ID

42522

Beskrivning

Study ID: 106464 Clinical Study ID: 106464 Study Title: A Study of the Efficacy Against Episodes of Clinical Malaria Due to P. Falciparum Infection of GSK Biologicals Candidate Vaccine RTS, S/AS01, Administered According to a 0,1,2-months Schedule in Children Aged 5 to 17 Months Living in Tanzania & Kenya Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00380393 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: GSK malaria vaccine 257049 Vaccine, Sanofi-Pasteur's Human Diploid Cell Rabies Vaccine Trade Name: N/A Study Indication: Malaria ODM derived from https://clinicaltrials.gov/ct2/show/study/NCT00380393. This Phase IIb randomized, double-blind, controlled study of the efficacy against episodes of clinical malaria due to Plasmodium falciparum infection of GlaxoSmithKline Biologicals’ candidate vaccine RTS, S/AS01E, administered IM according to a 0, 1, 2-month vaccination schedule in children aged 5 months to 17 months living in Tanzania and Kenya. This study includes the following 7 clinical study visits (3 different visit types) during a double-blind phase (Day -60 to Month 6 1/2) and a single-blind phase including an extension for a subset of patients (month 7 to month 14). Clinical visit 1: Baseline visit, screening, and randomisation (DAY -60 to 0) Clinical visit 2: Vaccination I (MONTH 0, DAY 0 | DOSE 1 | 0 - 60 DAYS AFTER VISIT 1) Clinical visit 3: Vaccination II (MONTH 1, DAY 30 | DOSE 2 | 21 - 35 DAYS AFTER VISIT 2) Clinical visit 4: Vaccination III (MONTH 2, DAY 60 | DOSE 3 | 21 - 35 DAYS AFTER VISIT 3) Clinical visit 5: Blood Sample, ACD (MONTH 3, DAY 90 | 21 - 42 DAYS AFTER VISIT 4) Clinical visit 6: Blood Sample, ACD (MONTH 6 1/2 | CROSS-SECTIONAL VISIT FOR ACD | FINAL STUDY VISIT FOR DOUBLE-BLIND PHASE) Clinical visit 7: Blood Sample, ACD (MONTH 14 | FINAL STUDY VISIT SINGLE-BLIND PHASE) Field-worker home visits: During the vaccination period, clinical visits are accompanied by daily field-worker visits for a one-week period subsequent to each vaccine administration at clinical visits 2, 3, and 4 (visit code 21-26 following clinical visit 2; visit code 27-32 following clinical visit 3; visit code 33-38 following clinical visit 4). After completion of the vaccination period, clinical visits are then accompanied by weekly field-worker home visits (visit code 39-40 following clinical visit 4/dose 3; visit code 41-55 following clinical visit 5; visit code 56-86 following clinical visit 6). These visits serve the additional purpose of Active Case Detection (ACD). Passive Case Detection (PCD) for clinical malaria disease is performed both during the course of the double-blind (day -60 to month 6 1/2) and the single-blind phase (month 7 to month 14). Definition of Serious Adverse Events (SAE): A serious adverse event (SAE) is any untoward medical occurrence that (a) results in death, (b) is life-threatening, (c) requires hospitalization or prolongation of existing hospitalization, (d) results in disability/incapacity, or (e) is a congenital anomaly/birth defect in the offspring of a study subject. Also see item descriptions for additional specification. Instructions for reporting Serious Adverse Events (SAE): Please report any serious adverse event (SAE) as specified in the study protocol by filling in this form. Serious Adverse Events (SAEs) related to study participation (e.g. procedures, invasive tests, change from existing therapy) or SAEs related to 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 (ref to protocol) following administration of the last dose of vaccine / placebo / comparator for each subject. (1) Complete this form for each Serious Adverse Event as fully and accurately as possible in order to allow the safety department to make an assessment of the initially reported information and to minimize the time spent dealing with data queries. Ensure that all information on the SAE pages is consistent with information given on CRF pages: * Demography * General Medical History / Physical Examination * Vaccine administration page(s) (for administered doses) * Medication * Concomitant Vaccination (2) Sign and date below section 11 and section 12. Complete section 12 of the SAE form if needed only. (3) Send the SAE form to: * The GSK Biologicals study contact. Refer to protocol for contact name and number. * In the event of a death determined by the investigator to be related to the vaccination, sending of the fax must be accompanied by phone call to the study contact for reporting SAEs. The SAE form must be sent to GlaxoSmithKline within 24 hours of becoming aware of these events. (4) The Serious Adverse Event (SAE) report must be checked for final assessment at the end of the study. Note that informed consent has to be obtained prior to any study procedure.

