A Phase 3, Randomized, Double-blind, Active Comparator-controlled, Multicenter Clinical Study to Evaluate the Safety, Tolerability, and Immunogenicity of V114 in Recipients of Allogeneic Hematopoietic Stem Cell Transplant (PNEU-STEM)
Phase: PHASE3
Conditions: Pneumococcal Infections
Sponsor: Merck Sharp & Dohme LLC

Official Protocol Title: 
NCT number: 
NCT03565900 
Document Date: 
02-Apr-2019
A Phase 3, Randomized, Double-blind, Active Comparator-
controlled, Multicenter Clinical Study to Evaluate the Safety, 
Tolerability, and Immunogenicity of V114 in Recipients of 
Allogeneic Hematopoietic Stem Cell Transplant (PNEU-STEM)

PRODUCT: V114 
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Title Page
THIS PROTOCOL AMENDMENT AND ALL OF THE INFORMATION RELATING 
TO IT ARE CONFIDENTIAL AND PROPRIETARY PROPERTY OF MERCK 
SHARP & DOHME CORP., A SUBSIDIARY OF MERCK & CO., INC., NJ, U.S.A. 
(MSD).
Protocol Title: A Phase 3, Randomized, Double-blind, Active Comparator-controlled, 
Multicenter Clinical Study to Evaluate the Safety, Tolerability, and Immunogenicity of V114 
in Recipients of Allogeneic Hematopoietic Stem Cell Transplant (PNEU-STEM)
Protocol Number: 022-04
Compound Number: V114
Sponsor Name:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
(hereafter referred to as the Sponsor or MSD)
Legal Registered Address:
One Merck Drive
P.O. Box 100
Whitehouse Station, New Jersey, 08889-0100, U.S.A.
Regulatory Agency Identifying Number(s):
IND
14977
EudraCT
2018-000066-11
Approval Date: 02-April-2019
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Sponsor Signatory
Typed Name:
Title:
Date
Protocol-specific Sponsor contact information can be found in the Investigator Study
File Binder (or equivalent).
Investigator Signatory
I agree to conduct this clinical study in accordance with the design outlined in this protocol 
and to abide by all provisions of this protocol.
Typed Name:
Title:
Date
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DOCUMENT HISTORY
Document
Date of Issue
Overall Rationale
Amendment 4
02-APR-2019
The primary purpose of this amendment is 
to adjust the stratification factor for steroid
use and clarify the definition and reporting 
time frame for specific events of interest.
Amendment 3
14-NOV-2018
The primary purpose of this amendment is 
to add a pediatric cohort (≥3 years of age) 
to the existing study.
Amendment 2
28-AUG-2018
The primary purpose of this amendment is 
to include country-specific requirements 
for the Swedish Health Authority.
Amendment 1
04-JUN-2018
The primary purpose of this amendment is 
to remove the collection of medical device 
incidents from the protocol. The 
implementation of the FDA guidance for 
reporting events related to combination 
products was delayed until January 2020. 
Therefore, the current protocol is not within 
the scope of medical device reporting 
requirements.
Original Protocol
15-MAY-2018
Not applicable.
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PROTOCOL AMENDMENT SUMMARY OF CHANGES
Amendment: 04
Overall Rationale for the Amendments:
The primary purpose of this amendment is to adjust the stratification factor for steroid use and clarify the definition and reporting time
frame for specific events of interest. Other clarifications and editorial revisions were also made as shown in the Summary of Changes 
Table below.
Summary of Changes Table:
Section # and Name
Description of Change 
Brief Rationale 
1.3 Schedule of Activities (AE 
monitoring)
8.4.1 Time Period and Frequency for 
Collecting AE, SAE, and Other 
Reportable Safety Information
Updated to specify that specific events of 
interest must be reported throughout the 
duration of the individual’s participation in 
the study.
Revisions made for clarity.
4.1 Overall Design
6.3.2 Stratification
9.1 Statistical Analysis Plan Summary
9.10 Subgroup analysis
Updated stratification factor for 
corticosteroid use as follows:
Original: Use of systemic steroids below a 
prednisone equivalent dosage of 
≤0.5 mg/kg/day (including no steroid use) 
within 14 days before Day 1.
Revised: Use of systemic steroids within 
14 days before randomization (Day 1).
The steroid stratification factor was 
adjusted to align with the clinical use of 
steroid medication and steroid tapers in 
hematopoietic stem cell transplant (HSCT) 
recipients who have, or who are at high 
risk for, graft-versus-host disease (GVHD).
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Section # and Name
Description of Change 
Brief Rationale 
5.2 Exclusion Criteria
Updated exclusion criterion 21 as follows 
(new text in bold, deleted text in 
strikethough):
Prior or scheduled to receive receipt of
immunoglobulins or plasma products within 
30 days of administration of study vaccine.
Revision made for clarity.
6.1 Study Intervention(s) Administered
Updated the sourcing for Prevnar 13™ from 
“Central” to “Central or local.”
Revision made to accommodate country 
requirements.
8.1.10 Telephone Contact Questionnaire
Added specific events of interest to the list 
of data to be reported from the telephone 
contact.
Revision made for clarity.
8.4.8 Specific Events of Interest
Updated text as follows:
•
Throughout a participant’s participation 
in the study, new onset and/or change
worsening of GVHD status since Day 1 
as well as relapse and progression of 
underlying disease (ie, the disease for 
which allo-HSCT was performed [see 
inclusion criterion 2 in Section 5.1]) will 
be recorded as specific events of interest. 
Specific events of interest are to be 
reported as non-serious or serious 
AEs as defined in Appendix 3.
Standard reporting time frames for non-
serious and serious AEs (serious and 
Revision made for clarity and accuracy.
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Section # and Name
Description of Change 
Brief Rationale 
non-serious) will apply (see Table 4 in 
Section 8.4.1).
9.6.2 Statistical Methods for Safety 
Analyses
•
Updated to include the evaluation of 
specific events of interest at each 
analysis timepoint.
•
Revised the description of the special 
events of interest analysis as follows:
In addition, the proportion of 
participants who develop have new 
onset and/or worsening of GVHD 
during study participation as well as 
relapse and progression of underlying 
disease (ie, the disease for which the 
allo-HSCT was performed [see inclusion 
criterion 2 in Section 5.1]) during study 
participation will be summarized 
descriptively.
Revision made for clarity
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Section # and Name
Description of Change 
Brief Rationale 
10.3.4 Recording AE and SAE
Updated the time period during which 
injection-site redness/erythema or swelling 
will be evaluated as follows:
Original: Injection-site redness/erythema 
from the day of vaccination through Day 5 
postvaccination will be evaluated by 
maximum size.
Revised: Injection-site redness/erythema 
from the day of vaccination through Day 5 
(for adult participants) or Day 14 (for 
pediatric participants) postvaccination will 
be evaluated by maximum size.
Revision made for accuracy.
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Table of Contents
DOCUMENT HISTORY ........................................................................................................3
PROTOCOL AMENDMENT SUMMARY OF CHANGES...............................................4
1
PROTOCOL SUMMARY ............................................................................................15
1.1
Synopsis.................................................................................................................15
1.2
Schema ..................................................................................................................22
1.3
Schedule of Activities (SoA)................................................................................23
2
INTRODUCTION..........................................................................................................34
2.1
Study Rationale....................................................................................................34
2.2
Background ..........................................................................................................35
2.2.1
V114 and Pneumococcal Disease................................................................35
2.2.2
Preclinical and Clinical Studies ...................................................................36
2.2.3
Information on Other Study-related Therapy ..............................................36
2.2.3.1
Prevnar 13™......................................................................................36
2.2.3.2
PNEUMOVAX™23..........................................................................37
2.3
Benefit/Risk Assessment......................................................................................37
3
HYPOTHESIS, OBJECTIVES, AND ENDPOINTS .................................................38
4
STUDY DESIGN............................................................................................................41
4.1
Overall Design......................................................................................................41
4.2
Scientific Rationale for Study Design.................................................................43
4.2.1
Rationale for Endpoints ...............................................................................43
4.2.1.1
Immunogenicity Endpoints................................................................43
4.2.1.2
Safety Endpoints................................................................................44
4.2.1.3
Future Biomedical Research..............................................................44
4.2.2
Rationale for the Use of Comparator/Placebo .............................................44
4.3
Justification for Dose...........................................................................................45
4.4
Beginning and End of Study Definition .............................................................45
4.4.1
Clinical Criteria for Early Study Termination .............................................45
5
STUDY POPULATION ................................................................................................45
5.1
Inclusion Criteria.................................................................................................45
5.2
Exclusion Criteria................................................................................................46
5.3
Lifestyle Considerations......................................................................................49
5.4
Screen Failures.....................................................................................................49
5.5
Participant Replacement Strategy......................................................................49
6
STUDY INTERVENTION............................................................................................49
6.1
Study Intervention(s) Administered...................................................................49
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6.2
Preparation/Handling/Storage/Accountability .................................................51
6.2.1
Dose Preparation..........................................................................................51
6.2.2
Handling, Storage, and Accountability........................................................51
6.3
Measures to Minimize Bias: Randomization and Blinding..............................51
6.3.1
Intervention Assignment..............................................................................51
6.3.2
Stratification.................................................................................................52
6.3.3
Blinding........................................................................................................52
6.4
Study Intervention Compliance..........................................................................52
6.5
Concomitant Therapy..........................................................................................53
6.5.1
Rescue Medications and Supportive Care ...................................................53
6.6
Dose Modification (Escalation/Titration/Other)...............................................53
6.7
Intervention After the End of the Study............................................................53
6.8
Clinical Supplies Disclosure................................................................................53
7
DISCONTINUATION OF STUDY INTERVENTION AND PARTICIPANT 
WITHDRAWAL............................................................................................................54
7.1
Discontinuation of Study Intervention...............................................................54
7.2
Participant Withdrawal From the Study...........................................................55
7.3
Lost to Follow-up .................................................................................................55
8
STUDY ASSESSMENTS AND PROCEDURES........................................................55
8.1
Administrative and General Procedures ...........................................................57
8.1.1
Informed Consent/Assent.............................................................................57
8.1.1.1
General Informed Consent/Assent.....................................................58
8.1.1.2
Consent/Assent and Collection of Specimens for Future
Biomedical Research .........................................................................58
8.1.2
Inclusion/Exclusion Criteria ........................................................................58
8.1.3
Participant Identification Card.....................................................................59
8.1.4
Medical History ...........................................................................................59
8.1.5
Prior and Concomitant Medications Review...............................................59
8.1.5.1
Prior Medications...............................................................................59
8.1.5.2
Concomitant Medications..................................................................59
8.1.6
Assignment of Screening Number...............................................................59
8.1.7
Assignment of Treatment/Randomization Number.....................................60
8.1.8
Study Intervention Administration ..............................................................60
8.1.8.1
Timing of Dose Administration.........................................................61
8.1.9
Electronic Vaccination Report Card ............................................................61
8.1.10
Telephone Contact Questionnaire................................................................62
8.1.11
Discontinuation and Withdrawal .................................................................62
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8.1.11.1
Withdrawal From Future Biomedical Research ................................62
8.1.12
Participant Blinding/Unblinding..................................................................63
8.1.13
Calibration of Equipment.............................................................................64
8.2
Immunogenicity Assessments .............................................................................64
8.2.1
Electrochemiluminescence (ECL) ...............................................................64
8.2.2
Multiplex Opsonophagocytic Assay (MOPA).............................................64
8.3
Safety Assessments...............................................................................................65
8.3.1
Physical Examinations.................................................................................65
8.3.2
Pregnancy Test.............................................................................................65
8.3.3
Body Temperature Measurement.................................................................66
8.3.4
Safety Assessments and Use of the eVRC...................................................66
8.3.5
Clinical Laboratory Assessments.................................................................67
8.4
Adverse Events (AEs), Serious Adverse Events (SAEs), and Other 
Reportable Safety Events ....................................................................................68
8.4.1
Time Period and Frequency for Collecting AE, SAE, and Other 
Reportable Safety Event Information ..........................................................68
8.4.2
Method of Detecting AEs, SAEs, and Other Reportable Safety Events......70
8.4.3
Follow-up of AE, SAE, and Other Reportable Safety Event Information...70
8.4.4
Regulatory Reporting Requirements for SAE .............................................70
8.4.5
Pregnancy and Exposure During Breastfeeding ..........................................70
8.4.6
Disease-related Events and/or Disease-related Outcomes Not Qualifying 
as AEs or SAEs............................................................................................71
8.4.7
Events of Clinical Interest (ECIs) ................................................................71
8.4.8
Specific Events of Interest ...........................................................................71
8.5
Treatment of Overdose........................................................................................71
8.6
Pharmacokinetics.................................................................................................71
8.7
Pharmacodynamics..............................................................................................71
8.8
Future Biomedical Research Sample Collection...............................................71
8.9
Planned Genetic Analysis Sample Collection....................................................72
8.10
Biomarkers ...........................................................................................................72
8.11
Medical Resource Utilization and Health Economics.......................................72
8.12
Visit Requirements...............................................................................................72
8.12.1
Screening......................................................................................................72
8.12.2
Treatment Period/Vaccination Visit ............................................................72
8.12.3
Discontinued Participants Continuing to be Monitored in the Study ..........72
9
STATISTICAL ANALYSIS PLAN .............................................................................73
9.1
Statistical Analysis Plan Summary.....................................................................73
9.2
Responsibility for Analyses/In-house Blinding .................................................75
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9.3
Hypotheses/Estimation ........................................................................................75
9.4
Analysis Endpoints...............................................................................................76
9.4.1
Immunogenicity Endpoints..........................................................................76
9.4.2
Safety Endpoints..........................................................................................76
9.5
Analysis Populations............................................................................................77
9.5.1
Immunogenicity Analysis Populations ........................................................77
9.5.2
Safety Analysis Populations ........................................................................78
9.6
Statistical Methods...............................................................................................79
9.6.1
Statistical Methods for Immunogenicity Analyses ......................................79
9.6.2
Statistical Methods for Safety Analyses ......................................................80
9.6.3
Demographic and Baseline Characteristics .................................................82
9.7
Interim Analyses ..................................................................................................83
9.8
Multiplicity ...........................................................................................................83
9.9
Sample Size and Power Calculations .................................................................83
9.9.1
Sample Size and Power for Immunogenicity Analyses...............................83
9.9.2
Sample Size and Power for Safety Analyses ...............................................84
9.10
Subgroup Analyses...............................................................................................85
9.11
Compliance (Medication Adherence).................................................................85
9.12
Extent of Exposure...............................................................................................85
10
SUPPORTING DOCUMENTATION AND OPERATIONAL
CONSIDERATIONS.....................................................................................................86
10.1
Appendix 1: Regulatory, Ethical, and Study Oversight Considerations........86
10.1.1
Code of Conduct for Clinical Trials.............................................................86
10.1.2
Financial Disclosure.....................................................................................88
10.1.3
Data Protection.............................................................................................88
10.1.3.1
Confidentiality of Data ......................................................................89
10.1.3.2
Confidentiality of Participant Records...............................................89
10.1.3.3
Confidentiality of IRB/IEC Information............................................89
10.1.4
Committees Structure...................................................................................89
10.1.4.1
Scientific Advisory Committee..........................................................89
10.1.4.2
Executive Oversight Committee........................................................89
10.1.4.3
External Data Monitoring Committee ...............................................90
10.1.5
Publication Policy........................................................................................90
10.1.6
Compliance with Study Registration and Results Posting Requirements ...90
10.1.7
Compliance with Law, Audit, and Debarment ............................................91
10.1.8
Data Quality Assurance ...............................................................................91
10.1.9
Source Documents .......................................................................................92
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10.1.10
Study and Site Closure.................................................................................92
10.2
Appendix 2: Clinical Laboratory Tests..............................................................93
10.3
Appendix 3: Adverse Events: Definitions and Procedures for Recording, 
Evaluating, Follow-up, and Reporting...............................................................94
10.3.1
Definition of AE ..........................................................................................94
10.3.2
Definition of SAE ........................................................................................95
10.3.3
Additional Events Reported.........................................................................96
10.3.4
Recording AE and SAE ...............................................................................96
10.3.5
Reporting of AE, SAE, and Other Reportable Safety Events to the 
Sponsor ......................................................................................................101
10.4
Appendix 4: Medical Device Incidents: Definition and Procedures for 
Recording, Evaluating, Follow-up, and Reporting.........................................103
10.5
Appendix 5: Contraceptive Guidance and Pregnancy Testing......................104
10.5.1
Definitions..................................................................................................104
10.5.2
Contraception Requirements......................................................................104
10.5.3
Pregnancy Testing......................................................................................105
10.6
Appendix 6: Collection and Management of Specimens for Future 
Biomedical Research..........................................................................................106
10.7
Appendix 7: Country-specific Requirements..................................................111
10.7.1
Country-Specific Request from Swedish Health Authority.......................111
10.7.1.1
Benefit/Risk Assessment .................................................................111
10.7.1.2
Ethics Committee Review [Institutional Review Board 
(IRB)/Independent Ethics Committee (IEC)] ..................................113
10.8
Appendix 8: Abbreviations ...............................................................................114
11
REFERENCES.............................................................................................................115
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LIST OF TABLES
Table 1
Study Interventions..........................................................................................50
Table 2
Approximate Blood Volumes Drawn by Study Visit and by 
Sample Type (Adult Cohort) ...........................................................................57
Table 3
Approximate Blood Volumes Drawn by Study Visit and by 
Sample Type (Pediatric Cohort) ......................................................................57
Table 4
Reporting Time Periods and Time Frames for Adverse Events and 
Other Reportable Safety Events.......................................................................69
Table 5
Analysis Strategy for Immunogenicity Variables............................................80
Table 6
Analysis Strategy for Safety Parameters..........................................................82
Table 7
Within-Group 95% CIs for Varying Hypothetical IgG GMCs and 
Varying Standard Deviations with 105 Evaluable Participants in 
Each Vaccination Group..................................................................................84
Table 8
Protocol-Required Safety Laboratory Assessments.........................................93
Table 9
Contraceptive Methods ..................................................................................105
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LIST OF FIGURES
Figure 1
V114-022 Study Design...................................................................................22
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1
PROTOCOL SUMMARY
1.1
Synopsis
Protocol Title: A Phase 3, Randomized, Double-blind, Active Comparator-controlled, 
Multicenter Clinical Study to Evaluate the Safety, Tolerability, and Immunogenicity of V114 
in Recipients of Allogeneic Hematopoietic Stem Cell Transplant (PNEU-STEM)
Short Title: Safety and Immunogenicity of V114 in Recipients of Allo-HSCT
Acronym: PNEUmococcal Conjugate Vaccine Trials: V114-022 (PNEU-STEM)
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Hypotheses, Objectives, and Endpoints:     
The following objectives and endpoints will be evaluated in adult and pediatric recipients of 
allogeneic hematopoietic stem cell transplant (allo-HSCT).
Primary Objectives
Primary Endpoints
- Objective: To evaluate the safety and 
tolerability of 3 doses of V114 and 3 doses of 
Prevnar 13™ with respect to the proportion 
of participants with adverse events (AEs) 
within each vaccination group.
Following any of the 3 doses of V114 or 
Prevnar 13™ for adults ≥18 years of age:
- Solicited injection-site AEs from Day 1 
through Day 5 postvaccination 
- Solicited systemic AEs from Day 1 through 
Day 14 postvaccination 
- Vaccine-related serious adverse events 
(SAEs) from Day 1 postvaccination to Month 
12 after allo-HSCT
Following any of the 3 doses of V114 or 
Prevnar 13™ for pediatrics (3 to <18 years of 
age):
- Solicited injection-site AEs from Day 1 
through Day 14 postvaccination
- Solicited systemic AEs from Day 1 through 
Day 14 postvaccination
- Vaccine-related serious adverse events 
(SAEs) from Day 1 postvaccination to Month 
12 after allo-HSCT
- Objective: To evaluate the serotype-specific 
immunoglobulin G (IgG) Geometric Mean 
Concentrations (GMCs) at 30 days following 
the 3rd dose of V114 and following the 3rd 
dose of Prevnar 13™ within each vaccination 
group.
- Serotype-specific IgG responses for the 15 
serotypes in V114 at Day 90
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Secondary Objectives
Secondary Endpoints
- Objective: To evaluate the safety and 
tolerability of PNEUMOVAX™23 
(administered 12 months after allo-HSCT in 
participants who do not develop GVHD) 
with respect to the proportion of participants 
with AEs within each vaccination group.
Following vaccination with 
PNEUMOVAX™23 for adults ≥18 years of 
age:
- Solicited injection-site AEs from Day 1 
through Day 5 postvaccination 
- Solicited systemic AEs from Day 1 through 
Day 14 postvaccination 
- Vaccine-related SAEs from Month 12 after 
allo- HSCTto 1 month after vaccination or 
the completion of the study.
Following vaccination with 
PNEUMOVAX™23 for pediatrics (3 to <18 
years of age):
- Solicited injection-site AEs from Day 1 
through Day 14 postvaccination
- Solicited systemic AEs from Day 1 through 
Day 14 postvaccination
- Vaccine-related SAEs from Month 12 to  
after allo-HSCT to 1 month after vaccination 
or the completion of the study.
- Objective: To evaluate the safety and 
tolerability of a 4th dose of V114 and a 4th 
dose of Prevnar 13™ (both administered 12 
months after allo-HSCT in participants who 
develop GVHD) with respect to the 
proportion of participants with AEs within 
each vaccination group.
Following vaccination with a 4th dose of 
V114 or Prevnar 13™ for adults ≥18 years of 
age:
- Solicited injection-site AEs from Day 1 
through Day 5 postvaccination 
- Solicited systemic AEs from Day 1 through 
Day 14 postvaccination 
- Vaccine-related SAEs Day 1 through 6 
months after 4th vaccination of V114 and 
Prevnar 13™ or completion of the study.
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Following vaccination with a 4th dose of 
V114 or Prevnar 13™ for pediatrics (3 to 
<18 years of age):
- Solicited injection-site AEs from Day 1 
through Day 14 postvaccination
- Solicited systemic AEs from Day 1 through 
Day 14 postvaccination
- Vaccine-related SAEs from  Day 1 through 
6 months after 4th vaccination of V114 and 
Prevnar 13™ or completion of the study.
- Objective: To evaluate the serotype-specific 
opsonophagocytic activity (OPA) Geometric 
Mean Titers (GMTs) at 30 days following 
the 3rd dose of V114 and following the 3rd 
dose of Prevnar 13™ within each vaccination 
group.
- Serotype-specific OPA responses for the 15 
serotypes in V114 at Day 90
- Objective: To evaluate the serotype-specific 
(1) OPA GMTs and IgG GMCs at baseline 
(prevaccination with V114 or Prevnar 13™) 
and (2) Geometric Mean Fold Rises 
(GMFRs) and proportions of participants 
with a ≥4-fold rise from baseline to 30 days 
following the 3rd dose of V114 and 3rd dose 
of Prevnar 13™ separately for both IgG and 
OPA responses within each vaccination 
group. 
- Serotype-specific OPA and IgG responses 
for the 15 serotypes in V114 at Day 1 and 
Day 90
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Overall Design:
Study Phase
Phase 3
Primary Purpose
Prevention
Indication
Pneumococcal disease
Population
Recipients of allo-HSCT
Study Type
Interventional
Intervention Model
Parallel
This is a multi-site study.
Type of Control
Active control without placebo
Study Blinding
Double-blind
Masking
Participant
Investigator
Estimated Duration of Study
The Sponsor estimates that the study will require 
approximately 35 months from the time the first participant 
signs the informed consent until the last participant’s last 
study-related telephone call or visit.
For purposes of analysis and reporting, the overall study 
ends when the Sponsor receives the last serology assay 
result.
Number of Participants:
Approximately 250 adult participants and approximately 50 pediatric participants (≥3 years 
of age) will be randomized, with approximately 150 participants in each intervention group.
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Intervention Groups and Duration:
Intervention 
Groups
Intervention 
Group Name
Vaccine
Dose 
Strength
Dose 
Frequency
Route 
of 
Admin. Vaccination Regimen
Use
V114
V114
Refer to 
IB
Once per 
Month for 3 
Doses Total
IM
3 Doses: Visit
2 (Day 1), 
Visit 3 (Day 30), and 
Visit 4 (Day 60)
Experimental
PNEUMOVAX™23a
OR
Refer to 
product 
labeling
Single 
Dose
IM
Single Dose at 
Visit 6 (12 Months 
after allo-HSCT)
Experimental
V114 
(4th Dose)b
Refer to 
IB
4th Dose
IM
Single Dose at 
Visit 6 (12 Months 
after allo-HSCT)
Experimental
Prevnar 13™
Prevnar 13™
Refer to 
product 
labeling
Once per 
Month for 3 
Doses Total
IM
3 Doses: Visit
2 (Day 1), 
Visit 3 (Day 30), and 
Visit 4 (Day 60)
Experimental
PNEUMOVAX™23a
OR
Refer to 
product 
labeling
Single 
Dose
IM
Single Dose at 
Visit 6 (12 Months 
after allo-HSCT)
Experimental
Prevnar 13™ (4th Dose)b
Refer to 
product 
labeling
4th Dose
IM
Single Dose at 
Visit 6 (12 Months 
after allo-HSCT)
Experimental
a PNEUMOVAX™23 is administered to participants who do not have chronic graft-versus-host disease.
b For participants who have chronic graft-versus-host disease, a 4th dose of V114 or Prevnar 13™ (double-
blind; same as was administered for the first 3 doses) administered at Visit 6 (12 months after allo-HSCT) 
instead of PNEUMOVAX™23. 
allo-HSCT = allogeneic hematopoietic stem cell transplant; IB = Investigator’s Brochure; 
IM = intramuscular
Total 
Number
2 intervention groups
Duration of 
Participation
Each participant will participate in the study for approximately 11 months from 
the time the participant or the participant’s legally acceptable representative signs 
the Informed Consent Form (ICF) through the final contact.
07X67T

