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42847

Beschreibung

Visit 5 Booster Dose Vaccine Administration form Study ID: 208127/125 Clinical Study ID: 208127/125 (Ext-HAB-038 Month 90) Study Title: A double-blind, randomized study to evaluate the immunogenicity and reactogenicity of two different lots of GlaxoSmithKline Biologicals' combined hepatitis A / hepatitis B vaccine in healthy children between 6 and 15 years of age. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor:GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Hepatitis A (Inactivated), Hepatitis B (Recombinant) Vaccine Trade Name: Twinrix Study Indication: Hepatitis A; Hepatitis B

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Versionen (2)
  1. 24.08.17 24.08.17 -
  2. 17.09.21 17.09.21 -
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GlaxoSmithKline

Hochgeladen am

17. September 2021

DOI

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Creative Commons BY-NC 3.0
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    Visit 5 Booster Dose Vaccine Administration Biologicals HepA/HepB vaccine 208127/125

    Englisch

    Visit 5 Booster Dose Vaccine Administration Biologicals HepA/HepB vaccine 208127/125

    1 Formulare  
    Header
    Beschreibung

    Header

    Alias
    UMLS CUI-1
    C1320722
    Protocol
    Beschreibung

    Protocol

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C1507394
    Activity
    Beschreibung

    Activity

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C1512346
    Subject number
    Beschreibung

    Subject number

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C2348585
    VACCINE ADMINISTRATION
    Beschreibung

    VACCINE ADMINISTRATION

    Alias
    UMLS CUI-1
    C2368628
    Temperature :
    Beschreibung

    As specified in the protocol, the temperature of the subject should be taken by the oral route.

    Datentyp

    float

    Maßeinheiten
    • °C
    Alias
    UMLS CUI [1]
    C0005903
    °C
    Axillary route
    Beschreibung

    Axillary temperature

    Datentyp

    boolean

    Alias
    UMLS CUI [1]
    C1531924
    Oral route
    Beschreibung

    Oral temperature

    Datentyp

    boolean

    Alias
    UMLS CUI [1]
    C1532216
    Rectal route
    Beschreibung

    Rectal temperature

    Datentyp

    boolean

    Alias
    UMLS CUI [1]
    C0489749
    Has the study vaccine been administered ?
    Beschreibung

    If Yes, complete the table below.

    Datentyp

    boolean

    Alias
    UMLS CUI [1,1]
    C0042210
    UMLS CUI [1,2]
    C0008972
    Please specify and go to next page :
    Beschreibung

    Study vaccine has not been administered

    Datentyp

    text

    Alias
    UMLS CUI [1,1]
    C0042210
    UMLS CUI [1,2]
    C0008972
    HAB
    Beschreibung

    Vaccine

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C5397396
    Site/Route of injection: Deltoid I.M.
    Beschreibung

    Please specify side :

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C2700396
    Date administered (day month year)
    Beschreibung

    Date administered

    Datentyp

    date

    Alias
    UMLS CUI [1]
    C0011008
    Time (24 hr. clock)
    Beschreibung

    Time

    Datentyp

    time

    Alias
    UMLS CUI [1]
    C0040223
    Has the study vaccine been administered according to the protocol ?
    Beschreibung

    Vaccine protocol

    Datentyp

    boolean

    Alias
    UMLS CUI [1]
    C2368628
    UMLS CUI [2]
    C1507394
    Injection site :
    Beschreibung

    study vaccine has not been administered according to the protocol

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C2700396
    Route :
    Beschreibung

    study vaccine has not been administered according to the protocol

    Datentyp

    text

    Alias
    UMLS CUI [1]
    C1828121
    POST VACCINATION OBSERVATION
    Beschreibung

    POST VACCINATION OBSERVATION

    Alias
    UMLS CUI-1
    C1443955
    UMLS CUI-2
    C0700325
    Has any adverse experience occurred during the immediate 30 minute post vaccination observation period ?
    Beschreibung

    If Yes, please fill in the Adverse Experience Section and detail the exact time of onset.

    Datentyp

    boolean

    Alias
    UMLS CUI [1,1]
    C0877248
    UMLS CUI [1,2]
    C0151862
    Has any prophylactic medication been administered in anticipation of study vaccine reactions ?
    Beschreibung

    If Yes, please complete the Medication Section

    Datentyp

    boolean

    Alias
    UMLS CUI [1,1]
    C0420172
    UMLS CUI [1,2]
    C0413534
    Zum Seitenanfang zurückkehren

    Ähnliche Modelle

    Visit 5 Booster Dose Vaccine Administration Biologicals HepA/HepB vaccine 208127/125

    1 Formulare
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header
    C1320722 (UMLS CUI-1)
    Protocol
    Item
    Protocol
    text
    C1507394 (UMLS CUI [1])
    Activity
    Item
    Activity
    text
    C1512346 (UMLS CUI [1])
    Subject number
    Item
    Subject number
    text
    C2348585 (UMLS CUI [1])
    Item Group
    VACCINE ADMINISTRATION
    C2368628 (UMLS CUI-1)
    Temperature
    Item
    Temperature :
    float
    C0005903 (UMLS CUI [1])
    Axillary temperature
    Item
    Axillary route
    boolean
    C1531924 (UMLS CUI [1])
    Oral temperature
    Item
    Oral route
    boolean
    C1532216 (UMLS CUI [1])
    Rectal temperature
    Item
    Rectal route
    boolean
    C0489749 (UMLS CUI [1])
    Study vaccine administered
    Item
    Has the study vaccine been administered ?
    boolean
    C0042210 (UMLS CUI [1,1])
    C0008972 (UMLS CUI [1,2])
    Study vaccine not administered
    Item
    Please specify and go to next page :
    text
    C0042210 (UMLS CUI [1,1])
    C0008972 (UMLS CUI [1,2])
    Item
    HAB
    text
    C5397396 (UMLS CUI [1])
    Vaccine
    Code List
    HAB
    CL Item
    HAB (HAB)
    Item
    Site/Route of injection: Deltoid I.M.
    text
    C2700396 (UMLS CUI [1])
    Site/Route of injection
    Code List
    Site/Route of injection: Deltoid I.M.
    CL Item
    left (left)
    CL Item
    right (right)
    Date administered
    Item
    Date administered (day month year)
    date
    C0011008 (UMLS CUI [1])
    Time
    Item
    Time (24 hr. clock)
    time
    C0040223 (UMLS CUI [1])
    Vaccine protocol
    Item
    Has the study vaccine been administered according to the protocol ?
    boolean
    C2368628 (UMLS CUI [1])
    C1507394 (UMLS CUI [2])
    Injection site
    Item
    Injection site :
    text
    C2700396 (UMLS CUI [1])
    Route
    Item
    Route :
    text
    C1828121 (UMLS CUI [1])
    Item Group
    POST VACCINATION OBSERVATION
    C1443955 (UMLS CUI-1)
    C0700325 (UMLS CUI-2)
    Adverse experience after vaccination
    Item
    Has any adverse experience occurred during the immediate 30 minute post vaccination observation period ?
    boolean
    C0877248 (UMLS CUI [1,1])
    C0151862 (UMLS CUI [1,2])
    Prophylactic medication
    Item
    Has any prophylactic medication been administered in anticipation of study vaccine reactions ?
    boolean
    C0420172 (UMLS CUI [1,1])
    C0413534 (UMLS CUI [1,2])
    Zum Seitenanfang zurückkehren 

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