ID
35599
Description
Study ID: 111631 Clinical Study ID: 111631 Study Title: A Phase III, open, non-randomized, multi-centric, single dose study to assess immunogenicity and safety of Fluarix / Influsplit SSW 2008/2009 injected intramuscularly in young adults (18 to 60 years) and in elderly (over 60 years). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00706563 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Influenza vaccine Trade Name: Fluarix Study Indication: Influenza
Keywords
Versions (1)
- 3/11/19 3/11/19 -
Copyright Holder
GSK group of companies
Uploaded on
March 11, 2019
DOI
To request one please log in.
License
Creative Commons BY-NC 3.0
Model comments :
You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.
Itemgroup comments for :
Item comments for :
In order to download data models you must be logged in. Please log in or register for free.
Immunogenicity and safety of Fluarix / Influsplit in young adults and elderly - 111631
Concomitant Medication, Non-Serious Adverse Events, Study Conclusion
Description
CONCOMITANT VACCINATION
Description
Vaccination details
Description
Trade / (Generic) Name
Data type
text
Description
Route
Data type
text
Description
Administration date
Data type
date
Description
CONCOMITANT MEDICATION
Description
Medication details
Description
Trade / Generic Name
Data type
text
Description
Medical Indication
Data type
text
Description
Prophylactic
Data type
boolean
Description
Total daily dose
Data type
text
Description
Route
Data type
text
Description
Start date
Data type
date
Description
End date
Data type
date
Description
Ongoing
Data type
boolean
Description
NON-SERIOUS ADVERSE EVENTS
Description
Adverse Events
Description
AE No.
Data type
integer
Description
Description
Data type
text
Description
AE Site
Data type
text
Description
Date Started
Data type
date
Description
Date Stopped
Data type
date
Description
Maximum Intensity
Data type
text
Description
Relationship to investigational products
Data type
boolean
Description
Outcome
Data type
text
Description
Medically attended visit
Data type
boolean
Description
Medical Involvement
Data type
text
Description
STUDY CONCLUSION
Description
PREGNANCY INFORMATION
Description
ELIMINATION CRITERIA
Description
SUBJECT WITHDRAWAL
Description
subject withdrawal
Data type
boolean
Description
tick one box only
Data type
text
Description
SAE No.
Data type
integer
Description
AE No.
Data type
integer
Description
Protocol violation specify
Data type
text
Description
Specify Other
Data type
text
Description
Who made the decision
Data type
text
Description
Date of last contact
Data type
date
Description
If No -> Please give details in Adverse Events section
Data type
boolean
Description
INVESTIGATOR'S SIGNATURE
Description
Investigator's Confirmation
Data type
date
Description
Investigator's signature
Data type
text
Description
Printed Investigator's name:
Data type
text
Description
USE OF HUMAN SAMPLES BY GSK
Description
Centre
Data type
integer
Description
Use of Human Samples by GSK
Data type
text
Description
This may include the management of the quality of these current tests, the maintenance or improvement of these current tests, the development of new test methods for the markers described in the protocol as well as making sure that new tests are comparable to previous methods and work reliably.
Data type
boolean
Description
These investigations excludes genetics and HIV testing.
Data type
boolean
Description
Further investigation by GSK Biologicals into the ability of Fluarix TM vaccine to protect people if any findings from related studies require it and further research in Influenza disease under study. These investigations excludes genetic and HIV testing.
Data type
boolean
Description
This research excludes genetic and HIV testing and does not affect subject participation in the study.
Data type
boolean
Description
GSK storage period
Data type
text
Description
Complete and submit a new form for each change during the study.
Data type
date
Description
INVESTIGATOR'S SIGNATURE