Länk

https://clinicaltrials.gov/ct2/show/study/NCT00380393

Nyckelord

  1. 2021-08-17 2021-08-17 -
  2. 2021-08-17 2021-08-17 -
Rättsinnehavare

GlaxoSmithKline

Uppladdad den

17 augusti 2021

DOI

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Licens

Creative Commons BY-NC 4.0

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Efficacy of P. Falciparum Vaccine Against Malaria in Children NCT00380393

Serious Adverse Event Report

Administrative
Beskrivning

Administrative

Alias
UMLS CUI-1
C1320722
Subject number
Beskrivning

Subject number

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Country
Beskrivning

Country

Datatyp

text

Alias
UMLS CUI [1]
C0454664
Hospital identifier
Beskrivning

Hospital identifier

Datatyp

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Randomisation Number
Beskrivning

Randomisation Number

Datatyp

integer

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0237753
Serious Adverse Events
Beskrivning

Serious Adverse Events

Alias
UMLS CUI-1
C1519255
SAE Report Number
Beskrivning

SAE Report Number

Datatyp

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0684224
UMLS CUI [1,3]
C0237753
Receipt date clinical study sponsor
Beskrivning

Receipt date clinical study sponsor

Datatyp

date

Alias
UMLS CUI [1,1]
C2985846
UMLS CUI [1,2]
C2347796
SAE report initial
Beskrivning

SAE report initial

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0684224
UMLS CUI [1,3]
C0205265
SAE follow-up report
Beskrivning

SAE follow-up report

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C1704685
SAE follow-up report
Beskrivning

SAE follow-up report

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C1704685
SAE follow-up report
Beskrivning

SAE follow-up report

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C1704685
Document section
Beskrivning

Document section

Alias
UMLS CUI-1
C1828479
Serious adverse event
Beskrivning

Serious adverse event

Datatyp

text

Alias
UMLS CUI [1]
C1519255
Serious adverse event start date
Beskrivning

Serious adverse event start date

Datatyp

date

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0808070
Serious adverse event outcome
Beskrivning

Serious adverse event outcome

Datatyp

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C1705586
Serious adverse event end date
Beskrivning

Serious adverse event end date

Datatyp

date

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0806020
Serious adverse event maximum symptom intensity
Beskrivning

Serious adverse event maximum symptom intensity

Datatyp

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0518690
UMLS CUI [1,3]
C0806909
Action taken SAE
Beskrivning

Action taken SAE

Datatyp

text

Alias
UMLS CUI [1,1]
C2826626
UMLS CUI [1,2]
C1519255
Patient withdrawn from trial due to SAE
Beskrivning

Patient withdrawn from trial due to SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C1519255
SAE investigational new drugs relationships
Beskrivning

SAE investigational new drugs relationships

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0013230
UMLS CUI [1,3]
C0439849
Medically attended visit due to SAE
Beskrivning

Medically attended visit due to SAE

Datatyp

text

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C1519255
SAE autopsy
Beskrivning

SAE autopsy

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0004398
UMLS CUI [1,2]
C1519255
Document Section SAE
Beskrivning

Document Section SAE

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C1519255
SAE death
Beskrivning

SAE death

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0011065
SAE life-threatening
Beskrivning

SAE life-threatening

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826244
SAE hospitalisation | prolonged hospitalisation
Beskrivning

SAE hospitalisation | prolonged hospitalisation

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0019993
UMLS CUI [2,1]
C1519255
UMLS CUI [2,2]
C0745041
SAE admission date
Beskrivning

SAE admission date

Datatyp

date

Alias
UMLS CUI [1,1]
C1302393
UMLS CUI [1,2]
C1519255
SAE discharge date
Beskrivning

SAE discharge date

Datatyp

date

Alias
UMLS CUI [1,1]
C2361123
UMLS CUI [1,2]
C1519255
SAE disability
Beskrivning

SAE disability

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0231170
SAE congenital anomaly
Beskrivning

