ID
41663
Beschreibung
Study ID: 105874 Clinical Study ID: 105874 Study Title: Bridging Safety & Immunogenicity Study of GSK Biologicals' Candidate Malaria Vaccine RTS,S/AS01E (0.5 mL Dose) to RTS,S/AS02D (0.5 mL Dose) Administered IM According to a 0, 1, 2-Month Schedule in Gabonese Children Aged 18 Months to 4 Years Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00307021 https://clinicaltrials.gov/ct2/show/NCT00307021 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: GSK Biologicals' candidate Plasmodium falciparum malaria vaccine 257049 Trade Name: N/A Study Indication: Malaria This study has a total of 7 visits. Visit 1 = Screening, Visits 2-6 are during the double-blind phase (Month 0-3) and Visit 7 is during the single-blind phase (Month 4-14). This form is to be used in case of a Serious Adverse Event (SAE), which is here defined as: A serious adverse event (SAE) is any untoward medical occurrence that: a. results in death, b. is life-threatening, NOTE: The term 'life-threatening' in the definition of 'serious' refers to an event in which the subject was at risk of death at the time of the event. It does not refer to an event, which hypothetically might have caused death, if it were more severe. c. requires hospitalization or prolongation of existing hospitalization, NOTE: In general, hospitalization signifies that the subject has been detained (usually involving at least an overnight stay) at the hospital or emergency ward for observation and/or treatment that would not have been appropriate in the physician’s office or out-patient setting. Complications that occur during hospitalization are AEs. If a complication prolongs hospitalization or fulfils any other serious criteria, the event is serious. When in doubt as to whether “hospitalization” occurred or was necessary, the AE should be considered serious. Hospitalization for elective treatment of a pre-existing condition that did not worsen from baseline is not considered an AE. d. results in disability/incapacity, or NOTE: The term disability means a substantial disruption of a person’s ability to conduct normal life functions. This definition is not intended to include experiences of relatively minor medical significance such as uncomplicated headache, nausea, vomiting, diarrhoea, influenza, and accidental trauma (e.g. sprained ankle) which may interfere or prevent everyday life functions but do not constitute a substantial disruption. e. is a congenital anomaly/birth defect in the offspring of a study subject. f. Medical or scientific judgement should be exercised in deciding whether reporting is appropriate in other situations, such as important medical events that may not be immediately lifethreatening or result in death or hospitalization but may jeopardize the subject or may require medical or surgical intervention to prevent one of the other outcomes listed in the above definition. These should also be considered serious. Examples of such events are invasive or malignant cancers, intensive treatment in an emergency room or at home for allergic bronchospasm, blood dyscrasias or convulsions that do not result in hospitalization. Serious Adverse Events (SAEs) related to study participation (e.g. procedures, invasive tests, change from existing therapy) or SAEs related to GSK concurrent medication will be collected and recorded from the time the subject consents to participate in the study. For all other SAEs, the standard time period for collecting and recording SAEs will begin from the administration of the first dose of vaccine / placebo / comparator and will end minimum 30 days (see protocol) following administration of the last dose of vaccine / placebo / comparator for each subject.
Link
https://clinicaltrials.gov/ct2/show/NCT00307021
Stichworte
Versionen (1)
- 05.12.20 05.12.20 -
Rechteinhaber
GlaxoSmithKline
Hochgeladen am
5. Dezember 2020
DOI
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Lizenz
Creative Commons BY-NC 4.0
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Safety & Immunogenicity of two GSK Biologicals' Candidate Malaria Vaccines in young children, NCT00307021
Serious Adverse Event Report
- StudyEvent: ODM
Beschreibung
SAE
Alias
- UMLS CUI-1
- C1519255
Beschreibung
Diagnosis only (if known), otherwise sign/symptom. A separate form should be used for each SAE however if multiple SAEs which are temporarily or clinically related are apparent at the time of initial reporting then these may be reported on the same page.
Datentyp
text
Alias
- UMLS CUI [1]
- C1519255
Beschreibung
The start date should document the first occurrence of the SAE. This is generally the start date of the signs/symptoms and not necessarily the date that the event met the definition of serious.
