- 9/20/21 - 1 form, 1 itemgroup, 11 items, 2 languages
Itemgroup: Example Itemgroup
- 3/25/19 - 1 form, 2 itemgroups, 3 items, 1 language
Itemgroups: Administrative data,Telephone contact
- 2/20/19 - 1 form, 2 itemgroups, 5 items, 1 language
Itemgroups: Administrative data,Telephone contact
Study ID: 107495 Clinical Study ID: 107495 Study Title: A phase II, open, randomized study in adults aged between 18 and 60 years designed to evaluate the reactogenicity and immunogenicity of a 1- and 2-dose prime-boost concept of pandemic monovalent (H5N1) influenza vaccine (split virus formulation) adjuvanted with AS03, administered according to different vaccination schedules. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00430521 https://clinicaltrials.gov/ct2/show/NCT00430521 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: Pandemic influenza vaccine (GSK1119711A)-formulation 1, Pandemic influenza vaccine (GSK1119711A)-formulation 2 Trade Name: N/A Study Indication: Influenza There are 4 workbooks (WB): WB 1: Protocol 107495, (H5N1-012), Groups: VT/VT/6Mo, VT/IN/6Mo WB 2: Protocol 107495, (H5N1-012), Groups: VT/VT/12Mo, VT/IN/12Mo WB 3: Protocol 107495 (H5N1-012) GROUPS: 2VT/VT/6MO, 2VT/IN/6MO WB 4: Protocol 107495 (H5N1-012) Groups: 2VT/VT/12Mo, 2VT/IN/12Mo Every Workbook has the following visits: Visit Day 0 (Screening, Dose 1), Visit Day 21, Visit Month 6, Visit Month 12 and Visit Month 18. After Month 6 (+30 days, if applicable) and Month 12 (+30 days, if applicable) there is a Core Analysis section, followed by a final study conclusion after Month 18. Workbook 1 schedules a vaccination at screening and Month 6 each, Workbook 2 at Screening and Month 12. 30 days after the first vaccination there is an additional telephone contact. After the second vaccination additional visits/contacts are necessary in both workbooks: a visit at Month 6/12 + 7 and 21 days and a telephone contact on Month 6/12 + 30 days. Workbook 3 schedules a vaccination at screening, Day 21 and Month 6 and Workbook 4 at screening, Day 21 and Month 12. After the second vaccination there is an additional visit on Day 42 and a telephone contact on day 51. After the third vaccination there are additional visits/contacts: visits at Month 6/12 + 7 and 21 days and a telephone contact at Month 6/12 + 30 days. After Month 6 (+30 days, if applicable) and Month 12 (+30 days, if applicable) there is a Core Analysis section. This document contains Telephone contact form. It has to be filled in for: WB 1: Day 30 and Month 6 + 30 D WB 2: Day 30 and Month 12 + 30 D WB 3: Day 51 and Month 6 + 30 D WB 4: Day 51 and Month 12 + 30 D
- 2/5/19 - 1 form, 2 itemgroups, 3 items, 1 language
Itemgroups: Administrative Data,Telephone Contact
- 12/22/17 - 1 form, 7 itemgroups, 19 items, 1 language
Itemgroups: Date of Telephone contact,Adverse event,Concomitant medication,Study medication,Laboratory test,Laboratory test,Signature of investigator
- 12/22/17 - 1 form, 7 itemgroups, 19 items, 1 language
Itemgroups: Date of Telephone contact,Adverse event,Concomitant medication,Study medication,Laboratory test,Laboratory test,Signature of investigator
- 12/22/17 - 1 form, 7 itemgroups, 19 items, 1 language
Itemgroups: Date of Telephone contact,Adverse event,Concomitant medication,Study medication,Laboratory test,Laboratory test,Signature of investigator

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial