLS CUI [1]
    C0947611

    Similar models

    Concomitant Medication

    1. StudyEvent: ODM
      1. Concomitant Medication
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de dados
    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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