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C1519255
Beschreibung
All SAEs must be followed until the events are resolved, the condition stabilises, the events are otherwise explained, or the subject is lost to follow-up. (rest of the paragraph not readable)
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1705586
Beschreibung
If fatal, record date of death Record the date of resolution or the date of death as applicable. (rest of paragraph not readable)
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C1519255
Beschreibung
Record the maximum intensity that occurred over the duration of the event (see protocol for definition of intensity). Amend the intensity if it increases.
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0518690
- UMLS CUI [1,3]
- C0806909
Beschreibung
If administration of the investigational product was stopped permanently and not restarted enter 1-Investigational product(s) withdrawn and enter the date that investigational product was discontinued in section 9. If administration of the investigational product was not modified and all scheduled doses were given enter 2-Dose not changed. If administration of investigational product was temporarily interrupted but then restarted enter 3-Dose Interrupted. If the subject did not receive investigational product dose at the time of the event or if the subject has received all his doses or if the subject died and there was no prior decision to discontinue investigational product enter X-Not applicable.
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1704758
- UMLS CUI [1,2]
- C1519255
Beschreibung
Withdrawal due to SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C2349954
- UMLS CUI [1,2]
- C1519255
Beschreibung
This box is mandatory and has to be completed before faxing the form. It is a regulatory requirement for investigators to assess relationship to investigational product(s) based on information available. (...) Confounding factors, such as concomitant medication, a concurrent illness, or relevant medical history, should also be considered. (Rest of paragraph not readable)
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1519255
Beschreibung
Medically attended visit because of SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
- UMLS CUI [1,3]
- C1519255
Beschreibung
Outcome fatal, autopsy performed
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1302234
- UMLS CUI [1,3]
- C0004398
Beschreibung
Seriousness
Alias
- UMLS CUI-1
- C1710056
Beschreibung
SAE Results in death
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1705232
- UMLS CUI [1,2]
- C1519255
Beschreibung
SAE is life threatening
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1517874
- UMLS CUI [1,2]
- C1519255
Beschreibung
SAE requires or prolongs hospitalization
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C2826664
- UMLS CUI [1,2]
- C1519255
- UMLS CUI [2,1]
- C1519255
- UMLS CUI [2,2]
- C0745041
Beschreibung
Hospitalisation: Date of admission
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0806429
- UMLS CUI [1,2]
- C1519255
Beschreibung
Hospitalisation: Date of discharge
Datentyp
date
Alias
- UMLS CUI [1,1]
- C2710998
- UMLS CUI [1,2]
- C1519255
Beschreibung
SAE results in disability / incapacity
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0231170
Beschreibung
SAE causes Congenital anomaly / birth defect in the offspring
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C0000768
- UMLS CUI [1,2]
- C1519255
Beschreibung
Other Reason for SAE
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C3840932
Beschreibung
Other Reason for SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C3840932
Beschreibung
Demography Data
Alias
- UMLS CUI-1
- C0011298
Beschreibung
Date of birth
Datentyp
date
Alias
- UMLS CUI [1]
- C0421451
Beschreibung
Sex
Datentyp
text
Alias
- UMLS CUI [1]
- C0079399
Beschreibung
Weight
Datentyp
float
Maßeinheiten
- kg
Alias
- UMLS CUI [1]
- C0005910
Beschreibung
Weight
Datentyp
integer
Maßeinheiten
- Pounds
Alias
- UMLS CUI [1]
- C0005910
Beschreibung
Weight
Datentyp
integer
Maßeinheiten
- Ounces
Alias
- UMLS CUI [1]
- C0005910
Beschreibung
Investigational Product
Alias
- UMLS CUI-1
- C0304229
Beschreibung
If deliberate or inadvertent administration of further dose(s) of investigational product(s) to the subject occurred, did the reported adverse event recur?
