20-valent Pneumococcal Conjugate Vaccine Safety and Immunogenicity Study of a 4-Dose Series in Healthy Infants
- Conditions
- Pneumococcal Disease
- Interventions
- Biological: 20-valent pneumococcal conjugate vaccineBiological: 13-valent pneumococcal conjugate vaccine
- Registration Number
- NCT04382326
- Lead Sponsor
- Pfizer
- Brief Summary
20-valent Pneumococcal Conjugate Vaccine Safety and Immunogenicity Study of a 4-Dose Series in Healthy Infants
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1997
- Male or female infants born at >36 weeks of gestation and 2 months of age at the time of consent.
- Healthy infants determined by clinical assessment, including medical history and clinical judgment, to be eligible for the study.
- History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (eg, anaphylaxis)
- Major known congenital malformation or serious chronic disorder
- Other acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results
- Previous receipt of >1 dose of hepatitis B vaccine; or receipt of a single hepatitis B vaccine dose administered at >30 days old, or previous receipt of any licensed or investigational pneumococcal vaccine, or planned receipt through study participation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 20-valent pneumococcal conjugate vaccine 20-valent pneumococcal conjugate vaccine Pneumococcal conjugate vaccine 13-valent pneumococcal conjugate vaccine 13-valent pneumococcal conjugate vaccine Pneumococcal conjugate vaccine
- Primary Outcome Measures
Name Time Method Percentage of Participants With Local Reactions Within 7 Days After Dose 3 Within 7 days after Dose 3 Local reactions were recorded using an electronic diary. Local reactions included redness, swelling and pain at the injection site. Redness and swelling were graded as mild (0.5 to 2.0 cm), moderate (\>2.0 to 7.0 cm) and severe (\>7.0 cm). Pain at injection site was graded as mild (hurt if gently touched example, whimpered, winced, protested, or withdrew), moderate (hurt if gently touched, with crying), and severe (caused limitation of limb movement).
Percentage of Participants With Local Reaction Within 7 Days After Dose 2 Within 7 Days After Dose 2 Local reactions were recorded using an electronic diary. Local reactions included redness, swelling and pain at the injection site. Redness and swelling were graded as mild (0.5 to 2.0 cm), moderate (\>2.0 to 7.0 cm) and severe (\>7.0 cm). Pain at injection site was graded as mild (hurt if gently touched example, whimpered, winced, protested, or withdrew), moderate (hurt if gently touched, with crying), and severe (caused limitation of limb movement).
Percentage of Participants With Local Reactions Within 7 Days After Dose 1 Within 7 days after Dose 1 Local reactions were recorded using an electronic diary. Local reactions included redness, swelling and pain at the injection site. Redness and swelling were graded as mild (0.5 to 2.0 cm), moderate (\>2.0 to 7.0 cm) and severe (\>7.0 cm). Pain at injection site was graded as mild (hurt if gently touched example, whimpered, winced, protested, or withdrew), moderate (hurt if gently touched, with crying), and severe (caused limitation of limb movement).
Percentage of Participants With Systemic Events Within 7 Days After Dose 1 Within 7 days after Dose 1 Systemic events included fever, decreased appetite, drowsiness/increased sleep and irritability, recorded by parents/legal guardians of participant's using an e-diary. Fever was defined as temperature greater than or equal to (\>=) 38.0 degrees Celsius (C) and categorized as \>=38.0 to 38.4 degrees C, \>38.4 to 38.9 degrees C, \>38.9 to 40.0 degrees C and \>40.0 degrees C. Decreased appetite was graded as mild (decreased interest in eating), moderate (decreased oral intake) and severe (refusal to feed). Drowsiness was graded as mild (increased or prolonged sleeping bouts), moderate (slightly subdued, interfered with daily activity) and severe (disabling, not interested in usual daily activity). Irritability was graded as mild (easily consolable), moderate (required increased attention) and severe (inconsolable, crying could not be comforted). 95% CI was based on Clopper and Pearson method.
