ID

36658

Descripción

Study ID: 107191 Clinical Study ID: 107191 Study Title: A Phase IIb, controlled, randomised, multicenter, single blind study to demonstrate the Non-Inferiority of the low dose influenza vaccine with or without adjuvant AS03 compared with FluarixTM (GlaxoSmithKline Biologicals) administered intramuscularly in elderly >= 60 years. Patient Level Data: NA Clinicaltrials.gov Identifier: NA EudraCT Number: 2006-000939-97 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: Candidate Influenza Vaccine GSK1247446A Trade Name: FluarixTM Study Indication: Influenza The purpose of this form is to conclude the study. It should be filled out at the phone contact and rechecked at visit 3. Visit 1: Day 0, Pre vaccination Visit 2: Day 21, Post vaccination 1 Phone contact: Day 30, post vaccination 1 Visit 3: Day 180, post vaccination 1 Visit 1 and 2 are part of the study: "Demonstration of the Non-Inferiority of the Low Dose Influenza Vaccine Compared with Fluarix NCT00321373"

Palabras clave

Versiones (2)
  1. 13/2/19 13/2/19 -
  2. 29/5/19 29/5/19 - Sarah Riepenhausen
Titular de derechos de autor

GlaxoSmithKline

Subido en

29 de mayo de 2019

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

Demonstration of the Non-Inferiority of the Low Dose Influenza Vaccine Compared with Fluarix EudraCT Number 2006-000939-97

Inglés

Study Conclusion

1 formularios  
  1. StudyEvent: ODM
    1. Study Conclusion
Administrative Data
Descripción

Administrative Data

Alias
UMLS CUI-1
C1320722
Assessment Date
Descripción

Assessment Date

Tipo de datos

date

Alias
UMLS CUI [1]
C2985720
Subject Number
Descripción

Subject Number

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348585
Follow-Up Studies
Descripción

Follow-Up Studies

Alias
UMLS CUI-1
C0016441
If a booster study or a follow-up study is offered in the future, would the subject be willing to be contacted and learn more about it?
Descripción

Follow-Up Studies

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0016441
Please specify the most appropriate reason
Descripción

if subject not willing to be contacted

Tipo de datos

text

Alias
UMLS CUI [1]
C0566251
Please specify
Descripción

If reason for not willing to be contacted was a (serious) adverse event.

Tipo de datos

text

Alias
UMLS CUI [1]
C0877248
UMLS CUI [2]
C1519255
Please specify
Descripción

If there was another reason for not willing to be contacted.

Tipo de datos

text

Alias
UMLS CUI [1]
C0205394
Occurence of SAE
Descripción

Occurence of SAE

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C2745955
Did the subject experience any Serious Adverse Event?
Descripción

Occurence of Serious Adverse Event

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2745955
Specify total number of SAE's
Descripción

If any SAE occurred

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0449788
Elimination Criteria
Descripción

Elimination Criteria

Alias
UMLS CUI-1
C0680251
Did any elimination criteria become applicable?
Descripción

Elimination Criteria

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0680251
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0008976
Specify
Descripción

If any elimination criteria become applicable

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0680251
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0008976
UMLS CUI [1,4]
C1521902
Status of Treatment Blind
Descripción

Status of Treatment Blind

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

Status of Treatment Blind

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0749659
UMLS CUI [1,2]
C2347038
Complete date treatment blind was broken
Descripción

If treatment blind was broken

Tipo de datos

date

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0011008
Tick one reason below for breaking treatment blind.
Descripción

If treatment blind was broken

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0392360
Specify
Descripción

If there was another reason for breaking the treatment blind.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3897431
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2348235
Investigators Signature
Descripción

Investigators Signature

Alias
UMLS CUI-1
C2346576
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.
Descripción

Investigator's Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C2346576
Date
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Printed Investigator's name
Descripción

Investigators Name

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Volver a la parte superior de la página

Similar models

Study Conclusion

1 formularios
  1. StudyEvent: ODM
    1. Study Conclusion
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Assessment Date
Item
Assessment Date
date
C2985720 (UMLS CUI [1])
Subject Number
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Item Group
Follow-Up Studies
C0016441 (UMLS CUI-1)
Follow-Up Studies
Item
If a booster study or a follow-up study is offered in the future, would the subject be willing to be contacted and learn more about it?
boolean
C0016441 (UMLS CUI [1])
Item
Please specify the most appropriate reason
text
C0566251 (UMLS CUI [1])
Reason
Code List
Please specify the most appropriate reason
CL Item
Adverse Events, or Serious Adverse Events (Adverse Events, or Serious Adverse Events)
CL Item
Other (Other)
Adverse Events or Serious Adverse Events
Item
Please specify
text
C0877248 (UMLS CUI [1])
C1519255 (UMLS CUI [2])
Other
Item
Please specify
text
C0205394 (UMLS CUI [1])
Item Group
Occurence of SAE
C1519255 (UMLS CUI-1)
C2745955 (UMLS CUI-2)
Occurence of Serious Adverse Event
Item
Did the subject experience any Serious Adverse Event?
integer
C1519255 (UMLS CUI [1,1])
C2745955 (UMLS CUI [1,2])
Number of SAE's
Item
Specify total number of SAE's
integer
C1519255 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item Group
Elimination Criteria
C0680251 (UMLS CUI-1)
Elimination Criteria
Item
Did any elimination criteria become applicable?
boolean
C0680251 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
Elimination Criteria Specification
Item
Specify
text
C0680251 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
Item Group
Status of Treatment Blind
C0749659 (UMLS CUI-1)
C2347038 (UMLS CUI-2)
Status of Treatment Blind
Item
Was the treatment blind broken during the study?
boolean
C0749659 (UMLS CUI [1,1])
C2347038 (UMLS CUI [1,2])
Date Treatment Blind Broken
Item
Complete date treatment blind was broken
date
C3897431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Tick one reason below for breaking treatment blind.
integer
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Reason Treatment Blind Broken
Code List
Tick one reason below for breaking treatment blind.
CL Item
Medical emergency requiring identification of investigational product for further treatments (1)
CL Item
Other (9)
Other Specification
Item
Specify
text
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Investigators Signature
C2346576 (UMLS CUI-1)
Investigator's Signature
Item
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.
text
C2346576 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Investigators Name
Item
Printed Investigator's name
text
C2826892 (UMLS CUI [1])
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial