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Study Continuation, Elimination Criteria, ICF Amendment, Breastfeeding Continuation

1 forms  
Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Identifier
Description

Clinical Trial Subject Unique Identifier

Data type

integer

Alias
UMLS CUI [1]
C2348585
Cohort
Description

Please note that while the rest of this form is applicable to all cohorts, the itemgroup regarding breastfeeding is only applicable to Cohort 2 (= HIV-neg. exposed infants).

Data type

integer

Alias
UMLS CUI [1]
C0599755
Visit Type
Description

This form is to be used at each Visit (Visits 2 to 10).

Data type

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0545082
Date of Visit
Description

Visit 1 is scheduled at 6-10 weeks of life. The interval between Visits 1 and 2, 2 and 3, as well as 3 and 4 has to be 28-42 days each. Visit 5 then takes place at 9-10 months of age. The interval between Visit 5 and 6 again has to be 28-42 days. Visit 7 is scheduled at 12-13 months of age, Visit 8 at 15-18 months, Visit 9 at 16-19 months, and the final Visit 10 is performed when the subjects are 24-27 months old.

Data type

date

Alias
UMLS CUI [1]
C1320303
Study Continuation
Description

Study Continuation

Alias
UMLS CUI-1
C0805733
UMLS CUI-2
C0008976
Did the subject return for this visit?
Description

If yes, complete the approriate forms. If no, please select the ONE most appropriate reason and skip the following forms of this visit, or select "Same reason and decision as previous visit" (option available from Visit 2 (HIV-pos. and HIV-exposed cohorts) or 3 (all HIV-negative, unexposed cohorts) onwards).

Data type

boolean

Alias
UMLS CUI [1]
C0805733
reason for study non-continuation
Description

If SAE, please complete and submit SAE report, and specify SAE No. If AE, please complete Non-serious Adverse Event form, and specify AE No. or solicited AE code. If Other Reason, please specify

Data type

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0457454
UMLS CUI [1,3]
C0008976
Same reason and decision as previous visit
Description

This option is not applicable to the HIV-negative, unexposed cohorts at Visit 2, but is available to all cohorts from Visit 3 onwards.

Data type

boolean

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0457454
UMLS CUI [1,3]
C0008976
UMLS CUI [1,4]
C2127115
UMLS CUI [2,1]
C0457454
UMLS CUI [2,2]
C0008976
UMLS CUI [2,3]
C0679006
UMLS CUI [2,4]
C2127115
Specify SAE Number
Description

if SAE major reason for non-continuation

Data type

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0237753
Specify AE Number
Description

if AE major reason for non-continuation

Data type

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0237753
Specify solicited AE Code
Description

if AE major reason for discontinuation

Data type

integer

Alias
UMLS CUI [1,1]
C1517001
UMLS CUI [1,2]
C1518404
UMLS CUI [1,3]
C0600091
Specify other reason for non-continuation
Description

e.g.: consent withdrawal, Protocol violation, …

Data type

text

Alias
UMLS CUI [1,1]
C3840932
UMLS CUI [1,2]
C2348235
UMLS CUI [1,3]
C0457454
UMLS CUI [1,4]
C0008976
Please select who made the decision
Description

Who made discontinuation decision

Data type

text

Alias
UMLS CUI [1,1]
C0457454
UMLS CUI [1,2]
C0008976
UMLS CUI [1,3]
C0679006
Elimination Criteria during Study
Description

Elimination Criteria during Study

Alias
UMLS CUI-1
C0680251
UMLS CUI-2
C0347984
UMLS CUI-3
C0008976
Use of any investigational or non-registered product (drug or vaccine) other than the study vaccines within 30 days preceding the first dose of the study vaccines.
Description

leads to elimination from safety and immunogenicity ATP analyses

Data type

boolean

Alias
UMLS CUI [1,1]
C0332185
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0013230
UMLS CUI [2,1]
C0332185
UMLS CUI [2,2]
C0205394
UMLS CUI [2,3]
C1875384
Administration of a pneumococcal vaccine not foreseen by the study protocol
Description

leads to elimination from safety and immunogenicity ATP analyses

Data type

boolean

Alias
UMLS CUI [1,1]
C2368628
UMLS CUI [1,2]
C1444655
UMLS CUI [1,3]
C2348563
UMLS CUI [1,4]
C0358314
A positive HIV DNA-PCR test during the study
Description

leads to elimination from safety and immunogenicity ATP analyses only applicable to HIV unexposed uninfected infants and HIV exposed uninfected infants (i.e. Cohorts 2-5)

