Sanofi Pasteur, TIV + H1N1, Pediatric Population
This study has been completed.
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT00943202
First received: July 21, 2009
Last updated: April 11, 2013
Last verified: December 2010
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Results First Received: April 28, 2011
| Study Type: | Interventional |
|---|---|
| Study Design: | Allocation: Randomized; Endpoint Classification: Safety/Efficacy Study; Intervention Model: Parallel Assignment; Masking: Open Label; Primary Purpose: Prevention |
| Condition: |
Influenza |
| Interventions: |
Biological: Inactivated H1N1 Vaccine Biological: Trivalent Inactivated Influenza Vaccine |
Participant Flow
Recruitment Details
| Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations |
|---|
| Participants were healthy males and females, age 6 months to 17 years, recruited from existing volunteer populations and from the communities at large around the clinical sites. Participants were enrolled between 20AUG2009 and 21SEP2009. |
Pre-Assignment Details
| Significant events and approaches for the overall study following participant enrollment, but prior to group assignment |
|---|
| No text entered. |
Reporting Groups
| Description | |
|---|---|
| Group 1: Day 0-H1N1; Day 21-H1N1; Day 42-TIV | Participants received 15 mcg H1N1 Vaccine on Day 0; 15 mcg H1N1 Vaccine on Day 21, and Trivalent Influenza Vaccine (TIV) on Day 42 |
| Group 2: Day 0-H1N1+TIV; Day 21-H1N1 | Participants received 15 mcg H1N1 Vaccine + Trivalent Influenza Vaccine (TIV) on Day 0 and 15 mcg H1N1 Vaccine on Day 21 |
| Group 3: Day 0-H1N1; Day 21-H1N1+TIV | Participants received 15 mcg H1N1 Vaccine on Day 0 and 15 mcg H1N1 Vaccine + Trivalent Influenza Vaccine (TIV) on Day 21 |
| Group 4: Day 0-TIV; Day 21-H1N1; Day 42-H1N1 | Participants received Trivalent Influenza Vaccine (TIV) on Day 0; 15 mcg H1N1 Vaccine on Day 21, and 15 mcg H1N1 Vaccine on Day 42. |
Participant Flow: Overall Study
| Group 1: Day 0-H1N1; Day 21-H1N1; Day 42-TIV | Group 2: Day 0-H1N1+TIV; Day 21-H1N1 | Group 3: Day 0-H1N1; Day 21-H1N1+TIV | Group 4: Day 0-TIV; Day 21-H1N1; Day 42-H1N1 | |
|---|---|---|---|---|
| STARTED | 133 | 133 | 133 | 132 |
| COMPLETED | 132 | 131 | 133 | 131 |
| NOT COMPLETED | 1 | 2 | 0 | 1 |
Baseline Characteristics
Reporting Groups
| Description | |
|---|---|
| Group 1: Day 0-H1N1; Day 21-H1N1; Day 42-TIV | Participants received 15 mcg H1N1 Vaccine on Day 0; 15 mcg H1N1 Vaccine on Day 21, and Trivalent Influenza Vaccine (TIV) on Day 42 |
| Group 2: Day 0-H1N1+TIV; Day 21-H1N1 | Participants received 15 mcg H1N1 Vaccine + Trivalent Influenza Vaccine (TIV) on Day 0 and 15 mcg H1N1 Vaccine on Day 21 |
| Group 3: Day 0-H1N1; Day 21-H1N1+TIV | Participants received 15 mcg H1N1 Vaccine on Day 0 and 15 mcg H1N1 Vaccine + Trivalent Influenza Vaccine (TIV) on Day 21 |
| Group 4: Day 0-TIV; Day 21-H1N1; Day 42-H1N1 | Participants received Trivalent Influenza Vaccine (TIV) on Day 0; 15 mcg H1N1 Vaccine on Day 21, and 15 mcg H1N1 Vaccine on Day 42. |
| Total | Total of all reporting groups |
Baseline Measures
| Group 1: Day 0-H1N1; Day 21-H1N1; Day 42-TIV | Group 2: Day 0-H1N1+TIV; Day 21-H1N1 | Group 3: Day 0-H1N1; Day 21-H1N1+TIV | Group 4: Day 0-TIV; Day 21-H1N1; Day 42-H1N1 | Total | |
|---|---|---|---|---|---|
|
Number of Participants
[units: participants] |
133 | 133 | 133 | 132 | 531 |
|
Age
[units: participants] |
|||||
| <=18 years | 133 | 133 | 133 | 132 | 531 |
| Between 18 and 65 years | 0 | 0 | 0 | 0 | 0 |
| >=65 years | 0 | 0 | 0 | 0 | 0 |
|
Age
[units: years] Mean ± Standard Deviation |
8.0 ± 5.0 | 8.2 ± 5.3 | 7.9 ± 5.3 | 8.5 ± 5.0 | 8.1 ± 5.1 |
|
Gender
[units: participants] |
|||||
| Female | 68 | 71 | 57 | 57 | 253 |
| Male | 65 | 62 | 76 | 75 | 278 |
|
Region of Enrollment
[units: participants] |
|||||
| United States | 133 | 133 | 133 | 132 | 531 |
Outcome Measures
| 1. Primary: | Number of Participants Age 6 Months to Less Than 36 Months With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Influenza H1N1 2009 Virus 21 Days Following the First Dose of H1N1 Vaccine [ Time Frame: Day 0 prior to vaccination and 21 days after the first H1N1 vaccination ] |
| 2. Primary: | Number of Participants Age 36 Months to 9 Years With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Influenza H1N1 2009 Virus 21 Days Following the First Dose of H1N1 Vaccine [ Time Frame: Day 0 prior to vaccination and 21 days after the first H1N1 vaccination ] |
| 3. Primary: | Number of Participants Age 10 to 17 Years With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Influenza H1N1 2009 Virus 21 Days Following the First Dose of H1N1 Vaccine [ Time Frame: Day 0 prior to vaccination and 21 days after the first H1N1 vaccination ] |
| 4. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Subjective Systemic Reactions After the First Vaccination [ Time Frame: Within 8 days (Day 0-7) post first vaccination ] |
| 5. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Subjective Systemic Reactions After the First Vaccination [ Time Frame: Within 8 days (Day 0-7) post first vaccination ] |
| 6. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Subjective Systemic Reactions After the First Vaccination [ Time Frame: Within 8 days (Day 0-7) post first vaccination ] |
| 7. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Subjective Systemic Reactions After the Second Vaccination [ Time Frame: Within 8 days (Day 0-7) post second vaccination ] |
| 8. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Subjective Systemic Reactions After the Second Vaccination [ Time Frame: Within 8 days (Day 0-7) post second vaccination ] |
| 9. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Subjective Systemic Reactions After the Second Vaccination [ Time Frame: Within 8 days (Day 0-7) post second vaccination ] |
| 10. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Subjective Systemic Reactions After the Third Vaccination [ Time Frame: Within 8 days (Day 0-7) post third vaccination ] |
| 11. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Subjective Systemic Reactions After the Third Vaccination [ Time Frame: Within 8 days (Day 0-7) post third vaccination ] |
| 12. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Subjective Systemic Reactions After the Third Vaccination [ Time Frame: Within 8 days (Day 0-7) post third vaccination ] |
| 13. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Quantitative Systemic Reactions After the First Vaccination [ Time Frame: Within 8 days (Day 0-7) post first vaccination ] |
| 14. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Quantitative Systemic Reactions After the First Vaccination [ Time Frame: Within 8 days (Day 0-7) post first vaccination ] |
| 15. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Quantitative Systemic Reactions After the First Vaccination [ Time Frame: Within 8 days (Day 0-7) post first vaccination ] |
| 16. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Quantitative Systemic Reactions After the Second Vaccination [ Time Frame: Within 8 days (Day 0-7) post second vaccination ] |
| 17. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Quantitative Systemic Reactions After the Second Vaccination [ Time Frame: Within 8 days (Day 0-7) post second vaccination ] |
| 18. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Quantitative Systemic Reactions After the Second Vaccination [ Time Frame: Within 8 days (Day 0-7) post second vaccination ] |
| 19. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Quantitative Systemic Reactions After the Third Vaccination [ Time Frame: Within 8 days (Day 0-7) post third vaccination ] |
| 20. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Quantitative Systemic Reactions After the Third Vaccination [ Time Frame: Within 8 days (Day 0-7) post third vaccination ] |
| 21. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Quantitative Systemic Reactions After the Third Vaccination [ Time Frame: Within 8 days (Day 0-7) post third vaccination ] |
| 22. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Subjective Local Reactions After the First H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post first H1N1 vaccination ] |
| 23. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Subjective Local Reactions After the First H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post first H1N1 vaccination ] |
| 24. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Subjective Local Reactions After the First H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post first H1N1 vaccination ] |
| 25. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Subjective Local Reactions After the Second H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post second H1N1 vaccination ] |
| 26. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Subjective Local Reactions After the Second H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post second H1N1 vaccination ] |
| 27. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Subjective Local Reactions After the Second H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post second H1N1 vaccination ] |
| 28. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Subjective Local Reactions After the TIV Vaccination [ Time Frame: Within 8 days (Day 0-7) post TIV vaccination ] |
| 29. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Subjective Local Reactions After the TIV Vaccination [ Time Frame: Within 8 days (Day 0-7) post TIV vaccination ] |
| 30. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Subjective Local Reactions After the TIV Vaccination [ Time Frame: Within 8 days (Day 0-7) post TIV vaccination ] |
| 31. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Quantitative Local Reactions After the First H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post first H1N1 vaccination ] |
| 32. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Quantitative Local Reactions After the First H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post first H1N1 vaccination ] |
| 33. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Quantitative Local Reactions After the First H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post first H1N1 vaccination ] |
| 34. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Quantitative Local Reactions After the Second H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post second H1N1 vaccination ] |
| 35. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Quantitative Local Reactions After the Second H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post second H1N1 vaccination ] |
| 36. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Quantitative Local Reactions After the Second H1N1 Vaccination [ Time Frame: Within 8 days (Day 0-7) post second H1N1 vaccination ] |
| 37. Primary: | Number of Participants Age 6 to Less Than 36 Months Reporting Solicited Quantitative Local Reactions After the TIV Vaccination [ Time Frame: Within 8 days (Day 0-7) post TIV vaccination ] |
| 38. Primary: | Number of Participants Age 36 Months to 9 Years Reporting Solicited Quantitative Local Reactions After the TIV Vaccination [ Time Frame: Within 8 days (Day 0-7) post TIV vaccination ] |
| 39. Primary: | Number of Participants Age 10 to 17 Years Reporting Solicited Quantitative Local Reactions After the TIV Vaccination [ Time Frame: Within 8 days (Day 0-7) post TIV vaccination ] |
| 40. Primary: | Number of Participants Reporting Vaccine-associated Serious Adverse Events (SAEs) [ Time Frame: Day 0 through 180 days after the last vaccination ] |
| 41. Primary: | Number of Participants Age 6 Months to Less Than 36 Months With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the H1N1 2009 Virus 21 Days Following the First Dose of H1N1 Vaccine [ Time Frame: Day 21 after first H1N1 vaccination ] |
| 42. Primary: | Number of Participants Age 36 Months to 9 Years With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the H1N1 2009 Virus 21 Days Following the First Dose of H1N1 Vaccine [ Time Frame: Day 21 after first H1N1 vaccination ] |
| 43. Primary: | Number of Participants Age 10 to 17 Years With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the H1N1 2009 Virus 21 Days Following the First Dose of H1N1 Vaccine [ Time Frame: Day 21 after first H1N1 vaccination ] |
| 44. Secondary: | Number of Participants Age 6 to Less Than 36 Months With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Virus Strains in the 2009-2010 Trivalent Influenza Vaccine (TIV) 21 Days Following the Last Vaccination [ Time Frame: Day 0 prior to first vaccination and 21 days after last vaccination ] |
| 45. Secondary: | Number of Participants Age 36 Months to 9 Years With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Virus Strains in the 2009-2010 Trivalent Influenza Vaccine (TIV) 21 Days Following the Last Vaccination [ Time Frame: Day 0 prior to first vaccination and Day 21 after last vaccination ] |
| 46. Secondary: | Number of Participants Age 10 to 17 Years With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Virus Strains in the 2009-2010 Trivalent Influenza Vaccine (TIV) 21 Days Following the Last Vaccination [ Time Frame: Day 0 prior to first vaccination and Day 21 after last vaccination ] |
| 47. Secondary: | Number of Participants Age 6 to Less Than 36 Months With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the Virus Strains in the 2009-2010 Trivalent Influenza Vaccine (TIV) 21 Days Following the Last Vaccination [ Time Frame: Day 21 after last vaccination ] |
| 48. Secondary: | Number of Participants Age 36 Months to 9 Years With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the Virus Strains in the 2009-2010 Trivalent Influenza Vaccine (TIV) 21 Days Following the Last Vaccination [ Time Frame: Day 21 after last vaccination ] |
| 49. Secondary: | Number of Participants Age 10 to 17 Years With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the Virus Strains in the 2009-2010 Trivalent Influenza Vaccine (TIV) 21 Days Following the Last Vaccination [ Time Frame: Day 21 after last vaccination ] |
| 50. Secondary: | Number of Participants Age 6 to Less Than 36 Months With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the H1N1 2009 Virus 21 Days Following the Second Dose of H1N1 Vaccine [ Time Frame: Day 21 after the second H1N1 vaccination ] |
| 51. Secondary: | Number of Participants Age 36 Months to 9 Years With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the H1N1 2009 Virus 21 Days Following the Second Dose of H1N1 Vaccine [ Time Frame: Day 21 after the second H1N1 vaccination ] |
| 52. Secondary: | Number of Participants Age 10 to 17 Years With a Serum Hemagglutination Inhibition Assay (HAI) Antibody Titer of 1:40 or Greater Against the H1N1 2009 Virus 21 Days Following the Second Dose of H1N1 Vaccine [ Time Frame: Day 21 after the second H1N1 vaccination ] |
| 53. Secondary: | Number of Participants Age 6 to Less Than 36 Months With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Influenza H1N1 2009 Virus 21 Days Following the Second Dose of H1N1 Vaccine [ Time Frame: Day 0 prior to first vaccination and 21 days after the second H1N1 vaccination ] |
| 54. Secondary: | Number of Participants Age 36 Months to 9 Years With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Influenza H1N1 2009 Virus 21 Days Following the Second Dose of H1N1 Vaccine [ Time Frame: Day 0 prior to first vaccination and 21 days after the second H1N1 vaccination ] |
| 55. Secondary: | Number of Participants Age 10 to 17 Years With 4-fold or Greater Hemagglutination Inhibition Assay (HAI) Antibody Titer Increases Against the Influenza H1N1 2009 Virus 21 Days Following the Second Dose of H1N1 Vaccine [ Time Frame: Day 0 prior to first vaccination and 21 days after the second H1N1 vaccination ] |
Serious Adverse Events| Time Frame | Solicited events were collected for 8 days after each vaccination, unsolicited events through 21 days after last vaccination, and serious adverse events and new onset chronic medical conditions through 180 days after last vaccination. |
|---|---|
| Additional Description | For events solicited on a Memory Aid in the 8 days after vaccination, a participant was considered to have one event if it was reported as experienced at any time in the 8 day period. |
Reporting Groups
| Description | |
|---|---|
| Group 1: Day 0-H1N1; Day 21-H1N1; Day 42-TIV | Participants received 15 mcg H1N1 Vaccine on Day 0; 15 mcg H1N1 Vaccine on Day 21, and Trivalent Influenza Vaccine (TIV) on Day 42 |
| Group 2: Day 0-H1N1+TIV; Day 21-H1N1 | Participants received 15 mcg H1N1 Vaccine + Trivalent Influenza Vaccine (TIV) on Day 0 and 15 mcg H1N1 Vaccine on Day 21 |
| Group 3: Day 0-H1N1; Day 21-H1N1+TIV | Participants received 15 mcg H1N1 Vaccine on Day 0 and 15 mcg H1N1 Vaccine + Trivalent Influenza Vaccine (TIV) on Day 21 |
| Group 4: Day 0-TIV; Day 21-H1N1; Day 42-H1N1 | Participants received Trivalent Influenza Vaccine (TIV) on Day 0; 15 mcg H1N1 Vaccine on Day 21, and 15 mcg H1N1 Vaccine on Day 42. |
Serious Adverse Events
| Group 1: Day 0-H1N1; Day 21-H1N1; Day 42-TIV | Group 2: Day 0-H1N1+TIV; Day 21-H1N1 | Group 3: Day 0-H1N1; Day 21-H1N1+TIV | Group 4: Day 0-TIV; Day 21-H1N1; Day 42-H1N1 | |
|---|---|---|---|---|
| Total, serious adverse events | ||||
| # participants affected / at risk | 0/133 (0.00%) | 3/133 (2.26%) | 1/133 (0.75%) | 2/132 (1.52%) |
| Immune system disorders | ||||
| Anaphylactic reaction * 1 | ||||
| # participants affected / at risk | 0/133 (0.00%) | 0/133 (0.00%) | 1/133 (0.75%) | 1/132 (0.76%) |
| # events | 0 | 0 | 1 | 1 |
| Infections and infestations | ||||
| Abscess * 1 | ||||
| # participants affected / at risk | 0/133 (0.00%) | 1/133 (0.75%) | 0/133 (0.00%) | 0/132 (0.00%) |
| # events | 0 | 1 | 0 | 0 |
| Injury, poisoning and procedural complications | ||||
| Head injury * 1 | ||||
| # participants affected / at risk | 0/133 (0.00%) | 1/133 (0.75%) | 0/133 (0.00%) | 0/132 (0.00%) |
| # events | 0 | 1 | 0 | 0 |
| Multiple fractures * 1 | ||||
| # participants affected / at risk | 0/133 (0.00%) | 1/133 (0.75%) | 0/133 (0.00%) | 0/132 (0.00%) |
| # events | 0 | 1 | 0 | 0 |
| Metabolism and nutrition disorders | ||||
| Type 1 diabetes mellitus * 1 | ||||
| # participants affected / at risk | 0/133 (0.00%) | 0/133 (0.00%) | 0/133 (0.00%) | 1/132 (0.76%) |
| # events | 0 | 0 | 0 | 1 |
| * | Events were collected by non-systematic assessment |
|---|---|
| 1 | Term from vocabulary, MedDRA (13.0) |
Other Adverse Events
More Information
Certain Agreements:
Limitations and Caveats
Results Point of Contact:
Publications of Results:
| Principal Investigators are NOT employed by the organization sponsoring the study. | ||||||
| There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. | ||||||
The agreement is:
|
Limitations and Caveats
| Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data |
|---|
| Due to difficulties identifying children in the youngest age stratum who were previously primed, enrollment in this stratum was closed prior to meeting the planned number of participants. |
Results Point of Contact:
Name/Title: Sharon E. Frey, M.D.
Organization: Division of Infectious Diseases and Immunology, Saint Louis University Medical School
phone: 314-977-5500
e-mail: freyse@slu.edu
Organization: Division of Infectious Diseases and Immunology, Saint Louis University Medical School
phone: 314-977-5500
e-mail: freyse@slu.edu
Publications of Results:
| Responsible Party: | National Institute of Allergy and Infectious Diseases (NIAID) |
| ClinicalTrials.gov Identifier: | NCT00943202 History of Changes |
| Other Study ID Numbers: | 09-0047, N01AI80003C |
| Study First Received: | July 21, 2009 |
| Results First Received: | April 28, 2011 |
| Last Updated: | April 11, 2013 |
| Health Authority: | United States: Institutional Review Board United States: Food and Drug Administration United States: Federal Government |