A Phase II Study in Healthy Adults (19-64 Years of Age) to Assess the Safety, Reactogenicity and Immunogenicity of Sequential or Simultaneous Intramuscular Administration of an AS03-adjuvanted A/H7N9 Inactivated Influenza Vaccine With Seasonal Influenza Vaccine
Phase: PHASE2
Conditions: Avian Influenza, Influenza, Influenza Immunisation
Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)

A Phase II Study in Healthy Adults (19-64 Years of Age) to Assess the Safety, 
Reactogenicity and Immunogenicity of Sequential or Simultaneous Intramuscular 
Administration of an AS03-adjuvanted A/H7N9 Inactivated Influenza Vaccine 
with Seasonal Influenza Vaccine 
DMID Protocol Number: 
17-0077
DMID Funding Mechanism: Vaccine and Treatment Evaluation Units 
Pharmaceutical Support: 
Sanofi Pasteur 
GlaxoSmithKline Biologicals 
IND Sponsor: Division of Microbiology and Infectious Diseases, National 
Institute of Allergy and Infectious Diseases, National Institutes of Health 
Lead Principal Investigator: Kathleen M. Neuzil, MD, MPH 
DMID Clinical Project Manager: Tena Knudsen, RN 
DMID Medical Monitor: Shy Shorer, MD, MBA, EJD 
DMID Medical Officer: Trinka Coster, MD, MS 
DMID Scientific Lead: Chris Roberts, PhD 
Version: 5.0 
 September 18, 2018 

DMID Protocol 17-0077 
Version 5.0 
Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
September 18, 2018 
 
2 
STATEMENT OF COMPLIANCE 
This trial will be carried out in accordance with Good Clinical Practice (GCP) and as required by 
the following: 
• United States Code of Federal Regulations (CFR) 45 CFR Part 46: Protection of 
Human Subjects 
• Food and Drug Administration (FDA) Regulations, as applicable: 21 CFR Part 50 
(Protection of Human Subjects), 21 CFR Part 54 (Financial Disclosure by Clinical 
Investigators), 21 CFR Part 56 (Institutional Review Boards), 21 CFR Part 11, 
and 21 CFR Part 312 (Investigational New Drug Application), 21 CFR 812 
(Investigational Device Exemptions) 
• International Conference on Harmonisation: Good Clinical Practice (ICH E6); 62 
Federal Register 25691 (1997); and future revisions 
• Belmont Report: Ethical Principles and Guidelines for the Protection of Human 
Subjects of Research, Report of the National Commission for the Protection of 
Human Subjects of Biomedical and Behavioral Research 
• National Institutes of Health (NIH) Office of Extramural Research, Research 
Involving Human Subjects, as applicable 
• National Institute of Allergy and Infectious Diseases (NIAID) Clinical Terms of 
Award, as applicable 
• Applicable Federal, State, and Local Regulations and Guidance 

DMID Protocol 17-0077 
Version 5.0 
Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
September 18, 2018 
 
3 
SIGNATURE PAGE 
The signature below provides the necessary assurance that this trial will be conducted according 
to all stipulations of the protocol, including all statements regarding confidentiality, and 
according to local legal and regulatory requirements and applicable US federal regulations and 
ICH E6 Good Clinical Practice (GCP) guidelines. 
 
I agree to conduct the study in compliance with GCP and applicable regulatory requirements. 
 
I agree to conduct the study in accordance with the current protocol and will not make changes to 
the protocol without obtaining the sponsor’s approval and IRB/IEC approval, except when 
necessary to protect the safety, rights, or welfare of subjects. 
 
Site Principal Investigator: 
 
Signed: 
 
 
Date: 
 
 
Name 
Title 
 
 
 

DMID Protocol 17-0077 
Version 5.0 
Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
September 18, 2018 
 
4 
TABLE OF CONTENTS 
 
STATEMENT OF COMPLIANCE .................................................................................................2 
SIGNATURE PAGE ................................................................................................................................. 3 
TABLE OF CONTENTS .......................................................................................................................... 4 
LIST OF TABLES ..................................................................................................................................... 9 
LIST OF FIGURES ................................................................................................................................. 10 
LIST OF ABBREVIATIONS ................................................................................................................ 11 
PROTOCOL SUMMARY ...................................................................................................................... 14 
1 
Key Roles ........................................................................................................................................ 23 
2 
Background Information and Scientific Rationale ..................................................................... 25 
2.1 
Background Information ...........................................................................................25 
2.1.1 Public Readiness and Emergency Preparedness Act ....................................28 
2.2 
Scientific Rationale ........................................................................................................... 29 
2.3 
Potential Risks and Benefits ............................................................................................ 31 
2.3.1 Potential Risks ...................................................................................................... 31 
2.3.2 Known Potential Benefits .................................................................................... 38 
3 
Study Objectives and Outcome Measures ................................................................................... 39 
3.1 
Study Objectives ................................................................................................................ 39 
3.1.1 Primary ................................................................................................................... 39 
3.1.2 Secondary .............................................................................................................. 39 
3.1.3 Exploratory ............................................................................................................ 39 
3.2 
Study Outcome Measures ................................................................................................. 40 
3.2.1 Primary ................................................................................................................... 40 
3.2.2 Secondary .............................................................................................................. 41 
3.2.3 Exploratory ............................................................................................................ 42 
4 
Study Design ................................................................................................................................... 43 
5 
Study Enrollment and Withdrawal ............................................................................................... 45 
5.1 
Eligibility Criteria .............................................................................................................. 45 
5.1.1 Subject Inclusion Criteria .................................................................................... 45 
5.1.2 Subject Exclusion Criteria ................................................................................... 46 
5.2 
Treatment Assignment Procedures ................................................................................. 48 
5.2.1 Enrollment and Randomization Procedures ...................................................... 48 
5.2.2 Masking Procedures ............................................................................................. 49 
5.2.3 Reasons for Withdrawals and Discontinuation of Treatment ......................... 49 
5.2.4 Handling of Withdrawals and Discontinuation of Treatment ........................ 52 
5.2.5 Termination of Study ........................................................................................... 52 
6 
Study Intervention/Investigational Product................................................................................. 53 
6.1 
Study Product Description ............................................................................................... 53 

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6.1.1 Acquisition ............................................................................................................ 54 
6.1.2 Formulation, Storage, Packaging, and Labeling .............................................. 54 
6.1.3 Study Product Storage and Stability Procedures .............................................. 55 
6.2 
Dosage, Preparation, and Administration of Study Intervention/ Investigational 
Product ................................................................................................................................ 56 
6.3 
Modification of Study Intervention/Investigational Product for a Subject ................ 58 
6.4 
Accountability Procedures for the Study Intervention/ Investigational Product....... 58 
6.5 
Assessment of Subject Compliance with Study Intervention/ Investigational Product
 .............................................................................................................................................. 59 
6.6 
Concomitant Medications/Treatments ............................................................................ 59 
7 
Study Procedures and Evaluations ............................................................................................... 61 
7.1 
Clinical Evaluations .......................................................................................................... 61 
7.2 
Laboratory Evaluations ..................................................................................................... 62 
7.2.1 Clinical Laboratory Evaluations ......................................................................... 62 
7.2.2 Special Assays or Procedures ............................................................................. 63 
7.2.3 Specimen Preparation, Handling, and Shipping ............................................... 69 
7.2.3.1 Instructions for Specimen Preparation, Handling, and Storage ........69 
7.2.3.2 Specimen Shipment ................................................................................. 69 
8 
Study Schedule ............................................................................................................................... 71 
8.1 
Screening (Optional) and Enrollment Visits, All Groups ............................................ 71 
8.1.1 Visit 00, Screening Clinic Visit (Optional) (Day -28 to -1) ........................... 71 
8.1.2 Visit 01, Day 1, Enrollment (for subjects previously screened at Day -28 to -
1) and Dose 1, Clinic Visit .................................................................................. 72 
8.1.3 Visit 01, Day 1, Enrollment/Baseline (for subjects not previously screened 
at Day -28 to -1) and Dose 1, Clinic Visit ......................................................... 74 
8.2 
Follow-up Visits, Group 1 ................................................................................................ 76 
8.2.1 Visit 02, Day 4, Memory Aid Review, Phone Call ......................................... 76 
8.2.2 Visit 03, Day 8, Clinic Visit ................................................................................ 76 
8.2.3 Visit 04, Day 22, Dose 2, Clinic Visit ............................................................... 77 
8.2.4 Visit 05, Day 25, Memory Aid Review, Phone Call ....................................... 79 
8.2.5 Visit 06, Day 29, Clinic Visit ............................................................................. 79 
8.2.6 Visit 07, Day 43, Safety Follow-up Clinic Visit .............................................. 80 
8.2.7 Visit 08, Day 64, Safety Follow-up, Clinic Visit ............................................. 81 
8.2.8 Visit 09, Day 181, Safety Follow-up, Clinic Visit ........................................... 81 
8.2.9 Visit 10, Day 202, Safety Follow-up, Clinic Visit ........................................... 82 
8.2.10 Visit 11, Day 387, Safety Follow-up, Phone Call ............................................ 83 
8.3 
Follow-up Visits, Group 2 ................................................................................................ 83 
8.3.1 Visit 02, Day 4, Memory Aid Review, Phone Call ......................................... 83 
8.3.2 Visit 03, Day 8, Clinic Visit ................................................................................ 83 
8.3.3 Visit 04, Day 22, Dose 2, Clinic Visit ............................................................... 84 

DMID Protocol 17-0077 
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8.3.4 Visit 05, Day 25, Memory Aid Review, Phone Call ....................................... 86 
8.3.5 Visit 06, Day 29, Clinic Visit ............................................................................. 86 
8.3.6 Visit 07, Day 43, Dose 3, Clinic Visit ............................................................... 87 
8.3.7 Visit 08, Day 46, Memory Aid Review, Phone Call ....................................... 89 
8.3.8 Visit 09, Day 50, Clinic Visit ............................................................................. 89 
8.3.9 Visit 10, Day 64, Safety Follow-up, Clinic Visit ............................................. 90 
8.3.10 Visit 11, Day 181, Safety Follow-up, Clinic Visit ........................................... 91 
8.3.11 Visit 12, Day 223, Safety Follow-up, Clinic Visit ........................................... 91 
8.3.12 Visit 13, Day 408, Safety Follow-up, Phone Call ............................................ 92 
8.4 
Follow-up Visits, Group 3 ................................................................................................ 92 
8.4.1 Visit 02, Day 4, Memory Aid Review, Phone Call ......................................... 92 
8.4.2 Visit 03, Day 8, Clinic Visit ................................................................................ 93 
8.4.3 Visit 04, Day 22, Safety Follow-up, Clinic Visit ............................................. 94 
8.4.4 Visit 05, Day 43, Safety Follow-up, Clinic Visit ............................................. 94 
8.4.5 Visit 06, Day 64, Safety Follow-up, Clinic Visit ............................................. 95 
8.4.6 Visit 07, Day 181, Safety Follow-up, Clinic Visit ........................................... 95 
8.4.7 Visit 08, Day 366, Safety Follow-up, Phone Call ............................................ 96 
8.5 
Early Termination Visit (if needed) ................................................................................ 96 
8.6 
Unscheduled Visit (if needed) ......................................................................................... 98 
9 
Assessment of Safety ................................................................................................................... 100 
9.1 
Specification of Safety Parameters ............................................................................... 100 
9.2 
Methods and Timing for Assessing, Recording, and Analyzing Safety Parameters
 ............................................................................................................................................ 100 
9.2.1 Adverse Events ................................................................................................... 100 
9.2.2 Reactogenicity .................................................................................................... 102 
9.2.3 Additional Adverse Event Severity Grading .................................................. 104 
9.2.4 Serious Adverse Events ..................................................................................... 107 
9.2.5 Procedures to be Followed in the Event of Abnormal Laboratory Test 
Values or Abnormal Clinical Findings ............................................................ 108 
9.3 
Reporting Procedures ...................................................................................................... 109 
9.3.1 Serious Adverse Events ..................................................................................... 109 
9.3.2 Regulatory Reporting for Studies Conducted Under DMID-Sponsored IND
 ............................................................................................................................... 110 
9.3.3 Reporting of Pregnancy ..................................................................................... 110 
9.4 
Type and Duration of Follow-up of Subjects after Adverse Events ......................... 110 
9.5 
Halting Rules .................................................................................................................... 111 
9.6 
Safety Oversight .............................................................................................................. 112 
9.6.1 Independent Safety Monitor (ISM) .................................................................. 112 
9.6.2 Data and Safety Monitoring Board (DSMB) .................................................. 113 
10 
Clinical Monitoring ...................................................................................................................... 115 

DMID Protocol 17-0077 
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Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
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10.1 
Site Monitoring Plan ....................................................................................................... 115 
11 
Statistical Considerations ............................................................................................................ 116 
11.1 
Introduction ...................................................................................................................... 116 
11.2 
Study Hypotheses ............................................................................................................ 116 
11.3 
Study Outcome Measures ............................................................................................... 116 
11.4 
Sample Size Considerations ........................................................................................... 116 
11.4.1 Study Population ................................................................................................ 116 
11.4.2 Subject Enrollment and Follow-up .................................................................. 117 
11.4.3 Sample Size ......................................................................................................... 117 
11.5 
Planned Interim Analyses ............................................................................................... 119 
11.5.1 Interim Safety Review ....................................................................................... 120 
11.5.2 Interim Immunogenicity Review ...................................................................... 120 
11.6 
Final Analysis Plan .......................................................................................................... 121 
11.6.1 Analysis Populations .......................................................................................... 121 
11.6.2 Safety Data .......................................................................................................... 122 
11.6.3 Immunogenicity Data......................................................................................... 123 
11.6.4 Missing Values and Outliers ............................................................................. 124 
12 
Data Collection Forms and Access to Source Data/Documents ............................................ 125 
13 
Quality Control and Quality Assurance ..................................................................................... 126 
14 
Ethics/Protection of Human Subjects ........................................................................................ 127 
14.1 
Ethical Standard ............................................................................................................... 127 
14.2 
Institutional Review Board............................................................................................. 127 
14.3 
Informed Consent Process .............................................................................................. 127 
14.3.1 Informed Consent ............................................................................................... 127 
14.4 
Exclusion of Women, Minorities, and Children (Special Populations) ................... 128 
14.5 
Subject Confidentiality ................................................................................................... 129 
14.6 
Study Discontinuation ..................................................................................................... 130 
14.7 
Costs, Subject Compensation, and Research Related Injuries .................................. 131 
14.8 
Future Use of Stored Specimens ................................................................................... 131 
15 
Data Handling and Record Keeping .......................................................................................... 133 
15.1 
Data Management Responsibilities ............................................................................... 133 
15.2 
Data Capture Methods .................................................................................................... 133 
15.3 
Types of Data ................................................................................................................... 134 
15.4 
Timing/Reports ................................................................................................................ 134 
15.5 
Study Records Retention ................................................................................................ 135 
16 
Protocol Deviations ...................................................................................................................... 136 
17 
Publication Policy ......................................................................................................................... 137 
18 
Literature References ................................................................................................................... 138 
Appendices .............................................................................................................................................. 143 
APPENDIX A: SCHEDULE OF STUDY PROCEDURES AND EVALUATIONS .................. 144 

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APPENDIX B: LIST OF POTENTIALLY IMMUNE-MEDIATED MEDICAL CONDITIONS
 ......................................................................................................................................................... 154 
 
 
 

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LIST OF TABLES 
Table 1: Study Design ....................................................................................................................21 
Table 2 a 
 ....................................................................................................................................65 
Table 2 b  ....................................................................................................................................67 
Table 2 c 
 ....................................................................................................................................69 
Table 3: Power (%) to Detect Safety Events: ..............................................................................117 
Table 4: Precision of Binomial Confidence Intervals: .................................................................118 
Table 5: Objective 1 -Minimum Detectable Difference in Proportion Responders with 
80% Power (N = 50 per group).................................................................................118 
Table 6: Objective 2 - Minimum Detectable Difference in Proportion Responders with 
80% Power ................................................................................................................119 
 
 
 
 

DMID Protocol 17-0077 
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Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
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LIST OF FIGURES 
Figure 1: Schematic of Study Design ............................................................................................22 
 

DMID Protocol 17-0077 
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Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
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LIST OF ABBREVIATIONS 
A/H1N1 
Influenza A Virus of the H1N1 Subtype 
A/H2N2 
Influenza A Virus of the H2N2 Subtype 
A/H3N2 
A/H3N2v 
Influenza A Virus of the H3N2 Subtype 
Influenza A Virus of the H3N2 Variant Subtype 
A/H5N1  
A/H5N2 
A/H5N3 
A/H5N6 
Influenza A Virus of the H5N1 Subtype 
Influenza A Virus of the H5N2 Subtype 
Influenza A Virus of the H5N3 Subtype 
Influenza A Virus of the H5N6 Subtype 
A/H7N7 
Influenza A Virus of the H7N7 Subtype 
A/H7N9 
Influenza A Virus of the H7N9 Subtype 
AS03 
Adjuvant System 03 
AdvantageEDCSM 
Electronic Data Capture System 
AE 
Adverse Event/Adverse Experience 
AESI 
Adverse Event of Special Interest 
ALT 
Alanine Aminotransferase 
ANCA 
Anti-Neutrophil Cytoplasmic Antibody 
BARDA 
Biomedical Advanced Research and Development Authority 
BLA 
Biologics License Applications 
BMI 
Body Mass Index 
BPM 
Beats Per Minute 
CDC 
Centers for Disease Control and Prevention 
CFR 
Code of Federal Regulations 
CHMP 
Committee for Medicinal Products for Human Use 
CI 
CMS 
Confidence Interval 
Clinical Materials Services 
Cr 
Creatinine 
CROMS 
Clinical Research Operations and Management Support 
CSL 
Commonwealth Serum Laboratories 
CSR 
Clinical Study Report 
°C 
Degrees Celsius 
°F 
Degrees Fahrenheit 
D 
Day(s) 
DCF 
Data Collection Form 
DHHS 
Department of Health and Human Services 
DMID 
Division of Microbiology and Infectious Diseases, NIAID, NIH 
DSMB 
Data and Safety Monitoring Board 
eCRF 
Electronic Case Report Form 
ESR 
Erythrocyte Sedimentation Rate 

DMID Protocol 17-0077 
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FDA 
Food and Drug Administration 
FWA 
Federalwide Assurance 
g/dL 
Grams per Deciliter 
GBS 
Guillain-Barré Syndrome 
GCP 
Good Clinical Practice 
GMT 
Geometric Mean Titer 
GSK 
GlaxoSmithKline Biologicals 
HA 
Hemagglutinin 
HAI 
Hemagglutination Inhibition 
Hgb 
Hemoglobin 
HIPAA 
Health Insurance Portability and Accountability Act 
HIV 
Human Immunodeficiency Virus 
HPAI 
Highly Pathogenic Avian Influenza 
HRSA 
Health Resources and Services Administration 
IATA 
International Air Transport Association 
IB 
Investigator’s Brochure 
ICF 
Informed Consent Form 
ICH 
 International Conference on Harmonisation 
ICMJE 
International Committee of Medical Journal Editors 
IgG 
Immunoglobulin G 
IIV 
Inactivated Influenza Vaccine 
IIV3 
Trivalent Inactivated Influenza Vaccine 
IIV4 
Quadrivalent Inactivated Influenza Vaccine 
IM 
Intramuscular 
IND 
Investigational New Drug Application 
IRB 
Institutional Review Board 
ISM 
Independent Safety Monitor 
IU/L 
International Unit(s) per Liter 
mcg  
Microgram(s) 
µL 
Microliter(s) 
MAAEs 
Medically-Attended Adverse Events 
MedDRA 
Medical Dictionary for Regulatory Activities 
MF59 
 MF59C.1 Adjuvant 
mg/dL 
Milligram(s) per Deciliter 
mITT 
Modified Intent-to-Treat 
mL 
Milliliter(s) 
mm 
Millimeter(s) 
mmHg 
Millimeters of Mercury 
MOP 
Manual of Procedures 

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N 
Number of Subjects 
NA 
Neuraminidase 
Neut 
Neutralizing or Neutralization 
NI  
Neuraminidase Inhibiting 
NIAID 
National Institute of Allergy and Infectious Diseases, DHHS 
NIH 
National Institutes of Health 
NSAIDs 
Non-Steroidal Anti-Inflammatory Drugs 
NOCMCs 
New-Onset Chronic Medical Conditions 
OER 
Office of Extramural Research 
OHRP 
Office for Human Research Protections 
PBS 
Phosphate Buffered Saline 
pH1N1 
2009 H1N1 Influenza 
PHI 
Personal Health Information 
PIMMCs 
Potentially Immune-Mediated Medical Conditions 
PLT 
Platelets 
PP 
Per Protocol 
PREP Act 
Public Readiness and Emergency Preparedness Act 
PRN 
As Needed 
QA 
Quality Assurance 
QC 
Quality Control 
SAE 
Serious Adverse Event/Serious Adverse Experience 
SAP 
Statistical Analysis Plan 
SDCC 
Statistical and Data Coordinating Center 
SOC 
System Organ Class 
SOP 
Standard Operating Procedure 
T. Bili 
Total Bilirubin 
TBD 
To Be Determined 
US 
United States 
V 
Visit(s) 
VTEU 
Vaccine and Treatment Evaluation Unit 
WBC 
White Blood Cells 
WHO 
World Health Organization 

DMID Protocol 17-0077 
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Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
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PROTOCOL SUMMARY 
Title: 
A Phase II Study in Healthy Adults (19-64 Years of Age) to Assess the 
Safety, Reactogenicity and Immunogenicity of Sequential or 
Simultaneous Intramuscular Administration of an AS03-adjuvanted 
A/H7N9 Inactivated Influenza Vaccine with Seasonal Influenza Vaccine 
 
Phase: 
II 
Population: 
Approximately 150 individuals 19-64 years old, who have no history of 
influenza A/H7N9 infection or prior receipt of an influenza virus H7 
subtype vaccine. 
Number of Sites: 
Up to 4 Vaccine and Treatment Evaluation Unit (VTEU) sites 
Study Duration: 
Approximately sixteen (16) months 
Subject Participation 
Duration: 
Approximately thirteen (13) months 
Estimated Time to Complete 
Enrollment: 
Approximately 12 weeks 
Description of Agent: 
Two doses delivered intramuscularly (IM) approximately 21 days apart 
of an AS03-adjuvanted 2017 H7N9 inactivated influenza vaccine (IIV) 
(3.75 mcg hemagglutinin [HA] from A/Hong Kong/125/2017 H7N9 
vaccine per dose) administered with a licensed seasonal influenza 
vaccine (15 mcg HA per strain per dose, quadrivalent IIV [IIV4]) given 
simultaneously with the first AS03-adjuvanted 2017 A/H7N9 IIV dose 
or sequentially at approximately 21 days prior to the first AS03-
adjuvanted 2017 A/H7N9 IIV dose.  One arm receiving only IIV4 is 
included as a comparator. All doses are to be given un-blinded following 
randomization. 
Study Objectives: 
 
Primary: 
Safety: 
• 
To assess the safety and reactogenicity following sequential or 
simultaneous IM administration of 2 doses of AS03-adjuvanted 
2017 H7N9 IIV and one dose of seasonal influenza vaccine 
(IIV4).  
Immunogenicity: 

DMID Protocol 17-0077 
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Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
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• 
To assess the serum hemagglutination inhibition (HAI) and 
neutralizing (Neut) antibody responses against A/H7N9 at 
approximately 21 days following receipt of two doses of AS03-
adjuvanted 2017 H7N9 IIV administered IM approximately 21 
days apart. 
• 
To assess the serum HAI and Neut antibody responses against 
the seasonal influenza strains at approximately 21 days 
following receipt of IIV4. 
 
Secondary: 
Safety: 
• 
To assess unsolicited non-serious adverse events (AEs), 
following sequential or simultaneous IM administration of 
AS03-adjuvanted 2017 H7N9 IIV and seasonal influenza 
vaccine (IIV4).  
• 
To assess medically-attended adverse events (MAAEs), 
including new-onset chronic medical conditions (NOCMCs) and 
potentially immune-mediated medical conditions (PIMMCs), 
following sequential or simultaneous IM administration of AS03 
adjuvanted 2017 H7N9 IIV and IIV4. 
Immunogenicity: 
• 
To assess the HAI and Neut antibody responses at 21 days 
following receipt of 1 dose of AS03-adjuvanted 2017 H7N9 IIV. 
 
Exploratory: 
Immunogenicity: 
• 
To assess the effects of age, sex, body mass index (BMI), and 
receipt of prior year(s) seasonal influenza vaccine(s) on serum 
HAI antibody responses following receipt of two doses of 
AS03-adjuvanted 2017 H7N9 IIV.  
• 
To assess the durability of the antibody response to the 2017 
H7N9 study vaccine strain and the IIV4 strains at approximately 
180 days following the second dose of AS03-adjuvanted 2017 
H7N9 IIV vaccine. 
• 
To assess the neuraminidase (NA) content of the 2017 H7N9 
IIV and the licensed seasonal IIV4 and determine the serum 
antibody responses to NA following receipt of 2017 H7N9 IIV 
and licensed seasonal IIV4. 
 

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Study Outcome Measures: 
 
Primary: 
Safety: 
• 
Occurrence of all serious adverse events (SAEs) following the 
first study vaccination through approximately 12 months after 
the last study vaccination. 
• 
Occurrence of study vaccine-related SAEs following the first 
study vaccination through approximately 12 months after the 
last study vaccination. 
• 
Occurrence of solicited injection site and systemic AEs 
following each study vaccination through 7 days after each 
study vaccination.  
• 
Occurrence of clinical safety laboratory AEs following each 
study vaccination through approximately 7 days after each study 
vaccination. 
Immunogenicity: 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
seroconversion against the 2017 H7N9 study vaccine strain 
(defined as either a pre-vaccination titer <1:10 and a post-
vaccination titer ≥1:40 or a pre-vaccination titer ≥1:10 and a 
minimum four-fold rise in post-vaccination antibody titer) at 
approximately 21 days after 2 doses of AS03-adjuvanted 2017 
H7N9 IIV (Group 1– Day 43; Group 2 – Day 64; Group 3 – 
N/A). 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
seroconversion against each of the study IIV4 strains at 
approximately 21 days after receipt of study IIV4 (Groups 1, 2 
and 3 – Day 22).  
• 
For HAI and Neut antibodies, percentage of subjects with an 
antibody titer of ≥1:40 against the influenza 2017 H7N9 study 
vaccine strain at approximately 21 days following receipt of 2 
doses of AS03-adjuvanted 2017 H7N9 IIV (Group 1– Day 43; 
Group 2 – Day 64; Group 3 – N/A). 
• 
For HAI and Neut antibodies, percentage of subjects with an 
antibody titer of ≥1:40 against each of the study IIV4 strains at 
approximately 21 days after receipt of study IIV4 (Groups 1, 2 
and 3 – Day 22).  
• 
Geometric Mean Titers (GMTs) of serum HAI and Neut 
antibodies against the 2017 H7N9 IIV strain at approximately 21 

DMID Protocol 17-0077 
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days following receipt of 2 doses of AS03-adjuvanted 2017 
H7N9 IIV (Group 1– Day 43; Group 2 – Day 64; Group 3 – 
N/A).  
• 
GMTs of serum HAI and Neut antibodies against each of the 
2017 IIV4 strains at approximately 21 days after receipt of IIV4 
(Groups 1, 2, and 3 – Day 22). 
 
Secondary: 
Safety: 
• 
Occurrence of study vaccine-related unsolicited non-serious AEs 
following each study vaccination through approximately 21 days 
after each study vaccination. 
• 
Occurrence of all unsolicited non-serious AEs following each 
study vaccination through approximately 21 days after each 
study vaccination.  
• 
Occurrence of MAAEs, including NOCMCs and PIMMCs, 
following the first study vaccination through approximately 12 
months after the last study vaccination. 
Immunogenicity: 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
seroconversion against the 2017 H7N9 vaccine strain at 
approximately 21 days after receipt of 1 dose of AS03-
adjuvanted 2017 H7N9 IIV (Group 1– Day 22; Group 2 – Day 
43; Group 3 – N/A). 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
serum HAI and Neut antibody titers ≥1:40 against the influenza 
2017 H7N9 vaccine strain at baseline and approximately 21 
days after receipt of 1 dose of AS03-adjuvanted 2017 H7N9 IIV 
(Group 1–Day 1 (baseline) and Day 22; Group 2 –Day 22 
(baseline), and Day 43; Group 3 – N/A). 
• 
GMTs of serum HAI and Neut antibodies against the influenza 
2017 H7N9 vaccine virus at baseline and at approximately 21 
days after receipt of 1 dose of AS03-adjuvanted 2017 H7N9 IIV 
(Group 1–Day 1 (baseline) and Day 22; Group 2 –Day 22 
(baseline), and Day 43; Group 3 – N/A). 
Exploratory: 

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Immunogenicity: was manufactured using 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
seroconversion, percentage with titer ≥1:40 and the GMTs 
against the 2017 H7N9 study vaccine strain approximately 21 
and 180 days after 2 doses of adjuvanted 2017 H7N9 IIV, 
stratified by age, sex, BMI, and prior receipt of seasonal 
influenza vaccine(s) for Groups 1 and 2. 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
seroconversion, percentage with a titer ≥1:40 and the GMTs 
against the IIV4 vaccine strains approximately 21 and 180 days 
after receipt of IIV4, stratified by age, sex, BMI, and prior 
receipt of seasonal influenza vaccine(s). 
• 
For HAI and Neut antibodies, percentage of subjects achieving 
seroconversion, percentage with titer ≥1:40, and GMTs against 
the 2017 H7N9 study vaccine strain at approximately 180 days 
after 2 doses of adjuvanted 2017 H7N9 IIV for Groups 1 and 2. 
• 
Percentage of subjects with detectable levels of serum N1, N2 
and N9 NA-specific antibody elicited by 2017 H7N9 and 
seasonal IIV4 vaccination, and the correlation of the NA content 
of 2017 H7N9 IIV and seasonal IIV4 with the elicited NA-
specific antibody responses at baseline and approximately 21 
and 180 days after 2 doses of adjuvanted 2017 H7N9 IIV for 
Groups 1 and 2, and approximately 21 and 180 days after receipt 
of the seasonal IIV4 vaccine for all Groups. 
 
Description of Study Design: 
This is a randomized, un-blinded, Phase II study in males and non-
pregnant females, who are in good health, 19 to 64 years of age. This 
clinical trial is designed to assess the safety, reactogenicity, and 
immunogenicity of a pre-pandemic AS03 (GlaxoSmithKline Biologicals 
[GSK]) adjuvanted 2017 monovalent inactivated influenza A/H7N9 
vaccine (2017 H7N9 IIV) manufactured by Sanofi Pasteur (3.75 mcg of 
HA per dose), with Phosphate Buffered Saline (PBS) diluent, when two 
doses are administered 21 days apart either sequentially or 
simultaneously (within 15 minutes) with licensed seasonal influenza 
vaccine.
 
 
IIV4 will be provided through the Division of Microbiology and 
Infectious Diseases (DMID) DMID Clinical Materials Services 
Contract (CMS), Fisher BioServices. 

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Subjects will be randomized into one of three treatment groups as shown 
in Table 1. Group 1 will receive two doses of AS03-adjuvanted 2017 
H7N9 IIV, each dose administered IM approximately 21 days apart, and 
one dose of licensed seasonal IIV4 will be administered IM 
simultaneously (within 15 minutes) in opposite arms with the first dose 
of AS03 adjuvanted 2017 H7N9 IIV. Group 1 is the only Group, and 
only on study Day 1, that subjects will receive two vaccines 
administered IM simultaneously.  Group 2 will receive one dose of 
IIV4 approximately 21 days prior to the IM administration of two doses 
of AS03-adjuvanted 2017 H7N9 IIV; each dose of AS03-adjuvanted 
2017 H7N9 IIV will be given approximately 21 days apart. In Groups 1 
and 2, the second dose of adjuvanted 2017 H7N9 IIV may be 
administered in the subject’s preferred arm. If the subject has no 
preference, the second dose of adjuvanted 2017 H7N9 IIV may be given 
in either arm as long as there is no hindrance of the reactogenicity 
assessment. Group 3 will receive one dose IM of IIV4 as an un-blinded 
comparator in the subject’s preferred arm. 
Subjects who are in good health and meet all eligibility criteria 
(including an erythrocyte sedimentation rate [ESR], urine or serum 
pregnancy test, history and physical exam) within 28 days prior to the 
first vaccination or on the day of, but prior to, the first vaccination will 
be eligible for randomization as stated above. Baseline clinical safety 
laboratories will be drawn prior to the first vaccine dose and will not be 
used to screen subjects for eligibility. 
Reactogenicity will be measured by the occurrence of solicited injection 
site and systemic reactions from the time of each study vaccination 
through 7 days after each study vaccination. Unsolicited non-serious 
AEs will be collected from the time of each study vaccination through 
approximately 21 days after each study vaccination. SAEs and MAAEs, 
including NOCMCs and PIMMCs, will be collected from the time of the 
first study vaccination through approximately 12 months after the last 
study vaccination. Clinical laboratory evaluations for safety will be 
performed on venous blood collected prior to each study vaccination and 
approximately 7 days after each study vaccination. 
Immunogenicity testing will include performing HAI and Neut antibody 
assays against the 2017 H7N9 vaccine virus on serum samples collected 
for Group 1 on Days 1 (baseline), 22, and 43, and at approximately 180 
days post second 2017 H7N9 IIV dose (Day 202), and for Group 2 on 
Days 22 (baseline), 43, and 64, and at approximately 180 days post 
second 2017 H7N9 IIV dose (Day 223). Serological antibody assays will 

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be performed against the vaccine viruses in IIV4 from serum samples 
collected at baseline (Day 1) and approximately 21 and 180 days 
following receipt of IIV4 (Groups 1, 2, and 3).   
Novel methods for identifying and assessing alternative correlates of 
protection against influenza infection are needed.  To assess the NA 
specific antibody response to vaccination, it is first necessary to 
determine the NA content of inactivated influenza vaccine; this assay is 
under development.  If successful, the NA content in a dosage-specific 
manner can be correlated to the N9 NA-specific antibody responses 
elicited by the 2017 H7N9 IIV. 
Subjects will be ineligible to participate in this trial if they have received 
the licensed 2017-2018 licensed seasonal IIV (IIV3 or IIV4, including 
high dose vaccine for the elderly) any time prior to enrollment; IIV4 will 
be provided at the first study vaccination to all participants in the study. 
 
 

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Table 1: Study Design 
 
Day 1 
Dose 1 
Approximately Day 22 
Dose 2 
Approximately Day 43 
Dose 3 
Group 1 
(Age 19-64) 
 n=60 
Dose 1 (First and Second 
Study Vaccinations):  
Sanofi Pasteur H7N9 
vaccine 3.75 mcg/ PBS 
diluent, plus GSK AS03 
adjuvant 
+ IIV4 
Dose 2 (Third Study 
Vaccination): 
Sanofi Pasteur H7N9 
vaccine 3.75 mcg/ PBS 
diluent, plus GSK AS03 
adjuvant 
 
N/A  
Group 2 
(Age 19-64) 
 n=60 
Dose 1 (First Study 
Vaccination): 
IIV4 
 
Dose 2 (Second Study 
Vaccination): 
Sanofi Pasteur H7N9 
vaccine 3.75 mcg/ PBS 
diluent, plus GSK AS03 
adjuvant 
 
Dose 3 (Third Study 
Vaccination): 
Sanofi Pasteur H7N9 
vaccine 3.75 mcg/ PBS 
diluent, plus GSK AS03 
adjuvant 
 
Group 3 
(Age 19-64) 
 n=30 
Dose 1 (First Study 
Vaccination): 
IIV4  
 
N/A 
N/A 
Total 
Enrollment, 
n = ~150 
Blood for HAI/Neut assays for 2017 H7N9 IIV will be collected:  
• 
for Group 1 on Days 1 (baseline), 22, and 43, and at approximately 180 
days post second adjuvanted 2017 H7N9 IIV dose (Day 202) 
• 
for Group 2, on Days 22 (baseline), 43, and 64, and at approximately  
180 days post second 2017 H7N9 IIV dose (Day 223). 
 
