ID

36307

Descrição

Study ID: 111258 Clinical Study ID: 111258 Study Title: A phase IV, observer-blind, randomized single-dose post-marketing study to compare the safety and immunogenicity of Fluviral Trivalent Split Virion Influenza Vaccine (2007 - 2008 Season) made with new vs. aged bulk material, in adults ranging in age from 18 to 60 Years. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00586469 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 4 Study Recruitment Status: Completed Generic Name: Influenza Vaccine Trade Name: Fluviral Study Indication: Influenza

Palavras-chave

Versões (1)
  1. 02/05/2019 02/05/2019 -
Titular dos direitos

GlaxoSmithKline

Transferido a

2 de maio de 2019

DOI

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Licença

Creative Commons BY-NC 3.0
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Fluvial Trivalent Split Vision Influenza Vaccine; NCT00586469

Inglês

Study Conclusion

1 Formulários  
  1. StudyEvent: ODM
    1. Study Conclusion
Administrative Data
Descrição

Administrative Data

Alias
UMLS CUI-1
C1320722
Subject Number
Descrição

Clinical Trial Subject Unique Identifier

Tipo de dados

integer

Alias
UMLS CUI [1]
C2348585
Occurrence of Serious Adverse Event
Descrição

Occurrence of Serious Adverse Event

Alias
UMLS CUI-1
C1519255
Did the subject experience any Serious Adverse Event during the study period?
Descrição

Serious Adverse Event

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1519255
If Yes, specify total number of SAE's
Descrição

Serious Adverse Event, Count of entities

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0449788
Pregnancy Information
Descrição

Pregnancy Information

Alias
UMLS CUI-1
C0032961
UMLS CUI-2
C1533716
Did the subject become pregnant during the study?
Descrição

Pregnancy, Clinical Trials

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0032961
UMLS CUI [1,2]
C0008976
Status of Treatment Blind
Descrição

Status of Treatment Blind

Alias
UMLS CUI-1
C0749659
UMLS CUI-2
C2347038
Was the treatment blind broken during the study?
Descrição

Subject Unblinding Event Record

Tipo de dados

boolean

Alias
UMLS CUI [1]
C3897431
Complete Date
Descrição

Subject Unblinding Event Record, Date in time

Tipo de dados

date

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0011008
Tick one reason below
Descrição

Subject Unblinding Event Record, Indication

Tipo de dados

text

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0392360
Elimination Criteria
Descrição

Elimination Criteria

Alias
UMLS CUI-1
C0680251
Did any elimination criteria become applicable during the study?
Descrição

Exclusion Criteria

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0680251
Specify
Descrição

Exclusion Criteria

Tipo de dados

text

Alias
UMLS CUI [1]
C0680251
Withdraw
Descrição

Withdraw

Alias
UMLS CUI-1
C2349954
Was the subject withdrawn from the study?
Descrição

Withdraw

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2349954
Major reason for withdrawal (tick one box only).
Descrição

Withdraw, Indication

Tipo de dados

text

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C3146298
UMLS CUI [1,3]
C1522508
Specifications
Descrição

Withdraw, Indication, Details

Tipo de dados

text

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C3146298
UMLS CUI [1,3]
C1522508
Date of last contact
Descrição

Withdraw, Date last contact

Tipo de dados

date

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0805839
Was the subject in good condition at date of last contact?
Descrição

Withdraw, Date last contact, General physical condition

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0805839
UMLS CUI [1,3]
C1142435
Investigator's Signature
Descrição

Investigator's Signature

Alias
UMLS CUI-1
C2346576
Investigator's signature
Descrição

I confirm that I have reviewed the data in this Case Report Form for this subject. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date below.

Tipo de dados

text

Alias
UMLS CUI [1]
C2346576
Date
Descrição

Investigator Signature, Date in time

Tipo de dados

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Printed Investigator's name
Descrição

Investigator Name

Tipo de dados

text

Alias
UMLS CUI [1]
C2826892
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Similar models

Study Conclusion

1 Formulários
  1. StudyEvent: ODM
    1. Study Conclusion
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Clinical Trial Subject Unique Identifier
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Item Group
Occurrence of Serious Adverse Event
C1519255 (UMLS CUI-1)
Serious Adverse Event
Item
Did the subject experience any Serious Adverse Event during the study period?
boolean
C1519255 (UMLS CUI [1])
Serious Adverse Event, Count of entities
Item
If Yes, specify total number of SAE's
integer
C1519255 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item Group
Pregnancy Information
C0032961 (UMLS CUI-1)
C1533716 (UMLS CUI-2)
Item
Did the subject become pregnant during the study?
text
C0032961 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
Pregnancy, Clinical Trials
Code List
Did the subject become pregnant during the study?
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not Applicable (not of childbearing potential or male) (3)
Item Group
Status of Treatment Blind
C0749659 (UMLS CUI-1)
C2347038 (UMLS CUI-2)
Subject Unblinding Event Record
Item
Was the treatment blind broken during the study?
boolean
C3897431 (UMLS CUI [1])
Subject Unblinding Event Record, Date in time
Item
Complete Date
date
C3897431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Tick one reason below
text
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Withdraw, Decision
Code List
Tick one reason below
CL Item
Medical emergency requiring identification of investigational product for further treatments. (1)
CL Item
Other, specify (2)
Item Group
Elimination Criteria
C0680251 (UMLS CUI-1)
Exclusion Criteria
Item
Did any elimination criteria become applicable during the study?
boolean
C0680251 (UMLS CUI [1])
Exclusion Criteria
Item
Specify
text
C0680251 (UMLS CUI [1])
Item Group
Withdraw
C2349954 (UMLS CUI-1)
Withdraw
Item
Was the subject withdrawn from the study?
boolean
C2349954 (UMLS CUI [1])
Item
Major reason for withdrawal (tick one box only).
text
C2349954 (UMLS CUI [1,1])
C3146298 (UMLS CUI [1,2])
C1522508 (UMLS CUI [1,3])
Withdraw, Indication
Code List
Major reason for withdrawal (tick one box only).
CL Item
Serious adverse event (Please specify SAE N°) (1)
CL Item
Non-Serious adverse event (Please specify unsolicited AE N° or solicited AE code) (2)
CL Item
Protocol violation, please specify (3)
CL Item
Consent withdrawal, not due to an adverse event. (4)
CL Item
Migrated / moved from the study area (5)
CL Item
Lost to follow-up. (6)
CL Item
Other, please specify (7)
Withdraw, Indication, Details
Item
Specifications
text
C2349954 (UMLS CUI [1,1])
C3146298 (UMLS CUI [1,2])
C1522508 (UMLS CUI [1,3])
Withdraw, Date last contact
Item
Date of last contact
date
C2349954 (UMLS CUI [1,1])
C0805839 (UMLS CUI [1,2])
Withdraw, Date last contact, General physical condition
Item
Was the subject in good condition at date of last contact?
boolean
C2349954 (UMLS CUI [1,1])
C0805839 (UMLS CUI [1,2])
C1142435 (UMLS CUI [1,3])
Item Group
Investigator's Signature
C2346576 (UMLS CUI-1)
Investigator Signature
Item
Investigator's signature
text
C2346576 (UMLS CUI [1])
Investigator Signature, Date in time
Item
Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Investigator Name
Item
Printed Investigator's name
text
C2826892 (UMLS CUI [1])
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