ID

36111

Beschreibung

Study ID: 100556 (Y11) Clinical Study ID: 100556 Study Title: Long-Term Persistence Follow-up Study to Evaluate the Immune Persistence of GSK Biologicals' Combined Hepatitis A / Hepatitis B Vaccine in Healthy Adult Volunteers Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00289718 Sponsor: GlaxoSmithKline Phase: phase 3 Study Recruitment Status: Completed Generic Name: Hepatitis A (Inactivated), Hepatitis B (Recombinant) Vaccine Trade Name: Twinrix Study Indication: Hepatitis A; Hepatitis B

Stichworte

Versionen (1)
  1. 15.04.19 15.04.19 -
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GlaxoSmithKline

Hochgeladen am

15. April 2019

DOI

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Creative Commons BY-NC 3.0
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Immune Persistence of GSK Biologicals' Combined Hepatitis A / Hepatitis B Vaccine in Healthy Adult Volunteers NCT00289718

Englisch

Long-Term Follow Up (Year 15; Additional vaccination; one month post vaccination) - Check for Study Continuation; Laboratory Tests

1 Formulare  
Administrative
Beschreibung

Administrative

Alias
UMLS CUI-1
C1320722
Subject number
Beschreibung

Subject number

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
Check for Study Continuation
Beschreibung

Check for Study Continuation

Alias
UMLS CUI-1
C0805733
UMLS CUI-2
C0008976
Did the subject return for follow-up concerning the additional vaccination visit?
Beschreibung

Yes → Please complete the next pages. No → Please complete below.

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0332156
UMLS CUI [2,1]
C0042196
UMLS CUI [2,2]
C0940824
Please tick the ONE most appropriate reason and skip the following pages of this visit.
Beschreibung

Please tick the ONE most appropriate reason and skip the following pages of this visit.

Datentyp

text

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C0332156
UMLS CUI [1,3]
C0392360
If SAE, please specify SAE No
Beschreibung

If SAE, please specify SAE No

Datentyp

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0237753
If Non-serious Adverse Event, please specify unsolicited AE No or solicited AE Code
Beschreibung

If Non-serious Adverse Event, please specify unsolicited AE No or solicited AE Code

Datentyp

text

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0237753
If other reason, please specify
Beschreibung

If other reason, please specify

Datentyp

text

Alias
UMLS CUI [1,1]
C3840932
UMLS CUI [1,2]
C2348235
Please tick, who took the decision
Beschreibung

Please tick, who took the decision

Datentyp

text

Alias
UMLS CUI [1]
C0679006
Laboratory Tests
Beschreibung

Laboratory Tests

Alias
UMLS CUI-1
C0022885
Has a blood sample been taken?
Beschreibung

Has a blood sample been taken?

Datentyp

boolean

Alias
UMLS CUI [1]
C0005834
Date of blood sample been taken
Beschreibung

Please complete only if different from visit date

Datentyp

date

Alias
UMLS CUI [1,1]
C1277698
UMLS CUI [1,2]
C0011008
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Ähnliche Modelle

Long-Term Follow Up (Year 15; Additional vaccination; one month post vaccination) - Check for Study Continuation; Laboratory Tests

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Item Group
Check for Study Continuation
C0805733 (UMLS CUI-1)
C0008976 (UMLS CUI-2)
Did the subject return for follow-up concerning the additional vaccination visit?
Item
Did the subject return for follow-up concerning the additional vaccination visit?
boolean
C1522577 (UMLS CUI [1,1])
C0332156 (UMLS CUI [1,2])
C0042196 (UMLS CUI [2,1])
C0940824 (UMLS CUI [2,2])
Item
Please tick the ONE most appropriate reason and skip the following pages of this visit.
text
C1522577 (UMLS CUI [1,1])
C0332156 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Please tick the ONE most appropriate reason and skip the following pages of this visit.
Code List
Please tick the ONE most appropriate reason and skip the following pages of this visit.
CL Item
Serious adverse event (complete the Serious Adverse Event form)  (SAE)
CL Item
Non-Serious adverse event (complete the Non-serious Adverse Event section)  (AEX)
CL Item
Other, please specify (e.g.: consent withdrawal, Protocol violation, …) (OTH)
If SAE, please specify SAE No
Item
If SAE, please specify SAE No
integer
C1519255 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
If Non-serious Adverse Event, please specify unsolicited AE No or solicited AE Code
Item
If Non-serious Adverse Event, please specify unsolicited AE No or solicited AE Code
text
C1518404 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
If other reason, please specify
Item
If other reason, please specify
text
C3840932 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item
Please tick, who took the decision
text
C0679006 (UMLS CUI [1])
Please tick, who took the decision
Code List
Please tick, who took the decision
CL Item
Investigator (I)
CL Item
Subject (P)
Item Group
Laboratory Tests
C0022885 (UMLS CUI-1)
Has a blood sample been taken?
Item
Has a blood sample been taken?
boolean
C0005834 (UMLS CUI [1])
Date of blood sample been taken
Item
Date of blood sample been taken
date
C1277698 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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