SAE congenital anomaly

Datatyp

boolean

Alias
UMLS CUI [1]
C2826727
Other SAE seriousness
Beskrivning

Other SAE seriousness

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1710056
UMLS CUI [1,2]
C0205394
Other SAE seriousness to specify
Beskrivning

Other SAE seriousness to specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C1710056
UMLS CUI [1,3]
C1521902
Document Section Demography Data
Beskrivning

Document Section Demography Data

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C0011298
Date of birth
Beskrivning

Date of birth

Datatyp

date

Alias
UMLS CUI [1]
C0421451
Gender
Beskrivning

Gender

Datatyp

text

Alias
UMLS CUI [1]
C0079399
Body weight
Beskrivning

Body weight

Datatyp

float

Måttenheter
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Body Weight
Beskrivning

Body Weight

Datatyp

integer

Måttenheter
  • Pounds
Alias
UMLS CUI [1]
C0005910
Pounds
Body Weight
Beskrivning

Body Weight

Datatyp

integer

Måttenheter
  • Ounces
Alias
UMLS CUI [1]
C0005910
Ounces
Document section SAE recurrence
Beskrivning

Document section SAE recurrence

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C1519255
UMLS CUI-3
C0034897
Serious adverse event recurrence post re-exposition to experimental drug
Beskrivning

Serious adverse event recurrence post re-exposition to experimental drug

Datatyp

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0034897
UMLS CUI [1,3]
C2347900
UMLS CUI [1,4]
C0304229
Document Section SAE Causations
Beskrivning

Document Section SAE Causations

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C1519255
UMLS CUI-3
C0085978
Disease during clinical trial SAE
Beskrivning

Disease during clinical trial SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0008976
UMLS CUI [1,4]
C1519255
Disease medical history SAE
Beskrivning

Disease medical history SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0262926
UMLS CUI [1,3]
C1519255
Lack of efficacy SAE
Beskrivning

Lack of efficacy SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0235828
UMLS CUI [1,2]
C1519255
Withdrawal of investigational drug SAE
Beskrivning

Withdrawal of investigational drug SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0304229
UMLS CUI [1,3]
C1519255
Pharmaceutical preparations SAE
Beskrivning

Pharmaceutical preparations SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1519255
Study subject participation status SAE | Medical procedure study protocol SAE
Beskrivning

Study subject participation status SAE | Medical procedure study protocol SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2348568
UMLS CUI [1,2]
C1519255
UMLS CUI [2,1]
C0199171
UMLS CUI [2,2]
C2348563
UMLS CUI [2,3]
C1519255
Other SAE causation
Beskrivning

Other SAE causation

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C1519255
UMLS CUI [1,3]
C0085978
Other SAE seriousness causation to specify
Beskrivning

Other SAE seriousness causation to specify

Datatyp

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C1519255
UMLS CUI [1,3]
C0085978
UMLS CUI [1,4]
C1521902
Document Section Medical Conditions
Beskrivning

Document Section Medical Conditions

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C0012634
Relevant disease, hypersensitivity, or operative surgical procedure for SAE
Beskrivning

Relevant disease, hypersensitivity, or operative surgical procedure for SAE

Datatyp

text

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C2347946
UMLS CUI [1,3]
C1519255
UMLS CUI [2,1]
C0020517
UMLS CUI [2,2]
C2347946
UMLS CUI [2,3]
C1519255
UMLS CUI [3,1]
C0543467
UMLS CUI [3,2]
C2347946
UMLS CUI [3,3]
C1519255
Date of onset relevant disease | hypersensitivity | operative surgical procedure
Beskrivning

Date of onset relevant disease | hypersensitivity | operative surgical procedure

Datatyp

date

Alias
UMLS CUI [1,1]
C0574845
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C2347946
UMLS CUI [1,4]
C1519255
UMLS CUI [2,1]
C0574845
UMLS CUI [2,2]
C0020517
UMLS CUI [2,3]
C2347946
UMLS CUI [2,4]
C1519255
UMLS CUI [3,1]
C0574845
UMLS CUI [3,2]
C0543467
UMLS CUI [3,3]
C2347946
UMLS CUI [3,4]
C1519255
Disease present SAE
Beskrivning

Disease present SAE

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0150312
UMLS CUI [1,3]
C1519255
Date of last occurrence disease SAE
Beskrivning

Date of last occurrence disease SAE

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C2745955
UMLS CUI [1,4]
C0012634
UMLS CUI [1,5]
C1519255
Document Section Risk Factors
Beskrivning

Document Section Risk Factors

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C0035648
Risk factors SAE in family or social history (smoking, diet, drug abuse, occupational hazard)
Beskrivning

Risk factors SAE in family or social history (smoking, diet, drug abuse, occupational hazard)

Datatyp

text

Alias
UMLS CUI [1,1]
C0035648
UMLS CUI [1,2]
C1519255
UMLS CUI [1,3]
C0241889
UMLS CUI [2,1]
C0035648
UMLS CUI [2,2]
C1519255
UMLS CUI [2,3]
C3714536
UMLS CUI [3]
C1519384
UMLS CUI [4]
C0001948
UMLS CUI [5]
C0012155
UMLS CUI [6]
C0013146
UMLS CUI [7]
C0337074
Document Section Pharmaceutical Preparations
Beskrivning

Document Section Pharmaceutical Preparations

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C0013227
Pharmaceutical preparations medication name
Beskrivning

Pharmaceutical preparations medication name

Datatyp

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2360065
Dose
Beskrivning

Dose

Datatyp

integer

Alias
UMLS CUI [1]
C3174092
Unit of medication dose
Beskrivning

Unit of medication dose

Datatyp

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C3174092
Frequency
Beskrivning

Frequency

Datatyp

text

Alias
UMLS CUI [1]
C3476109
Route
Beskrivning

Route

Datatyp

text

Alias
UMLS CUI [1]
C0013153
Concomitant medication previous occurrence
Beskrivning

Concomitant medication previous occurrence

Datatyp

boolean

Alias
UMLS CUI [1]
C2826667
Start date pharmaceutical preparations
Beskrivning

Start date pharmaceutical preparations

Datatyp

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C0013227
Stop date pharmaceutical preparations
Beskrivning

Stop date pharmaceutical preparations

Datatyp

date

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C0013227
Pharmaceutical preparations continuous
Beskrivning

Pharmaceutical preparations continuous

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0549178
Indication pharmaceutical preparations
Beskrivning

Indication pharmaceutical preparations

Datatyp

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0013227
Document Section Investigational Drug Details
Beskrivning

Document Section Investigational Drug Details

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C0013230
UMLS CUI-3
C1522508
Vaccines medication name
Beskrivning

Vaccines medication name

Datatyp

text

Alias
UMLS CUI [1,1]
C0042210
UMLS CUI [1,2]
C2360065
Dose number vaccines
Beskrivning

Dose number vaccines

Datatyp

integer

Alias
UMLS CUI [1,1]
C1115464
UMLS CUI [1,2]
C0042210
Lot number vaccines
Beskrivning

Lot number vaccines

Datatyp

text

Alias
UMLS CUI [1,1]
C1115660
UMLS CUI [1,2]
C0042210
Administration of vaccine route | anatomic site
Beskrivning

Administration of vaccine route | anatomic site

Datatyp

text

Alias
UMLS CUI [1,1]
C2368628
UMLS CUI [1,2]
C0013153
UMLS CUI [2,1]
C2368628
UMLS CUI [2,2]
C1515974
Date of vaccine administration
Beskrivning

Date of vaccine administration

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C2368628
Subject unblinding event record
Beskrivning

Subject unblinding event record

Datatyp

text

Alias
UMLS CUI [1]
C3897431
Document Section Evaluation Procedures
Beskrivning

Document Section Evaluation Procedures

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C1261322
Assessments
Beskrivning

Assessments

Datatyp

text

Alias
UMLS CUI [1,1]
C1261322
UMLS CUI [1,2]
C1519255
Document Section Narrative Remarks
Beskrivning

Document Section Narrative Remarks

Alias
UMLS CUI-1
C1828479
UMLS CUI-2
C0947611
Comment SAE | signs and symptoms and treatment of SAE
Beskrivning

Comment SAE | signs and symptoms and treatment of SAE

Datatyp

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C1519255
UMLS CUI [2,1]
C0037088
UMLS CUI [2,2]
C1519255
UMLS CUI [2,3]
C0678257
UMLS CUI [3]
C2981656
Investigator's Signature
Beskrivning