Data type

boolean

Alias
UMLS CUI [1,1]
C1294177
UMLS CUI [1,2]
C1335447
UMLS CUI [1,3]
C0347984
UMLS CUI [1,4]
C2347804
Administration of immunoglobulins and/or any blood products since birth or administration during the study period.
Description

leads to elimination from immunogenicity ATP analysis

Data type

boolean

Alias
UMLS CUI [1,1]
C0205156
UMLS CUI [1,2]
C0021027
UMLS CUI [1,3]
C1533734
UMLS CUI [2,1]
C0205156
UMLS CUI [2,2]
C0371802
UMLS CUI [3,1]
C0021027
UMLS CUI [3,2]
C1533734
UMLS CUI [3,3]
C0347984
UMLS CUI [3,4]
C2347804
UMLS CUI [4,1]
C0371802
UMLS CUI [4,2]
C0347984
UMLS CUI [4,3]
C2347804
Any confirmed or suspected immunosuppressive or immunodeficient condition based on medical history and physical examination.
Description

leads to elimination from immunogenicity ATP analysis applicable to HIV unexposed uninfected infants only (i.e. Cohorts 3, 4, 5)

Data type

boolean

Alias
UMLS CUI [1,1]
C0750484
UMLS CUI [1,2]
C0021051
UMLS CUI [2,1]
C0750484
UMLS CUI [2,2]
C4048329
UMLS CUI [3,1]
C0242114
UMLS CUI [3,2]
C0021051
UMLS CUI [4,1]
C0242114
UMLS CUI [4,2]
C4048329
Informed Consent Amendment 1 / 2
Description

Informed Consent Amendment 1 / 2

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C0680532
UMLS CUI-3
C2348563
Has the informed consent following the Amendment 1/ Amendment 2 approval been signed before or the day of this visit, or between the previous performed visit and this visit?
Description

(applicable only if ICF Amendment 1 / Amendment 2 has not been signed at previous performed visit)

Data type

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0680532
UMLS CUI [1,3]
C2348563
Date of ICF Amendment signed
Description

(this item is not applicable for Visit 1, i.e. a date is not recorded if the Amendment has been signed at/before Visit 1)

Data type

date

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0680532
UMLS CUI [1,3]
C0011008
Breastfeeding
Description

Breastfeeding

Alias
UMLS CUI-1
C0006147
Is the mother still breastfeeding since last visit?
Description

If no, record date of cessation

Data type

boolean

Alias
UMLS CUI [1,1]
C0006147
UMLS CUI [1,2]
C0549178
Breastfeeding Cessation Date
Description

if applicable

Data type

date

Alias
UMLS CUI [1,1]
C0006147
UMLS CUI [1,2]
C0806020
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Similar models

Study Continuation, Elimination Criteria, ICF Amendment, Breastfeeding Continuation

