Participants Ages 12-15

Volunteer by completing the questionnaire below

For participants ages 16-17 please complete the questionnaire HERE.

 

Studies that involve new medications or new vaccines have strict rules about who can take part. Therefore, we need to collect some information about you to help us understand whether you will be able to participate in this study.

VLA2001-301 is a clinical study testing a new vaccine candidate (VLA2001) to prevent COVID-19. We will evaluate this investigational product against a placebo. Valneva Austria GmbH is the Sponsor of this study and Pharm Olam LLC is the company supporting Valneva in performing the trial in the UK.

We are committed to protecting and respecting your and your child’s privacy. For general information on how Valneva Austria GmbH processes personal data in relation to this website, please see our Privacy Notice.

By clicking the "Next" button on the form, you consent to allow Valneva Austria GmbH to store and process the personal information and the answers to the questionnaire submitted to determine your potential eligibility for this study and submit the data to the participating NHS study site.

Please complete the following questionnaire and find out if your child qualifies for trial participation.

Please send all questionnaire support inquiries to: ukcovid19study@pharm-olam.com

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Please select the participant's age.
Has a pregnancy been confirmed?
Does your child have a medical condition treated with medications that requires regular visits to a GP or specialist and/or that require frequent adjustments of medication?
Does your child have a history of cancer in the past 5 years other than skin cancer?
Does your child have a history of a severe or uncontrolled autoimmune or inflammatory disease (like Guillain-Barre syndrome)?
Does your child have a history of HIV?
Does your child have a history of immunosuppressive therapy in the past 4 weeks?
Does your child have a history of allergy to any vaccines?
Has your child received any vaccinations intended to prevent COVID-19?
Has your child had a vaccine other than the licensed influenza (Flu) vaccine in the past month?
Has your child had already a COVID-19 infection?
The study requires your child’s attendance at a visit approximately 4 weeks, 6 weeks, 10 weeks, 7 months, 8 months, 9 months (for some), 10 months (for some), 12 months (for some) and 14 months (for some) after their first vaccination. Do you have any plans that might make this difficult?
Email
Child’s First Name
Child's Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
What is your phone number?
What is your post code?
(This helps us route you to the correct participating NHS facility)
We are committed to protecting and respecting your and your child’s privacy. By submitting information to us via this website personal details will be stored and may be submitted to the participating NHS or private research site. For details on the processing of personal data please review our Privacy Notice. Due to high numbers of responses, we might not be able to get back to everyone—if you do not hear from us, then we are unable to offer your child participation in this trial.Please send all questionnaire support inquiries to: ukcovid19study@pharm-olam.com
By clicking submit below, you consent to allow Valneva COVID-19 Study to store and process the personal information submitted above to provide you the content requested.

Please select a location...

Thank you for your interest

Due to a high number of responses, we might not be able to get back to everyone—if you do not hear from us, then we are unable to offer you participation in this trial.

Please send all questionnaire support inquiries to:ukcovid19study@pharm-olam.com

Thank you for taking the time to complete this pre-screening questionnaire.

Unfortunately, you are not eligible for this trial, however we are very grateful for your interest.

Please confirm you are completing the correct form to participate:

If you find you are unable to take part for any reason, this is not necessarily a reflection of your health or whether you could have a COVID-19 vaccine in the future.

Please send all questionnaire support inquiries to:ukcovid19study@pharm-olam.com

For more information about Valneva and their COVID-19 vaccine candidate please refer to https://valneva.com/research-development/covid-19-vla2001/