A Phase 3, Multicenter, Randomized, Double-blind, Active Comparator-controlled Study to Evaluate the Safety, Tolerability, and Immunogenicity of V114 Followed by Administration of PNEUMOVAX™23 Six Months Later in Immunocompetent Adults Between 18 and 49 Years of Age at Increased Risk for Pneumococcal Disease (PNEU - DAY)
Phase: PHASE3
Conditions: Pneumococcal Infections
Sponsor: Merck Sharp & Dohme LLC

Official Protocol Title: 
NCT number: 
NCT03547167  
Document Date: 
31-Aug-2018
A Phase 3, Multicenter, Randomized, Double-blind, Active Comparator-
controlled Study to Evaluate the Safety, Tolerability, and 
Immunogenicity of V114 Followed by Administration of 
PNEUMOVAX™23 Six Months Later in Immunocompetent Adults 
Between 18 and 49 Years of Age at Increased Risk for Pneumococcal 
Disease (PNEU –DAY).

PRODUCT: V114 
1
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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, Multicenter, Randomized, Double-blind, Active Comparator-
controlled Study to Evaluate the Safety, Tolerability, and Immunogenicity of V114 Followed 
by Administration of PNEUMOVAX™23 Six Months Later in Immunocompetent Adults 
Between 18 and 49 Years of Age at Increased Risk for Pneumococcal Disease (PNEU –
DAY).
Protocol Number: 017-02
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
EudraCT
14977
2017-004915-38
Approval Date: 31-August-2018
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
2
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
3
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
PROTOCOL AMENDMENT SUMMARY OF CHANGES
Amendment: 02
Overall Rationale for the Amendments:
The primary purpose of this amendment is to include a spirometry assessment at Visit 1 (Screening) for those otherwise eligible 
individuals who have a clinical history of asthma or chronic obstructive pulmonary disease (COPD) and who do not have spirometry 
results from within the previous 5 years. This change will ensure that those individuals with a clinical diagnosis of asthma or COPD 
who do not have spirometry results available within the previous 5 years meet the documentation requirements for inclusion in the 
study. 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 
1.2
Schema
1.3.1
Schedule of Activities for the 
Main Study
1.3.2
Schedule of Activities for Native 
Americans Enrolled through the Johns 
Hopkins Center for American Indian 
Health (CAIH) Participating in the 
Substudy
5.1
Inclusion Criteria
Changed to include a spirometry assessment 
at Visit 1 (Screening) for individuals who 
are otherwise eligible for study enrollment
based on a clinical history of asthma or
COPD but who do not have spirometry 
results from within the previous 5 years. 
Inclusion criteria 1c and 1d were updated 
with specific details, and the Schema and 
Schedule of Assessments reflect these 
changes.
Spirometry assessment was included at 
Visit 1 (Screening) to:

improve recognition and diagnosis of 
chronic lung disease (eg, asthma and/or 
COPD) through the use of a standard 
respiratory lung function test, as these 
tests can support a clinical diagnosis of 
asthma/COPD in the primary care 
setting, and 