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Clinical Trial Subject Unique Identifier
Item
Subject Identifier
integer
C2348585 (UMLS CUI [1])
Item
Cohort
integer
C0599755 (UMLS CUI [1])
Cohort
Code List
Cohort
CL Item
HIV-pos. (1)
CL Item
HIV-neg. exposed (2)
CL Item
HIV-neg. unexposed, 3+1 schedule (3)
CL Item
HIV-neg. unexposed, 3+0 schedule (4)
CL Item
HIV-neg. unexposed, 2+1 schedule (5)
Item
Visit Type
integer
C0332307 (UMLS CUI [1,1])
C0545082 (UMLS CUI [1,2])
Visit Type
Code List
Visit Type
CL Item
Visit 2 (2)
CL Item
Visit 3 (3)
CL Item
Visit 4 (4)
CL Item
Visit 5 (5)
CL Item
Visit 6 (6)
CL Item
Visit 7 (7)
CL Item
Visit 8 (8)
CL Item
Visit 9 (9)
CL Item
Visit 10 (10)
Date of Visit
Item
Date of Visit
date
C1320303 (UMLS CUI [1])
Item Group
Study Continuation
C0805733 (UMLS CUI-1)
C0008976 (UMLS CUI-2)
Returned for this visit?
Item
Did the subject return for this visit?
boolean
C0805733 (UMLS CUI [1])
Item
reason for study non-continuation
text
C0392360 (UMLS CUI [1,1])
C0457454 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
major reason for vaccine non-administration
Code List
reason for study non-continuation
CL Item
Serious adverse event (SAE)
CL Item
Non-Serious adverse event (AEX)
CL Item
Other (OTH)
Same study discontinuation reason and decision as previous visit
Item
Same reason and decision as previous visit
boolean
C0392360 (UMLS CUI [1,1])
C0457454 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
C2127115 (UMLS CUI [1,4])
C0457454 (UMLS CUI [2,1])
C0008976 (UMLS CUI [2,2])
C0679006 (UMLS CUI [2,3])
C2127115 (UMLS CUI [2,4])
Specify SAE Number
Item
Specify SAE Number
integer
C1519255 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Specify AE Number
Item
Specify AE Number
integer
C1518404 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Specify solicited AE Code
Item
Specify solicited AE Code
integer
C1517001 (UMLS CUI [1,1])
C1518404 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,3])
Specify other reason for study discontinuation
Item
Specify other reason for non-continuation
text
C3840932 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C0457454 (UMLS CUI [1,3])
C0008976 (UMLS CUI [1,4])
Item
Please select who made the decision
text
C0457454 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
C0679006 (UMLS CUI [1,3])
Who made non-administration decision
Code List
Please select who made the decision
CL Item
Investigator (I)
CL Item
Parents/Guardians (P)
Item Group
Elimination Criteria during Study
C0680251 (UMLS CUI-1)
C0347984 (UMLS CUI-2)
C0008976 (UMLS CUI-3)
Recent other investigational or non-registered drug/vaccine
Item
Use of any investigational or non-registered product (drug or vaccine) other than the study vaccines within 30 days preceding the first dose of the study vaccines.
boolean
C0332185 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0013230 (UMLS CUI [1,3])
C0332185 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C1875384 (UMLS CUI [2,3])
Administration of a pneumococcal vaccine not foreseen by the study protocol
Item
Administration of a pneumococcal vaccine not foreseen by the study protocol
boolean
C2368628 (UMLS CUI [1,1])
C1444655 (UMLS CUI [1,2])
C2348563 (UMLS CUI [1,3])
C0358314 (UMLS CUI [1,4])
positive HIV DNA-PCR test during study
Item
A positive HIV DNA-PCR test during the study
boolean
C1294177 (UMLS CUI [1,1])
C1335447 (UMLS CUI [1,2])
C0347984 (UMLS CUI [1,3])
C2347804 (UMLS CUI [1,4])
Administration of immunoglobulins and/or any blood products since birth or administration during the study period
Item
Administration of immunoglobulins and/or any blood products since birth or administration during the study period.
boolean
C0205156 (UMLS CUI [1,1])
C0021027 (UMLS CUI [1,2])
C1533734 (UMLS CUI [1,3])
C0205156 (UMLS CUI [2,1])
C0371802 (UMLS CUI [2,2])
C0021027 (UMLS CUI [3,1])
C1533734 (UMLS CUI [3,2])
C0347984 (UMLS CUI [3,3])
C2347804 (UMLS CUI [3,4])
C0371802 (UMLS CUI [4,1])
C0347984 (UMLS CUI [4,2])
C2347804 (UMLS CUI [4,3])
confirmed or suspected immunosuppressive or immunodeficient condition
Item
Any confirmed or suspected immunosuppressive or immunodeficient condition based on medical history and physical examination.
boolean
C0750484 (UMLS CUI [1,1])
C0021051 (UMLS CUI [1,2])
C0750484 (UMLS CUI [2,1])
C4048329 (UMLS CUI [2,2])
C0242114 (UMLS CUI [3,1])
C0021051 (UMLS CUI [3,2])
C0242114 (UMLS CUI [4,1])
C4048329 (UMLS CUI [4,2])
Item Group
Informed Consent Amendment 1 / 2
C0021430 (UMLS CUI-1)
C0680532 (UMLS CUI-2)
C2348563 (UMLS CUI-3)
Informed Consent Amendment 1/ 2
Item
Has the informed consent following the Amendment 1/ Amendment 2 approval been signed before or the day of this visit, or between the previous performed visit and this visit?
boolean
C0021430 (UMLS CUI [1,1])
C0680532 (UMLS CUI [1,2])
C2348563 (UMLS CUI [1,3])
Date of ICF Amendment signed
Item
Date of ICF Amendment signed
date
C0021430 (UMLS CUI [1,1])
C0680532 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Breastfeeding
C0006147 (UMLS CUI-1)
Breastfeeding continuing?
Item
Is the mother still breastfeeding since last visit?
boolean
C0006147 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Breastfeeding Cessation Date
Item
Breastfeeding Cessation Date
date
C0006147 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
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