PRODUCT: V114 
21
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Governance Committees:
Steering Committee
No
Executive Oversight Committee
Yes
Data Monitoring Committee
Yes
Clinical Adjudication Committee
No
Study governance considerations are outlined in Appendix 1.
Study Accepts Healthy Volunteers: No
A list of abbreviations used in this document can be found in Appendix 8.
07X67T

PRODUCT: V114 
22
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
1.2
Schema
The study design is depicted in Figure 1. 
Figure 1
V114-022 Study Design
07X67T

PRODUCT: V114
23
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
1.3
Schedule of Activities (SoA)
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Administrative and General Procedures 
Informed Consent
X
Consent must be 
obtained before any 
study procedures.
Informed Consent 
for 
Future Biomedical 
Research (Optional) 
X
Consent for future 
biomedical research 
samples must be 
obtained before the 
blood sample for ≥18 
years of age and saliva 
for <18 years of age 
(DNA sample) is 
collected.
Assignment of 
Screening Number 
X
Inclusion/Exclusion 
Criteria
X
X
Medical History
X
X
The participant’s 
medical history for the 
5 years prior to these 
visits will be reviewed.
History of tobacco use 
will also be collected 
for all participants.
07X67T

PRODUCT: V114
24
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Screening 
Laboratory Tests
X
Complete blood count 
with differential, blood 
chemistry (including 
renal function).
Assignment of
Randomization 
Number 
X
Participant 
Identification Card
X
Prior/Concomitant 
Medication and 
Non-Study 
Vaccination Review
X
X
X
X
X
X
X
X
X
X
V114 or 
Prevnar 13™ 
Administration 
(Blinded) 
X
X
X
At each of the 
identified visits, 
participants will 
receive either a single 
dose of V114 or a 
single dose of
Prevnar 13™.
07X67T

PRODUCT: V114
25
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
PNEUMOVAX™23
Administration
or
V114 or 
Prevnar 13™ 
Administration 
(Blinded) 
X
At Visit 6 (12 months 
after allo-HSCT), 
eligible participants 
will receive a single 
dose of 
PNEUMOVAX™23. 
Participants with 
chronic graft-versus-
host disease (GVHD) 
will receive a 4th dose 
of V114 or Prevnar 
13™ (blinded) instead 
of 
PNEUMOVAX™23. 
07X67T

PRODUCT: V114
26
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Provide electronic 
Vaccination Report 
Card (eVRC) 
X
X
All participants will be 
provided an eVRC at 
Visit 2 (Day 1) and 
Visit 6 (12 months 
after allo-HSCT) to 
record adverse events 
(AEs) and body 
temperature 
measurements. 
Instructions for using 
the eVRC will be 
reviewed with the 
participant or 
participant’s legally 
acceptable 
representative. 
Review eVRC Data 
with Participant or 
Participant’s Legally 
Acceptable 
Representative
X
X
X
X
X
X
X
X
Collect eVRC 
Device from 
Participant or 
Participant’s Legally 
Acceptable 
Representative
X
X
07X67T

PRODUCT: V114
27
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Complete Telephone 
Contact 
Questionnaire
X
X d
Site personnel will 
contact study 
participants to collect 
additional information 
based on a Telephone 
Contact Questionnaire 
provided by the 
Sponsor. Data to be 
reported from this 
discussion will include 
serious adverse events 
(SAEs) and/or any 
updates to previously 
reported safety 
information. The 
planned Phone Contact 
at 9 months after 
allogeneic 
hematopoietic stem 
cell transplant (allo-
HSCT) should occur 
after Visit 5. If a study 
site visit occurs within 
30 days before the 
time point 9 months 
after allo-HSCT, then 
this 
07X67T

PRODUCT: V114
28
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Phone Contact will not 
be necessary and the 
Telephone Contact 
Questionnaire will not 
be required.
Safety Procedures
Complete Physical 
Examination
X
To be performed by 
the investigator or 
medically qualified 
designee before study 
vaccine is 
administered.
Directed Physical 
Examination
X
X
X
To be performed by 
the investigator or 
medically qualified 
designee before study 
vaccine is 
administered.
07X67T

PRODUCT: V114
29
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Pregnancy Test – If 
Applicable
X
X
X
X
A pregnancy test 
consistent with local 
requirements (sensitive 
to at least 25 IU beta 
human chorionic 
gonadotropin [β-hCG]) 
must be performed 
before administration 
of study vaccine in 
females who are of 
reproductive potential. 
Urine or serum tests 
can be used, and 
results must be 
negative before 
vaccination can occur.
Pregnancy tests can be 
repeated as needed 
based on local 
requirements.
07X67T

PRODUCT: V114
30
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Body Temperature 
Measurement Before 
Vaccination
X
X
X
X
Each participant's 
body temperature must 
be taken before 
vaccination. 
Participants who 
present with fever 
(oral or tympanic 
temperature ≥100.4°F 
[≥38.0°C]; axillary or 
temporal temperature 
≥99.4°F [≥37.4°C]; or 
rectal temperature 
≥101.4°F [≥38.6°C]) 
will have the 
vaccination delayed 
until fever is resolved 
for 72 hours.
30-Minute 
Postvaccination 
Observation Period
X
X
X
X
To be performed by 
blinded study site 
personnel only.
07X67T

PRODUCT: V114
31
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
AE Monitoring
X
X
X
X
X
X
X
X
X
X
X
X
X d
AEs (serious and 
nonserious) are to be 
reported from Days 1 
through 14 following
each vaccination. 
SAEs, specific events 
of interest, and deaths 
are to be reported 
throughout the 
duration of an 
individual’s study 
participation.
AEs (serious and 
nonserious) that occur 
after the consent is 
signed but before 
allocation/
randomization are also 
to be reported 
(Section 8.4.1).
07X67T

PRODUCT: V114
32
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
Immunogenicity Procedures
Serum for 
Immunogenicity 
Assays (including 
Retention Serum)
X
X
X
X
Blood samples must be 
collected before study 
vaccination when 
applicable.
After completion of 
electrochemiluminesce
nce (ECL) and 
opsonophagocytic 
(OPA) testing, serum 
samples will be stored 
to conduct any 
additional study-
related testing as 
required by regulatory 
agencies or the 
Sponsor Leftover sera 
from the study may be 
used for the 
development and/or 
validation of 
pneumococcal assays 
after completion of all 
study-related 
immunogenicity 
07X67T

PRODUCT: V114
33
PROTOCOL/AMENDMENT NO.: 022-04
V114-022-04 FINAL PROTOCOL
02-APR-2019
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Phone 
Contact
3
Phone 
Contact
4
Phone 
Contact
5
Phone 
Contact
6
Phone 
Contact
7
Phone 
Contact d
Scheduled Time: 
Day 1
Day 15
Day 30
Day 45 Day 60 Day 75
Day 90
9 Months
after Allo-
HSCT
12 Months
after Allo-
HSCT
15 days 
after Visit 
6
30 Days 
after 
Visit 6
6 Months 
after Visit 
6
Results from all 
screening procedures 
at Visit 1 must be 
available before 
randomization into the 
study at Visit 2 
(Day 1), which must 
occur ≤30 days after 
Visit 1.
Visit Window:
Within 30 
days 
before 
Visit 2
90 to180 
days after 
Allo-
HSCT
Day 15 
to Day 
19 after 
Visit 2a
Day 30 
to Day 
44 after 
Visit 2a
Day 15 
to Day 
19 after 
Visit 3b
Day 30 
to Day 
44 after 
Visit 3b
Day 15 
to Day 
19 after 
Visit 4c
Day 30 
to Day 
44 after 
Visit 4c
Day 256 to 
Day 284 
after Allo-
HSCT
Day 335 to 
Day 395 
after Allo-
HSCT
Day 15 to 
Day 19 
after 
Visit 6
Day 30 
to Day 
44 after 
Visit 6
Day 166
to Day 
194 after 
Visit 6d
testing; this applies 
only to sera received 
from randomized study 
participants who 
provided consent for 
future biomedical 
research.
Future Biomedical Research
Blood (DNA) for 
Future Biomedical 
Research (Optional)
for adult participants 
≥18 years of age.
X
Collected from 
randomized 
participants who 
provided consent for 
future biomedical 
research (Section 8.8)
Saliva (DNA) for 
Future Biomedical 
Research for 
pediatric participants 
<18 years of age.
X
Collected from 
randomized 
participants who 
provided 
consent/assent for 
Future Biomedical 
Research (See 
Section 8.8).
a
When scheduling the Phone Contact (Day 15) and Visit 3 (Day 30), “Day 1” is the date of Visit 2 vaccination.
b
When scheduling the Phone Contact (Day 45) and Visit 4 (Day 60), “Day 1” is the date of Visit 3 vaccination.
c
When scheduling the Phone Contact (Day 75) and Visit 5 (Day 90), “Day 1” is the date of Visit 4 vaccination. 
d
This Phone Contact (6 months after Visit 6) will only be conducted in recipients of V114 or Prevnar13™at Visit 6.
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2
INTRODUCTION
Merck Sharp & Dohme Corp. (MSD) is developing an investigational 15-valent 
pneumococcal conjugate vaccine (PCV) (referred to as V114) for the prevention of 
pneumococcal disease caused by the serotypes in the vaccine. V114 contains the 13 serotypes 
(1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F) present in the licensed vaccine 
Prevnar 13™ (pneumococcal 13-valent conjugate vaccine [diphtheria CRM197 protein], 
Wyeth Pharmaceuticals, a subsidiary of Pfizer, Inc., Philadelphia, PA), plus 2 additional 
serotypes (22F, 33F).
2.1
Study Rationale
Allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are at increased risk for 
pneumococcal infections and have a high risk for invasive pneumococcal disease (IPD) 
[Engelhard, D., et al 2002] [Giebink, G. S., et al 1986] [Youssef, S., et al 2007]. IPD is 
associated with high morbidity and mortality in allo-HSCT recipients, with rates of disease 
being 20- to 30-fold higher than the general population. Pneumococcal disease can occur 
early (<3 months post-transplantation), but the majority of IPD cases are reported ≥4 months 
post transplantation [Engelhard, D., et al 2002]. 
Immunization is the main preventative strategy against pneumococcal disease [Rubin, L. G., 
et al 2014]. The majority of pneumococcal disease cases are observed >4 months after HSCT
[Engelhard, D., et al 2002] [Cordonnier, C., et al 2009]. The vaccination series is 
recommended to be initiated at 3 to 6 months post-transplantation to ensure earlier protection 
against Streptococcus pneumoniae [Rubin, L. G., et al 2014]. Several clinical studies in both 
adult and pediatric populations have demonstrated the acceptable safety and immunogenicity 
profiles of 3 to 4 doses of PCV given 1 month apart followed by a dose of 
PNEUMOVAX™23 [Cordonnier, C., et al 2015]. Current international guidelines 
recommend the administration of 3 doses of PCV (eg, Prevnar 13™), at 1-month intervals, to 
be started from 3 to 6 months after transplant, followed at 12 months after transplant by a
dose of PNEUMOVAX™23 (pneumococcal vaccine, polyvalent [23-valent]) [Tomblyn, 
Marcie, et al 2009] [Rubin, L. G., et al 2014]. In patients with chronic graft-versus-host 
disease (GVHD), an additional dose of PCV can be administered at 12 months after HSCT 
[Rubin, L. G., et al 2014], instead of PNEUMOVAX™23. 
This clinical study is designed to describe the safety, tolerability, and immunogenicity of 
V114 compared with Prevnar 13™ in allo-HSCT recipients (≥3 years of age) who have not 
received a pneumococcal vaccine (vaccine-naïve) after the transplant. This study will also 
describe the safety and tolerability of PNEUMOVAX™23 administered 12 months after the 
allo-HSCT. Immune responses to the 15 serotypes contained in V114 following 
PNEUMOVAX™23 administration will also be described. Consistent with current 
guidelines, participants with chronic GVHD will receive a 4th dose of either V114 or 
Prevnar 13™ at 12 months post-transplant instead of PNEUMOVAX™23. Chronic GVHD 
should be assessed in accordance with NIH consensus criteria [Jagasia, M. H., et al 2015].
Recommendation for minimum platelet count is based on the Clinical Practice Guideline 
from the AABB [Kaufman, R. M., et al 2015]. Safety, tolerability, and immunogenicity
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following administration of the 4th dose of either V114 or Prevnar 13™ will be described. 
The data from this study will contribute to the overall safety database and immunogenicity 
profile of V114 in individuals ≥3 years of age and older.
2.2
Background
2.2.1
V114 and Pneumococcal Disease
Refer to the Investigator’s Brochure (IB) for V114 for more detailed background, including 
information on pneumococcal disease burden.
S. pneumoniae is a significant cause of disease worldwide, with clinical manifestations 
including pneumonia, meningitis, otitis media, sinusitis, and sepsis. Adults with comorbid 
conditions, in particular immunocompromised individuals, have a higher incidence of 
invasive pneumococcal disease (IPD) morbidity and mortality in all age groups compared to 
adults without the comorbid conditions [Lexau, C. A., et al 2005]. 
Currently licensed pneumococcal conjugate vaccines (eg, Prevnar™, Synflorix™, and 
Prevnar 13™) were first implemented in infant immunization programs in many countries 
worldwide. Prevnar™ was first licensed in 2000 and later replaced by Prevnar 13™in 2009 
for the European Union and in 2010 for the United States. Although Prevnar 13™ is 
indicated for children and adults, Synflorix™ is only indicated for children up to 5 years of 
age. Widespread use of PCVs has reduced the burden of pneumococcal disease caused by the 
serotypes contained in the vaccines in children who were targeted by the vaccination 
programs and unvaccinated individuals from other age groups (herd protection) [Centers for 
Disease Control and Prevention 2008] [Ruckinger, S., et al 2009] [Farrell, D. J, et al 2007] 
[Pilishvili, Tamara, et al 2010] [Lexau, C. A., et al 2005] [Metlay, J. P., et al 2006] [Whitney, 
Cynthia G., et al 2003] [Moore, M. R., et al 2015] [Lepoutre, A., et al 2015] [Weiss, S., et al 
2015] [Martinelli, D., et al 2014] [Guevara, M., et al 2016] [Waight, P. A., et al 2015] 
[Jokinen, J., et al 2015] [Palmu, A. A., et al 2015] [Wagenvoort, G. H., et al 2016]. Prevnar 
13™ was also shown to be efficacious against vaccine-type nonbacteremic pneumococcal 
pneumonia and IPD in adults ≥65 years of age [Bonten, M. J., et al 2015]. These study results 
were the basis of the recommendation from the ACIP for the sequential administration of 
Prevnar 13™ followed at least 12 months later by PNEUMOVAX™23 in adults ≥65 years of 
age [Tomczyk, S., et al 2014] [Kobayashi, M., et al 2015]. 
Although cases of IPD have decreased following implementation of PCVs, an increase in 
IPD caused by serotypes not covered by currently available vaccines has been observed. 
V114 contains 2 additional serotypes (22F, 33F) compared with Prevnar 13™. The selection 
of 22F and 33F was primarily based on epidemiological importance of these 2 additional 
serotypes. Recent data from the United States suggest that 22F is the most common serotype 
not included in Prevnar 13™ in adults ≥18 years of age, causing 13% of IPD cases. Serotype 
33F is associated with an additional 5% of IPD cases [Moore, M. R., et al 2015]. Data from 
the United Kingdom also showed that, in 2013/2014, 22F and 33F are frequent serotypes in 
adults ≥65 years of age, accounting for approximately 10% and 4% of IPD cases in that age 
group, respectively [Waight, P. A., et al 2015]. Data from 2014 reported in the 2016 annual 
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epidemiological report on IPD by the European Centre for Disease Prevention and Control 
showed that both serotypes 22F and 33F are among the most common serotypes causing IPD 
[European Centre for Disease Prevention and Control 2016]. In pediatrics, approximately 4 
years after inclusion of Prevnar™ in the United States infant immunization schedule, 
serotypes 22F and 33F accounted for approximately 13% of IPD cases in children <5 years 
of age (incidence rate of IPD due to 22F and 33F combined of 3.1 cases per 100,000 person-
years [PY]), in contrast to 1.3% of IPD cases in the pre-PCV7 era (incidence rate of 22F and 
33F IPD of 1.2 cases per 100,000 PY) [Hicks, L. A., et al 2007]. By 2013, both 22F and 33F 
were among the leading serotypes causing IPD beyond those already included in 
Prevnar 13™, accounting for approximately 21% of all IPD in children <5 years of age in the 
United States [Moore, M. R., et al 2015]
The serotypes included in V114 will provide broad coverage of the leading serotypes 
associated with pneumococcal disease worldwide. V114 is designed to meet continuing 
medical and public health needs for PCVs globally, as well as to address the emergence of 
pneumococcal disease caused by serotypes not contained in currently licensed PCVs. V114 is 
designed to offer broader serotype coverage than Prevnar 13™ against pneumococcal disease 
in both pediatric and adult populations.
2.2.2
Preclinical and Clinical Studies
Refer to the IB for information on completed preclinical and clinical studies conducted with 
V114. 
2.2.3
Information on Other Study-related Therapy
2.2.3.1
Prevnar 13™
Refer to approved labeling for detailed background information on Prevnar 13™.
Prevnar 13™ contains all of the pneumococcal serotypes included in Prevnar™ (4, 6B, 9V, 
14, 18C, 19F, and 23F) plus 6 additional serotypes (1, 3, 5, 6A, 7F, and 19A). The adult 
indication was approved based on immune responses elicited by Prevnar 13™ in comparison 
with PNEUMOVAX™23. A placebo-controlled clinical efficacy study (Community 
Acquired Pneumonia Immunization Trial in Adults [CAPiTA]) evaluated the efficacy of 
Prevnar 13™ against pneumococcal pneumonia and IPD in immunocompetent adults 
≥65 years of age. Results from CAPiTA showed that Prevnar 13™ was 45.6% 
(95% confidence interval [CI]: 21.8% to 62.5%) efficacious against vaccine-type 
nonbacteremic pneumococcal pneumonia and 75.0% (95% CI: 41.4% to 90.8%) efficacious 
against vaccine-type IPD in adults ≥65 years of age [Bonten, M. J., et al 2015].
In many countries, Prevnar 13™ is given as a part of routine immunization schedules for all 
infants and children 2 to 59 months of age and for children 60 to 71 months of age with 
immunocompromising conditions. Children without a history of immunization with 
Prevnar 13™ are recommended to receive catch up immunization with Prevnar 13™, 
regardless of previous immunization with other PCVs containing fewer PnPs serotypes. The 
Advisory Committee on Immunization Practices (ACIP) also recommends children 6 to 
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18 years of age with immunocompromising conditions, functional or anatomic asplenia, CSF 
leaks, or cochlear implants, also receive Prevnar 13™. Children and adults who have 
undergone stem cell transplantation receive 3 dose series of Prevnar 13™  after 
transplantation[Centers for Disease Control and Prevention (CDC) 2013].
Prevnar™ and Prevnar 13™ are also known as Prevenar™ and Prevenar 13™ in many 
countries outside of the United States; these vaccines are referred to as Prevnar™ and 
Prevnar 13™ throughout this document.
2.2.3.2
PNEUMOVAX™23
Refer to approved labeling for detailed background information on PNEUMOVAX™23.
PNEUMOVAX™23 is comprised of the polysaccharides from 23 of the most important 
serotypes causing disease in adults (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 
17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F). The formulation is not adjuvanted and no 
carrier protein is used. 
In the United States, PNEUMOVAX™23 is recommended by the ACIP for routine use in 
immunocompetent adults ≥65 years of age as sequential administration at least 1 year after 
Prevnar 13™ [Kobayashi, M., et al 2015]. It is also recommended for use in adults aged 19 to 
64 years of age with underlying medical conditions that increase the risk for serious 
pneumococcal infection. These conditions include but are not limited to chronic heart 
disease, chronic lung disease (including chronic obstructive pulmonary disease, emphysema, 
and asthma), diabetes mellitus, alcoholism, chronic liver disease (including cirrhosis), and 
cigarette smoking [Centers for Disease Control and Prevention 2010]. 
PNEUMOVAX™23 is also recommended in immunocompromised adults ≥19 years of age; 
in this population, a dose of PNEUMOVAX™23 is recommended ≥8 weeks following a 
dose of Prevnar 13™ [Kobayashi, M., et al 2015]. Vaccination with PNEUMOVAX™23 is 
also recommended for children 2 to 18 years of age with underlying medical conditions after 
completing all recommended Prevnar 13™doses [Centers for Disease Control and 
Prevention (CDC) 2013]. Many countries follow similar age-based and/or risk-based 
recommendations for the use of PNEUMOVAX™23 [Castiglia P. 2014].  
2.3
Benefit/Risk Assessment
It cannot be guaranteed that participants in clinical studies will directly benefit from 
intervention during participation, as clinical studies are designed to provide information 
about the safety and effectiveness of an investigational vaccine.
Approximately 50% of participants will receive Prevnar 13™, the standard of care, as the 
active comparator in this study. Based on the available data, V114 is expected to provide 
comparable immune responses to Prevnar 13™ for the shared serotypes while providing 
additional coverage for the 2 serotypes (22F, 33F) unique to V114. However, it is unknown if 
the investigational V114 will have the same benefit as Prevnar 13™ in the recipients of 
allo-HSCT.
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As per current guidelines, eligible participants will also receive PNEUMOVAX™23 at 
12 months after allo-HSCT to enhance immune responses and broaden protection against 
additional serotypes [Rubin, L. G., et al 2014]. However, participants who develop chronic 
GVHD during their first year after allo-HSCT will be considered ineligible to receive 
PNEUMOVAX™23. Instead of PNEUMOVAX™23, participants with chronic GVHD will 
receive a 4th dose of blinded study vaccine (ie, V114 or Prevnar 13™) at 12 months after 
allo-HSCT. 
Additional details regarding specific benefits and risks for participants participating in this 
clinical study may be found in the accompanying IB and Informed Consent Form (ICF). See 
Appendix 10.7.1 for Country-specific requirements for Sweden.
3
HYPOTHESIS, OBJECTIVES, AND ENDPOINTS
The following objectives and endpoints will be evaluated in adult and pediatric recipients of 
allogeneic hematopoietic stem cell transplant (allo-HSCT).
Objectives
Endpoints
Primary
•
Objective: To evaluate the safety and 
tolerability of 3 doses of V114 and 3 doses 
of Prevnar 13™ with respect to the 
proportion of participants with adverse 
events (AEs) within each vaccination group.
Following any of the 3 doses of V114 or 
Prevnar 13™for adults ≥18 years of age:
•
Solicited injection-site AEs from Day 
1 through Day 5 postvaccination 
•
Solicited systemic AEs from Day 1 
through Day 14 postvaccination 
•
Vaccine-related serious adverse events 
(SAEs) from Day 1 postvaccination to 
Month 12 after allo-HSCT
Following any of the 3 doses of V114 or 
Prevnar 13™for pediatrics (3 to <18
years of age):
•
Solicited injection-site AEs from Day 
1 through Day 14 postvaccination
•
Solicited systemic AEs from Day 1 
through Day 14 postvaccination
•
Vaccine-related serious adverse events 
(SAEs) from Day 1 postvaccination to 
Month 12 after allo-HSCT
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•
Objective: To evaluate the serotype-specific 
immunoglobulin G (IgG) Geometric Mean 
Concentrations (GMCs) at 30 days 
following the 3rd dose of V114 and 
following the 3rd dose of Prevnar 13™ 
within each vaccination group.
•
Serotype-specific IgG responses for 
the 15 serotypes in V114 at Day 90
Secondary
•
Objective: To evaluate the safety and 
tolerability of PNEUMOVAX™23
(administered 12 months after allo-HSCT in 
participants who do not develop GVHD)
with respect to the proportion of participants 
with AEs within each vaccination group.
Following vaccination with 
PNEUMOVAX™23 for adults ≥18 years 
of age:
•
Solicited injection-site AEs from Day 
1 through Day 5 postvaccination 
•
Solicited systemic AEs from Day 1 
through Day 14 postvaccination 
•
Vaccine-related SAEs from Month 12 
after allo- HSCT to 1 month after
vaccination or the completion of the 
study.
Following vaccination with 
PNEUMOVAX™23 for pediatrics (3 to 
<18 years of age):
•
Solicited injection-site AEs from Day 
1 through Day 14 postvaccination
•
Solicited systemic AEs from Day 1 
through Day 14 postvaccination
•
Vaccine-related SAEs from Month 12 
to after allo-HSCT to 1 month after
vaccination or the completion of the 
study.
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•
Objective: To evaluate the safety and 
tolerability of a 4th dose of V114 and a 4th 
dose of Prevnar 13™ (both administered 12 
months after allo-HSCT in participants who 
develop GVHD) with respect to the 
proportion of participants with AEs within 
each vaccination group.
Following vaccination with a 4th dose of 
V114 or Prevnar 13™for adults ≥18 years 
of age:
•
Solicited injection-site AEs from Day 
1 through Day 5 postvaccination 
•
Solicited systemic AEs from Day 1 
through Day 14 postvaccination 
•
Vaccine-related SAEs Day 1 through 6 
months after 4th vaccination of V114 
and Prevnar 13™or completion of the 
study.
Following vaccination with a 4th dose of 
V114 or Prevnar 13™for pediatrics (3 to 
<18 years of age):
•
Solicited injection-site AEs from Day
1 through Day 14 postvaccination
•
Solicited systemic AEs from Day 1 
through Day 14 postvaccination
•
Vaccine-related SAEs from Day 1 
through 6 months after 4th vaccination 
of V114 and Prevnar 13™or 
completion of the study.
•
Objective: To evaluate the serotype-specific 
opsonophagocytic activity (OPA) Geometric 
Mean Titers (GMTs) at 30 days following 
the 3rd dose of V114 and following the 3rd 
dose of Prevnar 13™ within each 
vaccination group.
•
Serotype-specific OPA responses for 
the 15 serotypes in V114 at Day 90
•
Objective: To evaluate the serotype-specific 
(1) OPA GMTs and IgG GMCs at baseline 
(prevaccination with V114 or Prevnar 13™) 
and (2) Geometric Mean Fold Rises 
(GMFRs) and proportions of participants 
with a ≥4-fold rise from baseline to 30 days 
following the 3rd dose of V114 and 3rd 
dose of Prevnar 13™ separately for both 
IgG and OPA responses within each 
vaccination group. 
•
Serotype-specific OPA and IgG 
responses for the 15 serotypes in V114 
at Day 1 and Day 90
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Exploratory
•
Objective: To evaluate the serotype-specific 
(1) IgG GMCs and OPA GMTs at 30 days 
postvaccination with either 
PNEUMOVAX™23 (participants without 
chronic GVHD) or a 4th dose of V114 or 
Prevnar 13™ (participants with chronic 
GVHD) administered at Month 12 after 
allo-HSCT within each vaccination group;
(2) GMFRs and proportions of participants 
with a ≥4-fold rise from prevaccination 
(Month 12 after allo-HSCT) to 30 days 
following either PNEUMOVAX™23 or a 
4th dose of V114 or Prevnar 13™ (Month 
13 after allo-HSCT) for both IgG and OPA 
responses within each vaccination group.
•
Serotype-specific IgG and OPA 
responses for the 15 serotypes in V114 
at Month 12 and Month 13 after allo-
HSCT
•
Objective: To evaluate the serotype-specific 
IgG GMCs at 30 days postvaccination for 
participants administered 3 doses of V114 
compared to participants administered 3 
doses of Prevnar 13™.
•
Serotype-specific IgG responses for 
the 15 serotypes in V114 at Day 90
4
STUDY DESIGN
4.1
Overall Design
This is a Phase 3, randomized, double-blind, active comparator-controlled, parallel-group, 
multicenter, clinical study to describe the safety, tolerability, and immunogenicity of V114 
and Prevnar 13™ when administered as a 3-dose regimen in recipients of allo-HSCT.
Prospective participants will be screened for enrollment at Visit 1, which must occur within 
30 days before Visit 2 (Day 1). At Visit 2 (Day 1), which must occur 90 to 180 days after a 
first allo-HSCT, eligible participants will be randomly assigned in a 1:1 ratio to 1 of the 
2 blinded study vaccines (V114 or Prevnar 13™). 
A total of approximately 250 adult and 50 pediatric participants will be randomized so that 
approximately 150 participants will receive V114 and approximately 150 participants will 
receive Prevnar 13™. The randomization process will be performed using stratification 
techniques to ensure a reasonable balance between the 2 study vaccine groups with regard to 
the following factors: use of systemic steroids within 14 days before randomization (Day 1), 
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age category (3 to <18 years and 18 to 49 years or ≥50 years), and haploidentical donor status
(yes or no).
Blinded study vaccine (V114 or Prevnar 13™) will be administered to each eligible 
participant at each of the following 3 time points: Visit 2 (Day 1), Visit 3 (Day 30), and 
Visit 4 (Day 60). 
Eligible participants will also receive a single dose of PNEUMOVAX™23 at Visit 6 
(12 months after allo-HSCT). However, participants who develop chronic GVHD during the 
first year after allo-HSCT will be considered ineligible to receive PNEUMOVAX™23 and 
will instead receive a 4th dose of blinded study vaccine (V114 or Prevnar 13™) at Visit 6.
Participants will be followed for local and systemic AEs from Day 1 through Day 14 
following each vaccination. Information for SAEs and deaths, regardless of whether the 
events are considered to be vaccine-related by the investigator, will be collected from the 
time consent is signed through completion of participation in the study. An external Data 
Monitoring Committee (DMC) will conduct a periodic review of safety and tolerability data 
for the adult V114 Phase 3 program. A description of the structure, function, and guidelines 
for decision-making by the DMC, along with the timing and content of the safety reviews 
will be outlined in the DMC charter. Information regarding the composition of the DMC is 
provided in Appendix 1.
Throughout a participant’s participation in the study, new onset and/or change in GVHD as 
well as relapse and progression of underlying disease (ie, the disease for which allo-HSCT 
was performed) will be recorded as specific events of interest.
Blood samples for immunogenicity assays will be obtained at the following time points:

Immediately before V114 or Prevnar 13™ vaccination at Visit 2 (Day 1)

30 days after the 3rd vaccination with V114 or Prevnar 13™ Visit 5 (Day 90)

Immediately before vaccination with PNEUMOVAX™23, or 4th dose of either V114 
or Prevnar 13™, administered 12 months after allo-HSCT (Visit 6)

30 days after vaccination with PNEUMOVAX™23, or 4th dose of either V114 or 
Prevnar 13™ (Visit 7)
After completion of electrochemiluminescence (ECL) and OPA testing, serum samples will 
be stored to conduct any additional study-related testing as required by regulatory agencies or 
the Sponsor. Leftover sera from the study may be used for the development and/or validation 
of pneumococcal assays after completion of all study-related immunogenicity testing; this 
applies only to sera received from randomized study participants who provided consent for 
future biomedical research.
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Specific procedures to be performed during the study, as well as their prescribed times and 
associated visit windows, are outlined in the SoA in Section 1.3. Details of each procedure 
are provided in Section 8.
4.2
Scientific Rationale for Study Design
The enrollment of allo-HSCT recipients is intended to assess safety, tolerability, and 
immunogenicity in a population that is representative of allo-HSCT recipients for whom 
pneumococcal vaccination is recommended. The proposed dosing regimen and vaccination 
strategy (3 doses of PCV followed by, at 12 months after allo-HSCT, PNEUMOVAX™23 or 
a 4th dose of either V114 or Prevnar 13™ in participants with chronic GVHD) is consistent 
with current guidelines for pneumococcal vaccination in recipients of allo-HSCT. The 
immunogenicity and safety endpoints, including the duration of the safety follow-up period, 
are consistent with previous studies evaluating the safety of PCVs in recipients of 
allo-HSCT.
4.2.1
Rationale for Endpoints
4.2.1.1
Immunogenicity Endpoints
Previous studies have demonstrated the need for the administration of at least 3 doses of PCV 
in recipients of HSCT in order to achieve satisfactory antibody responses. Serotype-specific 
IgG GMCs generally increased after each of the first 3 doses of PCV and generally remained 
stable after PNEUMOVAX™23 [Cordonnier, C., et al 2015].
Sera from participants will be used to measure vaccine-induced serotype-specific IgG and 
OPA responses for all 15 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, 
and 33F) included in V114 using the pneumococcal electrochemiluminescence (PnECL) 
assay and Multiplexed Opsonophagocytic Assay (MOPA) assay. 
Several studies have shown a positive correlation between serotype-specific IgG antibody 
concentrations and OPA titers in children and adults [Centers for Disease Control and 
Prevention 2010] [Anttila, M., et al 1999] [Romero-Steiner, S., et al 1997]. OPA assesses 
levels of functional antibodies capable of opsonizing pneumococcal capsular polysaccharides 
for presentation to phagocytic cells for engulfment and subsequent killing, and therefore is 
considered an important immunologic surrogate for protection against IPD in adults. Note 
that no antibody concentration or titer for either assay has been defined as the threshold value 
that correlates with protection in adults.
In this study, IgG responses are considered primary because prophylactic antibiotic therapy 
may interfere with the OPA assay.
Details on the immunogenicity endpoints evaluated in this study can be found in 
Section 9.4.1.
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4.2.1.2
Safety Endpoints
The safety endpoints evaluated in this study were selected based on the product’s safety 
profile demonstrated in previous studies, published data from marketed PCVs, and feedback 
received from regulatory agencies during product development. The electronic Vaccination 
Report Card (eVRC), used to record AEs during the postvaccination periods defined in 
Section 8.1.9, was structured as recommended in the final Food and Drug Administration 
Patient Reported Outcome Guidance [U.S. Food and Drug Administration 2009]. 
Details on the safety endpoints evaluated in this study can be found in Section 8.3.4 and 
Section 9.4.2.
Details on AEs, including definitions and reporting requirements, can be found in 
Appendix 4.
4.2.1.3
Future Biomedical Research
The Sponsor will conduct future biomedical research on specimens for which consent was 
provided during this study. This research may include genetic analyses (DNA), gene 
expression profiling (ribonucleic acid [RNA]), proteomics, metabolomics (serum, plasma), 
and/or the measurement of other analytes, depending on which specimens are consented for 
future biomedical research.
Such research is for biomarker testing to address emergent questions not described elsewhere 
in the protocol (as part of the main study) and will only be conducted on specimens from 
appropriately consented participants. The objective of collecting/retaining specimens for 
future biomedical research is to explore and identify biomarkers that inform the scientific 
understanding of diseases and/or their therapeutic treatments. The overarching goal is to use 
such information to develop safer, more effective drugs/vaccines, and/or to ensure that 
participants receive the correct dose of the correct drug/vaccine at the correct time. The 
details of this future biomedical research substudy are presented in Appendix 6.
4.2.2
Rationale for the Use of Comparator/Placebo
This study utilizes Prevnar 13™ as the active comparator as this is the only PCV licensed in 
many developed countries. 
Prevnar 13™ is approved in children for, among other indications, the prevention of invasive 
disease, and in adults 18 years of age and older for the prevention of pneumococcal 
pneumonia and invasive disease caused by 13 S. pneumoniae serotypes (1, 3, 4, 5, 6A, 6B, 
7F, 9V, 14, 18C, 19A, 19F, and 23F).
Refer to approved labeling for detailed background information on Prevnar 13™.
The standard of care in recipients of allo-HSCT includes 3 doses of Prevnar 13™, 
administered at 1-month intervals starting 3 to 6 months after transplant, followed at 
12 months after allo-HSCT by a dose of PNEUMOVAX™23 (or a 4th dose of Prevnar 13™ 
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instead for patients who have chronic GVHD) [Tomblyn, M., et al 2009]. The active 
comparator that is the current standard of care is expected to provide meaningful safety and 
immunogenicity data against which safety and immunogenicity of V114 may be evaluated in
recipients of allo-HSCT.
4.3
Justification for Dose
Each dose of V114 used in this study is similar to that used in previous V114 adult and 
pediatric clinical studies (refer to the V114 IB for more detailed information on dose 
selection). However, while most previous adult clinical studies included a single dose only of 
V114, the current study includes 3 doses of V114 (with an additional 4th dose in participants 
with chronic GVHD) that are administered in accordance with current guidance for 
allo-HSCT recipients.
The doses of Prevnar 13™ and PNEUMOVAX™23 selected for use in this study are 
consistent with approved doses.
4.4
Beginning and End of Study Definition
The overall study begins when the first participant signs the informed consent/assent form. 
The overall study ends when the last participant completes the last study-related telephone-
call or visit, withdraws from the study, or is lost to follow-up (ie, the participant is unable to 
be contacted by the investigator).
For purposes of analysis and reporting, the overall study ends when the Sponsor receives the 
last serology assay result.
4.4.1
Clinical Criteria for Early Study Termination
There are no prespecified criteria for terminating the study early.
5
STUDY POPULATION
Male/Female participants at least 3 years of age who have received allo-HSCT will be 
enrolled in this study.
Prospective approval of protocol deviations to recruitment and enrollment criteria, also 
known as protocol waivers or exemptions, is not permitted.
5.1
Inclusion Criteria
Participants are eligible to be included in the study only if all of the following criteria apply:
1. Received a human leukocyte antigen (HLA) compatible donor including haploidentical 
and mismatched (related or unrelated) first allo-HSCT (ie, bone marrow or peripheral 
blood stem cell) 90 to 180 days prior to randomization (Visit 2).
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2. Received the allo-HSCT for acute lymphoblastic leukemia (ALL) in first or second 
remission, acute myeloid leukemia (AML) in first or second remission, chronic myeloid 
leukemia (CML) in first chronic or accelerated phase, Hodgkin’s lymphoma, 
non-Hodgkin's lymphoma, myelodysplastic syndrome (MDS), myelofibrosis,
myeloproliferative diseases, and non-malignant disease such as aplastic anemia, or 
sickle cell disease in participants ≥18 years of age and any non- malignant disease for
participants 3 to <18 years of age.
3. Life expectancy >12 months after allo-HSCT, according to investigator judgement.
4. Clinically stable engraftment according to investigator judgment.
Demographics
5. Participant is Male or Female ≥3 years of age.
Female Participants
6. A female participant is eligible to participate if she is not pregnant (Appendix 5), not 
breastfeeding, and at least 1 of the following conditions applies:
a.
Not a woman of childbearing potential (WOCBP) as defined in Appendix 5.
OR
b. A WOCBP who agrees to use 1 of the contraceptive methods as defined in 
Appendix 5 during the treatment period and for at least 6 weeks after the last dose of 
study intervention.
Informed Consent
7. The participant or legally acceptable representative (exclusively used for subjects who 
are <18 years of age) understands the study procedures, alternate treatments available, 
and risks involved with the study and voluntarily agrees to participate by giving written 
informed consent or assent (provided by a legally acceptable representative for subjects 
<18 years of age). Participants may also provide consent for future biomedical research. 
However, these participants may participate in the main study without participating in 
future biomedical research. 
5.2
Exclusion Criteria
Participants are excluded from the study if any of the following criteria apply:
Medical Conditions
1. Receipt of a previous allo-HSCT.
Note: recipients of a previous autologous HSCT are eligible.
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2. Received allo-HSCT with ex-vivo graft manipulation (e.g. CD34 selection, TCR alpha 
beta depletion, etc.), in vivo T cell depletion with alemtuzumab, or haploidentical 
allo-HSCT with high dose anti-thymocyte globulin.
3. Received allo-HSCT for:

Multiple myeloma

In participants ≥18 years of age only, any nonmalignant diseases except sickle 
cell disease and aplastic anemia.
4. Persistent or relapsed primary disease (diagnosed as per the investigator’s institution’s 
morphologic criteria for refractory or relapse of disease) after allo-HSCT.
5. History of severe GVHD (Grade 3 or 4 GVHD) after allo- HSCT
Note: Overall GVHD status is determined as per GVHD grading scale used by 
investigator institution.
6. Planned organ transplantation after allo-HSCT.
7. History of culture-positive pneumococcal disease occurring after allo-HSCT 
(eg, positive blood culture, positive cerebrospinal fluid culture, or positive culture at 
another sterile site).
8. Known hypersensitivity to any component of pneumococcal polysaccharide vaccine, 
pneumococcal conjugate vaccine, or any diphtheria toxoid-containing vaccine.
9. History of acquired immunodeficiency such as documented HIV infection, or anatomic 
asplenia.
10. Coagulation disorder contraindicating intramuscular vaccinations.
11. *Recent febrile illness (defined as oral or tympanic temperature ≥100.4°F [≥38.0°C]; 
axillary or temporal temperature ≥99.4°F [≥37.4°C]; or rectal temperature ≥101.4°F 
[≥38.6°C]) or received antibiotic therapy for any acute illness occurring within 72 hours 
before receipt of study vaccine.
12. Severe hepatic impairment (defined as Child-Pugh Class C) at Screening (Visit 1).
13. *Serum aspartate transaminase (AST) or alanine transaminase (ALT) >6 × upper limit of 
normal (ULN) or serum total bilirubin >2.5 × ULN at Screening (Visit 1).
14. *Grade ≥4 renal impairment (estimated glomerular filtration rate <30 ml/min/1.73m2 or 
dialysis) at Screening (Visit 1).
15. *Platelet count <30,000/µL at Screening (Visit 1).
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16. *Absolute neutrophil count <1,000/µL at Screening (Visit 1).
17. A WOCBP who has a positive urine or serum pregnancy test before the 1st vaccination 
at Visit 2.
Prior/Concomitant Therapy
18. Received chimeric antigen receptor T-cell (CAR-T) therapy or checkpoint inhibitor 
directed therapy (ie, anti PD-1) after allo-HSCT.
19. Received or planned to receive anti- CD20 B-cell targeted therapy (eg, rituximab) after 
allo- HSCT.
20. *Received systemic steroids at a prednisone equivalent dose >0.5 mg/kg/day (steroids at 
a prednisone equivalent dose ≤0.5 mg/kg/day are allowed) for ≥14 consecutive days and 
has not completed treatment at least 30 days before administration of any study vaccine.
21. *Prior or scheduled receipt of immunoglobulins or plasma products within 30 days of 
administration of study vaccine.
22. Non-study pneumococcal vaccine administered after allo-HSCT, or is expected to 
receive non-study pneumococcal vaccine during participation in the study.
23. *Received any licensed, non-live vaccine within 14 days before receipt of any study 
vaccine, or is scheduled to receive any licensed, non-live vaccine within 14 days after 
receipt of any study vaccine.
Exception: inactivated influenza vaccine and haemophilus influenzae type B (Hib)
vaccine may be administered, but only if it is administered at least 7 days before receipt 
of any study vaccine and/or at least 7 days after receipt of any study vaccine.
24. *Received any live vaccine within 30 days before receipt of any study vaccine or is 
scheduled to receive any live vaccine within 30 days after receipt of any study vaccine.
Prior/Concurrent Clinical Study Experience
25. Is currently participating or has participated in an interventional clinical study with an 
investigational compound/agent or device within 2 weeks of participating in this current 
study, or plans to receive any investigational compound/agent or device (in addition to 
existing therapy) within 2 weeks of any vaccination, that in the opinion of the 
investigator would interfere with the evaluation of the study objectives.
Other Exclusions 
26. Is, at the time of signing informed consent/assent, a user of recreational or illicit drugs or 
has had a recent history (within the last year) of drug or alcohol abuse or dependence as 
assessed by the study investigator.
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27. Has history or current evidence of any condition, therapy, laboratory test result 
abnormality, or other circumstance that might expose the participant to risk by 
participating in the study, confound the results of the study, or interfere with the 
participant’s participation for the full duration of the study.
28. Is or has an immediate family member (eg, spouse, parent/legal guardian, sibling, or 
child) who is investigational site or Sponsor staff directly involved with this study.
For items with an asterisk (*), if the participant meets these exclusion criteria, the 
Day 1 Visit may be rescheduled for a time when these criteria are not met and the Day 1 
Visit will still occur within 90 to 180 days after allo-HSCT.
5.3
Lifestyle Considerations
No lifestyle restrictions are required.
5.4
Screen Failures
Screen failures are defined as participants who consent to participate in the clinical study, but 
are not subsequently randomized in the study]. A minimal set of screen failure information is 
required to ensure transparent reporting of screen failure participants to meet the 
Consolidated Standards of Reporting Trials (CONSORT) publishing requirements and to 
respond to queries from regulatory authorities. Minimal information includes demography, 
screen failure details, eligibility criteria, and any AEs or SAEs meeting reporting 
requirements as outlined in the data entry guidelines.
5.5
Participant Replacement Strategy
A participant who withdraws from the study will not be replaced.
6
STUDY INTERVENTION
Study intervention is defined as any investigational intervention(s), marketed product(s), 
placebo, or medical device(s) intended to be administered to a study participant according to 
the study protocol.
Clinical supplies [V114, Prevnar 13™, PNEUMOVAX™23] will be packaged to support 
enrollment . Clinical supplies will be affixed with a clinical label in accordance with 
regulatory requirements.
6.1
Study Intervention(s) Administered
The study interventions to be used in this study are outlined in Table 1.
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Table 1
Study Interventions
Arm 
Name
Arm Type
Intervention Name
Type
Dose Formulation
Unit Dose 
Strength
Dosage 
Level
Route of 
Admin
Vaccination 
Regimen
Use
IMP/
NIMP
Sourcing
V114
Experimental
V114
Biological/
Vaccine
Sterile suspension
Refer to IB
0.5 mL
IM
3 Doses:
Visit 2 (Day 1)
Visit 3 (Day 30)
Visit 4 (Day 60)
Experi
mental
IMP
Central
PNEUMOVAX™2
3a
OR
Biological/
Vaccine
Sterile suspension
Refer to 
product 
labeling
0.5 mL
IM
Single Dose at 
Visit 6 (12 Months 
after Allo-HSCT)
Experi
mental
IMP
Central
V114 
(4th Dose)b
Biological/
Vaccine
Sterile suspension
Refer to IB
0.5 mL
IM
4th Dose at 
Visit 6 (12 Months 
after Allo-HSCT)
Experi
mental
IMP
Central
Prevnar 
13™
Active 
Comparator
Prevnar 13™
Biological/
Vaccine
Sterile suspension
Refer to 
product 
labeling
0.5 mL
IM
3 Doses: 
Visit 2 (Day 1)
Visit 3 (Day 30)
Visit 4 (Day 60)
Experi
mental
IMP
Central or 
local
PNEUMOVAX™2
3a
OR
Biological/
Vaccine
Sterile suspension
Refer to 
product 
labeling
0.5 mL
IM
Single Dose at 
Visit 6 (12 Months 
after Allo-HSCT)
Experi
mental
IMP
Central
Prevnar 13™ 
(4th Dose)b
Biological/
Vaccine
Sterile suspension
Refer to 
product 
labeling
0.5 mL
IM
4th Dose at 
Visit 6 (12 Months 
after Allo-HSCT)
Experi
mental
IMP
Central
a PNEUMOVAX™23 is administered to participants who do not have chronic graft-versus-host disease.
b For participants with chronic graft-versus-host disease, a 4th dose of V114 or Prevnar 13™ (blinded; same as first 3 doses) is administered instead of PNEUMOVAX™23. 
Admin = administration; IB = Investigator’s Brochure; IM = intramuscular; IMP = investigational medicinal product; NIMP = non-investigational medicinal product.
The definition of IMP and NIMP is based on guidance issued by the European Commission. Regional and/or country differences of the definition of IMP/NIMP may exist. In these 
circumstances, local legislation is followed.
All supplies indicated in Table 1 will be provided per the "Sourcing" column depending upon local country operational requirements. 
Every attempt should be made to source these supplies from a single lot/batch number. The study site is responsible for recording the 
lot number, manufacturer, and expiry date for any locally purchased product per local guidelines unless otherwise instructed by the 
Sponsor.
Refer to Section 8.1.8 for details regarding administration of the study intervention.
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6.2
Preparation/Handling/Storage/Accountability
6.2.1
Dose Preparation
There are no specific calculations or evaluations required to be performed in order to 
administer the proper dose to each participant. The rationale for selection of doses to be used 
in this study is provided in Section 4.3. 
6.2.2
Handling, Storage, and Accountability
The investigator or designee must confirm appropriate temperature conditions have been 
maintained during transit for all study intervention received, and any discrepancies are 
reported and resolved before use of the study intervention.
Only participants enrolled in the study may receive study intervention, and only authorized 
site staff may supply or administer study intervention. All study interventions must be stored 
in a secure, environmentally controlled, and monitored (manual or automated) area in 
accordance with the labeled storage conditions with access limited to the investigator and 
authorized site staff.
The investigator, institution, or the head of the medical institution (where applicable) is 
responsible for study intervention accountability, reconciliation, and record maintenance (ie, 
receipt, reconciliation, and final disposition records).
For all study sites, the local country Sponsor personnel or designee will provide appropriate 
documentation that must be completed for drug accountability and return, or local discard 
and destruction if appropriate. Where local discard and destruction is appropriate, the 
investigator is responsible for ensuring that a local discard/destruction procedure is 
documented.
The study site is responsible for recording the lot number, manufacturer, and expiry date for 
any locally purchased product (if applicable) as per local guidelines unless otherwise 
instructed by the Sponsor.
The investigator shall take responsibility for and shall take all steps to maintain appropriate 
records and ensure appropriate supply, storage, handling, distribution, and usage of study 
interventions in accordance with the protocol and any applicable laws and regulations.
6.3
Measures to Minimize Bias: Randomization and Blinding
6.3.1
Intervention Assignment
Treatment allocation/randomization will occur centrally using an interactive response 
technology (IRT) system. There are 2 study intervention arms. Participants will be assigned 
randomly in a 1:1 ratio to V114 and Prevnar 13™, respectively.
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6.3.2
Stratification
Treatment allocation/randomization will be stratified according to the following factors:
1. Use of systemic steroids within 14 days before randomization (Day 1) (yes or no)
2. Age category (3 to <18 years,18 to 49 years, or ≥50 years)
3. Haploidentical donor status (yes or no)
6.3.3
Blinding
A double-blinding technique will be used. V114 and Prevnar 13™will be prepared and/or 
dispensed by an unblinded pharmacist or unblinded qualified study site personnel. The 
participant and the investigator who is involved in the clinical evaluation of the participants 
will remain blinded to the group assignments.
Because the V114 and Prevnar 13™ have a different appearance, a member of the study site 
staff will be unblinded for the purposes of receiving, maintaining, preparing and/or 
dispensing, and administering these study vaccines. PNEUMOVAX™23 will also be 
prepared and/or dispensed and administered by unblinded study site staff for consistency of 
study vaccine administration across all visits and to protect the study blind in the participants 
receiving a 4th dose of V114 or Prevnar 13™due to chronic GVHD. In order to avoid bias, 
the unblinded study personnel will have no further contact with study participants for any 
study-related procedures/assessments after administration of study vaccines, which includes 
all safety follow up procedures. Additionally, blinded site personnel will not be present in the 
exam room when study vaccines are administered. Contact between participants and 
unblinded study personnel after vaccination administration is strictly prohibited.
Blinded site personnel will be responsible for all safety and immunogenicity follow-up 
procedures after vaccine administration.
An unblinded Clinical Research Associate will monitor vaccine accountability at the study 
site. All other Sponsor personnel or delegate(s) and Merck Research Laboratories (MRL) 
employees directly involved with the conduct of this study will remain blinded to the 
participant-level intervention assignment.
See Section 8.1.12 for a description of the method of unblinding a participant during the 
study should such action be warranted.
6.4
Study Intervention Compliance
Interruptions from the protocol specified plan for V114 or Prevnar 13™ vaccination at 
Visit 2 (Day 1), Visit 3 (Day 30), and Visit 4 (Day 60), and PNEUMOVAX™23 or 4th dose 
of V114 or Prevnar 13™ at Visit 6 (12 months after allo-HSCT), require consultation 
between the investigator and the Sponsor and written documentation of the collaborative 
decision on participant management.
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6.5
Concomitant Therapy
Medications or vaccinations specifically prohibited in the exclusion criteria are not allowed
during the ongoing study. If there is a clinical indication for any medication or vaccination 
specifically prohibited, discontinuation from study intervention may be required. The 
investigator should discuss any questions regarding this with the Sponsor Clinical Director. 
The final decision on any supportive therapy or vaccination rests with the investigator and/or 
the participant’s primary physician. However, the decision to continue the participant on 
study intervention requires the mutual agreement of the investigator, the Sponsor, and the 
participant.
Listed below are specific restrictions for concomitant therapy or vaccination:
1. Any administration of a non-study pneumococcal vaccine is prohibited during the 
study.
2. Administration of any non-live vaccine within the 14 days before or 14 days after 
receipt of any study vaccine is prohibited.
Exception: Inactivated influenza vaccine and haemophilus influenzae type B (Hib)
vaccine may be administered but must be given at least 7 days before and at least 
7 days after receipt of any study vaccine.
3. Administration of any live vaccine within 30 days before or 30 days after receipt of 
any study vaccine is prohibited.
4. Administration of immunoglobulins or plasma products is prohibited within 30 days 
of administration of any study vaccine.
Any deviation from the above requires consultation between the investigator and the Sponsor 
and written documentation of the collaborative decision on participant management.
6.5.1
Rescue Medications and Supportive Care
No rescue or supportive medications are specified to be used in this study.
6.6
Dose Modification (Escalation/Titration/Other)
No dose modification is allowed in this study.
6.7
Intervention After the End of the Study
There is no study-specified intervention following the end of the study.
6.8
Clinical Supplies Disclosure
This study is blinded but supplies are provided open label; therefore, an unblinded 
pharmacist or qualified study site personnel will be used to blind supplies. Study intervention
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identity (name, strength, or potency) is included in the label text; random code/disclosure 
envelopes or lists are not provided.
The emergency unblinding call center will use the intervention/randomization schedule for 
the study to unblind participants and to unmask study intervention identity. The emergency 
unblinding call center should only be used in cases of emergency (see Section 8.1.12). In the 
event that the emergency unblinding call center is not available for a given site in this study, 
the central electronic intervention allocation/randomization system (IRT) should be used to 
unblind participants and to unmask study intervention identity. The Sponsor will not provide 
random code/disclosure envelopes or lists with the clinical supplies.
See Section 8.1.12 for a description of the method of unblinding a participant during the 
study, should such action be warranted.
7
DISCONTINUATION OF STUDY INTERVENTION AND PARTICIPANT 
WITHDRAWAL
7.1
Discontinuation of Study Intervention
Discontinuation of study intervention does not represent withdrawal from the study.
As certain data on clinical events beyond study intervention discontinuation may be 
important to the study, they must be collected through the participant’s last scheduled follow-
up, even if the participant has discontinued study intervention. Therefore, all participants 
who discontinue study intervention prior to completion of the protocol-specified vaccinations
will still continue to participate in the study as specified in Section 1.3 and Section 8.12.3, 
unless the participant withdraws consent (Section 7.2).
Participants may discontinue study intervention at any time for any reason or be discontinued 
from the study intervention at the discretion of the investigator should any untoward effect 
occur. In addition, a participant may be discontinued from study intervention by the 
investigator or the Sponsor if study intervention is inappropriate, the study plan is violated, or 
for administrative and/or other safety reasons. Specific details regarding procedures to be 
performed at study intervention discontinuation are provided in Section 8.1.11.
A participant must be discontinued from study intervention but continue to be monitored in 
the study for any of the following reasons:
•
The participant requests to discontinue study intervention.
•
The participant has a medical condition or personal circumstance which, in the opinion of 
the investigator and/or Sponsor, placed the participant at unnecessary risk from continued 
administration of study intervention.
•
The participant has a confirmed positive urine or serum pregnancy test before any study 
vaccination visit.
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For participants who are discontinued from study intervention but continue to be monitored 
in the study, see Section 1.3 and Section 8.12.3 for those procedures to be completed at each 
specified visit.
Discontinuation from study intervention is “permanent.” Once a participant is discontinued, 
he/she shall not be allowed to restart study intervention.
7.2
Participant Withdrawal From the Study
A participant must be withdrawn from the study if the participant or the participant’s legally 
acceptable representative withdraws consent from the study.
If a participant withdraws from the study, they will no longer receive study treatment or be 
followed at scheduled protocol visits.
Specific details regarding procedures to be performed at the time of withdrawal from the 
study,as well as specific details regarding withdrawal from future biomedical research, are 
outlined in Section 8.1.11. The procedures to be performed should a participant repeatedly 
fail to return for scheduled visits and/or if the study site is unable to contact the participant 
are outlined in Section 7.3.
7.3
Lost to Follow-up
If a participant fails to return to the clinic for a required study visit and/or if the site is unable 
to contact the participant, the following procedures are to be performed:
•
The site must attempt to contact the participant and reschedule the missed visit. If the 
participant is contacted, the participant should be counseled on the importance of 
maintaining the protocol-specified visit schedule.
•
The investigator or designee must make every effort to regain contact with the participant 
at each missed visit (eg, telephone calls and/or a certified letter to the participant’s last 
known mailing address or locally equivalent methods). These contact attempts should be 
documented in the participant’s medical record.
•
Note: A participant is not considered lost to follow-up until the last scheduled visit for the 
individual participant. The missing data for the participant will be managed via the 
prespecified statistical data handling and analysis guidelines.
8
STUDY ASSESSMENTS AND PROCEDURES
•
Study procedures and their timing are summarized in the SoA.
•
Adherence to the study design requirements, including those specified in the SoA, is 
essential and required for study conduct.
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•
The investigator is responsible for ensuring that procedures are conducted by 
appropriately qualified or trained staff. Delegation of study site personnel responsibilities 
will be documented in the Investigator Trial File Binder (or equivalent).
•
All study-related medical decisions must be made by an investigator who is a qualified 
physician .
•
All screening evaluations must be completed and reviewed to confirm that potential 
participants meet all eligibility criteria. The investigator will maintain a screening log to 
record details of all participants screened and to confirm eligibility or record reasons for 
screening failure, as applicable.
•
Additional evaluations/testing may be deemed necessary by the investigator and or the 
Sponsor for reasons related to participant safety. In some cases, such evaluation/testing 
may be potentially sensitive in nature (eg, HIV, Hepatitis C), and thus local regulations 
may require that additional informed consent be obtained from the participant. In these 
cases, such evaluations/testing will be performed in accordance with those regulations.
Table 2 shows the approximate blood volumes drawn by study visit and by sample type for 
the adult cohort. The maximum amount of blood collected from each participant at each 
study visit will not exceed 30 mL and the total amount of blood for the entire study will not 
exceed 89 mL. For those adult participants ≥18 years of age that consent to future biomedical 
research, an additional blood sample of approximately 8.5 mL will be taken.
Table 3 shows the approximate blood volumes drawn by study visit and by sample type for 
the pediatric cohort. The maximum amount of blood collected from each participant at each 
study visit will not exceed 10 mL and the total amount of blood for the entire study will not 
exceed 45.5 mL. Repeat or unscheduled samples may be taken for safety reasons or for 
technical issues with the samples.
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Table 2
Approximate Blood Volumes Drawn by Study Visit and by Sample Type
(Adult Cohort)
Study Visit
Visit 1
(Screen-
ing)
Visit 2
(Day 1)
Visit 3
(Day 30)
Visit 4
(Day 60)
Visit 5
(Day 90)
Visit 6
(12 Months
after Allo-
HSCT)
Visit 7
(30 Days 
after 
Visit 6)
Blood parameter
Approximate Blood Volume (mL)
Complete blood count
2 mL
N/A
N/A
N/A
N/A
N/A
N/A
Chemistry panel
6 mL
N/A
N/A
N/A
N/A
N/A
N/A
Serum for immunogenicity assays 
(including retention serum)
N/A
20 mL
N/A
N/A
20 mL
20 mL
20 mL
Blood (DNA) for future biomedical 
research
N/A
8.5 mL
N/A
N/A
N/A
N/A
N/A
Expected Total (mL)
8 mL
28.5 mL
N/A
N/A
20 mL
20 mL
20 mL
allo-HSCT = allogeneic hematopoietic stem cell transplant; DNA = deoxyribonucleic acid; allo-HSCT = 
allogeneic hematopoietic stem cell transplant; N/A = not applicable
Table 3
Approximate Blood Volumes Drawn by Study Visit and by Sample Type
(Pediatric Cohort)
Study Visit
Visit 1
(Screen-
ing)
Visit 2
(Day 1)
Visit 3
(Day 30)
Visit 4
(Day 60)
Visit 5
(Day 90)
Visit 6
(12 Months
after Allo-
HSCT)
Visit 7
(30 Days 
after 
Visit 6)
Blood parameter
Approximate Blood Volume (mL)
Complete blood count
2 mL
N/A
N/A
N/A
N/A
N/A
N/A
Chemistry panel
3.5 mL
N/A
N/A
N/A
N/A
N/A
N/A
Serum for immunogenicity assays 
(including retention serum)
N/A
10 mL
N/A
N/A
10 mL
10 mL
10 mL
Blood (DNA) for future biomedical 
research
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Expected Total (mL)
5.5 mL
10 mL
N/A
N/A
10 mL
10 mL
10 mL
8.1
Administrative and General Procedures
8.1.1
Informed Consent/Assent
The investigator or medically qualified designee (consistent with local requirements) must 
obtain documented consent, and assent if applicable, from each potential participant prior to 
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participating in a clinical study or future biomedical research. If there are changes to the 
participant’s status during the study (eg, health or age of majority requirements), the 
investigator or medically qualified designee must ensure the appropriate consent/assent is in 
place.
8.1.1.1
General Informed Consent/Assent
Consent/assent must be documented by the participant’s dated signature on a consent/assent
form along with the dated signature of the person conducting the consent discussion.
A copy of the signed and dated consent/assent form should be given to the participant before 
participation in the study.
The initial informed consent/assent form, any subsequent revised written informed 
consent/assent form, and any written information provided to the participant must receive the 
Institutional Review Board/Independent Ethics Committee’s (IRB/IEC’s) approval/favorable 
opinion in advance of use. The participant should be informed in a timely manner if new 
information becomes available that may be relevant to the participant’s willingness to 
continue participation in the study. The communication of this information will be provided 
and documented via a revised consent/assent form or addendum to the original consent/assent
form that captures the participant’s dated signature.
Specifics about a study and the study population will be added to the consent/assent form 
template at the protocol level.
The informed consent will adhere to IRB/IEC requirements, applicable laws and regulations, 
and Sponsor requirements. The assent, as applicable will adhere to IRB/IEC requirements, 
applicable laws and regulations and Sponsor requirements.
8.1.1.2
Consent/Assent and Collection of Specimens for Future Biomedical 
Research
The investigator or medically qualified designee will explain the future biomedical research 
consent/assent to the participant, answer all of his/her questions, and obtain written informed 
consent/assent before performing any procedure related to the future biomedical research 
substudy. A copy of the informed consent/assent will be given to the participant.
8.1.2
Inclusion/Exclusion Criteria
All inclusion and exclusion criteria will be reviewed by the investigator who is a qualified 
physician to ensure that the participant qualifies for the study.
If the participant meets any of the exclusion criteria with an asterisk (*), Visit 2 (Day 1) may 
be rescheduled for a time when these criteria are not met and the Day 1 visit will still occur 
within 90 to 180 days after allo-HSCT. 
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8.1.3
Participant Identification Card
All participants will be given a participant identification card identifying them as participants 
in a research study. The card will contain study site contact information (including direct 
telephone numbers) to be used in the event of an emergency. The investigator or qualified 
designee will provide the participant with a participant identification card immediately after 
the participant provides written informed consent. At the time of intervention
allocation/randomization, site personnel will add the intervention/randomization number to 
the participant identification card.
The participant identification card also contains contact information for the emergency 
unblinding call center so that a healthcare provider can obtain information about study 
intervention in emergency situations where the investigator is not available.
8.1.4
Medical History
A medical history will be obtained by the investigator or qualified designee at Visit 1 
(Screening visit) and will be confirmed before vaccination at Visit 2 (Day 1). The 
participant’s medical history for the 5 years prior to Visit 2 (Day 1) will be obtained to 
ensure that the participant satisfies the inclusion and exclusion criteria of the study. History 
of tobacco use will also be collected for all participants.
8.1.5
Prior and Concomitant Medications Review
8.1.5.1
Prior Medications
The investigator or qualified designee will review and record prior vaccinations and 
medications taken by the participant within 30 days before the 1st dose of study vaccine at 
Visit 2 (Day 1).
8.1.5.2
Concomitant Medications
The investigator or qualified designee will record medication, if any, taken by the participant 
during the study.
New and/or concomitant medications taken after the 1st dose of study vaccination at Visit 2 
(Day 1) and non-study vaccines received since Visit 2 will be recorded with the eVRC as 
specified in Section 8.3.4. 
8.1.6
Assignment of Screening Number
All consented participants will be given a unique screening number that will be used to 
identify the participant for all procedures that occur prior to randomization.Each participant 
will be assigned only 1 screening number. Screening numbers must not be re-used for 
different participants.
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Any participant who is screened multiple times will retain the original screening number 
assigned at the initial screening visit. Specific details on the screening/rescreening visit 
requirements are provided in Section 8.12.1.
8.1.7
Assignment of Treatment/Randomization Number
All eligible participants will be randomly allocated and will receive a 
treatment/randomization number. The treatment/randomization number identifies the 
participant for all procedures occurring after treatment allocation/randomization. Once a 
treatment/randomization number is assigned to a participant, it can never be re-assigned to 
another participant.
A single participant cannot be assigned more than 1 treatment/randomization number.
8.1.8
Study Intervention Administration
V114 or Prevnar 13™ will be administered at Visit 2 (Day 1), Visit 3 (Day 30), and Visit 4 
(Day 60). PNEUMOVAX™23, or alternatively V114 or Prevnar 13™for participants with 
chronic GVHD, will be administered at Visit 6 (12 months after allo-HSCT).
Unblinded study personnel not otherwise involved in the conduct of the study will prepare 
and administer the study vaccine. Study vaccines should be prepared and administered by 
appropriately qualified members of the study personnel (eg, physician, nurse, physician’s 
assistant, nurse practitioner, pharmacist or medical assistant) as allowed by local/state, 
country and institutional guidance. Procedures for handling, preparing, and administering the 
unblinded vaccines are provided in the Investigator Trial File Binder. Unblinded study 
personnel should follow the preparation and administration instructions for Prevnar 13™ as 
specified in the product labels.
Study vaccines should be removed from the refrigerator no more than 1 hour before 
vaccination. The time of removal and time of vaccination should be documented in the 
participant’s chart.
If the V114 is provided as a syringe: Prior to administration of study vaccine, the unblinded 
pharmacist should shake vigorously to obtain a homogenous white suspension. If 
white-colored insoluble particle appears, the unblinded pharmacist should use rapid, 
horizontal hand-shaking for 5 to 10 seconds while holding the syringe in between the thumb 
and index finger until complete resuspension. This action should be repeated, as necessary. If 
appearance is otherwise, the vaccine should not be administered. 
If V114 is provided as a vial: Prior to administration of study vaccine, the unblinded 
pharmacist should use rapid, horizontal hand-shaking for up to 5 seconds while holding the 
vial in between the thumb and index finger to obtain a homogenous white suspension. This 
action should be repeated, as necessary. If appearance is otherwise, the vaccine should not be 
administered. 
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The vaccine should not be used if the vaccine cannot be resuspended. Study personnel should 
follow the preparation and administration instructions for Prevnar 13™ and 
PNEUMOVAX™23 as specified in the product labels.  Prevnar 13™ and 
PNEUMOVAX™23 will be supplied as a pre-filled syringe.
V114, Prevnar 13™ and PNEUMOVAX™23 will be administered to adult and pediatric 
participants as a single 0.5-mL intramuscular injection in the deltoid region of the 
participant’s arm. Adequate treatment provision, including epinephrine and equipment for 
maintaining an airway, should be available for immediate use should an anaphylactic or 
anaphylactoid reaction occur [Centers for Disease Control and Prevention 2015].  
Unblinded study personnel should not have contact with participants for any study-related 
procedures/assessments after administration of study vaccines, which includes all safety 
follow-up procedures. All safety and immunogenicity assessments will be conducted by 
blinded personnel, and the participant and/or participant’s parent/guardian will be blinded to 
the study vaccine received by the participant. Vaccination information, such as Component 
Identification Number and time of vaccination, must be recorded on the appropriate eCRF as 
per the Data Entry Guidelines.
8.1.8.1
Timing of Dose Administration
Vaccinations may be administered at any time of day, and without regard to timing of meals. 
Each participant's body temperature must be taken before each vaccine administration. 
Individuals who present with fever (oral or tympanic temperature ≥100.4°F [≥38.0°C]; 
axillary or temporal temperature ≥99.4°F [≥37.4°C]; or rectal temperature ≥101.4°F 
[≥38.6°C]) will have the vaccination delayed until fever is resolved for at least 72 hours.
The collection of blood samples and administration of pregnancy tests (if applicable) must be 
done before each vaccine administration.
All participants will be observed for 30 minutes after each vaccination for any immediate 
reactions. This observation must be performed by blinded site personnel for all study 
vaccines (Section 1.3 and Section 6.3.3).
8.1.9
Electronic Vaccination Report Card
The eVRC was developed to be administered electronically via a hand-held device. This item 
was structured as recommended in the final Food and Drug Administration Patient Reported 
Outcome Guidance [U.S. Food and Drug Administration 2009]. The investigator or delegate 
will train the participant or participant’s legally acceptable representative in the use of the 
eVRC at Visit 2 (Day 1) and Visit 6 (12 months after allo- HSCT).
Temperatures, injection-site reactions, vaccine-specific complaints, other complaints or 
illnesses, and concomitant medications or vaccinations will be recorded on the eVRC as 
described in Section 1.3 and Section 8.3.4. 
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
The investigator or delegate will review the data captured on the eVRC with the 
participant or the participant’s legally acceptable representative at Phone Contact 
(Day 15), Visit 3 (Day 30), Phone Contact (Day 45), Visit 4 (Day 60), Phone Contact 
(Day 75), and Visit 5 (Day 90), as well as at Phone Contact (15 days after Visit 6) and 
Visit 7 (the Follow-up visit, 30 days after Visit 6).

Any differences between eVRC data and the clinical database must be clearly 
explained in the participant’s source documentation with an indication of where the 
information was obtained (eg, from the Day 15 Postdose Telephone Contact with the 
participant or participant’s legally acceptable representative).
For the AEs outlined above, the investigator will use the information provided by the 
participant or the participant’s legally acceptable representative both on the eVRC, and 
verbally at the time of eVRC review, to apply the appropriate assessment of intensity and 
toxicity as described in Appendix 3.  
8.1.10
Telephone Contact Questionnaire
Site personnel will contact study participants or the participant’s legally acceptable 
representative at approximately 9 months after the reported date of their allo-HSCT to collect 
additional information based on a Telephone Contact Questionnaire provided by the Sponsor.
Data to be reported from this discussion will include SAEs, specific events of interest, and/or
any updates to previously reported safety information. 
If a study site visit occurs within 30 days before the 9-month post-allo-HSCT time point, then 
this Phone Contact will not occur and the Telephone Contact Questionnaire will not be 
required.
A second safety follow-up telephone contact will need to be conducted only for those
participants receiving a 4th dose of V114 or Prevnar 13™at 6 months after Visit 6.
8.1.11
Discontinuation and Withdrawal
Participants who discontinue study intervention prior to completion of the protocol-specified 
vaccinations should be encouraged to continue to be followed for all remaining study visits.
When a participant withdraws from participation in the study, all applicable activities 
scheduled for the final study visit (Visit 7 [30 Days after Visit 6]) should be performed (at 
the time of withdrawal). Any AEs that are present at the time of withdrawal should be 
followed in accordance with the safety requirements outlined in Section 8.4 .
8.1.11.1
Withdrawal From Future Biomedical Research
Participants may withdraw their consent for future biomedical research. Participants may 
withdraw consent at any time by contacting the principal investigator for the main study. If 
medical records for the main study are still available, the investigator will contact the 
Sponsor using the designated mailbox (clinical.specimen.management@merck.com). 
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Subsequently, the participant's consent for future biomedical research will be withdrawn. A 
letter will be sent from the Sponsor to the investigator confirming the withdrawal. It is the 
responsibility of the investigator to inform the participant of completion of withdrawal. Any 
analyses in progress at the time of request for withdrawal or already performed prior to the 
request being received by the Sponsor will continue to be used as part of the overall research 
study data and results. No new analyses would be generated after the request is received.
In the event that the medical records for the main study are no longer available (eg, if the 
investigator is no longer required by regulatory authorities to retain the main study records) 
or the specimens have been completely anonymized, there will no longer be a link between 
the participant’s personal information and their specimens. In this situation, the request for 
specimen withdrawal cannot be processed.
8.1.12
Participant Blinding/Unblinding
STUDY INTERVENTION IDENTIFICATION INFORMATION IS TO BE UNMASKED 
ONLY IF NECESSARY FOR THE WELFARE OF THE PARTICIPANT. EVERY 
EFFORT SHOULD BE MADE NOT TO UNBLIND.
For emergency situations where the investigator or medically qualified designee (consistent 
with local requirements) needs to identify the drug used by a participant and/or the dosage 
administered, he/she will contact the emergency unblinding call center by telephone and 
make a request for emergency unblinding. As requested by the investigator or medically 
qualified designee, the emergency unblinding call center will provide the information to 
him/her promptly and report unblinding to the Sponsor. Prior to contacting the emergency 
unblinding call center to request unblinding of a participant’s treatment assignment, the 
investigator who is a qualified physician should make reasonable attempts to enter the 
intensity/toxicity grade of the AEs observed, the relation to study intervention, the reason 
thereof, etc., in the medical chart. If it is not possible to record this assessment in the chart 
prior to the unblinding, the unblinding should not be delayed.
In the event that unblinding has occurred, the circumstances around the unblinding (eg, date, 
reason, and person performing the unblinding) must be documented promptly, and the 
Sponsor Clinical Director notified as soon as possible.
Participants whose treatment assignment has been unblinded by the investigator or medically 
qualified designee and/or nonstudy treating physician should continue to be monitored in the 
study. Participants may receive PNEUMOVAX™23, or V114 or Prevnar 13™ for 
participants with chronic GVHD, at Visit 6 (12 months after allo-HSCT) after a benefit/risk 
assessment and consultation between the investigator/delegate and Sponsor
Additionally, the investigator or medically qualified designee must go into the IRT system 
and perform the unblind in the IRT system to update drug disposition. In the event that the 
emergency unblinding call center is not available for a given site in this study, the IRT 
system should be used for emergency unblinding in the event that this is required for 
participant safety.
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8.1.13
Calibration of Equipment
The investigator or qualified designee has the responsibility to ensure that any device or 
instrument used for a clinical evaluation/test during a clinical study that provides information 
about inclusion/exclusion criteria and/or safety or efficacy parameters shall be suitably 
calibrated and/or maintained to ensure that the data obtained is reliable and/or reproducible. 
Documentation of equipment calibration must be retained as source documentation at the 
study site.
8.2
Immunogenicity Assessments
Sera from participants will be used to measure vaccine-induced OPA and IgG for serotypes 
included in V114 and Prevnar 13™. These endpoints will be tested for all blood draws. 
Blood collection, storage and shipment instructions for serum samples will be provided in the 
operations/laboratory manual.
Measurement of serotype-specific IgG will be measured using the PnECL v2.0 assay to 
assess the concentration of binding antibodies to capsular polysaccharide of S. pneumoniae
for the serotypes included in the study vaccines.
The MOPA will be used for measuring OPA GMTs. Opsonization of pneumococci for 
phagocytosis is an important mechanism by which antibodies to polysaccharides protect 
against disease in vivo. The OPA assay is a useful tool for assessing the protective function 
of serotype-specific antibodies and therefore the immunogenicity of pneumococcal vaccine 
formulations.
8.2.1
Electrochemiluminescence (ECL)
MSD has developed and optimized a multiplex, ECL-based detection method for the 
quantitation of IgG serotype-specific antibodies to the 15 pneumococcal polysaccharide 
serotypes contained in V114. The PnECL v2.0 assay is based on the Meso-Scale Discovery 
technology, which employs disposable multi-spot microtiter plates. The benefits of the ECL 
multiplex technology over the prior enzyme-linked immunosorbent assay methodology 
include speed, equivalent or better sensitivity, increased dynamic range, the ability to 
multiplex, and reduction in required serum sample and reagent volumes. The measurement of 
immune responses to the 15 serotypes included in V114 is performed using an assay format 
consisting of 2 groups of 7 and 8 serotypes each. The PnECL v2.0 assay for all 15 serotypes 
has undergone validation. The validation study evaluated various performance parameters of 
the assay including precision, ruggedness, relative accuracy, dilutional linearity, selectivity, 
and specificity. The validation results were evaluated against prespecified acceptance criteria 
for each of the parameters.
8.2.2
Multiplex Opsonophagocytic Assay (MOPA)
The MOPA, developed and published by Professor Moon Nahm (Director of the United 
States World Health Organization pneumococcal serology reference laboratory and National 
Institutes of Health pneumococcal reference laboratories), is a multiplexed OPA assay 
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capable of measuring 4 serotypes at a time, against a total of 16 serotypes of pneumococci 
[Burton, Robert L. and Nahm, Moon H. 2006]. The OPA is an antibody-mediated killing 
assay that measures the ability of human serum to kill S. pneumoniae serotypes with the help 
of complement and phagocytic effector cells. The ability of the assay to simultaneously test 4 
serotypes/run reduces the amount of serum needed for testing. The assay readout is the 
opsonization index, which is the reciprocal of the highest dilution that gives ≥50% bacterial 
killing, as determined by comparison to assay background controls. Merck Sharp & Dohme 
Corp. has developed and optimized the MOPA in a high throughput micro-colony platform. 
The MOPA assay for all 15 V114 serotypes has undergone validation. The validation study 
evaluated various performance parameters of the assay including precision, relative 
accuracy/dilutional linearity, and specificity. The validation results were evaluated against 
pre-specified acceptance criteria for each of the parameters.
8.3
Safety Assessments
Details regarding specific safety procedures/assessments to be performed in this study are 
provided. 
Planned time points for all safety assessments are provided in the SoA.
8.3.1
Physical Examinations
A complete physical examination will be conducted by an investigator or medically qualified 
designee (consistent with local requirements) as clinically relevant for this patient population 
before vaccination at Visit 2 (Day 1).  A directed physical examination will be conducted by 
an investigator or medically qualified designee (consistent with local requirements) before 
vaccination at Visit 3 (Day 30), Visit 4 (Day 60), and Visit 6 (12 months after allo-HSCT). 
Investigators should pay special attention to clinical signs related to previous illnesses.  A 
directed physical examination includes obtaining vital signs (heart rate, respiratory rate, 
blood pressure, body temperature) and a physical examination focused on complaints based 
on medical history. In the source documents, investigators should document physical exam 
data and the status of all active medical conditions. Note that temperature is the only vital 
sign to be collected in the InForm database for this trial.
A complete physical examination includes but is not limited to the assessments of systemic 
assessment of general appearance, vital signs (heart rate, respiratory rate, blood pressure, 
body temperature), eyes, throat, mouth, cardiovascular, respiratory, gastrointestinal, skin, 
neurologic and psychiatric systems, and other organ systems as indicated.
8.3.2
Pregnancy Test
A pregnancy test consistent with local requirements (sensitive to at least 25 IU beta human 
chorionic gonadotropin [β-hCG]) must be performed before vaccination at Visit 2 (Day 1), 
Visit 3 (Day 30), Visit 4 (day 60), and Visit 6 (122 months after allo-HSCT) in WOCBP as 
described in Section 1.3. Pregnancy tests can be repeated as needed based on local 
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requirements. Urine or serum tests can be used, and results must be negative before 
vaccination can occur.
8.3.3
Body Temperature Measurement
Prevaccination body temperature will be taken by study staff before vaccination as described 
in Section 1.3.  Participants who have febrile illness (oral temperature ≥38.0°C [≥100.4°F] or 
axillary temperature ≥37.4°C [≥99.4°F]) occurring at or within 72 hours of a study 
vaccination visit must be rescheduled.  Oral is the preferred method of obtaining participant’s 
temperature. Axillary (underarm) is an acceptable method for pediatric participants but 
temperature needs to be confirmed by oral measurement if fever is detected. If an axillary 
temperature is reported to be ≥37.4°C (≥99.4°F), an oral temperature must be taken. 
The participant or the participant’s legally acceptable representative will be asked to record 
body temperature using their eVRC during the eVRC-specified postvaccination follow-up 
period (Section 8.3.4). Adult participants should be instructed to take their post vaccination 
body temperatures Day 1 through Day 5 following each vaccination.  Post vaccination 
temperatures for pediatric participants <18 years of age should be taken Day 1 through Day 7 
following each vaccination by the participant or the participant’s legally acceptable 
representative.  For pediatric participants, a temperature measurement must be recorded in 
the eVRC if fever is suspected during Day 8 through Day 14 postvaccination.
Postvaccination temperature readings should be taken at approximately the same time each 
day.  Temporal or tympanic thermometers to collect temperature for this study is prohibited.
All fevers must be reported Day 1 through Day 14, unless the fever is a symptom of another 
reported AE. 
8.3.4
Safety Assessments and Use of the eVRC
All participants will be observed for 30 minutes after each vaccination for any immediate 
reactions. If any immediate AEs are observed during this period, the time at which the event 
occurred within this time frame, as well as the event itself, any concomitant medications that 
were administered, and resolution of the event, must be recorded on the appropriate eCRF.
Adult participants will use the eVRC (Section 8.1.9) to document the following information:
•
Oral body temperatures measured Day 1 (day of vaccination) through Day 5 
postvaccination;
•
Solicited injection-site AEs (redness/erythema, swelling, and tenderness/pain) Day 1 
through Day 5 postvaccination;
•
Solicited systemic AEs (muscle pain/myalgia, joint pain/arthralgia, headache, and 
tiredness/fatigue) Day 1 through Day 14 postvaccination;
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•
Any other injection-site or systemic AEs Day 1 through Day 14 postvaccination; and
•
Concomitant medications and nonstudy vaccinations Day 1 to Day 14 postvaccination.
Pediatric participants or the participant’s legally acceptable representative will use the eVRC 
(Section 8.1.9) to document the following information:
Pediatric participants 3 to <18 years of age
•
Body temperatures measured Day 1 (day of vaccination) through Day 7 postvaccination; 
Day 8 through Day 14 postvaccination if fever is suspected
•
Solicited injection-site AEs (redness/erythema, swelling, tenderness/pain, and hard lump) 
Day 1 through Day 14 postvaccination
•
Solicited systemic AEs (muscle pain/myalgia, joint pain/arthralgia, headache, 
tiredness/fatigue, and hives or welts) Day 1 through Day 14 postvaccination
•
Any other injection-site or systemic AEs Day 1 through Day 14 postvaccination
•
Use of any analgesic or antipyretic on the day of vaccination.
•
Concomitant medications and nonstudy vaccinations Day 1 to Day 14 postvaccination.
8.3.5
Clinical Laboratory Assessments
•
Refer to Appendix 2 for the list of clinical laboratory tests to be performed and to the 
SoA for the timing and frequency.
•
All protocol-required laboratory assessments, as defined in Appendix 2, must be 
conducted in accordance with the laboratory manual and the SoA.
•
If laboratory values from nonprotocol specified laboratory assessments performed at the 
institution’s local laboratory require a change in study participant management or are 
considered clinically significant by the investigator (eg, SAE or AE or dose 
modification), then the results must be recorded in the appropriate CRF (eg, SLAB).
•
For any laboratory tests with values considered clinically significantly abnormal during 
participation in the study or within 30 to 44 days after the last dose of study intervention, 
every attempt should be made to perform repeat assessments until the values return to 
normal or baseline or if a new baseline is established as determined by the investigator.
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8.4
Adverse Events (AEs), Serious Adverse Events (SAEs), and Other Reportable 
Safety Events
The definitions of an AE or SAE, as well as the method of recording, evaluating, and 
assessing causality of AE and SAE and the procedures for completing and transmitting AE, 
SAE, and other reportable safety event reports can be found in Appendix 3.
Adverse events, SAEs, and other reportable safety events will be reported by the participant 
or the participant’s legally acceptable representative.
The investigator and any designees are responsible for detecting, documenting, and reporting 
events that meet the definition of an AE or SAE as well as other reportable safety events. 
Investigators remain responsible for following up AE, SAEs, and other reportable safety 
events for outcome according to Section 8.4.3.
The investigator, who is a qualified physician, will assess events that meet the definition of 
an AE or SAE as well as other reportable safety events with respect to seriousness, 
intensity/toxicity and causality.
8.4.1
Time Period and Frequency for Collecting AE, SAE, and Other Reportable 
Safety Event Information
All AEs, SAEs, and other reportable safety events that occur after the consent form is signed 
but before allocation/randomization must be reported by the investigator if they cause the 
participant to be excluded from the study, or are the result of a protocol-specified 
intervention, including but not limited to washout or discontinuation of usual therapy, diet, 
placebo treatment, or a procedure.
All AEs, SAEs, and other reportable safety events must be reported by the investigator from 
the day of allocation/randomization to the first vaccination and from the day of each 
vaccination through 14 days postvaccination. SAEs and specific events of interest must also 
be reported throughout the duration of the individual’s participation in the study, regardless 
of whether or not related to the Sponsor’s product.
Additionally, any SAE brought to the attention of an investigator at any time outside of the 
time period specified in the previous paragraph also must be reported immediately to the 
Sponsor if the event is either:

A death that occurs prior to the participant completing the study.
OR

An SAE that is considered by an investigator who is a qualified physician to be vaccine 
related.
Investigators are not obligated to actively seek AE or SAE or other reportable safety events 
in former study participants. However, if the investigator learns of any SAE, including a 
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death, at any time after a participant has been discharged from the study, and he/she 
considers the event to be reasonably related to the study intervention or study participation, 
the investigator must promptly notify the Sponsor.
All initial and follow-up AEs, SAEs, and other reportable safety events will be recorded and 
reported to the Sponsor or designee within the time frames as indicated in Table 4.
Table 4
Reporting Time Periods and Time Frames for Adverse Events and Other 
Reportable Safety Events
Type of Event
Reporting Time 
Period:
Consent to 
Randomization/ 
Allocation
Reporting Time 
Period:
Randomization/ 
Allocation 
through Protocol-
Specified Follow-
up Period
Reporting Time Period:
After the Protocol 
Specified Follow-up 
Period
Time frame 
to Report 
Event and 
Follow-up 
Information 
to 
SPONSOR:
Non-Serious Adverse 
Event (NSAE)
Report if:
- due to protocol-
specified 
intervention
- causes exclusion
- participant is 
receiving placebo 
run-in or other 
run-in treatment
Report all
Not required
Per data entry 
guidelines
Serious Adverse Event 
(SAE)
Report if:
- due to protocol-
specified 
intervention
- causes exclusion
- participant is 
receiving placebo 
run-in or other 
run-in treatment
Report all
Report if:
- drug/vaccine related.
- any death until 
participant completion of 
study
(Follow ongoing to 
outcome)
Within 24 
hours of 
learning of 
event
Pregnancy/Lactation 
Exposure
Report if:
- due to 
intervention
- causes exclusion
Report all
Previously reported –
Follow to 
completion/termination; 
report outcome
Within 24 
hours of 
learning of 
event
Event of Clinical 
Interest
There are no Events of Clinical Interest for this study.
Not 
applicable
Cancer
Report if:
- due to 
intervention
- causes exclusion
Report all
Not required
Within 5 
calendar days 
of learning of 
event
Overdose
Report if:
- receiving 
placebo run-in or 
other run-in 
medication 
Report all
Not required
Within 5 
calendar days 
of learning of 
event
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8.4.2
Method of Detecting AEs, SAEs, and Other Reportable Safety Events
Care will be taken not to introduce bias when detecting AE and/or SAE and other reportable 
safety events. Open-ended and nonleading verbal questioning of the participant is the 
preferred method to inquire about AE occurrence.
8.4.3
Follow-up of AE, SAE, and Other Reportable Safety Event Information
After the initial AE/SAE report, the investigator is required to proactively follow each 
participant at subsequent visits/contacts. All AE, SAE, and other reportable safety events 
including pregnancy and exposure during breastfeeding, cancer, and overdose will be 
followed until resolution, stabilization, until the event is otherwise explained, or the 
participant is lost to follow-up (as defined in Section 7.3). In addition, the investigator will 
make every attempt to follow all nonserious AEs that occur in randomized participants for 
outcome. Further information on follow-up procedures is given in Appendix 3.
8.4.4
Regulatory Reporting Requirements for SAE
Prompt notification (within 24 hours) by the investigator to the Sponsor of SAE is essential 
so that legal obligations and ethical responsibilities towards the safety of participants and the 
safety of a study intervention under clinical investigation are met.
The Sponsor has a legal responsibility to notify both the local regulatory authority and other 
regulatory agencies about the safety of a study intervention under clinical investigation. All 
AEs will be reported to regulatory authorities, IRB/IECs, and investigators in accordance 
with all applicable global laws and regulations (ie, per ICH Topic E6 (R2) Guidelines for 
Good Clinical Practice [GCP]).
Investigator safety reports must be prepared for suspected unexpected serious adverse 
reactions (SUSARs) according to local regulatory requirements and Sponsor policy and 
forwarded to investigators as necessary.
An investigator who receives an investigator safety report describing an SAE or other 
specific safety information (eg, summary or listing of SAE) from the Sponsor will file it 
along with the IB and will notify the IRB/IEC, if appropriate according to local requirements.
8.4.5
Pregnancy and Exposure During Breastfeeding
Although pregnancy and infant exposure during breastfeeding are not considered AEs, any 
pregnancy or infant exposure during breastfeeding in a participant (spontaneously reported to 
the investigator or their designee) that occurs during the study are reportable to the Sponsor.
All reported pregnancies must be followed to the completion/termination of the pregnancy. 
Pregnancy outcomes of spontaneous abortion, missed abortion, benign hydatidiform mole, 
blighted ovum, fetal death, intrauterine death, miscarriage, and stillbirth must be reported as 
serious events (Important Medical Events). If the pregnancy continues to term, the outcome 
(health of infant) must also be reported.
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8.4.6
Disease-related Events and/or Disease-related Outcomes Not Qualifying as 
AEs or SAEs
This is not applicable to this study.
8.4.7
Events of Clinical Interest (ECIs)
There are no events of clinical interest for this study.
8.4.8
Specific Events of Interest
Throughout a participant’s participation in the study, new onset and/or worsening of GVHD
status since Day 1 as well as relapse and progression of underlying disease (ie, the disease for 
which allo-HSCT was performed [see inclusion criterion 2 in Section 5.1]) will be recorded 
as specific events of interest. Specific events of interest are to be reported as non-serious or 
serious AEs as defined in Appendix 3. Standard reporting time frames for non-serious and 
serious AEs will apply (see Table 4 in Section 8.4.1).
8.5
Treatment of Overdose
In this study, an overdose is the administration of more than 1 dose of any individual study 
vaccine in any 24-hour period.
No specific information is available on the treatment of overdose.
Decisions regarding dose interruptions or modifications will be made by the investigator in 
consultation with the Sponsor Clinical Director based on the clinical evaluation of the 
participant.
All reports of overdose must be reported by the investigator within 5 calendar days to the 
Sponsor either by electronic media or paper. Electronic reporting procedures can be found in 
the electronic data collection (EDC) data entry guidelines. Paper reporting procedures can be 
found in the Investigator Trial File Binder (or equivalent).
8.6
Pharmacokinetics
PK parameters will not be evaluated in this study.
8.7
Pharmacodynamics
Pharmacodynamic parameters will not be evaluated in this study.
8.8
Future Biomedical Research Sample Collection
If the participant or the participant’s legally acceptable representative signs the future 
biomedical research consent, the following specimens will be obtained as part of future 
biomedical research:
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•
DNA for future research
•
Leftover study serum after completion of immunogenicity testing stored for future 
research
8.9
Planned Genetic Analysis Sample Collection
Planned genetic analysis samples will not be evaluated in this study.
8.10
Biomarkers
Biomarkers are not evaluated in this study.
8.11
Medical Resource Utilization and Health Economics
Medical Resource Utilization and Health Economics are not evaluated in this study.
8.12
Visit Requirements
Visit requirements are outlined in Section 1.3. Specific procedure-related details are provided 
in Section 8.
8.12.1
Screening
Screening procedures will be conducted at Visit 1 as outlined in Section 1.3.
8.12.2
Treatment Period/Vaccination Visit
Requirements during the treatment period are outlined in Section 1.3.
8.12.3
Discontinued Participants Continuing to be Monitored in the Study
A participant may discontinue from study intervention (ie, vaccination) but continue to 
participate in subsequent protocol visits as outlined in Section 1.3, as long as the participant 
or the participant’s legally acceptable representative does not withdraw consent. 
Protocol-specified activities, including blood draws for immunogenicity assessments and AE 
monitoring, should occur at these visits.
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9
STATISTICAL ANALYSIS PLAN
This section outlines the statistical analysis strategy and procedures for the study. Changes to 
analyses made after the protocol has been finalized, but prior to unblinding, will be 
documented in a supplemental statistical analysis plan and referenced in the Clinical Study 
Report (CSR) for the study. Post hoc exploratory analyses will be clearly identified in the 
CSR. 
9.1
Statistical Analysis Plan Summary
Key elements of the statistical analysis plan are summarized below; the comprehensive plan 
is provided in Sections 9.2 through 9.12.
Study Design Overview
A Phase 3, Randomized, Double-Blind, Active Comparator-Controlled, 
Multicenter Clinical Trial to Evaluate the Safety, Tolerability, and 
Immunogenicity of V114 in Recipients of Allogeneic Hematopoietic 
Stem Cell Transplant (PNEU-STEM)
Treatment Assignment
Approximately 250 adult participants and approximately 50 pediatric 
participants (3 years of age and older) will be randomized, with 
approximately 150 participants in each intervention group.  
Participants will be randomly assigned in a 1:1 ratio to V114 or 
Prevnar 13™, respectively. Randomization will be stratified into 
12 groups based on (1) use of systemic steroids within 14 days before
randomization (Day 1) (yes or no) and (2) age category (3 to 
<18 years,18 to 49 years and ≥50 years) (3) haploidentical donor status 
(yes or no) as described in Section 6.3.2. 
Analysis Populations
Immunogenicity: Per-Protocol (PP)
Safety: All Participants as Treated (APaT)
Primary Endpoint(s)
Immunogenicity:

Serotype-specific IgG GMCs at 30 days following the 3rd dose of
V114 or Prevnar 13™ (Day 90)
Safety: Following any of the 3 doses of V114 and any of the 3 doses of
Prevnar 13™for adults (≥18 years of age):

Proportion of participants with solicited injection-site AEs 
(redness/erythema, swelling, tenderness/pain) from Day 1 through 
Day 5 postvaccination

Proportion of participants with solicited systemic AEs (muscle 
pain/myalgia, joint pain/arthralgia, headache, and tiredness/fatigue)
from Day 1 through Day 14 postvaccination

Proportion of participants with vaccine-related SAEs from Day 1 
postvaccination to Month 12 following allo-HSCT
     Following any of the 3 doses of V114 and any of the 3 doses of    
      Prevnar 13™for pediatrics (3 to <18 years of age):

Proportion of participants with solicited injection-site AEs 
(redness/erythema, swelling, tenderness/pain, and hard lump) from
Day 1 through Day 14 postvaccination
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
Proportion of participants with solicited systemic AEs (muscle 
pain/myalgia, joint pain/arthralgia, headache, tiredness/fatigue, and 
hives and welts ) from Day 1 through Day 14 postvaccination

Proportion of participants with vaccine-related SAEs from Day 1 
postvaccination to Month 12 after Allo-HSCT
Key Secondary Endpoints
Immunogenicity:

Serotype-specific OPA GMTs at 30 days following the 3rd dose of
V114 or Prevnar 13™ (Day 90)
Safety: The following analysis endpoints will be evaluated following 
vaccination with PNEUMOVAX™23 and following the 4th dose of V114 
or Prevnar 13™ (separately) for adults (≥18 years of age):

Proportion of participants with solicited injection-site AEs 
(redness/erythema, swelling, tenderness/pain) from Day 1 through 
Day 5 postvaccination

Proportion of participants with solicited systemic AEs (muscle 
pain/myalgia, joint pain/arthralgia, headache, and tiredness/fatigue)
from Day 1 through Day 14 postvaccination

Proportion of participants with vaccine-related SAEs from Month 12 
Allo-HSCT to 1 month postvaccination or the completion of the 
study. (from Month 12 to Month 13 after allo-HSCT or the 
completion of the study)
The following analysis endpoints will be evaluated following vaccination 
with PNEUMOVAX™23 and following the 4th dose of V114 or Prevnar 
13™ (separately) for pediatrics (3 to <18 years of age):

Proportion of participants with solicited injection-site AEs 
(redness/erythema, swelling, tenderness/pain, hard lump) from Day 1 
through Day 14 postvaccination

Proportion of participants with solicited systemic AEs (muscle 
pain/myalgia, joint pain/arthralgia, headache, tiredness/fatigue, hives 
and welts) from Day 1 through Day 14 postvaccination

Proportion of participants with vaccine-related SAEs from Month 12 
Allo-HSCT to 1 month postvaccination or the completion of the 
study. (from Month 12 to Month 13 after allo-HSCT or the 
completion of the study)
Statistical Methods for Key 
Immunogenicity Analyses
Immunogenicity analyses will be conducted for the adult and pediatric 
participants for each of the 15 pneumococcal serotypes in V114 
separately. To address the primary immunogenicity objective, estimation 
of the IgG GMCs at 30 days following the 3rd vaccination with V114 or 
Prevnar 13™ (Day 90) will include descriptive summaries and 
within-group 95% CIs to be calculated for each vaccination group. A 
similar statistical approach will be used to evaluate the OPA responses at 
Day 90.
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Statistical Methods for Key 
Safety Analyses
The analysis strategy for safety parameters following each vaccination is 
described in Section 9.6.2. Safety parameters will be summarized for 
adult and pediatric participants separately via descriptive statistics. In 
addition, for select safety parameters, 95% within-group CIs will be 
provided.
Interim Analyses
To support the periodic review of safety and tolerability data across the 
V114 Phase 3 program, an external unblinded statistician will provide 
unblinded interim safety summaries to an independent external DMC for 
their review. There are no plans to conduct an interim analysis of 
unblinded immunogenicity data in this study. However, unblinded 
immunogenicity data will be made available to the DMC upon request to 
enable a benefit-risk assessment.
Multiplicity
No adjustment will be made for multiplicity.
Sample Size and Power 
Immunogenicity:
This study will randomize approximately 150 participants into the V114 
group and 150 participants into the Prevnar 13™ group. It is assumed 
that approximately 105 participants per group will be evaluable for 
immunogenicity analyses at Day 90 (70% evaluability rate). There are no 
hypotheses to be evaluated, but Section 9.9.1 provides information about 
the expected variability of the IgG GMCs given the sample size. 
Safety: 
Section 9.9.2 provides information about the ability of this study to 
estimate the incidence of AEs within the V114 group. 
9.2
Responsibility for Analyses/In-house Blinding
The statistical analysis of the data obtained from this study will be the responsibility of the 
Clinical Biostatistics department of the Sponsor.
This study will be conducted as a double-blind study under in-house blinding procedures. 
The official, final database will not be unblinded until medical/scientific review has been 
performed, protocol deviations have been identified, and data have been declared final and 
complete.
The Clinical Biostatistics department will generate the randomized allocation schedule(s) for 
study intervention assignment. Randomization will be implemented using an IRT.
Blinding issues related to the planned interim analyses are described in Section 9.7.
9.3
Hypotheses/Estimation
Objectives of the study are stated in Section 3. This is an estimation study and no formal 
hypothesis testing will be performed.
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9.4
Analysis Endpoints
Immunogenicity and safety analysis endpoints that will be summarized are listed below.
9.4.1
Immunogenicity Endpoints
For all participants (adult and pediatric) a description of immunogenicity assessments is 
contained in Section 8.2.
The immune responses will be measured for each of the following serotypes contained in 
V114: 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F. The primary 
immunogenicity endpoints are the serotype-specific IgG GMCs at 30 days following the 3rd
dose of V114 and Prevnar 13™ (Day 90).
The secondary immunogenicity analysis endpoints include:
•
Serotype-specific OPA GMTs at 30 days following the 3rd dose of V114 and Prevnar 
13™ (Day 90)
•
Serotype-specific GMFRs and proportions of participants with a ≥4-fold rise from 
prevaccination (Day 1) to 30 days following the 3rd dose of V114 and Prevnar 13™
(Day 90) for both IgG and OPA responses.
The exploratory immunogenicity analysis endpoints include:

Serotype-specific IgG GMCs and OPA GMTs at 30 days postvaccination with
PNEUMOVAX™23 (Month 13 after allo-HSCT)

Serotype-specific IgG GMCs and OPA GMTs at 30 days postvaccination with a 4th
dose of V114 or Prevnar 13™(Month 13 after allo-HSCT)

Serotype-specific GMFRs and proportions of participants with a ≥4-fold rise from 
prior to vaccination (Month 12 after allo-HSCT) to 30 days following 
PNEUMOVAX™23 (Month 13 after allo-HSCT) for both IgG and OPA responses

Serotype-specific GMFRs and proportions of participants with a ≥4-fold rise from 
prior to vaccination (Month 12 after allo-HSCT) to 30 days following a 4th dose of 
V114 or Prevnar 13™(Month 13 after allo-HSCT) for both IgG and OPA responses 
9.4.2
Safety Endpoints
A description of safety measures is contained in Sections 8.3 and 8.4. The analysis of safety 
results is described in Section 9.6.2.
Safety and tolerability will be assessed by clinical review of all relevant parameters 
separately for adults and pediatric participants, including adverse events and postvaccination 
temperature measurements following any of the 3 doses of V114 and Prevnar 13™,
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following PNEUMOVAX™23, and following the 4th dose of V114 or Prevnar 13™ 
(separately). 
The safety analysis endpoints for adults (≥18 years of age) include:
•
Proportion of participants with solicited injection-site AEs (redness/erythema, swelling, 
tenderness/pain) from Day 1 through Day 5 postvaccination
•
Proportion of participants with solicited systemic AEs (muscle pain/myalgia, joint 
pain/arthralgia, headache, and tiredness/fatigue) from Day 1 through Day 14 
postvaccination
•
Proportions of participants with the broad AE categories consisting of any AE, a 
vaccine-related AE, a SAE, a death, an AE which is both vaccine-related and serious, and 
discontinuation due to an AE, and the proportion of participants who died
•
Proportion of participants with maximum temperature measurements meeting the 
Brighton Collaboration cut points from Day 1 through Day 5 postvaccination
The safety analysis endpoints for pediatrics 3 to <18 years of age include:
•
Proportion of participants with solicited injection-site AEs (redness/erythema, swelling, 
tenderness/pain, and hard lump) from Day 1 through Day 14 postvaccination
•
Proportion of participants with solicited systemic AEs (muscle pain/myalgia, joint 
pain/arthralgia, headache, tiredness/fatigue, and hives and welts) from Day 1 through 
Day 14 postvaccination
•
Proportions of participants with the broad AE categories consisting of any AE, a 
vaccine-related AE, a SAE, a death, an AE which is both vaccine-related and serious, and 
discontinuation due to an AE, and the proportion of participants who died
•
Proportion of participants with maximum temperature measurements meeting the 
Brighton Collaboration cut points from Day 1 through Day 7 postvaccination
9.5
Analysis Populations
9.5.1
Immunogenicity Analysis Populations
The Per-Protocol (PP) population will serve as the primary population for the analysis of 
immunogenicity data in this study. The PP population consists of all randomized participants 
without deviations from the protocol that may substantially affect the results of the 
immunogenicity endpoints. Potential deviations that may result in the exclusion of a 
participant from the PP population for all immunogenicity analyses include the following:
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•
Failure to receive study vaccine at Visit 2 (Day 1), Visit 3 (Day 30), and Visit 4 (Day 60)
•
Failure to receive correct clinical material as per randomization schedule (ie, participants 
who were cross-treated) at Visit 2 (Day 1), Visit 3 (Day 30), and Visit 4 (Day 60)
•
Receipt of prohibited medication or prohibited vaccine prior to study vaccination at 
Visit 2 (Day 1), Visit 3 (Day 30), and Visit 4 (Day 60)
Additional potential deviations that may result in the exclusion of a participant from the 
PP population for specific immunogenicity analyses (depending on the time point) include:
•
Failure to receive study vaccine at Visit 6 (Month 12 after allo-HSCT)
•
Receipt of prohibited medication or prohibited vaccine prior to a blood sample collection
•
Collection of blood sample outside of the pre-specified window (as described in 
Section 1.3)
The final determination on protocol deviations, and thereby the composition of the 
PP population, will be made prior to the final unblinding of the database. Participants will be 
included in the vaccination group to which they are randomized for the analysis of 
immunogenicity data using the PP population.
A supportive analysis using the Full Analysis Set (FAS) population will also be performed 
for the primary immunogenicity endpoints. The FAS population consists of all randomized 
participants who received at least 1 vaccination and have at least 1 serology result. 
Participants will be included in the vaccination group to which they are randomized for the 
analysis of immunogenicity data using the FAS population. 
9.5.2
Safety Analysis Populations
Safety analyses will be conducted in the All Participants as Treated (APaT) population, 
which consists of all randomized participants who received at least 1 dose of study 
vaccination. Participants will be included in the group corresponding to the study vaccination 
they actually received for the analysis of safety data using the APaT population. This will be 
the group to which they are randomized except for participants who take incorrect study 
vaccination; such participants will be included in the group corresponding to the study 
vaccination actually received. Safety parameters for cross-treated subjects (received 
vaccination both from v114 and Prevnar13) will be summarized separately. At least 
1 temperature measurement obtained subsequent to study intervention is required for 
inclusion in the analyses of temperature.
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9.6
Statistical Methods
Statistical testing and inference for immunogenicity and safety analyses are described in 
Section 9.6.1 and Section 9.6.2, respectively. Section 9.6.3 describes how demographic and 
baseline characteristics will be summarized.
9.6.1
Statistical Methods for Immunogenicity Analyses
This section describes the statistical methods that address the primary and secondary 
immunogenicity objectives. Methods related to exploratory objectives will be described in 
the supplemental statistical analysis plan.
Immunogenicity analyses will be conducted for each of the 15 pneumococcal serotypes in 
V114 separately. To address the primary immunogenicity objective, evaluation of the IgG 
GMCs at 30 days following the 3rd dose of V114 and Prevnar 13™ (Day 90) will include 
descriptive summaries and within-group 95% CIs to be calculated for each vaccination 
group. Point estimates for the IgG GMCs will be calculated by exponentiating the estimates 
of the mean of the natural log values. The within-group CIs will be derived by exponentiating 
the CIs of the mean of the natural log values based on the t-distribution. 
A similar statistical approach will be used to evaluate the OPA responses at 30 days 
following the 3rd dose of V114 and Prevnar 13™ (Day 90). 
Descriptive statistics with point estimates and within-group 95% CIs will be provided for all 
other immunogenicity endpoints. For the continuous endpoints, a similar statistical approach 
will be used as described above for the primary endpoint. Point estimates will be calculated 
by exponentiating the estimates of the mean of the natural log values and the within-group 
CIs will be derived by exponentiating the CIs of the mean of the natural log values based on 
the t-distribution. For the dichotomous endpoints, the within-group CIs will be calculated 
based on the exact method proposed by Clopper and Pearson [Clopper, C. J. and Pearson, E. 
S. 1934].
Reverse Cumulative Distribution Curves for IgG concentrations and OPA titers will be 
graphically displayed by serotype at Day 90. A detailed analysis strategy for immunogenicity 
endpoints is listed in Table 5.
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Table 5
Analysis Strategy for Immunogenicity Variables
Endpoint/Variable
(Description, Time Point)
Primary vs. 
Supportive 
Approach†
Statistical 
Method
Analysis 
Population
Missing 
Data 
Approach
Primary Endpoints
IgG GMCs at Day 90
P
Descriptive 
Statistics
(estimate, 95% CI)
PP
Missing data 
will not be 
imputed
S
FAS
Secondary Endpoints
OPA GMTs at Day 90 
P
Descriptive 
Statistics
(estimate, 95% CI)
PP
Missing data 
will not be 
imputed
GMFR and %s of participants with a ≥4-fold 
rise from Day 1 to Day 90 for both IgG and 
OPA responses
P
Descriptive 
Statistics
(estimate, 95% CI)
PP
Missing data 
will not be 
imputed
† P=Primary approach; S=Supportive approach.
CI = Confidence Interval; FAS = Full Analysis Set; GMC = Geometric Mean Concentration; GMT = Geometric 
Mean Titer; IgG = Immunoglobulin G; OPA = Opsonophagocytic Activity; PP = Per-Protocol.
To address the exploratory immunogenicity objectives aiming to evaluate the IgG GMCs at 
30 days following the 3rd dose of V114 and Prevnar 13™ (Day 90) between vaccination 
groups, the serotype-specific IgG GMCs will be compared between vaccination groups 
through the estimation of serotype-specific IgG GMC ratios for each of the 15 serotypes in 
V114. Estimation of the IgG GMC ratios and computation of the corresponding 95% CIs will 
be calculated using a constrained longitudinal data analysis (cLDA) method proposed by 
Liang and Zeger [Liang, K-Y and Zeger, S. L. 2000]. Details regarding the cLDA models 
will be included in the supplemental statistical analysis plan.
9.6.2
Statistical Methods for Safety Analyses
Safety and tolerability will be assessed by clinical review of all relevant parameters 
separately for adults and pediatric participants including AEs and postvaccination 
temperature measurements.
The analysis strategy of safety parameters is summarized in Table 6. The proportion of 
participants with solicited injection-site AEs (redness/erythema, swelling, tenderness/pain 
from Day 1 to Day 5 postvaccination for adult participants, and redness/erythema, swelling, 
tenderness/pain, and hard lump from Day 1 to Day 14 postvaccination for pediatric 
participants) and solicited systemic AEs (muscle pain/myalgia, joint pain/arthralgia, 
headache, and tiredness/fatigue from Day 1 to Day 14 postvaccination for adult participants,
and muscle pain/myalgia, joint pain/arthralgia, headache, tiredness/fatigue, and hives and 
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welts for pediatric participants) will be provided along with the corresponding within-group 
95% CIs (based on the exact binomial method proposed by Clopper and Pearson [Clopper, C. 
J. and Pearson, E. S. 1934]). In addition, the broad AE categories consisting of the proportion 
of participants with any AE, a vaccine-related AE, a SAE, an AE which is both vaccine-
related and serious, discontinuation due to an AE, and the proportion of participants who died 
will be summarized in the same manner separately for adult and pediatric participants. The 
proportion of participants with maximum temperature measurements meeting the Brighton 
Collaboration cut points (from Day 1 through Day 5 postvaccination for adult participants,
and Day 1 through Day 7 for pediatric participants) will also will be provided along with the 
corresponding within-group 95% CIs. Point estimates by vaccination group will be provided 
for all other safety parameters (specific AE terms and system organ class terms). 
The analysis of safety parameters will be evaluated separately for adult and pediatric 
participants at 3 separate time points: (1) following administration of any of the 3 doses of 
V114 and Prevnar 13™ (combined across each of the vaccinations), (2) following 
administration of PNEUMOVAX™23 (administered 12 months after allo-HSCT), and 
(3) following administration of a 4th dose of V114 or Prevnar 13™(administered 12 months 
after allo-HSCT). Descriptive summaries of AEs following administration of any of the 
3 doses of V114 or Prevnar 13™ will include NSAE within 14 days of vaccination and 
SAEs/special events of interest occurring Day 1 through Month 12 after allo-HSCT (prior to 
vaccination with PNEUMOVAX™23 or a 4th dose of V114 or Prevnar 13™). Descriptive 
summaries of AEs following administration of PNEUMOVAX™will include NSAEs within 
14 days of vaccination and SAEs/special events of interest occurring Month 12 after 
allo-HSCT (Day 1 relative to vaccination with PNEUMOVAX™23) through Month 13 after 
allo-HSCT (Day 30 relative to vaccination with PNEUMOVAX™23). Descriptive 
summaries of AEs following administration of a 4th dose of V114 or Prevnar 13™ will 
include NSAEs within 14 days of vaccination and SAEs/special events of interest occurring 
Month 12 after allo-HSCT (Day 1 relative to vaccination with a 4th dose of V114 or 
Prevnar 13™) through Month 13 after allo-HSCT (Day 30 relative to vaccination with a 4th
dose of V114 or Prevnar 13™).
The rate of SAEs, vaccine-related SAEs and death that occur throughout the entire study 
follow-up period will also be summarized per 1000 person-years of follow-up by vaccination 
group. 
In addition, the proportion of participants who have new onset and/or worsening of GVHD as 
well as relapse and progression of the underlying disease (ie, the disease for which the 
allo-HSCT was performed [see inclusion criterion 2 in Section 5.1]) during study 
participation will be summarized descriptively. Limited summaries may also be generated 
following each of the 3 doses of vaccination of V114 or Prevnar 13™.
Safety analyses will be based on observed data (ie, no imputation of missing data).
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Table 6
Analysis Strategy for Safety Parameters 
Safety Endpoint
95% CI for Within-
Group Comparison
Descriptive Statistics
Injection-site redness/erythema (Days 1 to 5 for 
adult participants and Day 1 to Day 14 for pediatric 
participants)†
X
X
Injection-site swelling (Days 1 to 5 for adult 
participants and Day 1 to Day 14 for pediatric 
participants)†
X
X
Injection-site tenderness/pain (Days 1 to 5 for adult 
participants and Day 1 to Day 14 for pediatric 
participants) †
X
X
Injection-site hard lump/induration for pediatric 
participants (Days 1 to 14) †
Muscle pain/myalgia (Days 1 to 14)†
X
X
X
X
Joint pain/arthralgia (Days 1 to 14)†
X
X
Headache (Days 1 to 14)†
X
X
Tiredness/fatigue (Days 1 to 14)†
X
X
Hives or welts/urticarial for pediatric participants
(Days 1 to 14) †
Any AE‡
X
X
X
X
Any vaccine-related AE‡
X
X
Any SAE‡
X
X
Any vaccine-related SAE‡
X
X
Discontinuation due to AE‡
X
X
Death‡
X
X
Maximum temperature measurements meeting the 
Brighton Collaboration cut points (Days 1 to 5 for 
adult participants and Day 1 to Day 7 for pediatric 
participants)
X
X
Specific AEs by SOCs and PT
X
† Includes solicited events only.
‡ These endpoints are broad adverse event categories. For example, descriptive statistics for the safety endpoint 
of “Any AE” will provide the number and percentage of participants with at least 1 AE.
AE = adverse event; CI = confidence interval; PT = preferred term; SAE = serious adverse event; SOC =
System Organ Class; X = results will be provided.
9.6.3
Demographic and Baseline Characteristics
The comparability of the vaccination groups for each relevant demographic and baseline 
characteristic will be assessed by the use of summary tables. No statistical hypothesis tests 
will be performed on these characteristics. The number and percentage of participants 
screened and randomized and the primary reasons for screening failure and discontinuation 
will be displayed. Demographic variables (eg, age, race, and gender), baseline characteristics, 
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prior and concomitant vaccinations and therapies will be summarized by vaccination group 
either by descriptive statistics or categorical tables.
9.7
Interim Analyses
A periodic review of safety and tolerability data across the V114 Phase 3 program will be 
conducted by an independent, unblinded, external DMC. A description of the structure, 
function, and guidelines for decision-making by the DMC, along with the timing and content 
of the safety reviews will be outlined in the DMC charter. Information regarding the 
composition of the DMC is provided in Appendix 1. There are no plans to conduct an interim 
analysis of unblinded immunogenicity data in this study. However, unblinded 
immunogenicity data will be made available to the DMC upon request to enable a benefit-
risk assessment.
Study enrollment is likely to be ongoing at the time of any interim analyses. Blinding to 
intervention assignment will be maintained at all investigational sites. The results of interim 
analyses will not be shared with the investigators prior to the completion of the study. 
Participant-level unblinding will be restricted to an external unblinded statistician performing 
the interim analysis.
The DMC will serve as the primary reviewer of the results of the safety interim analyses and 
will make recommendations for discontinuation of the study or protocol modifications to an 
Executive Oversight Committee of the Sponsor (see Appendix 1 for details on the 
Committees Structure for this study). If the DMC recommends modifications to the design of 
the protocol or discontinuation of the study, this Executive Oversite Committee (and 
potentially other limited Sponsor personnel) may be unblinded to results at the intervention 
level in order to act on these recommendations. The extent to which individuals are 
unblinded with respect to results of interim analyses will be documented by the unblinded 
statistician. Additional logistical details will be provided in the DMC Charter. 
Intervention-level results from the safety interim analysis will be provided by the unblinded 
statistician to the DMC. Prior to final study unblinding, the unblinded statistician will not be 
involved in any discussions regarding modifications to the protocol, statistical methods, 
identification of protocol deviations, or data validation efforts after the interim analyses.
9.8
Multiplicity
No adjustment will be made for multiplicity.
9.9
Sample Size and Power Calculations
9.9.1
Sample Size and Power for Immunogenicity Analyses
This is a descriptive study. This study will randomize approximately 150 participants into 
the V114 group and 150 participants into the Prevnar 13™group. It is assumed that 
approximately 105 participants per vaccination group will be evaluable for PP
immunogenicity analyses at Day 90 (based on a 70% evaluability rate).
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The width of the within-group 95% CIs for the serotype-specific IgG GMCs depend on the 
sample size, variability of the natural log concentrations, and the magnitude of the IgG GMC. 
In Table 7, 95% CIs for various hypothetical Day 90 IgG GMCs and various hypothetical 
standard deviation estimates for the natural log titers are displayed.
Table 7
Within-Group 95% CIs for Varying Hypothetical IgG GMCs and Varying 
Standard Deviations with 105 Evaluable Participants in Each Vaccination Group
Standard 
Deviation of 
natural log titers†
Serotype-specific IgG GMC†
1
5
10
1.0
(0.83, 1.21)
(4.13, 6.05)
(8.26, 12.10)
1.5
(0.75, 1.33)
(3.75, 6.66)
(7.51, 13.32)
2.0
(0.68, 1.47)
(3.41, 7.33)
(6.82, 14.66)
†The estimates of the standard deviation, GMT and GMC are representative of those observed in 
V114-006.
CI=Confidence Interval; GMC= Geometric Mean Concentration; IgG= Immunoglobulin G.
9.9.2
Sample Size and Power for Safety Analyses
The sample size was selected to achieve a reasonably sized safety database in this population 
exposed to V114. The probability of observing at least 1 SAE in this study depends on the 
number of participants vaccinated and the underlying percentage of participants with a SAE 
in the study population. Calculations below assume that 100% of the randomized participants 
will be evaluable for safety analyses. 
For adult participants, there is an 80% chance of observing at least 1 SAE among 
125 participants in the V114 group if the underlying incidence of a SAE is 1.3% (1 of every 
77 participants receiving the vaccine). There is a 50% chance of observing at least 1 SAE 
among 125 participants in the V114 group if the underlying incidence of a SAE is 0.6% (1 of 
every 182 participants receiving the vaccine). If no SAEs are observed among the 
125 participants in the V114 group, this study will provide 97.5% confidence that the 
underlying percentage of participants with a SAE is <2.9% (1 in every 35 participants) in the 
V114 group. 
For pediatric participants, there is an 80% chance of observing at least 1 SAE among 
25 participants in the V114 group if the underlying incidence of a SAE is 6.2% (1 of every 
16 participants receiving the vaccine). There is a 50% chance of observing at least 1 SAE 
among 125 participants in the V114 group if the underlying incidence of a SAE is 2.7% (1 of 
every 37 participants receiving the vaccine). If no SAEs are observed among the 
25 participants in the V114 group, this study will provide 97.5% confidence that the 
underlying percentage of participants with a SAE is <13.7% (1 in every 7 participants) in the 
V114 group. 
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9.10
Subgroup Analyses
Subgroup analyses (e.g., use of systemic steroids within 14 days before randomization
[Day 1], age category) will be performed for the primary immunogenicity endpoints and/or
selected safety endpoints (summary of AEs and summary of solicited AEs). Details of 
subgroup analyses will be documented in the supplemental statistical analysis plan.
9.11
Compliance (Medication Adherence)
Compliance will not be calculated. However, the number and proportion of randomized 
participants receiving each vaccination will be summarized (Section 9.12).
9.12
Extent of Exposure
The extent of exposure will be summarized by the number and proportion of randomized 
participants vaccinated at each vaccination visit by vaccination group.
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10
SUPPORTING DOCUMENTATION AND OPERATIONAL
CONSIDERATIONS
10.1
Appendix 1: Regulatory, Ethical, and Study Oversight Considerations
10.1.1
Code of Conduct for Clinical Trials
Merck Sharp and Dohme Corp., a subsidiary of Merck & Co., Inc. (MSD)
Code of Conduct for Interventional Clinical Trials
I. Introduction
A. Purpose
MSD, through its subsidiaries, conducts clinical trials worldwide to evaluate the safety and effectiveness of our 
products. As such, we are committed to designing, implementing, conducting, analyzing and reporting these trials 
in compliance with the highest ethical and scientific standards. Protection of participants in clinical trials is the 
overriding concern in the design of clinical trials. In all cases, MSD clinical trials will be conducted in compliance 
with local and/or national regulations (eg, International Council for Harmonisation Good Clinical Practice [ICH-
GCP]) and in accordance with the ethical principles that have their origin in the Declaration of Helsinki.
B. Scope
Highest ethical and scientific standards shall be endorsed for all clinical interventional investigations sponsored by 
MSD irrespective of the party (parties) employed for their execution (eg, contract research organizations, 
collaborative research efforts). This Code is not intended to apply to trials that are observational in nature, or 
which are retrospective. Further, this Code does not apply to investigator-initiated trials, which are not under the 
full control of MSD.
II. Scientific Issues
A. Trial Conduct
1. Trial Design
Except for pilot or estimation trials, clinical trial protocols will be hypothesis-driven to assess safety, 
efficacy, and/or pharmacokinetic or pharmacodynamic indices of MSD or comparator products. 
Alternatively, MSD may conduct outcomes research trials, trials to assess or validate various endpoint 
measures, or trials to determine patient preferences, etc.
The design (ie, participant population, duration, statistical power) must be adequate to address the specific
purpose of the trial. Participants must meet protocol entry criteria to be enrolled in the trial. 
2. Site Selection
MSD selects investigative sites based on medical expertise, access to appropriate participants, adequacy of 
facilities and staff, previous performance in clinical trials, as well as budgetary considerations. Prior to trial 
initiation, sites are evaluated by MSD personnel to assess the ability to successfully conduct the trial.
3. Site Monitoring/Scientific Integrity
Investigative trial sites are monitored to assess compliance with the trial protocol and general principles of 
Good Clinical Practice (GCP). MSD reviews clinical data for accuracy, completeness, and consistency. Data 
are verified versus source documentation according to standard operating procedures. Per MSD policies and 
procedures, if fraud, scientific/research misconduct, or serious GCP-noncompliance is suspected, the issues 
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are investigated. When necessary, the clinical site will be closed, the responsible regulatory authorities and 
ethics review committees notified.
B. Publication and Authorship
Regardless of trial outcome, MSD commits to publish primary and secondary results of its registered trials of 
marketed products in which treatment is assigned, according to the prespecified plans for data analysis. To the 
extent scientifically appropriate, MSD seeks to publish the results of other analyses it conducts that are important 
to patients, physicians, and payers. Some early phase or pilot trials are intended to be hypothesis-generating rather 
than hypothesis testing, in such cases, publication of results may not be appropriate since the trial may be 
underpowered and the analyses complicated by statistical issues such as multiplicity.
MSD’s policy on authorship is consistent with the recommendations published by the International Committee of 
Medical Journal Editors (ICMJE). In summary, authorship should reflect significant contribution to the design and 
conduct of the trial, performance or interpretation of the analysis, and/or writing of the manuscript. All named 
authors must be able to defend the trial results and conclusions. MSD funding of a trial will be acknowledged in 
publications.
III. Participant Protection
A. Ethics Committee Review (Institutiona Review Board [IRB]/Independent Ethics Committee [IEC])
All clinical trials will be reviewed and approved by an IRB/IEC before being initiated at each site. Significant 
changes or revisions to the protocol will be approved by the ethics committee prior to implementation, except 
changes required urgently to protect participant safety that may be enacted in anticipation of ethics committee 
approval. For each site, the ethics committee and MSD will approve the participant informed consent form.
B. Safety
The guiding principle in decision-making in clinical trials is that participant welfare is of primary importance. 
Potential participants will be informed of the risks and benefits of, as well as alternatives to, trial participation. At 
a minimum, trial designs will take into account the local standard of care.
All participation in MSD clinical trials is voluntary. Participants enter the trial only after informed consent is 
obtained. Participants may withdraw from an MSD trial at any time, without any influence on their access to, or 
receipt of, medical care that may otherwise be available to them.
C. Confidentiality
MSD is committed to safeguarding participant confidentiality, to the greatest extent possible. Unless required by 
law, only the investigator, Sponsor (or representative), ethics committee, and/or regulatory authorities will have 
access to confidential medical records that might identify the participant by name.
D. Genomic Research
Genomic research will only be conducted in accordance with a protocol and informed consent authorized by an 
ethics committee.
IV. Financial Considerations
A. Payments to Investigators
Clinical trials are time- and labor-intensive. It is MSD’s policy to compensate investigators (or the sponsoring 
institution) in a fair manner for the work performed in support of MSD trials. MSD does not pay incentives to 
enroll participants in its trials. However, when enrollment is particularly challenging, additional payments may be 
made to compensate for the time spent in extra recruiting efforts.
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MSD does not pay for participant referrals. However, MSD may compensate referring physicians for time spent 
on chart review to identify potentially eligible participants.
B. Clinical Research Funding
Informed consent forms will disclose that the trial is sponsored by MSD and that the investigator or sponsoring 
institution is being paid or provided a grant for performing the trial. However, the local ethics committee may 
wish to alter the wording of the disclosure statement to be consistent with financial practices at that institution. As 
noted above, all publications resulting from MSD trials will indicate MSD as a source of funding.
C. Funding for Travel and Other Requests
Funding of travel by investigators and support staff (eg, to scientific meetings, investigator meetings, etc.) will be 
consistent with local guidelines and practices.
V. Investigator Commitment
Investigators will be expected to review MSD’s Code of Conduct as an appendix to the trial protocol, and in signing the 
protocol, agree to support these ethical and scientific standards.
10.1.2
Financial Disclosure
Financial Disclosure requirements are outlined in the US Food and Drug Administration 
Regulations, Financial Disclosure by Clinical Investigators (21 CFR Part 54). It is the 
Sponsor's responsibility to determine, based on these regulations, whether a request for 
Financial Disclosure information is required. It is the investigator's/subinvestigator's 
responsibility to comply with any such request.
The investigator/subinvestigator(s) agree, if requested by the Sponsor in accordance with 21 
CFR Part 54, to provide his/her financial interests in and/or arrangements with the Sponsor to 
allow for the submission of complete and accurate certification and disclosure statements. 
The investigator/subinvestigator(s) further agree to provide this information on a 
Certification/Disclosure Form, commonly known as a financial disclosure form, provided by 
the Sponsor. The investigator/subinvestigator(s) also consent to the transmission of this 
information to the Sponsor in the United States for these purposes. This may involve the 
transmission of information to countries that do not have laws protecting personal data.
10.1.3
Data Protection
Participants will be assigned a unique identifier by the Sponsor. Any participant records or 
datasets that are transferred to the Sponsor will contain the identifier only; participant names 
or any information that would make the participant identifiable will not be transferred.
The participant must be informed that his/her personal study-related data will be used by the 
Sponsor in accordance with local data protection law. The level of disclosure must also be 
explained to the participant. 
The participant must be informed that his/her medical records may be examined by Clinical 
Quality Assurance auditors or other authorized personnel appointed by the Sponsor, by 
appropriate IRB/IEC members, and by inspectors from regulatory authorities.
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10.1.3.1
Confidentiality of Data
By signing this protocol, the investigator affirms to the Sponsor that information furnished to 
the investigator by the Sponsor will be maintained in confidence, and such information will 
be divulged to the IRB, IEC, or similar or expert committee; affiliated institution and 
employees, only under an appropriate understanding of confidentiality with such board or 
committee, affiliated institution and employees. Data generated by this study will be 
considered confidential by the investigator, except to the extent that it is included in a 
publication as provided in the Publications section of this protocol.
10.1.3.2
Confidentiality of Participant Records
By signing this protocol, the investigator agrees that the Sponsor (or Sponsor representative), 
IRB/IEC, or regulatory authority representatives may consult and/or copy study documents to 
verify worksheet/CRF report form data. By signing the consent form, the participant agrees 
to this process. If study documents will be photocopied during the process of verifying 
worksheet/CRF information, the participant will be identified by unique code only; full 
names/initials will be masked prior to transmission to the Sponsor.
By signing this protocol, the investigator agrees to treat all participant data used and 
disclosed in connection with this study in accordance with all applicable privacy laws, rules 
and regulations.
10.1.3.3
Confidentiality of IRB/IEC Information
The Sponsor is required to record the name and address of each IRB/IEC that reviews and 
approves this study. The Sponsor is also required to document that each IRB/IEC meets 
regulatory and ICH GCP requirements by requesting and maintaining records of the names 
and qualifications of the IRB/IEC members and to make these records available for 
regulatory agency review upon request by those agencies.
10.1.4
Committees Structure
10.1.4.1
Scientific Advisory Committee
This study was developed in collaboration with a Scientific Advisory Committee (SAC). The 
SAC is comprised of both Sponsor and non-Sponsor scientific experts who provide input 
with respect to study design, interpretation of study results, and subsequent peer-reviewed 
scientific publications.
10.1.4.2
Executive Oversight Committee
The Executive Oversight Committee (EOC) is comprised  of members of Sponsor Senior 
Management. The EOC will receive and decide upon any recommendations made by the
external DMC regarding the study.
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10.1.4.3
External Data Monitoring Committee
To supplement the routine study monitoring outlined in this protocol, an external DMC will 
monitor the interim data from this study. The voting members of the committee are external 
to the Sponsor. The members of the DMC must not be involved with the study in any other 
way (eg, they cannot be study investigators) and must have no competing interests that could 
affect their roles with respect to the study.
The DMC will make recommendations to the EOC regarding steps to ensure both participant 
safety and the continued ethical integrity of the study. Also, the DMC will review interim 
study results, consider the overall risk and benefit to study participants (Section 9.7) and 
recommend to the EOC whether the study should continue in accordance with the protocol.
Specific details regarding composition, responsibilities, and governance, including the roles 
and responsibilities of the various members and the Sponsor protocol team; meeting 
facilitation; the study governance structure; and requirements for and proper documentation 
of DMC reports, minutes, and recommendations will be described in the DMC charter that is 
reviewed and approved by all the DMC members.
10.1.5
Publication Policy
The results of this study may be published or presented at scientific meetings. The Sponsor 
will comply with the requirements for publication of study results. In accordance with 
standard editorial and ethical practice, the Sponsor will generally support publication of 
multicenter studies only in their entirety and not as individual site data. In this case, a 
coordinating investigator will be designated by mutual agreement.
If publication activity is not directed by the Sponsor, the investigator agrees to submit all 
manuscripts or abstracts to the Sponsor before submission. This allows the Sponsor to protect 
proprietary information and to provide comments.  
Authorship will be determined by mutual agreement and in line with International Committee 
of Medical Journal Editors authorship requirements.
10.1.6
Compliance with Study Registration and Results Posting Requirements
Under the terms of the Food and Drug Administration Amendments Act (FDAAA) of 2007 
and the European Medicines Agency (EMA) clinical trial Directive 2001/20/EC, the Sponsor 
of the study is solely responsible for determining whether the study and its results are subject
to the requirements for submission to http://www.clinicaltrials.gov, 
www.clinicaltrialsregister.eu or other local registries. MSD, as Sponsor of this study, will 
review this protocol and submit the information necessary to fulfill these requirements. MSD 
entries are not limited to FDAAA or the EMA clinical trial directive mandated trials. 
Information posted will allow participants to identify potentially appropriate studies for their 
disease conditions and pursue participation by calling a central contact number for further 
information on appropriate study locations and study site contact information.
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By signing this protocol, the investigator acknowledges that the statutory obligations under 
FDAAA, the EMA clinical trials directive or other locally mandated registries are that of the 
Sponsor and agrees not to submit any information about this study or its results to those 
registries. 
10.1.7
Compliance with Law, Audit, and Debarment
By signing this protocol, the investigator agrees to conduct the study in an efficient and 
diligent manner and in conformance with this protocol; generally accepted standards of GCP
(eg, International Conference on Harmonization of Technical Requirements for Registration 
of Pharmaceuticals for Human Use GCP: Consolidated Guideline and other generally 
accepted standards of good clinical practice); and all applicable federal, state and local laws, 
rules and regulations relating to the conduct of the clinical study. The Code of Conduct, a 
collection of goals and considerations that govern the ethical and scientific conduct of 
clinical investigations sponsored by MSD, is provided in this appendix under the Code of 
Conduct for Clinical Studies.
The investigator agrees not to seek reimbursement from participants, their insurance 
providers, or from government programs for procedures included as part of the study 
reimbursed to the investigator by the Sponsor.
The investigator will promptly inform the Sponsor of any regulatory authority inspection 
conducted for this study.
The investigator agrees to provide the Sponsor with relevant information from inspection 
observations/findings to allow the Sponsor to assist in responding to any citations resulting 
from regulatory authority inspection and will provide the Sponsor with a copy of the 
proposed response for consultation before submission to the regulatory authority. 
Persons debarred from conducting or working on clinical studies by any court or regulatory 
authority will not be allowed to conduct or work on this Sponsor’s studies. The investigator 
will immediately disclose in writing to the Sponsor if any person who is involved in 
conducting the study is debarred or if any proceeding for debarment is pending or, to the best 
of the investigator’s knowledge, threatened.
10.1.8
Data Quality Assurance
All participant data relating to the study will be recorded on printed or electronic CRF unless 
transmitted to the Sponsor or designee electronically (eg, laboratory data). The investigator 
or qualified designee is responsible for verifying that data entries are accurate and correct by 
physically or electronically signing the CRF.
Detailed information regarding Data Management procedures for this protocol will be 
provided separately.
The investigator must maintain accurate documentation (source data) that supports the 
information entered in the CRF.
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The investigator must permit study-related monitoring, audits, IRB/IEC review, and 
regulatory agency inspections and provide direct access to source data documents.
Study documentation will be promptly and fully disclosed to the Sponsor by the investigator 
upon request and also shall be made available at the study site upon request for inspection, 
copying, review, and audit at reasonable times by representatives of the Sponsor or any 
regulatory authorities. The investigator agrees to promptly take any reasonable steps that are 
requested by the Sponsor or any regulatory authorities as a result of an audit or inspection to 
cure deficiencies in the study documentation and worksheets/CRFs.
The Sponsor or designee is responsible for the data management of this study including 
quality checking of the data.
Study monitors will perform ongoing source data review and verification to confirm that data 
entered into the CRF by authorized site personnel are accurate, complete, and verifiable from 
source documents; that the safety and rights of participants are being protected; and that the 
study is being conducted in accordance with the currently approved protocol and any other 
study agreements, ICH GCP, and all applicable regulatory requirements.
Records and documents, including signed ICF, pertaining to the conduct of this study must 
be retained by the investigator for 15 years after study completion unless local regulations or 
institutional policies require a longer retention period. No records may be destroyed during 
the retention period without the written approval of the Sponsor. No records may be 
transferred to another location or party without written notification to the Sponsor.
10.1.9
Source Documents
Source documents provide evidence for the existence of the participant and substantiate the 
integrity of the data collected. Source documents are filed at the investigator’s site.
Data reported on the CRF or entered in the eCRF that are transcribed from source documents 
must be consistent with the source documents or the discrepancies must be explained. The 
investigator may need to request previous medical records or transfer records, depending on 
the study. Also, current medical records must be available.
10.1.10
Study and Site Closure
The Sponsor or its designee may stop the study or study site participation in the study for 
medical, safety, regulatory, administrative, or other reasons consistent with applicable laws, 
regulations, and GCP.
In the event the Sponsor prematurely terminates a particular study site, the Sponsor will 
promptly notify that study site’s IRB/IEC.
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10.2
Appendix 2: Clinical Laboratory Tests
•
The tests detailed in Table 8 will be performed according to local requirements.
•
Protocol-specific requirements for inclusion or exclusion of participants are detailed in 
Section 5 of the protocol.
•
Additional tests may be performed at any time during the study as determined necessary 
by the investigator or required by local regulations.
Table 8
Protocol-Required Safety Laboratory Assessments
Laboratory 
Assessments
Parameters
Hematology
Platelet Count 
RBC Indices:
MCV
MCH
%Reticulocytes
WBC count with 
Differential:
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
RBC Count
Hemoglobin
Hematocrit
Chemistry
Blood Urea 
Nitrogen (BUN)
Potassium
Aspartate 
Aminotransferase
(AST)/ Serum 
Glutamic-
Oxaloacetic 
Transaminase 
(SGOT)
Total bilirubin (and 
direct bilirubin, if 
total bilirubin is 
elevated above the 
upper limit of 
normal)
Albumin
Bicarbonate
Chloride
Phosphorous
Creatinine
Sodium
Alanine 
Aminotransferase
(ALT)/ Serum 
Glutamic-Pyruvic 
Transaminase 
(SGPT)
Total Protein
Glucose 
Calcium
Alkaline 
phosphatase
Other Screening 
Tests
Serum or urine β-hCG pregnancy test (as needed for WOCBP)
β-hCG = β human chorionic gonadotropin; WOCBP = woman/women of childbearing potential.
The investigator (or medically qualified designee) must document their review of each 
laboratory safety report.
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10.3
Appendix 3: Adverse Events: Definitions and Procedures for Recording, 
Evaluating, Follow-up, and Reporting
10.3.1
Definition of AE
AE definition
•
An AE is any untoward medical occurrence in a clinical study participant, temporally 
associated with the use of study intervention, whether or not considered related to the 
study intervention.
•
NOTE: An AE can therefore be any unfavorable and unintended sign (including an 
abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally 
associated with the use of a study intervention.
•
NOTE: For purposes of AE definition, study intervention (also referred to as Sponsor’s 
product) includes any pharmaceutical product, biological product, vaccine, device, 
diagnostic agent, or protocol specified procedure whether investigational (including 
placebo or active comparator product) or marketed, manufactured by, licensed by, 
provided by, or distributed by the Sponsor for human use in this study.
Events meeting the AE definition
•
Any abnormal laboratory test results (hematology, clinical chemistry, or urinalysis) or 
other safety assessments (eg, ECG, radiological scans, vital signs measurements), 
including those that worsen from baseline, considered clinically significant in the medical 
and scientific judgment of the investigator.
•
Exacerbation of a chronic or intermittent pre-existing condition including either an 
increase in frequency and/or intensity of the condition.
•
New conditions detected or diagnosed after study intervention administration even 
though it may have been present before the start of the study.
•
Signs, symptoms, or the clinical sequelae of a suspected drug-drug interaction.
•
Signs, symptoms, or the clinical sequelae of a suspected overdose of either study 
intervention or a concomitant medication.
•
For all reports of overdose (whether accidental or intentional) with an associated AE, the 
AE term should reflect the clinical symptoms or abnormal test result. An overdose 
without any associated clinical symptoms or abnormal laboratory results is reported using 
the terminology “accidental or intentional overdose without adverse effect.”
•
Any new cancer or progression of existing cancer.
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Events NOT meeting the AE definition
•
Medical or surgical procedure (eg, endoscopy, appendectomy): the condition that leads to 
the procedure is the AE.
•
Situations in which an untoward medical occurrence did not occur (social and/or 
convenience admission to a hospital).
•
Anticipated day-to-day fluctuations of pre-existing disease(s) or condition(s) present or 
detected at the start of the study that do not worsen.
•
Surgery planned prior to informed consent to treat a pre-existing condition that has not 
worsened.
•
Refer to Section 8.4.7 for protocol-specific exceptions.
10.3.2
Definition of SAE
If an event is not an AE per definition above, then it cannot be an SAE even if serious 
conditions are met.
An SAE is defined as any untoward medical occurrence that, at any dose:
a.
Results in death
b. Is life-threatening
•
The term “life-threatening” in the definition of “serious” refers to an event in which 
the participant was at risk of death at the time of the event. It does not refer to an 
event, which hypothetically might have caused death, if it were more severe.
c.
Requires inpatient hospitalization or prolongation of existing hospitalization
•
Hospitalization is defined as an inpatient admission, regardless of length of stay, even 
if the hospitalization is a precautionary measure for continued observation. (Note: 
Hospitalization for an elective procedure to treat a pre-existing condition that has not 
worsened is not an SAE. A pre-existing condition is a clinical condition that is 
diagnosed prior to the use of an MSD product and is documented in the participant’s 
medical history.
d. Results in persistent or significant disability/incapacity
•
The term disability means a substantial disruption of a person’s ability to conduct 
normal life functions.
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•
This definition is not intended to include experiences of relatively minor medical 
significance such as uncomplicated headache, nausea, vomiting, diarrhea, influenza, 
and accidental trauma (eg, sprained ankle) that may interfere with or prevent 
everyday life functions but do not constitute a substantial disruption.
e.
Is a congenital anomaly/birth defect
•
In offspring of participant taking the product regardless of time to diagnosis.
f.
Other important medical events
•
Medical or scientific judgment should be exercised in deciding whether SAE 
reporting is appropriate in other situations such as important medical events that may 
not be immediately life-threatening or result in death or hospitalization but may 
jeopardize the participant or may require medical or surgical intervention to prevent 1 
of the other outcomes listed in the above definition. These events should usually be 
considered serious.
Examples of such events include invasive or malignant cancers, intensive treatment in 
an emergency room or at home for allergic bronchospasm, blood dyscrasias or 
convulsions that do not result in hospitalization, or development of drug dependency 
or drug abuse.
10.3.3
Additional Events Reported
Additional events that require reporting
In addition to the above criteria, AEs meeting either of the below criteria, although not 
serious per ICH definition, are reportable to the Sponsor.
•
Is a cancer
•
Is associated with an overdose
10.3.4
Recording AE and SAE
AE and SAE recording
•
When an AE/SAE occurs, it is the responsibility of the investigator to review all 
documentation (eg, hospital progress notes, laboratory, and diagnostics reports) related to 
the event.
•
The investigator will record all relevant AE/SAE information on the AE 
CRFs/worksheets at each examination.
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•
It is not acceptable for the investigator to send photocopies of the participant’s medical 
records to the Sponsor in lieu of completion of the AE CRF page.
•
There may be instances when copies of medical records for certain cases are requested by 
the Sponsor. In this case, all participant identifiers, with the exception of the participant 
number, will be blinded on the copies of the medical records before submission to the 
Sponsor.
•
The investigator will attempt to establish a diagnosis of the event based on signs, 
symptoms, and/or other clinical information. In such cases, the diagnosis (not the 
individual signs/symptoms) will be documented as the AE/SAE.
Assessment of Intensity/Toxicity
•
An event is defined as “serious” when it meets at least 1 of the predefined outcomes as 
described in the definition of an SAE, not when it is rated as severe.
•
The investigator will make an assessment of intensity for each AE and SAE (and other 
reportable safety event) reported during the study and assign it to 1 of the following 
categories:
-
Mild: An event that is easily tolerated by the participant, causing minimal discomfort 
and not interfering with everyday activities (for pediatric studies, awareness of 
symptoms, but easily tolerated).
-
Moderate: An event that causes sufficient discomfort to interfere with normal 
everyday activities (for pediatric studies definitely acting like something is wrong).
-
Severe: An event that prevents normal everyday activities. An AE that is assessed as 
severe should not be confused with an SAE. Severe is a category utilized for rating 
the intensity of an event; and both AE and SAE can be assessed as severe (for 
pediatric studies, extremely distressed or unable to do usual activities).
•
Injection-site redness/erythema or swelling from the day of vaccination through Day 5 
(for adult participants) or Day 14 (for pediatric participants) postvaccination will be 
evaluated by maximum size.
•
The investigator will make an assessment of toxicity for each AE and SAE (and other 
reportable event) reported during the study. Toxicity is only being assessed for adults 
18 years of age and older. A toxicity grade will be assigned to injection-site AEs, specific 
systemic AEs, other systemic AEs, and vital sign (temperature) AEs as shown in the 
following tables. The toxicity grading scales used in this study are adapted from the 
“FDA Guidance for Industry: Toxicity Grading Scale for Healthy Adult and Adolescent 
Volunteers Enrolled in Preventive Vaccine Clinical Trials, September 2007.”
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Injection Site Reaction 
to Study 
Vaccine/Placeboa
Grade 1
Grade 2
Grade 3
Grade 4
Injection-site AEs occurring Days 1 through 5 following receipt of study vaccine/placebo
Pain/Tenderness
Does not interfere 
with activity
Repeated use of non-
narcotic pain reliever 
>24 hours or 
interferes with 
activity
Any use of narcotic 
pain reliever or 
prevents daily 
activity
ER visit or 
hospitalization
Erythema/Redness
Size measured as
B
Size measured as
C or D
Size measured as
E→
Necrosis or 
exfoliative dermatitis 
or results in ER visit 
or hospitalization
Induration/Swelling
Size measured as 
B
Size measured as
C or D
Size measured as
E→
Necrosis or ER visit 
or hospitalization
Other 
Does not interfere 
with activity
Repeated use of non-
narcotic pain reliever 
>24 hours or 
interferes with 
activity
Any use of narcotic 
pain reliever or 
prevents daily 
activity
ER visit or 
hospitalization
Any injection-site reaction that begins ≥ 6 days after receipt of study vaccine/placebo
Pain/tenderness
Erythema/Redness
Induration/Swelling
Other
Does not interfere 
with activity
Repeated use of non-
narcotic pain reliever 
>24 hours or 
interferes with 
activity
Any use of narcotic 
pain reliever or 
prevents daily 
activity
ER visit or 
hospitalization
Abbreviations: AE=adverse event; ER=emergency room; eVRC=electronic vaccine report card; SAE=serious adverse event
a Based upon information provided by the patient on the eVRC and verbally during VRC review. Erythema/Redness and 
Induration/Swelling are specific injection-site AEs with size designations of letters A through E→, based upon a graphic in 
the eVRC. Size A is not assigned a toxicity grade; however, injection-site AEs that measure size A should be reported as 
adverse experiences. If the participant has an ER visit or is hospitalized for any injection-site AE, that AE is to be assigned a 
toxicity grade of 4, regardless of the size measured.
Specific Systemic AE Toxicity Grading Scale
Systemic (General)
Mild 
(Grade 1)
Moderate 
(Grade 2)
Severe 
(Grade 3)
Potentially Life 
Threatening
(Grade 4)
Headache
No interference with 
activity
Repeated use of non-
narcotic pain reliever 
>24 hours or some 
interference with 
activity
Significant; any use of 
narcotic pain reliever 
or prevents daily 
activity
ER visit or 
hospitalization
Fatigue
No interference with 
activity
Some interference with 
activity
Significant; prevents 
daily activity
ER visit or 
hospitalization
Myalgia
No interference with 
activity
Some interference with 
activity
Significant; prevents 
daily activity
ER visit or 
hospitalization
Abbreviations: AE=adverse event; ER=emergency room
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Other Systemic AE Toxicity Grading Scale
Systemic Illnessa
Mild 
(Grade 1)
Moderate 
(Grade 2)
Severe 
(Grade 3)
Potentially Life 
Threatening
(Grade 4)b
Illness or clinical AE 
(as defined according 
to applicable 
regulations)
No interference with 
activity
Some interference with 
activity not requiring 
medical intervention
Prevents daily activity 
and required medical 
intervention
ER visit or 
hospitalization
Abbreviations: AE=adverse event; ER=emergency room; eVRC=electronic vaccine report card; SAE=serious adverse event
a Based upon information provided by the patient on the eVRC and verbally during the eVRC review during the primary 
safety follow-up period. For SAEs reported beyond the primary safety follow-up period, grading will be based upon the 
initial report and/or follow-up of the event.
b AEs resulting in death will be assessed as Grade 4
Vital Sign (Temperature) Toxicity Grading Scale
Vital Signsa
Mild 
(Grade 1)
Moderate 
(Grade 2)
Severe 
(Grade 3)
Potentially Life 
Threatening
(Grade 4)
Fever 
(°C)b
(°F)b
38.0 to 38.4
100.4 to 101.1
38.5 to 38.9
101.2 to 102.0
39.0 to 40.0
102.1 to 104.0
>40.0
>104.0
a Participant should be at rest for all vital sign requirements
b Oral temperature; no recent hot or cold beverages or smoking
Assessment of causality
•
Did the Sponsor’s product cause the AE?
•
The determination of the likelihood that the Sponsor’s product caused the AE will be 
provided by an investigator who is a qualified physician. The investigator’s signed/dated 
initials on the source document or worksheet that supports the causality noted on the AE 
form, ensures that a medically qualified assessment of causality was done. This initialled 
document must be retained for the required regulatory time frame. The criteria below are 
intended as reference guidelines to assist the investigator in assessing the likelihood of a 
relationship between the test product and the AE based upon the available information.
•
The following components are to be used to assess the relationship between the 
Sponsor’s product and the AE; the greater the correlation with the components and 
their respective elements (in number and/or intensity), the more likely the Sponsor’s 
product caused the AE:
-
Exposure: Is there evidence that the participant was actually exposed to the 
Sponsor’s product such as: reliable history, acceptable compliance assessment (diary, 
etc.), seroconversion or identification of vaccine virus in bodily specimen?
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-
Time Course: Did the AE follow in a reasonable temporal sequence from 
administration of the Sponsor’s product? Is the time of onset of the AE compatible 
with a vaccine-induced effect?
-
Likely Cause: Is the AE not reasonably explained by another etiology such as 
underlying disease, other drug(s)/vaccine(s), or other host or environmental factors?
-
Rechallenge: Was the participant re-exposed to the Sponsor’s product in the study?
-
If yes, did the AE recur or worsen?
-
If yes, this is a positive rechallenge.
-
If no, this is a negative rechallenge.
(Note: This criterion is not applicable if: (1) the initial AE resulted in death or permanent 
disability, or (2) the study is a single-dose vaccine study); or (3) Sponsor’s product(s) is/are 
used only 1 time.)
NOTE: IF A RECHALLENGE IS PLANNED FOR AN AE THAT WAS SERIOUS AND 
MAY HAVE BEEN CAUSED BY THE SPONSOR’S PRODUCT, OR IF RE-EXPOSURE 
TO THE SPONSOR’S PRODUCT POSES ADDITIONAL POTENTIAL SIGNIFICANT 
RISK TO THE PARTICIPANT THEN THE RECHALLENGE MUST BE APPROVED IN 
ADVANCE BY THE SPONSOR CLINICAL DIRECTOR, AND IF REQUIRED, THE 
IRB/IEC.
-
Consistency with study intervention profile: Is the clinical/pathological 
presentation of the AE consistent with previous knowledge regarding the Sponsor’s 
product or drug class pharmacology or toxicology?
-
The assessment of relationship will be reported on the CRFs /worksheets by an 
investigator who is a qualified physician according to his/her best clinical judgment, 
including consideration of the above elements.
-
Use the following scale of criteria as guidance (not all criteria must be present to be 
indicative of a Sponsor’s product relationship).
-
Yes, there is a reasonable possibility of Sponsor’s product relationship:
-
There is evidence of exposure to the Sponsor’s product. The temporal sequence of the 
AE onset relative to the administration of the Sponsor’s product is reasonable. The 
AE is more likely explained by the Sponsor’s product than by another cause.
-
No, there is not a reasonable possibility of Sponsor’s product relationship:
-
Participant did not receive the Sponsor’s product OR temporal sequence of the AE 
onset relative to administration of the Sponsor’s product is not reasonable OR the AE 
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is more likely explained by another cause than the Sponsor’s product. (Also entered 
for a participant with overdose without an associated AE.)
•
For each AE/SAE, the investigator must document in the medical notes that he/she has 
reviewed the AE/SAE and has provided an assessment of causality.
•
There may be situations in which an SAE has occurred and the investigator has minimal 
information to include in the initial report to the Sponsor. However, it is very important 
that the investigator always make an assessment of causality for every event before the
initial transmission of the SAE data to the Sponsor.
•
The investigator may change his/her opinion of causality in light of follow-up 
information and send an SAE follow-up report with the updated causality assessment.
•
The causality assessment is 1 of the criteria used when determining regulatory reporting 
requirements.
Follow-up of AE and SAE
•
The investigator is obligated to perform or arrange for the conduct of supplemental 
measurements and/or evaluations as medically indicated or as requested by Sponsor to
elucidate the nature and/or causality of the AE or SAE as fully as possible. This may 
include additional laboratory tests or investigations, histopathological examinations, or 
consultation with other health care professionals.
•
New or updated information will be recorded in the CRF.
•
The investigator will submit any updated SAE data to the Sponsor within 24 hours of 
receipt of the information.
10.3.5
Reporting of AE, SAE, and Other Reportable Safety Events to the Sponsor
AE, SAE, and other reportable safety event reporting to Sponsor via electronic data 
collection tool
•
The primary mechanism for reporting to the Sponsor will be the electronic data collection 
(EDC) tool.
•
Electronic reporting procedures can be found in the EDC data entry guidelines (or 
equivalent).
•
If the electronic system is unavailable for more than 24 hours, then the site will use 
the paper AE Reporting form.
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•
Reference Section 8.4.1  for reporting time requirements.
•
The site will enter the SAE data into the electronic system as soon as it becomes 
available.
•
After the study is completed at a given site, the EDC tool will be taken off-line to prevent 
the entry of new data or changes to existing data.
•
If a site receives a report of a new SAE from a study participant or receives updated data 
on a previously reported SAE after the EDC tool has been taken off-line, then the site can 
report this information on a paper SAE form or by telephone (see next section).
•
Contacts for SAE reporting can be found in the Investigator Study File Binder (or 
equivalent).
SAE reporting to the Sponsor via paper CRF
•
If the EDC tool is not operational, facsimile transmission or secure e-mail of the SAE 
paper CRF is the preferred method to transmit this information to the Sponsor.
•
In rare circumstances and in the absence of facsimile equipment, notification by 
telephone is acceptable with a copy of the SAE data collection tool sent by overnight 
mail or courier service.
•
Initial notification via telephone does not replace the need for the investigator to 
complete and sign the SAE CRF pages within the designated reporting time frames.
•
Contacts and instructions for SAE reporting and paper reporting procedures can be found 
in the Investigator Study File Binder (or equivalent).
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10.4
Appendix 4: Medical Device Incidents: Definition and Procedures for Recording, 
Evaluating, Follow-up, and Reporting
Not applicable
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10.5
Appendix 5: Contraceptive Guidance and Pregnancy Testing
10.5.1
Definitions
Women of Childbearing Potential (WOCBP)
A woman is considered fertile following menarche and until becoming postmenopausal 
unless permanently sterile.
Women in the following categories are not considered WOCBP:
•
Premenarchal
•
Premenopausal female with 1 of the following:
-
Documented hysterectomy
-
Documented bilateral salpingectomy
-
Documented bilateral oophorectomy
Note: Documentation can come from the site personnel’s review of the participant’s medical 
records, medical examination, or medical history interview.
•
Postmenopausal female
-
A postmenopausal state is defined as no menses for 12 months without an alternative 
medical cause.
•
A high follicle stimulating hormone (FSH) level in the postmenopausal range may be 
used to confirm a postmenopausal state in women not using hormonal contraception or 
hormone replacement therapy (HRT). However, in the absence of 12 months of 
amenorrhea, confirmation with 2 FSH measurements in the postmenopausal range is 
required.
-
Females on HRT and whose menopausal status is in doubt will be required to use 1 of 
the nonhormonal highly effective contraception methods if they wish to continue their 
HRT during the study. Otherwise, they must discontinue HRT to allow confirmation 
of postmenopausal status before study enrollment.
10.5.2
Contraception Requirements
Female Participants
Female participants of childbearing potential are eligible to participate if they agree to use 
1 of the contraception methods described in Table 9 consistently and correctly during the 
protocol-defined time frame in Section 5.1.
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Table 9
Contraceptive Methods
Acceptable Contraceptive Methods
Failure rate of >1% per year when used consistently and correctly.
●
Male or female condom with or without spermicide
●
Cervical cap, diaphragm or sponge with spermicide
Highly Effective Contraceptive Methods That Are User Dependenta
Failure rate of <1% per year when used consistently and correctly.
●
Combined (estrogen- and progestogen- containing) hormonal contraceptionb
○
Oral
○
Intravaginal
○
Transdermal
○
Injectable
●
Progestogen only hormonal contraceptionb,c
○
Oral
○
Injectable
Highly Effective Methods That Have Low User Dependency
Failure rate of <1% per year when used consistently and correctly.
●
Progestogen- only contraceptive implantb
●
Intrauterine hormone-releasing system (IUS)b
●
Intrauterine device (IUD)
●
Bilateral tubal occlusion
●
Vasectomized partner
A vasectomized partner is a highly effective contraception method provided that the partner is the sole 
male sexual partner of the WOCBP and the absence of sperm has been confirmed. If not, an additional 
highly effective method of contraception should be used.
●
Sexual abstinence
Sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual
intercourse during the entire period of risk associated with the study intervention. The reliability of 
sexual abstinence needs to be evaluated in relation to the duration of the study and the preferred and 
usual lifestyle of the participant.
Notes:
Use should be consistent with local regulations regarding the use of contraceptive methods for participants of 
clinical studies.
a
Typical use failure rates are higher than perfect-use failure rates (ie, when used consistently and 
correctly).
b
If locally required, in accordance with Clinical Trial Facilitation Group guidelines, acceptable hormonal 
contraceptives are limited to those which inhibit ovulation.
10.5.3
Pregnancy Testing
WOCBP should only be included after a negative highly sensitive urine or serum pregnancy
test.
Pregnancy testing will be performed whenever an expected menstrual cycle is missed or 
when pregnancy is otherwise suspected.
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10.6
Appendix 6: Collection and Management of Specimens for Future Biomedical 
Research
1.
Definitions

Biomarker: A biological molecule found in blood, other body fluids, or tissues that is
a sign of a normal or abnormal process or of a condition or disease. A biomarker may
be used to see how well the body responds to a treatment for a disease or condition. 

Pharmacogenomics: The investigation of variations of DNA and RNA characteristics 
as related to drug/vaccine response.2

Pharmacogenetics: A subset of pharmacogenomics, pharmacogenetics is the influence 
of variations in DNA sequence on drug/vaccine response.2

DNA: Deoxyribonucleic acid.

RNA: Ribonucleic acid.
2.
Scope of Future Biomedical Research
The specimens consented and/or collected in this study as outlined in Section 8.8 will be 
used in various experiments to understand:
•
The biology of how drugs/vaccines work
•
Biomarkers responsible for how a drug/vaccine enters and is removed by the body
•
Other pathways drugs/vaccines may interact with
•
The biology of disease
The specimen(s) may be used for future assay development and/or drug/vaccine 
development.
It is now well recognized that information obtained from studying and testing clinical 
specimens offers unique opportunities to enhance our understanding of how individuals 
respond to drugs/vaccines, enhance our understanding of human disease and ultimately 
improve public health through development of novel treatments targeted to populations 
with the greatest need. All specimens will be used by the Sponsor or those working for or 
with the Sponsor.
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3.
Summary of Procedures for Future Biomedical Research.

Participants for Enrollment
All participants enrolled in the clinical study will be considered for enrollment in the 
future biomedical research substudy

Informed Consent
Informed consent for specimens (ie, DNA, RNA, protein, etc.) will be obtained 
during screening for protocol enrollment from all participants or legal guardians at a 
study visit by the investigator or his or her designate. Informed consent for future 
biomedical research should be presented to the participants on the visit designated in 
the SoA. If delayed, present consent at next possible Participant Visit. Consent forms 
signed by the participant will be kept at the clinical study site under secure storage for 
regulatory reasons.
A template of each study site’s approved informed consent will be stored in the 
Sponsor’s clinical document repository.

eCRF Documentation for Future Biomedical Research Specimens
Documentation of participant consent for future biomedical research will be captured 
in the eCRFs. Any specimens for which such an informed consent cannot be verified 
will be destroyed.

Future Biomedical Research Specimen(s)
Collection of specimens for future biomedical research will be performed as outlined 
in the SoA. In general, if additional blood specimens are being collected for future 
biomedical research, these will usually be obtained at a time when the participant is 
having blood drawn for other study purposes.
4.
Confidential Participant Information for Future Biomedical Research
In order to optimize the research that can be conducted with future biomedical research 
specimens, it is critical to link participant' clinical information with future test results. In 
fact little or no research can be conducted without connecting the clinical study data to 
the specimen. The clinical data allow specific analyses to be conducted. Knowing 
participant characteristics like gender, age, medical history and treatment outcomes are 
critical to understanding clinical context of analytical results.
To maintain privacy of information collected from specimens obtained for future 
biomedical research, the Sponsor has developed secure policies and procedures. All 
specimens will be single-coded per ICH E15 guidelines as described below.
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At the clinical study site, unique codes will be placed on the future biomedical research 
specimens. This code is a random number which does not contain any personally 
identifying information embedded within it. The link (or key) between participant 
identifiers and this unique code will be held at the study site. No personal identifiers will 
appear on the specimen tube.
5.
Biorepository Specimen Usage
Specimens obtained for the Sponsor will be used for analyses using good scientific 
practices. Analyses utilizing the future biomedical research specimens may be performed 
by the Sponsor, or an additional third party (eg, a university investigator) designated by 
the Sponsor. The investigator conducting the analysis will follow the Sponsor’s privacy 
and confidentiality requirements. Any contracted third party analyses will conform to the 
specific scope of analysis outlined in this substudy. Future biomedical research 
specimens remaining with the third party after specific analysis is performed will be 
reported to the Sponsor.
6.
Withdrawal From Future Biomedical Research
Participants may withdraw their consent for future biomedical research and ask that their 
biospecimens not be used for future biomedical research. Participants may withdraw 
consent at any time by contacting the principal investigator for the main study. If medical 
records for the main study are still available, the investigator will contact the Sponsor 
using the designated mailbox (clinical.specimen.management@merck.com). 
Subsequently, the participant's specimens will be flagged in the biorepository and 
restricted to main study use only. If specimens were collected from study participants 
specifically for future biomedical research, these specimens will be removed from the 
biorepository and destroyed. Documentation will be sent to the investigator confirming 
withdrawal and/or destruction, if applicable. It is the responsibility of the investigator to 
inform the participant of completion of the withdrawal and/or destruction, if applicable. 
Any analyses in progress at the time of request for withdrawal/destruction or already 
performed prior to the request being received by the Sponsor will continue to be used as 
part of the overall research study data and results. No new analyses would be generated 
after the request is received.
In the event that the medical records for the main study are no longer available (eg, if the 
investigator is no longer required by regulatory authorities to retain the main study 
records) or the specimens have been completely anonymized, there will no longer be a 
link between the participant’s personal information and their specimens. In this situation, 
the request for withdrawal of consent and/or destruction cannot be processed.
7.
Retention of Specimens
Future biomedical research specimens will be stored in the biorepository for potential 
analysis for up to 20 years from the end of the main study. Specimens may be stored for 
longer if a regulatory or governmental authority has active questions that are being 
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answered. In this special circumstance, specimens will be stored until these questions 
have been adequately addressed.
Specimens from the study site will be shipped to a central laboratory and then shipped to 
the Sponsor-designated biorepository. If a central laboratory is not utilized in a particular 
study, the study site will ship directly to the Sponsor-designated biorepository. The 
specimens will be stored under strict supervision in a limited access facility which 
operates to assure the integrity of the specimens. Specimens will be destroyed according 
to Sponsor policies and procedures and this destruction will be documented in the 
biorepository database.
8.
Data Security
Databases containing specimen information and test results are accessible only to the 
authorized Sponsor representatives and the designated study administrator research 
personnel and/or collaborators. Database user authentication is highly secure, and is 
accomplished using network security policies and practices based on international 
standards to protect against unauthorized access.
9.
Reporting of Future Biomedical Research Data to Participants
No information obtained from exploratory laboratory studies will be reported to the 
participant, family, or physicians. Principle reasons not to inform or return results to the 
participant include: Lack of relevance to participant health, limitations of predictive 
capability, and concerns regarding misinterpretation.
If important research findings are discovered, the Sponsor may publish results, present 
results in national meetings, and make results accessible on a public website in order to 
rapidly report this information to doctors and participants. Participants will not be 
identified by name in any published reports about this study or in any other scientific 
publication or presentation.
10.
Future Biomedical Research Study Population
Every effort will be made to recruit all participants diagnosed and treated on Sponsor 
clinical studies for future biomedical research.
11.
Risks Versus Benefits of Future Biomedical Research
For future biomedical research, risks to the participant have been minimized and are 
described in the Future Biomedical Research informed consent.
The Sponsor has developed strict security, policies, and procedures to address participant 
data privacy concerns. Data privacy risks are largely limited to rare situations involving 
possible breach of confidentiality. In this highly unlikely situation, there is risk that the 
information, like all medical information, may be misused.
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12.
Questions
Any questions related to the future biomedical research should be emailed directly to 
clinical.specimen.management@merck.com.
13.
References

National Cancer Institute [Internet]: Available from 
https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45618

International Conference on Harmonization [Internet]: E15: Definitions for Genomic 
Biomarkers, Pharmacogenomics, Pharmacogenetics, Genomic Data and Sample 
Coding Categories. Available from 
http://www.ich.org/products/guidelines/efficacy/efficacy-single/article/definitions-
for-genomic-biomarkers-pharmacogenomics-pharmacogenetics-genomic-data-and-
sample-cod.html

Industry Pharmacogenomics Working Group [Internet]: Understanding the Intent, 
Scope and Public Health Benefits of Exploratory Biomarker Research: A Guide for 
IRBs/IECs and Investigational Site Staff. Available at http://i-pwg.org/ 

Industry Pharmacogenomics Working Group [Internet]: Pharmacogenomics 
Informational Brochure for IRBs/IECs and Investigational Site Staff. Available at 
http://i-pwg.org/
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10.7
Appendix 7: Country-specific Requirements
10.7.1
Country-Specific Request from Swedish Health Authority
10.7.1.1
Benefit/Risk Assessment
Prior to the evaluation of V114 in humans, preclinical animal studies were conducted in rats, 
mice, rabbits, and non-human primates, and study results showed that the vaccine was 
immunogenic and displayed an acceptable safety profile. V114 contains similar components 
as the licensed vaccines Prevenar™ and Prevenar 13™which comprise a subset of 
respectively 7 and 13 of the 15 PnPs conjugated to the CRM197 carrier protein found in V114, 
as well as Aluminum Phosphate Adjuvant (APA). The safety profiles for Prevenar™ and 
Prevenar 13™ can be found in the respective product labeling. Two different formulations of 
V114 were studied in 8 Phase 1 and Phase 2 clinical studies involving 4,140 subjects 
comprising of 2,960 children (90 toddlers, 12 to 18 months of age and 2,870 infants, 6 to 
12 weeks of age) who received a 4-dose regimen of study vaccine given at 2, 4, 6, and 12 to 
15 months of age and 1,810 adults (180 young adults 18 to 49 years of age and 1,630 adults 
≥50 years of age) who received a single dose of the study vaccine. A total of 2,685 subjects 
(1,950 children and 735 adults) received at least 1 dose of V114. 
Both nonadjuvanted V114 and APA-adjuvanted V114 were evaluated in early Phase 1 
(single dose in toddlers and young adults 18-49 years of age) and Phase 2 (4-dose regimen in 
infants) clinical studies. The 2 vaccines displayed acceptable safety profiles comparable to 
Prevenar™ and Prevenar 13™. In 1 adult Phase 2 clinical study comparing the safety and 
immunogenicity of V114 to Prevenar 13™and PNEUMOVAX™23, the safety profile of 
V114 was also shown to be comparable to PNEUMOVAX™23. Following vaccination with 
V114, the most frequently reported adverse events were those solicited in the clinical study
and included injection-site pain/tenderness (72% in infants and 60% in adults), redness (59% 
in infants and 14% in adults), and swelling (49% in infants and 20% in adults). Most 
frequently reported systemic adverse events were those solicited in the studies; muscle pain 
(29%), fatigue (25%), headache (17%), and joint pain (17%) were commonly reported 
among adults while irritability (86%), drowsiness (72%), decreased appetite (57%) were 
commonly reported in infants following any vaccination. Vaccine-induced immune responses 
were directed to all 15 serotypes included in V114 and recipients of the adjuvanted V114 
vaccine generally tended to exhibit higher serotype-specific IgG GMCs and OPA GMTs for 
the majority of the serotypes included in V114, justifying the inclusion of APA in the vaccine 
formulation in order to provide optimal antibody responses. Although the antibody responses 
measured in adults vaccinated with V114 were comparable to those measured in recipients of 
Prevenar 13™for most shared serotypes, antibody responses measured in infants vaccinated 
with V114 were generally lower than those vaccinated with Prevenar 13™ for some shared 
serotypes at 1 month postdose 3. The results from study V114-003 indicated a need for 
formulation optimization of the candidate vaccine, particularly the need for determining the 
optimal amount of polysaccharide for each serotype and optimal concentration of aluminum 
adjuvant needed in V114 to elicit optimal serotype-specific IgG and OPA responses in 
infants.
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The Sponsor conducted additional clinical studies to optimize the vaccine formulation and 
assess its tolerability, safety, and immunogenicity profiles. As part of the formulation 
optimization, 2 formulations of V114 (Formulation A and Formulation B) were tested 
clinically in several Phase 1/2 clinical studies involving a small number (20 to 50 subjects per
arm) of young adults (18 to 49 years of age) and infants (V114-004 and V114-005), as well 
as larger number (125 to 230 subjects per arm) of pneumococcal vaccine-naïve adults 
50 years of age and older (V114-006) and adults 65 years of age or older with prior history
(at least 1 year prior to study entry) of vaccination with PNEUMOVAX™23 (V114-007). 
Both V114 formulations displayed an acceptable safety profile and induced comparable 
levels of antibodies to Prevenar 13™ for the shared serotypes. V114 also induced higher 
antibodies to serotypes 22F and 33F, which are not included in Prevenar 13™ and have 
emerged recently as important causes of pneumococcal disease in both children and adults.
Results from these studies identified a formulation (Formulation B) with improved clinical 
performance in both infants and older adults. A pediatric Phase 2 study (V114-008) involving 
1,050 infants (350 per arm) is ongoing to confirm the performance of Formulation B 
observed in V114-005. Following vaccination with V114 Formulation B, the most frequently 
reported adverse events were those solicited in the clinical study and included injection-site 
pain/tenderness (64% in infants and 60% in adults), redness (38% in infants and 11% in 
adults), and swelling (20% in infants and 16% in adults). Most frequently reported systemic 
adverse events were those solicited in the studies; muscle pain (18%), fatigue (17%), 
headache (12%), and joint pain (7%) were commonly reported among adults, while 
irritability (82%), drowsiness (60%), decreased appetite (32%) were commonly reported in 
infants following any vaccination.
Several studies have evaluated the safety and immunogenicity of pneumococcal vaccines in 
adult and pediatric recipients of allogeneic HSCT [Meisel, R., et al 2007] [Kumar, D., et al 
2007] [Pao, M., et al 2008] [Okinaka, K., et al 2017] [Cordonnier, C., et al 2009] 
[Cordonnier, C., et al 2010] [Cordonnier, C., et al 2015]. The number of doses and nature of 
the pneumococcal vaccines administered varied between studies although most recent studies 
consisted of the sequential administration of 3-4 doses of pneumococcal conjugate vaccine 
(Prevenar™or Prevenar 13™) followed by a dose of PNEUMOVAX™23. Results from 
these studies showed that pneumococcal vaccination was associated with an increased 
frequency of local and systemic reactions associated with repeated dosing; the majority of 
reported adverse events (AEs) were those solicited in the study, including injection site 
(pain/tenderness, redness, and swelling) AEs and systemic (fever, headache, fatigue, muscle 
pain, and joint pain) AEs. These events were transient (average of 5 days for local AEs and 7 
days for systemic AEs). Moreover, AEs associated with withdrawal from the study were 
generally due to underlying disease and none of the 14 deaths reported were related to the 
study vaccine. Vaccine-induced immune responses increased with each subsequent dose and 
responses to the fourth dose were higher than the third dose, implying the establishment of an 
immune memory. Overall, study results supported the benefit of vaccinating HSCT recipients 
with Prevenar 13™ followed by PNEUMOVAX™23 [European Medicines Agency 2014].
Previous studies comparing the safety and immunogenicity of the investigational V114 to 
Prevenar 13™and/or PNEUMOVAX™23 did not show a difference in the frequency and 
severity of AEs reported following vaccination [Ermlich, S. J., et al 2018]. The comparable 
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safety and immunogenicity profiles of V114 to Prevenar 13™ and PNEUMOVAX™23 in 
previous clinical studies involving healthy children and adults indicate that V114 will likely 
display comparable safety and immunogenicity profiles to these licensed vaccines among 
immunocompromised individuals, including HSCT recipients. Although V114 induces 
antibody responses to 2 more serotypes (22F and 33F) than Prevenar 13™, it cannot be 
guaranteed that participants in V114 clinical studies will directly benefit from intervention 
during participation, as clinical studies are designed to provide information about the safety 
and effectiveness of an investigational vaccine.
In conclusion, the investigational V114 vaccine has comparable safety and immunogenicity 
profiles to Prevenar 13™ and PNEUMOVAX™23, 2 licensed pneumococcal vaccines that 
were clinically evaluated in several studies involving HSCT recipients and currently 
recommended for the prevention against pneumococcal disease in this group of high-risk 
individuals. The satisfactory clinical performance and general tolerability of V114 in healthy 
children and adults to date supports the clinical evaluation of the investigational vaccine in 
HSCT recipients. Given the accepted benefit of vaccinating HSCT recipients with 
Prevenar 13™ and PNEUMOVAX™23 by professional societies and national immunization 
institutions/agencies, the benefit/risk for vaccinating HSCT recipients with V114 is favorable 
as it is anticipated that V114 will provide health benefits comparable to these licensed 
vaccines [Lopez, A., et al 2017]. The safety profile of the investigational V114 vaccine is 
closely monitored on a continuing basis by an external data monitoring committee.
10.7.1.2
Ethics Committee Review [Institutional Review Board (IRB)/Independent 
Ethics Committee (IEC)]
The following statement will replace the Participant Protection Section III, Part A of 
Appendix 1, Code of Conduct for Clinical Trials:
The protocol, protocol amendments, ICF, Investigator Brochure, and other relevant 
documents must be submitted to and approved by the applicable Competent Authority and 
IRB/IEC before the study is initiated in accordance with EU Directive 2001/20/EC, Article 
10 (a) and/or local requirements.
Any amendments to the protocol will require IRB/IEC and Competent Authority approval 
before implementation of changes made to the study design, except for changes necessary to 
eliminate an immediate hazard to study participants [2001/20/EC, Article 10 (b)].
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10.8
Appendix 8: Abbreviations
Abbreviation
Expanded Term
AE
adverse event 
CRF
Case Report Form 
DMC
Data Monitoring Committee 
DNA
deoxyribonucleic acid 
ECG
electrocardiogram 
ECL
Electrochemiluminescence
eCRF
electronic Case Report Form
EDC
electronic data collection 
EMA
European Medicines Agency
FDAAA
Food and Drug Administration Amendments Act
EU
European Union
eVRC
Electronic Vaccination Report Card
FAS
Full Analysis Set
FSH
Follicle stimulating hormone 
GCP
Good Clinical Practice 
HRT
hormone replacement therapy
GMC
Geometric Mean Concentration
GMFR
Geometric Mean Fold Rise
GMT
Geometric Mean Titer
IB
Investigator’s Brochure 
ICF
Informed Consent Form 
ICH
International Conference on Harmonization
IEC
Independent Ethics Committee
IgG
Immunoglobulin G
IMP
Investigational Medicinal Product
IPD
Invasive Pneumococcal Disease
IRB
Institutional Review Board 
IUD
intrauterine device
IUS
intrauterine hormone-releasing system
IVRS/IWRS
Interactive Voice Response System/Integrated Web Response System
MOPA
Multiplexed Opsonophagocytic Assay
MRL
Merck Research Laboratories
NIMP
Non-Investigational Medicinal Product 
NSAE
Non-Serious Adverse Event 
PnECL
Pneumococcal Electrochemiluminescence
PP
Per-Protocol
PPV23
PNEUMOVAX™23
RNA
ribonucleic acid
SAE
serious adverse event 
SoA
schedule of activities
SUSAR
suspected unexpected serious adverse reaction
WOCBP
woman/women of childbearing potential 
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11
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04MG9J
07X67T

PRODUCT: V114 
123
PROTOCOL/AMENDMENT NO.: 022-04 
V114-022-04 FINAL PROTOCOL
02-APR-2019
[Wagenvoort, G. H., et al 
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