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0034897
- UMLS CUI [1,3]
- C1517331
- UMLS CUI [1,4]
- C0304229
Beschreibung
Possible causes of SAE
Alias
- UMLS CUI-1
- C3828190
Beschreibung
Possible cause of SAE other than investigational product: Disease under study
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C0012634
- UMLS CUI [1,6]
- C0347984
- UMLS CUI [1,7]
- C0008976
Beschreibung
Possible cause of SAE other than investigational product: Medical condition
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C4745084
Beschreibung
Possible cause of SAE other than investigational product: Lack of efficacy
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C0235828
Beschreibung
Possible cause of SAE other than investigational product: Withdrawal of investigational product
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C2349954
- UMLS CUI [1,6]
- C0304229
Beschreibung
Possible cause of SAE other than investigational product: Concomitant medication
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C2347852
Beschreibung
Possible cause of SAE other than investigational product: Activity related to study participation
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C2348568
Beschreibung
Possible cause of SAE other than investigational product: Other
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C0205394
Beschreibung
Possible cause of SAE other than investigational product: Other
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1705847
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C0205394
Beschreibung
Relevant Medical Conditions
Alias
- UMLS CUI-1
- C0262926
Beschreibung
Give any concomitant medication(s) which may have contributed to the event. There is no need to list medications which are definitely not linked to the event.
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0262926
- UMLS CUI [1,3]
- C1519255
Beschreibung
Date of onset of medical condition
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0574845
Beschreibung
Condition present at time of SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0347984
- UMLS CUI [1,3]
- C1519255
Beschreibung
Date of last occurrence of medical condition
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C2745955
- UMLS CUI [1,4]
- C0011008
Beschreibung
Other relevant risk factors
Alias
- UMLS CUI-1
- C0035648
Beschreibung
Family or social history relevant to SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0241889
- UMLS CUI [1,2]
- C2347946
- UMLS CUI [1,3]
- C1519255
- UMLS CUI [2,1]
- C3714536
- UMLS CUI [2,2]
- C2347946
- UMLS CUI [2,3]
- C1519255
- UMLS CUI [3]
- C1519384
- UMLS CUI [4]
- C0013146
- UMLS CUI [5]
- C0337074
Beschreibung
Relevant Concomitant Medication
Alias
- UMLS CUI-1
- C2347852
Beschreibung
Drug name Concomitant Medication
Datentyp
text
Alias
- UMLS CUI [1,1]
- C2347852
- UMLS CUI [1,2]
- C2360065
Beschreibung
Concomitant Medication Dose
Datentyp
text
Alias
- UMLS CUI [1]
- C2826811
Beschreibung
Concomitant Medication Unit
Datentyp
text
Alias
- UMLS CUI [1]
- C2826646
Beschreibung
Concomitant Medication Frequency
Datentyp
text
Alias
- UMLS CUI [1]
- C2826654
Beschreibung
Concomitant Medication Route
Datentyp
text
Alias
- UMLS CUI [1]
- C2826730
Beschreibung
Concomitant Medication taken prior to study
Datentyp
text
Alias
- UMLS CUI [1]
- C2826667
Beschreibung
Concomitant Medication Date started
Datentyp
date
Alias
- UMLS CUI [1]
- C2826734
Beschreibung
Concomitant Medication Date stopped
Datentyp
date
Alias
- UMLS CUI [1]
- C2826744
Beschreibung
Concomitant Medication Reason for medication
Datentyp
text
Alias
- UMLS CUI [1]
- C2826696
Beschreibung
Details of investigational product(s)
Alias
- UMLS CUI-1
- C0304229
- UMLS CUI-2
- C1522508
Beschreibung
Vaccine should be given as described on the CRF vaccination page (or protocol). In case of multiple vaccinations on the same day, it is important to also mention if the vaccines were administered mixed or separetely.
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0042210
- UMLS CUI [1,2]
- C2360065
Beschreibung
Vaccine Dose Number
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0042210
- UMLS CUI [1,2]
- C1115464
Beschreibung
Vaccine Lot Number
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0042210
- UMLS CUI [1,2]
- C1115660
Beschreibung
Vaccine Route / site
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0013153
- UMLS CUI [1,2]
- C0042210
- UMLS CUI [2,1]
- C1515974
- UMLS CUI [2,2]
- C0042210
Beschreibung
Vaccine Date of administration
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C2368628
Beschreibung
Treatment blind broken at investigational site
Datentyp
text
Alias
- UMLS CUI [1]
- C3897431
Beschreibung
Details of relevant assessments
Alias
- UMLS CUI-1
- C1261322
- UMLS CUI-2
- C1519255
Beschreibung
Details of tests/procedures to diagnose/confirm SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C1519255
- UMLS CUI [2,1]
- C0011900
- UMLS CUI [2,2]
- C1519255
Beschreibung
Narrative remarks
Alias
- UMLS CUI-1
- C0947611
Beschreibung
Narrative remarks: description of signs/symptoms and details of TREATMENT given for SAE
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0037088
- UMLS CUI [2,1]
- C1519255
- UMLS CUI [2,2]
- C2981656
Beschreibung
SAE additional / Follow-up information
Alias
- UMLS CUI-1
- C1524062
- UMLS CUI-2
- C1533716
- UMLS CUI-3
- C1519255
- UMLS CUI-4
- C1522577
Beschreibung
SAE additional / follow-up information
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1524062
- UMLS CUI [1,2]
- C1533716
- UMLS CUI [1,3]
- C1519255
- UMLS CUI [2,1]
- C1522577
- UMLS CUI [2,2]
- C1533716
- UMLS CUI [2,3]
- C1519255
Beschreibung
Investigator's signature
Alias
- UMLS CUI-1
- C2346576
Beschreibung
Report Type
Datentyp
integer
Alias
- UMLS CUI [1]
- C0585733
Beschreibung
Investigator's signature
Datentyp
text
Alias
- UMLS CUI [1]
- C2346576
Beschreibung
Date of signature
Datentyp
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Beschreibung
Investigator's name
Datentyp
text
Alias
- UMLS CUI [1]
- C2826892
Ähnliche Modelle
Serious Adverse Event Report
- StudyEvent: ODM
C0019994 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,2])
C2985846 (UMLS CUI [1,2])
C2347796 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,2])
C0806909 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0085978 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1386497 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1302234 (UMLS CUI [1,2])
C0004398 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [2,1])
C0745041 (UMLS CUI [2,2])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0231170 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C3840932 (UMLS CUI [1,2])
C3840932 (UMLS CUI [1,2])
C0034897 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C0012634 (UMLS CUI [1,5])
C0347984 (UMLS CUI [1,6])
C0008976 (UMLS CUI [1,7])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C4745084 (UMLS CUI [1,5])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C0235828 (UMLS CUI [1,5])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C2349954 (UMLS CUI [1,5])
C0304229 (UMLS CUI [1,6])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C2347852 (UMLS CUI [1,5])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C2348568 (UMLS CUI [1,5])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
C0085978 (UMLS CUI [1,2])
C1705847 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C0205394 (UMLS CUI [1,5])
C0262926 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C0574845 (UMLS CUI [1,2])
C0347984 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1517741 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
C2347946 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C3714536 (UMLS CUI [2,1])
C2347946 (UMLS CUI [2,2])
C1519255 (UMLS CUI [2,3])
C1519384 (UMLS CUI [3])
C0013146 (UMLS CUI [4])
C0337074 (UMLS CUI [5])
C2360065 (UMLS CUI [1,2])
C1522508 (UMLS CUI-2)
C2360065 (UMLS CUI [1,2])
C1115464 (UMLS CUI [1,2])
C1115660 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,2])
C1515974 (UMLS CUI [2,1])
C0042210 (UMLS CUI [2,2])
C2368628 (UMLS CUI [1,2])
C1519255 (UMLS CUI-2)
C1519255 (UMLS CUI [1,2])
C0011900 (UMLS CUI [2,1])
C1519255 (UMLS CUI [2,2])
C0037088 (UMLS CUI [1,2])
C1519255 (UMLS CUI [2,1])
C2981656 (UMLS CUI [2,2])
C1533716 (UMLS CUI-2)
C1519255 (UMLS CUI-3)
C1522577 (UMLS CUI-4)
C1533716 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1522577 (UMLS CUI [2,1])
C1533716 (UMLS CUI [2,2])
C1519255 (UMLS CUI [2,3])
C0011008 (UMLS CUI [1,2])