increase the number of eligible 
individuals with chronic lung disease.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
4
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Section # and Name
Description of Change 
Brief Rationale 
1.3.2
Schedule of Activities for Native 
Americans Enrolled through the Johns 
Hopkins Center for American Indian 
Health (CAIH) Participating in the 
Substudy
8.1.9
Vaccination Report Card
Changed to allow collection of the paper 
VRC for participants enrolled in the CAIH
substudy at either Visit 2C or Visit 3, and at 
either Visit 4C or Visit 5 (at the discretion of 
the site personnel). 
Clarified that the completed paper VRC will 
be reviewed in full with the participant by 
the site personnel at the time of collection.
Collection of the paper VRC at Visits 2C 
and 4C allows for a more timely collection 
and assessment of safety data as these 
visits are approximately 15 days after each 
study vaccination.
5.1
Inclusion Criteria
The time period between the following 
required diagnostic tests and screening, 
which are required to determine participant 
eligibility, was increased to within 5 years of 
Visit 1 (Screening): FibroScan®;
FibroTest®; spirometry; diagnostic 
documentation for chronic heart disease, 
including echocardiography.
Inclusion criteria 1b, 1c, 1d, and 1e were 
updated accordingly.
Length of time between required 
diagnostic tests and screening was 
increased to provide more flexibility for 
inclusion of participants in the study.
5.2
Exclusion Criteria
Proliferative diabetic retinopathy was 
removed from exclusion criterion #2.
Proliferative diabetic retinopathy was 
originally intended to be a marker for 
unstable diabetes. However, this procedure 
is not used consistently across the sites 
and, therefore, is no longer considered to 
be a good marker of unstable diabetes.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
5
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Section # and Name
Description of Change 
Brief Rationale 
5.2
Exclusion Criteria
Four exclusion criteria were added: 
#30:  Diabetes mellitus with HgA1c ≥10% 
at Visit 1 (Screening).
#31:  Chronic liver disease with Child-Pugh 
Class B or C cirrhosis at Visit 1(Screening).
#32:  Chronic lung disease with COPD 
GOLD Stage 4 or severe persistent asthma 
at Visit 1 (Screening).
#33:  Chronic heart disease with NYHA 
heart failure Class 4 at Visit 1 (Screening).
These additional exclusion criteria were 
added to clarify that individuals with these 
conditions cannot be enrolled under a 
different risk category (such as smokers).
8.1.8
Study Intervention 
Administration
The following text was added:
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.
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].
Text was added to provide guidance on 
expected vaccine administration 
instructions. 
Throughout
Editorial revisions
Changes are minor and have not been 
summarized individually.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
6
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Table of Contents
PROTOCOL AMENDMENT SUMMARY OF CHANGES...............................................3
1
PROTOCOL SUMMARY ............................................................................................13
1.1
Synopsis.................................................................................................................13
1.2
Schema ..................................................................................................................18
1.3
Schedule of Activities (SoA) ................................................................................19
1.3.1
Schedule of Activities for the Main Study...................................................19
1.3.2
Schedule of Activities for Native Americans Enrolled through the Johns 
Hopkins Center for American Indian Health (CAIH) Participating in the 
Substudy.......................................................................................................26
2
INTRODUCTION..........................................................................................................33
2.1
Study Rationale....................................................................................................33
2.2
Background ..........................................................................................................34
2.2.1
V114 and Pneumococcal Disease ................................................................34
2.2.2
Preclinical and Clinical Studies ...................................................................35
2.2.3
Information on Other Study-related Therapy ..............................................35
2.2.3.1
Prevnar 13™......................................................................................35
2.2.3.2
PNEUMOVAX™23 ..........................................................................36
2.3
Benefit/Risk Assessment......................................................................................36
3
HYPOTHESIS, OBJECTIVES, AND ENDPOINTS .................................................37
4
STUDY DESIGN............................................................................................................39
4.1
Overall Design ......................................................................................................39
4.1.1
Main Study...................................................................................................39
4.1.2
Substudy.......................................................................................................40
4.2
Scientific Rationale for Study Design.................................................................41
4.2.1
Rationale for Endpoints ...............................................................................42
4.2.1.1
Immunogenicity Endpoints................................................................42
4.2.1.2
Safety Endpoints ................................................................................42
4.2.1.3
Future Biomedical Research..............................................................43
4.2.2
Rationale for the Use of Comparator/Placebo .............................................43
4.3
Justification for Dose ...........................................................................................43
4.4
Beginning and End of Study Definition .............................................................44
4.4.1
Clinical Criteria for Early Study Termination .............................................44
5
STUDY POPULATION ................................................................................................44
5.1
Inclusion Criteria.................................................................................................44
5.2
Exclusion Criteria ................................................................................................47
5.3
Lifestyle Considerations ......................................................................................49
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
7
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
5.4
Screen Failures.....................................................................................................49
5.5
Participant Replacement Strategy......................................................................50
6
STUDY INTERVENTION............................................................................................50
6.1
Study Intervention(s) Administered...................................................................50
6.2
Preparation/Handling/Storage/Accountability .................................................52
6.2.1
Dose Preparation..........................................................................................52
6.2.2
Handling, Storage, and Accountability........................................................52
6.3
Measures to Minimize Bias: Randomization and Blinding..............................52
6.3.1
Intervention Assignment..............................................................................52
6.3.2
Stratification.................................................................................................53
6.3.3
Blinding........................................................................................................54
6.4
Study Intervention Compliance..........................................................................55
6.5
Concomitant Therapy..........................................................................................55
6.5.1
Rescue Medications and Supportive Care ...................................................55
6.6
Dose Modification (Escalation/Titration/Other)...............................................56
6.7
Intervention After the End of the Study............................................................56
6.8
Clinical Supplies Disclosure................................................................................56
7
DISCONTINUATION OF STUDY INTERVENTION AND PARTICIPANT 
WITHDRAWAL............................................................................................................56
7.1
Discontinuation of Study Intervention...............................................................56
7.2
Participant Withdrawal From the Study...........................................................57
7.3
Lost to Follow-up .................................................................................................57
8
STUDY ASSESSMENTS AND PROCEDURES ........................................................58
8.1
Administrative and General Procedures ...........................................................59
8.1.1
Informed Consent.........................................................................................59
8.1.1.1
General Informed Consent.................................................................60
8.1.1.2
Consent and Collection of Specimens for Future Biomedical 
Research.............................................................................................60
8.1.2
Inclusion/Exclusion Criteria ........................................................................60
8.1.3
Participant Identification Card.....................................................................60
8.1.4
Medical History ...........................................................................................61
8.1.5
Prior and Concomitant Medications Review ...............................................61
8.1.5.1
Prior Medications...............................................................................61
8.1.5.2
Concomitant Medications ..................................................................61
8.1.6
Assignment of Screening Number...............................................................61
8.1.7
Assignment of Treatment/Randomization Number .....................................62
8.1.8
Study Intervention Administration ..............................................................62
8.1.8.1
Timing of Dose Administration.........................................................63
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
8
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
8.1.9
Vaccination Report Card..............................................................................63
8.1.10
6-month Safety Follow-up Questionnaire....................................................64
8.1.11
Discontinuation and Withdrawal .................................................................64
8.1.11.1
Withdrawal From Future Biomedical Research ................................64
8.1.12
Participant Blinding/Unblinding..................................................................64
8.1.13
Calibration of Equipment.............................................................................65
8.2
Immunogenicity Assessments .............................................................................65
8.2.1
Multiplex Opsonophagocytic Assay (MOPA).............................................66
8.2.2
Electrochemiluminescence (ECL) ...............................................................66
8.3
Safety Assessments...............................................................................................66
8.3.1
Physical Examinations.................................................................................67
8.3.2
Pregnancy Test.............................................................................................67
8.3.3
Body Temperature Measurement.................................................................67
8.3.4
Safety Assessments and Use of the Paper VRC/eVRC ...............................67
8.3.5
Clinical Laboratory Assessments.................................................................68
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 ..........................................................69
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...71
8.4.4
Regulatory Reporting Requirements for SAE .............................................71
8.4.5
Pregnancy and Exposure During Breastfeeding ..........................................71
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) ................................................................72
8.5
Treatment of Overdose........................................................................................72
8.6
Pharmacokinetics.................................................................................................72
8.7
Pharmacodynamics..............................................................................................72
8.8
Future Biomedical Research Sample Collection...............................................72
8.9
Planned Genetic Analysis Sample Collection ....................................................72
8.10
Biomarkers ...........................................................................................................72
8.11
Medical Resource Utilization and Health Economics.......................................73
8.12
Visit Requirements...............................................................................................73
8.12.1
Screening......................................................................................................73
8.12.2
Treatment Period/Vaccination Visit ............................................................73
8.12.3
Discontinued Participants Continuing to be Monitored in the Study ..........73
9
STATISTICAL ANALYSIS PLAN .............................................................................73
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
9
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
9.1
Statistical Analysis Plan Summary.....................................................................73
9.2
Responsibility for Analyses/In-house Blinding .................................................75
9.3
Hypotheses/Estimation ........................................................................................75
9.4
Analysis Endpoints...............................................................................................75
9.4.1
Immunogenicity Endpoints..........................................................................75
9.4.2
Safety Endpoints ..........................................................................................76
9.5
Analysis Populations............................................................................................77
9.5.1
Immunogenicity Analysis Populations ........................................................77
9.5.2
Safety Analysis Populations ........................................................................77
9.6
Statistical Methods...............................................................................................78
9.6.1
Statistical Methods for Immunogenicity Analyses ......................................78
9.6.2
Statistical Methods for Safety Analyses ......................................................79
9.6.3
Demographic and Baseline Characteristics .................................................81
9.7
Interim Analyses ..................................................................................................81
9.8
Multiplicity ...........................................................................................................82
9.9
Sample Size and Power Calculations .................................................................82
9.9.1
Sample Size and Power for Immunogenicity Analyses ...............................82
9.9.2
Sample Size and Power for Safety Analyses ...............................................83
9.10
Subgroup Analyses...............................................................................................83
9.11
Compliance (Medication Adherence).................................................................84
9.12
Extent of Exposure...............................................................................................84
10
SUPPORTING DOCUMENTATION AND OPERATIONAL
CONSIDERATIONS .....................................................................................................85
10.1
Appendix 1: Regulatory, Ethical, and Study Oversight Considerations ........85
10.1.1
Code of Conduct for Clinical Trials.............................................................85
10.1.2
Financial Disclosure.....................................................................................87
10.1.3
Data Protection.............................................................................................87
10.1.3.1
Confidentiality of Data ......................................................................87
10.1.3.2
Confidentiality of Participant Records...............................................87
10.1.3.3
Confidentiality of IRB/IEC Information............................................88
10.1.4
Committees Structure...................................................................................88
10.1.4.1
External Data Monitoring Committee ...............................................88
10.1.4.2
Executive Oversight Committee........................................................88
10.1.4.3
Scientific Advisory Committee..........................................................88
10.1.5
Publication Policy........................................................................................89
10.1.6
Compliance with Study Registration and Results Posting Requirements ...89
10.1.7
Compliance with Law, Audit, and Debarment ............................................89
10.1.8
Data Quality Assurance ...............................................................................90
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
10
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
10.1.9
Source Documents .......................................................................................91
10.1.10
Study and Site Closure.................................................................................91
10.2
Appendix 2: Clinical Laboratory Tests..............................................................92
10.3
Appendix 3: Adverse Events: Definitions and Procedures for Recording, 
Evaluating, Follow-up, and Reporting...............................................................93
10.3.1
Definition of AE ..........................................................................................93
10.3.2
Definition of SAE ........................................................................................94
10.3.3
Additional Events Reported.........................................................................95
10.3.4
Recording AE and SAE ...............................................................................95
10.3.5
Reporting of AE, SAE, and Other Reportable Safety Events to the 
Sponsor ......................................................................................................100
10.4
Appendix 4: Medical Device Incidents: Definition and Procedures for 
Recording, Evaluating, Follow-up, and Reporting.........................................102
10.5
Appendix 5: Contraceptive Guidance and Pregnancy Testing......................103
10.5.1
Definitions..................................................................................................103
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 (Does not apply to CAIH participants) .......................105
10.7
Appendix 7: Country-specific Requirements ..................................................110
10.8
Appendix 8: Abbreviations ...............................................................................111
11
REFERENCES.............................................................................................................113
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
11
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
LIST OF TABLES
Table 1
Study Interventions ....................................................................................51
Table 2
Approximate Blood Volumes Drawn by Study Visit and by Sample 
Types for Participants Enrolled at non-CAIH Sites...................................59
Table 3
Approximate Blood Volumes Drawn by Study Visit and by Sample 
Types for Participants Enrolled at CAIH Sites ..........................................59
Table 4
Reporting Time Periods and Time Frames for Adverse Events and 
Other Reportable Safety Events.................................................................70
Table 5
Analysis Strategy for Immunogenicity Variables......................................79
Table 6
Analysis Strategy for Safety Parameters Following Each Vaccination .....81
Table 7
Within-group 95% CIs for Varying Hypothetical OPA GMTs and 
Varying Standard Deviations.....................................................................83
Table 8
Protocol-required Safety Laboratory Assessments....................................92
Table 9
Contraceptive Methods ............................................................................104
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
12
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
LIST OF FIGURES
Figure 1
V114-017 Study Design.............................................................................18
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
13
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
1
PROTOCOL SUMMARY
1.1
Synopsis
Protocol Title: A Phase 3, Multicenter, Randomized, Double-blind, Active Comparator-
controlled Study to Evaluate the Safety, Tolerability, and Immunogenicity of V114 Followed 
by Administration of PNEUMOVAX™23 Six Months Later in Immunocompetent Adults 
Between 18 and 49 Years of Age at Increased Risk for Pneumococcal Disease (PNEU –
DAY).
Short Title: Safety and Immunogenicity of V114 in Adults at Risk for Pneumococcal 
Disease
Acronym: PNEUmococcal Conjugate Vaccine Trials: V114-017 (PNEU – DAY)
Hypotheses, Objectives, and Endpoints:
Objectives and endpoints described below will be evaluated in pneumococcal vaccine-naïve 
participants 18 to 49 years of age (inclusive) who are at increased risk for pneumococcal 
disease due to (1) an underlying medical condition, (2) behavioral habits such as smoking, or 
(3) living in a community/environment with increased risk of disease transmission.
Primary Objectives
Primary Endpoints
- Objective: To evaluate the safety and 
tolerability of V114 and Prevnar 13™ with 
respect to the proportion of participants with 
adverse events (AEs) within each vaccination 
group separately.
Following vaccination with V114 or 
Prevnar 13™:
- 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 to Month 6
- Objective: To evaluate the serotype-specific 
opsonophagocytic activity (OPA) Geometric 
Mean Titers (GMTs) at 30 days 
postvaccination (Day 30) with V114 and 
Prevnar 13™ within each vaccination group 
separately.
- Serotype-specific OPA responses for the 15 
serotypes in V114 at Day 30
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
14
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Secondary Objectives
Secondary Endpoints
- Objective: To evaluate the safety and 
tolerability of PNEUMOVAX™23 
administered 6 months following V114 and 
following Prevnar 13™ with respect to the 
proportion of participants with AEs within 
each vaccination group separately.
Following vaccination with 
PNEUMOVAX™23:
- 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 6 to 
Month 7
- Objective: To evaluate the serotype-specific 
Immunoglobulin G (IgG) Geometric Mean 
Concentrations (GMCs) at 30 days 
postvaccination (Day 30) with V114 and 
Prevnar 13™ within each vaccination group 
separately.
- Serotype-specific IgG responses for the 15 
serotypes in V114 at Day 30
- Objective: To evaluate the serotype-specific 
Geometric Mean Fold Rises (GMFRs) and 
proportions of participants with a ≥4-fold rise 
from prevaccination (Day 1) to 30 days 
postvaccination (Day 30) for both OPA and 
IgG responses for participants administered 
V114 and for participants administered 
Prevnar 13™ within each vaccination group 
separately. 
- Serotype-specific OPA and IgG responses 
for the 15 serotypes in V114 at Day 1 and 
Day 30
- Objective: To evaluate the serotype-specific 
(1) OPA GMTs and IgG GMCs at 30 days 
postvaccination with PNEUMOVAX™23 
(Month 7), (2) GMFRs and proportions of 
participants with a ≥4-fold rise from 
prevaccination (Day 1) to 30 days 
postvaccination with PNEUMOVAX™23 
(Month 7) for both OPA and IgG responses, 
(3) GMFRs and proportions of participants 
with a ≥4-fold rise from prevaccination with 
PNEUMOVAX™23 (Month 6) to 30 days 
postvaccination with PNEUMOVAX™23 
(Month 7) for both OPA and IgG responses 
for participants administered V114 and 
separately for participants administered 
Prevnar 13™ 6 months before receipt of 
PNEUMOVAX™23.
- Serotype-specific OPA and IgG responses 
for the 15 serotypes in V114 at Day 1, Month 
6, and Month 7
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
15
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Overall Design:
Study Phase
Phase 3
Primary Purpose
Prevention
Indication
Pneumococcal disease
Population
Pneumococcal vaccine-naïve participants 18 to 49 years of 
age (inclusive) who are at increased risk for pneumococcal 
disease due to (1) an underlying medical condition, (2) 
behavioral habits such as smoking, or (3) living in a 
community/environment with increased risk of disease 
transmission.
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 20 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 1500 individuals will be randomly assigned in a 3:1 ratio to receive either 
V114 (1125 participants) or Prevnar 13™ (375 participants) at Visit 2 (Day 1). 
Approximately 600 participants will be Native American living on or near a reservation in 
the southwestern United States who are enrolled in the study through clinical sites of Johns 
Hopkins CAIH.
A subset of Native American participants will be asked to participate in a substudy in which 
naso- and oropharyngeal swabs and urine samples will be collected to support the 
development of a novel diagnostic assay for the detection of pneumococcal disease. 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
16
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Enrollment into the substudy will be halted when 300 participants have been enrolled or 
when general enrollment into the main study at the CAIH sites is completed, whichever event 
comes first.
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
Single 
dose
IM 
Single Dose 
at Visit 2
(Day 1)
Experimental
PNEUMOVAX™23
Refer to 
product 
labeling
Single 
dose
IM
Single Dose 
at Visit 4 
(Month 6)
Experimental
Prevnar 
13™
Prevnar 13™
Refer to 
product 
labeling
Single 
dose
IM 
Single Dose 
at Visit 2
(Day 1)
Experimental
PNEUMOVAX™23
Refer to 
product 
labeling
Single 
dose
IM
Single Dose 
at Visit 4 
(Month 6)
Experimental
IB = Investigator’s Brochure; IM = intramuscular
Total 
Number
2 intervention groups
Duration of 
Participation
Each participant will participate in the study for approximately 7 months from 
the time the participant signs the Informed Consent Form (ICF) through the final 
contact. 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
17
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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: Yes
A list of abbreviations used in this document can be found in Appendix 8.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
18
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
1.2
Schema
The key components of the study design are depicted in Figure 1.
Figure 1
V114-017 Study Design
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
19
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
1.3
Schedule of Activities (SoA)
1.3.1
Schedule of Activities for the Main Study
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
Administrative and General Procedures
Informed Consent
X
Consent must be obtained before any 
study procedures.
Informed Consent for Future 
Biomedical Research (Note: Consent 
and samples will not be collected 
from Native American participants 
enrolled via Johns Hopkins Center 
for American Indian Health [CAIH])
X
Informed consent for future biomedical 
research samples must be obtained 
before the blood sample (DNA sample) 
is collected.
Assignment of Screening Number
X
Participant Identification Card
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
20
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
Disease-specific Laboratory and 
Diagnostic Assessments:
Diabetes mellitus: hemoglobin A1c
Chronic liver disease: aspartate 
aminotransferase, alanine 
aminotransferase, total bilirubin, 
prothrombin time/international 
normalized ratio, albumin, platelets
Chronic lung disease: spirometry 
X
Spirometry can be performed at 
screening if prospective participants 
have a clinical history of COPD or 
asthma consistent with inclusion criteria 
but no supporting documentation by 
spirometry as required by Inclusion 
Criteria 1c and 1d. 
Alcohol Use Disorders Identification 
Test (AUDIT-C)
X
AUDIT-C results will be used for 
stratification.
Assignment of Randomization Number
X
Prior/Concomitant Medication and 
Non-Study Vaccination Review
X
X
X
X
X
X
V114 or Prevnar 13™ Administration 
(Blinded)
X
At Visit 2 (Day 1), participants will 
receive either a single dose of V114 (or 
a single dose of Prevnar 13™. 
PNEUMOVAX™23 Administration 
(Open-label)
X
At Visit 4 (Month 6), participants will 
receive a single dose of 
PNEUMOVAX™23.
Provide Electronic Vaccination Report 
Card (eVRC) to Participants Not 
Enrolled through the CAIH
X
X
Participants will be provided an eVRC 
at Visit 2 (Day 1) and Visit 4 (Month 6) 
to record adverse events (AEs) and 
body temperature measurements. 
Instructions for using the eVRC will be 
reviewed with the participant.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
21
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
Provide Paper Vaccination Report Card 
(VRC) to Native American participants 
enrolled via Johns Hopkins CAIH
X
X
Participants will be provided a paper 
VRC at Visit 2 (Day 1) and Visit 4 
(Month 6) to record AEs and body 
temperature measurements. Instructions 
for using the paper VRC will be 
reviewed with the participant.
Review Paper VRC/eVRC Data with 
Participant
Xa
X
Xa
X
Site personnel will discuss information 
entered into the paper VRC/eVRC with 
participants during the telephone 
contacts conducted on Day 15 and 
Month 6.5. A full review of the 
completed paper VRC/eVRC will occur 
at Visit 3 (Day 30) and Visit 5 
(Month 7).
Collect Paper VRC/eVRC from 
participant
X
X
6-month Safety Follow-up 
Questionnaire
X
Site personnel will review the 
information in the 6-month Safety 
Follow-up Questionnaire provided by 
the Sponsor with the participant. Data 
to be reported from this discussion will 
include SAEs and/or any updates to 
previously reported safety information.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
22
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
Safety Procedures
Directed Physical Examination
X
X
To be performed by the investigator or 
medically qualified designee for 
determination of disease-specific 
physical assessments at Visit 1 
(Screening) and before 
PNEUMOVAX™23 vaccination at 
Visit 4 (Month 6).
Complete Physical Examination
X
To be performed by the investigator or 
medically qualified designee before 
study vaccine is administered.
Pregnancy Test – if applicable
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 the 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
23
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
Body Temperature Measurement 
Before Vaccination
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
To be performed by blinded study site 
personnel only.
AE Monitoring
X
X
X
X
X
X
X
AEs (serious and nonserious) are to be 
reported from Days 1 through 14 
following each vaccination. Serious 
adverse events (SAEs) and deaths are to 
be reported throughout the duration of 
an individual’s study participation.
AEs that occur after the consent form is 
signed but before 
allocation/randomization are also to be 
reported (Section 8.4.1).
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
24
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
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 
opsonophagocytic (OPA) and 
electrochemiluminescence (ECL)
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.

For participants enrolled via the 
CAIH, any sera remaining after 
OPA and ECL testing will be 
returned to the CAIH for 
destruction.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
25
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-up
Comments
Visit Number:
1
2
Telephone 
Contacta
3
4
Telephone 
Contacta
5
Scheduled Time:
Screening
Day 1
Day 15
Day 30
Month 
6
Month 6.5
Month 7
Visit Window:
30 days 
or less 
after 
Visit 1
Day 15 to 
Day 19 
after 
Visit 2b
Day 30 
to Day 
44 after 
Visit 2b
Day 166 
to Day 
194 
after 
Visit 2b
Day 15 to 
Day 19 after 
Visit 4c
Day 30 to 
Day 44 after 
Visit 4c
The results from all screening 
procedures at Visit 1 must be available 
before enrollment into the study at 
Visit 2 (Day 1).
Future Biomedical Research
Blood (DNA) for Future Biomedical 
Research
X
Collected from randomized participants 
who provided consent for future 
biomedical research (Section 8.8).
Native American participants enrolled 
via the CAIH will not participate in 
future biomedical research.
a
For participants enrolled via the CAIH, this visit may be conducted in person at the discretion of the investigator. 
b
When scheduling the Telephone Contact (Day 15), Visit 3 (Day 30), and Visit 4 (Month 6), “Day 1” is the date of Visit 2.
c
When scheduling the Telephone Contact (Month 6.5) and Visit 5 (Month 7), “Day 1” is the date of Visit 4.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
26
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
1.3.2
Schedule of Activities for Native Americans Enrolled through the Johns Hopkins Center for American Indian Health 
(CAIH) Participating in the Substudy
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Administrative Procedures and General Procedures
Informed Consent (to 
include consent for 
nasopharyngeal [NP] and 
oropharyngeal [OP] swabs 
and urine collection 
substudy)
X
Consent must be obtained 
before any study procedures.
Assignment of Screening 
Number
X
Participant Identification 
Card
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
27
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Disease-specific 
Laboratory and 
Diagnostic Assessments:
Diabetes mellitus:
hemoglobin A1c
Chronic liver disease:
aspartate aminotransferase, 
alanine aminotransferase, 
total bilirubin, prothrombin 
time/international 
normalized ratio, albumin, 
platelets  
Chronic lung disease: 
spirometry
X
Spirometry can be 
performed at screening if 
prospective participants have 
a clinical history of COPD 
or asthma consistent with 
inclusion criteria but no 
supporting documentation 
by spirometry as required by 
Inclusion Criteria 1c and 1d.
Alcohol Use Disorders 
Identification Test 
(AUDIT-C) 
X
AUDIT-C results will be 
used for stratification.
Assignment of 
Randomization Number
X
Prior/Concomitant 
Medication and Non-Study 
Vaccination Review
X
X
X
X
X
X
V114 or Prevnar 13™ 
Administration (Blinded)
X
At Visit 2 (Day 1), 
participants will receive 
either a single dose of V114 
or a single dose of 
Prevnar 13™. 
PNEUMOVAX™23 
Administration (Open-
label)
X
At Visit 4 (Month 6), all 
participants will receive a 
single dose of 
PNEUMOVAX™23.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
28
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Provide Paper Vaccination 
Report Card (VRC) to 
Participants
X
X
Participants will be provided 
a paper VRC at Visit 2 
(Day 1) and Visit 4 
(Month 6) to record adverse 
events (AEs) and body 
temperature measurements. 
Instructions for using the 
paper VRC will be reviewed 
with the participant.
Review Paper VRC Data 
with Participant
X
X
X
X
Site personnel will fully 
review all information 
entered onto the paper VRC 
with CAIH Substudy 
participants during Visit 2C 
and Visit 4C. A full review 
of the completed paper VRC 
will occur at Visit 3 (Day 
30) and Visit 5 (Month 7) if 
not reviewed and collected 
at the previous visit.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
29
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Collect Paper VRC from 
Participant
X
X
X
X
The paper VRC after the 
first vaccination can be 
collected at either Visit 
2C or Visit 3, and the 
paper VRC after the 
second vaccination can 
be collected at either 
Visit 4C or Visit 5 at the 
discretion of the study 
personnel. A full review 
of each completed paper 
VRC with the participant 
will occur at the time of 
collection by the site.
6-month Safety Follow-
up Questionnaire
X
Site personnel will 
review the information in 
the 6-month Safety 
Follow-up Questionnaire 
provided by the Sponsor 
with the participant. Data 
to be reported from this 
discussion will include 
SAEs and/or any updates 
to previously reported 
safety information
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
30
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Safety Procedures
Directed Physical 
Examination
X
X
To be performed by the 
investigator or medically 
qualified designee at Visit 1 
(Screening) for 
determination of disease-
specific physical 
assessments, and before 
PNEUMOVAX™23 
vaccination at Visit 4 
(Month 6).
Complete Physical 
Examination
X
To be performed by the 
investigator or medically 
qualified designee before 
study vaccine is 
administered.
Pregnancy Test – if 
applicable
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 the 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
31
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Body Temperature 
Measurement Before 
Vaccination
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
To be performed by blinded 
study site personnel only.
AE Monitoring
X
X
X
X
X
X
X
X
X
X
X
AEs (serious and 
nonserious) are to be 
reported from Days 1 
through 14 following each 
vaccination. Serious adverse 
events (SAEs) and deaths 
are to be reported throughout 
the duration of an 
individual’s study 
participation. AEs that occur 
after the consent form is 
signed but before 
allocation/randomization are 
also to be reported 
(Section 8.4.1).
 
 
050DGF
 
 
05KG3M

PRODUCT: V114
32
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Study Period
Screening
Intervention
Follow-
up
Visit Number:
1
2
2Aa
2Ba
2Ca
3
4
4Aa
4Ba
4Ca
5
Scheduled Time:
Screening
Day 
1
Day 
3
Day 
8
Day 
15
Day 
30
Month 
6
Day 
183
Day
188
Day
195
Month 
7
Comments
Visit Window:
30 days 
or less 
after 
Visit 1
Day 2
to 
Day 4 
after 
Visit 2b
Day 7
to 
Day 9 
after 
Visit 2b
Day 15 
to 
Day 17 
after 
Visit 2b
Day 30 
to 
Day 44 
after 
Visit 2b
Day 166 
to 
Day 194 
after 
Visit 2b
Day 2 
to 
Day 4 
after 
Visit 4 c
Day 7 
to 
Day 9 
after 
Visit 4 c
Day 15
to 
Day 17 
after 
Visit 4 c
Day 30
to 
Day 44 
after 
Visit 4 c
The results from all 
screening procedures at 
Visit 1 must be available 
before enrollment into the 
study at Visit 2 (Day 1).
Immunogenicity Procedures
Serum for Immunogenicity 
Assays
X
X
X
X
Blood samples must be 
collected before study 
vaccination when applicable.
Any sera remaining after 
OPA and ECL testing will 
be returned to the CAIH for 
destruction.
Substudy Assay Development Procedures
NP and OP swab collection 
for NP/OP colonization 
testing; urine sample 
collection for urine antigen 
detection assay
X
X
X
X
X
X
X
X
X
X
Any samples from NP/OP 
swab and urine collection 
remaining after protocol-
specified testing has been 
completed will be returned 
to the CAIH for destruction 
or for further testing by 
CAIH if agreed upon 
between Native American 
community and CAIH.
a
Substudy-specific visit.
b
When scheduling these visits, “Day 1” is the date of Visit 2.
c
When scheduling these visits, “Day 1” is the date of Visit 4.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
33
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
2
INTRODUCTION
Merck Sharp & Dohme Corp. (MSD) is developing an investigational 15-valent 
pneumococcal conjugate vaccine (PCV) (referred to as V114) for prevention of 
pneumococcal disease caused by the serotypes contained in the vaccine. V114 contains the 
13 serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, 19A, 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
Chronic heart, liver and lung disease, and diabetes increase the risk for invasive and 
noninvasive pneumococcal disease [Weycker, D., et al 2016] [Curcio, D., et al 2015] 
[Morton, J. B., et al 2017] [Torres, A., et al 2015]. Immunocompetent persons with 1 or more 
of these conditions are classified as immunocompetent ‘at risk’ by the Advisory Committee 
on Immunization Practices (ACIP), in contrast to the ‘high risk’ group of 
immunocompromised individuals [Centers for Disease Control and Prevention (CDC) 2010].
In the United States (US), the ACIP guidelines have included recommendations for 
pneumococcal vaccination for adults with diabetes and chronic cardiac, lung, and liver 
disease since the first pneumococcal polysaccharide vaccine was marketed in 1978 [Center 
for Disease Control 1978]; asthma and smoking were added as specific risk factors in 2010 
[Centers for Disease Control and Prevention (CDC) 2010]. Currently, PNEUMOVAX™23 
(pneumococcal vaccine, polyvalent [23-valent], MSD) is the only pneumococcal vaccine 
recommended by the ACIP for at-risk immunocompetent adults 19 to 64 years of age. 
However, in other countries, pneumococcal vaccine recommendations for this population 
also include Prevnar 13™, or sequential vaccination with Prevnar 13™and 
PNEUMOVAX™23, as some evidence suggests that functional antibody responses induced 
by PCVs are superior to those induced by pneumococcal polysaccharide vaccines [Centers 
for Disease Control and Prevention (CDC) 2010] [Center for Disease Control and Prevention 
2012] [Falkenhorst, G., et al 2017] [Australian Government Department of Health 2017] 
[French High Council for Public Health 2017] [Castiglia, P. 2014] [Jackson, L. A., et al 
2013].
The burden of pneumococcal disease is disproportionally high in some Native American 
communities on tribal land compared to the general US population [Weatherholtz, R., et al 
2010]. While the youngest and oldest individuals are at highest risk, elevated rates of 
invasive pneumococcal disease (IPD) are found throughout all age groups. Among Navajo 
adults, chronic heart failure, alcohol use, and unemployment are associated with an increased 
risk of IPD [Watt, J. P., et al 2007]. Many Native American populations experience a high 
burden of chronic medical conditions and poor socioeconomic risk factors. In 1997, the 
ACIP recommended routine use of PNEUMOVAX™23 for individuals ages 2 through 64 
years of age belonging to Alaska Natives or certain American Indian tribes, in addition to the 
age-based recommendation for individuals ≥ 65 years [Centers for Disease Control and 
Prevention 1997]. This recommendation was removed in 2010 due to the routine use of 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
34
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
PCVs in infants. However, an option was retained for targeted vaccination of adults living in 
areas with elevated risk for IPD compared to the general US population [Centers for Disease 
Control and Prevention (CDC) 2010].
Despite ACIP vaccination recommendations and the herd protection provided to adults due to 
routine infant PCV immunization, rates of IPD caused by serotypes included in currently 
marketed pneumococcal vaccines, as well as those not included in any vaccine, remain 
higher in at-risk adults than in healthy individuals [Pilishvili, T., et al 2014]. The associated 
morbidity and mortality and healthcare costs are substantial [Weycker, D., et al 2016] [Shea, 
K. M., et al 2014] and emphasize the need for new preventive strategies, including PCVs 
with extended serotype coverage.
This clinical study is designed to evaluate the safety, tolerability, and immunogenicity of a 
single dose of V114 and Prevnar 13™in immunocompetent, at-risk individuals, followed by 
sequential administration of PNEUMOVAX™23 6 months later. This study design will 
assess the safety of V114 for 6 months, while also providing data on the safety and 
immunogenicity of the sequential administration of PNEUMOVAX23™in this population.
The data from this study will contribute to the overall safety database and immunogenicity 
profile of V114 to support initial licensure in adults 18 through 49 years of age.
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.
Streptococcus 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 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 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]. 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
35
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 US 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 
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].
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, 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 trial 
(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 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
36
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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].
A post hoc analysis of the CAPiTA trial in individuals with defined comorbidities, including 
diabetes mellitus, chronic heart disease, respiratory or liver disease, asplenia, and smoking,
showed higher vaccine efficacy in individuals with diabetes mellitus and a non-significant 
trend towards lower efficacy in people with respiratory diseases [Huijts, S. M., et al 2017].
Prevnar™ and Prevnar 13™ are also known as Prevenar™ and Prevenar 13™ in many 
countries outside of the US; 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 US, 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 
through 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]. 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 
treatment during participation, as clinical studies are designed to provide information about 
the safety and effectiveness of an investigational vaccine.
Approximately 25% of participants will receive Prevnar 13™, the standard of care, as the 
active comparator in this study. 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. It is unknown if the investigational V114 will have 
the same benefit as Prevnar 13™. 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
37
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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).
3
HYPOTHESIS, OBJECTIVES, AND ENDPOINTS
Objectives and endpoints described below will be evaluated in pneumococcal vaccine-naïve 
participants 18 to 49 years of age (inclusive) who are at increased risk for pneumococcal 
disease due to (1) an underlying medical condition, (2) behavioral habits such as smoking, or 
(3) living in a community/environment with increased risk of disease transmission.
Objectives
Endpoints
Primary
•
Objective: To evaluate the safety and 
tolerability of V114 and Prevnar 13™
with respect to the proportion of 
participants with adverse events (AEs)
within each vaccination group separately.
Following vaccination with V114 or 
Prevnar 13™:
•
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 to Month 6
•
Objective: To evaluate the serotype-
specific opsonophagocytic activity (OPA) 
Geometric Mean Titers (GMTs) at 
30 days postvaccination (Day 30) with 
V114 and Prevnar 13™within each 
vaccination group separately.
•
Serotype-specific OPA responses for the 
15 serotypes in V114 at Day 30
Secondary
•
Objective: To evaluate the safety and 
tolerability of PNEUMOVAX™23 
administered 6 months following V114 
and following Prevnar 13™with respect 
to the proportion of participants with AEs
within each vaccination group separately.
Following vaccination with 
PNEUMOVAX™23:
•
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 6 to 
Month 7
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
38
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Objectives
Endpoints
•
Objective: To evaluate the serotype-
specific Immunoglobulin G (IgG) 
Geometric Mean Concentrations (GMCs)
at 30 days postvaccination (Day 30) with 
V114 and Prevnar 13™within each 
vaccination group separately.
•
Serotype-specific IgG responses for the 
15 serotypes in V114 at Day 30
•
Objective: To evaluate the serotype-
specific Geometric Mean Fold Rises
(GMFRs) and proportions of participants 
with a ≥4-fold rise from prevaccination 
(Day 1) to 30 days postvaccination 
(Day 30) for both OPA and IgG 
responses for participants administered 
V114 and for participants administered 
Prevnar 13™within each vaccination 
group separately.
•
Serotype-specific OPA and IgG 
responses for the 15 serotypes in V114 
at Day 1 and Day 30
•
Objective: To evaluate the serotype-
specific (1) OPA GMTs and IgG GMCs 
at 30 days postvaccination with 
PNEUMOVAX™23 (Month 7), 
(2) GMFRs and proportions of 
participants with a ≥4-fold rise from 
prevaccination (Day 1) to 30 days 
postvaccination with 
PNEUMOVAX™23 (Month 7) for both 
OPA and IgG responses, (3) GMFRs and 
proportions of participants with a ≥4-fold 
rise from prevaccination with 
PNEUMOVAX™23 (Month 6) to 
30 days postvaccination with 
PNEUMOVAX™23 (Month 7) for both 
OPA and IgG responses for participants 
administered V114 and separately for 
participants administered Prevnar 13™ 6 
months before receipt of 
PNEUMOVAX™23.
•
Serotype-specific OPA and IgG 
responses for the 15 serotypes in V114 at 
Day 1, Month 6, and Month 7
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
39
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Objectives
Endpoints
Tertiary/Exploratory
•
Objective: To evaluate the serotype-
specific OPA GMTs and IgG GMCs at 
30 days postvaccination (Day 30) with 
V114 compared with Prevnar 13™.
•
Serotype-specific OPA and IgG 
responses for the 15 serotypes in V114 
at Day 30
•
Objective: To evaluate the serotype-
specific OPA GMTs and IgG GMCs at 
30 days postvaccination with 
PNEUMOVAX™23 (Month 7) for 
participants administered V114 compared
with participants administered Prevnar 
13™ 6 months before receipt of 
PNEUMOVAX™23.
•
Serotype-specific OPA and IgG 
responses for the 15 serotypes in V114 
at Month 7
4
STUDY DESIGN
4.1
Overall Design
4.1.1
Main Study
Approximately 1500 individuals will be randomly assigned in a 3:1 ratio to receive either 
V114 (1125 participants) or Prevnar 13™ (375 participants) on Visit 2 (Day 1). All 
participants will also receive a single dose of PNEUMOVAX™23 at Visit 4 (Month 6).
Of the 1500 participants, approximately 600 will be Native American participants enrolled 
through clinical sites of the Johns Hopkins Center for American Indian Health (CAIH).
Participants must belong to at least 1 of the following risk categories:
1. Native American enrolled through a CAIH site
2. diabetes mellitus
3. chronic liver disease
4. chronic lung disease
5. chronic heart disease
6. current smoker
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
40
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Participants with underlying chronic lung, liver, or heart disease, diabetes, or smoking are to 
meet disease-specific enrollment criteria as outlined in Section 5.1 and are to be on stable 
treatment for their medical condition for at least 3 months, without any anticipated treatment 
changes. 
Participants will be followed for local and systemic AEs 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.
Blood samples for immunogenicity assays will be drawn immediately before V114 or 
Prevnar 13™ vaccination at Visit 2 (Day 1), at 30 days postvaccination at Visit 3 (Day 30), 
immediately before PNEUMOVAX™23 vaccination at Visit 4 (Month 6), and 30 days 
postvaccination at Visit 5 (Month 7).
For participants NOT enrolled via the CAIH, after completion of OPA and 
electrochemiluminescence (ECL) 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.
For participants enrolled via the CAIH, any sera remaining after OPA and ECL testing will 
be returned to the CAIH for destruction. Based on community preference, Native American 
participants enrolled via the CAIH will not participate in future biomedical research.
Specific procedures to be performed during the study, as well as their prescribed times and 
associated visit windows, are outlined in the Schedule of Activities (SoA) in Section 1.3. 
Details of each procedure are provided in Section 8.
4.1.2
Substudy
The Sponsor is developing a multivalent pneumococcal serotype-specific urine antigen 
detection assay (UAD) using serotype-specific monoclonal capture and detection antibodies 
in a sandwich-binding format on the Luminex platform as a tool for diagnosing invasive and 
non-invasive pneumococcal disease due to serotypes contained in V114. This substudy will 
be conducted in the Native American cohort enrolled via CAIH due to higher nasopharyngeal 
(NP) carriage rates in this population than the general population and due to feasibility of 
frequent sample collection via home visits. Each Native American participant enrolled 
through CAIH sites will be asked to participate in a substudy and enrollment will be halted 
either when 300 participants have been enrolled in the substudy or when enrollment at CAIH 
sites is completed for the main study, whichever event comes first.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
41
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
In addition to the procedures prescribed for the main study, substudy procedures will include 
the collection of NP and oropharyngeal (OP) swabs and urine samples at defined time points 
before and after each vaccine administration. The combined procedures from the main study 
and the substudy are outlined in the Substudy SoA in Section 1.3.2. Samples will be collected 
within 10 days before each vaccine administration (V114 or Prevnar 13™, and 
PNEUMOVAX™23) for baseline measurements and at the postvaccination visits indicated 
in the Substudy SoA.
This substudy will evaluate whether vaccination with V114 or with Prevnar 13™ and/or 
NP/OP colonization with S. pneumoniae will lead to a positive UAD for any of the 
15 pneumococcal serotypes included in V114. The rationale is based on experiences with 
other pneumococcal UADs. It has been shown that pneumococcal vaccination can turn the 
commercially available BinaxNOW™ S. pneumoniae, which detects the C-polysaccharide 
common to different pneumococcal serotypes, as well as investigative serotype-specific 
UADs positive [Priner, M., et al 2008] [Grijalva, C. G., et al 2015]. Furthermore, NP 
colonization with S. pneumoniae can lead to a positive BinaxNOW™S. pneumoniae in 
adults and children and to a positive serotype-specific UAD in children [Esposito, S., et al
2004] [Turner, P., et al 2011] [Knoll, M. D., et al 2016]. The impact of NP/OP colonization 
on serotype-specific UADs in adults is unknown. In this substudy, an NP/OP swabs will be 
evaluated for the presence of pneumococcal serotypes via polymerase chain reaction testing 
[Gillis, H. D., et al 2017].
An initial assessment on the day of vaccination will establish a baseline for each participant. 
It is unknown for how long pneumococcal antigens could be excreted in urine after 
vaccination. Therefore, multiple postvaccination samples will be taken to be able to provide 
estimates for the duration of the impact of vaccination on UAD performance. A UAD which 
turns positive for 1 or more serotypes in the days following vaccination in the absence of 
NP/OP colonization with the same serotype(s) or clinical pneumococcal disease is likely due 
to the pneumococcal vaccine administered.
There are no hypotheses associated with the NP/OP colonization and urine antigen testing 
conducted within this substudy. The results will be summarized in a report separate from the 
Clinical Study Report (CSR).
4.2
Scientific Rationale for Study Design
After infancy, the risk for pneumococcal disease increases with age and many guidelines 
include age-based criteria for pneumococcal immunization recommendations. However, 
chronic medical conditions can also predispose younger adults to pneumococcal disease 
[Weycker, D., et al 2016]. With a rise of obesity and metabolic syndrome-related illnesses, 
many individuals are suffering from more than 1 of these chronic diseases. Risk stacking and 
advanced disease stages are associated with disproportionally higher occurrence of 
pneumococcal infections and associated mortality in these individuals [Curcio, D., et al
2015] [Morton, J. B., et al 2017] [Torres, A., et al 2015]. It is therefore important to evaluate 
the safety and immunogenicity of V114 in this population.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
42
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
This study will investigate the safety, tolerability, and immunogenicity of V114 in 
pneumococcal vaccine-naïve participants 18 to 49 years of age (inclusive) who are at 
increased risk for pneumococcal disease due to (1) an underlying medical condition, (2) 
behavioral habits such as smoking, or (3) living in a community/environment with increased 
risk of disease transmission (Native American living on or around a reservation in the 
southwestern United States who is enrolled through clinical sites of the CAIH). The study 
population is representative of individuals with high morbidity due to pneumococcal disease, 
who may benefit from pneumococcal vaccination. Alcohol use increases the risk for 
pneumococcal disease but its impact on the immune response to pneumococcal vaccines is 
not well described [Bhatty, M., et al 2011] [McMahon, B. J., et al 1993]. Enrollment in this 
study will be stratified by the level of alcohol consumption of the participant based on results 
of the Alcohol Use Disorders Identification Test (AUDIT-C) screening. 
Individuals with end-stage heart, liver or lung disease and those with uncontrolled diabetes 
will be excluded from this study in order to allow them to prioritize their medical care over 
participation in this study and to avoid interference of medical treatment with the safety and 
immunogenicity of the vaccine.
4.2.1
Rationale for Endpoints
4.2.1.1
Immunogenicity Endpoints
Sera from participants will be used to measure vaccine-induced, serotype-specific OPA and 
IgG 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 Multiplexed Opsonophagocytic Assay (MOPA) assay 
and pneumococcal electrochemiluminescence (PnECL) 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 serotype-specific IgG concentration or OPA titer have been defined as the threshold 
value that correlates with protection in adults.
Details on the immunogenicity endpoints evaluated in this study can be found in 
Section 9.4.1.
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. 
Vaccination report cards (VRCs) will be used to record AEs during the postvaccination 
periods, as defined in Section 8.1.9. Participants enrolled via the CAIH will use paper VRCs 
and all other subjects will use electronic VRCs (eVRCs). This choice is based on community 
preference within the CAIH sites.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
43
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
The VRCs were 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 
3.
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.
Native American participants enrolled via the CAIH will not participate in future biomedical 
research.
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 for use in adults.  
Prevnar 13™ is approved for 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™.
4.3
Justification for Dose
The dosing regimen of V114 is similar to that used in previous adult V114 clinical studies in 
which 1 dose has resulted in a robust immune response (refer to the V114 IB for more 
detailed information on dose selection).
The doses of Prevnar 13™ and PNEUMOVAX™23 selected for use in this study are the 
approved doses.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
44
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
4.4
Beginning and End of Study Definition
The overall study begins when the first participant signs the ICF. 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 between the ages of 18 and 49 years (inclusive) who are at 
increased risk for pneumococcal disease due to (1) an underlying medical condition,
(2) behavioral habits such as smoking, or (3) living in a community/environment with 
increased risk of disease transmission 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. Native American from clinical sites of the CAIH in good health without any of the risk 
conditions for pneumococcal disease listed below (any underlying chronic illness must be 
documented to be in stable condition);
OR
Native American from clinical sites of the CAIH OR a participant from sites other than 
the CAIH with ≥1 of the following risk conditions for pneumococcal disease:
a.
Diabetes mellitus Type 1 or Type 2, receiving treatment with at least 1 approved 
anti-diabetic medication; with hemoglobin A1c (HgA1c) <10% at Screening 
(Visit 1).
b. Chronic liver disease with compensated cirrhosis (Child-Pugh Class A) due to 
non-alcoholic fatty liver disease, chronic hepatitis B, chronic hepatitis C, or 
alcoholic liver disease, diagnosed by clinician’s assessment, with at least 1 of the 
following liver staging assessments (Note: In cases where more than 1 staging 
assessment is available, only 1 result may be used to determine fibrosis status. 
Biopsy should be preferred over every other test and FibroScan® over the blood 
test based assessment. Participants with hepatitis C must have either completed a
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
45
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
course of treatment with direct antiviral therapy and had a 12-week treatment-free 
follow-up or be expected to remain untreated during the duration of this study): 
i.
Prior liver biopsy demonstrating cirrhosis 
ii.
FibroScan® performed with an interpretable score >12.5 kPa within 5 years
of Visit 1 (Screening). 
iii.
A FibroTest® (FibroSure®) with Fibrosis Score >0.75 performed within 5 
years of Visit 1 and an aspartate aminotransferase (AST): platelet ratio index 
(APRI) of >2 at Visit 1 (Screening) APRI formula:  AST ÷ lab upper limit of 
normal (ULN) for AST x 100 ÷ (platelet count ÷ 100) (APRI calculation to be 
provided by the central laboratory).
iv.
Prior imaging study with evidence of cirrhosis and an APRI of >2 at Visit 1 
(Screening)
v.
Prior imaging study with evidence of cirrhosis with splenomegaly and 
platelet count <120,000/µL at Visit 1 (Screening)
c.
Confirmed diagnosis of chronic obstructive pulmonary disease (COPD) with 
spirometric data in the preceding 5 years showing post-bronchodilator forced 
expiratory volume in 1 second (FEV1) over forced vital capacity (FVC) ratio 
(FEV1/FVC) <0.7, and FEV1 ≥30% predicted, corresponding to spirometric 
Global Initiative for Chronic Obstructive Lung Disease Stage 1 to 3 by severity 
assessment. For otherwise eligible individuals with a clinical history of COPD 
who do not have spirometry data from the preceding 5 years, spirometry can be 
performed at Visit 1 during the screening process by adequately trained personnel 
according to accepted guidelines.
d. Confirmed diagnosis of mild or moderate persistent asthma with documented 
reversible airflow obstruction on spirometry consistent with guidelines for the 
diagnosis of asthma performed within 5 years prior to Visit 1, and receipt of
guideline-directed therapy for mild to moderate asthma. For otherwise eligible 
individuals with a clinical history of asthma who are receiving guideline directed 
therapy for mild to moderate asthma but do not have spirometry data from the 
previous 5 years, spirometry can be performed at Visit 1 during the screening 
process by adequately trained personnel according to accepted guidelines for 
assessing reversibility. Inhaled bronchodilator and/or inhaled steroid therapy 
should be withheld prior to spirometry for a “wash-out” as per recommended 
guidelines.
e.
Confirmed diagnosis of chronic heart disease due to 1 of the following conditions 
documented within the last 5 years (Note: Participants must have New York Heart 
Association (NYHA) heart failure Class 1 to 3 at Visit 1 (Screening) and receive 
guideline directed oral heart failure treatment):
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
46
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
i.
Heart failure with reduced ejection fraction (EF): transthoracic 
echocardiography (TTE) or transesophageal echocardiography (TEE) with 
left ventricular EF <40%
ii.
Heart failure with preserved EF as diagnosed by a cardiologist based on 
clinical signs and symptoms, a TTE/TEE with left ventricular EF ≥50%, and 
either 1) plasma brain natriuretic peptide (BNP) >100 pg/mL or NT-proBNP 
>300 pg/mL or 2) at least 1 prior hospitalization or emergency room visit for 
heart failure
iii.
Non-cyanotic congenital heart disease 
f.
Current smoker who has smoked at least 100 cigarettes during lifetime, is 
currently smoking every day or most days of the week, and is not currently 
receiving smoking cessation therapy at Visit 1 (Screening) or planning to receive 
therapy during the study.
2. Receiving stable medical management for the conditions listed in Inclusion 
Criterion 1a-f, if applicable, for at least 3 months with no anticipated major change 
expected for the duration of the study.
Demographics
3. Participant is male or female 18 to 49 years of age (inclusive).
Female Participants
4. 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
5. The participant provides written informed consent for the study. The participant may also 
provide consent for future biomedical research. However, the participant may participate 
in the main study without participating in future biomedical research.
Native American participants enrolled via the CAIH will not participate in future 
biomedical research.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
47
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
5.2
Exclusion Criteria
Participants are excluded from the study if any of the following criteria apply:
Medical Conditions
1. History of active hepatitis with elevation in pretreatment aspartate transaminase (AST) or 
alanine transaminase (ALT) values >5 times the ULN within 3 months of Visit 1 
(Screening).
2. History of diabetic ketoacidosis or >1 episode of severe, symptomatic hypoglycemia
within 3 months of Visit 1 (Screening). 
3. Myocardial infarction, acute coronary syndrome, transient ischemic attack, or ischemic or 
hemorrhagic stroke within 3 months of Visit 1 (Screening). 
4. History of severe pulmonary hypertension with World Health Organization functional 
class ≥3 or history of Eisenmenger syndrome.
5. History of IPD (positive blood culture, positive cerebrospinal fluid culture, or positive 
culture at another sterile site) or known history of other culture-positive pneumococcal 
disease within 3 years of Visit 2 (Day 1).
6. Known hypersensitivity to any component of pneumococcal polysaccharide vaccine, 
PCV, or any diphtheria toxoid-containing vaccine.
7. Known or suspected impairment of immunological function including, but not limited to 
a history of congenital or acquired immunodeficiency, documented HIV infection, 
functional or anatomic asplenia, history of autoimmune disease (including but not limited 
to the autoimmune conditions outlined in the Investigator Trial File Binder for this 
study).
8. History of malignancy ≤5 years prior to signing informed consent (including 
hepatocellular carcinoma), except for adequately treated basal cell or squamous cell skin 
cancer or in situ cervical cancer.
9. History of Stage 4 or 5 Chronic Kidney Disease (Glomerular Filtration Rate below 
30 mL/min/1.73 m2) or nephrotic syndrome.
10. History of alcohol withdrawal or alcohol withdrawal seizure in the past 12 months. 
11. History of coagulation disorder contraindicating intramuscular vaccinations.
12. *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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
48
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
13. History of hospitalization within 3 months of Visit 1 (Screening). 
14. Planned organ transplantation (heart, liver, lung, kidney, or pancreas) or other planned 
major surgery during the duration of this study.
15. Expected survival for less than 1 year according to the investigator’s judgment.
16. A WOCBP who has a positive urine or serum pregnancy test before the first vaccination 
at Visit 2 (Day 1). 
Prior/Concomitant Therapy
17. Prior administration of any pneumococcal vaccine or expected to receive any 
pneumococcal vaccine during the study outside of the protocol.
18. Received systemic corticosteroids (prednisone equivalent of ≥20 mg/day) for 
≥14 consecutive days and has not completed intervention at least 30 days before study 
entry.  
19. Received systemic corticosteroids exceeding physiologic replacement doses 
(approximately 5 mg/day prednisone equivalent) within 14 days before vaccination.  
(Note: Topical, ophthalmic, intra-articular or soft-tissue [eg, bursa, tendon steroid 
injections], and inhaled/nebulized steroids are permitted).
20. Receiving immunosuppressive therapy, including chemotherapeutic agents used to treat 
cancer or other conditions, and interventions associated with organ or bone marrow 
transplantation, or autoimmune disease.
21. Receiving immunomodulatory therapy with biological agents such as monoclonal 
antibodies directed against interleukin or cytokine pathways which could potentially 
interfere with immunogenicity assessment.
22. *Received any licensed, non-live vaccine within the 14 days before receipt of any study 
vaccine or is scheduled to receive any licensed, non-live vaccine within 30 days 
following receipt of any study vaccine. Exception: Inactivated influenza vaccine may be 
administered but must be given at least 7 days before receipt of any study vaccine or at 
least 15 days after receipt of any study vaccine.
23. *Received any live vaccine within 30 days before receipt of any study vaccine or is 
scheduled to receive any live vaccine within 30 days following receipt of any study 
vaccine. 
24. Received a blood transfusion or blood products, including immunoglobulins within the 
6 months before receipt of study vaccine or is scheduled to receive a blood transfusion or 
blood product within 30 days of receipt of study vaccine. Autologous blood transfusions 
are not considered an exclusion criterion.
25. Receiving chronic home oxygen therapy.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
49
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Prior/Concurrent Clinical Study Experience
26. Is currently participating in or has participated in an interventional clinical study with an 
investigational compound or device within 2 months of participating in this current study.
Other Exclusions 
27. Is, at the time of signing informed consent, a user of recreational or illicit drugs or has 
had a recent history (within the last year) of drug abuse or dependence as assessed by the 
study investigator.
28. Has history or current evidence of any condition, therapy, lab 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.
29. 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.
30. Diabetes mellitus with HgA1c ≥10% at Visit 1 (Screening).
31. Chronic liver disease with Child-Pugh Class B or C cirrhosis at Visit 1(Screening).
32. Chronic lung disease with COPD GOLD Stage 4 or severe persistent asthma at Visit 1 
(Screening).
33. Chronic heart disease with NYHA heart failure Class 4 at Visit 1 (Screening).
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.
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
50
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 intervention(s) to be used in this study are outlined in Table 1.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
51
PROTOCOL/AMENDMENT NO.: 017-02
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Table 1
Study Interventions
Arm 
Name
Arm 
Type
Intervention 
Name
Type
Dose Formulation
Unit Dose 
Strength(s)
Dosage 
Level(s)
Route of 
Admin
Vaccination 
Regimen
Use
IMP/
NIMP
Sourcing
V114
Experime
ntal
V114
Biological
/Vaccine
Sterile suspension 
(prefilled syringe)
Refer to IB
0.5 mL
IM
Single Dose 
at Visit 2 
(Day 1)
Experimental
IMP
Central
PNEUMOVAX
™23
Biological
/Vaccine
Sterile solution 
(prefilled syringe)
Refer to 
product 
labeling
0.5 mL
IM
Single Dose 
at Visit 4 
(Month 6)
Experimental
IMP
Central
Prevnar
13™
Active 
Comparat
or
Prevnar 13™
Biological
/Vaccine
Sterile suspension 
(prefilled syringe)
Refer to 
product 
labeling
0.5 mL
IM
Single Dose 
at Visit 2 
(Day 1)
Experimental
IMP
Central
PNEUMOVAX
™23
Biological
/Vaccine
Sterile solution 
(prefilled syringe)
Refer to 
product 
labeling
0.5 mL
IM
Single Dose 
at Visit 4 
(Month 6)
Experimental
IMP
Central
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 thedefinition of IMP/NIMP 
may exist. In these circumstances, local legislation is followed.
All supplies indicated in Table 1 will be provided per the “Sourcing” row depending upon local country operational requirements. 
Every attempt should be made to source these supplies from a single lot/batch number.
Refer to Section 8.1.8 for details regarding administration of the study intervention.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
52
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 3:1 ratio to V114 or Prevnar 13™, respectively.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
53
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
6.3.2
Stratification
Randomization will be stratified based on:
1. whether a participant is enrolled at CAIH (approximately 600 Native American 
participants, 40% of the total enrollment) or not.
2. the type/number of risk factors for pneumococcal disease a participant has at the time of 
randomization.
Risk factors for pneumococcal disease include any chronic condition listed under Inclusion 
Criteria 1a – 1f (Section 5.1). In addition, based on the association of alcohol consumption 
and pneumococcal disease, an AUDIT-C score ≥5 will count as an additional risk factor for 
stratification. Note that Native American participants enrolled at CAIH sites can be enrolled 
in the study without having any of the chronic conditions listed under Inclusion Criteria 1a –
1f. For these participants, the AUDIT-C score can be the only risk factor for stratification. 
All participants who are not enrolled at CAIH sites must have ≥1 of the chronic conditions 
listed under Inclusion Criteria 1a – 1f. Therefore, for participants who are not enrolled at 
CAIH sites, the AUDIT-C score cannot be the only risk factor for stratification. However, an 
AUDIT-C score ≥5 contributes to the strata for assessment of risk stacking (by placing 
participants into the strata of 2 or ≥3 risk factors as shown below).
Categories of risk factors for stratified randomization will be defined as follows:
For participants enrolled at CAIH, randomization will be stratified into 1 of the following 
9 levels/strata: 

Individuals with only chronic liver disease

Individuals with only diabetes mellitus

Individuals with only chronic lung disease

Individuals with only chronic heart disease

Individuals who are a current smoker only

Individuals who only have an AUDIT-C score ≥5 

2 of the risk factors: chronic liver disease, diabetes mellitus, chronic lung disease, chronic 
heart disease, current smoker, AUDIT-C score ≥5 

3 or more of the risk factors: chronic liver disease, diabetes mellitus, chronic lung 
disease, chronic heart disease, current smoker, AUDIT-C score ≥5

Individuals with no risk factors who are Native American but do not fall into 1 of the 8 
strata above
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
54
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
For participants NOT enrolled at CAIH, randomization will be stratified into 1 of the 
following 7 levels/strata:

Individuals with only chronic liver disease

Individuals with only diabetes mellitus

Individuals with only chronic lung disease

Individuals with only chronic heart disease

Individuals who are a current smoker only

2 of the risk factors: chronic liver disease, diabetes mellitus, chronic lung disease, chronic 
heart disease, current smoker, AUDIT-C score ≥5†

3 or more of the risk factors: chronic liver disease, diabetes mellitus, chronic lung 
disease, chronic heart disease, current smoker, AUDIT-C score ≥5†
†While an AUDIT-C score ≥5 cannot be the only risk factor for stratification, an AUDIT-C 
score ≥5 can contribute to the strata for assessment of risk stacking.
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 the study vaccines. PNEUMOVAX™23 will also be prepared 
and/or dispensed and administered by unblinded study site staff for consistency even though 
it will be provided open label in this study. 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 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
55
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
6.4
Study Intervention Compliance
Interruptions from the protocol specified plan for V114 or Prevnar 13™ vaccination at 
Visit 2 (Day 1) and PNEUMOVAX™23 vaccination at Visit 4 (Month 6) vaccination require 
consultation between the investigator and the Sponsor and written documentation of the 
collaborative decision on participant management.
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 (items 1 to 4) are specific restrictions for concomitant therapy or vaccination
during the course of the study:
1. Any administration of a non-study pneumococcal vaccine is prohibited during the study.
2. Live and non-live vaccines may only be administered prior to or following the receipt of 
study vaccine according to the time frames specified in Exclusion Criteria (Section 5.2). 
Exception: Inactivated influenza vaccine may be administered but must be given at least 
7 days before receipt of any study vaccine or at least 15 days after receipt of any study 
vaccine.
3. Participants should not receive systemic corticosteroids (prednisone equivalent of 
≥20 mg/day for ≥14 consecutive days) starting from 30 days prior to through 30 days 
following vaccination. Note: Topical, ophthalmic, intra-articular or soft-tissue (eg, bursa, 
tendon steroid injections), and inhaled/nebulized steroids are permitted.
4. Participants should not receive systemic corticosteroids exceeding physiologic 
replacement doses (prednisone equivalent dose >5 mg/day) within 14 days before any 
vaccination. Note: Topical, ophthalmic, intra-articular or soft-tissue (eg, bursa, tendon 
steroid injections), and inhaled/nebulized steroids are permitted.
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
56
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 unblinded qualified study site personnel will be used to maintain the blinding 
of study staff who are directly involved in the clinical evaluation of participants in the study. 
Study intervention 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 vaccination 
regimen 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
57
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 vaccination 
with PNEUMOVAX™23 at Visit 4 (Month 6).
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 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
58
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
•
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 Study 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.
The approximate blood volumes drawn by study visit and sample type are shown in Table 2
for the main study and Table 3 for the substudy. The maximum amount of blood collected 
from each participant at each study visit for immunogenicity assessments will not exceed 
40 mL. For those participants that consent to future biomedical research, an additional blood 
sample of approximately 8.5 mL will be taken.
Native American participants enrolled via the CAIH will not participate in future biomedical 
research.
Repeat or unscheduled samples may be taken for safety reasons or for technical issues with 
the samples.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
59
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Table 2
Approximate Blood Volumes Drawn by Study Visit and by Sample Types for 
Participants Enrolled at non-CAIH Sites
Study Visit
Visit 1
Screening
Visit 2
Day 1
Visit 3
Day 30
Visit 4
Month 6
Visit 5
Month 7
Disease-specific laboratory assessments; only 
for subjects with:
Diabetes mellitus: Hemoglobin A1c
Chronic liver disease: AST, ALT, total bilirubin, 
PT/INR, albumin, platelets  
0 to 12
mL
N/A
N/A
N/A
N/A
Serum for immunogenicity assays (including 
retention serum)
N/A
40 mL
40 mL
40 mL
40 mL
Blood (DNA) for future biomedical research
N/A
8.5 mL
N/A
N/A
N/A
Expected total (mL)
0 to 12
mL
48.5 mL
40 mL
40 mL
40 mL
ALT = alanine aminotransferase; AST = aspartate aminotransferase; DNA = deoxyribonucleic acid; 
INR = international normalized ratio; N/A = not applicable; PT = prothrombin time
Table 3
Approximate Blood Volumes Drawn by Study Visit and by Sample Types for 
Participants Enrolled at CAIH Sites
Study Visit
Visit 1
Screening
Visit 2
Day 1
Visit 3
Day 30
Visit 4
Month 6
Visit 5
Month 7
Disease-specific laboratory assessments; only 
for subjects with:
Diabetes mellitus: Hemoglobin A1c
Chronic liver disease: AST, ALT, total bilirubin, 
PT/INR, albumin, platelets  
0 to 12
mL
N/A
N/A
N/A
N/A
Serum for immunogenicity assays (including 
retention serum)
N/A
40 mL
40 mL
40 mL
40 mL
Expected total (mL)
0 to12 mL
40 mL
40 mL
40 mL
40 mL
ALT = alanine aminotransferase; AST = aspartate aminotransferase; INR = international normalized ratio; N/A 
= not applicable; PT = prothrombin time
8.1
Administrative and General Procedures
8.1.1
Informed Consent
The investigator or medically qualified designee (consistent with local requirements) must 
obtain documented consent from each potential participant prior to 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 is in place.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
60
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
8.1.1.1
General Informed Consent
Consent must be documented by the participant’s dated signature on a consent form along 
with the dated signature of the person conducting the consent discussion.
A copy of the signed and dated consent form should be given to the participant before 
participation in the study.
The initial ICF, any subsequent revised written ICF, 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 form or addendum to 
the original consent form that captures the participant’s dated signature.
Specifics about a study and the study population will be added to the consent form template 
at the protocol level.
The informed consent will adhere to IRB/IEC requirements, applicable laws and regulations, 
and Sponsor requirements.
8.1.1.2
Consent and Collection of Specimens for Future Biomedical Research
The investigator or medically qualified designee will explain the future biomedical research 
consent to the participant, answer all of his/her questions, and obtain written informed 
consent before performing any procedure related to the future biomedical research substudy. 
A copy of the informed consent will be given to the participant.
Native American participants enrolled via the CAIH will not participate in future biomedical 
research.
8.1.2
Inclusion/Exclusion Criteria
All inclusion and exclusion criteria will be reviewed by the investigator, who is a qualified 
physician or medically qualified designee, to ensure that the participant qualifies for the 
study.
If the participant meets any of the Exclusion Criteria with an asterisk (*), Visit 1 (Screening) 
may be rescheduled for a time when these criteria are not met.
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 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
61
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 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 first 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 Visit 2 (Day 1) and non-study vaccines 
received since Visit 2 will be recorded with the paper VRC/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.
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
62
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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). PNEUMOVAX™23 will be 
administered at Visit 4 (Month 6).
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.
Unblinded study personnel not otherwise involved in the conduct of the study will prepare 
and administer V114, Prevnar 13™, or PNEUMOVAX™23 at the study site. 
PNEUMOVAX™23 will be administered open label. 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.
Prior to administration of V114, the unblinded pharmacist should shake the product 
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.  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.
Study vaccine will be administered 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]. Vaccination information, such as Component Identification Number and time of 
vaccination, must be recorded on the appropriate electronic case report form (eCRF) per the 
Data Entry Guidelines.
All safety and immunogenicity assessments will be conducted by blinded personnel, and the
participant will be blinded to the intervention (ie, V114 or Prevnar 13™) received.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
63
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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
Vaccination Report Card
Participants enrolled via the CAIH will use paper VRCs and all other subjects will use 
eVRCs. This choice is based on community preference within the CAIH sites.
The eVRC was developed to be administered electronically via a hand-held device. The 
paper VRCs/eVRCs were 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 in the use of the paper VRC and 
eVRCs at Visit 2 (Day 1) and Visit 4 (Month 6). 
Temperatures, injection-site reactions, vaccine-specific complaints, other complaints or 
illnesses, and concomitant medications or vaccinations will be recorded on the paper 
VRC/eVRC as described in Section 1.3 and Section 8.3.4.
For the main study, site personnel will discuss information entered into the paper VRC/eVRC 
with participants during the telephone contacts conducted on Day 15 and Month 6.5. A full 
review of the completed paper VRC/eVRC will occur at Visit 3 (Day 30) and Visit 5 
(Month 7).
For Native Americans enrolled through the CAIH participating in the substudy, site 
personnel will discuss information entered into the paper VRC with participants during 
Visit 2C and Visit 4C. The paper VRC can be collected at either Visit 2C or Visit 3, and at 
either Visit 4C or Visit 5 at the discretion of the study personnel. A full review of the 
completed paper VRC with the participant will occur at the time of collection by the site.
For the AEs outlined above, the investigator will use the information provided by the 
participant both on the paper VRC/eVRC, and verbally at the time of paper VRC/eVRC 
review, to apply the appropriate assessment of intensity and toxicity as described in 
Appendix 3.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
64
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
8.1.10
6-month Safety Follow-up Questionnaire
Site personnel will review the information in the 6-month Safety Follow-up Questionnaire 
provided by the Sponsor with the participant. Data to be reported from this discussion will 
include SAEs and/or any updates to previously reported safety information.
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 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). 
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.
Native American participants enrolled via the CAIH will not participate in future biomedical 
research.
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 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
65
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
Once an emergency unblinding has taken place, the principal investigator, site personnel, and 
Sponsor personnel may be unblinded so that the appropriate follow-up medical care can be 
provided to the participant.
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 at Visit 4 (Month 6) 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.
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. 
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
66
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
8.2.1
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 
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. MSD 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 prespecified 
acceptance criteria for each of the parameters.
8.2.2
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.
8.3
Safety Assessments
Details regarding specific safety procedures/assessments to be performed in this study are 
provided. The total amount of blood/tissue to be drawn/collected over the course of the study 
(from prestudy to poststudy visits), including approximate blood/tissue volumes 
drawn/collected by visit and by sample type per participant, can be found in Section 8.
Planned time points for all safety assessments are provided in the SoA.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
67
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
8.3.1
Physical Examinations
A complete physical examination will be conducted by an investigator or medically qualified 
designee (consistent with local requirements) 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) at Visit 1(Screening) to address disease-
specific inclusion/exclusion criteria, such as Child-Pugh Class for participants with chronic 
liver disease and NYHA Class for participants with chronic heart disease. A directed physical 
examination will also be conducted before vaccination at Visit 4 (Month 6).
Investigators should pay special attention to clinical signs related to previous illnesses.
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) 
and Visit 4 (Month 6) in WOCBP as described in Section 1.3. Pregnancy tests can be 
repeated as needed based on local requirements. Urine or serum tests can be used, and results 
must be negative before vaccination can occur.
8.3.3
Body Temperature Measurement
Each participant's body temperature should be taken before vaccination as described in 
Section 1.3.
Oral body temperatures will also be documented by participants using their paper 
VRC/eVRC during the VRC-specified postvaccination follow-up period (Section 8.3.4).
For this study, any 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 be considered 
an AE of fever. 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 Paper VRC/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 timeframe, as well as the event itself, any concomitant medications that 
were administered, and resolution of the event, must be recorded on the appropriate eCRF.
Participants will use the paper VRC/eVRC (Section 8.1.9) to document the following 
information:
•
Oral body temperatures measured Day 1 (day of vaccination) through Day 5 
postvaccination;
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
68
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
•
Solicited injection-site AEs (redness/erythema, swelling, tenderness/pain) Day 1 through 
Day 5 postvaccination;
•
Solicited systemic AEs (muscle pain/myalgia, joint pain/arthralgia, headache, 
tiredness/fatigue) Day 1 through Day 14 postvaccination;
•
Any other injection-site or systemic AEs Day 1 through Day 14 postvaccination; and
•
Concomitant medications and non-study 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.
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, when appropriate, by a caregiver or surrogate).
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
69
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 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:
1.
A death that occurs prior to the participant completing the study.
OR
2.
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 
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
70
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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
Timeframe 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
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
71
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
8.4.6
Disease-related Events and/or Disease-related Outcomes Not Qualifying as 
AEs or SAEs
This is not applicable to this study.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
72
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
8.4.7
Events of Clinical Interest (ECIs)
There are no events of clinical interest for this study.
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 signs the future biomedical research consent, the following specimens will 
be obtained as part of future biomedical research:
•
DNA for future research
•
Leftover study serum after completion of immunogenicity testing stored for future
research
Native American participants enrolled via the CAIH will not participate in future biomedical 
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
73
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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
In this trial, 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 does not withdraw consent.  Protocol-specified activities, including blood draws 
for immunogenicity assessments and AE monitoring, should occur at these visits.
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 CSR for the 
study.  Post hoc exploratory analyses will be clearly identified in the CSR.
Other planned analyses (ie, those specific to the substudy or future biomedical research) are 
beyond the scope of this document or will be documented in separate analysis plans.
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, Multicenter, Randomized, Double-Blind, Active Comparator-
Controlled Study to Evaluate the Safety, Tolerability, and 
Immunogenicity of V114 Followed by Administration of 
PNEUMOVAX™23 Six Months Later in Immunocompetent Adults 
Between 18 and 49 Years of Age at Increased Risk for Pneumococcal 
Disease.
Intervention Assignment
Participants will be randomly assigned in a 3:1 ratio to V114 or 
Prevnar 13™, respectively. Randomization will be stratified based on the 
categories defined in Section 6.3.2.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
74
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Analysis Populations
Immunogenicity: Per-Protocol (PP)
Safety: All Participants as Treated (APaT)
Primary Endpoint(s)
Immunogenicity:

The serotype-specific OPA GMTs at 30 days postvaccination with 
V114 and Prevnar 13™(Day 30)
Safety: 

Proportion of participants with solicited injection-site AEs 
(redness/erythema, swelling, tenderness/pain) from Day 1 through 
Day 5 following V114 or Prevnar 13™

Proportion of participants with solicited systemic AEs (muscle 
pain/myalgia, joint pain/arthralgia, headache, and tiredness/fatigue)
from Day 1 through Day 14 following V114 or Prevnar 13™

Proportion of participants with vaccine-related SAEs in the 6 
months following V114 or Prevnar 13™from Day 1 through Month 
6
Key Secondary Endpoints
Immunogenicity:

Serotype-specific IgG GMCs at 30 days postvaccination with V114 
and Prevnar 13™(Day 30)

Serotype-specific OPA GMTs and IgG GMCs at 30 days 
postvaccination with PNEUMOVAX™23 (Month 7)
Safety: 

Proportion of participants with solicited injection-site AEs 
(redness/erythema, swelling, tenderness/pain) from Day 1 through 
Day 5 following PNEUMOVAX™23

Proportion of participants with solicited systemic AEs (muscle 
pain/myalgia, joint pain/arthralgia, headache, and tiredness/fatigue)
from Day 1 through Day 14 following PNEUMOVAX™23

Proportion of participants with vaccine-related SAEs in the 30 
days following PNEUMOVAX™23 from Month 6 through Month 
7
Statistical Methods for Key 
Immunogenicity Analyses
Immunogenicity analyses will be conducted for each of the 15 
pneumococcal serotypes separately. To address the primary 
immunogenicity objective, evaluation of the OPA GMTs at 30 days 
postvaccination with V114 or Prevnar 13™ (Day 30) will include 
descriptive summaries and within-group 95% CIs will be calculated for 
each vaccination group.
A similar statistical approach will be used to evaluate the IgG GMCs at 
30 days postvaccination with V114 or Prevnar 13™  (Day 30) and the 
OPA GMTs and IgG GMCs at 30 days postvaccination with 
PNEUMOVAX™23 (Month 7).
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 via 
descriptive statistics. In addition, for select safety parameters, 95% 
within-group confidence intervals will be provided. 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
75
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 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:
The planned sample size is 1500 participants. Participants are to be 
randomly assigned in a 3:1 ratio to V114 or Prevnar 13™, respectively
(resulting in approximately 1125 participants in the V114 group and
approximately 375 participants in the Prevnar 13™ group). It is assumed 
that approximately 1013 participants in the V114 group and 337 in the 
Prevnar 13™ group will be evaluable for PP immunogenicity analyses at 
Day 30 (90% evaluability rate).  There are no hypotheses to be evaluated, 
but Section 9.9.1 provides information about the expected variability of 
the OPA GMTs 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.
9.4
Analysis Endpoints
Immunogenicity and safety analysis endpoints that will be summarized are listed below.
9.4.1
Immunogenicity Endpoints
A description of immunogenicity assessments is contained in Section 8.2. 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
76
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 endpoint is the serotype-specific OPA GMTs at 30 days 
postvaccination with V114 and Prevnar 13™(Day 30).
The secondary immunogenicity analysis endpoints include:

Serotype-specific IgG GMCs at 30 days postvaccination with V114 and Prevnar 13™
(Day 30)

Serotype-specific OPA GMTs and IgG GMCs at 30 days postvaccination with 
PNEUMOVAX™23 (Month 7)

Serotype-specific GMFR and proportion of participants with a ≥4-fold rise from 
prevaccination (Day 1) to 30 days postvaccination with V114 or Prevnar 13™ (Day 
30) for both OPA and IgG responses

Serotype-specific GMFR and proportion of participants with a ≥4-fold rise from 
prevaccination (Day 1) to 30 days postvaccination with PNEUMOVAX™23 (Month 
7) for both OPA and IgG responses

Serotype-specific GMFR and proportion of participants with a ≥4-fold rise from 
prevaccination with PNEUMOVAX™23 (Month 6) to 30 days postvaccination with 
PNEUMOVAX™23 (Month 7) for both OPA and IgG 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 including 
adverse events and postvaccination temperature measurements following V114 or Prevnar
13™ and following PNEUMOVAX™23 (separately).
The safety analysis endpoints 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, 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, 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
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
77
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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:

Failure to receive any study vaccine at Visit 2 (Day 1)

Failure to receive correct clinical material as per randomization schedule (ie, 
participants who were cross-treated)

Receipt of a prohibited medication or prohibited vaccine prior to study vaccination
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 PNEUMOVAX™23

Receipt of a prohibited medication or prohibited vaccine prior to a blood sample 
collection

