ID

35528

Descrizione

Study ID: 111652 Clinical Study ID: 111652 Study Title: A Study to Evaluate GSK Biologicals' Candidate Formulations of Pneumococcal Vaccines (GSK2189241A) in Elderly Subjects Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00756067 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: Pneumococcal vaccine GSK2189241A Trade Name: Pneumo 23™ Study Indication: Infections, Streptococcal

Keywords

  1. 07/03/19 07/03/19 -
Titolare del copyright

GSK group of companies

Caricato su

7 marzo 2019

DOI

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Licenza

Creative Commons BY-NC 3.0

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Candidate Formulations of Pneumococcal Vaccines in Elderly Subjects - 111652

Lab Reference Ranges, Consent Form

Administrative data
Descrizione

Administrative data

Subject Number
Descrizione

Subject Number

Tipo di dati

integer

LABORATORY REFERENCE RANGES
Descrizione

LABORATORY REFERENCE RANGES

LABORATORY NAME:
Descrizione

LABORATORY NAME:

Tipo di dati

text

LAB CODE
Descrizione

For internal use only

Tipo di dati

text

Date these reference ranges became effective:
Descrizione

Enter the reference range for each test. If the reference ranges for any test differ by age range, age units or sex, complete a separate form for each variation (e.g., males 0-16, males 17-99, females 0- 16, females 17-99 years).

Tipo di dati

date

Age range
Descrizione

Age range

Tipo di dati

integer

Low age range
Descrizione

Low age range

Tipo di dati

integer

High age range
Descrizione

High age range

Tipo di dati

integer

Age units
Descrizione

tick one box

Tipo di dati

text

Sex
Descrizione

Sex

Tipo di dati

text

Hematology
Descrizione

Hematology

[HB] Hemoglobin
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[RBC] Red Blood Cells
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[PLA] Platelets
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[WBC] White Blood Cells
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[NEU] Neutrophils
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[LYM] Lymphocytes
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[MON] Monocytes
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[EOS] Eosinophils
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[BAS] Basophils
Descrizione

Basophils

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[RET] Reticulocytes
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

Blood Chemistry
Descrizione

Blood Chemistry

[BUN] BUN
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[CREA] Creatinine
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[AST] AST/SGOT
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[ALT] ALT/SGPT
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[LDH] Lactate Dehydrogenase (LDH)
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

LD1
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

LD2
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

LD3
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

LD4
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

LD5
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[CHOL] Cholesterol
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[CPK] Creatine phosphokinase
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

[HAP] Serum Haptoglobin
Descrizione

Unit

Tipo di dati

text

Low Reference Value
Descrizione

Low Reference Value

Tipo di dati

text

High Reference value
Descrizione

High Reference value

Tipo di dati

text

USE OF HUMAN SAMPLES BY GSK
Descrizione

USE OF HUMAN SAMPLES BY GSK

In addition to the use of samples for the tests described in the protocol, samples might be used for other research by GSK (see protocol). Please tick "Yes" for what is also covered by the subject Informed Consent form of your center.
Descrizione

Use of Human Samples by GSK

Tipo di dati

text

1. Quality Assurance of tests described in the protocol
Descrizione

This may include the management of the quality of these current tests, the maintenance or improvement of these current tests, the development of new test methods for the markers described in the protocol as well as making sure that new tests are comparable to previous methods and work reliably.

Tipo di dati

boolean

2. Further investigation by GSK Biologicals into the ability of the vaccines to protect people if any findings from related studies require it and further research in the diseases caused by S. pneumoniae or Haemophilus influenzae under study.
Descrizione

These investigations excludes genetics and HIV testing.

Tipo di dati

boolean

3. Further investigation by GSK Biologicals into the ability of the vaccines to protect people if any findings from related studies require it and further research in the diseases caused by S. pneumoniae or Haemophilus influenzae under study.
Descrizione

These investigations excludes genetic and HIV testing. Investigator will always ask in advance the permission of the independent Ethics Committee/Institutional Review Board linked to the institution where this research is performed.

Tipo di dati

boolean

4.Further research by GSK Biologicals that is NOT RELATED to the vaccines or the diseases caused by S. pneumoniae or Haemophilus influenzae under study done on an anonymous basis (meaning that any identification linking the subject to the sample is destroyed).
Descrizione

This research excludes genetic and HIV testing and does not affect subject participation in the study.

Tipo di dati

boolean

Please tick below box if a 15 years GSK storage period is covered by the subject’s Informed Consent form of your center.
Descrizione

a 15 years GSK storage period

Tipo di dati

text

Specify Other
Descrizione

Specify Other

Tipo di dati

text

ICF Effective date:
Descrizione

Complete and submit a new form for each change during the study.

Tipo di dati

date

INVESTIGATOR'S SIGNATURE
Descrizione

INVESTIGATOR'S SIGNATURE

Investigator's signature:
Descrizione

Investigator's signature

Tipo di dati

text

Printed Investigator's name:
Descrizione

Printed Investigator's name

Tipo di dati

text

Date
Descrizione

Date

Tipo di dati

date

Similar models

Lab Reference Ranges, Consent Form

Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item Group
LABORATORY REFERENCE RANGES
LABORATORY NAME:
Item
LABORATORY NAME:
text
LAB CODE
Item
LAB CODE
text
Date
Item
Date these reference ranges became effective:
date
Item
Age range
integer
Code List
Age range
CL Item
low (1)
CL Item
high (2)
Low age range
Item
Low age range
integer
High age range
Item
High age range
integer
Item
Age units
text
Code List
Age units
CL Item
years (1)
CL Item
months (2)
CL Item
weeks (3)
CL Item
days (4)
Item
Sex
text
Code List
Sex
CL Item
Male reference range (1)
CL Item
Female reference range (2)
CL Item
Male and Female reference range (3)
Item Group
Hematology
Hemoglobin
Item
[HB] Hemoglobin
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Red Blood Cells
Item
[RBC] Red Blood Cells
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Platelets
Item
[PLA] Platelets
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
White Blood Cells
Item
[WBC] White Blood Cells
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Neutrophils
Item
[NEU] Neutrophils
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Lymphocytes
Item
[LYM] Lymphocytes
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Monocytes
Item
[MON] Monocytes
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Eosinophils
Item
[EOS] Eosinophils
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Basophils
Item
[BAS] Basophils
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Reticulocytes
Item
[RET] Reticulocytes
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Item Group
Blood Chemistry
BUN
Item
[BUN] BUN
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Creatinine
Item
[CREA] Creatinine
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
AST/SGOT
Item
[AST] AST/SGOT
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
ALT/SGPT
Item
[ALT] ALT/SGPT
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Lactate Dehydrogenase (LDH)
Item
[LDH] Lactate Dehydrogenase (LDH)
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
LD1
Item
LD1
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
LD2
Item
LD2
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
LD3
Item
LD3
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
LD4
Item
LD4
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
LD5
Item
LD5
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Cholesterol
Item
[CHOL] Cholesterol
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Creatine phosphokinase
Item
[CPK] Creatine phosphokinase
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Serum Haptoglobin
Item
[HAP] Serum Haptoglobin
text
Low Reference Value
Item
Low Reference Value
text
High Reference value
Item
High Reference value
text
Item Group
USE OF HUMAN SAMPLES BY GSK
Use of Human Samples by GSK
Item
In addition to the use of samples for the tests described in the protocol, samples might be used for other research by GSK (see protocol). Please tick "Yes" for what is also covered by the subject Informed Consent form of your center.
text
1. Quality Assurance of tests described in the protocol
Item
1. Quality Assurance of tests described in the protocol
boolean
2. Further investigation by GSK Biologicals into the ability of the vaccines to protect people if any findings from related studies require it and further research in the diseases caused by S. pneumoniae or Haemophilus influenzae under study.
Item
2. Further investigation by GSK Biologicals into the ability of the vaccines to protect people if any findings from related studies require it and further research in the diseases caused by S. pneumoniae or Haemophilus influenzae under study.
boolean
3. Further investigation by GSK Biologicals into the ability of the vaccines to protect people if any findings from related studies require it and further research in the diseases caused by S. pneumoniae or Haemophilus influenzae under study.
Item
3. Further investigation by GSK Biologicals into the ability of the vaccines to protect people if any findings from related studies require it and further research in the diseases caused by S. pneumoniae or Haemophilus influenzae under study.
boolean
4.Further research by GSK Biologicals that is NOT RELATED to the vaccines or the diseases caused by S. pneumoniae or Haemophilus influenzae under study done on an anonymous basis (meaning that any identification linking the subject to the sample is destroyed).
Item
4.Further research by GSK Biologicals that is NOT RELATED to the vaccines or the diseases caused by S. pneumoniae or Haemophilus influenzae under study done on an anonymous basis (meaning that any identification linking the subject to the sample is destroyed).
boolean
Item
Please tick below box if a 15 years GSK storage period is covered by the subject’s Informed Consent form of your center.
text
Code List
Please tick below box if a 15 years GSK storage period is covered by the subject’s Informed Consent form of your center.
CL Item
At least 15 years storage period by GSK Biologicals (1)
CL Item
Other (2)
Specify Other
Item
Specify Other
text
ICF Effective date
Item
ICF Effective date:
date
Item Group
INVESTIGATOR'S SIGNATURE
Investigator's signature
Item
Investigator's signature:
text
Printed Investigator's name
Item
Printed Investigator's name:
text
Date
Item
Date
date

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