Investigator's Signature

Alias
UMLS CUI-1
C2346576
SAE report type
Beskrivning

SAE report type

Datatyp

integer

Alias
UMLS CUI [1,1]
C3897642
UMLS CUI [1,2]
C0332307
Investigator signature
Beskrivning

Investigator signature

Datatyp

text

Alias
UMLS CUI [1]
C2346576
Date of investigator signature
Beskrivning

Date of investigator signature

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C2346576
Investigator name
Beskrivning

Investigator name

Datatyp

text

Alias
UMLS CUI [1]
C2826892
Type of report
Beskrivning

Type of report

Datatyp

integer

Alias
UMLS CUI [1,2]
C0332307
UMLS CUI [1,1]
C3897642
Document Section SAE follow-up information
Beskrivning

Document Section SAE follow-up information

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C1533716
UMLS CUI-3
C1522577
Additional information SAE follow-up
Beskrivning

Additional information SAE follow-up

Datatyp

text

Alias
UMLS CUI [1,1]
C1524062
UMLS CUI [1,2]
C1533716
UMLS CUI [1,3]
C1519255
UMLS CUI [1,4]
C1522577
Investigator's Signature
Beskrivning

Investigator's Signature

Alias
UMLS CUI-1
C2346576
SAE report type
Beskrivning

SAE report type

Datatyp

integer

Alias
UMLS CUI [1,1]
C3897642
UMLS CUI [1,2]
C0332307
Investigator signature
Beskrivning

Investigator signature

Datatyp

text

Alias
UMLS CUI [1]
C2346576
Date of investigator signature
Beskrivning

Date of investigator signature

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C2346576
Investigator name
Beskrivning

Investigator name

Datatyp

text

Alias
UMLS CUI [1]
C2826892

Similar models

Serious Adverse Event Report

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
C1320722 (UMLS CUI-1)
Subject number
Item
integer
C2348585 (UMLS CUI [1])
Country
Item
text
C0454664 (UMLS CUI [1])
Hospital identifier
Item
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Randomisation Number
Item
integer
C0034656 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item Group
C1519255 (UMLS CUI-1)
SAE Report Number
Item
integer
C1519255 (UMLS CUI [1,1])
C0684224 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,3])
Receipt date clinical study sponsor
Item
date
C2985846 (UMLS CUI [1,1])
C2347796 (UMLS CUI [1,2])
SAE report initial
Item
boolean
C1519255 (UMLS CUI [1,1])
C0684224 (UMLS CUI [1,2])
C0205265 (UMLS CUI [1,3])
SAE follow-up report
Item
boolean
C1519255 (UMLS CUI [1,1])
C1704685 (UMLS CUI [1,2])
SAE follow-up report
Item
boolean
C1519255 (UMLS CUI [1,1])
C1704685 (UMLS CUI [1,2])
SAE follow-up report
Item
boolean
C1519255 (UMLS CUI [1,1])
C1704685 (UMLS CUI [1,2])
Item Group
C1828479 (UMLS CUI-1)
Serious adverse event
Item
text
C1519255 (UMLS CUI [1])
Serious adverse event start date
Item
date
C1519255 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Item
integer
C1519255 (UMLS CUI [1,1])
C1705586 (UMLS CUI [1,2])
Code List
Serious adverse event outcome
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
CL Item
 (5)
Serious adverse event end date
Item
date
C1519255 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
text
C1519255 (UMLS CUI [1,1])
C0518690 (UMLS CUI [1,2])
C0806909 (UMLS CUI [1,3])
Code List
Serious adverse event maximum symptom intensity
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (X)
Item
text
C2826626 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Code List
Action taken SAE
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (X)
Patient withdrawn from trial due to SAE
Item
boolean
C0422727 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
SAE investigational new drugs relationships
Item
boolean
C1519255 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
Item
text
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
Code List
Medically attended visit due to SAE
CL Item
 (HO)
CL Item
 (ER)
CL Item
 (MD)
SAE autopsy
Item
boolean
C0004398 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
C1828479 (UMLS CUI-1)
C1519255 (UMLS CUI-2)
SAE death
Item
boolean
C1519255 (UMLS CUI [1,1])
C0011065 (UMLS CUI [1,2])
SAE life-threatening
Item
boolean
C1519255 (UMLS CUI [1,1])
C2826244 (UMLS CUI [1,2])
SAE hospitalisation | prolonged hospitalisation
Item
boolean
C1519255 (UMLS CUI [1,1])
C0019993 (UMLS CUI [1,2])
C1519255 (UMLS CUI [2,1])
C0745041 (UMLS CUI [2,2])
SAE admission date
Item
date
C1302393 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
SAE discharge date
Item
date
C2361123 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
SAE disability
Item
boolean
C1519255 (UMLS CUI [1,1])
C0231170 (UMLS CUI [1,2])
SAE congenital anomaly
Item
boolean
C2826727 (UMLS CUI [1])
Other SAE seriousness
Item
boolean
C1710056 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Other SAE seriousness to specify
Item
text
C0205394 (UMLS CUI [1,1])
C1710056 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item Group
C1828479 (UMLS CUI-1)
C0011298 (UMLS CUI-2)
Date of birth
Item
date
C0421451 (UMLS CUI [1])
Item
text
C0079399 (UMLS CUI [1])
Code List
Gender
CL Item
 (Male)
CL Item
 (Female)
Body weight
Item
float
C0005910 (UMLS CUI [1])
Body Weight
Item
integer
C0005910 (UMLS CUI [1])
Body Weight
Item
integer
C0005910 (UMLS CUI [1])
Item Group
C1828479 (UMLS CUI-1)
C1519255 (UMLS CUI-2)
C0034897 (UMLS CUI-3)
Item
text
C1519255 (UMLS CUI [1,1])
C0034897 (UMLS CUI [1,2])
C2347900 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
Code List
Serious adverse event recurrence post re-exposition to experimental drug
CL Item
 (Yes)
CL Item
 (No)
CL Item
 (Unknown at this time)
CL Item
 (Not applicable)
Item Group
C1828479 (UMLS CUI-1)
C1519255 (UMLS CUI-2)
C0085978 (UMLS CUI-3)
Disease during clinical trial SAE
Item
boolean
C0012634 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,4])
Disease medical history SAE
Item
boolean
C0012634 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
Lack of efficacy SAE
Item
boolean
C0235828 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Withdrawal of investigational drug SAE
Item
boolean
C2349954 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
Pharmaceutical preparations SAE
Item
boolean
C0013227 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Study subject participation status SAE | Medical procedure study protocol SAE
Item
boolean
C2348568 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0199171 (UMLS CUI [2,1])
C2348563 (UMLS CUI [2,2])
C1519255 (UMLS CUI [2,3])
Other SAE causation
Item
boolean
C0205394 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0085978 (UMLS CUI [1,3])
Other SAE seriousness causation to specify
Item
text
C0205394 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0085978 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])
Item Group
C1828479 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
Relevant disease, hypersensitivity, or operative surgical procedure for SAE
Item
text
C0012634 (UMLS CUI [1,1])
C2347946 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C0020517 (UMLS CUI [2,1])
C2347946 (UMLS CUI [2,2])
C1519255 (UMLS CUI [2,3])
C0543467 (UMLS CUI [3,1])
C2347946 (UMLS CUI [3,2])
C1519255 (UMLS CUI [3,3])
Date of onset relevant disease | hypersensitivity | operative surgical procedure
Item
date
C0574845 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C2347946 (UMLS CUI [1,3])
C1519255 (UMLS CUI [1,4])
C0574845 (UMLS CUI [2,1])
C0020517 (UMLS CUI [2,2])
C2347946 (UMLS CUI [2,3])
C1519255 (UMLS CUI [2,4])
C0574845 (UMLS CUI [3,1])
C0543467 (UMLS CUI [3,2])
C2347946 (UMLS CUI [3,3])
C1519255 (UMLS CUI [3,4])
Disease present SAE
Item
boolean
C0012634 (UMLS CUI [1,1])
C0150312 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
Date of last occurrence disease SAE
Item
date
C0011008 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0012634 (UMLS CUI [1,4])
C1519255 (UMLS CUI [1,5])
Item Group
C1828479 (UMLS CUI-1)
C0035648 (UMLS CUI-2)
Risk factors SAE in family or social history (smoking, diet, drug abuse, occupational hazard)
Item
text
C0035648 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0241889 (UMLS CUI [1,3])
C0035648 (UMLS CUI [2,1])
C1519255 (UMLS CUI [2,2])
C3714536 (UMLS CUI [2,3])
C1519384 (UMLS CUI [3])
C0001948 (UMLS CUI [4])
C0012155 (UMLS CUI [5])
C0013146 (UMLS CUI [6])
C0337074 (UMLS CUI [7])
Item Group
C1828479 (UMLS CUI-1)
C0013227 (UMLS CUI-2)
Pharmaceutical preparations medication name
Item
text
C0013227 (UMLS CUI [1,1])
C2360065 (UMLS CUI [1,2])
Dose
Item
integer
C3174092 (UMLS CUI [1])
Unit of medication dose
Item
text
C1519795 (UMLS CUI [1,1])
C3174092 (UMLS CUI [1,2])
Frequency
Item
text
C3476109 (UMLS CUI [1])
Route
Item
text
C0013153 (UMLS CUI [1])
Concomitant medication previous occurrence
Item
boolean
C2826667 (UMLS CUI [1])
Start date pharmaceutical preparations
Item
date
C0808070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Stop date pharmaceutical preparations
Item
date
C0806020 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Pharmaceutical preparations continuous
Item
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Indication pharmaceutical preparations
Item
text
C0392360 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Item Group
C1828479 (UMLS CUI-1)
C0013230 (UMLS CUI-2)
C1522508 (UMLS CUI-3)
Vaccines medication name
Item
text
C0042210 (UMLS CUI [1,1])
C2360065 (UMLS CUI [1,2])
Dose number vaccines
Item
integer
C1115464 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Lot number vaccines
Item
text
C1115660 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Administration of vaccine route | anatomic site
Item
text
C2368628 (UMLS CUI [1,1])
C0013153 (UMLS CUI [1,2])
C2368628 (UMLS CUI [2,1])
C1515974 (UMLS CUI [2,2])
Date of vaccine administration
Item
date
C0011008 (UMLS CUI [1,1])
C2368628 (UMLS CUI [1,2])
Item
text
C3897431 (UMLS CUI [1])
Code List
Subject unblinding event record
CL Item
 (No)
CL Item
 (Yes)
CL Item
 (Not applicable)
Item Group
C1828479 (UMLS CUI-1)
C1261322 (UMLS CUI-2)
Assessments
Item
text
C1261322 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
C1828479 (UMLS CUI-1)
C0947611 (UMLS CUI-2)
Comment SAE | signs and symptoms and treatment of SAE
Item
text
C0947611 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2,1])
C1519255 (UMLS CUI [2,2])
C0678257 (UMLS CUI [2,3])
C2981656 (UMLS CUI [3])
Item Group
C2346576 (UMLS CUI-1)
Item
integer
C3897642 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
SAE report type
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
Investigator signature
Item
text
C2346576 (UMLS CUI [1])
Date of investigator signature
Item
date
C0011008 (UMLS CUI [1,1])
C2346576 (UMLS CUI [1,2])
Investigator name
Item
text
C2826892 (UMLS CUI [1])
Item
integer
C0332307 (UMLS CUI [1,2])
C3897642 (UMLS CUI [1,1])
Code List
Type of report
CL Item
Erstmeldung Sponsor (1)
CL Item
Follow-up Sponsor (2)
CL Item
 (3)
CL Item
Kombinierter Erst- und Abschlußbericht Sponsor (4)
Item Group
C1519255 (UMLS CUI-1)
C1533716 (UMLS CUI-2)
C1522577 (UMLS CUI-3)
Additional information SAE follow-up
Item
text
C1524062 (UMLS CUI [1,1])
C1533716 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1522577 (UMLS CUI [1,4])
Item Group
C2346576 (UMLS CUI-1)
Item
integer
C3897642 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Code List
SAE report type
CL Item
 (1)
CL Item
 (2)
CL Item
 (3)
CL Item
 (4)
Investigator signature
Item
text
C2346576 (UMLS CUI [1])
Date of investigator signature
Item
date
C0011008 (UMLS CUI [1,1])
C2346576 (UMLS CUI [1,2])
Investigator name
Item
text
C2826892 (UMLS CUI [1])

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