Percentage of Participants With Systemic Events Within 7 Days After Dose 2 Within 7 days after Dose 2 Systemic events included fever, decreased appetite, drowsiness/increased sleep and irritability, recorded by parents/legal guardians of participant's using an e-diary. Fever was defined as temperature \>= 38.0 degrees C and categorized as \>=38.0 to 38.4 degrees C, \>38.4 to 38.9 degrees C, \>38.9 to 40.0 degrees C and \>40.0 degrees C. Decreased appetite was graded as mild (decreased interest in eating), moderate (decreased oral intake) and severe (refusal to feed). Drowsiness was graded as mild (increased or prolonged sleeping bouts), moderate (slightly subdued, interfered with daily activity) and severe (disabling, not interested in usual daily activity). Irritability was graded as mild (easily consolable), moderate (required increased attention) and severe (inconsolable, crying could not be comforted). 95% CI was based on Clopper and Pearson method.
Percentage of Participants With Systemic Events Within 7 Days After Dose 3 Within 7 days after Dose 3 Systemic events included fever, decreased appetite, drowsiness/increased sleep and irritability, recorded by parents/legal guardians of participant's using an e-diary. Fever was defined as temperature \>= 38.0 degrees C and categorized as \>=38.0 to 38.4 degrees C, \>38.4 to 38.9 degrees C, \>38.9 to 40.0 degrees C and \>40.0 degrees C. Decreased appetite was graded as mild (decreased interest in eating), moderate (decreased oral intake) and severe (refusal to feed). Drowsiness was graded as mild (increased or prolonged sleeping bouts), moderate (slightly subdued, interfered with daily activity) and severe (disabling, not interested in usual daily activity). Irritability was graded as mild (easily consolable), moderate (required increased attention) and severe (inconsolable, crying could not be comforted). 95% CI was based on Clopper and Pearson method.
Percentage of Participants With Local Reactions Within 7 Days After Dose 4 Within 7 days after Dose 4 Local reactions were recorded using an electronic diary. Local reactions included redness, swelling and pain at the injection site. Redness and swelling were graded as mild (0.5 to 2.0 cm), moderate (\>2.0 to 7.0 cm) and severe (\>7.0 cm). Pain at injection site was graded as mild (hurt if gently touched example, whimpered, winced, protested, or withdrew), moderate (hurt if gently touched, with crying), and severe (caused limitation of limb movement). 95 percent (%) confidence interval (CI) was based on Clopper and Pearson method.
Percentage of Participants With Systemic Events Within 7 Days After Dose 4 Within 7 days after Dose 4 Systemic events included fever, decreased appetite, drowsiness/increased sleep and irritability, recorded by parents/legal guardians of participant's using an e-diary. Fever was defined as temperature \>= 38.0 degrees C and categorized as \>=38.0 to 38.4 degrees C, \>38.4 to 38.9 degrees C, \>38.9 to 40.0 degrees C and \>40.0 degrees C. Decreased appetite was graded as mild (decreased interest in eating), moderate (decreased oral intake) and severe (refusal to feed). Drowsiness was graded as mild (increased or prolonged sleeping bouts), moderate (slightly subdued, interfered with daily activity) and severe (disabling, not interested in usual daily activity). Irritability was graded as mild (easily consolable), moderate (required increased attention) and severe (inconsolable, crying could not be comforted). 95% CI was based on Clopper and Pearson method.
Percentage of Participants With Newly Diagnosed Chronic Medical Conditions (NDCMCs) From Dose 1 to 6 Months Following Dose 4 From Dose 1 to 6 months following Dose 4 An NDCMC was defined as a significant disease or medical condition, not previously identified, that was expected to be persistent or was otherwise long-lasting in its effects. 95% CI was based on the Clopper and Pearson method.
Percentage of Participants With Adverse Events (AEs) From Dose 1 to 1 Month After Dose 3 From Dose 1 to 1 Month after Dose 3 An AE was any untoward medical occurrence in a participants, temporally associated with the use of study treatment, whether or not considered related to the study treatment. 95% CI was based on the Clopper and Pearson method. AEs reported in this outcome measure excluded local reactions and systemic events.
Percentage of Participants With AEs From Dose 4 to 1 Month After Dose 4 From Dose 4 to 1 month after Dose 4 An AE was any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. 95% CI was based on the Clopper and Pearson method. AEs reported in this outcome measure excluded local reactions and systemic events.
Percentage of Participants With Serious Adverse Events (SAEs) From Dose 1 to 6 Months Following Dose 4 From Dose 1 to 6 months following Dose 4 A SAE was any untoward medical occurrence that, at any dose: resulted in death; required inpatient hospitalisation or prolongation of existing hospitalisation; was life-threatening; resulted in persistent or significant disability/ incapacity; congenital anomaly/birth defect and other important medical events. 95% CI was based on the Clopper and Pearson method.
Percentage of Participants With Predefined Serotype-specific Immunoglobulin G (IgG) Concentrations 1 Month After Dose 3 1 month after Dose 3 Pre-specified levels of serotypes were as follows: for serotype 1, 3, 4, 6A, 7F, 9V, 14, 18C, 19F, 23F, 8, 10A, 11A, 12F, 15B, 22F, 33F: \>=0.35 microgram per mL (mcg/mL), for serotype 5: \>=0.23 mcg/mL, for serotype 6B: \>=0.10 mcg/mL and for serotype 19A: \>=0.12 mcg/mL. 95% CI was based on the Clopper and Pearson method.
Serotype-specific IgG Geometric Mean Concentration (GMCs) and Geometric Mean Ratios (GMRs) at 1 Month After Dose 4 From Dose 1 to 6 months following Dose 4 Concentrations of anticapsular IgG for the 20 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F, 8, 10A, 11A, 12F, 15B, 22F, and 33F) were determined in all participants at 1 month after Dose 4 using the Luminex assay. Results were expressed as IgG concentrations. GMCs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution. Assay result below LLOQ was set to 0.5\*LLOQ. Geometric mean ratios (GMRs) were reported in statistical analysis section and were calculated by exponentiating mean difference of logarithm of concentration and corresponding 2-sided 95% CIs (based on Student's t distribution).
Percentage of Participants With Prespecified Antibody Levels to Specific Concomitant Vaccine Antigens 1 Month After Dose 3 1 month after Dose 3 Concentration of antibody to diphtheria toxoid (predefined level ≥0.1 IU/mL), tetanus toxoid (predefined level ≥0.1 IU/mL), IgG antibodies to pertussis antigens (pertussis toxin, filamentous hemagglutinin and pertactin, each with the predefined level as the 5th percentile observed in the 13vPnC group), hepatitis B antibody (in milli-international units per mL \[mIU/mL\]) (predefined level ≥10 mIU/mL), neutralizing antibody (NA) titers to poliovirus types 1, 2, and 3 (predefined level NA titer ≥1:8), Haemophilus influenzae type b (Hib) (≥0.15 μg/mL) were determined on subsets of sera collected at the immunogenicity time point 1 month after Dose 3. The antibody levels were measured by a validated multiplex Luminex immunoassay. The concomitant immune responses were measured on random subsets.
- Secondary Outcome Measures
Name Time Method Serotype-specific IgG Geometric Mean Fold Rise (GMFRs) From 1 Month After Dose 3 to Before Dose 4 1 month after Dose 3 to before Dose 4 GMFR of pneumococcal 20vPnC serotypes included: 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F. The GMFR from 1 month after Dose 3 to before Dose 4 were reported from Dose 3 evaluable immunogenicity participant.
Serotype-specific IgG GMCs and GMRs at 1 Month After Dose 3 1 month after Dose 3 Pneumococcal IgG antibody against each of the 20 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F, 8, 10A, 11A, 12F, 15B, 22F and 33F) was measured using direct binding Luminex assay. Results were expressed as IgG concentrations. GMCs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution. Assay result below LLOQ were set to 0.5\*LLOQ.GMRs were reported in statistical analysis section and were calculated by exponentiating mean difference of logarithm of concentration and corresponding 2-sided 95% CI (based on Student's t distribution). Assay result below LLOQ were set to 0.5\*LLOQ.GMRs were reported in statistical analysis section and were calculated by exponentiating mean difference of logarithm of concentration and corresponding 2-sided 95% CI (based on Student's t distribution).
Percentage of Participants With Predefined IgG Concentrations 1 Month After Dose 4 1 month after Dose 4 Pre-specified levels of serotypes were as follows: for serotype 1, 3, 4, 6A, 7F, 9V, 14, 18C, 19F, 23F, 8, 10A, 11A, 12F, 15B, 22F, 33F: \>=0.35 microgram per mL (mcg/mL), for serotype 5: \>=0.23 mcg/mL, for serotype 6B: \>=0.10 mcg/mL and for serotype 19A: \>=0.12 mcg/mL. 95% CI was based on the Clopper and Pearson method.
Serotype-specific IgG GMFRs From 1 Month After Dose 3 to 1 Month After Dose 4 from 1 month after Dose 3 to 1 month after Dose 4 GMFR of pneumococcal 20vPnC serotypes included: 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F. The GMFR from 1 month after Dose 3 to 1 month after Dose 4 were reported from participants in both Dose 3 and Dose 4 evaluable immunogenicity populations.
Serotype-Specific Opsonophagocytic Activity (OPA) Geometric Mean Titers (GMTs) at 1 Month After Dose 3 1 month after Dose 3 OPA titers for the 20 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F, 8, 10A, 11A, 12F, 15B, 22F, and 33F) were determined in randomized subsets of participants at 1 month after Dose 3. Results were expressed as OPA titers. GMTs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution. OPA titers were determined in randomized subsets of participants at 1 month after Dose 3.
Percentage of Participants With Alternative Prespecified Hib Antibody Level 1 Month After Dose 3 1 month after Dose 3 Antibody concentration to the Hib vaccine antigens were determined on sera collected from a randomly selected subset of participants with sufficient sera volumes. Percentage of participants with alternative prespecified Hib antibody (≥1.0 μg/mL) were reported from Dose 3 evaluable immunogenicity participants.
GMRs of Prespecified Antibody Levels to Specific Concomitant Vaccine Antigens (Rubella) 1 Month After Dose 4 1 month after Dose 4 Antibody concentrations to concomitant vaccine antigen (rubella) were determined on sera collected 1 month after Dose 4 from a randomly selected subset of participants with sufficient sera volumes. GMs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution and were reported from Dose 4 evaluable immunogenicity participants.
Serotype-specific OPA GMTs at 1 Month After Dose 4 1 month after Dose 4 OPA titers for the 20 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F, 8, 10A, 11A, 12F, 15B, 22F, and 33F) were determined in randomized subsets of participants at 1 month after Dose 4. Results were expressed as OPA titers. GMTs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution. OPA titers were determined in randomized subsets of participants at 1 month after Dose 4.
Serotype-specific IgG GMFRs From 1 Month Before to 1 Month After Dose 4 From 1 month before to 1 month after Dose 4 GMFR of pneumococcal 20vPnC serotypes included: 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F. The GMFR from 1 month before Dose 4 to 1 month after Dose 4 were reported from Dose 4 evaluable immunogenicity participants.
Geometric Mean Ratios (GMRs) of Prespecified Antibody Levels to Specific Concomitant Vaccine Antigen (Measles) 1 Month After Dose 4 1 month after Dose 4 Antibody concentrations to concomitant vaccine antigen (measles) were determined on sera collected 1 month after Dose 4 from a randomly selected subset of participants with sufficient sera volumes. GMs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution and were reported from Dose 4 evaluable immunogenicity participants.
GMRs of Prespecified Antibody Levels to Specific Concomitant Vaccine Antigen (Mumps) 1 Month After Dose 4 1 month after Dose 4 Antibody concentrations to concomitant vaccine antigen (mumps) were determined on sera collected 1 month after Dose 4 from a randomly selected subset of participants with sufficient sera volumes. GMs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution and were reported from Dose 4 evaluable immunogenicity participants.
GMRs of Prespecified Antibody Levels to Specific Concomitant Vaccine Antigen (Varicella) 1 Month After Dose 4 1 month after Dose 4 Antibody concentrations to concomitant vaccine antigen (varicella) were determined on sera collected 1 month after Dose 4 from a randomly selected subset of participants with sufficient sera volumes. GMs and 2-sided CIs were calculated by exponentiating the mean logarithm of the concentrations and the corresponding CIs based on the Student's t distribution and were reported from Dose 4 evaluable immunogenicity participants.
Trial Locations
- Locations (98)
Palmetto Pediatrics, PA
🇺🇸North Charleston, South Carolina, United States
Northwest Arkansas Pediatrics
🇺🇸Fayetteville, Arkansas, United States
Houston Clinical Research Associates
🇺🇸Houston, Texas, United States
Lockman & Lubell Pediatric Associates
🇺🇸Fort Washington, Pennsylvania, United States
Pediatric Research of Charlottesville, LLC
🇺🇸Charlottesville, Virginia, United States
Alliance for Multispecialty Research, LLC
🇺🇸El Dorado, Kansas, United States
Optumcare Colorado Springs, LLC
🇺🇸Colorado Springs, Colorado, United States
Tekton Research, Inc
🇺🇸San Antonio, Texas, United States
Coast Clinical Research, LLC
🇺🇸Bellflower, California, United States
Advanced Investigative Medicine, Inc.
🇺🇸Hawthorne, California, United States
MedPharmics, LLC
🇺🇸Gulfport, Mississippi, United States
Southeastern Pediatric Associates
🇺🇸Dothan, Alabama, United States
The Children's Clinic of Jonesboro, P.A.
🇺🇸Jonesboro, Arkansas, United States
Gardens Medical Center
🇺🇸Bell Gardens, California, United States
Priti Desai, M.D. Inc.
🇺🇸Covina, California, United States
Universal Biopharma Research Institute Inc.
🇺🇸Fresno, California, United States
Acevedo Clinical Research Associates
🇺🇸Miami, Florida, United States
Uptown Pediatrics
🇺🇸Columbus, Georgia, United States
The Iowa Clinic
🇺🇸West Des Moines, Iowa, United States
Next Phase Research Alliance
🇺🇸Homestead, Florida, United States
Omega Pediatrics
🇺🇸Roswell, Georgia, United States
Kentucky Pediatric/Adult Research
🇺🇸Bardstown, Kentucky, United States
Smart Medical Research, Inc
🇺🇸Jackson Heights, New York, United States
Child Health Care Associates
🇺🇸Liverpool, New York, United States
Velocity Clinical Research, Covington
🇺🇸Metairie, Louisiana, United States
University of Maryland, Baltimore, Center for Vaccine Development and Global Health
🇺🇸Baltimore, Maryland, United States
SUNY Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Pediatric Medical Associates
🇺🇸East Norriton, Pennsylvania, United States
ECU Physicians Pediatric Outpatient Clinic
🇺🇸Greenville, North Carolina, United States
The Vancouver Clinic, Inc
🇺🇸Vancouver, Washington, United States
Pediatric Associates of Fairfield
🇺🇸Fairfield, Ohio, United States
Sanford Children's Specialty Clinic
🇺🇸Sioux Falls, South Dakota, United States
San Miguel Medical
🇵🇷Trujillo Alto, Puerto Rico
Pediatric Associates of Charlottesville, PLC
🇺🇸Charlottesville, Virginia, United States
Cooperativa de Facultad Medica Sanacoop DBA Instituto Sanacoop
🇵🇷Bayamon, Puerto Rico
Clinical Research Puerto Rico
🇵🇷Guayama, Puerto Rico
San Juan Hospital
🇵🇷San Juan, Puerto Rico
Diagnostic Clinic of Longview
🇺🇸Longview, Texas, United States
Ashley Pediatrics Day and Night Clinic
🇺🇸McAllen, Texas, United States
Children's of Alabama
🇺🇸Birmingham, Alabama, United States
UAB Pediatric Primary Care Clinic at Children's of Alabama
🇺🇸Birmingham, Alabama, United States
Children's Physicians Dundee
🇺🇸Omaha, Nebraska, United States
Michael W. Simon, MD, PSC
🇺🇸Lexington, Kentucky, United States
Coastal Bend Clinical Research
🇺🇸Corpus Christi, Texas, United States
Matrix Clinical Research
🇺🇸Gardena, California, United States
Kaiser Permanente Oakland
🇺🇸Oakland, California, United States
Center for Clinical Trials of San Gabriel
🇺🇸West Covina, California, United States
Crystal Biomedical Research, LLC
🇺🇸Miami Lakes, Florida, United States
Axcess Medical Research
🇺🇸Loxahatchee Groves, Florida, United States
Saltzer Health
🇺🇸Nampa, Idaho, United States
Columbus Regional Research Institute
🇺🇸Columbus, Georgia, United States
Boeson Research
🇺🇸Missoula, Montana, United States
Leo Jenkins Cancer Center Pharmacy
🇺🇸Greenville, North Carolina, United States
ECU Physicians Adult and Pediatric Health Center
🇺🇸Greenville, North Carolina, United States
Senders Pediatrics
🇺🇸South Euclid, Ohio, United States
Allegheny Health and Wellness Pavilion
🇺🇸Erie, Pennsylvania, United States
Premier Medical Group
🇺🇸Clarksville, Tennessee, United States
DCOL Center for Clinical Research
🇺🇸Longview, Texas, United States
Kool Kids Pediatrics
🇺🇸Houston, Texas, United States
La Providence Pediatrics Clinic
🇺🇸Houston, Texas, United States
Wee Care Pediatrics
🇺🇸Syracuse, Utah, United States
Dr. Ruben Aleman & Associates
🇺🇸McAllen, Texas, United States
Wasatch Pediatrics, Cottonwood Office
🇺🇸Murray, Utah, United States
Dixie Pediatrics
🇺🇸Saint George, Utah, United States
Hispanic Alliance for Clinical and Translational Research
🇵🇷San Juan, Puerto Rico
Qway Research
🇺🇸Hialeah, Florida, United States
Snake River Research, PLLC
🇺🇸Idaho Falls, Idaho, United States
Holston Medical Group
🇺🇸Kingsport, Tennessee, United States
Bio-Medical Research, LLC
🇺🇸Miami, Florida, United States
LeBonheur Children's Hospital
🇺🇸Memphis, Tennessee, United States
Velocity Clinical Research at Primary Pediatrics, Macon
🇺🇸Baton Rouge, Louisiana, United States
Midwest Children's Health Research Institute
🇺🇸Lincoln, Nebraska, United States
Idaho Falls Pediatrics
🇺🇸Idaho Falls, Idaho, United States
ACC Pediatric Research
🇺🇸Haughton, Louisiana, United States
Gentle Medicine Associates
🇺🇸Boynton Beach, Florida, United States
Clinical Research Prime
🇺🇸Idaho Falls, Idaho, United States
Family First Medical Center
🇺🇸Idaho Falls, Idaho, United States
The Pediatric Center
🇺🇸Idaho Falls, Idaho, United States
Suncoast Research Associates, LLC
🇺🇸Miami, Florida, United States
Sanford 69th & Louise Family Medicine
🇺🇸Sioux Falls, South Dakota, United States
Meridian Clinical Research
🇺🇸Hastings, Nebraska, United States
Benchmark Research
🇺🇸Covington, Louisiana, United States
ASR, LLC
🇺🇸Nampa, Idaho, United States
The Pediatric Center of Frederick, LLC
🇺🇸Frederick, Maryland, United States
Children's Colorado Health Pavilion (Child Health Clinic)
🇺🇸Aurora, Colorado, United States
Children's Hospital Colorado
🇺🇸Aurora, Colorado, United States
Sarkis Clinical Trials
🇺🇸Gainesville, Florida, United States
Benton Pediatrics
🇺🇸Gainesville, Florida, United States
Children's Health Center
🇺🇸Tampa, Florida, United States
Blank Children's Pediatric Clinic
🇺🇸Des Moines, Iowa, United States
Unity Point Health
🇺🇸Des Moines, Iowa, United States
Novak Center for Children's Health
🇺🇸Louisville, Kentucky, United States
Brownsboro Park Pediatrics
🇺🇸Louisville, Kentucky, United States
Coastal Pediatric Research
🇺🇸Charleston, South Carolina, United States
Medpharmics
🇺🇸Albuquerque, New Mexico, United States
Dayton Clinical Research
🇺🇸Dayton, Ohio, United States
Ohio Pediatric Research Association, Inc.
🇺🇸Dayton, Ohio, United States
Orange County Research Institute
🇺🇸Ontario, California, United States