Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Quality Assurance of tests
Item
Quality Assurance of tests described in the protocol
boolean
C0178932 (UMLS CUI [1])
Use of Biologicals for further influenza vaccine/disease (excluding genetics and HIV testing)
Item
Further investigation by GSK Biologicals into the ability of influenza vaccine to protect people if any findings from related studies require it and further research in influenza disease under study. These investigations excludes genetics and HIV testing.
boolean
C0457083 (UMLS CUI [1,1])
C0005522 (UMLS CUI [1,2])
C0021403 (UMLS CUI [1,3])
C0457083 (UMLS CUI [2,1])
C0005522 (UMLS CUI [2,2])
C4316910 (UMLS CUI [2,3])
C1298908 (UMLS CUI [3,1])
C1320549 (UMLS CUI [3,2])
C1298908 (UMLS CUI [4,1])
C1321876 (UMLS CUI [4,2])
Use of Biologicals for further influenza vaccine/disease (excluding genetics and HIV testing), independent Ethics Committee
Item
Further investigation by GSK Biologicals into the ability of influenza 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. Investigator will always ask in advance the permission of the independent Ethics Committee/Institutional Review Board linked to the institution where this research is performed.
boolean
C0457083 (UMLS CUI [1,1])
C0005522 (UMLS CUI [1,2])
C0021403 (UMLS CUI [1,3])
C0457083 (UMLS CUI [2,1])
C0005522 (UMLS CUI [2,2])
C4316910 (UMLS CUI [2,3])
C1298908 (UMLS CUI [3,1])
C1320549 (UMLS CUI [3,2])
C1298908 (UMLS CUI [4,1])
C1321876 (UMLS CUI [4,2])
C0332158 (UMLS CUI [5,1])
C0086911 (UMLS CUI [5,2])
Use of Biologicals for further research NOT RELATED influenza vaccine/disease (excluding genetics and HIV testing)
Item
Further research by GSK Biologicals that is NOT RELATED to influenza vaccine or influenza disease under study done on an anonymous basis (meaning that any identification linking the subject to the sample is destroyed). This research excludes genetic and HIV testing and does not affect subject participation in the study.
boolean
C0457083 (UMLS CUI [1,1])
C0005522 (UMLS CUI [1,2])
C1546988 (UMLS CUI [1,3])
C0021403 (UMLS CUI [1,4])
C0457083 (UMLS CUI [2,1])
C0005522 (UMLS CUI [2,2])
C1546988 (UMLS CUI [2,3])
C4316910 (UMLS CUI [2,4])
C3858751 (UMLS CUI [3,1])
C0039593 (UMLS CUI [3,2])
C1298908 (UMLS CUI [4,1])
C1320549 (UMLS CUI [4,2])
C1298908 (UMLS CUI [5,1])
C1321876 (UMLS CUI [5,2])
Item
Please tick if a 15 years GSK storage period is covered by the subject's Informed Consent form of your center.
integer
C1698986 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
C0370003 (UMLS CUI [1,3])
Code List
Please tick if a 15 years GSK storage period is covered by the subject's Informed Consent form of your center.
CL Item
At least 15 years storage period by GSK Biologicals (1)
Other GSK storage period
Item
If other GSK storage period, please specify
text
C0205394 (UMLS CUI [1,1])
C1698986 (UMLS CUI [1,2])
C0449238 (UMLS CUI [1,3])
C0370003 (UMLS CUI [1,4])
ICF Effective date
Item
ICF Effective date
date
C0011008 (UMLS CUI [1,1])
C0009797 (UMLS CUI [1,2])
Investigator's Signature
Item
Investigator's Signature
text
C2346576 (UMLS CUI [1])
Printed Investigator’s name
Item
Printed Investigator’s name
text
C2826892 (UMLS CUI [1])
Date of signature
Item
Date of signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])