Serological antibody assays will also be performed against the vaccine viruses in 
IIV4 from serum samples collected at baseline (Day 1) and approximately 21 and 
180 days following receipt of IIV4 (Groups 1, 2 and 3). 
 
Safety Lab Timepoints: 
Group 1: 4 timepoints per subject (Days 1, 8, 22, and 29)  
Group 2: 6 timepoints per subject (Days 1, 8, 22, 29, 43, and 50) 
Group 3: 2 timepoints per subject (Days 1 and 8) 
and Early Termination and /or Unscheduled Visits 
 

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Figure 1: Schematic of Study Design
 
 
 
Planned Enrollment: Total N=~150 Subjects 
 
The study is planned to enroll a minimum of 150 subjects with a target of  
60 in Groups 1and 2, and 30 in Group 3. 
 
Administer Study Vaccine per Subject Treatment Assignments on 
Day 1, and approximately Day 22 and Day 43  
Assessment of Final 
Outcome Measures 
Consent 
 
Assess Eligibility 
19-64 Years Old 
(N = ~150) 
Randomize 2:2:1 
Clinical, Safety, Reactogenicity, and 
Immunogenicity Assessments 

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1 
KEY ROLES 
Lead Principal Investigator: 
 
Kathleen M. Neuzil, MD, MPH 
Professor of Medicine and Pediatrics 
Director, Center for Vaccine Development 
University of Maryland School of Medicine 
 
Co-Investigators: 
Paul W. Spearman, MD (CCHMC) 
Cincinnati Children's Hospital Medical Center 
 
C. Buddy Creech, MD, MPH (Vanderbilt) 
Associate Professor of Pediatrics, Division of Pediatric 
Infectious Diseases 
Director, Vanderbilt Vaccine Research Program 
 
Paul Goepfert, MD (UAB) 
Professor of Medicine 
Director, Alabama Vaccine Research Clinic 
 
 
DMID Clinical Project Manager: 
Tena Knudsen, RN 
Division of Microbiology and Infectious Diseases 
NIAID, NIH 
5601 Fishers Lane, Room 8E36,  
Bethesda, MD 20892-9825 
Work: 240-627-3290 
Email: knudsent@niaid.nih.gov 
 
DMID Medical Monitor: 
Shy Shorer, MD, MBA, RAC 
Division of Microbiology and Infectious Diseases 
NIAID, NIH 
5601 Fishers Lane, Room 7E50 
Rockville, MD 20892-9825 
Phone: 240-627-3371 
Email: shorers@niaid.nih.gov 
 
DMID Medical Officer: 
 
Trinka Coster, MD, MS 
Medical Officer, Respiratory Disease Branch 
Division of Microbiology and Infectious Diseases 
NIAID, NIH  
5601 Fishers Lane, Room 8E25, MSC 9826 

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Bethesda, MD 20852  
Work: 301 538-2963 
Email: trinka.coster@nih.gov 
 
DMID Scientific Lead: 
 
Chris Roberts, Ph.D. 
Division of Microbiology and Infectious Diseases 
NIAID/NIH/DHHS 
 
Safety and Pharmacovigilance 
Contractor: 
 
DMID Pharmacovigilance Group 
Clinical Research Operations and Management Support 
(CROMS) 
6500 Rock Spring Dr., Suite 650 
Bethesda, MD 20814 
SAE Hot Line: 1-800-537-9979 (US) 
SAE Fax: 800-275-7619 (US) 
SAE Email: PVG@dmidcroms.com 
 
 
Statistical and Data Coordinating 
Center: 
The Emmes Corporation 
401 N. Washington St., Suite 700 
Rockville, MD 20850 
Phone: 301-251-1161 
Email: flutrials@emmes.com 
 
Study Agent Repository: 
Fisher BioServices 
c/o DMID Clinical Materials Services (CMS) 
Contract 
20439 Seneca Meadows Parkway 
Germantown, MD 20876 
Phone: 240-477-1350 
Fax: 240-477-1360 
Email: DMID.CMS@ThermoFisher.com 
 
HAI and Neut Antibody Assays 
Laboratory: 
 
 
NA Content Assays and NA 
Antibody Assays Laboratory: 
 
Southern Research 
2000 9th Avenue South 
Birmingham, AL 35205 
 
TBD 
 

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2 
BACKGROUND INFORMATION AND SCIENTIFIC 
RATIONALE 
2.1 
Background Information 
The continued emergence of novel influenza A viruses in humans including subtypes H5N1, 
H3N2v, H7N7, H9N2, 2009 H1N1, and most recently H5N6 and H7N9, underscores the need 
for focused efforts to prepare for the next influenza pandemic [1-6]. Four pandemics occurred 
during the last century. It was estimated that during the 1918 influenza A/H1N1 pandemic as 
many as 40 million deaths occurred worldwide [7]. Excess mortality, high morbidity, and social 
disruption were all noted during the 1957 influenza A/H2N2 and the 1968 influenza A/H3N2 
pandemics [8]. In April 2009, a novel influenza virus (2009 A/H1N1) originated in pigs and 
spread to humans around the world becoming the first pandemic of this century. In each of these 
influenza pandemics, human populations lacked significant levels of pre-existing immunity to a 
highly transmissible form of the virus enabling it to spread rapidly. Thus, each emergence of a 
new strain of influenza virus in the human population has the potential to result in a global public 
health emergency. 
A major cornerstone of pandemic preparedness is the capacity to rapidly produce and deliver 
sufficient quantities of safe and effective strain-specific pandemic influenza vaccines. The threat 
of pandemic influenza in 1976 (swine influenza) and again in 1977 (Russian influenza) resulted 
in IIV development programs that provided important insights into variables influencing the 
immune responses to immunization [9, 10]. Vaccine- associated factors potentially affecting the 
immunogenicity of IIVs that were noted during the 1976 experience and have been refined in 
subsequent years include the amount of viral HA protein in the vaccine, the number and intervals 
of doses administered, the addition of immune stimulating components (i.e., adjuvants), and the 
manufacturing methods used to produce the vaccine (i.e., whole virus, split virus, or purified 
surface antigen). Host-specific factors, including the recipient’s age, their prior influenza 
infections and/or vaccinations, and the presence of underlying diseases and their treatments, all 
can influence the immune responses elicited by an influenza vaccine. 
Serum antibodies targeting the influenza virus HA and NA, the major surface glycoproteins on 
influenza viruses, play a key role in protective immunity to influenza virus infection [11]. Since 
protection against infection with seasonal influenza virus strains has been shown to correlate 
with both serum HAI and Neut antibody levels, their measurements are used routinely to assess 
the immunogenicity of both seasonal and pandemic IIVs. Recent data also supports an important 
role for neuraminidase inhibiting (NI) antibodies in protection against disease [12]. In a recent 
human influenza challenge study, serum NI antibody levels were also identified as an 
independent correlate of protection against influenza illness [13].  In the current study, we plan 

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to assess the NA content of 2017 H7N9 IIV and determine the correlation of NA content at 
different vaccine dosages with the elicited humoral antibody responses to the NA. 
Several approaches have been used to increase the immunogenicity of IIVs. Standard-dose 
inactivated seasonal influenza vaccines contain 7.5 mcg of HA antigen per vaccine strain (for 
children aged <36 months) or 15 mcg of HA antigen per vaccine strain (for persons aged ≥36 
months). Clinical studies evaluating increased HA-containing influenza vaccines performed over 
the past 35 years have shown dose-related increases in serum and mucosal antibody responses 
[14-22]. Higher HA dosage vaccines can lead to enhanced antibody responses in the elderly [23]. 
In 2009, a high-dose IIV containing 4 times the standard HA antigen per seasonal vaccine strain 
was approved in the US for use in individuals 65 years of age and older.  
In general, clinical studies evaluating vaccines made from novel avian influenza viruses (e.g., 
A/H5N1, A/H7N7, and H7N9) suggest that these vaccines are substantially less immunogenic 
than those from other novel subtypes (e.g., 2009 A/H1N1 pandemic virus, even when 
administered at high HA dosages [24, 25]). Due to the poor immunogenicity of H5 and H7 
vaccines, the inclusion of adjuvants was evaluated to assess their ability to boost anti-viral serum 
immunoglobulin G (IgG) levels. In the US, aluminum salts are licensed as adjuvants in 
combination with several vaccines; however, their use in subvirion influenza A/H5N1 vaccines 
has shown either no effect or a very modest enhancement of immune responses compared to 
non-aluminum salt containing formulations [26-28]. In contrast, the use of oil-in-water emulsion 
adjuvants, most notably proprietary adjuvants AS03 and MF59 produced by GSK and Seqirus, 
respectively, has resulted in increased antibody responses to IIVs containing novel HAs in 
numerous clinical trials [29-33]. In an early study, dosage levels ranging from 3.75 to 30 mcg of 
A/H5N1 antigen administered with or without AS03 resulted in significant increases in antibody 
GMTs in groups who received the adjuvanted formulations [31]. These GMTs met the 
Committee for Medicinal Products for Human Use (CHMP) criterion for seroconversion rate 
(>40%) after a single dose with adjuvant. Following the second vaccine dose, all adjuvanted 
formulations complied with both CHMP and US Food and Drug Administration (FDA) criteria 
for seroconversion and seroprotection rates, whereas from the non-adjuvanted groups only the 30 
mcg formulation met the CHMP criterion for seroconversion [31]. GSK received approval for 
the registration of a pre-pandemic AS03-adjuvanted, monovalent inactivated A/H5N1 virus 
vaccine by European regulatory authorities in 2008 and FDA approval of their Biologics License 
Applications (BLA) for Influenza A (H5N1) Virus Monovalent Vaccine Adjuvanted (with 
AS03) in 2013. 
Following the 2009 emergence of the novel A/H1N1 pandemic virus, the European Commission 
granted marketing authorization of GSK’s egg-derived AS03-adjuvanted monovalent inactivated 
2009 A/H1N1 virus vaccine (Pandemrix™) and Novartis’ egg-derived MF59-adjuvanted, 
monovalent inactivated 2009 A/H1N1 virus vaccine (FOCETRIATM). These adjuvanted 

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monovalent inactivated 2009 A/H1N1 virus vaccines were widely used throughout Europe and in 
many other countries, albeit not in the US. 
The inclusion of adjuvants in clinical trials evaluating IIVs has also frequently been associated 
with increased injection site reactogenicity [26]. Additionally, in late 2010, a possible association 
between an increased risk of narcolepsy in children and adolescents who had received the AS03-
containing Pandemrix™ was reported in Finland and Sweden. Some, but not all, countries in 
which retrospective studies were conducted showed a similar association [34-43]. (See also 
Section 2.3.1 Potential Risks for further discussion). 
Because of the substantial increases in antibody responses when these oil-in-water emulsion 
adjuvants were added to otherwise poorly immunogenic, novel HA influenza vaccines, they may 
be a critical component of the public health response to the next influenza pandemic. As part of 
its pandemic preparedness efforts, the US Government maintains stockpiles of unique HA-
containing influenza vaccines, including those against influenza A/H7N9 and A/H5N1 viruses, 
as well as AS03 and MF59 adjuvants. The National Institute of Allergy and Infectious Diseases 
(NIAID) has conducted several clinical trials to evaluate A/H7N9 and A/H5N1 vaccines 
administered with and without these adjuvants in healthy adult and elderly populations and found 
that the vaccines co-administered with adjuvants were well tolerated, exhibited dose-sparing and 
substantially increased the immunogenicity of strain-specific novel HA vaccines compared to 
non-adjuvanted formulations [44-49]. In response to emerging H5N8 viruses that have caused 
extensive outbreaks in domestic poultry and wild birds in South East Asia [50, 51], NIAID is 
also conducting 2 ongoing clinical trials with an H5N8 vaccine produced by bioCSL (Seqirus) 
administered with either AS03 (GSK) or MF59 (Seqirus) in healthy individuals 19-64 years of 
age (NCT02624219 and NCT03014310). 
Since March of 2013 [52], avian influenza A/H7N9 viruses have continued to circulate in China 
causing discrete outbreaks (or waves) in humans with high mortality over the past 5 years. By 
late 2016, a “fifth wave” of outbreaks was identified in China and as of December 7, 2017 a total 
of 1,565 laboratory-confirmed human infections with avian influenza A/H7N9 virus have been 
reported by the World Health Organization (WHO) [53, 54]. Whereas most cases have been 
centered in and around mainland China, there have been several traveler associated cases, 
including two in travelers reported by Canada who were returning from China in early 2015 [55]. 
Most of the reported human cases have been associated with exposure to infected live poultry or 
contaminated environments, including markets where live poultry are sold. Influenza A/H7N9 
viruses continue to be detected in poultry and their environments in the areas where human cases 
are occurring. Information to date indicates that these viruses do not transmit easily from human 
to human with most isolates appearing to have retained their susceptibility to NA inhibitors [53]. 
Laboratory studies have shown that A/H7N9 influenza viruses readily infect cells from human 

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respiratory tract tissue samples and can spread from ferret to ferret by droplet transmission, 
thereby increasing the concern about the pandemic potential of these viruses [56, 57]. 
Since the onset of the “fifth wave” of H7N9 outbreaks in October 2016, more human cases of 
H7N9 infection have been reported in China than any prior H7N9 epidemic wave [54]. In 
addition, an antigenically distinct lineage of these fifth wave H7N9 viruses known as the 
Yangtze River Delta lineage, has recently emerged and has been associated with an increasing 
number of human cases. This lineage has also resulted in a broader geographic spread of infected 
birds and human cases within China than previously seen. Further, several H7N9 viruses in the 
Yangtze River Delta lineage have recently acquired genetic changes characteristic of highly 
pathogenic avian influenza (HPAI) viruses and have now shown an increased ability to infect 
and kill poultry [53, 58].  
The U.S. Department of Health and Human Services (DHHS) recently assessed H7N9 influenza 
virus as having a significant potential to cause a pandemic, and the greatest risk of causing 
severe disease. As a result, HHS has supported the production of fifth wave inactivated influenza 
H7N9 vaccine for the U.S. stockpile and for an assessment of its safety and immunogenicity in 
clinical trials. 
2.1.1 
Public Readiness and Emergency Preparedness Act 
For this protocol the study products monovalent inactivated influenza 2017 H7N9 virus vaccine 
manufactured by Sanofi Pasteur and adjuvant (AS03) manufactured by GSK, are covered under 
the Public Readiness and Emergency Preparedness Act (PREP Act). Under the PREP Act, 
covered persons are immune from liability actions brought from the administration or use of a 
covered countermeasure that is the subject of a declaration. The PREP Act provides immunity 
for covered persons (such as manufacturers, distributers, program planners, and other qualified 
persons who prescribe, administer, or dispense the 2017 H7N9 IIV with or without adjuvant) 
from tort liability, unless the injury was caused by willful misconduct. 
The PREP Act also established the Countermeasures Injury Compensation Program (CICP) to 
provide compensation for serious injuries that occur as the result of the administration or use of 
certain countermeasures. Any requests for compensation must be filed within one year of 
administration or use of the countermeasure. Requests would go to the Health Resources and 
Services Administration (HRSA) Preparedness Countermeasures Injury Compensation Program 
(http://www.hrsa.gov/cicp/). Compensation may then be available for medical benefits, lost 
wages, and death benefits to eligible individuals for specified injuries in accordance with 
regulations published by the Secretary of HRSA. Eligibility for compensation and the injuries for 
which compensation may be available are further defined by regulation. 

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An individual who suffers a serious physical injury or death from administration and use of the 
2017 H7N9 IIV with or without adjuvant may request benefits from CICP. A serious physical 
injury means an injury that is life threatening, results in, or requires, medical or surgical 
intervention to prevent permanent impairment of a body function, or permanent damage to body 
structure. The CICP is the payer of last resort. This means that it only covers expenses or 
provides benefits that other third-party payers, such as health insurance, the Department of 
Veterans Affairs, or Workers’ Compensation programs don’t have an obligation to pay. 
If no funds have been appropriated to the compensation program, the Secretary of HRSA does 
not make a final determination on the individual’s request within 240 days, or if the individual 
decides not to accept the compensation, the injured individual or his representative may pursue a 
tort claim in the US District Court for the District of Columbia, but only if the claim involves 
willful misconduct, is pled with particularity required under the PREP Act, verified, and 
accompanied by an affidavit by a physician who did not treat the individual and certified medical 
records. Any award is reduced by any public or private insurance or worker’s compensation 
available to the injured individual. Awards for non-economic damages, such as pain, suffering, 
physical impairment, mental anguish, and loss of consortium are also limited. If the individual 
accepts compensation, or if there is no willful misconduct, then the individual does not have a 
tort claim that can be filed in a United States Federal or a State court. 
2.2 
Scientific Rationale 
As part of the US Government’s past pandemic preparedness efforts, Sanofi Pasteur under 
contract to the Biomedical Advanced Research and Development Authority (BARDA)/DHHS, 
produced several novel pre-pandemic vaccines that were evaluated by NIAID’s VTEU sites to 
assess their safety, reactogenicity, and immunogenicity when mixed prior to administration with 
either AS03 or MF59 oil-in-water adjuvants manufactured by GSK and Novartis (now Seqirus), 
respectively. In general, these trials have demonstrated that adjuvant use results in a significant 
dose-sparing effect. NIAID is currently conducting similar “mix and match” clinical trials using 
an H5N8 vaccine antigen produced by Seqirus and mixed with either AS03 or MF59 adjuvants 
(NCT03014310, NCT02624219). 
The large number of human infections starting with the “fifth wave” of H7N9 outbreaks in late 
2016, has raised the pandemic risk assessment of influenza A/H7N9 viruses circulating in China. 
The Yangtze River Delta lineage, a distinct H7N9 viral lineage, has now emerged and has been 
associated with many of the cases in the fifth epidemic wave. This has also resulted in a broader 
geographic spread of infected birds and human cases within China than previously reported. 
Further, several H7N9 viruses in the Yangtze River Delta lineage have recently acquired genetic 
changes characteristic of HPAI viruses and have now shown an increased ability to infect and 
kill poultry [54, 58]. To date, no cases of H7N9 from the new lineage have been identified in 

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birds or people infected outside of China; however, a few cases have been identified in Hong 
Kong and Taiwan in infected travelers returning from China. Importantly, antigenic analysis of 
the fifth wave H7N9 viruses and serology studies indicate that the stockpiled H7N9 vaccine 
manufactured several years ago does not induce protective HAI or Neut antibodies against the 
Yangtze River Delta lineage. Hence, there is broad consensus across HHS and interagency 
leadership that a new vaccine should be developed that would be effective against the currently 
predominating H7N9 viruses.  
The potential for a negative effect of prior seasonal vaccination on vaccine effectiveness and 
immunogenicity has been debated for decades [59, 60].  In recent years, several observational 
studies have reported that the response to and effectiveness of influenza vaccine during any 
given season may be modified by receipt of seasonal influenza vaccine in prior seasons [61-63].     
Likewise, several evaluations of H5N1 and 2009 H1N1 vaccines suggest that prior receipt of 
seasonal vaccine is associated with a lower response to H5N1 or 2009 H1N1 vaccines, 
respectively [64-67]. Similar immunological interference has been reported in individuals who 
received seasonal IIV3 in the weeks to months prior to H1N1 and H5N1 vaccines, whereas other 
studies failed to identify significant differences or observed improved responses [67-69].    
 
Overall, the effects of prior vaccination have not been observed consistently across all studies 
and seasons, and likely differ by timing of vaccine administration, influenza virus type or 
subtype, and presence and type of adjuvant used.  In regards to H7N9 vaccines, as reported by 
Jackson et al., generally higher GMTs and proportion with an HAI titer of 40 or higher at 21 
days after dose 2 were observed in the group that did not receive seasonal influenza vaccine.  In 
a logistic regression model, older age and prior receipt of seasonal influenza vaccine were 
independently associated with a lower likelihood of achieving an HAI titer of 40 or higher after 
dose 2 [47].  In the Jackson et al. study, the receipt of seasonal vaccines occurred before the start 
of the trial, as reported by the participants.  Data from randomized control trials of seasonal 
vaccines given concomitantly or sequentially with H7N9 vaccines are not available. 
The goal of this clinical trial is to assess the safety, reactogenicity and immunogenicity of two 
doses of AS03-adjuvanted 2017 H7N9 IIV administered sequentially or simultaneous with 
seasonal influenza vaccine and to assess potential interference with the immunogenicity of either 
vaccine. The public health goal would be to maximize protection to the seasonal strains and 
H7N9 strain in the target population while ensuring acceptable tolerability and safety.  While the 
prior seasonal influenza vaccine history of the target population will vary substantially and 
cannot be readily altered, it is important to understand the effects of simultaneous versus 
sequential delivery of H7N9 strains with currently available seasonal influenza vaccines to 
inform vaccination programs.  This study will provide important information on two scenarios 1) 
seasonal influenza vaccine given with the first dose of H7N9 and 2) seasonal influenza vaccine 
given prior to H7N9 vaccine. 

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Another goal of this study is to assess, in at least a subset of samples, if serum IgG elicited by the 
2017 H7N9 IIV recognize antigenically drifted variants of influenza A/H7 viruses. Since 
antibodies targeting the NA may represent an independent correlate of protection against 
influenza infection [11-13], we plan to assess the NA content of the 2017 H7N9 vaccine and 
determine if there is a dose-specific correlation of NA content with elicited humoral antibody 
responses to the N9 NA. 
Based on previously conducted studies with a 2013 H7N9 IIV manufactured by Sanofi Pasteur 
administered with AS03, we anticipate that two doses of the 2017 H7N9 IIV administered IM 
with AS03 adjuvant approximately 21 days apart will be well-tolerated. 
2.3 
Potential Risks and Benefits 
2.3.1 
Potential Risks 
The potential risks of participating in this trial are those associated with having blood drawn, the 
IM injection and possible reactions to the monovalent inactivated influenza H7N9 vaccine plus 
PBS diluent and/or AS03 adjuvant, and breach of confidentiality. 
Drawing blood may cause transient discomfort and fainting. Fainting is usually transient and 
managed by having the subject lie down and elevate his/her legs. Bruising at the blood draw site 
may occur, but can be prevented or lessened by applying pressure to the blood draw site for a 
few minutes after the blood is taken. IM injection may also cause transient discomfort and 
fainting. Drawing blood and IM injection may cause infection. The use of aseptic (sterile) 
technique will make infection at the site where blood will be drawn or where the study 
vaccination will be given extremely unlikely. 
There is a small amount of risk to subjects who report that they are in good health but who have 
an unknown health problem at the time of screening. This trial will screen by physical exam, 
history, vital signs and sedimentation rate. Baseline safety labs for white blood cells (WBC), 
hemoglobin (Hgb), platelets (PLT), alanine aminotransferase (ALT), total bilirubin (T. Bili), and 
creatinine (Cr) will be drawn prior to study vaccination but results will not be reviewed until 
after study vaccination. To minimize the risk, subjects will not receive the second study 
vaccination unless, the most recently evaluated clinical safety laboratory values obtained prior to 
the second study vaccination are Grade 2 or less and the subject does not meet any of the other 
criteria listed in Section 5.2.3. 
There is potential for AEs to occur more frequently in the adjuvanted vaccine groups [70] than in 
the non-adjuvanted group and there is potentially a higher risk for AEs to occur more frequently 
in the higher dose influenza antigen groups than in the lower dose viral antigen groups. The 

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monovalent A/H7N9 vaccine to be used in this study has not been tested for safety in animals 
and has not previously been evaluated in humans. The DMID, NIAID sponsored two Phase II 
clinical trials that included an assessment of the safety, reactogenicity, and immunogenicity of 
two IM doses of a monovalent A/H7N9 vaccine produced by Sanofi Pasteur, Swiftwater, PA, 
administered with or without AS03 in healthy adults (DMID Protocol 13-0032; NCT01938742 
and DMID Protocol 13-0033; NCT01942265).  
 
Overall, the study products administered in both of these clinical trials were generally safe and 
well-tolerated. For DMID Protocol 13-0032, nine SAEs were reported. All were assessed as 
being not related to study product. Two cases of Autoimmune thyroiditis (Hashimoto’s 
disease/Hashimoto’s thyroiditis) or Adverse Events of Special Interest (AESIs) were reported in 
this clinical trial: one case was assessed as not related to study product (due to preexisting 
Thyroid Peroxidase Antibodies) and the second case was assessed as related to study product (no 
preexisting Thyroid Peroxidase Antibodies). 
For DMID Protocol 13-0033, sixteen SAEs were reported, fifteen of these SAEs were assessed 
as being not related to study product. One SAE was considered to be related: acute inferior 
myocardial infarction. Two AESIs were reported in this clinical trial: psoriasiform dermatitis and 
celiac disease (both assessed as not related to study product because both disorders pre-existed 
to vaccination, but both disorders received the diagnosis after vaccination). 
 
The current monovalent split IIV was derived from the influenza virus A/Hong Kong/125/2017 
(H7N9).  The manufacturing process for the production of this investigational A/H7N9 vaccine 
is similar to the process used to produce the licensed Influenza Virus Vaccine Fluzone® family of 
products. As such, the safety profile of the candidate A/H7N9 vaccine should be similar to the 
current Fluzone® vaccine. 
 formulation has been 
determined by
 
 
 In this clinical trial, the labeling of the original 
 
 The vaccine preparation has been adjusted to 
meet the targeted concentration by 
 
 was produced in accordance with the commercial process
 
 
The final vaccine preparation is 
 
  
  
The potential risks to subjects are anticipated to be similar to those observed for Sanofi Pasteur’s 
unadjuvanted licensed inter-pandemic (seasonal) IIVs (Fluzone® and Fluzone® High-Dose), 
their unadjuvanted licensed 2009 A/H1N1 and A/H5N1 monovalent IIVs, and for previously 
conducted 2013 H7N9 IIV administered with and without AS03 and MF59 (see the Sanofi 

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Pasteur Investigator’s Brochure (Investigational Pandemic Influenza Virus vaccines, Monovalent 
A/Shanghai/2/2013 (H7N9) product code 504, Monovalent A/Hong Kong/125/2017 (H7N9) 
product code 504, Monovalent A/Indonesia/05/2005 (H5N1) product code 458, Monovalent 
A/Vietnam/1203/2004 (H5N1) product code 399, Monovalent A/Bar-Headed Goose/Qinghai 
Lake/1A/2005 (H5N1) product code 458, Version Number 1.0, January 2018). 
Occasionally, adult recipients of unadjuvanted licensed, IIVs may develop influenza-like 
reactions, such as fever, feverishness (chills/shivering/sweating), fatigue (tiredness), malaise 
(general unwell feeling), myalgia (body aches/muscular pain), arthralgia (joint pain), headache, 
and/or nausea. Some subjects may develop reactions at the injection site, including pruritus 
(itching), ecchymosis (bruising), erythema (redness), induration (hardness), edema (swelling), 
pain, and/or tenderness. Most of these reactions peak in intensity in the first 24 hours after 
vaccination and disappear without treatment within 1 or 2 days. Analgesics (e.g., acetaminophen, 
ibuprofen, or similar non-steroidal anti-inflammatory drugs [NSAIDs]) and rest may generally 
relieve or lessen these reactions. Bruising can sometimes occur due to the vaccination procedure. 
In addition, post-marketing surveillance indicates autoimmune disorders as potential risks for 
pandemic vaccines based on those identified for the seasonal IIVs; these may also include, but 
are not limited to, neuritis, convulsions, severe allergic reactions, syncope, encephalitis, 
thrombocytopenia, vasculitis, and Guillain-Barré syndrome (GBS). Reports of these reactions 
were rare; however, exact incidence rates cannot be precisely calculated.  
Acute and potentially life-threatening allergic reactions (i.e., anaphylaxis) are also possible. 
These reactions occur in about 1 in 4 million people given a vaccination. These reactions can 
manifest as skin rash (hives), swelling around the mouth, throat, or eyes (angioedema), difficulty 
breathing (bronchospasm), a fast pulse (tachycardia), or decrease in blood pressure 
(hypotension). If these reactions occur, they can usually be stopped by the administration of 
emergency medications by the study personnel. As with any vaccine or medication, there is a 
very small chance of a death, although researchers do not expect this to occur. 
During the swine influenza (H1N1) vaccine campaign of 1976, some recipients developed a 
paralytic illness called GBS. GBS is an acute inflammatory neuropathy characterized by 
weakness, hyporeflexia or areflexia, and elevated protein concentrations in cerebrospinal fluid. 
The rate of GBS was significantly increased in individuals receiving the 1976 swine influenza 
(H1N1) vaccine at about 1 per 100,000 vaccine recipients. This syndrome has not been seen 
consistently with other influenza vaccines. Most persons who develop GBS recover completely, 
although the recovery period may be as little as a few weeks or as long as a few years. About 
30% of those with GBS still have residual weakness after 3 years and about 3% may suffer a 
relapse of muscle weakness and tingling sensations many years after the initial attack. Intensive 
surveillance of GBS after administration of IIVs since 1976 has shown a slight increase in risk 
over background cases (more than one additional case of GBS per million persons) following 

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vaccination, typically with onset within 6 weeks after vaccination [71]. Interestingly, although 
vaccination rates have increased in the last 10 years, the numbers of reported cases of vaccine-
associated GBS have declined [72]. A recent study in Canada showed that the 2009 H1N1 
vaccine was associated with a small but significant risk of GBS in persons 50 years and older 
[73]. An active, population-based surveillance study conducted in the United States during the 
2009-2010 influenza season found less than 1 excess GBS case per million doses of 2009 H1N1 
vaccine administered – a rate similar to that associated with some previously administered 
annual influenza vaccines [74-76]. Another study using the Medicare system showed an elevated 
risk of GBS with 2009 monovalent H1N1 vaccination (incidence rate ratio = 2.41, 95% 
confidence interval (CI): 1.14, 5.11; attributable risk = 2.84 per million doses administered, 95% 
CI: 0.21, 5.48) [77]. An international collaboration study also supported a conclusion of an 
association between 2009 H1N1 vaccination and GBS [78]. It is unknown if the administration 
of the monovalent inactivated influenza 2017 H7N9 virus vaccine to be used in this clinical trial 
will result in an increased incidence of GBS as the mechanism leading to this AE has not been 
completely elucidated. 
As of November 22, 2015 (per the manufacturer’s IB dated February 2016), data are available 
for 56 GSK sponsored clinical trials of AS03-adjuvanted monovalent pandemic vaccines 
manufactured by GSK. More than 18,000 adults (age ≥18 years) and 6,900 pediatric (6 months to 
17 years old) clinical trial participants have received at least one dose of a GSK-manufactured, 
AS03-adjuvanted monovalent pandemic influenza vaccine. Clinical data collected by GSK as of 
November 22, 2015, suggest that inactivated monovalent (pre)pandemic influenza virus antigens 
adjuvanted with AS03 have generally acceptable safety and benefit/risk profiles, though the 
incidence rates of solicited local and systemic AEs are higher with AS03-adjuvanted antigens 
than with antigen alone, a licensed IIV3, or placebo. Some unsolicited AEs (e.g., insomnia, 
dizziness, cystitis) were associated with a higher relative risk among H5N1/AS03 recipients in 
contrast to Fluarix® or placebo recipients. 
The information and guidance that follow are based on pre-clinical and clinical study results for 
GSK-manufactured AS03-adjuvanted monovalent pandemic vaccines, post-marketing safety 
surveillance data seen with unadjuvanted, IIV3s and (in the case of the H1N1 vaccines) post-
marketing safety surveillance data seen to date for both Pandemrix™ and Arepanrix™ H1N1 
vaccines. 
The reactogenicity profile in humans of GSK-manufactured AS03-adjuvanted vaccines is 
primarily associated with the adjuvant. The incidence and severity of injection site redness, 
swelling, and pain at the injection site in recipients of AS03-adjuvanted vaccines are increased 
relative to monovalent pandemic influenza antigen alone, a licensed IIV3, or placebo. There is no 
increase in injection site and systemic reactogenicity events in recipients of AS03-adjuvanted 
vaccines after a second dose of vaccine relative to the first when given 21 days apart. In young 

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children (6 months to 6 years old), increased frequency of fever has been observed following a 
heterologous booster dose of adjuvanted vaccine administered 6 months after the primary series. 
As of November 22, 2015, there has been no evidence in clinical trials to support a conclusion 
that any potential immune-mediated disease or group of diseases was causally related to an AS03-
adjuvanted vaccine. There have been no deaths in GSK clinical trials of AS03-adjuvanted 
pandemic influenza vaccines assessed as related to study vaccine. A total of 1,428 non-fatal SAEs 
have been reported for adult subjects as of November 22, 2015. Fifteen of these events were 
deemed related to vaccination by the Investigator or GSK. Of these, six occurred in recipients of 
an adjuvanted H1N1 vaccine: asthma, herpes zoster, hepatic enzyme increased, and pain in 
extremity, polymyalgia rheumatic, and thrombocytopenia. Three occurred in recipients of 
unadjuvanted H1N1 vaccine: alanine aminotransferase increased, hypersensitivity, and multiple 
sclerosis. One SAE classified as related (myalgia) occurred in a subject who received a control 
product. Four SAEs classified as related occurred in recipients of an adjuvanted H5N1 vaccine: 
autoimmune hepatitis, angina pectoris, pulmonary embolism, and non-Hodgkin’s lymphoma. One 
SAE classified as related (lobar pneumonia) occurred in a recipient of an unadjuvanted H5N1 
vaccine. Overall, the reactogenicity and safety profile of AS03-adjuvanted pandemic vaccines is 
acceptable and no safety concerns have been identified in clinical trials. 
Narcolepsy is a chronic sleep disorder with a background incidence rate, based on US data, of 
approximately 1.37 per 100,000 per year, with a peak onset between 10 and 19 years of age in 
some datasets. Narcolepsy, when associated with cataplexy is seen almost exclusively in 
individuals who are HLA DQB1*0602 allele carriers [79]. An autoimmune etiology has been 
proposed. In the post-marketing period for adjuvanted H1N1 pandemic vaccines, several 
epidemiological studies conducted in several countries independently of GSK reported an 
increased risk of narcolepsy with or without cataplexy in subjects who were vaccinated with 
Dresden-manufactured H1N1 (Pandemrix™ H1N1) vaccine during the 2009-2010 season. These 
studies have described an absolute risk increase of narcolepsy of approximately 1.4 to 8 additional 
cases per 100,000 vaccinated children/adolescents, and approximately one additional case per 
100,000 vaccinated adults compared to background rates of 0.12 to 0.79 per 100,000 
children/adolescents per year and 0.67 to 1.10 per 100,000 adults per year. The observed temporal 
association between narcolepsy and vaccination with Pandemrix™ H1N1 is not fully understood, 
and further research to evaluate the association between narcolepsy and Pandemrix™ H1N1, and 
other possible contributory factors to the development of narcolepsy during the 2009-2010 
pandemic, such as genetic and environmental factors, is being conducted. A GSK-supported 
study was conducted in Quebec, Canada, to assess the risk of narcolepsy associated with 
Arepanrix H1N1, using various index dates, risk periods, observation periods, and 
epidemiological designs. Overall, GSK considers that there is no strong evidence of an 
association between Q-Pan-H1N1 and narcolepsy in Quebec.  Recently, the CDC conducted a 
study to assess trends in narcolepsy incidence rates before and after 2009 H1N1 influenza 

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(pH1N1) vaccination campaigns and to evaluate the risk of narcolepsy following adjuvanted 
pH1N1 vaccines. Results of the incidence rates analysis indicated no change in narcolepsy rates 
between the period before wild-type pH1N1 virus circulation and the period after the start of 
pH1N1vaccination campaigns in any countries except Sweden, the first signaling country, and 
Taiwan, where incidence began to increase upon wild-type pH1N1 virus circulation. In the case-
control analysis, no association was observed for AS03-adjuvanted pH1N1 vaccine and 
narcolepsy in children or adults, and in the case-coverage analysis, no association was observed 
for narcolepsy in children, the only age groups studied. However, the data for the AS03-
adjuvanted pH1N1 vaccine, Pandemrix™, were limited. (20th Annual Conference on Vaccine 
Research, April 24-26th, 2017, Abstract S6-1). 
No post-marketing data are available for AS03 administered in combination with any GSK-
manufactured H5N1, H7N1, H7N9, or H9N2 antigen. However, millions of doses of GSK-
manufactured H1N1 antigens, combined with AS03, were administered in the context of the 
2009/10 pandemic response. In addition to the adverse reactions reported in clinical trials, the 
following have been reported during post-marketing experience with Pandemrix™ (H1N1) and 
Arepanrix™ (H1N1): 
• Immune system disorders 
o Rare: anaphylaxis, allergic reactions 
• Nervous system disorders 
o Rare: febrile convulsions (in subjects below 20 years of age), somnolence**, GBS* 
*Spontaneous reports of GBS syndrome have been received following vaccination 
with Arepanrix™ (H1N1); however, a causal association between vaccination and 
GBS has not been established. Data from a post-marketing epidemiological study in 
Canada indicate a small but significant increased relative risk of GBS of 1.80 (95% 
CI, 1.63-4.62) in the 56-day period following vaccination with Arepanrix™ (H1N1, 
in persons 50 years of age and older). The number of GBS cases attributable to 
vaccination was approximately 2 per 1 million doses. 
**reported in patients with narcolepsy and as a temporary event following 
vaccination 
o Very rare1: narcolepsy with or without cataplexy 
1Frequency based on estimated attributable risk from epidemiological studies in 
several European countries. 

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• Skin and subcutaneous tissue disorders 
o Rare: angioedema, generalized skin reactions, urticaria 
• General disorders and administration site conditions 
o Rare: injection site reactions (such as inflammation, mass, ecchymosis) 
From post-marketing surveillance with interpandemic (seasonal) trivalent vaccines, the following 
additional AEs have been reported: 
• Blood and lymphatic system disorders 
o Transient thrombocytopenia 
• Nervous system disorders 
o Neuralgia, convulsions 
o Neurological disorders, such as encephalomyelitis, neuritis, and GBS 
• Vascular disorders 
o Vasculitis with transient renal involvement 
As of November 22, 2015, the available data for women who become pregnant during clinical 
trials of AS03-adjuvanted (pre) pandemic influenza vaccines do not suggest any causal 
relationship between adverse pregnancy outcomes and receipt of an AS03-adjuvanted vaccine. 
However, there is no available data related to the risks of exposure to H7N9 vaccines 
administered with or without AS03 upon pregnancy and pregnancy outcomes. 
Subjects will be asked to provide personal health information (PHI). All attempts will be made to 
keep this PHI confidential within the limits of the law. However, there is a chance that 
unauthorized persons will see the subject’s PHI. All study records will be kept in a locked file 
cabinet or maintained in a locked room at the participating VTEU sites. Electronic files will be 
password-protected. Only people who are involved in the conduct, oversight, monitoring, or 
auditing of this trial will be allowed access to the PHI that is collected. Any publications from 
this trial will not use information that will identify subjects by name. Organizations that may 
inspect and/or copy research records maintained at the participating VTEU sites for quality 
assurance and data analysis include groups such as the local Institutional Review Board (IRB), 
NIAID, and the FDA. 

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A description of this clinical trial will be available on http://www.ClinicalTrials.gov, as required 
by US Law. This web site will not include information that can identify subjects.  
There may be other risks, discomforts, or side effects that are unknown at this time. 
2.3.2 
Known Potential Benefits 
There are no known benefits attributable to the receipt of the 2017 H7N9 IIV in PBS with or 
without AS03 adjuvant. Vaccination using the 2017 H7N9 IIV with AS03 adjuvant may or may 
not provide protection against a serious disease with the influenza 2017 H7N9 virus, should the 
participant be exposed. The duration of any such protection is currently unknown. The 2017 
H7N9 IIV with or without AS03 adjuvant is not expected to offer protection against circulating 
seasonal influenza viruses. There may be pandemic preparedness benefits to society in the future 
if the vaccine and adjuvants being evaluated in this clinical trial prove to be sufficiently safe and 
immunogenic and can be employed if a need for widespread influenza 2017 H7N9 vaccination 
occurs. 

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3 
STUDY OBJECTIVES AND OUTCOME MEASURES 
3.1 
Study Objectives 
3.1.1 
Primary 
Safety: 
• To assess the safety and reactogenicity following sequential or simultaneous IM 
administration of 2 doses of AS03-adjuvanted 2017 H7N9 IIV and one dose of seasonal 
influenza vaccine (IIV4).  
Immunogenicity: 
• To assess the serum HAI and Neut antibody responses against A/H7N9 at approximately 
21 days following receipt of two doses of AS03-adjuvanted 2017 H7N9 IIV administered 
IM approximately 21 days apart. 
• To assess the serum HAI and Neut antibody responses against the seasonal influenza 
strains at approximately 21 days following receipt of IIV4. 
3.1.2 
Secondary  
Safety: 
• To assess unsolicited non-SAEs following sequential or simultaneous IM administration 
of AS03-adjuvanted 2017 H7N9 IIV and seasonal influenza vaccine (IIV4) 
• To assess MAAEs, including NOCMCs and PIMMCs, following sequential or 
simultaneous IM administration of AS03-adjuvanted 2017 H7N9 IIV and IIV4 
Immunogenicity: 
• To assess the HAI and Neut antibody responses at 21 days following receipt of 1 dose of 
AS03-adjuvanted 2017 H7N9 IIV. 
3.1.3 
Exploratory 
Immunogenicity: 

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• To assess the effects of age, sex, BMI, and receipt of prior year(s) seasonal influenza 
vaccine(s) on serum HAI antibody responses following receipt of two doses of AS03-
adjuvanted 2017 H7N9 IIV.  
• To assess the durability of the antibody response to the 2017 H7N9 study vaccine strain 
and the IIV4 strains at approximately 180 days following the second dose of AS03-
adjuvanted 2017 H7N9 IIV vaccine.  
• To assess the NA content of the 2017 H7N9 IIV and the licensed seasonal IIV4 and 
determine the serum antibody responses to NA following receipt of 2017 H7N9 IIV and 
licensed seasonal IIV4. 
3.2 
Study Outcome Measures 
3.2.1 
Primary 
Safety: 
• Occurrence of all SAEs following the first study vaccination through approximately 12 
months after the last study vaccination. 
• Occurrence of study vaccine-related SAEs following the first study vaccination through 
approximately 12 months after the last study vaccination. 
• Occurrence of solicited injection site and systemic AEs following each study vaccination 
through 7 days after each study vaccination. 
• Occurrence of clinical safety laboratory AEs following each study vaccination through 
approximately 7 days after each study vaccination. 
Immunogenicity: 
• For HAI and Neut antibodies, percentage of subjects achieving seroconversion against 
the 2017 H7N9 study vaccine strain (defined as either a pre-vaccination titer <1:10 and a 
post-vaccination titer ≥1:40 or a pre-vaccination titer ≥1:10 and a minimum four-fold rise 
in post-vaccination antibody titer) at approximately 21 days after 2 doses of AS03-
adjuvanted 2017 H7N9 IIV (Group 1– Day 43; Group 2 – Day 64; Group 3 – N/A). 
• For HAI and Neut antibodies, percentage of subjects achieving seroconversion against 
each of the study IIV4 strains at approximately 21 days after receipt of study IIV4 
(Groups 1, 2 and 3 – Day 22).  
• For HAI and Neut antibodies, percentage of subjects with an antibody titer of ≥1:40 
against the influenza 2017 H7N9 study vaccine strain at approximately 21 days following 

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receipt of 2 doses of AS03-adjuvanted 2017 H7N9 IIV (Group 1 – Day 43; Groups 2 – 
Day 64; Group 3 – N/A). 
• For HAI and Neut antibodies, percentage of subjects with an antibody titer of ≥1:40 
against each of the study IIV4 strains at approximately 21 days after receipt of study IIV4 
(Groups 1, 2 and 3 – Day 22).  
• GMTs of serum HAI and Neut antibodies against the 2017 H7N9 IIV strain at 
approximately 21 days following receipt of 2 doses of AS03-adjuvanted 2017 H7N9 IIV 
(Group 1– Day 43; Group 2 – Day 64; Group 3 – N/A).  
• GMTs of serum HAI and Neut antibodies against each of the 2017 IIV4 strains at 
approximately 21 days after receipt of IIV4 (Group 1, 2 and 3– Day 22). 
3.2.2 
Secondary 
Safety: 
• Occurrence of study vaccine-related unsolicited non-serious AEs following each study 
vaccination through approximately 21 days after each study vaccination. 
• Occurrence of all unsolicited non-SAEs following each study vaccination through 
approximately 21 days after each study vaccination.  
• Occurrence of MAAEs, including NOCMCs and PIMMCs, following the first study 
vaccination through approximately 12 months after the last study vaccination. 
Immunogenicity: 
• For HAI and Neut antibodies, percentage of subjects achieving seroconversion against 
the 2017 H7N9 vaccine strain at approximately 21 days after receipt of 1 dose of AS03-
adjuvanted 2017 H7N9 IIV (Group 1– Day 22; Group 2 – Day 43; Group 3 – N/A). 
• For HAI and Neut antibodies, percentage of subjects achieving serum HAI and Neut 
antibody titers ≥1:40 against the influenza 2017 H7N9 vaccine strain at baseline and 
approximately 21 days after receipt of 1 dose of AS03-adjuvanted 2017 H7N9 IIV 
(Group 1–Day 1 (baseline) and Day 22; Group 2 –Day 22 (baseline) and Day 43; Group 3 
– N/A). 
• GMTs of serum HAI and Neut antibodies against the influenza 2017 H7N9 vaccine virus 
at baseline and at approximately 21 days after receipt of 1 dose of AS03-adjuvanted 2017 
H7N9 IIV. (Group 1–Day 1 (baseline) and Day 22; Group 2 –Day 22 (baseline) and Day 
43; Group 3 – N/A). 

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3.2.3 
Exploratory 
Immunogenicity: 
• For HAI and Neut antibodies, percentage of subjects achieving seroconversion, 
percentage with titer ≥1:40 and the GMTs against the 2017 H7N9 study vaccine strain 
approximately 21 and 180 days after 2 doses of adjuvanted 2017 H7N9 IIV, stratified by 
age, sex, BMI, and prior receipt of seasonal influenza vaccine(s) for Groups 1 and 2. 
• For HAI and Neut antibodies, percentage of subjects achieving seroconversion, 
percentage with a titer ≥1:40 and the GMTs against the IIV4 vaccine strains 
approximately 21 and 180 days after receipt of IIV4, stratified by age, sex, BMI, and 
prior receipt of seasonal influenza vaccine(s). 
• For HAI and Neut antibodies, percentage of subjects achieving seroconversion, 
percentage with titer ≥1:40, and GMTs against the 2017 H7N9 study vaccine strain at 
approximately 180 days after 2 doses of adjuvanted 2017 H7N9 IIV for Groups 1 and 2. 
• Percentage of subjects with detectable levels of serum N1, N2 and N9 NA-specific 
antibody elicited by 2017 H7N9 and seasonal IIV4 vaccination, and the correlation of the 
NA content of 2017 H7N9 IIV and seasonal IIV4 with the elicited NA specific antibody 
responses at baseline and approximately 21 and 180 days after 2 doses of adjuvanted 
2017 H7N9 IIV for Groups 1 and 2; and approximately 21 and 180 days after receipt of 
the seasonal IIV4 vaccine for all Groups. 
 
 

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4 
STUDY DESIGN 
This is a randomized, un-blinded, Phase II study in males and non-pregnant females, who are in 
good health, 19 to 64 years of age. This clinical trial is designed to assess the safety, 
reactogenicity, and immunogenicity of a pre-pandemic AS03 (GSK) adjuvanted 2017 
monovalent inactivated influenza A/H7N9 vaccine (2017 H7N9 IIV) manufactured by Sanofi 
Pasteur (3.75 mcg of HA per dose) and Phosphate Buffered Saline (PBS) diluent, when two 
doses are administered 21 days apart either sequentially or simultaneously (within 15 minutes) 
with licensed seasonal influenza vaccine.  The 2017 H7N9 IIV was manufactured using a reverse 
genetics-derived reassortant candidate vaccine virus IDCDC RG56B (H7N9), containing the HA 
and NA from low pathogenic influenza A/Hong Kong/125/2017 (H7N9) and the PB2, PB1, PA, 
NP, M and NS from A/Puerto Rico/8/1934 (H1N1). IIV4 will be provided through the DMID 
CMS, Fisher BioServices. 
Subjects who are in good health and meet all eligibility criteria (including an ESR, urine or 
serum pregnancy test [female subjects], history and physical exam) within 28 days prior to the 
first vaccination or on the day of, but prior to, first vaccination, will be eligible for randomization 
into one of three treatment arms as shown in Table 1. Baseline clinical safety laboratories will be 
drawn prior to the first vaccine dose and will not be used to screen subjects for eligibility. 
Reactogenicity will be measured by the occurrence of solicited injection site and systemic 
reactions from the time of each study vaccination through 7 days after each study vaccination. 
Unsolicited non-serious AEs will be collected from the time of each study vaccination through 
approximately 21 days after each study vaccination. SAEs and MAAEs, including NOCMCs and 
PIMMCs, will be collected from the time of the first study vaccination through approximately 12 
months after the last study vaccination. Clinical laboratory evaluations for safety will be 
performed on venous blood collected prior to each study vaccination and approximately 7 days 
after each study vaccination. 
Immunogenicity testing will include performing HAI and Neut antibody assays against the 2017 
H7N9 vaccine virus on serum samples collected for Group 1 on Days 1 (baseline), 22, and 43, 
and at approximately 180 days post second adjuvanted 2017 H7N9 IIV dose (Day 202), and for 
Group 2 on Study Days 22 (baseline), 43, and 64, and at approximately 180 days post second 
2017 H7N9 IIV adjuvanted dose (Day 223).Serological antibody assays will be performed 
against the vaccine viruses in IIV4 from serum samples collected at baseline (Day 1) and 
approximately 21 and 180 days following receipt of IIV4 (Groups 1, 2, and 3).   
Novel methods for identifying and assessing alternative correlates of protection against influenza 
infection are needed.  To assess the NA-specific antibody response to vaccination, it is first 
necessary to determine the NA content of inactivated influenza vaccine; this assay is under 

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development.  If successful, the NA content in a dosage-specific manner can be correlated to the 
N9 NA-specific antibody responses elicited by the 2017 H7N9 IIV. 
Subjects will be ineligible to participate in this trial if they have received the 2017-2018 licensed 
seasonal IIV (IIV3 or IIV4, including high dose vaccine for the elderly) any time prior to 
enrollment; IIV4 will be provided at the first study vaccination to all participants in the study. 
For additional details on study procedures and evaluations and study schedule by study 
visits/days, see Sections 7 and 8 and Appendix A: Schedule of Study Procedures and 
Evaluations. 

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5 
STUDY ENROLLMENT AND WITHDRAWAL 
Approximately 150 individuals 19-64 years of age, males and non-pregnant females, who are in 
good health by history and meet all eligibility criteria, will be enrolled at up to 4 VTEU sites 
participating in this trial. The target population should reflect the community at large at each of 
the participating VTEU sites. Estimated time to complete enrollment in this trial is 
approximately 12 weeks. Information regarding this trial may be provided to potential subjects 
who have previously participated in vaccine trials conducted at the participating VTEU sites. 
Other forms and/or mechanisms of recruitment may also be used. The local IRB will approve all 
materials prior to use. 
Subject Inclusion and Exclusion Criteria must be assessed by a study clinician licensed to make 
medical diagnoses and listed on the Form FDA 1572 as the site principal investigator or sub-
investigator. 
No exemptions are granted on Subject Inclusion or Exclusion Criteria in DMID-sponsored 
studies. Questions about eligibility should be directed toward the DMID Medical Officer. 
5.1 
Eligibility Criteria 
5.1.1 
Subject Inclusion Criteria 
Subjects eligible to participate in this trial must meet all of the following inclusion criteria: 
1. Provide written informed consent prior to initiation of any study procedures. 
2. Are able to understand and comply with planned study procedures and be available for all 
study visits. 
3. Are males or non-pregnant females, 19 -64 years of age, inclusive. 
4. Are in good health1. 
1As determined by medical history and physical examination to evaluate acute or currently ongoing chronic medical 
diagnoses or conditions, defined as those that have been present for at least 90 days, which would affect the assessment 
of the safety of subjects or the immunogenicity of study vaccinations. Chronic medical diagnoses or conditions should 
be stable for the last 60 days (no hospitalizations, Emergency Room (ER), or urgent care for condition and no adverse 
symptoms that need medical intervention such as medication change/supplemental oxygen). This includes no change in 
chronic prescription medication, dose, or frequency as a result of deterioration of the chronic medical diagnosis or 
condition in the 60 days prior to enrollment. Any prescription change that is due to change of health care provider, 
insurance company, etc., or that is done for financial reasons, as long as in the same class of medication, will not be 
considered a deviation of this inclusion criterion. Any change in prescription medication due to improvement of a 
disease outcome, as determined by the site principal investigator or appropriate sub-investigator, will not be 
considered a deviation of this inclusion criterion. Subjects may be on chronic or as needed (prn) medications if, in the 
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or assessment of reactogenicity and immunogenicity and do not indicate a worsening of medical diagnosis or 
condition. Similarly, medication changes subsequent to enrollment and study vaccination are acceptable provided 
there was no deterioration in the subject’s chronic medical condition that necessitated a medication change, and there 
is no additional risk to the subject or interference with the evaluation of responses to study vaccination. Note: Topical, 
nasal, and inhaled medications (with the exception of inhaled corticosteroids as outlined in the Subject Exclusion 
Criteria [see Section 5.1.2]), herbals, vitamins, and supplements are permitted. 
5. Oral temperature is less than 100.0°F. 
6. Pulse is 47 to 100 beats per minute (bpm), inclusive. 
7. Systolic blood pressure is 85 to 150 mmHg, inclusive (subjects <65 years of age), 85 to 
160 mmHg, inclusive (subjects > 65 years of age). 
8. Diastolic blood pressure is 55 to 95 mmHg, inclusive. 
9. ESR is less than 30 mm per hour. 
10. Women of childbearing potential2 must use an acceptable contraception method3 from 30 
days before first study vaccination until 60 days after last study vaccination. 
2Not sterilized via tubal ligation, bilateral oophorectomy, salpingectomy, hysterectomy, or successful Essure® 
placement (permanent, non-surgical, non-hormonal sterilization) with documented radiological confirmation test at 
least 90 days after the procedure, and still menstruating or <1 year of the last menses if menopausal. 
3Includes, non-male sexual relationships, abstinence from sexual intercourse with a male partner, monogamous 
relationship with vasectomized partner who has been vasectomized for 180 days or more prior to the subject receiving 
the first study vaccination, barrier methods such as condoms or diaphragms with spermicide or foam, effective 
intrauterine devices, NuvaRing®, and licensed hormonal methods such as implants, injectables, or oral contraceptives 
(“the pill”). 
11. Women of childbearing potential must have a negative urine or serum pregnancy test 
within 24 hours prior to study vaccination. 
5.1.2 
Subject Exclusion Criteria 
Subjects eligible to participate in this trial must not meet any of the following exclusion criteria: 
1. Have an acute illness4, as determined by the site principal investigator or appropriate sub-
investigator, within 72 hours prior to study vaccination. 
4An acute illness which is nearly resolved with only minor residual symptoms remaining is allowable if, in the opinion 
of the site principal investigator or appropriate sub-investigator, the residual symptoms will not interfere with the 
ability to assess safety parameters as required by the protocol. 
2. Have any medical disease or condition that, in the opinion of the site principal 
investigator or appropriate sub-investigator, is a contraindication to study participation5. 
5Including acute or chronic medical disease or condition, defined as persisting for at least 90 days, that would place 
the subject at an unacceptable risk of injury, render the subject unable to meet the requirements of the protocol, or may 
interfere with the evaluation of responses or the subject’s successful completion of this trial. 

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3. Have immunosuppression as a result of an underlying illness or treatment, a recent 
history or current use of immunosuppressive or immunomodulating disease therapy.  
4. Use of anticancer chemotherapy or radiation therapy (cytotoxic) within 3 years prior to 
study vaccination. 
5. Have known active neoplastic disease or a history of any hematologic malignancy. Non-
melanoma, treated, skin cancers are permitted. 
6. Have known human immunodeficiency virus (HIV), hepatitis B, or hepatitis C infection. 
7. Have known hypersensitivity or allergy to eggs, egg or chicken protein, squalene-based 
adjuvants, or other components of the study vaccine. 
8. Have a history of severe reactions following previous immunization with licensed or 
unlicensed influenza vaccines. 
9. Have a personal or family history of narcolepsy. 
10. Have a history of GBS. 
11. Have a history of convulsions or encephalomyelitis within 90 days prior to study 
vaccination. 
12. Have a history of PIMMCs6 
6Refer to Appendix B: List of Potentially Immune-Mediated Medical Conditions. 
13. Have a history of alcohol or drug abuse within 5 years prior to study vaccination. 
14. Have any diagnosis, current or past, of schizophrenia, bipolar disease, or other psychiatric 
diagnosis that may interfere with subject compliance or safety evaluations. 
15. Have been hospitalized for psychiatric illness, history of suicide attempt, or confinement 
for danger to self or others within 10 years prior to study vaccination. 
16. Have taken oral or parenteral (including intra-articular) corticosteroids of any dose within 
30 days prior to study vaccination. 
17. Have taken high-dose inhaled corticosteroids7 within 30 days prior to each study 
vaccination. 
7High-dose defined per age as using inhaled high dose per reference chart https://www.nhlbi.nih.gov/health-
pro/guidelines/current/asthma-guidelines/quick-reference-html#estimated-comparative-daily-doses  
18. Received a licensed live vaccine within 30 days prior to the first study vaccination, or 
plan to receive a licensed live vaccine within 30 days before or after each study 
vaccination. 
19. Received or plan to receive a licensed, inactivated, vaccine (excluding all flu vaccines) 
within 14 days before or after each study vaccination.  

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20. Received or plan to receive the 2017-2018 inactivated seasonal flu vaccine prior to or 
during the clinical trial and for the remainder of the 2017-2018 season.  
21. Received Ig or other blood products (with exception of Rho D Ig) within 90 days prior to 
each study vaccination. 
22. Received an experimental agent8 within 30 days prior to the first study vaccination, or 
expect to receive an experimental agent9 during the 13-month trial-reporting period. 
8Including vaccine, drug, biologic, device, blood product, or medication. 
9Other than from participation in this trial. 
23. Are participating or plan to participate in another clinical trial with an interventional 
agent10 that will be received during the 13-month trial-reporting period. 
10Including licensed or unlicensed vaccine, drug, biologic, device, blood product, or medication. 
24. Received or plan to receive an influenza A/H7 vaccine11 or have a history of influenza 
A/H7 subtype infection.  
11And assigned to a group receiving influenza A/H7 vaccine. 
25. Have traveled to mainland China and had substantial12 direct contact with live or freshly 
slaughtered poultry or pigeons within the past five years. 
12Substantial contact is defined as visited a poultry farm and/or a live poultry market.  
26. Occupational exposure to or substantial direct physical contact13 with birds in the past 
year and through the 21 days after the last study vaccination. 
13Exposure to free range chickens in the yard is exclusionary. Casual contact with birds at petting zoos or county or 
state fairs, or having pet birds does not exclude subjects from study participation. 
27. Female subjects who are breastfeeding or plan to breastfeed at any given time from the 
first study vaccination until 30 days after the last study vaccination. 
28. Plan to travel outside the US (continental US, Hawaii, and Alaska) from enrollment 
through 21 days after the last study vaccination. 
5.2 
Treatment Assignment Procedures 
5.2.1 
Enrollment and Randomization Procedures 
Per ICH guideline E6: Good Clinical Practice (GCP), screening records will be kept at each 
participating VTEU site to document the reason why an individual was screened, but failed trial 
entry criteria. The reasons why individuals failed screening will be recorded in the Statistical and 
Data Coordinating Center’s (SDCC) AdvantageEDCSM (Electronic Data Capture System). 

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Once consented and upon entry of demographic data and confirmation of eligibility for this trial, 
the subject will be enrolled and randomly assigned to one of three treatment arms. Subjects in 
Groups 1 and 2 will receive three vaccinations. Subjects in Group 3 will receive IIV4 as an 
unblinded comparator. Subjects will be randomized with allocation 2:2:1 into three treatment 
arms (see Table 1), stratified by clinical site.  
Enrollment of subjects will be done online using the enrollment module of AdvantageEDCSM. 
The randomization code will be prepared by statisticians at the SDCC and included in the 
enrollment module for this trial. AdvantageEDCSM will assign each subject to a treatment arm 
after the demographic and eligibility data have been entered into the system.  
Instructions for use of the enrollment module are included in the AdvantageEDCSM User’s 
Guide. Manual back-up procedures and instructions are provided for use in the event that a 
participating VTEU site temporarily loses access to the Internet or the online enrollment system 
is unavailable. 
5.2.2 
Masking Procedures 
This is an un-blinded clinical trial. 
Subjects, investigators, study personnel performing any study-related assessments following 
study vaccine administration are not blinded to study treatment. However, laboratory personnel 
performing HAI and Neut antibody assays will receive serum samples blinded to subject ID 
number and sample visit number. 
The randomization scheme will be generated by the SDCC and each subject’s treatment 
assignment will be displayed in AdvantageEDC upon enrollment. 
The Data and Safety Monitoring Board (DSMB) may receive data in aggregate and presented by 
treatment arm, including expected and observed rates of the expected AEs. The DSMB will 
review grouped data in the closed session only. 
5.2.3 
Reasons for Withdrawals and Discontinuation of Treatment 
Subjects may voluntarily withdraw their consent for trial participation at any time and for any 
reason, without penalty. 
A subject may withdraw or be withdrawn from this trial for any of the following reasons: 

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• Medical disease or condition, or any new clinical finding for which continued 
participation, in the opinion of the site principal investigator or appropriate sub-
investigator, would compromise the safety of the subject, or would interfere with the 
subject's successful completion of this trial, or would interfere with the evaluation of 
responses (for example, has baseline significant laboratory abnormalities). 
• Subject no longer meets eligibility criteria (see Section 5.1). Note: Medication changes in 
the 60 days prior to enrollment, as specified in Subject Inclusion Criterion #4, are 
exclusionary for receipt of the first study vaccination only. 
• As deemed necessary by the site principal investigator or appropriate sub-investigator for 
noncompliance or other reasons. 
• Subject withdrawal of consent. 
• Subject lost to follow-up. 
• Termination of this trial. 
• New information becomes available that makes further participation unsafe. 
The second and/or third dose will not be administered to a subject if any of the following criteria 
are met: 
• Medical condition or medication change for which continued participation, in the opinion 
of the site principal investigator or appropriate sub-investigator, would pose a risk to the 
subject or would be likely to confound interpretation of the results. 
• Presence of signs or symptoms that could confound or confuse assessment of study 
vaccine reactogenicity. For subjects with injection site or systemic signs or symptoms, or 
with an acute illness, including an oral temperature greater than or equal to 100°F, the 
subsequent study vaccination should be postponed/deferred until signs, symptoms, or 
acute illness have resolved, or are improving as further specified below, and if within the 
acceptable protocol-specified window for Dose 2 (Group 1 and Group 2, Day 22+7), or 
Dose 3 (Group 2, Day 43+7). No exceptions to the protocol-specified window will be 
made. Note for afebrile, acute illness only: If a subject is afebrile, his/her acute illness is 
nearly resolved with only minor residual symptoms remaining, this occurs within the 
acceptable protocol-specified window for Dose 2 (Group 1 and Group 2, Day 22+7), or 
Dose 3 (Group 2, Day 43+7) and, in the opinion of the site principal investigator or 
appropriate sub-investigator, the residual symptoms will not interfere with the ability to 
assess safety parameters as required by the protocol, the subject may receive the 
subsequent study vaccination without further approval from the DMID Medical Officer. 
No exceptions to the protocol-specified window will be made.  

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• Grade 3 solicited or unsolicited AE that is ongoing, whether or not it is improved or 
resolving.  
• Any unresolved or continuing Grade 2 AE that has not decreased in severity to Grade 1 
or less.  
• An unresolved or continuing Grade 1 AE is permissible following the documented 
determination by the site principal investigator or appropriate sub-investigator, that it 
would not render study vaccination unsafe or interfere with the evaluation of responses. 
• Grade 3 solicited or unsolicited AE that occurs without alternative etiology in the 8 days 
following each study vaccination. 
• Grade 3 clinical safety laboratory value (according to the toxicity table, Section 9.2.3) 
that does not decrease to Grade 2 or less prior to the second study vaccination. Any 
clinical safety laboratory parameter may be re-evaluated only once at the central (clinical) 
laboratory in order to assess eligibility prior to the next study vaccination. If the clinical 
safety laboratory value decreases to Grade 2 or less, the subject may receive the next 
study vaccination. The subsequent study vaccination should be scheduled to occur within 
the acceptable protocol-specified window for the Dose 2 (Group 1 and Group 2, Day 
22+7), or Dose 3 (Group 2, Day 43+7). No exceptions to the protocol-specified window 
will be made. 
• New onset of illness or condition that meets the Subject Exclusion Criteria (see Section 
5.1.2). 
• Hospitalization that occurs before administration of the second or third study vaccination.  
• Subject no longer meets eligibility criteria (see Section 5.1). Note: Medication changes 
subsequent to the first study vaccination are not exclusionary for receipt of the second 
study vaccination provided there was no deterioration in the subject’s chronic medical 
condition that necessitated a medication change, and there is no additional risk to the 
subject or interference with the evaluation of responses to study vaccination. 
• As deemed necessary by the site principal investigator or appropriate sub-investigator for 
noncompliance or other reasons. 
• Subject refusal of further study vaccination. 
• Subject withdrawal of consent. 
• Subject lost to follow-up. 
• Termination of this trial. 
• New information becomes available that makes further participation unsafe. 

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5.2.4 
Handling of Withdrawals and Discontinuation of Treatment 
The primary reason for withdrawal from this trial will be recorded on the Study Status data 
collection form (DCF). Subjects will be encouraged to complete the Early Termination Visit. 
The Early Termination Visit procedures are listed in Section 8.5. 
Although subjects are free to withdraw at any time or may be withdrawn by the site principal 
investigator or appropriate sub-investigator at any time (see Section 5.2.3), those subjects do not 
receive Dose 2 or Dose 3 of study vaccine will be encouraged to remain in this trial for follow-up 
safety assessments (may be conducted by phone call rather than in person) continuing through 
approximately 12 months after their last study vaccination. These subjects will also be 
encouraged to provide a venous blood sample for immunogenicity assays at approximately 21 
days and 180 days after their last study vaccination, if applicable. See the protocol-specific 
Manual of Procedures (MOP) for alternate follow-up requirements. 
Every attempt will be made to follow all AEs, including solicited injection site and systemic 
reactions, unsolicited non-serious AEs, SAEs and MAAEs, including NOCMCs and PIMMCs, 
ongoing at the time of early withdrawal through resolution as per applicable collection times 
defined for the specific type of AE. 
In the case of subjects who fail to appear for a follow-up safety assessment, extensive effort (i.e., 
three documented contact attempts via phone calls made on separate occasions and followed by a 
certified letter) will be made to locate or recall them, or at least to determine their health status. 
These efforts will be documented in the subject’s study records. 
Subjects who withdraw, or are withdrawn or terminated from this trial, or are lost to follow-up 
after signing the informed consent form (ICF), randomization, and receipt of study vaccine will 
not be replaced. However, if a subject withdraws after signing the ICF, but before randomization 
and/or receipt of study vaccine, they may be replaced. 
5.2.5 
Termination of Study 
Although the sponsor has every intention of completing this trial, it reserves the right to 
terminate this trial at any time for clinical or administrative reasons. Reasons for termination 
include, but are not limited to, study closure due to DSMB review and recommendation and at 
the discretion of DMID. 

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6 
STUDY INTERVENTION/INVESTIGATIONAL 
PRODUCT 
6.1 
Study Product Description 
2017 H7N9 IIV 
Sanofi Pasteur has developed a monovalent 2017 H7N9 IIV manufactured from a reverse 
genetics-derived reassortant virus containing the HA and NA from influenza A/Hong 
Kong/125/2017 (H7N9) and the PB2, PB1, PA, NP, M and NS from A/Puerto Rico/8/1934 
(H1N1).  The manufacturing process for the production of this monovalent 2017 A/H7N9 
IIV is similar to the manufacturing process used to produce the licensed IIV Fluzone® family 
of products.  
The HA content of the A/H7N9 vaccine formulation has been determined by 
 
In 
this clinical trial, the labeling of the original 
 
 The vaccine preparation has been adjusted to
 
 
The final vaccine preparation is 
 
  
PBS diluent 
The PBS diluent was produced in accordance with the commercial process utilized in 
manufacture of 
 buffer/diluent for the formulation of Fluzone®, influenza virus 
vaccine.  
AS03 Adjuvant [Adjuvant System AS(03)] 
AS03 is GSK’s proprietary 
Fluzone® Quadrivalent Influenza Vaccine (IIV4)  
IIV4 manufactured by Sanofi Pasteur for IM injection is an inactivated influenza vaccine, 
prepared from influenza viruses propagated in embryonated chicken eggs.  Fluzone® 
Quadrivalent is formulated to contain HA of each of the following four influenza strains 
recommended for the 2017-2018 influenza season: A/Michigan/45/2015 X-275 (H1N1), 
A/Hong Kong/4801/2014 X-263B (H3N2), B/Phuket/3073/2013 (B Yamagata lineage), and 
B/Brisbane/60/2008 (B Victoria lineage). The single-dose, pre-filled syringe (0.5 mL) 

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without thimerosal, clear plunger rod, without needle will be supplied as package of 10 
syringes.  
6.1.1 
Acquisition 
2017 H7N9 IIV will be provided by Sanofi Pasteur under contract to BARDA/DHHS.  
The PBS diluent will be provided by Sanofi Pasteur under contract to BARDA/DHHS. 
AS03 adjuvant will be provided by GSK under contract to BARDA/DHHS.  
Fluzone® Quadrivalent Influenza Vaccine (IIV4) will be provided through the DMID Clinical 
Materials Services (CMS) Contract, Fisher BioServices.  
Upon request by DMID, 2017 H7N9 IIV, PBS diluent, and AS03 adjuvant will be transferred to 
the following address: 
DMID Clinical Materials Services Contract 
Fisher BioServices 
20439 Seneca Meadows Parkway 
Germantown, MD 20876 
Phone: 240-477-1350 
Fax: 240-477-1360 
Email: DMID.CMS@ThermoFisher.com 
Sterile empty vials will be obtained by the DMID Clinical Materials Services (CMS), Fisher 
BioServices. 
2017 H7N9 IIV, AS03 adjuvant, PBS diluent, IIV4 and sterile empty vials for study vaccine 
preparation will be provided through the DMID CMS to the participating VTEU sites prior to the 
start of this trial upon request and with prior approval from DMID. Should the site principal 
investigator require additional 2017 H7N9 IIV, PBS diluent, AS03 adjuvant, IIV4 or sterile 
empty vials during this trial, further instructions are provided in the protocol-specific MOP. 
6.1.2 
Formulation, Storage, Packaging, and Labeling 
2017 H7N9 IIV 
Investigational influenza virus A/Hong Kong vaccine (H7N9), a monovalent type A inactivated 
vaccine for IM use, is a sterile suspension prepared from pandemic influenza virus candidate 
vaccine propagated in embryonated chicken eggs. The vaccine contains no preservative 
(thimerosal).  No components of this vaccine contain latex. It is essentially clear and slightly 
opalescent in color and is supplied in single-dose glass vials. The vials must be stored at 2°C to 
8°C (36°F to 46°F). Do not freeze. Vials will be provided with latex-free stoppers.  

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The specific mixing instructions are included in the MOP to achieve specific doses. 
Please note the difference 
 in the vial.   
 
  
 
 
 
PBS Diluent 
The 
 is provided as 
 
 
 It is essentially 
, and should be stored 
 The 
PBS diluent will be provided in 
 
 
AS03 Adjuvant [Adjuvant System (03)] 
The AS03 adjuvant is supplied as a preservative-free, oil-in-water, whitish to yellowish 
homogenous milky liquid emulsion in single-use vials. The vials must be stored at 2°C to 8°C 
(36°F to 46°F). Do not freeze. Vials will be provided with latex-free stoppers.  
 
Fluzone® Quadrivalent Influenza Vaccine (IIV4) Fluzone® Quadrivalent Influenza Vaccine, 
Sanofi Pasteur, pre-filled syringes, thimerosal-free, 0.5 mL single-dose prefilled syringes (pack 
of 10). The pre-filled syringes must be stored at 2°C to 8°C (36°F to 46°F). Do not freeze. 
 
Each of these study products will be labeled according to manufacturer specifications and 
include the statement “Caution: New Drug Limited by Federal Law to Investigational Use.” 
Further details are included in the respective, applicable IBs for the 2017 H7N9 IIV, AS03 
adjuvant, and IIV4 as well as in the protocol-specific MOP. 
Sterile empty vials will be provided with latex-free stoppers. 
6.1.3 
Study Product Storage and Stability Procedures 
The temperature of the storage unit must be manually recorded daily (excluding non-business 
days and holidays as applicable) and continuously monitored and recorded during the duration of 
this trial per the participating VTEU site standard operating procedures (SOPs), and 
documentation will be maintained. If the temperature fluctuates outside of the required range, the 

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affected study product(s) must be quarantined at the correct storage temperature and labeled as 
‘Do Not Use’ (until further notice). The research pharmacist must alert the site principal 
investigator and study coordinator if the temperature fluctuates outside of the required range. In 
the event the temperature fluctuates outside of the required range, including accidental deep-
freezing or disruption of the cold chain, the affected study product(s) must not be administered. 
The site principal investigator or responsible person should immediately contact the DMID 
Product Support Team at DMIDProductSupportTeam@niaid.nih.gov for further instructions 
before any additional study vaccinations are administered. Based on the information collected, 
DMID and/or the manufacturer will determine whether the affected study product(s) can be used. 
If it cannot be used, the site will receive specific instructions on how to return the affected study 
product(s) to the DMID CMS or destroy it on site. 
6.2 
Dosage, Preparation, and Administration of Study Intervention/ 
Investigational Product 
See the protocol-specific MOP Appendices for detailed information on the preparation, labeling, 
storage, and administration of study vaccine for each treatment arm. Study vaccine preparation 
will be performed by the participating VTEU site research pharmacist on the same day of study 
vaccine administration.  
Visually inspect the 2017 H7N9 IIV, PBS diluent, IIV4 and AS03 adjuvant upon receipt and 
prior to use. If the study product(s) appear(s) to have been damaged, contaminated or discolored, 
contain visible particulate matter or if there are any concerns regarding its integrity, do NOT use 
the affected study product(s). The affected study product(s) must be quarantined at 2°C to 8°C 
(36°F to 46°F) and labeled as ‘Do Not Use’ (until further notice). The site principal investigator 
or responsible person should immediately contact the DMID Product Support Team at 
DMIDProductSupportTeam@niaid.nih.gov and DMID Clinical Project Manager for further 
instructions before any additional study vaccinations are administered. Based on the information 
collected, DMID and/or the manufacturer will determine whether the affected study product(s) 
can be used. If it cannot be used, the site will receive specific instructions on how to return the 
affected study product(s) to the DMID CMS or destroy it on site. If the 2017 H7N9 vaccine, PBS 
diluent, or the AS03 adjuvant is unusable, study personnel will use another vial from the study 
supply. Replacement vials may be requested by contacting DMID. Additional instructions for 
quarantine and DMID contact information are provided in the protocol-specific MOP. 
For those doses that must be admixed, visually inspect the 2017 H7N9 IIV/PBS diluent plus 
adjuvant admixture prior to use. The admixture will be milky in appearance. If it appears to have 
been damaged, contaminated or discolored, contain visible particulate matter, or if there are any 
concerns regarding its integrity, do NOT use it. The affected 2017 H7N9 IIV/PBS diluent plus 

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adjuvant admixture must be quarantined at room temperature and labeled as ‘Do Not Use’ (until 
further notice). The site principal investigator or responsible person should immediately contact 
the DMID Product Support Team at DMIDProductSupportTeam@niaid.nih.gov and DMID 
Clinical Project Manager for further instructions before any additional study vaccinations are 
administered. Based on the information collected, DMID and/or the manufacturer will determine 
whether the 2017 H7N9 IIV/PBS diluent plus adjuvant admixture can be used. If it cannot be 
used, the site will receive specific instructions on how to send the 2017 H7N9 IIV/PBS diluent 
plus adjuvant admixture to the DMID CMS or destroy it on site. If the 2017 H7N9 IIV/PBS 
diluent plus adjuvant admixture is unusable, the participating VTEU sites’ research pharmacist 
will prepare another vial. Additional instructions for quarantine and DMID contact information 
are provided in the protocol-specific MOP. 
For those doses that must be admixed, the 2017 H7N9 IIV/PBS diluent plus adjuvant admixture, 
once mixed, must be stored at room temperature in an upright position and must be used within 8 
hours. Gently invert the final mixed vial 5 to 7 times immediately before the single dose is 
withdrawn.  Do not shake the final mixed vial.  Only one dose should be withdrawn from the 
final mixed vial. 
Study vaccine administration will be performed by a study personnel member who is 
credentialed to administer vaccines and may also participate in dose preparation, and may be 
involved in study-related assessments or have subject contact for data collection following study 
vaccine administration.  
 
For treatment assignment per Group, refer to Table 1.  
On study Day 1, Groups 1-3 will receive Dose 1. For Group 1, Dose 1 consists of one 
vaccination of AS03-adjuvanted 2017 H7N9 IIV and one vaccination of licensed seasonal IIV4 
in the deltoid muscle of opposite arms. This is the only Group, and the only study Day for Group 
1, that subjects will receive two vaccines administered IM simultaneously (within 15 minutes of 
each other). On Day 1, Group 2 and Group 3 will receive one vaccination of IIV4 administered 
IM in the deltoid muscle of the subject’s preferred arm.   
On study Day 22, Group 1 will receive the second dose of adjuvanted 2017 H7N9 IIV, and 
Group 2 will receive the first dose of adjuvanted 2017 H7N9 IIV. 
On Day 43, Group 2 will receive the second dose of adjuvanted 2017 H7N9 IIV. 
All study vaccinations will be administered as a 0.5 mL IM injection. The site of each injection 
(right and/or left arm) will be recorded on the appropriate DCF.  

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Aseptic technique will be used for the withdrawal and administration of each dose of study 
vaccine using a disposable sterile needle appropriate in length for each subject and a disposable 
sterile 1 mL syringe. See the protocol-specific MOP for information on how to administer IM 
injections. Each dose of study vaccine must be administered within 30 minutes of drawing into 
the syringe (not to exceed 8 hours total since admixing time), and the prepared syringe must be 
stored at room temperature until administered.  
Dose calculations are based on the actual HA content per 0.5 mL. Each 0.5 mL dose of AS03 
adjuvanted study vaccine contains one 0.25 mL dose of AS03 adjuvant. 
For Fluzone Quadrivalent, before administering a dose of vaccine, shake the prefilled syringe. 
Aseptic technique will be used for the administration of each dose of study vaccine using a 
disposable sterile needle appropriate in length for each subject. 
Subjects will be observed in the clinic for at least 20 minutes after the vaccination (for Group 1, 
Dose 1, the 20 minute clock will start after receipt of the second vaccination). The vaccination 
site will be examined, post-administration reactogenicity assessments will be performed, and any 
AE/SAEs will be recorded on the appropriate DCF prior to discharge from the clinic. 
6.3 
Modification of Study Intervention/Investigational Product for a 
Subject 
There will be no dose modifications. If a subject’s study vaccination is deferred, it should be 
rescheduled to occur within the acceptable protocol-specified window for that visit. No 
exceptions to the protocol-specified window will be made. 
  
6.4 
Accountability Procedures for the Study Intervention/ 
Investigational Product 
After receipt of the 2017 H7N9 IIV, PBS diluent, AS03 adjuvant, IIV4 and sterile empty vials, 
the site principal investigator is responsible for study product distribution and disposition, and 
has ultimate responsibility for study product accountability. The site principal investigator may 
delegate to the participating VTEU sites’ research pharmacist responsibility for study product 
accountability. The participating VTEU sites’ research pharmacist will be responsible for 
maintaining complete records and documentation of study product receipt, accountability, 
dispensation, storage conditions, and final disposition of the study product(s). The study product 
accountability records and dispensing logs will also capture vial numbers, including final mixed 

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vial number, date of study vaccine preparation/administration, time of study vaccine preparation, 
expiration of study vaccine preparation, time study vaccine is drawn into the syringe, and amount 
of study vaccine withdrawn for administration. Time of study vaccine administration to the 
subject will be captured on the appropriate DCF. All study product(s), including the amount of 
2017 H7N9 IIV, AS03 adjuvant, IIV4 and admixture, whether administered or not, must be 
documented on the appropriate study product accountability record or dispensing log. The 
sponsor's monitoring staff will verify the participating VTEU sites’ study product accountability 
records and dispensing logs per the site monitoring plan. 
Used and unused vials of 2017 H7N9 IIV, AS03 adjuvant, IIV4 and admixture will be retained 
until monitored and released for disposition as applicable. The pre-filled IIV4 single use syringe 
will be disposed of per site processes once the vaccine is administered. This can occur on an 
ongoing basis for used vials of 2017 H7N9 IIV, AS03 adjuvant, IIV4 and admixture. Used vials 
of A/H7N9 vaccine, AS03 adjuvant and admixture may be destroyed in accordance with site-
specific SOPs following each monitoring visit where Study Product Accountability is monitored, 
and resolution of any discrepancies. Final disposition of the unused 2017 H7N9 IIV, AS03 
adjuvant, IIV4 and sterile empty vials will be determined by DMID and communicated to the 
participating VTEU sites by the DMID Clinical Project Manager. 
6.5 
Assessment of Subject Compliance with Study Intervention/ 
Investigational Product 
Study product will be administered to subjects by a study vaccine administrator via IM injection 
at all dosing times according to subject treatment assignment and as described in Section 6.2. 
Thus, subject compliance is not anticipated to be an issue. There will be no dose schedule 
modifications, other than within the protocol-specified windows, as described in Section 6.3. 
6.6 
Concomitant Medications/Treatments 
Administration of any medications, therapies, or vaccines will be recorded on the appropriate 
DCF. Concomitant medications will include all current medications and medications taken in the 
60 days prior to signing the ICF through approximately 21 days after the last study vaccination 
or early termination (if prior to 21 days after the last study vaccination), whichever occurs first. 
Medications reported in the electronic case report form (eCRF) are limited to those taken within 
30 days prior to the first study vaccination through approximately 21 days after the last study 
vaccination. Prescription and over-the-counter drugs will be included as well as herbals, 
vitamins, and supplements. In addition, receipt of non-study influenza vaccines will be solicited 
through approximately 180 days after the last study vaccination, and reported in the eCRF. Use 
of a new medication should prompt evaluation for the occurrence of any MAAE, including a new 
diagnosis of chronic medical disease or condition. 

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Medications that might interfere with the evaluation of the investigational product(s) should not 
be used during the trial-reporting period (approximately 12 months after the last study 
vaccination) unless clinically indicated as part of the subject’s health care. Medications in this 
category include the prohibited medications per the Subject Exclusion Criteria (see Section 
5.1.2). In addition, the site principal investigator or appropriate sub-investigator may identify 
other medications that should not be used due to a risk to subject safety or assessment of 
reactogenicity and immunogenicity. 

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7 
STUDY PROCEDURES AND EVALUATIONS 
7.1 
Clinical Evaluations 
Complete medical history will be obtained by interview of subjects at the screening visit 
(optional) or on Day 1 prior to the first study vaccination. Subjects will be queried regarding a 
history of significant medical disorders of the head, eyes, ears, nose, throat, mouth, 
cardiovascular system, lungs, gastrointestinal tract, liver, pancreas, kidney, urologic system, 
nervous system, blood, lymph nodes, endocrine system, musculoskeletal system, skin, and 
genital/reproductive tract. A history of any allergies, cancer, immunodeficiency, psychiatric 
illness, substance abuse, and autoimmune disease will be solicited. Subjects will also be queried 
regarding a personal history and family history of narcolepsy. At follow-up visits after the first 
study vaccination, an interim medical history will be obtained by interview of subjects noting 
any changes since the previous clinic visit or contact. The interim medical history should include 
an assessment for new medical conditions and symptoms suggestive of PIMMCs. 
Concomitant medications will be collected as described in Section 6.6. 
At the screening visit (optional) or the baseline visit (Day 1), a physical examination will be 
performed on all subjects to include the following organs and organ systems: skin, head and 
neck, lungs, heart, liver, spleen, extremities, lymph nodes, and nervous system, by a study 
clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as the site 
principal investigator or sub-investigator. At follow-up visits after the first, second, and/or third 
study vaccinations, a targeted physical examination may be performed, if indicated based on the 
subject’s interim medical history, by a study clinician licensed to make medical diagnoses and 
listed on the Form FDA 1572 as the site principal investigator or sub-investigator. Targeted 
physical examinations should also include an assessment for signs suggestive of PIMMCs. 
Vital signs (oral temperature, pulse, and blood pressure) will be collected at the screening visit 
(optional) and prior to each study vaccination (Day 1, and approximately Days 22 and 43, as 
applicable to study group). Vital signs assessed on Day 1 prior to the first study vaccination will 
be considered as baseline. Subjects must not eat or drink anything hot or cold, or smoke within 
10 minutes prior to taking oral temperature. 
Height and weight will be collected at the screening visit (optional) or on Day 1 prior to the first 
study vaccination for the calculation of BMI. 
Reactogenicity assessments will include an assessment of solicited AEs occurring from the time 
of each study vaccination through Day 8 after each study vaccination, which includes an 
assessment of injection site reactions including pruritus (itching), ecchymosis (bruising), 

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erythema (redness), induration (hardness), edema (swelling), pain, and tenderness as well as 
systemic reactions including fever, feverishness (chills/shivering/sweating), fatigue (tiredness), 
malaise (general unwell feeling), myalgia (body aches/muscular pain exclusive of the injection 
site), arthralgia (joint pain exclusive of the injection site), headache, and nausea. Pre-
administration reactogenicity assessments will be performed prior to each study vaccination to 
establish baseline, then the study vaccination will be given (see Section 5.2.3). 
Subjects will be observed in the clinic for at least 20 minutes after each study vaccination. The 
study vaccination site will be examined, post-administration reactogenicity assessments will be 
performed, and any AE/SAEs will be recorded on the appropriate DCF prior to discharge from 
the clinic. The study vaccination site will also be examined approximately 7 days after each 
study vaccination. 
All subjects will complete a subject memory aid from the time of each study vaccination through 
7 days after each study vaccination. Subject memory aids will be reviewed with the subjects for 
AEs (solicited injection site and systemic reactions and unsolicited AEs) approximately 3 and 7 
days after each study vaccination via phone call (Day 4) and clinical visit (Day 8). 
7.2 
Laboratory Evaluations 
7.2.1 
Clinical Laboratory Evaluations 
Urine or serum pregnancy tests will be performed locally by site laboratory at the screening visit 
(optional) and within 24 hours prior to each study vaccination on all women of childbearing 
potential. Results must be negative and known prior to randomization on Day 1 and 
administration of each study vaccination to be eligible for participation in this trial and receipt of 
each study vaccination. ESR will be collected from each subject at screening (optional) (within 
28 days prior to the first study vaccination) or on Day 1 prior to study vaccination to confirm 
trial eligibility. To be eligible for participation in this trial and receipt of the first study 
vaccination, the subject’s ESR evaluation must be confirmed to meet the eligibility criteria as 
outlined in the Subject Inclusion Criteria (see Section 5.1.1). 
• The ESR evaluation will be performed locally by the site. A venous blood sample 
(approximately 4 mL) will be collected from each subject at the baseline visit. 
Clinical safety laboratory parameters (WBC, Hgb, PLT, ALT, T. Bili, Cr) will be collected from 
each subject prior to each study vaccination and approximately 7 days after each study 
vaccination. These evaluations will be performed by the central (clinical) laboratory. Venous 
blood samples (approximately 10 mL) will be collected for each of these safety labs. The results 

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from the clinical safety laboratory parameters collected on Day 1 will not be available or 
reviewed prior to study vaccination, and will serve as a safety baseline assessment only. 
The volume of venous blood to be collected for ESR as well as clinical safety laboratory 
evaluations is presented in Table 2. 
7.2.2 
Special Assays or Procedures 
Immunogenicity 
Assays to determine serum levels of HAI and Neut antibodies will be performed at Southern 
Research. Immunogenicity testing will include performing HAI and Neut antibody assays 
against the 2017 H7N9 vaccine virus on serum samples collected for Group 1 on Days 1 
(baseline), 22, and 43, and at approximately 180 days post second 2017 H7N9 IIV dose (Day 
202), and for Group 2 on Days 22 (baseline), 43, and 64, and at approximately 180 days post 
second 2017 H7N9 IIV dose (Day 223). Serological antibody assays will be performed 
against the vaccine viruses in IIV4 from serum samples collected at baseline (Day 1) and 
approximately 21 and 180 days following receipt of IIV4 (Groups 1, 2 and 3).  Subjects who 
withdraw early will have HAI and Neut antibody assays run on available sera.  
The assays for determination of the NA content and antibodies to the NA are under 
development. If successful, the correlation of NA content in the 2017 H7N9 IIV with elicited 
N9 NA-specific serum antibody responses may be assessed.  2017 H7N9 IIV and adjuvant 
will be shipped from the DMID CMS to the NA content assay designated laboratory for NA 
content assessment. Any laboratory involved with the determination of NA content or NA-
specific antibody responses will remain blinded to the HAI and Neut antibodies results 
performed at Southern Research. 
After all subjects in Groups 1 and 2 have completed the Day 64 clinic visit (Visit 08 for 
Group 1 and Visit 10 for Group 2), samples for the HAI and Neut analysis will be shipped 
from the DMID CMS to Southern Research. Following the last subject’s clinic visit at 180 
days after the last study vaccination (Visit 10 for Group 1 and Visit 12 for Group 2), samples 
for the final HAI and Neut analysis will be shipped from the DMID CMS to Southern 
Research.  
For all Groups, serological antibody assays will be performed against the vaccine viruses in 
IIV4 from serum samples collected at baseline (Study Day 1), and 21 and 180 days following 
receipt of IIV4.  
Venous blood samples (10 mL) will also be collected for future use at the same time points. 
Sites may elect to allow subjects to consent to study participation but to have the option to 

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opt out of the collection of the future use samples, or may include collection of future use 
samples as a condition of study participation and not allow the opt out option. 
The volume of venous blood to be collected for immunogenicity assays and future research is 
presented in Table 2. 
 
 

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Table 2 a 
Group 1 Venipuncture Volumes (mL): 
Vaccination Period 
Study Visit Number 
V00 
V01 
V03 
V04 
V06 
 
V07 
Total 
(mL) 
Study Day post Dose 1 
(H7N9 + IIV4) 
Screening 
(Optional)  
D -28 to -1 
Enrollment 
Dose 1 
D1 
 D8+2d 
 D22+7d 
 D29 
 
 D43 
Study Day post Dose 2 
(H7N9) 
 
 
 
Dose 2 
D1 
 D8+2d 
 
 D22+7d 
Study Vaccination 
 
X 
 
X 
 
 
 
ESR 
4^ 
4^* 
 
 
 
 
4  
Clinical Baseline and 
Safety Laboratory 
Evaluations~ 
  
10† 
10 
10† 
10 
 
40  
Immunogenicity Assays 
  
10† 
 
10† 
 
10 
30 
Serum Sample for Future 
Research# 
 
10† 
10 
10† 
10 
10 
50 
Total (mL) 
(4) 0 
(30) 34 
20 
30 
20 
 
20 
 
124 
^ Drawn up to 28 days prior to study vaccination. Results must be known and confirmed to meet the eligibility 
criterion prior to randomization and first study vaccination.   
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
# Sites may elect to allow subjects to consent to study participation but to have the option to opt out of the 
collection of the future use samples, or may include collection of future use samples as a condition of study 
participation and not allow the opt out option.† 
All blood drawn immediately prior to study vaccination. 
* Not required if done at the optional screening visit 
 
 
 
 
 
 

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Group 1 Venipuncture Volumes (mL): 
Follow-up Period 
Study Visit Number 
V08 
V09 
V10 
Total 
(mL) 
Study Day post Dose 1 
(H7N9 + IIV4) 
D64 
D181 
±14 
D202 
Study Day post Dose 2 
(H7N9) 
D43+7 
 
D181±14 
Clinical Safety Laboratory 
Evaluations~ 
 
 
 
 
Immunogenicity Assays 
 
10 
10 
20 
Serum Sample for Future 
Research# 
10 
10 
10 
30 
Total (mL) 
10 
20 
20 
50 
^  Drawn up to 28 days prior to study vaccination. Results must be known and confirmed to meet the eligibility 
criterion prior to randomization and first study vaccination.   
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
# Sites may elect to allow subjects to consent to study participation but to have the option to opt out of the 
collection of the future use samples, or may include collection of future use samples as a condition of study 
participation and not allow the opt out option. 
† All blood drawn immediately prior to study vaccination. 
*  Not required if done at the optional screening visit 
 

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Table 2 b 
Group 2 Venipuncture Volumes (mL): 
Vaccination Period 
Study Visit Number 
V00 
V01 
V03 
V04 
V06 
 
V07 
Total 
(mL) 
Study Day post Dose 1 
(IIV4) 
Screening 
(Optional)  
D -28 to -1 
Enrollment 
and Dose 1 
D1 
D8+2d 
D22+7d 
D29 
D43 
Study Day post Dose 2 
(H7N9) 
 
 
 
Dose 2 
D1 
D8+2d 
D22+7d 
Study Day post Dose 3 
(H7N9) 
 
 
 
 
 
 Dose 3 
D1 
 
Study Vaccination 
 
X 
 
X 
 
X 
 
ESR 
4^ 
4^* 
 
 
 
 
4  
Clinical Baseline and 
Safety Laboratory 
Evaluations~ 
  
10† 
10 
10† 
 
10 
10† 
50  
Immunogenicity Assays 
  
10† 
 
10† 
 
10† 
30 
Serum Sample for Future 
Research# 
 
10† 
10 
10† 
10 
10† 
50 
Total (mL) 
(4) 0 
(30) 34 
20 
30 
20 
 
30 
 
134 
^ Drawn up to 28 days prior to study vaccination. Results must be known and confirmed to meet the eligibility 
criterion prior to randomization and first study vaccination.   
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
# Sites may elect to allow subjects to consent to study participation but to have the option to opt out of the 
collection of the future use samples, or may include collection of future use samples as a condition of study 
participation and not allow the opt out option. 
† All blood drawn immediately prior to study vaccination. 
*  Not required if done at the optional screening visit 

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Group 2 Venipuncture Volumes (mL): 
Follow-up Period 
Study Visit Number 
 
V09 
V10 
V11 
V12 
Total 
(mL) 
Study Day post Dose 1 
(IIV4) 
 
D50 
D64 
D181 
±14 
D223 
Study Day post Dose 2 
(H7N9) 
 
D29 
D43 
 
D202 
Study Day post Dose 3 
(H7N9) 
 
D8+2d 
D22+7d 
 
D181±14 
 
Clinical Safety Laboratory 
Evaluations~ 
 
10  
 
 
 
10  
Immunogenicity Assays 
 
 
10 
10 
10 
30 
Serum Sample for Future 
Research# 
 
10 
10 
10 
10 
40 
Total (mL) 
20 
20 
20 
20 
80 
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
# Sites may elect to allow subjects to consent to study participation but to have the option to opt out of the 
collection of the future use samples, or may include collection of future use samples as a condition of study 
participation and not allow the opt out option.

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Table 2 c 
Group 3 Venipuncture Volumes (mL): 
Vaccination and Follow-up  
Study Visit Number 
V00 
V01 
V03 
V04 
V05 
V06 
V07 
Total 
(mL) 
Study Day post Dose 1 
(IIV4) 
Screening 
(Optional)  
D -28 to -1 
Enrollment 
and Dose 1 
D1 
D8+2d 
D22+7d 
D43+7d 
D64+7d 
D181±14 d 
Study Vaccination 
 
X 
 
 
 
 
 
 
ESR 
4^ 
4^* 
 
 
 
 
 
4  
Clinical Baseline and 
Safety Laboratory 
Evaluations~ 
  
10† 
10 
 
 
 
 
20  
Immunogenicity Assays 
  
10† 
 
10 
 
 
10 
30 
Serum Sample for Future 
Research# 
 
10† 
10 
10 
10 
10 
10 
60 
Total (mL) 
(4) 0 
(30) 34 
20 
20 
10 
10 
20 
114 
^ Drawn up to 28 days prior to study vaccination. Results must be known and confirmed to meet the eligibility 
criterion prior to randomization and first study vaccination.   
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
# Sites may elect to allow subjects to consent to study participation but to have the option to opt out of the 
collection of the future use samples, or may include collection of future use samples as a condition of study 
participation and not allow the opt out option. 
† All blood drawn immediately prior to study vaccination. 
*  Not required if done at the optional screening visit 
7.2.3 
Specimen Preparation, Handling, and Shipping 
7.2.3.1 
Instructions for Specimen Preparation, Handling, and Storage 
Instructions for specimen preparation, handling, and storage are included in the central (clinical) 
laboratory manual and protocol-specific MOP as appropriate. 
7.2.3.2 
Specimen Shipment 
Specimen shipment will occur at intervals during the course of this trial following all applicable 
International Air Transport Association (IATA) requirements and according to the specifics for 

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storage temperature and documentation as detailed in the central (clinical) laboratory manual and 
protocol-specific MOP as appropriate. 
Specimens for safety laboratory evaluations will be shipped from the participating VTEU sites to 
the central (clinical) laboratory. 
Specimens for HAI and Neut antibody assays will be shipped from the participating VTEU sites 
to the DMID CMS, and then provided by the DMID CMS to Southern Research in a blinded 
manner. 
Specimens for the NA antibody assays will be shipped from the participating VTEU sites to the 
DMID CMS, and then provided by the DMID CMS to the NA antibody assay laboratory once it 
has been identified. 
Further instructions for specimen shipment are included in the central (clinical) laboratory 
manual and protocol-specific MOP, as appropriate. 

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8 
STUDY SCHEDULE 
Complete study schedule details listed by type of visit are described below. Refer also to 
Sections 4 and 7 and Appendix A: Schedule of Study Procedures and Evaluations. For detailed 
information regarding the study schedule for discontinued subjects, please reference the MOP– 
Discontinued Subjects Remaining on Study. 
8.1 
Screening (Optional) and Enrollment Visits, All Groups 
8.1.1 
Visit 00, Screening Clinic Visit (Optional) (Day -28 to -1) 
• Subjects will be provided with a description of this trial (purpose and study procedures) 
and asked to read and sign the ICF. The ICF will be signed prior to performing any study 
procedures, including administration of the first and second study vaccinations for Group 
1, and the first study vaccination for Groups 2 and 3. 
• Demographic information will be obtained by interview of subjects. 
• Eligibility criteria will be reviewed with subjects. 
• Complete medical history will be obtained by interview of subjects to ensure eligibility. 
• All concomitant medications taken within 60 days prior to signing the ICF will be 
reviewed with subjects to determine stability of chronic diseases and eligibility. 
Medications reported in the eCRF are limited to those taken within 30 days prior to the 
first study vaccination.  
• Subject receipt of licensed seasonal influenza vaccine over the previous two seasons, 
what type (inactivated or live attenuated), and approximate date of vaccination will be 
recorded on the appropriate DCF, if known. Prior receipt of licensed seasonal influenza 
vaccine in the 2017/2018 season is exclusionary (see Section 5.1.2).  
• Subject receipt of non-seasonal influenza vaccines, including those that are experimental, 
what type (inactivated or live attenuated), what subtype (e.g., A/H3, A/H5, A/H9) and 
approximate date of vaccination will be recorded on the appropriate DCF, if known. Prior 
receipt of non-seasonal influenza vaccines are not exclusionary, except influenza A/H7 
vaccines (see Section 5.1.2). 
• Vital signs, including oral temperature, pulse, and blood pressure, will be obtained to 
ensure eligibility prior to first study vaccination. Subjects must not eat or drink anything 
hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
• Height and weight will be collected for the calculation of BMI. 

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• A physical examination will be performed on all subjects to include the following organs 
and organ systems: skin, head and neck, lungs, heart, liver, spleen, extremities, lymph 
nodes, abdomen, general appearance, musculoskeletal and nervous system and as 
assessment for signs suggestive of a PIMMC, by a study clinician licensed to make 
medical diagnoses and listed on the Form FDA 1572 as the site principal investigator or 
sub-investigator. 
• A urine or serum pregnancy test may be performed on all women of childbearing 
potential. Results must be negative to ensure eligibility. 
• Approximately 4 mL of venous blood will be collected for ESR, and performed locally 
by the site. The ESR value must be confirmed as less than 30 mm per hour prior to 
randomization and the first vaccination. 
8.1.2 
Visit 01, Day 1, Enrollment (for subjects previously screened at Day -28 to -1) 
and Dose 1, Clinic Visit 
Group 1 (First and Second Study Vaccinations):  AS03 adjuvanted 2017 H7N9 IIV + IIV4 
Groups 2 and 3 (First Study Vaccination):  IIV4 
• Subject’s willingness to participate will be reconfirmed and documented in the subject’s 
study records prior to performing any further study procedures, including administration 
of the first vaccination. 
• Eligibility criteria, including results of the ESR will be reviewed.  
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects prior to the vaccination and any changes since the previous clinic visit or contact 
will be noted. 
• All concomitant medications will be reviewed with subjects prior to the first vaccination 
for accuracy and completeness. Any new concomitant medications taken since the 
screening visit will be reviewed with subjects and assessed for continued eligibility prior 
to the first vaccination.  
• Vital signs, including oral temperature, pulse, and blood pressure, will be obtained to 
ensure eligibility prior to the first vaccination. Vital signs assessed on Day 1 prior to the 
first vaccination will be considered as baseline. Subjects must not eat or drink anything 
hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed prior to the first vaccination, if indicated based on review of 
complete medical history and any updates obtained by interview of subjects since the 

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screening visit, by a study clinician licensed to make medical diagnoses and listed on the 
Form FDA 1572 as the site principal investigator or sub-investigator. 
• A urine or serum pregnancy test will be performed within 24 hours prior to the first 
vaccination on all women of childbearing potential. Results must be negative and known 
prior to randomization and first vaccination. 
• Subjects will be enrolled in AdvantageEDCSM and assigned randomly to a treatment arm 
prior to the first vaccination. 
• Pre-administration reactogenicity assessments will be performed prior to the first 
vaccination to establish baseline.  
• Approximately 10 mL of venous blood will be collected immediately prior to the first 
vaccination for baseline serum antibody assays. 
• Approximately 10 mL of venous blood will be collected immediately prior to the first 
vaccination for baseline clinical safety labs (WBC, Hgb, PLT, ALT, T. Bili, Cr), and 
performed by the central (clinical) laboratory. The results from this blood draw will not 
be available or reviewed prior to the vaccination, and will serve as a safety baseline 
assessment only. 
• Approximately 10 mL of venous blood will be collected prior to vaccination for future 
research from subjects who consent, either by signing an informed consent form that 
includes collection of future use samples as a condition of study participation or by 
indicating that they opt in to sample collection for future use if the informed consent form 
allows the option to choose that option. 
• Subjects will then receive a single dose of vaccine (Group 1 will receive 2 vaccines) via 
IM injection into the deltoid muscle of the preferred arm, or if randomized to Group 1, in 
both arms within 15 minutes of each other. The site of injection (right and/or left arm) 
and time of administration will be recorded on the appropriate DCF. Subjects will be 
observed in the clinic for at least 20 minutes after the vaccination. The vaccination site 
will be examined, post-administration reactogenicity assessments will be performed, and 
any AE/SAEs will be recorded on the appropriate DCF prior to discharge from the clinic.  
• Subjects will be provided with a memory aid and other study-related materials to record 
daily oral temperature, solicited injection site and systemic reactions, any unsolicited 
AEs, and concomitant medications. Subjects will be encouraged to take their oral 
temperature around the same time each day. Subjects must not eat or drink anything hot 
or cold, or smoke within 10 minutes prior to taking oral temperature. Subjects will be 
instructed on how to use their memory aid and how to measure and record AEs prior to 
discharge from the clinic. Subjects will be instructed to notify the study center if they 
develop any severe reactions after the vaccination(s). If the site principal investigator or 

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appropriate sub-investigator deems the reaction severe enough, further instructions will 
be given to the subject on the proper course of action, including a return to the clinic for 
immediate evaluation if appropriate. 
8.1.3 
Visit 01, Day 1, Enrollment/Baseline (for subjects not previously screened at Day 
-28 to -1) and Dose 1, Clinic Visit 
Group 1 (First and Second Study Vaccinations):  AS03 adjuvanted 2017 H7N9 IIV + IIV4 
Groups 2 and 3 (First Study Vaccination):  IIV4 
• Subjects will be provided with a description of this trial (purpose and study procedures) 
and asked to read and sign the ICF. The ICF will be signed prior to performing any study 
procedures, including administration of the first vaccination. 
• Demographic information will be obtained by interview of subjects. 
• Complete medical history will be obtained by interview of subjects prior to the first 
vaccination to ensure eligibility. 
• All concomitant medications taken within 60 days prior to signing the ICF will be 
reviewed with subjects and reported in the eCRF prior to the first vaccination. 
Medications reported in the eCRF are limited to those taken within 30 days prior to the 
first vaccination. 
• Subject receipt of licensed seasonal influenza vaccine over the previous two seasons, 
what type (inactivated or live attenuated), and approximate date of vaccination will be 
recorded on the appropriate DCF, if known. Prior receipt of 2017-2018 licensed seasonal 
influenza vaccine is exclusionary.  
• Subject receipt of non-seasonal influenza vaccines, including those that are experimental, 
what type (inactivated or live attenuated), what subtype (e.g., A/H3, A/H5, A/H9) and 
approximate date of vaccination will be recorded on the appropriate DCF, if known. Prior 
receipt of non-seasonal influenza vaccines are not exclusionary, except influenza A/H7 
vaccines (see Section 5.1.2). 
• Vital signs, including oral temperature, pulse, and blood pressure, will be obtained to 
ensure eligibility prior to the first vaccination. Vital signs assessed on Day 1 prior to the 
first vaccination will be considered as baseline. Subjects must not eat or drink anything 
hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
• Height and weight will be collected prior to the first vaccination for the calculation of 
BMI. 
• A physical examination will be performed on all subjects to include the following organs 
and organ systems: skin, head and neck, lungs, heart, liver, spleen, extremities, lymph 

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nodes, abdomen, general appearance, musculoskeletal and nervous system and as 
assessment for signs suggestive of a PIMMC, by a study clinician licensed to make 
medical diagnoses and listed on the Form FDA 1572 as the site principal investigator or 
sub-investigator. 
• Approximately 4 mL of venous blood will be collected for ESR, and performed locally 
by the site. The ESR value must be confirmed as less than 30 mm per hour prior to 
randomization and first vaccination. 
• Eligibility criteria, including results of ESR evaluation, will be reviewed with subjects 
prior to the first vaccination to ensure continued eligibility. 
• A urine or serum pregnancy test will be performed within 24 hours prior to the first 
vaccination on all women of childbearing potential. Results must be negative and known 
prior to randomization and first vaccination. 
• Subjects will be enrolled in AdvantageEDCSM and assigned randomly to a treatment arm 
prior to the first vaccination. 
• Pre-administration reactogenicity assessments will be performed prior to the first 
vaccination to establish baseline.  
• Approximately 10 mL of venous blood will be collected immediately prior to the first 
vaccination for baseline serum antibody assays. 
• Approximately 10 mL of venous blood will be collected immediately prior to the first 
vaccination for baseline clinical safety labs (WBC, Hgb, PLT, ALT, T. Bili, Cr), and 
performed by the central (clinical) laboratory. The results from this blood draw will not 
be available or reviewed prior to vaccination, and will serve as a safety baseline 
assessment only. 
• Approximately 10 mL of venous blood will be collected prior to vaccination for future 
research from subjects who consent, either by signing an informed consent form that 
includes collection of future use samples as a condition of study participation or by 
indicating that they opt in to sample collection for future use if the informed consent form 
allows the option to choose that option. 
• Subjects will then receive a single dose of study vaccine (Group 1 will receive 2 
vaccines) via IM injection into the deltoid muscle of the preferred arm, or if randomized 
to Group 1, in both arms within 15 minutes of each other. The site of injection (right 
and/or left arm) and time of administration will be recorded on the appropriate DCF. 
Subjects will be observed in the clinic for at least 20 minutes after the vaccination. The 
vaccination site will be examined, post-administration reactogenicity assessments will be 
performed, and any AE/SAEs will be recorded on the appropriate DCF prior to discharge 
from the clinic. 

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• Subjects will be provided with a memory aid and other study-related materials to record 
daily oral temperature, solicited injection site and systemic reactions, any unsolicited 
AEs, and concomitant medications. Subjects will be encouraged to take their oral 
temperature around the same time each day. Subjects must not eat or drink anything hot 
or cold, or smoke within 10 minutes prior to taking oral temperature. Subjects will be 
instructed on how to use their memory aid and how to measure and record AEs prior to 
discharge from the clinic. Subjects will be instructed to notify the study center if they 
develop any severe reactions after the vaccination(s). If the site principal investigator or 
appropriate sub-investigator deems the reaction severe enough, further instructions will 
be given to the subject on the proper course of action, including a return to the clinic for 
immediate evaluation if appropriate. 
8.2 
Follow-up Visits, Group 1 
Follow-up visits are scheduled in reference to vaccination dates as indicated for each visit 
window. 
8.2.1 
Visit 02, Day 4, Memory Aid Review, Phone Call 
(Window: 3 (±1) days post Dose 1) 
Study personnel will contact subjects by phone to solicit any AE/SAE and concomitant 
medication information (including solicitation for receipt of any non-study influenza vaccines, 
including those that are experimental, what type (inactivated or live attenuated), what subtype 
(e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected) and review information on their 
memory aid. Based on the information, subjects may be asked to return to the clinic for 
evaluation. 
8.2.2 
Visit 03, Day 8, Clinic Visit 
(Window: 7 (+2) days post first Dose 1)) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Memory aid information will be reviewed with subjects. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 

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recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF.  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The H7N9 and IIV4 vaccination sites will be examined. 
• Approximately 10 mL of venous blood will be collected for safety labs, WBC, Hgb, PLT, 
ALT, T. Bili, Cr, and performed by the central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.2.3 
Visit 04, Day 22, Dose 2, Clinic Visit 
(Window: 21 (+7) days post Dose 1) 
• Eligibility criteria will be reviewed with subjects prior to the vaccination to ensure 
continued eligibility. 
• For a subject to receive the vaccination, refer to section 5.2.3 for subsequent dose 
eligibility criteria.   
• Interim medical history, including an assessment for new medical conditions stability of 
chronic diseases and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects prior to the vaccination and any changes since the previous clinic visit or contact 
will be noted. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected. Prior receipt of 
non-seasonal influenza vaccines are not exclusionary, except influenza A/H7 vaccines 
(see Section 5.1.2) will be recorded on the appropriate DCF prior to the vaccination. 
• All AE/SAEs will be recorded on the appropriate DCF.  

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• Vital signs, including oral temperature, pulse, and blood pressure, will be obtained prior 
to the study vaccination. Subjects must not eat or drink anything hot or cold, or smoke 
within 10 minutes prior to taking oral temperature. Note: Vital signs are not required for 
subjects who are discontinued from receipt of the vaccination and are being followed for 
safety. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed prior to the vaccination, if indicated based on review of 
interim medical history, by a study clinician licensed to make medical diagnoses and 
listed on the Form FDA 1572 as the site principal investigator or sub-investigator. 
• A urine or serum pregnancy test will be performed within 24 hours prior to the study 
vaccination on all women of childbearing potential. Results must be negative and known 
prior to the vaccination. 
• Pre-administration reactogenicity assessments will be performed prior to the study 
vaccination to establish baseline.  
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for safety labs WBC, Hgb, PLT, ALT, T. Bili, Cr, and performed by the 
central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for serum antibody assays. 
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for future research from subjects who consent, either by signing an informed 
consent form that includes collection of future use samples as a condition of study 
participation or by indicating that they opt in to sample collection for future use if the 
informed consent form allows the option to choose that option. 
• Subjects will then receive a single dose of study vaccine via IM injection into the deltoid 
muscle of the preferred arm.  If the subject has no preference, the second dose of 
adjuvanted 2017 H7N9 IIV may be given in either arm as long as there is no hindrance of 
the reactogenicity assessment. The site of injection (right or left arm) and time of 
administration will be recorded on the appropriate DCF. Subjects will be observed in the 
clinic for at least 20 minutes after the vaccination. The vaccination site will be examined, 
post-administration reactogenicity assessments will be performed, and any AE/SAEs will 
be recorded on the appropriate DCF prior to discharge from the clinic. 
• Subjects will be provided with a memory aid and other study-related materials to record 
daily oral temperature, solicited injection site and systemic reactions, any unsolicited 
AEs, and concomitant medications. Subjects will be encouraged to take their oral 
temperature around the same time each day. Subjects must not eat or drink anything hot 

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or cold, or smoke within 10 minutes prior to taking oral temperature. Subjects will be 
instructed on how to use their memory aid and how to measure and record AEs prior to 
discharge from the clinic. Subjects will be instructed to notify the study center if they 
develop any severe reactions after the vaccination. If the site principal investigator or 
appropriate sub-investigator deems the reaction severe enough, further instructions will 
be given to the subject on the proper course of action, including a return to the clinic for 
immediate evaluation if appropriate. 
8.2.4 
Visit 05, Day 25, Memory Aid Review, Phone Call 
(Window: 3 (±1) days post Dose 2)  
Study personnel will contact subjects by phone to solicit any AE/SAE and concomitant 
medication information (including solicitation for receipt of any non-study influenza vaccines, 
including those that are experimental, what type (inactivated or live attenuated), what subtype 
(e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected) and review information on their 
memory aid. Based on the information, subjects may be asked to return to the clinic for 
evaluation. Note: For subjects who are discontinued from the receipt of Dose 2, AEs will be 
limited to SAEs and MAAEs, including NOCMCs and PIMMCs. 
8.2.5 
Visit 06, Day 29, Clinic Visit 
(Window: 7 (+2) days post Dose 2) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Memory aid information will be reviewed with subjects. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF. Note: for subjects who 
discontinued from the receipt of Dose 2, AEs will be limited to SAEs and MAAEs, 
including NOCMCs and PIMMCs. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 

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a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The Dose 2 (third vaccination) site will be examined. 
• Approximately 10 mL of venous blood will be collected for safety labs WBC, Hgb, PLT, 
ALT, T. Bili, Cr, and performed by the central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.2.6 
Visit 07, Day 43, Safety Follow-up Clinic Visit 
(Window: 21 (+7) days post Dose 2) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for serum antibody assays. 
• Approximately 10 mL of venous blood will be for future research from subjects who 
consent, either by signing an informed consent form that includes collection of future use 
samples as a condition of study participation or by indicating that they opt in to sample 
collection for future use if the informed consent form allows the option to choose that 
option. 

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8.2.7 
Visit 08, Day 64, Safety Follow-up, Clinic Visit 
(Window: 42 days (+7) days post Dose 2) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All SAEs and MAAEs, including NOCMs and PIMMCs, will be recorded on the 
appropriate DCF.  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator.  
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent to collection of serum for future research. 
8.2.8 
Visit 09, Day 181, Safety Follow-up, Clinic Visit  
(Window: 180 (±14) days post Dose 1)  
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic medical diseases, and symptoms suggestive of PIMMCs, will be obtained by 
interview of subjects and any changes since the previous clinic visit or contact will be 
noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• AEs limited to MAAEs, including NOCMCs and PIMMCs, and SAEs that have occurred 
since the previous clinic visit or contact will be solicited  

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• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for serum antibody assays.  
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option.  
8.2.9 
Visit 10, Day 202, Safety Follow-up, Clinic Visit 
(Window: 180 (±14) days post Dose 2) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic medical diseases, and symptoms suggestive of PIMMCs, will be obtained by 
interview of subjects and any changes since the previous clinic visit or contact will be 
noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF.AEs limited to MAAEs, including NOCMCs and PIMMCs, and 
SAEs that have occurred since the previous clinic visit or contact will be solicited  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for serum antibody assays.  
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option.  

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8.2.10 
Visit 11, Day 387, Safety Follow-up, Phone Call 
(Window: 365 (±14) days post Dose 2) 
Subjects will be contacted by phone to query for safety events. AEs limited to MAAEs, 
including NOCMCs and PIMMCS, and SAEs that have occurred since the previous clinic visit 
or contact will be solicited. Based on the information, subjects may be asked to return to the 
clinic for evaluation. 
8.3 
Follow-up Visits, Group 2  
Follow-up visits are scheduled in reference to vaccination dates as indicated for each visit 
window. 
8.3.1 
Visit 02, Day 4, Memory Aid Review, Phone Call 
(Window: 3 (±1) days post Dose 1) 
Study personnel will contact subjects by phone to solicit any AE/SAE and concomitant 
medication information (including solicitation for receipt of any non-study influenza vaccines, 
including those that are experimental, what type (inactivated or live attenuated), what subtype 
(e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected) and review information on their 
memory aid. Based on the information, subjects may be asked to return to the clinic for 
evaluation. 
8.3.2 
Visit 03, Day 8, Clinic Visit 
(Window: 7 (+2) days post Dose 1)  
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Memory aid information will be reviewed with subjects. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF.  

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• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The first vaccination site will be examined. 
• Approximately 10 mL of venous blood will be collected for safety labs, WBC, Hgb, PLT, 
ALT, T. Bili, Cr, and performed by the central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.3.3 
Visit 04, Day 22, Dose 2, Clinic Visit 
(Window: 21 (+7) days post first study vaccination)  
• Eligibility criteria will be reviewed with subjects prior to the vaccination to ensure 
continued eligibility. 
• For a subject to receive the vaccination, refer to section 5.2.3 for subsequent dose 
eligibility criteria.   
• Interim medical history, including an assessment for new medical conditions stability of 
chronic diseases and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects prior to the vaccination and any changes since the previous clinic visit or contact 
will be noted. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected. Prior receipt of 
non-seasonal influenza vaccines are not exclusionary, except influenza A/H7 vaccines 
(see Section 5.1.2) will be recorded on the appropriate DCF prior to the vaccination. 
• All AE/SAEs will be recorded on the appropriate DCF.  
• Vital signs, including oral temperature, pulse, and blood pressure, will be obtained prior 
to the vaccination. Subjects must not eat or drink anything hot or cold, or smoke within 

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10 minutes prior to taking oral temperature. Note: Vital signs are not required for subjects 
who are discontinued from receipt of Dose 2 and are being followed for safety. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed prior to the vaccination, if indicated based on review of 
interim medical history, by a study clinician licensed to make medical diagnoses and 
listed on the Form FDA 1572 as the site principal investigator or sub-investigator. 
• A urine or serum pregnancy test will be performed within 24 hours prior to the 
vaccination on all women of childbearing potential. Results must be negative and known 
prior to the vaccination. 
• Pre-administration reactogenicity assessments will be performed prior to the vaccination 
to establish baseline.  
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for safety labs WBC, Hgb, PLT, ALT, T. Bili, Cr, and performed by the 
central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for serum antibody assays. 
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for future research from subjects who consent, either by signing an informed 
consent form that includes collection of future use samples as a condition of study 
participation or by indicating that they opt in to sample collection for future use if the 
informed consent form allows the option to choose that option. 
• Subjects will then receive a single dose of study vaccine via IM injection into the deltoid 
muscle of the preferred arm. The second vaccination may be given in either arm as long 
as there is no interference with the reactogenicity assessment. The site of injection (right 
or left arm) and time of administration will be recorded on the appropriate DCF. Subjects 
will be observed in the clinic for at least 20 minutes after the vaccination. The 
vaccination site will be examined, post-administration reactogenicity assessments will be 
performed, and any AE/SAEs will be recorded on the appropriate DCF prior to discharge 
from the clinic. 
• Subjects will be provided with a memory aid and other study-related materials to record 
daily oral temperature, solicited injection site and systemic reactions, any unsolicited 
AEs, and concomitant medications. Subjects will be encouraged to take their oral 
temperature around the same time each day. Subjects must not eat or drink anything hot 

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or cold, or smoke within 10 minutes prior to taking oral temperature. Subjects will be 
instructed on how to use their memory aid and how to measure and record AEs prior to 
discharge from the clinic. Subjects will be instructed to notify the study center if they 
develop any severe reactions after the second vaccination. If the site principal 
investigator or appropriate sub-investigator deems the reaction severe enough, further 
instructions will be given to the subject on the proper course of action, including a return 
to the clinic for immediate evaluation if appropriate. 
8.3.4 
Visit 05, Day 25, Memory Aid Review, Phone Call 
(Window: 3 (±1) days post Dose 2) 
Study personnel will contact subjects by phone to solicit any AE/SAE and concomitant 
medication information (including solicitation for receipt of any non-study influenza vaccines, 
including those that are experimental, what type (inactivated or live attenuated), what subtype 
(e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected) and review information on their 
memory aid. Based on the information, subjects may be asked to return to the clinic for 
evaluation. Note: For subjects who are discontinued from the receipt of Dose 2, AEs will be 
limited to SAEs and MAAEs, including NOCMCs and PIMMCs. 
8.3.5 
Visit 06, Day 29, Clinic Visit 
(Window: 7 (+2) days post Dose 2) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Memory aid information will be reviewed with subjects. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF. Note: for subjects who 
discontinued from the receipt of Dose 2, AEs will be limited to SAEs and MAAEs, 
including NOCMCs and PIMMCs. 

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• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The second vaccination site will be examined. 
• Approximately 10 mL of venous blood will be collected for safety labs WBC, Hgb, PLT, 
ALT, T. Bili, Cr, and performed by the central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.3.6 
Visit 07, Day 43, Dose 3, Clinic Visit 
(Window: 21 (+7) days post Dose 2) 
• Eligibility criteria will be reviewed with subjects prior to the vaccination to ensure 
continued eligibility. 
• For a subject to receive the third vaccination, refer to section 5.2.3 for subsequent dose 
eligibility criteria.  
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected. Prior receipt of 
non-seasonal influenza vaccines are not exclusionary, except influenza A/H7 vaccines 
(see Section 5.1.2) will be recorded on the appropriate DCF. 
• Vital signs, including oral temperature, pulse, and blood pressure, will be obtained prior 
to the vaccination. Subjects must not eat or drink anything hot or cold, or smoke within 
10 minutes prior to taking oral temperature. Note: Vital signs are not required for subjects 
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• All AE/SAEs will be recorded on the appropriate DCF. Note: Vital signs are not required 
for subjects who are discontinued from receipt of Dose 3 and are being followed for 
safety. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• A urine or serum pregnancy test will be performed within 24 hours prior to the 
vaccination on all women of childbearing potential. Results must be negative and known 
prior to the vaccination. 
• Pre-administration reactogenicity assessments will be performed prior to the vaccination 
to establish baseline.  
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for safety labs WBC, Hgb, PLT, ALT, T. Bili, Cr, and performed by the 
central (clinical) laboratory.   
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for serum antibody assays. 
• Approximately 10 mL of venous blood will be collected immediately prior to the 
vaccination for future research from subjects who consent, either by signing an informed 
consent form that includes collection of future use samples as a condition of study 
participation or by indicating that they opt in to sample collection for future use if the 
informed consent form allows the option to choose that option. 
• Subjects will then receive a single dose of study vaccine via IM injection into the deltoid 
muscle of the preferred arm. The third vaccination may be given in either arm as long as 
there is no interference with the reactogenicity assessment. The site of injection (right or 
left arm) and time of administration will be recorded on the appropriate DCF. Subjects 
will be observed in the clinic for at least 20 minutes after the vaccination. The third 
vaccination site will be examined, post-administration reactogenicity assessments will be 
performed, and any AE/SAEs will be recorded on the appropriate DCF prior to discharge 
from the clinic. 
• Subjects will be provided with a memory aid and other study-related materials to record 
daily oral temperature, solicited injection site and systemic reactions, any unsolicited 
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temperature around the same time each day. Subjects must not eat or drink anything hot 
or cold, or smoke within 10 minutes prior to taking oral temperature. Subjects will be 
instructed on how to use their memory aid and how to measure and record AEs prior to 
discharge from the clinic. Subjects will be instructed to notify the study center if they 
develop any severe reactions after the vaccination. If the site principal investigator or 
appropriate sub-investigator deems the reaction severe enough, further instructions will 
be given to the subject on the proper course of action, including a return to the clinic for 
immediate evaluation if appropriate. 
8.3.7 
Visit 08, Day 46, Memory Aid Review, Phone Call 
(Window: 3 (±1) days post Dose 3) 
Study personnel will contact subjects by phone to solicit any AE/SAE and concomitant 
medication information (including solicitation for receipt of any non-study influenza vaccines, 
including those that are experimental, what type (inactivated or live attenuated), what subtype 
(e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected) and review information on their 
memory aid. Based on the information, subjects may be asked to return to the clinic for 
evaluation. Note: For subjects who are discontinued from the receipt of Dose 3, AEs will be 
limited to SAEs and MAAEs, including NOCMCs and PIMMCs. 
8.3.8 
Visit 09, Day 50, Clinic Visit 
(Window: 7 (+2) days post Dose 3) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Memory aid information will be reviewed with subjects. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF. Note: for subjects who 
discontinued from the receipt of Dose 3, AEs will be limited to SAEs and MAAEs, 
including NOCMCs and PIMMCs. 

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• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The third vaccination site will be examined. 
• Approximately 10 mL of venous blood will be collected for safety labs, WBC, Hgb, PLT, 
ALT, T. Bili, Cr, and performed by the central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.3.9 
Visit 10, Day 64, Safety Follow-up, Clinic Visit 
(Window: 21 (+7) days post Dose 3) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF. Note: for subjects who 
discontinued from the receipt of Dose 3, AEs will be limited to SAEs and MAAEs, 
including NOCMCs and PIMMCs. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator.  
• Approximately 10 mL of venous blood will be collected for serum antibody assays. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 

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future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.3.10 
Visit 11, Day 181, Safety Follow-up, Clinic Visit  
   
(Window: 180 (±14) days post Dose 1) 
 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic medical diseases, and symptoms suggestive of PIMMCs, will be obtained by 
interview of subjects and any changes since the previous clinic visit or contact will be 
noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• AEs limited to MAAEs including NOCMCs, PIMMCs, and SAEs that have occurred 
since the previous clinic visit or contact will be solicited.  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for serum antibody assays. 
   
• Approximately 10 mL of venous blood will be collected for future research, either by 
signing an informed consent form that includes collection of future use samples as a 
condition of study participation or by indicating that they opt in to sample collection for 
future use if the informed consent form allows the option to choose that option.  
8.3.11 
Visit 12, Day 223, Safety Follow-up, Clinic Visit 
(Window: 180 (±14) days post Dose 3) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic medical diseases, and symptoms suggestive of PIMMCs, will be obtained by 

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interview of subjects and any changes since the previous clinic visit or contact will be 
noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• AEs limited to MAAEs including NOCMCs, PIMMCs, and SAEs that have occurred 
since the previous clinic visit or contact will be solicited.  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for serum antibody assays. 
   
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option.  
8.3.12 
Visit 13, Day 408, Safety Follow-up, Phone Call 
(Window: 365 (±14) days post Dose 3) 
Subjects will be contacted by phone to query for safety events. AEs limited to MAAEs, 
including NOCMCs and PIMMCS, and SAEs that have occurred since the previous clinic visit 
or contact will be solicited. Based on the information, subjects may be asked to return to the 
clinic for evaluation. 
8.4 
Follow-up Visits, Group 3 
Follow-up visits are scheduled in reference to the vaccination date that is indicated for each visit 
window. 
8.4.1 
Visit 02, Day 4, Memory Aid Review, Phone Call 
(Window: 3 (±1) days post dose) 

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Study personnel will contact subjects by phone to solicit any AE/SAE and concomitant 
medication information (including solicitation for receipt of any non-study influenza vaccines, 
including those that are experimental, what type (inactivated or live attenuated), what subtype 
(e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected) and review information on their 
memory aid. Based on the information, subjects may be asked to return to the clinic for 
evaluation. 
8.4.2 
Visit 03, Day 8, Clinic Visit 
(Window: 7 (+2) days post dose)  
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Memory aid information will be reviewed with subjects. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF.  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The vaccination site will be examined. 
• Approximately 10 mL of venous blood will be collected for safety labs, WBC, Hgb, PLT, 
ALT, T. Bili, Cr, and performed by the central (clinical) laboratory. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 

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8.4.3 
Visit 04, Day 22, Safety Follow-up, Clinic Visit 
(Window: 21 (+7) days post dose)  
• Interim medical history, including an assessment for new medical conditions stability of 
chronic diseases and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• All concomitant medications (including solicitation for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All AE/SAEs will be recorded on the appropriate DCF.  
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for serum antibody assays. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.4.4 
Visit 05, Day 43, Safety Follow-up, Clinic Visit 
(Window: 42 (+7) days post dose) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 

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• All SAEs and MAAEs, including NOCMs and PIMMCs, will be recorded on the 
appropriate DCF. A targeted physical examination, including an assessment for signs 
suggestive of PIMMCs, may be performed, if indicated based on review of interim 
medical history, by a study clinician licensed to make medical diagnoses and listed on the 
Form FDA 1572 as the site principal investigator or sub-investigator. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
 
8.4.5 
Visit 06, Day 64, Safety Follow-up, Clinic Visit 
(Window: 63 (+7) days post dose) 
• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF.  
• All SAEs and MAAEs, including NOCMs and PIMMCs, will be recorded on the 
appropriate DCF. A targeted physical examination, including an assessment for signs 
suggestive of PIMMCs, may be performed, if indicated based on review of interim 
medical history, by a study clinician licensed to make medical diagnoses and listed on the 
Form FDA 1572 as the site principal investigator or sub-investigator.  
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.4.6 
Visit 07, Day 181, Safety Follow-up, Clinic Visit 
(Window: 180 (±14) days post dose) 
 

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• Interim medical history, including an assessment for new medical conditions, stability of 
chronic diseases, and symptoms suggestive of PIMMCs, will be obtained by interview of 
subjects and any changes since the previous clinic visit or contact will be noted. 
• Concomitant medications (solicitation only for receipt of any non-study influenza 
vaccines, including those that are experimental, what type (inactivated or live attenuated), 
what subtype (e.g., A/H3, A/H5, A/H9) and approximate date of vaccination will be 
recorded on the appropriate DCF, if known and not previously collected) will be recorded 
on the appropriate DCF. 
• All SAEs and MAAEs, including NOCMs and PIMMCs, will be recorded on the 
appropriate DCF. A targeted physical examination, including an assessment for signs 
suggestive of PIMMCs, may be performed, if indicated based on review of interim 
medical history, by a study clinician licensed to make medical diagnoses and listed on the 
Form FDA 1572 as the site principal investigator or sub-investigator.  
• Approximately 10 mL of venous blood will be collected for serum antibody assays. 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent, either by signing an informed consent form that includes collection of 
future use samples as a condition of study participation or by indicating that they opt in to 
sample collection for future use if the informed consent form allows the option to choose 
that option. 
8.4.7 
Visit 08, Day 366, Safety Follow-up, Phone Call 
(Window: 365 (±14) days post dose) 
Subjects will be contacted by phone to query for safety events. AEs limited to MAAEs, 
including NOCMCs, and PIMMCS, and SAEs that have occurred since the previous clinic visit 
or contact will be solicited. Based on the information, subjects may be asked to return to the 
clinic for evaluation. 
8.5 
Early Termination Visit (if needed) 
The following activities will be performed at the early termination visit on subjects who 
withdraw, are withdrawn, or terminated from this trial: 
• Interim medical history, including an assessment for new medical conditions and 
symptoms suggestive of PIMMCs, will be obtained by interview of subjects and any 
changes since the previous clinic visit or contact will be noted. 

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• Memory aid information will be reviewed with subjects (if within 7 days after the last 
study vaccination). 
• All concomitant medications will be recorded on the appropriate DCF (if within 21 days 
after the last study vaccination). Receipt of any non-study influenza vaccine, including 
those that are experimental, what type (inactivated or live attenuated), what subtype (e.g., 
A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected, will be recorded if within 180 
days after the last vaccination. 
• All AE/SAEs will be recorded on the appropriate DCF. AEs will be limited to SAEs and 
MAAEs, including NOCMCs and PIMMCs, that have occurred since the previous clinic 
visit or contact will be solicited (if after 21 days after the last vaccination).  
• Vital signs, including oral temperature, pulse, and blood pressure, may be obtained if 
indicated. Subjects must not eat or drink anything hot or cold, or smoke within 10 
minutes prior to taking oral temperature. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The study vaccination site(s) will be examined (if within 7 days after the last 
vaccination). 
• Post-administration reactogenicity assessments will be performed (if within 7 days after 
the last vaccination). 
• Approximately 10 mL of venous blood will be collected for WBC, Hgb, PLT, ALT, T. 
Bili, Cr, and performed by the central (clinical) laboratory (if within 7 days after the last 
vaccination). 
• Approximately 10 mL of venous blood will be collected for serum antibody assays (if 
within 21 days after the last vaccination). 
• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent (if within 21 days after the last vaccination).  

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8.6 
Unscheduled Visit (if needed) 
Unscheduled visits may occur at any time during this trial. Any of the following activities may 
be performed: 
• Interim medical history, including an assessment for new medical conditions and 
symptoms suggestive of PIMMCs, will be obtained by interview of subjects and any 
changes since the previous clinic visit or contact will be noted (if indicated). 
• Memory aid information will be reviewed with subjects (if within 7 days after the last 
vaccination). 
• All concomitant medications will be recorded on the appropriate DCF (if within 21 days 
after the last vaccination). Receipt of any non-study influenza vaccine, including those 
that are experimental, what type (inactivated or live attenuated), what subtype (e.g., 
A/H3, A/H5, A/H9) and approximate date of vaccination will be recorded on the 
appropriate DCF, if known and not previously collected, will be recorded if within 180 
days after the last vaccination. 
• All AE/SAEs will be recorded on the appropriate DCF. AEs will be limited to SAEs and 
MAAEs, including NOCMCs and PIMMCs, if after 21 days after the last vaccination. 
• Vital signs, including oral temperature, pulse, and blood pressure, may be obtained if 
indicated. Subjects must not eat or drink anything hot or cold, or smoke within 10 
minutes prior to taking oral temperature. 
• A targeted physical examination, including an assessment for signs suggestive of 
PIMMCs, may be performed, if indicated based on review of interim medical history, by 
a study clinician licensed to make medical diagnoses and listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• The study vaccination site(s) will be examined (if within 7 days after the last 
vaccination). 
• Post-administration reactogenicity assessments will be performed (if within 7 days after 
the last vaccination). 
• Approximately 10 mL of venous blood will be collected for WBC, Hgb, PLT, ALT, T. 
Bili, Cr, and performed by the central (clinical) laboratory (if indicated). 
• Approximately 10 mL of venous blood will be collected for serum antibody assays (if 
within 21 days after the last vaccination). 

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• Approximately 10 mL of venous blood will be collected for future research from subjects 
who consent (if within 21 days after the last vaccination). 

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9 
ASSESSMENT OF SAFETY 
9.1 
Specification of Safety Parameters 
Safety will be assessed by the frequency and severity of: 
1. SAEs occurring from the time of the first study vaccination through approximately 12 
months after the last study vaccination. 
2. Solicited AEs – reactogenicity events occurring from the time of each study vaccination 
through 7 days after each study vaccination: 
a) Injection site reactions including pruritus, ecchymosis, erythema, induration 
(hardness)/edema (swelling), pain, and tenderness. 
b) Systemic reactions including fever, feverishness, fatigue, malaise, myalgia, arthralgia, 
headache, and nausea. 
3. Clinical safety laboratory AEs occurring from the time of each study vaccination through 
approximately 7 days after each study vaccination. Parameters to be evaluated include 
WBC, Hgb, PLT, ALT, T. Bili, Cr. 
4. Unsolicited AEs – non-serious AEs occurring from the time of each study vaccination 
through approximately 21 days after each study vaccination. 
5. MAAEs, including NOCMCs and PIMMCs, occurring from the time of the first study 
vaccination through approximately 12 months after the last study vaccination. 
9.2 
Methods and Timing for Assessing, Recording, and Analyzing Safety 
Parameters 
9.2.1 
Adverse Events 
Adverse Event (AE): (ICH) E6 defines an AE as any untoward medical occurrence in a patient 
or clinical investigation subject administered a pharmaceutical product regardless of its causal 
relationship to the study treatment. An AE can therefore be any unfavorable and unintended sign 
(including an abnormal laboratory finding), symptom, or disease temporally associated with the 
use of a medicinal (investigational) product. The occurrence of an AE may come to the attention 
of study personnel during study visits and interviews of a study recipient presenting for medical 
care, or upon review by a study monitor. 

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AEs, including solicited injection site and systemic (subjective and quantitative) reactions, not 
meeting the protocol-defined criteria for SAEs will be captured on the appropriate DCF and 
eCRF. Information to be collected for unsolicited non-serious AEs includes event description, 
date of onset, licensed study clinician’s assessment of severity and relationship to study product 
and alternate etiology (if not related to study product) (assessed only by those with the training 
and authority to make a diagnosis and listed on the Form FDA 1572 as the site principal 
investigator or sub-investigator), date of resolution of the event, seriousness, and outcome. AEs 
occurring during the trial collection and reporting period will be documented appropriately 
regardless of relationship. AEs will be followed through resolution. 
Any medical condition that is present at the time that the subject is screened will be considered 
as baseline and not reported as an AE. However, if the severity of any pre-existing medical 
condition increases, it will be recorded as an AE. 
AEs must be graded for severity and assessed for relationship to study product (see definitions 
below). AEs characterized as intermittent require documentation of onset and duration of each 
episode. The start and stop date of each reported AE will be recorded on the appropriate DCF 
and eCRF. 
FDA defines an AE as any untoward medical occurrence associated with the use of a drug in 
humans, whether or not considered drug related. 
New-Onset Chronic Medical Conditions (NOCMCs): NOCMCs are defined as any new ICD-
10 diagnosis that is applied to the subject during the duration of the study, after receipt of the 
study agent, that is expected to continue for at least 3 months and requires continued health care 
intervention. 
Medically-Attended Adverse Events (MAAEs): For each unsolicited AE experienced, the 
subject will be asked if he/she had received medical attention, defined as hospitalization, an ER 
visit, or an otherwise unscheduled visit to or from medical personnel for any reason. AEs 
characterized by such unscheduled medical care will be designated as MAAEs. 
Potentially Immune-Mediated Medical Conditions (PIMMCs): PIMMCs constitute a group 
of AEs that includes diseases which are clearly autoimmune in etiology and other inflammatory 
and/or neurologic disorders which may or may not have autoimmune etiologies. PIMMCs 
currently in effect are presented in Appendix B: List of PIMMCs. 
Severity of Event: AEs will be assessed by a licensed study clinician listed on the Form FDA 
1572 as the site principal investigator or appropriate sub-investigator using a protocol-defined 
grading system (see Sections 9.2.2 and 9.2.3). For events not included in the protocol-defined 
grading system, the following guidelines will be used to quantify severity: 

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• 
Mild (Grade 1): Events require minimal or no treatment and do not interfere with the 
subject’s daily activities. 
• 
Moderate (Grade 2): Events result in a low level of inconvenience or concern with 
therapeutic measures. Moderate events may cause some interference with functioning and 
daily activities. 
• 
Severe (Grade 3): Events interrupt the subject’s daily activities and may require systemic 
drug therapy or other treatment. Severe events are usually incapacitating. 
Relationship to Study Product: The licensed study clinician’s assessment of an AE's 
relationship to study product is part of the documentation process, but it is not a factor in 
determining what is or is not reported in this trial. If there is any doubt as to whether a clinical 
observation is an AE, the event should be reported. The relationship to study product must be 
assessed for AEs using the terms: related or not related. In a clinical trial, the study product must 
always be suspect. To help assess, the following guidelines are used: 
• Related – There is a reasonable possibility that the study product caused the AE. 
Reasonable possibility means that there is evidence to suggest a causal relationship 
between the study product and the AE. 
• Not Related – There is not a reasonable possibility that the administration of the study 
product caused the event. 
9.2.2 
Reactogenicity 
Reactogenicity events are AEs that are common and known to occur following administration of 
this type of study vaccine. The following Toxicity Grading Scales will be used to grade solicited 
local (injection site) and systemic (subjective and quantitative) reactions: 
Injection Site Reactogenicity Grading 
Injection Site Reaction 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
Pain – experienced 
without touching the 
injection site 
(spontaneous discomfort) 
Subject is aware of pain, 
but it does not interfere 
with daily activity, and 
no pain medication is 
taken 
Subject is aware of pain; 
there is interference with 
daily activity or it 
requires repeated use of a 
non-narcotic pain reliever 
for >24 hours 
Subject is aware of pain, 
and it prevents daily 
activity or requires any use 
of a narcotic pain reliever 
Tenderness – hurts only 
when injection site is 
The area immediately 
surrounding the injection 
The area immediately 
surrounding the injection 
The area immediately 
surrounding the injection 

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Injection Site Reaction 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
touched or the arm is 
moved 
site hurts only when 
touched or with arm 
motion, and it does not 
interfere with daily 
activity 
site hurts when touched or 
with arm motion, and it 
interferes with daily 
activity 
site hurts when touched or 
with arm motion, and it 
prevents daily activity 
Pruritus (Itching) 
Does not interfere with 
daily activity 
Interferes with daily 
activity 
Prevents daily activity 
Ecchymosis (Bruising)* 
Does not interfere with 
daily activity 
Interferes with daily 
activity 
Prevents daily activity 
Erythema (Redness)* 
Does not interfere with 
daily activity 
Interferes with daily 
activity 
Prevents daily activity 
Induration 
(Hardness)/Edema 
(Swelling)* 
Does not interfere with 
daily activity 
Interferes with daily 
activity 
Prevents daily activity 
* Will also be measured in mm but size will not be used as halting criteria. 
 
Ecchymosis, erythema, and induration (hardness)/edema (swelling) as analyzed by measurement 
will be graded as follows: 
Local (Injection Site) Reactogenicity Measurements 
Local (Injection Site) Reaction 
Small 
Medium 
Large 
Ecchymosis (Bruising)* 
<20 mm 
20 mm – 50 mm 
>50 mm 
Erythema (Redness)* 
<20 mm 
20 mm – 50 mm 
>50 mm 
Induration (Hardness)/Edema 
(Swelling)* 
<20 mm 
20 mm – 50 mm 
>50 mm 
* Will not be used as halting criteria. 
Subjective Systemic Reactogenicity Grading 
Systemic (Subjective) 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
Feverishness 
(Chills/Shivering/Sweating) 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 

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Systemic (Subjective) 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
Fatigue (Tiredness) 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 
Malaise (General Unwell 
Feeling) 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 
Myalgia (Body 
Aches/Muscular Pain)* 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 
Arthralgia (Joint Pain)* 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 
Headache 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 
Nausea 
No interference 
with daily activity 
Some interference with 
daily activity 
Significant interference, 
prevents daily activity 
* Not at injection site. 
 
Oral temperature# will be graded as follows: 
Quantitative Systemic Reactogenicity Grading 
Systemic (Quantitative) 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
Fever* - oral† 
38.0°C – 38.4°C 
100.4°F – 101.1°F 
38.5°C – 38.9°C 
101.2°F – 102.0°F 
>38.9°C 
>102.0°F 
# Oral temperature assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
* A fever can be considered not related to the study product if an alternative etiology can be documented. 
† Subjects must not eat or drink anything hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
9.2.3 
Additional Adverse Event Severity Grading 
Pulse and blood pressure# will be graded as follows: 
Physiologic Parameter 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
Bradycardia - beats per minute 
45 – 46 
40 – 44 
<40 

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Tachycardia - beats per minute 
101 – 130 
131 – 155 
>155 
Hypotension (systolic) mmHg 
80 – 84 
75 – 79 
<75 
Hypotension (diastolic) mmHg 
50 – 54 
45 – 49 
<45 
Hypertension (systolic) mmHg 
151 – 155 
156 – 160 
>160 
Hypertension (diastolic) mmHg 
96 – 100 
101 – 105 
>105 
# Pulse and blood pressure assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
 
 

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For Individuals >65 years of age, pulse and blood pressure# will be graded as follows:  
Physiologic Parameter 
Mild (Grade 1) 
Moderate (Grade 2) 
Severe (Grade 3) 
Bradycardia - bpm 
45 – 46 
40 – 44 
<40 
Tachycardia – bpm 
101 – 130 
131 – 155 
>155 
Hypotension (systolic) mm Hg 
80 – 84 
75 – 79 
<75 
Hypotension (diastolic) mm Hg 
50 – 54 
45 – 49 
<45 
Hypertension (systolic) mm Hg 
161 – 165 
166 – 170 
>170 
Hypertension (diastolic) mm Hg 
96 – 100 
101 – 105 
>105 
# Pulse and blood pressure assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
 
 

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Clinical safety laboratory results# will be graded as follows: 
Clinical Safety Laboratory Adverse Event Grading
75 
Hematology 
Mild 
(Grade 1) 
Moderate 
(Grade 2) 
Severe 
(Grade 3) 
WBC 103/µL (Decrease) 
2.5 – 3.9 
1.5 – 2.4 
<1.5 
WBC 103/µL (Increase) 
10.6 – 15.0 
15.1 – 20.0 
>20.0 
Hgb g/dL (Decrease) (Female) 
10.1 – 11.4 
8.5 – 10 
<8.5 
Hgb g/dL (Decrease) (Male) 
11.0 – 12.4 
9.5 – 10.9 
<9.5 
Platelets 103/µL (Decrease) 
125 – 139 
100 – 124 
<100 
Platelets 103/µL (Increase) 
416 – 550 
551– 750 
>750 
 
 
 
 
Chemistry 
Mild 
(Grade 1) 
Moderate 
(Grade 2) 
Severe 
(Grade 3) 
ALT IU/L (Increase) (Female) 
44 – 100 
101 – 200 
>200 
ALT IU/L (Increase) (Male) 
61 – 138 
139 – 275 
>275 
Total Bilirubin mg/dL (Increase) – 
when accompanied by any increase in 
ALT 
1.30 – 1.59 
1.60 – 1.80 
>1.80 
Total Bilirubin mg/dL (Increase) – 
when ALT is normal 
1.30 – 1.89 
1.90 – 2.40 
>2.40 
Creatinine mg/dL (Increase) 
(Female) 
1.1 – 1.7 
1.8 – 2.0 
>2.0 
Creatinine mg/dL (Increase) (Male) 
1.4 – 1.7 
1.8 – 2.0 
>2.0 
# Clinical laboratory evaluations assessed on Day 1 prior to the first study vaccination will be considered as 
baseline. 
9.2.4 Serious Adverse Events 
Serious Adverse Event (SAE): An AE or suspected adverse reaction is considered “serious” if, 
in the view of either the site principal investigator or sponsor, it results in any of the following 
outcomes: 
• Death, 
• A life-threatening AE*, 
• Inpatient hospitalization or prolongation of existing hospitalization, 

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• A persistent or significant incapacity or substantial disruption of the ability to conduct 
normal life functions, or 
• A congenital anomaly/birth defect. 
• Important medical events that may not result in death, be life-threatening, or require 
hospitalizations may be considered serious when, based upon appropriate medical 
judgment they may jeopardize the patient or subject and may require medical or surgical 
intervention to prevent one of the outcomes listed in this definition. Examples of such 
medical events include allergic bronchospasm requiring intensive treatment in an 
emergency room or at home, blood dyscrasias or convulsions that do not result in 
inpatient hospitalization, or the development of drug dependency or drug abuse. 
* Life-threatening AE. An AE is considered “life-threatening” if, in the view of either the site 
principal investigator or sponsor, its occurrence places the patient or subject at immediate risk of 
death. It does not include an AE that, had it occurred in a more severe form, might have caused 
death. 
SAEs will be: 
• 
Assessed for severity and relationship to study product and alternate etiology (if not 
related to study product) by a licensed study physician listed on the Form FDA 1572 as 
the site principal investigator or sub-investigator. 
• 
Recorded on the appropriate SAE form and eCRF. 
• 
Followed through resolution by a licensed study physician listed on the Form FDA 1572 
as the site principal investigator or sub-investigator. 
• 
Reviewed and evaluated by an Independent Safety Monitor (ISM) (as deemed necessary), 
the DSMB (periodic review unless related), DMID, and the IRB. 
9.2.5 
Procedures to be Followed in the Event of Abnormal Laboratory Test Values or 
Abnormal Clinical Findings 
The site principal investigator or appropriate sub-investigator is responsible for recording all 
AE/SAEs that are observed or reported during this trial, regardless of the relationship to study 
product. AE/SAEs, abnormal laboratory test values, or abnormal clinical findings will be 
collected, assessed, documented, reported, and followed appropriately, using a local laboratory 
as necessary. In determining eligibility, refer to section 5.1 and the protocol-specific MOP. 
 
 

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9.3 
Reporting Procedures 
Solicited injection site and systemic reactogenicity events will be documented and reported from 
the time of each study vaccination through 7 days after each study vaccination. 
Clinical safety laboratory AEs will be documented and reported from the time of each study 
vaccination through approximately 7 days after each study vaccination. 
Unsolicited non-serious AEs will be documented and reported from the time of each study 
vaccination through approximately 21 days after each study vaccination. 
SAEs and MAAEs, including NOCMCs and PIMMCs, will be documented and reported from 
the time of the first study vaccination through approximately 12 months after the last study 
vaccination. 
9.3.1 
Serious Adverse Events 
Any AE that meets a protocol-defined serious criterion must be submitted immediately (within 
24 hours of site awareness) on an SAE form to the DMID Pharmacovigilance Group at the 
following address: 
DMID Pharmacovigilance Group 
Clinical Research Operations and Management Support (CROMS) 
6500 Rock Spring Dr. Suite 650 
Bethesda, MD 20817, USA 
SAE Hot Line: 1-800-537-9979 (US) or 1-301-897-1709 (outside US) 
SAE FAX: 1-800-275-7619 (US) or 1-301-897-1710 (outside US) 
SAE Email Address: PVG@dmidcroms.com 
In addition to the SAE form, selected SAE data fields must also be entered into 
AdvantageEDCSM. Please see the protocol-specific MOP for details regarding this procedure. 
Other supporting documentation of the event may be requested by the DMID Pharmacovigilance 
Group and should be provided as soon as possible. 
The site will send a copy of the SAE report(s) to the ISM (as deemed necessary) when they are 
provided to the DMID Pharmacovigilance Group. The DMID Medical Monitor and DMID 
Clinical Project Manager will be notified of the SAE by the DMID Pharmacovigilance Group. 
The DMID Medical Monitor will review and assess the SAE for regulatory reporting and 
potential impact on study subject safety and protocol conduct. 

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At any time after completion of this trial, if the site principal investigator or appropriate sub-
investigator becomes aware of an SAE that is suspected to be related to study product, the site 
principal investigator or appropriate sub-investigator will report the event to the DMID 
Pharmacovigilance Group. 
9.3.2 
Regulatory Reporting for Studies Conducted Under DMID-Sponsored IND 
Following notification from the site principal investigator or appropriate sub-investigator, 
DMID, the Investigational New Drug Application (IND) sponsor, will report any suspected 
adverse reaction that is both serious and unexpected. DMID will report an AE as a suspected 
adverse reaction only if there is evidence to suggest a causal relationship between the drug and 
the AE. DMID will notify FDA and all participating site principal investigators (i.e., all principal 
investigators to whom the sponsor is providing drug under its IND(s) or under any principal 
investigator’s IND(s)) in an IND safety report of potential serious risks from clinical trials or any 
other source, as soon as possible, but in no case later than 15 calendar days after the sponsor 
determines that the information qualifies for reporting as specified in 21 CFR Part 312.32. DMID 
will also notify FDA of any unexpected fatal or life-threatening suspected adverse reaction as 
soon as possible, but in no case later than 7 calendar days after the sponsor’s initial receipt of the 
information. Relevant follow-up information to an IND safety report will be submitted as soon as 
the information is available. Upon request from FDA, DMID will submit to FDA any additional 
data or information that the agency deems necessary, as soon as possible, but in no case later 
than 15 calendar days after receiving the request. 
All serious events designated as “not related” to study product(s), will be reported to the FDA at 
least annually in a summary format. 
9.3.3 
Reporting of Pregnancy 
Pregnancies occurring in study subjects will be reported via AdvantageEDCSM on the Pregnancy 
Report form. No further study vaccinations will be administered to pregnant subjects, but with 
the subject’s permission all protocol-required venous blood samples will be obtained and the 
subject will continue to be followed for safety for the duration of this trial. Efforts will be made 
to follow all pregnancies reported during the course of this trial to pregnancy outcome pending 
the subject’s permission. 
9.4 
Type and Duration of Follow-up of Subjects after Adverse Events 
AEs will be collected, assessed, and followed through resolution from the time of each study 
vaccination through approximately 21 days after each study vaccination. 

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SAEs and MAAEs, including NOCMCs and PIMMCs, will be collected, assessed, and followed 
from the time of the first study vaccination through resolution even if this extends beyond the 
trial-reporting period (approximately 12 months after the last study vaccination). 
Resolution of an AE/SAE is defined as the return to pretreatment status or stabilization of the 
condition with the expectation that it will remain chronic. 
Follow-up procedures, evaluations, and outcomes will be recorded on the appropriate DCF. 
9.5 
Halting Rules 
For the purpose of halting rules only events that occur following the administration of the AS03 
adjuvanted 2017 H7N9 will be considered. Further enrollment and study vaccinations will be 
halted for DSMB review/recommendation if any of the following are reported: 
• Any subject experiences ulceration, abscess, or necrosis at the injection site related to 
study product administration. 
• Any 2 or more subjects experience laryngospasm, bronchospasm, or anaphylaxis within 1 
day after administration of study product that is considered related to study product. 
• Three or more subjects experience generalized urticaria (defined as occurring at more 
than two body parts) within 3 days after administration of study product that is 
considered related to study product. 
• Any subject experiences an SAE from the time of the first 2017 H7N9  vaccination 
through 14 days after each 2017 H7N9 vaccination. 
• Any subject experiences acute weakness of limbs and/or cranial nerve innervated muscles 
(description of potential signal of GBS) after administration of study product. 
• Any subject develops a PIMMC after administration of study product through the 
subject’s last study visit. 
This trial will also be halted for DSMB review/recommendation if, within 7 days after 
administration of any study vaccination, any of the following occurs within the 2017 A/H7N9 
IIV AS03-adjuvanted treatment arms (Group 1 or Group 2).   
• 7% or more of subjects (with a minimum of 3 subjects) who received at least one dose of 
study vaccine to date, cumulative to all 2017 H7N9 vaccine administrations, across 
Groups 1 and 2, experience the same severe (Grade 3) study vaccine-related injection site 
reaction. Ecchymosis, erythema, and induration (hardness)/edema (swelling) will also be 
measured in mm but size will not be used as halting criteria.  

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• 7% or more of subjects (with a minimum of 3 subjects) who received at least one dose of 
study vaccine to date, cumulative to all 2017 H7N9 vaccine administration, across 
Groups 1 and 2, experience the same severe (Grade 3) study vaccine-related subjective 
systemic reaction, for which the severity (grade) is corroborated by study personnel. 
• 7% or more of subjects (with a minimum of 3 subjects) who received at least one dose of 
study vaccine to date, cumulative to all 2017 H7N9 vaccine administration, across 
Groups 1 and 2, experience the same severe (Grade 3) study vaccine-related quantitative 
systemic reaction. 
• 7% or more of subjects (with a minimum of 3 subjects) who received at least one dose of 
study vaccine to date, cumulative to all 2017 H7N9 vaccine administration, across 
Groups 1 and 2, experience the same severe (Grade 3) study vaccine-related clinical 
safety laboratory AE. 
Grading scales for solicited injection site and systemic (subjective and quantitative) reactions are 
included in Section 9.2.2. 
Grading scales for clinical safety laboratory AEs are included in Section 9.2.3. 
If any of the halting rules are met following any subject receipt of any study vaccination, then 
this trial will not continue with the remaining enrollments or study vaccinations without a review 
by and recommendation from the DSMB to proceed. 
DMID retains the authority to suspend additional enrollment and study interventions/ 
administration of study product during the entire trial, as applicable. 
The DMID Medical Monitor is empowered to stop enrollment and study vaccinations if AEs that 
meet the halting criteria are reported. 
9.6 
Safety Oversight 
9.6.1 
Independent Safety Monitor (ISM) 
The ISM is a physician with relevant expertise whose primary responsibility is to provide 
independent safety monitoring in a timely fashion. For this trial, an ISM is not required. 
However, at each participating VTEU site, and at the request of DMID, in real time, the principal 
investigator should be able to identify an independent physician to function as an ad hoc ISM. 
That person should have the privileges to examine the subject, review the subject’s medical and 
study records, and provide an independent medical assessment and recommendation to DMID. 

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9.6.2 
Data and Safety Monitoring Board (DSMB) 
Safety oversight will be conducted by a DSMB that is an independent group of experts that 
monitors subject safety and advises DMID. The DSMB members will be separate and 
independent of study personnel participating in this trial and should not have scientific, financial 
or other conflict of interest related to this trial. The DSMB will consist of members with 
appropriate expertise to contribute to the interpretation of the data from this trial. The DSMB 
will operate under the rules of a DMID-approved charter that will be written at the organizational 
meeting of the DSMB. Procedures for DSMB reviews/meetings will be defined in the charter. 
Reports may include enrollment and demographic information, medical history, concomitant 
medications, physical assessments, clinical laboratory values, dosing compliance, solicited and 
unsolicited AE/SAEs, and HAI and Neut antibody assay results. The DSMB will review SAEs 
on a regular basis and ad hoc during this trial. The DMID Medical Monitor and the ISM (as 
deemed necessary) will be responsible for reviewing SAEs in real time.  
The DSMB will review study progress and participant, clinical, safety, and reactogenicity data at 
the following time points: 
• Data review for safety at study specific time frames; at least annually. 
• Electronic review when 8-day reactogenicity and clinical safety laboratory data following 
the first study vaccination is available for 25% of study participants. 
• Approximately when 8-day reactogenicity and clinical safety laboratory data following 
the first study vaccination is available for 75% of study participants. 
• Final review meeting: 6 to 8 months after clinical database lock to review the cumulative 
unblinded safety and immunogenicity data for this trial.  The data will be provided in a 
standard summary format.  The DSMB may be asked to provide recommendations in 
response to questions posed by DMID. 
• Ad hoc when a halting rule is met, for immediate concerns regarding observations during 
this trial, or as needed. 
Additional data may be requested by the DSMB, and interim statistical reports may be generated 
as deemed necessary and appropriate by DMID. The DSMB may receive data in aggregate and 
presented by treatment arm, including expected and observed rates of the expected AEs. The 
DSMB will review grouped data in the closed session only. As an outcome of each 
review/meeting, the DSMB will make a recommendation as to the advisability of proceeding 
with study vaccinations (as applicable), and to continue, modify, or terminate this trial. 

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The DSMB will operate under the rules of a DMID-approved charter that will be written at the 
organizational meeting of the DSMB. At this time, each data element that the DSMB needs to 
assess will be clearly defined. Procedures for DSMB reviews/meetings will be defined in the 
charter. The DSMB will review applicable data to include, but not limited to, study progress and 
participant, clinical, safety and reactogenicity data. Reports may include enrollment and 
demographic information, medical history, concomitant medications, physical assessments, 
clinical laboratory values, dosing compliance, solicited and unsolicited AE/SAEs, and HAI and 
Neut antibody assay results. 
DMID or the DSMB chair may convene the DSMB on an ad hoc basis according to protocol 
criteria or if there are immediate concerns regarding observations during the course of this trial. 
The DMID Medical Monitor is empowered to stop enrollment and study vaccinations if AEs that 
meet the halting criteria are reported. The DMID Medical Monitor and the ISM (as deemed 
necessary) will be responsible for reviewing SAEs in real time. The DSMB will review SAEs on 
a regular basis and ad hoc during this trial. 

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10 
CLINICAL MONITORING 
10.1 
Site Monitoring Plan 
Site monitoring is conducted to ensure that the human subjects’ protections, study and laboratory 
procedures, study intervention administration, and data collection processes are of high quality 
and meet sponsor, ICH/GCP guidelines and applicable regulations, and that this trial is 
conducted in accordance with the protocol, protocol-specific MOP and applicable sponsor SOPs. 
DMID, the sponsoring agency, or its designee will conduct site-monitoring visits as detailed in 
the clinical monitoring plan. 
Site visits will be made at standard intervals as defined by DMID and may be made more 
frequently as directed by DMID. Monitoring visits will include, but are not limited to, review of 
regulatory files, accountability records, eCRFs, ICFs, medical and laboratory reports, and 
protocol and GCP compliance. Site monitors will have access to each participating VTEU site, 
study personnel, and all study documentation according to the DMID-approved site monitoring 
plan. Study monitors will meet with site principal investigators to discuss any problems and 
actions to be taken and document visit findings and discussions. 

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11 
STATISTICAL CONSIDERATIONS 
11.1 
Introduction 
The goal of this clinical trial is to assess, in healthy adults ages 19 – 64, the safety, 
reactogenicity, and immunogenicity of a pre-pandemic AS03-adjuvanted 2017 H7N9 IIV when 
two doses are administered 21 days apart either sequentially or simultaneously (within 15 
minutes) with licensed seasonal influenza vaccine. Primary immunogenicity objectives include 
evaluating interference with response to 2017 H7N9 IIV vaccine virus strain 21 days post dose 2, 
and evaluating interference with response to seasonal influenza virus strains 21 days post receipt 
of IIV4. 
11.2 
Study Hypotheses 
This Phase II study is not designed to test a formal null hypothesis. Rather, it is intended to 
obtain sufficient data to obtain meaningful estimates of the immune response induced when 2017 
H7N9 IIV is administered sequentially or simultaneously (within 15 minutes) with licensed 
seasonal influenza vaccine, and to uncover any safety issues that occur at a sufficiently high rate 
that they might be observed in a study of this size. The sample size facilitates formal testing of 
selected hypotheses as discussed in Section 11.4.3, along with the probability of observing safety 
outcomes and the precision of immunogenicity outcomes. 
11.3 
Study Outcome Measures 
Please refer to study outcome measures in Section 3.2. 
11.4 
Sample Size Considerations 
Please refer to study design outlined in Section 4.0. 
11.4.1 
Study Population 
The study population for this clinical trial includes males and non-pregnant females, 19-64 years 
of age, who are in good health and meet all eligibility criteria. The subjects will be recruited 
from the general population at the participating VTEU sites that have substantial experience 
conducting large influenza vaccine studies. 

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11.4.2 
Subject Enrollment and Follow-up 
Based on the accrual rates observed in similar studies, it seems reasonable to expect that the 
participating VTEUs will be able to enroll this trial in a timely fashion. In previous DMID trials 
of A/H7N9 vaccines, 5 VTEUs recruited 975 healthy adults, ages 19-64 in 10 weeks. Prior 
experience suggests up to 15% of subjects may be excluded from the per protocol analysis for 
post dose 3 assessments, either because they did not receive the second or third study 
vaccinations, were lost-to-follow-up, or because they had a protocol deviation requiring their 
exclusion from the per protocol analysis.  
A total of N=60 in Groups 1-2, and N = 30 in Group 3 will be enrolled and randomized. 
Assuming up to 15% drop out by Day 64, this will ensure at least N=50 in Groups 1-2 and N=25 
in Group 3 are available for the primary immunogenicity analysis.  
Follow-up will consist of 2 segments. The first encompasses the core data for this trial and will 
consist of results for all study visits through approximately 21 days after the last study 
vaccination. The second segment consists of a 6-month immunogenicity assessment and follow-
up safety assessments through approximately 12 months after the last study vaccination. 
11.4.3 
Sample Size 
This study is planned to enroll a minimum of 60 subjects in Groups 1-2, and 30 subjects in 
Group 3. This study is not designed to test a formal null hypothesis. Rather, it is intended to 
obtain sufficient data to obtain meaningful estimates of the immune response and to uncover any 
safety issues that occur at a sufficiently high rate that they might be observed in a study of this 
size. As such, the type one error rate, alpha = 0.05, is not adjusted for multiple comparisons.  
While this study is not designed to test any specific null hypothesis, the following tables 
illustrate the precision and power for select estimates and comparisons of interest. 
Table 3 indicates the probability of observing one or more safety events, such as solicited 
injection site or systemic reactogenicity events or an unsolicited non-serious AE of a particular 
type for a single treatment arm (N = 30 or 60), and for all subjects receiving AS03-adjuvanted 
2017 H7N9 IIV (N = 120). 
Table 3: Power (%) to Detect Safety Events: 
Event 
Frequency 
N = 30 
N = 60 
N = 120 
≥10% 
Very Common 
96 
>99 
>99 
≥1% 
26 
45 
70 

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Common 
≥0.1% 
Uncommon 
3 
6 
11 
≥0.01% 
Rare 
<1 
<1 
1 
Binomial confidence intervals (CI) are widest (have the least precision) when the response rate is 
50%. Table 4 is presented to indicate the worst-case scenario for precision of observed exact 
(Clopper-Pearson) binomial confidence intervals. 
Table 4: Precision of Binomial Confidence Intervals: 
N 
95% CI 
30 
31-69 
60 
37-63 
120 
40-60 
 
For each of the primary immunogenicity objective, a power analysis is provided below for 
testing the following hypotheses with the planned sample size, where pc = proportion responders 
in comparator arm; pe = proportion responders in experimental arm. 
Test for difference in proportion responders: 
H0: pc – pe = 0 – No difference in proportion responders 
H1: pc – pe ≠ 0 – difference in response rates 
 
Table 5 and Table 6 present the minimum detectable differences in the proportion of subjects 
responding (e.g., attaining seroconversion or a titer ≥1:40) between two treatment arms using a 
two-sided Likelihood Ratio Test and alpha = 0.05. 
 
Primary Immunogenicity Objective 1: Evaluate antibody responses against A/H7N9 at 
approximately 21 days following receipt of two doses of AS03-adjuvanted 2017 H7N9 IIV. 
Comparison between simultaneous and sequential receipt to IIV4, i.e., Group 1 at Day 43 vs. 
Group 2 at Day 64. 
 
Table 5: Objective 1 -Minimum Detectable Difference in Proportion Responders with 80% 
Power (N = 50 per group) 
Assumed Proportion Responders  
comparator arm (pc) 
Minimum detectable 
difference in response 
rate (pc – pe) 
0.50 
0.27 

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Assumed Proportion Responders  
comparator arm (pc) 
Minimum detectable 
difference in response 
rate (pc – pe) 
0.60 
0.27 
0.70 
0.27 
0.80 
0.26 
0.90 
0.22 
 
Primary Immunogenicity Objective 2: Evaluate antibody responses against the seasonal 
influenza strains at approximately 21 days following receipt of IIV4. 
Comparator Group (N = 75):   
• Group 2 (IIV4/H7N9/H7N9) + Group 3 (IIV4) at Day 22  
Experimental Groups (N = 50/group): 
• Group 1 (H7N9+IIV4/H7N9) at Day 64 
 
Table 6: Objective 2 - Minimum Detectable Difference in Proportion Responders with 80% 
Power 
Assumed  
Proportion Responders  
comparator arm (pc) 
Minimum detectable 
decrease in response rate 
(pc - pe) 
0.40 
0.23 
0.50 
0.24 
0.60 
0.25 
0.70 
0.25 
0.80 
0.23 
0.90 
0.20 
11.5 
Planned Interim Analyses 
Interim analyses will only be used to terminate this trial in the event that unanticipated safety 
events deemed to be of sufficient concern require such action by the sponsor. These assessments 
will not be made on the basis of testing a formal statistical hypothesis; therefore, p-value 
adjustment will not be made to any analyses. A DSMB will be convened by DMID to review 
study progress and participant, clinical, safety, reactogenicity and immunogenicity data as 
described in Section 9.6.2. 

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No interim analysis of immunogenicity is planned, however, a preliminary report of safety and 
immunogenicity data through Day 64 will be prepared as described in Section 11.6; though this 
report will be released while subjects remain in the trial for long-term safety and immunogenicity 
follow-up, it will be considered the final analysis of these data. 
Emergent public health needs may dictate additional interim safety, reactogenicity, and/or 
immunogenicity analyses be performed on available information at any time during the trial. If 
this occurs, immunogenicity data will be analyzed as results are available from the central 
immunogenicity laboratory. 
11.5.1 
Interim Safety Review 
An interim safety review may include enrollment and demographic information, medical history, 
concomitant medications, physical assessments, clinical laboratory values, dosing compliance, 
and solicited and unsolicited AE/SAEs. Additional data may be requested by the DSMB, and 
interim statistical reports may be generated as deemed necessary and appropriate by DMID. The 
DSMB may receive data in aggregate and presented by treatment arm, including expected and 
observed rates of the expected AEs. The DSMB will review grouped data in the closed session 
only. The DSMB will meet and review this data at scheduled time points or ad hoc as needed 
during this trial as defined in the DSMB charter. As an outcome of each review/meeting, the 
DSMB will make a recommendation as to the advisability of proceeding with study vaccinations 
(as applicable), and to continue, modify, or terminate this trial. 
Additionally, this trial will be monitored to determine if any of the halting rules described in 
Section 9.5 are met. 
11.5.2 
Interim Immunogenicity Review 
No interim immunogenicity analysis is planned. Should emergent public health needs dictate 
immunogenicity review, immune responses will be summarized in terms of strain-specific 2017 
A/H7N9 and IIV4 HAI and Neut antibody titers for subjects that receive sequential or 
simultaneous administration of AS03-adjuvanted 2017 H7N9 IIV and seasonal IIV4. It is 
anticipated that all analyses will be carried out in parallel for both assays, but reports may be 
prepared separately for HAI and Neuts if results are available on different timelines. Interim 
analyses will focus on rates of titers ≥1:40, seroconversion (defined as either a pre-vaccination 
titer <1:10 and a post-vaccination titer ≥1:40 or a pre-vaccination titer ≥1:10 and a minimum 
four-fold rise in post-vaccination titer) and GMTs, along with corresponding 95% CIs. No 
formal hypothesis testing will be included in the interim analysis, and interim results will not 
have impact on conduct of this trial. 

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Any immunogenicity reports would be provided by the SDCC to the DMID Scientific Lead and 
Clinical Project manager, and the DSMB. Reports will include data summarized by treatment 
arm. 
11.6 
Final Analysis Plan 
Clinical, safety, and reactogenicity data through approximately 21 days after the third study 
vaccination will represent the primary clinical database for this trial. Once the last subject 
completes the visit that occurs approximately 21 days after the third study vaccination, the 
primary clinical database will be cleaned, monitored, and locked. Analyses of safety, 
reactogenicity, and available immunogenicity (HAI and Neut antibody assays through Day 64) 
data by treatment arm are planned. A preliminary report will be prepared by the SDCC after the 
primary clinical database is locked and all HAI and Neut data for the 2017 H7N9 vaccine strain 
and all IIV4 strains are received through 21 days after the last study vaccination is received. 
These analyses may be made available to the sponsor for planning subsequent trials and to the 
lead principal investigator for publication. These analyses will not be used to make any decisions 
concerning the conduct of this trial. All analyses of data included in the preliminary report for 
early release will be considered the final analysis of these data, and also included in the final 
clinical study report (CSR). 
Analysis of exploratory immunogenicity endpoints may be performed and released as the data 
are available from the research laboratories. Any such analyses would be considered the final 
analysis for the endpoint, and included in the CSR. The final CSR will be completed after the 
last subject’s last visit is completed, and the final clinical database including all long-term safety 
follow-up data is cleaned, monitored and locked. Additional exploratory immunogenicity 
endpoint data not available at the time of CSR preparation may be included in an addendum to 
the CSR. 
A formal statistical analysis plan (SAP) will be developed and finalized prior the primary clinical 
database lock, which defines the analyses to be included in the Preliminary report, and the final 
CSR. 
11.6.1 
Analysis Populations 
The Safety Analysis population includes all subjects who received at least one dose of study 
vaccine. 
The modified intent-to-treat (mITT) population includes all subjects who received at least one 
dose of study vaccine and contributed both pre- and at least one post-study vaccination venous 
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were reported. For analyses using the mITT population, subjects in Group 2 who discontinue 
treatment after receiving the single IIV4 dose (Dose 1) but prior to receiving the first dose of the 
H7N9 vaccine (Dose 2) will be analyzed with group 3. All other subjects will be grouped based 
on randomized treatment arm.  
The per protocol (PP) population includes all subjects in the mITT subset with the following 
exclusions: 
• Data from all available visits for subjects found to be ineligible at baseline. 
• Data from all visits subsequent to major protocol deviations, such as: 
• Second or third study vaccination not received, 
• Second or third study vaccination received out of window, 
• Receipt of non-study licensed live vaccine within 30 days before or after each study 
vaccination, 
• Receipt of non-study licensed inactivated vaccine within 14 days before or after 
each study vaccination, 
• Receipt of immunosuppressive therapy (e.g., corticosteroids) within 30 days before 
or after each study vaccination. 
• Data from any visit that occurs substantially out of window. 
For analyses using the PP population, subjects will be grouped based on study vaccinations 
received. 
11.6.2 
Safety Data 
Summaries and analysis of safety data will be presented for the Safety Analysis Population. All 
summaries and analyses will be presented for all subjects. 
Solicited AEs will be summarized by severity for each day after each study vaccination (Days 1-
8 post each study vaccination) and as the maximum severity over all 8 days. Additionally, 
solicited AEs will be analyzed by taking the most severe response over the follow-up period, 
dichotomizing into a binary variable (none versus mild, moderate, or severe) and using standard 
techniques, such as exact confidence intervals, to summarize the proportion of subjects reporting 
each symptom, any injection site symptom, and any systemic symptom. Summaries of solicited 
AEs will be presented separately for each study vaccination as well as overall study vaccinations 
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treatment arms using Chi-square or Fisher’s exact test. The proportion of subjects reporting 
solicited symptoms between the different study vaccinations (i.e., first vs. second, first vs. third, 
second vs. third, as applicable within each study group) will be compared using McNemar’s test. 
Unsolicited AEs will be coded by Medical Dictionary for Regulatory Activities (MedDRA) for 
preferred term and system organ class (SOC). The numbers of SAEs and MAAEs, including 
NOCMCs and PIMMCs, are likely to be small in this trial and will be reported by detailed 
listings showing the event description, MedDRA preferred term and SOC, relevant dates (study 
vaccinations and AEs), severity, relatedness, and outcome for each event. Non-serious 
unsolicited AEs will be summarized as number and percentage of subjects reporting at least one 
event in each MedDRA preferred term and SOC, cross tabulated by severity and relationship to 
study product. Additionally, the proportion of subjects and exact 95% CIs of AEs in aggregate 
and by MedDRA categories will be computed. 
Clinical laboratory data will be summarized by severity for each visit and as the maximum over 
all post-study vaccination visits. Graphical presentations may include box plots. 
11.6.3 
Immunogenicity Data  
Summaries and analysis of immunogenicity data will be presented for the mITT and PP 
populations. 
Immune responses in terms of 2017 H7N9 or IIV4 strain-specific HAI and Neut antibody titers 
will be summarized by treatment arm at each time point. Analyses will include number and 
percentage of subjects with a titer ≥1:40, number and percentage of subjects achieving 
seroconversion (defined as either a pre-vaccination titer <10 and a post-vaccination titer ≥1:40 or 
a pre-vaccination titer ≥1:10 and a minimum four-fold rise in post-vaccination antibody titer), 
and GMTs along with corresponding 95% CIs. Descriptive summary statistics will be provided 
for all assays and time points. The correlation between HAI and Neut antibody titers will be 
evaluated. Plots such as reverse cumulative distributions or longitudinal presentations of GMTs 
will be presented. 
Additionally, the immune response, as described above, will be summarized by available 
covariates, such as age, sex, BMI, and prior receipt of seasonal influenza vaccine(s), and these 
covariates may be considered statistical modeling. As an exploratory analysis, models may be 
developed to evaluate the relationship between study vaccination schedule and immune response.  
Additionally, N1, N2 and N9 NA-specific antibody assays are in development.  If successful, 
N1, N2 and N9 NA-specific responses may be assessed at baseline, 21, 42, 63, and 180 days 
after receipt of the first study vaccination.  For each time point, summaries may include number 

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and percentage of subjects with detectable N1, N2 and N9 NA response (to be defined in SAP 
based following assay development and selection) and GMTs along with corresponding 95% 
CIs. Descriptive summary statistics will be provided for all assays and time points. The 
correlation of N1, N2 and N9 NA response with HAI and Neut antibody titers will be evaluated, 
and plots such as reverse cumulative distributions or longitudinal presentations of GMTs will be 
presented. 
Further, a determination of the N9 NA content of the 2017 H7N9 IIV and the N1 and N2 content 
of seasonal licensed QIV is planned, and if successful, may be used to correlate the N1, N2 and 
N9 NA elicited antibody responses to the NA content of the 2017 H7N9 IIV and seasonal IIV4, 
respectively. Detectable NA antibody responses and GMTs will be summarized stratified by NA 
content, and statistical modeling may be used to examine the relationship of NA response with 
NA vaccine content, and study vaccination schedule.  
At least a subset of samples will also be tested for cross-reactive serum HAI and Neut antibody 
responses to antigenically drifted variants of influenza A/H7 viruses. Strain-specific results will 
be summarized using descriptive statistics as described above, correlations with 2017 H7N9 
responses, and association with study vaccine dose and adjuvant.  
Further immunogenicity testing and/or analyses may be carried out in the future based upon 
subjects’ prior receipt of non-seasonal influenza vaccines, including type (inactivated or live 
attenuated), what subtype (e.g. A/H3, A/H5, A/H9) and approximate date of vaccination. 
11.6.4 
Missing Values and Outliers 
All attempts will be made to collect all data per protocol. As missing data are expected to be 
minimal, no imputation will be performed for missing values. Any data point that appears to be 
erroneous or inexplicable based on clinical judgment will be investigated as a possible outlier. If 
data points are identified as outliers, sensitivity analyses will be performed to examine the 
impact of including or excluding the outliers. Any substantive differences in these analyses will 
be reported. 

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12 
DATA COLLECTION FORMS AND ACCESS TO 
SOURCE DATA/DOCUMENTS 
Each participating VTEU site will maintain appropriate medical and research records for this 
trial, in compliance with ICH E6, Section 4.9, and regulatory and institutional requirements for 
the protection of confidentiality of subjects. Each participating VTEU site will permit authorized 
representatives of the DMID, its designees, and appropriate regulatory agencies to examine (and 
when required by applicable law, to copy) clinical trial records for the purposes of quality 
assurance reviews, audits, monitoring and evaluation of the study safety and progress. These 
representatives will be permitted access to all source data, which include, but are not limited to, 
hospital records, clinical and office charts, laboratory notes, memoranda, evaluation checklists, 
pharmacy dispensing records, recorded data from automated instruments, copies or transcriptions 
certified after verification as being accurate and complete, microfiches, photographic negatives, 
microfilm or magnetic media, X-rays, and subject files and records kept at the pharmacy, at the 
laboratories, and medico-technical departments involved in the trial. Source data are all 
information, original records of clinical findings, observations, or other activities in a clinical 
trial necessary for the reconstruction and evaluation of the trial. 
Interview of subjects is sufficient for obtaining medical history. Solicitation of medical records 
from the subject’s primary care provider is not required. 

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13 
QUALITY CONTROL AND QUALITY ASSURANCE 
Following a written DMID-accepted site quality management plan, each participating VTEU site 
is responsible for conducting routine quality assurance (QA) and quality control (QC) activities 
to internally monitor study progress and protocol compliance. Each participating site principal 
investigator will provide direct access to all study-related sites, source data/DCFs, and reports for 
the purpose of monitoring and auditing by the sponsor, and inspection by local and regulatory 
authorities. Each site principal investigator will ensure all study personnel are appropriately 
trained and training documentation is current and maintained on site. 
The SDCC will implement QC procedures beginning with the data entry system and generate 
data QC checks that will be run on the database. Any missing data or data anomalies will be 
communicated to the participating VTEU site(s) for clarification and resolution. 

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14 
ETHICS/PROTECTION OF HUMAN SUBJECTS 
14.1 
Ethical Standard 
The site principal investigator will ensure that this trial is conducted in full conformity with 
principles of the Belmont Report: Ethical Principles and Guidelines for the Protection of Human 
Subjects of Research of the National Commission for the Protection of Human Subjects of 
Biomedical and Behavioral Research (April 18, 1979) and codified in 45 CFR 46, 21 CFR 50 
and 56, and ICH E6; 62 Federal Regulations 25691 (1997), if applicable. The site principal 
investigator’s institution will hold a current Federalwide Assurance (FWA) issued by the Office 
of Human Research Protection (OHRP) for federally funded research. 
14.2 
Institutional Review Board 
Prior to enrollment of subjects into this trial, the protocol and ICF will be reviewed and approved 
by the appropriate IRB listed on its FWA. 
The responsible official for the IRB will sign the IRB letter of approval of the protocol prior to 
the start of this trial and a copy will be provided to DMID. The IRB FWA number will be 
provided to DMID. 
Should amendments to the protocol be required, the amendments will be written by the sponsor 
and provided to the site principal investigator for submission to the IRB. 
14.3 
Informed Consent Process 
14.3.1 
Informed Consent 
The site principal investigator will choose subjects in accordance with the eligibility criteria 
detailed in Section 5.1. Before any study procedures are performed, subjects must sign an ICF 
that complies with the requirements of 21 CFR Part 50 and 45 CFR 46 and the local IRB. Study 
personnel may employ IRB-approved recruitment efforts prior to obtaining study consent; 
however, before any study procedures are performed to determine protocol eligibility an ICF 
must be signed. 
Informed consent is a process that is initiated prior to an individual agreeing to participate in a 
trial and continuing throughout the individual’s trial participation. Before any study procedures 
are performed subjects will receive a comprehensive explanation of the proposed study 

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procedures and study interventions/products. This will include the nature, risks and possible 
benefits of this trial, alternate therapies, any known AEs, the investigational status of the study 
interventions/products, and the other elements that are part of obtaining proper informed consent. 
Subjects will also receive a detailed explanation of the proposed use and disclosure of their 
protected health information, including specifically their serum samples. Subjects will be 
allowed sufficient time to consider participation in this research trial, after having the nature, 
risks, and possible benefits of this trial explained to them, and have the opportunity to discuss 
this trial with their family, friends, or legally authorized representative, or think about it prior to 
agreeing to participate. 
ICFs describing in detail the study interventions/products, study procedures, risks, and possible 
benefits will be given to subjects. The ICF must not include any exculpatory statements. ICFs 
will be IRB-approved and subjects will be asked to read and review the appropriate document. 
Upon reviewing the appropriate document, the site principal investigator (or designee) will 
explain this research trial to subjects and answer any questions that may arise. Subjects must sign 
the ICF, and written documentation of the informed consent process is required prior to starting 
any study procedures being done specifically for this trial, including determining eligibility and 
administering study product. 
By signing the ICF, subjects agree to complete all study procedures required by this trial, unless 
the subject withdraws voluntarily, or is withdrawn or terminated from this trial for any reason. 
The rights and welfare of subjects will be protected by emphasizing to subjects that the quality of 
their medical care will not be adversely affected if they decline to participate in or withdraw 
from this trial. 
DMID will provide the site principal investigator, in writing, any new information that 
significantly impacts the subject’s risk of receiving the investigational products. This new 
information will be communicated by the site principal investigator to subjects who consent to 
participate in this trial in accordance with IRB requirements. The ICF will be updated and 
subjects will be re-consented per IRB requirements, if necessary. Subjects will be given a copy 
of all ICFs that they sign. 
14.4 
Exclusion of Women, Minorities, and Children (Special Populations) 
This trial will be inclusive of all subjects ages 19-64 who meet the Subject Inclusion Criteria (see 
Section 5.1.1) and do not meet the Subject Exclusion Criteria (see Section 5.1.2), regardless of 
religion, sex, or ethnic background. Adults aged 18 are excluded because the CDC-
recommended adult immunization schedule considers adults as age 19 and above, and therefore 
this is the subject population chosen for this study [80]. Should the outcome of this trial be 
deemed acceptable, additional trials may be initiated including those in other populations. 

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It is unknown if the 2017 H7N9 IIV with or without AS03 adjuvant poses any risks to an unborn 
child. As of November 22, 2015 (per the most current version of the manufacturer’s IB), the 
available data for women who become pregnant during clinical trials of AS03-adjuvanted (pre) 
pandemic influenza vaccines do not suggest any causal relationship between adverse pregnancy 
outcomes and receipt of an AS03-adjuvanted vaccine. Women of childbearing potential who are 
not sterilized via tubal ligation, bilateral oophorectomy, salpingectomy,  hysterectomy, or 
successful Essure® placement (permanent, non-surgical, non-hormonal sterilization) with 
documented radiological confirmation test at least 90 days after the procedure, and still 
menstruating or who are not postmenopausal for ≥1 year must use an acceptable contraception 
method that may include, but is not limited to, non-male sexual relationships, abstinence from 
sexual intercourse with a male partner, monogamous relationship with a vasectomized partner 
who has been vasectomized for at least 180 days prior to the subject receiving the first study 
vaccination, barrier methods such as condoms or diaphragms with spermicide or foam, , effective 
intrauterine devices, NuvaRing® and licensed hormonal methods, such as implants, injectables, 
or oral contraceptives (“the pill”) for a minimum of 30 days prior to study product exposure and 
agree to practice highly effective contraception for the duration of study product exposure, 
including 60 days after their last study vaccination. A highly effective method of contraception is 
defined as one that results in a low failure rate (i.e., less than 1% per year) when used 
consistently and correctly. In addition to contraceptive use, all women of childbearing potential 
will be required to have a negative urine or serum pregnancy test within 24 hours prior to each 
study vaccination. If a female subject becomes pregnant while participating in this trial, we will 
ask her permission to follow-up with her about her health and the health of her baby through 
pregnancy outcome. 
Children will not be included in this trial as presently there are no safety or efficacy data in 
adults. 
14.5 
Subject Confidentiality 
Subject confidentiality is strictly held in trust by the site principal investigators, other study 
personnel, the sponsor, and their agents. This confidentiality is extended to cover testing of 
biological samples, in addition to the clinical information relating to participating subjects. 
Subjects will have code numbers and will not be identified by name. 
The study protocol, documentation, data, and all other information generated will be held in 
strict confidence. No information concerning this trial or the data will be released to any 
unauthorized third party without prior written approval of the sponsor. 
All information provided by the sponsor and all data and information generated by the 
participating VTEU sites as part of this trial (other than a subject’s medical records) will be kept 

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confidential by the site principal investigators and other study personnel to the extent permitted 
by law. These restrictions do not apply to: (1) information which becomes publicly available 
through no fault of the site principal investigators or other study personnel; (2) information 
which is necessary to disclose in confidence to an IRB solely for the evaluation of this trial; (3) 
information which is necessary to disclose in order to provide appropriate medical care to a study 
subject; or (4) study results which may be published as described in Section 17.  
The study monitor, applicable regulatory authorities, such as the FDA, or other authorized 
representatives of the sponsor may inspect all documents and records required to be maintained 
by the site principal investigators. This includes, but is not limited to, medical records (office, 
clinic, or hospital) and pharmacy records for the subjects in this trial. The participating VTEU 
sites will permit access to such records. 
To protect privacy, we have received a Certificate of Confidentiality.  With this Certificate, the 
researchers cannot be forced to release information that may identify the research subject, even 
by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or 
other proceedings.  The researchers will use the Certificate to resist any demands for information 
that would identify the subject, except as explained below. 
The Certificate cannot be used to resist a demand for information from personnel of the United 
States Government that is used for auditing or evaluation of federally funded projects, like this 
study, or for information that must be released in order to meet the requirements of the Federal 
Food and Drug Administration (FDA). 
A Certificate of Confidentiality does not prevent the subject from voluntarily releasing 
information about themselves or their involvement in this research.  If any person or agency 
obtains a written consent to receive research information, then the researchers may not use the 
Certificate to withhold that information.   
The Certificate of Confidentiality does not prevent the researchers from reporting without the 
subject’s consent, information that would identify the subject as a participant in the research 
project regarding matters that must be legally reported including: child and elder abuse, sexual 
abuse, or wanting to harm themselves or others.   
 
14.6 
Study Discontinuation 
If this trial is discontinued, subjects, who have signed the ICF and are randomized and 
vaccinated, will continue to be followed for safety for the duration of the prescribed safety 
follow-up period. No further study vaccinations will be administered. 

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14.7 
Costs, Subject Compensation, and Research Related Injuries 
There is no cost to subjects for taking part in this trial. 
Subjects may be compensated for their participation in this trial. Compensation will be in 
accordance with the local IRB’s policies and procedures, and subject to IRB approval. 
If it is determined by the participating VTEU site and the site principal investigator that an injury 
occurred to a subject as a direct result of the tests or treatments that are done for this trial, then 
referrals to appropriate health care facilities will be provided to the subject. Study personnel will 
try to reduce, control, and treat any complications from this trial. Immediate medical treatment 
may be provided by the participating VTEU site, such as giving emergency medications to stop 
immediate allergic reactions to the study vaccine. No financial compensation will be provided to 
the subject by the participating VTEU site for any injury suffered due to participation in this 
trial. 
For this protocol, the study products (monovalent inactivated influenza 2017 H7N9 virus vaccine 
manufactured by Sanofi Pasteur and adjuvant (AS03) manufactured by GSK), are covered under 
the Public Readiness and Emergency Preparedness Act (PREP Act), as described in Section 
2.1.1. 
 
14.8 
Future Use of Stored Specimens 
Residual samples/specimens are those that are left over after the study has been completed. 
Subjects may be asked for permission to keep any remaining (residual) clinical samples (serum) 
derived from venous blood samples for possible use in future research studies, such as examining 
additional immunological assessments or testing for antibodies against other viruses or bacteria, 
or the retention of those samples for possible future use may be a condition of study 
participation. Residual clinical samples for future use will be stored indefinitely at a central 
clinical storage facility and may be shared for purposes other than per protocol analysis with 
investigators at the participating VTEU site and with other investigators at other institutions once 
the clinical study report has been finalized. 
Other blood samples are being collected during the study specifically for future use, from 
subjects who consent to collection of those specimens either by signing an informed consent 
form that includes collection of future use samples as a condition of study participation or by 
indicating that they opt in to sample collection for future use if the informed consent form allows 
the option to choose that option. It is anticipated that up to ten 0.5 mL aliquots of serum from 

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each extra 10 mL venous blood sample will be available specifically for the purpose of future 
research, including but not limited to non-traditional immune assay development, assessing 
innate immune factors and the ability of H7 vaccine-induced antibodies to cross-react with other 
influenza viruses. These future research clinical samples will be stored indefinitely at a central 
clinical storage facility. 
Unlike residual samples, samples/specimens collected during the study solely for the purpose of 
future research may be requested from DMID and shipped from the DMID CMS at any time. 
The samples (residual and the extra venous blood sample collected solely for future use) will not 
be sold or used directly for production of any commercial product. No genetic tests will be 
performed on samples. Each sample will be encoded (labeled) only with a barcode and a unique 
tracking number to protect subject confidentiality. 
There are no benefits to subjects in the collection, storage and subsequent use of their specimens 
for future research. Reports about future research done with subjects’ samples will NOT be kept 
in their health records. 
Subjects who are provided the option to decide if residual samples may be retained for possible 
future use or if other blood specimens may be collected specifically for future use may change 
those decisions at any time by notifying the study doctors or nurses in writing. However, if the 
subject originally consents to future use of residual samples or collection of samples specifically 
for future research, and subsequently changes his/her decision, any data from a previously 
collected sample may still be used for this research. 

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15 
DATA HANDLING AND RECORD KEEPING 
The site principal investigator is responsible to ensure the accuracy, completeness, legibility, and 
timeliness of the data reported. 
DCFs will be derived from the eCRF and provided by the SDCC to record and maintain data for 
each subject enrolled in this trial. All DCFs should be completed in a neat, legible manner to 
ensure accurate interpretation of data. Black or blue ink is required to ensure clarity of 
reproduced copies. When making a change or correction, cross out the original entry with a 
single line and initial and date the change. Do not erase, overwrite, or use correction fluid or tape 
on the original. 
Data reported in the eCRF derived from the DCFs should be consistent with the DCFs or the 
discrepancies should be explained. 
The sponsor and/or its designee will provide guidance to the site principal investigators and other 
study personnel on making corrections to the DCFs and eCRF. 
15.1 
Data Management Responsibilities 
All DCFs and laboratory reports must be reviewed by the clinical team and data entry personnel, 
who will ensure that they are accurate and complete. AEs must be recorded on the appropriate 
DCF, assessed for severity and relationship, and reviewed by the site principal investigator or 
appropriate sub-investigator. 
Data collection is the responsibility of the study personnel at each participating VTEU site under 
the supervision of the respective site principal investigator. During this trial, the site principal 
investigator must maintain complete and accurate documentation for this trial. 
The SDCC for this trial will be responsible for data management, quality review, analysis, and 
reporting of the study data. 
15.2 
Data Capture Methods 
Clinical (including, but not limited to, AE/SAEs, concomitant medications, medical history, 
physical assessments, and clinical laboratory values), reactogenicity and immunogenicity data 
will be entered into a 21 CFR 11-compliant Internet Data Entry System provided by the SDCC. 
The data system includes password protection and internal quality checks, such as automatic 

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range checks, to identify data that appear inconsistent, incomplete, or inaccurate. Clinical and 
reactogenicity data will be entered directly from the DCFs completed by the study personnel. 
15.3 
Types of Data 
Data for this trial will include clinical, safety, and outcome measures (e.g., clinical laboratory 
values, reactogenicity and immunogenicity data). 
15.4 
Timing/Reports 
Clinical, safety and reactogenicity data through approximately 21 days after the second 
adjuvanted H7N9 study vaccination for Groups 1 and 2 will represent the primary clinical 
database for this trial. Once the last subject completes the visit that occurs approximately 21 days 
after the last adjuvanted H7N9 study vaccination, the primary clinical database will be cleaned, 
monitored and locked. Analyses of safety, reactogenicity, and primary and secondary 
immunogenicity data by treatment are planned. A preliminary report will be prepared by the 
SDCC after the primary clinical database is locked and all HAI and Neut data through 21 days 
after the last study vaccination are received. These analyses may be made available to the 
sponsor for planning subsequent trials and to the lead principal investigator for publication. 
These analyses will not be used to make any decisions concerning the conduct of this trial. All 
analyses of data included in the preliminary report for early release will be considered the final 
analysis of these data, and also included in the final CSR. 
Analysis of exploratory immunogenicity endpoints may be performed and released as the data is 
available from the central clinical laboratory. Any such analyses would be considered the final 
analysis for the endpoint, and included in the CSR. 
The final CSR will be completed after the last subject’s last visit is completed, and the final 
clinical database including all long-term safety follow-up data is cleaned, monitored and locked. 
Additional exploratory immunogenicity endpoint data not available at the time of CSR 
preparation may be included in an addendum to the CSR. 
Additional statistical reports may be generated as deemed necessary and appropriate by DMID. 
Safety and immunogenicity summary reports may be generated for the DSMB. 
After the final CSR is complete, and upon request and DMID approval, the SDCC will provide 
the participating VTEU sites with a summary of results by treatment arm and/or subject 
treatment assignments. In this regard, the participating VTEU sites requesting such information 
to share with study subjects must do so in compliance with their respective IRB guidelines. 

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15.5 
Study Records Retention 
Study records and reports including, but not limited to, eCRFs, source documents, ICFs, and 
study drug disposition records shall be maintained for 2 years after a marketing application is 
approved for the drug for the indication for which it is being investigated; or, if no application is 
to be filed or if the application is not approved for the drug, until 2 years after the investigation is 
discontinued and the FDA has been notified. ICFs for future use will be maintained as long as 
the sample exists. 
The participating VTEU sites must contact DMID for authorization prior to the destruction of 
any study records.  

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16 
PROTOCOL DEVIATIONS 
A protocol deviation is any noncompliance with the study protocol, GCP, or protocol-specific 
MOP requirements. The noncompliance may be either on the part of the subject, the site 
principal investigator, or other study personnel. As a result of deviations, corrective actions are 
to be developed by the site and implemented promptly. 
These practices are consistent with ICH E6: 
4.5 
Compliance with Protocol, Sections 4.5.1, 4.5.2, and 4.5.3 
5.1 
Quality Assurance and Quality Control, Section 5.1.1 
5.20 
Noncompliance, Sections 5.20.1, and 5.20.2 
It is the responsibility of the site principal investigator and other study personnel to use 
continuous vigilance to identify and report deviations within five working days of identification 
of the protocol deviation, or within five working days of the scheduled protocol-required 
activity. All deviations must be promptly reported to DMID, via the SDCC’s AdvantageEDCSM. 
All protocol deviations, as defined above, must be addressed in study subject DCFs. A 
completed copy of the DMID Protocol Deviation Form must be maintained in the Regulatory 
File as well as in the subject's chart. Protocol deviations must be sent to the local IRB per its 
guidelines. The site principal investigator and other study personnel are responsible for knowing 
and adhering to their IRB requirements. 

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17 
PUBLICATION POLICY 
All investigators funded by the NIH must submit or have submitted for them to the National 
Library of Medicine’s PubMed Central (http://www.ncbi.nlm.nih.gov/pmc/) an electronic 
version of their final, peer-reviewed manuscripts upon acceptance for publication, to be made 
publicly available no later than 12 months after the official date of publication.  The NIH Public 
Access Policy ensures the public has access to the published results of NIH funded research.  It 
requires investigators to submit final peer-reviewed journal manuscripts that arise from NIH 
funds to the digital archive PubMed Central upon acceptance for publication.  Further, the policy 
stipulates that these papers must be accessible to the public on PubMed Central no later than 12 
months after publication. 
Refer to: 
• 
NIH Public Access Policy, http://publicaccess.nih.gov/ 
• 
NIH Office of Extramural Research (OER) Grants and Funding, 
http://grants.nih.gov/grants/oer.htm 
As of January 2018, all clinical trials supported by the NIH must be registered on 
ClinicalTrials.gov, no later than 21 days after the enrollment of the first subject. Results of all 
clinical trials supported by the NIH, generally, need to be submitted no later than 12 months 
following the primary completion date. A delay of up to 2 years is available for trials that meet 
certain criteria and have applied for certification of delayed posting. 
As part of the result posting a copy of this protocol (and its amendments) and a copy of the 
Statistical Analysis Plan will be posted on ClincialTrials.gov. 
For this trial the responsible party is DMID which will register the trial and post results.   
The responsible party does not plan to request certification of delayed posting. 
Refer to: 
• 
Public Law 110-85, Section 801, Clinical Trial Databases 
• 
42CFR11 
• 
NIH NOT-OD-16-149 

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18 
LITERATURE REFERENCES 
 
1. 
Centers for Disease, C. and Prevention, Emergence of avian influenza A(H7N9) virus 
causing severe human illness - China, February-April 2013. MMWR Morb Mortal Wkly 
Rep, 2013. 62(18): p. 366-71. 
2. 
Fouchier, R.A., et al., Avian influenza A virus (H7N7) associated with human 
conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci 
U S A, 2004. 101(5): p. 1356-61. 
3. 
Lindstrom, S., et al., Human infections with novel reassortant influenza A(H3N2)v 
viruses, United States, 2011. Emerg Infect Dis, 2012. 18(5): p. 834-7. 
4. 
Peiris, M., et al., Human infection with influenza H9N2. Lancet, 1999. 354(9182): p. 916-
7. 
5. 
Perez-Padilla, R., et al., Pneumonia and respiratory failure from swine-origin influenza A 
(H1N1) in Mexico. N Engl J Med, 2009. 361(7): p. 680-9. 
6. 
Subbarao, K., et al., Characterization of an avian influenza A (H5N1) virus isolated from 
a child with a fatal respiratory illness. Science, 1998. 279(5349): p. 393-6. 
7. 
Oxford, J.S., Influenza A pandemics of the 20th century with special reference to 1918: 
virology, pathology and epidemiology. Rev Med Virol, 2000. 10(2): p. 119-33. 
8. 
Patriarca, P.A. and N.J. Cox, Influenza pandemic preparedness plan for the United 
States. J Infect Dis, 1997. 176 Suppl 1: p. S4-7. 
9. 
Galasso, G.J., F.J. Tyeryar, Jr., and J.R. La Montagne, Overview of clinical trials of 
influenza vaccines, 1976. J Infect Dis, 1977. 136 Suppl: p. S425-8. 
10. 
La Montagne, J.R., et al., Summary of clinical trials of inactivated influenza vaccine - 
1978. Rev Infect Dis, 1983. 5(4): p. 723-36. 
11. 
Couch, R.B. and J.A. Kasel, Immunity to influenza in man. Annu Rev Microbiol, 1983. 
37: p. 529-49. 
12. 
Couch, R.B., et al., Antibody correlates and predictors of immunity to naturally 
occurring influenza in humans and the importance of antibody to the neuraminidase. J 
Infect Dis, 2013. 207(6): p. 974-81. 
13. 
Memoli, M.J., et al., Evaluation of Antihemagglutinin and Antineuraminidase Antibodies 
as Correlates of Protection in an Influenza A/H1N1 Virus Healthy Human Challenge 
Model. MBio, 2016. 7(2): p. e00417-16. 
14. 
Ennis, F.A., et al., Correlation of laboratory studies with clinical responses to A/New 
Jersey influenza vaccines. J Infect Dis, 1977. 136 Suppl: p. S397-406. 
15. 
Gross, P.A., et al., Immunization of elderly people with high doses of influenza vaccine. J 
Am Geriatr Soc, 1988. 36(3): p. 209-12. 
16. 
Keitel, W.A., et al., High doses of purified influenza A virus hemagglutinin significantly 
augment serum and nasal secretion antibody responses in healthy young adults. J Clin 
Microbiol, 1994. 32(10): p. 2468-73. 
17. 
Matzkin, H. and E. Nili, Accidental tenfold overdose of influenza vaccine: a clinical and 
serological study. Isr J Med Sci, 1984. 20(5): p. 411-5. 

DMID Protocol 17-0077 
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139 
18. 
Mostow, S.R., et al., Inactivated vaccines. 1. Volunteer studies with very high doses of 
influenza vaccine purified by zonal ultracentrifugation. Postgrad Med J, 1973. 49(569): 
p. 152-8. 
19. 
Palache, A.M., et al., Antibody response after influenza immunization with various 
vaccine doses: a double-blind, placebo-controlled, multi-centre, dose-response study in 
elderly nursing-home residents and young volunteers. Vaccine, 1993. 11(1): p. 3-9. 
20. 
Remarque, E.J., et al., Improvement of the immunoglobulin subclass response to 
influenza vaccine in elderly nursing-home residents by the use of high-dose vaccines. 
Vaccine, 1993. 11(6): p. 649-54. 
21. 
Ruben, F.L. and G.G. Jackson, A new subunit influenza vaccine: acceptability compared 
with standard vaccines and effect of dose on antigenicity. J Infect Dis, 1972. 125(6): p. 
656-64. 
22. 
Ruben, F.L., C.W. Potter, and C.H. Stuart-Harris, Humoral and secretory antibody 
responses to immunization with low and high dosage split influenza virus vaccine. Arch 
Virol, 1975. 47(2): p. 157-66. 
23. 
Keitel, W.A., et al., Increasing doses of purified influenza virus hemagglutinin and 
subvirion vaccines enhance antibody responses in the elderly. Clin Diagn Lab Immunol, 
1996. 3(5): p. 507-10. 
24. 
Couch, R.B., et al., A randomized clinical trial of an inactivated avian influenza A 
(H7N7) vaccine. PLoS One, 2012. 7(12): p. e49704. 
25. 
Treanor, J.J., et al., Safety and immunogenicity of an inactivated subvirion influenza A 
(H5N1) vaccine. N Engl J Med, 2006. 354(13): p. 1343-51. 
26. 
Atmar, R.L. and W.A. Keitel, Adjuvants for pandemic influenza vaccines. Curr Top 
Microbiol Immunol, 2009. 333: p. 323-44. 
27. 
Bresson, J.L., et al., Safety and immunogenicity of an inactivated split-virion influenza 
A/Vietnam/1194/2004 (H5N1) vaccine: phase I randomised trial. Lancet, 2006. 
367(9523): p. 1657-64. 
28. 
Keitel, W.A., et al., Safety and immunogenicity of an inactivated influenza A/H5N1 
vaccine given with or without aluminum hydroxide to healthy adults: results of a phase I-
II randomized clinical trial. J Infect Dis, 2008. 198(9): p. 1309-16. 
29. 
Carmona, A., et al., Immunogenicity and safety of AS03-adjuvanted 2009 influenza A 
H1N1 vaccine in children 6-35 months. Vaccine, 2010. 28(36): p. 5837-44. 
30. 
Diez-Domingo, J., et al., Immunogenicity and Safety of H5N1 A/Vietnam/1194/2004 
(Clade 1) AS03-adjuvanted prepandemic candidate influenza vaccines in children aged 3 
to 9 years: a phase ii, randomized, open, controlled study. Pediatr Infect Dis J, 2010. 
29(6): p. e35-46. 
31. 
Leroux-Roels, I., et al., Antigen sparing and cross-reactive immunity with an adjuvanted 
rH5N1 prototype pandemic influenza vaccine: a randomised controlled trial. Lancet, 
2007. 370(9587): p. 580-9. 
32. 
McElhaney, J.E., et al., AS03-adjuvanted versus non-adjuvanted inactivated trivalent 
influenza vaccine against seasonal influenza in elderly people: a phase 3 randomised 
trial. Lancet Infect Dis, 2013. 13(6): p. 485-96. 
33. 
Vogel, F.R., et al., Emulsion-based adjuvants for influenza vaccines. Expert Rev 
Vaccines, 2009. 8(4): p. 483-92. 

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34. 
Increased risk of narcolepsy observed also among adults vaccinated with Pandemrix in 
Finland National Narcolepsy Task Force.  National Institute for Health and Welfare 
(THL) Finland. 
35. 
A registry based comparative cohort study in four Swedish counties of the risk for 
narcolepsy after vaccination with Pandemrix – a first and preliminary report. 
36. 
Choe, Y.J., G.R. Bae, and D.H. Lee, No association between influenza A(H1N1)pdm09 
vaccination and narcolepsy in South Korea: an ecological study. Vaccine, 2012. 30(52): 
p. 7439-42. 
37. 
Dauvilliers, Y., et al., Increased risk of narcolepsy in children and adults after pandemic 
H1N1 vaccination in France. Brain, 2013. 136(Pt 8): p. 2486-96. 
38. 
Eurosurveillance editorial, t., Swedish Medical Products Agency publishes report from a 
case inventory study on Pandemrix vaccination and development of narcolepsy with 
cataplexy. Euro Surveill, 2011. 16(26). 
39. 
Miller, E., et al., Risk of narcolepsy in children and young people receiving AS03 
adjuvanted pandemic A/H1N1 2009 influenza vaccine: retrospective analysis. BMJ, 
2013. 346: p. f794. 
40. 
Montplaisir, J., et al., Risk of narcolepsy associated with inactivated adjuvanted (AS03) 
A/H1N1 (2009) pandemic influenza vaccine in Quebec. PLoS One, 2014. 9(9): p. 
e108489. 
41. 
Nohynek, H., et al., AS03 adjuvanted AH1N1 vaccine associated with an abrupt increase 
in the incidence of childhood narcolepsy in Finland. PLoS One, 2012. 7(3): p. e33536. 
42. 
O'Flanagan, D., et al., Investigation of an association between onset of narcolepsy and 
vaccination with pandemic influenza vaccine, Ireland April 2009-December 2010. Euro 
Surveill, 2014. 19(17): p. 15-25. 
43. 
Wijnans, L., et al., The incidence of narcolepsy in Europe: before, during, and after the 
influenza A(H1N1)pdm09 pandemic and vaccination campaigns. Vaccine, 2013. 31(8): p. 
1246-54. 
44. 
 A Phase II Randomized, Partially-Blinded, Controlled, Trial in Healthy Adults Aged 65 
Years and Older to Assess the Safety, Reactogenicity, and Immunogenicity of an MF59-
Adjuvanted, Monovalent Inactivated Influenza A/H7N9 Virus Vaccine Administered 
Intramuscularly at Different Intervals and Dosages. 
45. 
Chen, W.H., et al., Safety, Reactogenicity, and Immunogenicity of Inactivated 
Monovalent Influenza A(H5N1) Virus Vaccine Administered With or Without AS03 
Adjuvant. Open Forum Infect Dis, 2014. 1(3): p. ofu091. 
46. 
Jackson, L.A., et al., Effect of Varying Doses of a Monovalent H7N9 Influenza Vaccine 
With and Without AS03 and MF59 Adjuvants on Immune Response: A Randomized 
Clinical Trial. JAMA, 2015. 314(3): p. 237-46. 
47. 
Jackson, L.A., et al., Immunogenicity and safety of varying dosages of a monovalent 2009 
H1N1 influenza vaccine given with and without AS03 adjuvant system in healthy adults 
and older persons. J Infect Dis, 2012. 206(6): p. 811-20. 
48. 
Mulligan, M.J., et al., Point-of-Use Mixing of Influenza H5N1 Vaccine and MF59 
Adjuvant for Pandemic Vaccination Preparedness: Antibody Responses and Safety. A 
Phase 1 Clinical Trial. Open Forum Infect Dis, 2014. 1(3): p. ofu102. 

DMID Protocol 17-0077 
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September 18, 2018 
 
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49. 
Mulligan, M.J., et al., Serological responses to an avian influenza A/H7N9 vaccine mixed 
at the point-of-use with MF59 adjuvant: a randomized clinical trial. JAMA, 2014. 
312(14): p. 1409-19. 
50. 
Lee, Y.J., et al., Novel reassortant influenza A(H5N8) viruses, South Korea, 2014. Emerg 
Infect Dis, 2014. 20(6): p. 1087-9. 
51. 
Wu, H., et al., Novel reassortant influenza A(H5N8) viruses in domestic ducks, eastern 
China. Emerg Infect Dis, 2014. 20(8): p. 1315-8. 
52. 
Gao, R., et al., Human infection with a novel avian-origin influenza A (H7N9) virus. N 
Engl J Med, 2013. 368(20): p. 1888-97. 
53. 
Analysis of recent scientific information on avian influenza A(H7N9) virus. WHO  
Influenza Update, 2017. 
54. 
Human infection with avian influenza A(H7N9) virus – China: 07 December 2017. WHO  
Emergencies preparedness, response, 2017. 
55. 
WHO Emergencies preparedness, response- Disease Outbreak News 5 April 2017. 
56. 
Zhou, J., et al., Biological features of novel avian influenza A (H7N9) virus. Nature, 
2013. 499(7459): p. 500-3. 
57. 
Zhu, H., et al., Infectivity, transmission, and pathology of human-isolated H7N9 influenza 
virus in ferrets and pigs. Science, 2013. 341(6142): p. 183-6. 
58. 
Li, Y., et al., Evolving HA and PB2 genes of influenza A (H7N9) viruses in the fifth wave 
- Increasing threat to both birds and humans? J Infect, 2017. 
59. 
Hoskins, T.W., et al., Controlled trial of inactivated influenza vaccine containing the a-
Hong Kong strain during an outbreak of influenza due to the a-England-42-72 strain. 
Lancet, 1973. 2(7821): p. 116-20. 
60. 
Hoskins, T.W., et al., Influenza at Christ's Hospital: March, 1974. Lancet, 1976. 1(7951): 
p. 105-8. 
61. 
Belongia, E.A., et al., Repeated annual influenza vaccination and vaccine effectiveness: 
review of evidence. Expert Rev Vaccines, 2017. 16(7): p. 1-14. 
62. 
Keitel, W.A., et al., Efficacy of repeated annual immunization with inactivated influenza 
virus vaccines over a five year period. Vaccine, 1997. 15(10): p. 1114-22. 
63. 
Ohmit, S.E., et al., Influenza vaccine effectiveness in the community and the household. 
Clin Infect Dis, 2013. 56(10): p. 1363-9. 
64. 
Langley, J.M., et al., A randomized, controlled non-inferiority trial comparing 
A(H1N1)pmd09 vaccine antigen, with and without AS03 adjuvant system, co-
administered or sequentially administered with an inactivated trivalent seasonal 
influenza vaccine. BMC Infect Dis, 2012. 12: p. 279. 
65. 
Peeters, M., et al., Safety and immunogenicity of an AS03-adjuvanted A(H1N1)pmd09 
vaccine administered simultaneously or sequentially with a seasonal trivalent vaccine in 
adults 61 years or older: data from two multicentre randomised trials. Vaccine, 2012. 
30(45): p. 6483-91. 
66. 
Roy-Ghanta, S., et al., Responses to A(H1N1)pdm09 influenza vaccines in participants 
previously vaccinated with seasonal influenza vaccine: a randomized, observer-blind, 
controlled study. J Infect Dis, 2014. 210(9): p. 1419-30. 
67. 
Uno, S., et al., Effect of prior vaccination with a seasonal trivalent influenza vaccine on 
the antibody response to the influenza pandemic H1N1 2009 vaccine: a randomized 
controlled trial. Microbiol Immunol, 2011. 55(11): p. 783-9. 

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68. 
Chen, W.H., et al., Phase 2 assessment of the safety and immunogenicity of two 
inactivated pandemic monovalent H1N1 vaccines in adults as a component of the U.S. 
pandemic preparedness plan in 2009. Vaccine, 2012. 30(28): p. 4240-8. 
69. 
Vajo, Z., et al., Safety and immunogenicity of a 2009 pandemic influenza A H1N1 vaccine 
when administered alone or simultaneously with the seasonal influenza vaccine for the 
2009-10 influenza season: a multicentre, randomised controlled trial. Lancet, 2010. 
375(9708): p. 49-55. 
70. 
Madan, A., et al., Immunogenicity and Safety of an AS03-Adjuvanted H7N9 Pandemic 
Influenza Vaccine in a Randomized Trial in Healthy Adults. J Infect Dis, 2016. 214(11): 
p. 1717-1727. 
71. 
Lasky, T., et al., The Guillain-Barre syndrome and the 1992-1993 and 1993-1994 
influenza vaccines. N Engl J Med, 1998. 339(25): p. 1797-802. 
72. 
Haber, P., et al., Guillain-Barre syndrome following influenza vaccination. JAMA, 2004. 
292(20): p. 2478-81. 
73. 
De Wals, P., et al., Risk of Guillain-Barre syndrome following H1N1 influenza 
vaccination in Quebec. JAMA, 2012. 308(2): p. 175-81. 
74. 
Juurlink, D.N., et al., Guillain-Barre syndrome after influenza vaccination in adults: a 
population-based study. Arch Intern Med, 2006. 166(20): p. 2217-21. 
75. 
Salmon, D.A., et al., Association between Guillain-Barre syndrome and influenza A 
(H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis. Lancet, 
2013. 381(9876): p. 1461-8. 
76. 
Wise, M.E., et al., Guillain-Barre syndrome during the 2009-2010 H1N1 influenza 
vaccination campaign: population-based surveillance among 45 million Americans. Am 
J Epidemiol, 2012. 175(11): p. 1110-9. 
77. 
Polakowski, L.L., et al., Chart-confirmed guillain-barre syndrome after 2009 H1N1 
influenza vaccination among the Medicare population, 2009-2010. Am J Epidemiol, 
2013. 178(6): p. 962-73. 
78. 
Dodd, C.N., et al., International collaboration to assess the risk of Guillain Barre 
Syndrome following Influenza A (H1N1) 2009 monovalent vaccines. Vaccine, 2013. 
31(40): p. 4448-58. 
79. 
Sullivan, S.S., Narcolepsy in adolescents. Adolesc Med State Art Rev, 2010. 21(3): p. 
542-55, x-xi. 
80. 
CDC, Recommended Immunizations for Adults: By Age. 2017. 
 

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143 
APPENDICES 
Appendix A: Schedule of Study Procedures and Evaluations 
Appendix B: List of Potentially Immune-Mediated Medical Conditions 
 

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APPENDIX A: SCHEDULE OF STUDY PROCEDURES AND 
EVALUATIONS 
Study Schedule, Group 1:  Vaccination Period  
Study Visit 
Number 
V00 
V01 
V02 
V03 
V04ψ 
V05 
V06 
Study Day post 
Dose 1 
Screening 
(Optional) 
D -28 to -1 
Enrollment 
Dose 1 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25 
D29 
Study Day post 
Dose 2 
 
 
 
 
Dose 2 
D1 
D4[±1] 
D8[+2] 
Obtain Informed 
Consent∞ 
X 
X¬ 
 
 
 
 
 
Collect 
Demographic 
Information 
X 
X†* 
 
 
 
 
 
Review 
Eligibility 
Criteria 
X 
X†¬1 
 
 
X† 
 
 
Medical History@ 
X 
X†¬* 
 
X 
X 
 
X 
Concomitant 
Medications 
Xς 
X†¬ς 
Xς 
Xς 
Xς 
Xς 
Xς 
Vital Signs$ 
(Oral 
Temperature%, 
Pulse, and BP) 
X 
X† 
 
 
X†2 
 
 
Height and 
Weight 
X 
X†* 
 
 
 
 
 
Physical 
Examination3 
X 
{X}†* 
 
{X} 
{X} 
 
{X} 
Urine or Serum 
Pregnancy Test 
X^ 
X†^ 
 
 
X†^ 
 
 
Venous Blood 
Collection for 
ESR 
X 
X≠* 
 
 
 
 
 
Venous Blood 
Collection for 
Clinical Safety 
Laboratory 
Evaluations~ 
 
X† 
 
X 
X† 
 
X 
Venous Blood 
Collection for 
Immunogenicity 
Assays 
 
X† 
 
 
X† 
 
 
Serum Sample 
Collected for 
Future Research4 
 
X† 
 
X 
X† 
 
X 
Safety Follow-up 
Phone Call 
 
 
X 
 
 
X 
 

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September 18, 2018 
 
145 
Study Visit 
Number 
V00 
V01 
V02 
V03 
V04ψ 
V05 
V06 
Study Day post 
Dose 1 
Screening 
(Optional) 
D -28 to -1 
Enrollment 
Dose 1 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25 
D29 
Study Day post 
Dose 2 
 
 
 
 
Dose 2 
D1 
D4[±1] 
D8[+2] 
Enrollment in 
AdvantageEDCSM 
and 
Randomization 
 
X† 
 
 
 
 
 
Pre-
Administration 
Reactogenicity 
Assessments 
 
X† 
 
 
X 
 
 
 Vaccination 
 
X 
 
 
X 
 
 
20-minute 
Evaluation After 
Study 
Vaccination 
 
X 
 
 
X 
 
 
Examine Study 
Vaccination Site 
 
X 
 
X 
X 
 
X 
Post-
Administration 
Reactogenicity 
Assessments 
 
X 
 
 
X 
 
 
Distribute 
Memory Aid and 
Study-Related 
Materials 
 
X 
 
 
X 
 
 
Review Memory 
Aid 
 
 
X 
X 
 
X 
X 
AE/SAE 
Assessment  
 
X& 
X& 
X& 
X& 
X& 
X& 
∞ Prior to study procedures. 
† Prior to study vaccination.  
1 Review results of clinical screening (ESR) or safety laboratory evaluations. 
¬ Review/confirm information or activity in subjects previously consented and screened. 
@ Complete medical history will be obtained by interview of subjects at screening (optional) or on Day 1 prior to the first study 
vaccination and interim medical history will be obtained by interview of subjects at follow-up visits after Dose 1 
ς  Receipt of non-study influenza vaccines will be solicited through approximately 180 days after the last study vaccination, and 
reported in the eCRF. 
* Not required if done at the optional screening visit. 
√ All current medications and medications taken within 60 days prior to signing the ICF. 
$ Vital signs assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
% Subjects must not eat or drink anything hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
2 Vital signs are not required for subjects who are discontinued from receipt of the third study vaccination and are being 
followed for safety. 
3 At the screening (or baseline if not done at screening) visit, a physical examination will be performed on all subjects to 
include the following organs and organ systems: skin, head and neck, lungs, heart, liver, spleen, extremities, lymph nodes, 
and nervous system. 
{} Targeted physical examination if indicated based on review of interim medical history. 
^ May be performed on all women of childbearing potential at screening (optional) and will be performed within 24 hours prior 
to each vaccination and results must be negative and known prior to each study vaccination. 

DMID Protocol 17-0077 
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146 
≠ To be performed locally by the site. The ESR value must be confirmed as <30 mm/hr prior to randomization and first study 
vaccination. 
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
Ψ  Subjects who do not receive the third study vaccination will continue with follow-up safety assessments (may be conducted by 
phone call) rather than in person continuing through approximately 12 months after their first study vaccination. These 
subjects will also be encouraged to provide a venous blood sample for immunogenicity assays at approximately 21 and 180 
days after their first study vaccination. 
4 For subjects who have consented to collected of serum for future research. 
& Inclusive of reactogenicity assessments performed on the day of each vaccination through 7 days after each study vaccination.  
 
Study Schedule, Group 1:  Follow-up Period  
Study Visit 
Number 
     
V07 
 
V08 
V09ψ 
V10 
V11 
Early 
Termination 
(if needed) 
Unscheduled 
(if needed) 
Study Day post 
Dose 1 
D43 
D64 
D181 
[±14] 
 D202 
 D387 
 
 
Study Day post 
Dose 2 
D22[+7] 
D43[+7] 
 
 D181[±14] 
     
D366[±14] 
 
 
Medical 
History@ 
X 
X 
X 
X 
 
X 
X (if indicated) 
Concomitant 
Medications 
Xς 
Xς 
Xς 
Xς 
 
X (if within 21 days 
after last study 
vaccination and 
receipt of any non-
study influenza 
vaccine will be 
recorded if within 
180 days after the 
2nd study 
vaccination) 
X (if within 21 
days after last 
study vaccination 
and receipt of any 
non-study 
influenza vaccine 
will be recorded 
if within 180 days 
after the 2nd 
study 
vaccination) 
Vital Signs$ 
(Oral 
Temperature%, 
Pulse, and BP) 
 
 
 
 
 
X (may be obtained 
if indicated) 
X (may be 
obtained if 
indicated) 
Physical 
Examination3 
{X} 
{X} 
{X} 
{X} 
 
{X} 
{X} 
Venous Blood 
Collection for 
Clinical Safety 
Laboratory 
Evaluations~ 
 
 
 
 
 
X (if within 7 days 
after the last study 
vaccination) 
X (if indicated) 
Venous Blood 
Collection for  
Immunogenicity  
Assays 
X 
 
X 
X 
 
X(if within 21 days 
after last study 
vaccination 
X(if within 21 
days after last 
study vaccination 
Serum Sample 
Collected for 
Future Research4 
X 
X 
X 
X 
 
X(if within 21 days 
after last  study 
vaccination 
X(if within 21 
days after last  
study vaccination   

DMID Protocol 17-0077 
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September 18, 2018 
 
147 
@ Complete medical history will be obtained by interview of subjects at screening (optional) or on Day 1 prior to the first study 
vaccination and interim medical history will be obtained by interview of subjects at follow-up visits after Dose 1 
ς  Receipt of non-study influenza vaccines will be solicited through approximately 180 days after the last study vaccination, and 
reported in the eCRF. 
$ Vital signs assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
% Subjects must not eat or drink anything hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
{} Targeted physical examination if indicated based on review of interim medical history 
.~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
Ψ  Subjects who do not receive the third study vaccination will continue with follow-up safety assessments (may be conducted by 
phone call) rather than in person continuing through approximately 12 months after their first study vaccination. These 
subjects will also be encouraged to provide a venous blood sample for immunogenicity assays at approximately 21 and 180 
days after their first study vaccination. 
4 For subjects who have consented to collected of serum for future use. 
 
Study Schedule, Group 2:  Vaccination Period 
Study Visit Number 
V00 
V01 
V02 
V03 
V04ψ 
V05 
V06 
V07ψ 
V08 
Study Day post Dose 1 
Screening 
(Optional) 
D -28 to -1 
Enrollment  
Dose 1 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25  
D29 
D43 
D46 
Study Day post Dose 2 
 
 
 
 
Dose 2 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25 
Study Day post Dose 3 
 
 
 
 
 
 
 
Dose 3 
D1 
D4[±1] 
Study Procedure/Evaluation 
 
Obtain Informed 
Consent∞ 
X 
X¬ 
 
 
 
 
 
 
 
Collect Demographic 
Information 
X 
X†* 
 
 
 
 
 
 
 
Review Eligibility 
Criteria 
X 
X†¬1 
 
 
X† 
 
 
X† 
 
Medical History@ 
X 
X†¬* 
 
X 
X 
 
X 
X 
 
Safety Follow-
up Phone Call 
 
 
 
 
 
X 
 
 
Examine Study 
Vaccination Site 
 
 
 
 
 
X (if within 7 days 
after last study 
vaccination) 
X (if within 7 
days after last 
study 
vaccination) 
Post-
Administration 
Reactogenicity 
Assessments 
 
 
 
 
 
X (if within 7 days 
after last study 
vaccination) 
X (if within 7 
days after last 
study 
vaccination) 
Review Memory 
Aid 
 
 
 
 
 
X (if within 7 days 
after last study 
vaccination) 
X (if within 7 
days after last 
study 
vaccination) 
AE/SAE 
Assessment 
X 
X 
X 
X 
X 
X& 
X& 

DMID Protocol 17-0077 
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Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
September 18, 2018 
 
148 
Study Visit Number 
V00 
V01 
V02 
V03 
V04ψ 
V05 
V06 
V07ψ 
V08 
Study Day post Dose 1 
Screening 
(Optional) 
D -28 to -1 
Enrollment  
Dose 1 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25  
D29 
D43 
D46 
Study Day post Dose 2 
 
 
 
 
Dose 2 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25 
Study Day post Dose 3 
 
 
 
 
 
 
 
Dose 3 
D1 
D4[±1] 
Study Procedure/Evaluation 
 
Concomitant Medications 
Xς 
X†¬ς 
Xς 
Xς 
Xς 
Xς 
Xς 
Xς 
Xς 
Vital Signs$ 
(Oral Temperature%, 
Pulse, and BP) 
X 
X† 
 
 
X†2 
 
 
X†2 
 
Height and Weight 
X 
X†* 
 
 
 
 
 
 
 
Physical Examination3 
X 
X†* 
 
{X} 
{X} 
 
{X} 
{X} 
 
Urine or Serum 
Pregnancy Test 
X^ 
X†^ 
 
 
X†^ 
 
 
X†^ 
 
Venous Blood Collection 
for ESR 
X 
X≠* 
 
 
 
 
 
 
 
Venous Blood Collection 
for Clinical Safety 
Laboratory Evaluations~ 
 
X† 
 
X 
X† 
 
X 
X† 
 
Venous Blood Collection 
for Immunogenicity 
Assays 
 
X† 
 
 
X† 
 
 
X† 
 
Serum Sample Collected 
for Future Research4 
 
X† 
 
X 
X† 
 
X 
X† 
 
Safety Follow-up Phone 
Call 
 
 
X 
 
 
X 
 
 
X 
Enrollment in 
AdvantageEDCSM and 
Randomization 
 
X† 
 
 
 
 
 
 
 
Pre-Administration 
Reactogenicity 
Assessments 
 
X† 
 
 
X 
 
 
X 
 
Vaccination 
 
X 
 
 
X 
 
 
X 
 
20-minute Evaluation 
After Vaccination 
 
X 
 
 
X 
 
 
X 
 
Examine Vaccination Site 
 
X 
 
X 
X 
 
X 
X 
 

DMID Protocol 17-0077 
Version 5.0 
Co-Administration of AS03-adjuvanted A/H7N9 with IIV4 
September 18, 2018 
 
149 
Study Visit Number 
V00 
V01 
V02 
V03 
V04ψ 
V05 
V06 
V07ψ 
V08 
Study Day post Dose 1 
Screening 
(Optional) 
D -28 to -1 
Enrollment  
Dose 1 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25  
D29 
D43 
D46 
Study Day post Dose 2 
 
 
 
 
Dose 2 
D1 
D4[±1] 
D8[+2] 
D22[+7] 
D25 
Study Day post Dose 3 
 
 
 
 
 
 
 
Dose 3 
D1 
D4[±1] 
Study Procedure/Evaluation 
 
Post-Administration 
Reactogenicity 
Assessments 
 
X 
 
 
X 
 
 
X 
 
Distribute Memory Aid 
and Study-Related 
Materials 
 
X 
 
 
X 
 
 
X 
 
Review Memory Aid 
 
 
X 
X 
 
X 
X 
 
X 
AE/SAE Assessment  
 
X& 
X& 
X& 
X& 
X& 
X& 
X& 
X& 
∞ Prior to study procedures. 
† Prior to study vaccination.  
1 Review results of clinical screening (ESR) or safety laboratory evaluations. 
¬ Review/confirm information or activity in subjects previously consented and screened. 
@ Complete medical history will be obtained by interview of subjects at screening (optional) or on Day 1 prior to the first study 
vaccination and interim medical history will be obtained by interview of subjects at follow-up visits after the first study 
vaccination. 
ς  Receipt of non-study influenza vaccines will be solicited through approximately 180 days after the last study vaccination, and 
reported in the eCRF. 
* Not required if done at the optional screening visit. 
√ All current medications and medications taken within 60 days prior to signing the ICF. 
$ Vital signs assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
% Subjects must not eat or drink anything hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
2 Vital signs are not required for subjects who are discontinued from receipt of the third study vaccination and are being 
followed for safety. 
3 At the screening (or baseline if not done at screening) visit, a physical examination will be performed on all subjects to 
include the following organs and organ systems: skin, head and neck, lungs, heart, liver, spleen, extremities, lymph nodes, 
and nervous system. 
{} Targeted physical examination if indicated based on review of interim medical history. 
^ May be performed on all women of childbearing potential at screening (optional) and will be performed within 24 hours prior 
to each vaccination and results must be negative and known prior to each study vaccination. 
≠ To be performed locally by the site. The ESR value must be confirmed as <30 mm/hr prior to randomization and first study 
vaccination. 
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
Ψ  Subjects who do not receive the third study vaccination will continue with follow-up safety assessments (may be conducted by 
phone call) rather than in person continuing through approximately 12 months after their first study vaccination. These 
subjects will also be encouraged to provide a venous blood sample for immunogenicity assays at approximately 21 and 180 
days after their first study vaccination. 
4 For subjects who have consented to collected of serum for future use. 
& Inclusive of reactogenicity assessments performed on the day of each vaccination through 7 days after each study vaccination.  
 
Study Schedule, Group 2:  Follow-up Period 

DMID Protocol 17-0077 
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September 18, 2018 
 
150 
@ Complete medical history will be obtained by interview of subjects at screening (optional) or on Day 1 prior to the first study 
vaccination and interim medical history will be obtained by interview of subjects at follow-up visits after the first study 
vaccination. 
ς  Receipt of non-study influenza vaccines will be solicited through approximately 180 days after the last study vaccination, and 
reported in the eCRF. 
$ Vital signs assessed on Day 1 prior to the first study vaccination will be considered as baseline. 
% Subjects must not eat or drink anything hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
{} Targeted physical examination if indicated based on review of interim medical history. 
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
Study Visit Number 
V09 
V10 
V11ψ 
V12 
V13 
Early 
Terminati
on (if 
needed) 
Unschedu
led (if 
needed) 
Study Day post Dose 
1 
D50 
D64 
D181 [±14] 
D223 
D408 
 
 
Study Day post Dose 
2 
D29 
D43 
 
D202 
D387 
 
 
Study Day post Dose 
3 
 D8[+2] 
 D22[+7] 
 
D181[±14] 
D366[±14] 
 
 
Medical History@ 
X 
X 
X 
X 
 
X 
X (if indicated) 
Concomitant 
Medications 
Xς 
Xς 
Xς 
Xς 
 
X (if within 21 days after last 
study vaccination and receipt 
of any non-study influenza 
vaccine will be recorded if 
within 180 days after the 2nd 
study vaccination) 
X (if within 21 days after last 
study vaccination and receipt 
of any non-study influenza 
vaccine will be recorded if 
within 180 days after the 2nd 
study vaccination) 
Vital Signs$ 
(Oral Temperature%, 
Pulse, and BP) 
 
 
 
 
 
X (may be obtained if 
indicated) 
X (may be obtained if 
indicated) 
Physical Examination3 
{X} 
{X} 
{X} 
{X} 
 
{X} 
{X} 
Venous Blood 
Collection for Clinical 
Safety Laboratory 
Evaluations~ 
X 
 
 
 
 
X (if within 7 days after the 
last study vaccination) 
X (if indicated) 
Venous Blood 
Collection for  
Immunogenicity  
Assays 
 
X 
X 
X 
 
X(if within 21 days after last 
study vaccination 
X(if within 21 days after last 
study vaccination 
Serum Sample 
Collected for Future 
Research4 
X 
X 
X 
X 
 
X(if within 21 days after last  
study vaccination 
X(if within 21 days after last  
study vaccination 
Safety Follow-up 
Phone Call 
 
 
 
 
X 
 
 
Examine Vaccination 
Site 
X 
 
 
 
 
X (if within 7 days after last 
study vaccination) 
X (if within 7 days after last 
study vaccination) 
Post-Administration 
Reactogenicity 
Assessments 
 
 
 
 
 
X (if within 7 days after last 
study vaccination) 
X (if within 7 days after last 
study vaccination) 
Review Memory Aid 
X 
 
 
 
 
X (if within 7 days after last 
study vaccination) 
X (if within 7 days after last 
study vaccination) 
AE/SAE Assessment 
X& 
X 
X 
X 
X 
X& 
X& 

DMID Protocol 17-0077 
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September 18, 2018 
 
151 
Ψ  Subjects who do not receive the second or third study vaccination will continue with follow-up safety assessments (may be 
conducted by phone call) rather than in person continuing through approximately 12 months after their first study vaccination. 
These subjects will also be encouraged to provide a venous blood sample for immunogenicity assays at approximately 21 and 
180 days after their first study vaccination. 
4 For subjects who have consented to collected of serum for future use 
& Inclusive of reactogenicity assessments performed on the day of each study vaccination through 7 days after each study 
vaccination.  
 
Study Schedule, Group 3:  Vaccination and Follow-up Periods 
Study Visit Number 
V00 
V01 
V02 
V03 
 
V04ψ 
 
V05 
 
V06 
 
V07ψ 
 
V08 
Study Day post  
 dose 
Screening 
(Optional) 
D -28 to -1 
Enrollment 
Dose 1 
D1 
D4[±1] 
D8[+2] 
 
D22[+7] 
 
D43[+7] 
 
D64[+7] 
 
D181[±14] 
 
D366[±14] 
Obtain Informed Consent 
X 
X¬ 
 
 
 
 
 
 
 
Collect Demographic 
Information 
X 
X†* 
 
 
 
 
 
 
 
Review Eligibility Criteria 
X 
X†¬1 
 
 
 
 
 
 
 
Medical History@ 
X 
X†¬* 
 
X 
X 
X 
X 
X 
 
Concomitant Medications 
Xς 
X†¬ς 
Xς 
Xς 
Xς 
 
Xς 
Xς 
 
Xς 
 
 
 
Vital Signs$ 
(Oral Temperature%, Pulse, 
and BP) 
X 
X† 
 
 
 
 
 
 
 
Height and Weight 
X 
X†* 
 
 
 
 
 
 
 
Physical Examination3 
X 
{X}†* 
 
{X} 
{X} 
{X} 
{X} 
{X} 
 
Urine or Serum Pregnancy 
Test 
X^ 
X†^ 
 
 
 
 
 
 
 
Venous Blood Collection for 
ESR 
X 
X≠* 
 
 
 
 
 
 
 
Venous Blood Collection for 
Clinical Safety Laboratory 
Evaluations~ 
 
X 
 
X 
 
 
 
 
 
 
 
Venous Blood Collection for 
Immunogenicity Assays 
 
X† 
 
 
 
X 
 
 
 
 
 
X 
 
Serum Sample Collected for 
Future Research4 
 
X† 
 
X 
X 
X 
X 
X 
 
Safety Follow-up Phone Call 
 
 
X 
 
 
 
 
 
X 
Enrollment in 
AdvantageEDCSM and 
Randomization 
 
X† 
 
 
 
 
 
 
 
Pre-Administration 
Reactogenicity Assessments 
 
X† 
 
 
 
 
 
 
 
 Vaccination 
 
X 
 
 
 
 
 
 
 

DMID Protocol 17-0077 
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September 18, 2018 
 
152 
Study Visit Number 
V00 
V01 
V02 
V03 
 
V04ψ 
 
V05 
 
V06 
 
V07ψ 
 
V08 
Study Day post  
 dose 
Screening 
(Optional) 
D -28 to -1 
Enrollment 
Dose 1 
D1 
D4[±1] 
D8[+2] 
 
D22[+7] 
 
D43[+7] 
 
D64[+7] 
 
D181[±14] 
 
D366[±14] 
20-minute Evaluation After 
Vaccination 
 
X 
 
 
 
 
 
 
 
Examine Vaccination Site 
 
X 
 
X 
 
 
 
 
 
Post-Administration 
Reactogenicity Assessments 
 
X 
 
 
 
 
 
 
 
Distribute Memory Aid and 
Study-Related Materials 
 
X 
 
 
 
 
 
 
 
Review Memory Aid 
 
 
X 
X 
 
 
 
 
 
AE/SAE Assessment  
 
X& 
X& 
X& 
X 
X 
X 
X 
X 
∞ Prior to study procedures. 
† Prior to study vaccination.  
1 Review results of clinical screening (ESR) or safety laboratory evaluations. 
¬ Review/confirm information or activity in subjects previously consented and screened 
@ Complete medical history will be obtained by interview of subjects at screening (optional) or on Day 1 prior to study 
vaccination and interim medical history will be obtained by interview of subjects at follow-up visits after the study 
vaccination. 
ς  Receipt of non-study influenza vaccines will be solicited through approximately 180 days after the study vaccination, and 
reported in the eCRF. 
* Not required if done at the optional screening visit. 
√ All current medications and medications taken within 60 days prior to signing the ICF. 
$ Vital signs assessed on Day 1 prior to the study vaccination will be considered as baseline. 
% Subjects must not eat or drink anything hot or cold, or smoke within 10 minutes prior to taking oral temperature. 
3 At the screening (or baseline if not done at screening) visit, a physical examination will be performed on all subjects to 
include the following organs and organ systems: skin, head and neck, lungs, heart, liver, spleen, extremities, lymph nodes, 
and nervous system. 
{} Targeted physical examination if indicated based on review of interim medical history. 
^ May be performed on all women of childbearing potential at screening (optional) and will be performed within 24 hours prior 
to study vaccination and results must be negative. 
≠ To be performed locally by the site. The ESR value must be confirmed as <30 mm/hr prior to randomization and study 
vaccination. 
~ Includes WBC, Hgb, PLT, ALT, T. Bili, Cr. 
4 For subjects who have consented to collected of serum for future use. 
& Inclusive of reactogenicity assessments performed on the day of vaccination through 7 days after study vaccination.  
 
Early Termination and Unscheduled Visits, Group 3 
Study Visit Number 
 
Early Termination (if 
needed) 
Unscheduled (if 
needed) 
Study Day post dose 
Medical History@ 
X 
X (if indicated) 

DMID Protocol 17-0077 
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September 18, 2018 
 
153 
 
 
 
 
 
 
 
 
@ Complete medical history 
will be obtained by interview 
of subjects at screening 
(optional) or on Day 1 prior to 
study vaccination and interim 
medical history will be 
obtained by interview of 
subjects at follow-up visits 
after the study vaccination. 
$ 
Vital signs assessed on Day 
1 prior to the study vaccination 
will be considered as baseline. 
% Subjects must not eat or 
drink anything hot or cold, or 
smoke within 10 minutes prior 
to taking oral temperature. 
{} Targeted physical 
examination if indicated based 
on review of interim medical 
history. 
~ Includes WBC, Hgb, PLT, 
ALT, T. Bili, Cr. 
4 
For subjects who have 
consented to collected of serum 
for future use. 
& Inclusive of reactogenicity 
assessments performed on the 
day of vaccination through 7 
days after study vaccination.  
 
 
 
 
Concomitant 
Medications 
X (if within 21 days 
after last study 
vaccination and receipt 
of any non-study 
influenza vaccine will 
be recorded if within 
180 days after the 2nd 
study vaccination) 
X (if within 21 days after 
last study vaccination and 
receipt of any non-study 
influenza vaccine will be 
recorded if within 180 days 
after the 2nd study) 
Vital Signs 
(Oral Temperature%, 
Pulse, and BP) 
X (may be obtained if 
indicated) 
X (may be obtained if 
indicated) 
Physical 
Examination3 
{X} 
{X} 
Venous Blood 
Collection for 
Clinical Safety 
Laboratory 
Evaluations~ 
X (if within 7 days after 
the last study 
vaccination) 
X (if indicated) 
Venous Blood 
Collection for  
Immunogenicity  
Assays 
X (if within 21 days 
after last study 
vaccination) 
X (if within 21 days after 
last study vaccination) 
Serum Sample 
Collected for Future 
Research4 
X(if within 21 days 
after last study 
vaccination 
X(if within 21 days after 
last study vaccination 
Examine Vaccination 
Site 
X (if within 7 days after 
last study vaccination) 
X (if within 7 days after last 
study vaccination) 
Post-Administration 
Reactogenicity 
Assessments 
X (if within 7 days after 
last study vaccination) 
X (if within 7 days after last 
study vaccination) 
Review Memory Aid 
X (if within 7 days after 
last study vaccination) 
X (if within 7 days after last 
study vaccination) 
AE/SAE Assessment  
X& 
X& 

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APPENDIX B: LIST OF POTENTIALLY IMMUNE-MEDIATED 
MEDICAL CONDITIONS 
(also known as Adverse Events of Special Interest (AESIs)) 
 
Gastrointestinal disorders 
• 
Celiac disease 
• 
Crohn’s disease 
• 
Ulcerative colitis 
• 
Ulcerative proctitis 
Liver disorders 
• 
Autoimmune cholangitis 
• 
Autoimmune hepatitis 
• 
Primary biliary cirrhosis 
• 
Primary sclerosing cholangitis 
Metabolic diseases 
• 
Addison’s disease 
• 
Autoimmune thyroiditis (including Hashimoto thyroiditis) 
• 
Diabetes mellitus type I 
• 
Grave's or Basedow’s disease 
Musculoskeletal disorders 
• 
Antisynthetase syndrome 
• 
Dermatomyositis 
• 
Juvenile chronic arthritis (including Still’s disease) 
• 
Mixed connective tissue disorder 
• 
Polymyalgia rheumatic 
• 
Polymyositis 
• 
Psoriatic arthropathy 
• 
Relapsing polychondritis 
• 
Rheumatoid arthritis 
• 
Scleroderma, including diffuse systemic form and CREST syndrome 
• 
Spondyloarthritis, including ankylosing spondylitis, reactive arthritis (Reiter's Syndrome) 
and undifferentiated spondyloarthritis 
• 
Systemic lupus erythematosus 

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• 
Systemic sclerosis 
Neuroinflammatory disorders 
• 
Acute disseminated encephalomyelitis, including site specific variants (e.g., non-
infectious encephalitis, encephalomyelitis, myelitis, myeloradiculomyelitis) 
• 
Cranial nerve disorders, including paralyses/paresis (e.g., Bell’s palsy) 
• 
Guillain-Barré syndrome, including Miller Fisher syndrome and other variants 
• 
Immune-mediated peripheral neuropathies and plexopathies, including chronic 
inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and 
polyneuropathies associated with monoclonal gammopathy 
• 
Multiple sclerosis 
• 
Narcolepsy 
• 
Optic neuritis 
• 
Transverse myelitis 
• 
Myasthenia gravis, including Eaton-Lambert syndrome 
Skin disorders 
• 
Alopecia areata 
• 
Autoimmune bullous skin diseases, including pemphigus, pemphigoid and dermatitis 
herpetiformis 
• 
Cutaneous lupus erythematosus 
• 
Erythema nodosum 
• 
Morphoea 
• 
Lichen planus 
• 
Psoriasis 
• 
Sweet’s syndrome 
• 
Vitiligo 
Vasculitides 
• 
Large vessels vasculitis including: giant cell arteritis such as Takayasu's arteritis and 
temporal arteritis 
• 
Medium sized and/or small vessels vasculitis including: polyarteritis nodosa, Kawasaki's 
disease, microscopic polyangiitis, Wegener's granulomatosis, Churg-Strauss syndrome 
(allergic granulomatous angiitis), Buerger’s disease thromboangiitis obliterans, 
necrotizing vasculitis and anti-neutrophil cytoplasmic antibody (ANCA) positive 
vasculitis (type unspecified), Henoch- Schonlein purpura, Behcet's syndrome, 
leukocytoclastic vasculitis 
 

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Others 
• 
Antiphospholipid syndrome 
• 
Autoimmune hemolytic anemia 
• 
Autoimmune glomerulonephritis (including IgA nephropathy, glomerulonephritis rapidly 
progressive, membranous glomerulonephritis, membranoproliferative glomerulonephritis, 
and mesangioproliferative glomerulonephritis) 
• 
Autoimmune myocarditis/cardiomyopathy 
• 
Autoimmune thrombocytopenia 
• 
Good pasture syndrome 
• 
Idiopathic pulmonary fibrosis 
• 
Pernicious anemia 
• 
Raynaud’s phenomenon 
• 
Sarcoidosis 
• 
Sjögren’s syndrome 
• 
Stevens-Johnson syndrome 
• 
Uveitis