ID
41663
Descrição
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
Palavras-chave
Versões (1)
- 05/12/2020 05/12/2020 -
Titular dos direitos
GlaxoSmithKline
Transferido a
5 de dezembro de 2020
DOI
Para um pedido faça login.
Licença
Creative Commons BY-NC 4.0
Comentários do modelo :
Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.
Comentários do grupo de itens para :
Comentários do item para :
Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.
Safety & Immunogenicity of two GSK Biologicals' Candidate Malaria Vaccines in young children, NCT00307021
Serious Adverse Event Report
- StudyEvent: ODM
Descrição
SAE
Alias
- UMLS CUI-1
- C1519255
Descrição
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.
Tipo de dados
text
Alias
- UMLS CUI [1]
- C1519255
Descrição
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.
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C1519255
Descrição
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)
Tipo de dados
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1705586
Descrição
If fatal, record date of death Record the date of resolution or the date of death as applicable. (rest of paragraph not readable)
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C1519255
Descrição
Record the maximum intensity that occurred over the duration of the event (see protocol for definition of intensity). Amend the intensity if it increases.
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0518690
- UMLS CUI [1,3]
- C0806909
Descrição
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.
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C1704758
- UMLS CUI [1,2]
- C1519255
Descrição
Withdrawal due to SAE
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C2349954
- UMLS CUI [1,2]
- C1519255
Descrição
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)
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1519255
Descrição
Medically attended visit because of SAE
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0545082
- UMLS CUI [1,2]
- C1386497
- UMLS CUI [1,3]
- C1519255
Descrição
Outcome fatal, autopsy performed
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1302234
- UMLS CUI [1,3]
- C0004398
Descrição
Seriousness
Alias
- UMLS CUI-1
- C1710056
Descrição
SAE Results in death
Tipo de dados
boolean
Alias
- UMLS CUI [1,1]
- C1705232
- UMLS CUI [1,2]
- C1519255
Descrição
SAE is life threatening
Tipo de dados
boolean
Alias
- UMLS CUI [1,1]
- C1517874
- UMLS CUI [1,2]
- C1519255
Descrição
SAE requires or prolongs hospitalization
Tipo de dados
boolean
Alias
- UMLS CUI [1,1]
- C2826664
- UMLS CUI [1,2]
- C1519255
- UMLS CUI [2,1]
- C1519255
- UMLS CUI [2,2]
- C0745041
Descrição
Hospitalisation: Date of admission
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C0806429
- UMLS CUI [1,2]
- C1519255
Descrição
Hospitalisation: Date of discharge
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C2710998
- UMLS CUI [1,2]
- C1519255
Descrição
SAE results in disability / incapacity
Tipo de dados
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0231170
Descrição
SAE causes Congenital anomaly / birth defect in the offspring
Tipo de dados
boolean
Alias
- UMLS CUI [1,1]
- C0000768
- UMLS CUI [1,2]
- C1519255
Descrição
Other Reason for SAE
Tipo de dados
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C3840932
Descrição
Other Reason for SAE
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C3840932
Descrição
Demography Data
Alias
- UMLS CUI-1
- C0011298
Descrição
Date of birth
Tipo de dados
date
Alias
- UMLS CUI [1]
- C0421451
Descrição
Sex
Tipo de dados
text
Alias
- UMLS CUI [1]
- C0079399
Descrição
Weight
Tipo de dados
float
Unidades de medida
- kg
Alias
- UMLS CUI [1]
- C0005910
Descrição
Weight
Tipo de dados
integer
Unidades de medida
- Pounds
Alias
- UMLS CUI [1]
- C0005910
Descrição
Weight
Tipo de dados
integer
Unidades de medida
- Ounces
Alias
- UMLS CUI [1]
- C0005910
Descrição
Investigational Product
Alias
- UMLS CUI-1
- C0304229
Descrição
If deliberate or inadvertent administration of further dose(s) of investigational product(s) to the subject occurred, did the reported adverse event recur?
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0034897
- UMLS CUI [1,3]
- C1517331
- UMLS CUI [1,4]
- C0304229
Descrição
Possible causes of SAE
Alias
- UMLS CUI-1
- C3828190
Descrição
Possible cause of SAE other than investigational product: Disease under study
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Medical condition
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Lack of efficacy
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Withdrawal of investigational product
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Concomitant medication
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Activity related to study participation
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Other
Tipo de dados
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
Descrição
Possible cause of SAE other than investigational product: Other
Tipo de dados
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
Descrição
Relevant Medical Conditions
Alias
- UMLS CUI-1
- C0262926
Descrição
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.
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0262926
- UMLS CUI [1,3]
- C1519255
Descrição
Date of onset of medical condition
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0574845
Descrição
Condition present at time of SAE
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0347984
- UMLS CUI [1,3]
- C1519255
Descrição
Date of last occurrence of medical condition
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C2745955
- UMLS CUI [1,4]
- C0011008
Descrição
Other relevant risk factors
Alias
- UMLS CUI-1
- C0035648
Descrição
Family or social history relevant to SAE
Tipo de dados
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
Descrição
Relevant Concomitant Medication
Alias
- UMLS CUI-1
- C2347852
Descrição
Drug name Concomitant Medication
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C2347852
- UMLS CUI [1,2]
- C2360065
Descrição
Concomitant Medication Dose
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826811
Descrição
Concomitant Medication Unit
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826646
Descrição
Concomitant Medication Frequency
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826654
Descrição
Concomitant Medication Route
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826730
Descrição
Concomitant Medication taken prior to study
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826667
Descrição
Concomitant Medication Date started
Tipo de dados
date
Alias
- UMLS CUI [1]
- C2826734
Descrição
Concomitant Medication Date stopped
Tipo de dados
date
Alias
- UMLS CUI [1]
- C2826744
Descrição
Concomitant Medication Reason for medication
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826696
Descrição
Details of investigational product(s)
Alias
- UMLS CUI-1
- C0304229
- UMLS CUI-2
- C1522508
Descrição
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.
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0042210
- UMLS CUI [1,2]
- C2360065
Descrição
Vaccine Dose Number
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0042210
- UMLS CUI [1,2]
- C1115464
Descrição
Vaccine Lot Number
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0042210
- UMLS CUI [1,2]
- C1115660
Descrição
Vaccine Route / site
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0013153
- UMLS CUI [1,2]
- C0042210
- UMLS CUI [2,1]
- C1515974
- UMLS CUI [2,2]
- C0042210
Descrição
Vaccine Date of administration
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C2368628
Descrição
Treatment blind broken at investigational site
Tipo de dados
text
Alias
- UMLS CUI [1]
- C3897431
Descrição
Details of relevant assessments
Alias
- UMLS CUI-1
- C1261322
- UMLS CUI-2
- C1519255
Descrição
Details of tests/procedures to diagnose/confirm SAE
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C1519255
- UMLS CUI [2,1]
- C0011900
- UMLS CUI [2,2]
- C1519255
Descrição
Narrative remarks
Alias
- UMLS CUI-1
- C0947611
Descrição
Narrative remarks: description of signs/symptoms and details of TREATMENT given for SAE
Tipo de dados
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0037088
- UMLS CUI [2,1]
- C1519255
- UMLS CUI [2,2]
- C2981656
Descrição
SAE additional / Follow-up information
Alias
- UMLS CUI-1
- C1524062
- UMLS CUI-2
- C1533716
- UMLS CUI-3
- C1519255
- UMLS CUI-4
- C1522577
Descrição
SAE additional / follow-up information
Tipo de dados
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
Descrição
Investigator's signature
Alias
- UMLS CUI-1
- C2346576
Descrição
Report Type
Tipo de dados
integer
Alias
- UMLS CUI [1]
- C0585733
Descrição
Investigator's signature
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2346576
Descrição
Date of signature
Tipo de dados
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Descrição
Investigator's name
Tipo de dados
text
Alias
- UMLS CUI [1]
- C2826892
Similar models
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])