Collection of a blood sample outside of the prespecified 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 endpoint. The FAS population consists of all randomized 
participants who received at least 1 study 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
78
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
At least 1 temperature measurement obtained subsequent to study intervention is required for 
inclusion in the analysis of temperature. 
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 OPA 
GMTs at 30 days postvaccination with V114 or Prevnar 13™ (Day 30) will include 
descriptive summaries, and within-group 95% CIs will be calculated for each vaccination 
group. Point estimates for the OPA GMTs 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 IgG GMCs at 30 days 
postvaccination with V114 or Prevnar 13™ (Day 30) and OPA GMTs and IgG GMCs at
30 days postvaccination with PNEUMOVAX™23 (Month 7).
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].
To address the exploratory immunogenicity objectives aiming to evaluate the OPA GMTs 
and the IgG GMCs 30 days postvaccination with V114 or Prevnar 13™ (Day 30) and at 
30 days postvaccination with PNEUMOVAX™23 (Month 7) for participants administered 
V114 compared to participants administered Prevnar 13™, the serotype-specific OPA GMTs 
and IgG GMTs will be compared between vaccination groups through the estimation of 
serotype-specific OPA GMT ratios and IgG GMC ratios for each of the 15 serotypes in V114 
at each of these time points. Estimation of the OPA GMT 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
79
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Reverse Cumulative Distribution Curves for OPA titers and IgG concentrations will be 
graphically displayed by serotype at each of the following time points: Day 30 and Month 7. 
A detailed analysis strategy for immunogenicity endpoints is listed in Table 5.
Table 5
Analysis Strategy for Immunogenicity Variables
Endpoint/Variable
(Description, Time Point)
Primary vs. 
Supportive 
Approach†
Statistical 
Method
Analysis 
Population
Missing Data 
Approach
Primary Endpoint
OPA GMTs at Day 30
P
Descriptive 
Statistics
(estimate, 95%
CI)
PP
Missing data 
will not be 
imputed
S
FAS
Secondary Endpoints
IgG GMCs at Day 30
P
Descriptive 
Statistics 
(estimate, 95%
CI)
PP
Missing data 
will not be 
imputed
GMFR and % of participants who achieved a
≥4-fold rise from Day 1 to Day 30
P
Descriptive 
Statistics
(estimate, 95%
CI) 
PP
Missing data 
will not be 
imputed
OPA GMTs and IgG GMCs at Month 7
P
Descriptive 
Statistics
(estimate, 95%
CI) 
PP
Missing data 
will not be 
imputed
GMFR and % of participants who achieved a
≥4-fold rise from Day 1 to Month 7
P
Descriptive 
Statistics
(estimate, 95%
CI) 
PP
Missing data 
will not be 
imputed
GMFR and % of participants who achieved a
≥4-fold rise from Month 6 to Month 7
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; 
GMFR = Geometric Mean Fold Rise; GMT = Geometric Mean Titer; IgG = immunoglobulin G; 
OPA = opsonophagocytic activity; PP = Per-Protocol
9.6.2
Statistical Methods for Safety Analyses
Safety and tolerability will be assessed by clinical review of all relevant parameters,
including AEs and postvaccination temperature measurements.
The analysis strategy for safety parameters following each vaccination 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) and solicited systemic AEs 
(muscle pain/myalgia, joint pain/arthralgia, headache, tiredness/fatigue from Day 1 to Day 14 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
80
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
postvaccination) 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 that 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.  The proportion of participants with maximum 
temperature measurements meeting the Brighton Collaboration cut points (from Day 1 
through Day 5) 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 at 2 separate time points: (1) following 
administration of V114 or Prevnar 13™ and (2) following administration of 
PNEUMOVAX™23.  Descriptive summaries of AEs following administration of V114 or 
Prevnar 13™ will include nonserious adverse events (NSAEs) within 14 days of vaccination 
and SAEs occurring Day 1 through Month 6 (prior to vaccination with PNEUMOVAX™23). 
Descriptive summaries of AEs following administration of PNEUMOVAX™23 will include 
NSAEs within 14 days of vaccination and SAEs occurring Month 6 (Day 1 relative to 
vaccination with PNEUMOVAX™23) through Month 7 (Day 30 relative to vaccination with 
PNEUMOVAX™23). 
Safety analyses will be based on the observed data (ie, with no imputation of missing data).
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
81
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Table 6
Analysis Strategy for Safety Parameters Following Each Vaccination
Safety Endpoint
95% CI for Within-Group 
Comparison
Descriptive Statistics
Injection-site redness/erythema (Days 1 to 5)†
X
X
Injection-site swelling (Days 1 to 5)†
X
X
Injection-site tenderness/pain (Days 1 to 5)†
X
X
Muscle pain/myalgia (Days 1 to 14)†
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
Any AE‡
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)
X
X
Specific AEs by SOC and PT
X
† Includes solicited events only.
‡   These endpoints are broad AE 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, 
and 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 adult 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
82
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 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 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 external 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 external 
unblinded statistician to the DMC. Prior to final study unblinding, the external 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 1125 participants into 
the V114 group and 375 participants into the Prevnar 13™group. It is assumed that 
approximately 1013 participants in the V114 group and 337 in the Prevnar 13™ group will 
be evaluable for PP immunogenicity analyses at Day 30 (based on a 90% evaluability rate). 
The width of the within-group 95% CIs for the serotype-specific OPA GMTs depend on the 
sample size, variability of the natural log concentrations, and the magnitude of the OPA 
GMT. In Table 7, 95% CIs for various hypothetical Day 30 OPA GMTs and various 
hypothetical standard deviation estimates for the natural log titers are displayed.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
83
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Table 7
Within-group 95% CIs for Varying Hypothetical OPA GMTs and Varying 
Standard Deviations
Standard 
Deviation 
of Natural 
Log 
Titers†
Serotype-specific OPA GMT†
500
1000
5000
V114
Prevnar 13™
V114
Prevnar 13™
V114
Prevnar 13™
1.5
(456, 548)
(426, 587)
(912, 1097)
(852, 1174)
(4559, 5485)
(4260, 5868)
2
(442, 566)
(404, 619)
(884, 1131)
(808, 1238)
(4421, 5655)
(4039, 6190)
2.5
(429, 583)
(383, 653)
(857, 1166)
(766, 1306)
(4287, 5832)
(3829, 6530)
Based on 1013 evaluable participants in the V114 group and 337 evaluable participants in the Prevnar 13™ 
group.
†The estimates of the standard deviation and OPA GMTs are representative of those observed in V114-006.
CI = confidence interval; GMT = Geometric Mean Tier; OPA = opsonophagocytic activity.
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 incidence of participants with a SAE in 
the study population. Calculations below assume that 100% of the randomized participants 
will be evaluable for safety analyses. There is an 80% chance of observing at least 1 SAE 
among 1125 participants in the V114 group if the underlying incidence of a SAE is 0.14% 
(1 of every 700 participants receiving the vaccine). There is a 50% chance of observing at 
least 1 SAE among 1125 participants in the V114 group if the underlying incidence of a SAE 
is 0.06% (1 of every 1623 participants receiving the vaccine). If no SAEs are observed 
among the 1125 participants in the V114 group, this study will provide 97.5% confidence 
that the underlying percentage of participants with a SAE is <0.34% (1 in every 294 
participants) in the V114 group.
9.10
Subgroup Analyses
Serotype-specific OPA GMTs and IgG GMCs at Day 30 and at Month 7 and their 
corresponding within-group 95% CIs will be calculated among participants enrolled at 
CAIH.
In addition, these endpoints will be evaluated in additional subgroups depending on the 
distribution of participants across the risk factors. Details will be provided in the 
supplemental Statistical Analysis Plan.
A similar approach will be used for subgroup analyses for safety endpoints (including 
summary of AEs and a summary of solicited AEs). 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
84
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
9.11
Compliance (Medication Adherence)
Given that participants will receive just a single dose of V114 or Prevnar 13™ and a single 
dose of PNEUMOVAX™23, 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 administered V114 or Prevnar 13™ and the number and proportion of 
randomized participants administered PNEUMOVAX™23.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
85
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 
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 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
86
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
87
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
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 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
88
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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
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.
10.1.4.2
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.
10.1.4.3
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
89
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
90
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
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 
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
91
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
92
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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
Other Screening 
Tests
Serum or urine β-hCG pregnancy test (as needed for WOCBP)
Disease-specific laboratory assessments:
Diabetes mellitus: Hemoglobin A1c
Chronic liver disease: AST, ALT, total bilirubin, PT/INR, albumin, platelets
ALT = alanine aminotransferase; AST = aspartate aminotransferase; β-hCG = β human chorionic gonadotropin; 
INR = international normalized ratio; PT = prothrombin time; WOCBP = woman/women of childbearing 
potential.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
93
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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, or are 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
94
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
•
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
95
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
•
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
96
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
•
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 
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.  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.”
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
97
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Injection-Site AE Toxicity Grading Scale
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: ER = emergency room
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
98
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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: 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?
-
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?
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
99
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
-
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 
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
100
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
•
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.
•
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).
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
101
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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).
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
102
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
10.4
Appendix 4: Medical Device Incidents: Definition and Procedures for Recording, 
Evaluating, Follow-up, and Reporting
Not applicable.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
103
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
104
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
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 (CTFG) guidelines, acceptable 
hormonal contraceptives are limited to those which inhibit ovulation.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
105
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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.
10.6
Appendix 6: Collection and Management of Specimens for Future Biomedical 
Research (Does not apply to CAIH participants)
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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
106
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
3. Summary of Procedures for Future Biomedical Research.

Participants for Enrollment

All participants enrolled in the clinical study study who are not Native American 
participants enrolled via the CAIH 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.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
107
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 
answered. In this special circumstance, specimens will be stored until these questions 
have been adequately addressed.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
108
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
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 who are not Native American participants enrolled via the CAIH 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.
12. Questions
Any questions related to the future biomedical research should be emailed directly to 
clinical.specimen.management@merck.com.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
109
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
13. References
1. National Cancer Institute [Internet]: Available from 
https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45618
2. 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 
3. 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/ 
4. Industry Pharmacogenomics Working Group [Internet]: Pharmacogenomics 
Informational Brochure for IRBs/IECs and Investigational Site Staff. Available at 
http://i-pwg.org/
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
110
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
10.7
Appendix 7: Country-specific Requirements
Not applicable.
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
111
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
10.8
Appendix 8: Abbreviations
Abbreviation
Expanded Term
ACIP
Advisory Committee on Immunization Practices
AE
adverse event
ALT
alanine transaminase
APaT
All Participants as Treated
APRI
AST:platelet ratio index
AST
aspartate transaminase
β-hCG
beta-human chorionic gonadotropin
BNP
brain natriuretic peptide
CAIH
Center for American Indian Health
CAPiTA
Community-Acquired Pneumonia Immunization Trial in Adults
CI
confidence interval
cLDA
constrained longitudinal data analysis
CSR
Clinical Study Report
DMC
Data Monitoring Committee
DNA
deoxyribonucleic acid
ECI
event of clinical interest
ECL
electrochemiluminescence
eCRF
electronic case report form
EDC
electronic data collection
EF
ejection fraction
EMA
European Medicines Agency
EOC
Executive Oversight Committee
eVRC
electronic Vaccination Report Card
FAS
Full Analysis Set
FDAAA
Food and Drug Administration Amendments Act
FEV1
forced expiratory volume in 1 second
FSH
follicle-stimulating hormone
GCP
Good Clinical Practice
GMC
Geometric Mean Concentration
GMFR
Geometric Mean Fold Rise
GMT
Geometric Mean Titer
HIV
Human Immunodeficiency Virus
HRT
hormonal replacement therapy 
IB
Investigator’s Brochure
ICF
Informed Consent Form
ICH
International Council for Harmonisation Good Clinical Practice
IEC
Independent Ethics Committee
IgG
Immunoglobulin G
IMP
investigational medicinal product
IRB
Institutional Review Board
IPD
Invasive Pneumococcal Disease
IRT
interactive response technology
IUD
intrauterine device
MOPA
Multiplexed Opsonophagocytic Assay
MSD
Merck Sharp & Dohme Corp.
NIMP
non-investigational medicinal product
NP
nasopharyngeal
NSAE
nonserious adverse event
NYHA
New York Heart Association
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
112
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
Abbreviation
Expanded Term
OP
oropharyngeal
OPA
opsonophagocytic activity
PCV
pneumococcal conjugate vaccine
PCV13
Prevnar 13™
PE
physical examination
PnECL
pneumococcal electrochemiluminescence
PP
Per-Protocol
RNA
ribonucleic acid
SAE
serious adverse event
SLAB
supplemental laboratory test
SoA
schedule of activities
S. pneumoniae
Streptococcus pneumoniae
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography
UAD
urine antigen detection assay
ULN
upper limit of normal
US
United States
VRC
Vaccination Report Card
WHO
World Health Organization
WOCBP
woman/women of childbearing potential
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
113
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
11
REFERENCES
[Anttila, M., et al 1999]
Anttila M, Voutilainen M, Jäntti V, Eskola J, 
Käyhty H. Contribution of serotype-specific IgG 
concentration, IgG subclasses and relative 
antibody avidity to opsonophagocytic activity 
against Streptococcus pneumoniae. Clin Exp 
Immunol 1999;118(3):402-7.
03QY70
[Australian Government 
Department of Health 
2017]
Australian Government Department of Health. 
The Australian immunisation handbook: 4.13 
pneumococcal disease [Internet]. 10th edition. 
Australia: Australian Government Department of 
Health; 2017 Aug. 21 p. Available from: 
http://immunise.health.gov.au/internet/immunise
/publishing.nsf/Content/9234F08B6DE9BB34C
A257D4D00234E27/$File/4%2013_Pneumococ
cal.pdf.
04VSW6
[Bhatty, M., et al 2011]
Bhatty M, Pruett SB, Swiatlo E, Nanduri B. 
Alcohol abuse and Streptococcus pneumoniae 
infections: consideration of virulence factors and 
impaired immune responses. Alcohol. 
2011;45:523-39.
04WB7Q
[Bonten, M. J., et al 
2015]
Bonten MJ, Huijts SM, Bolkenbaas M, Webber 
C, Patterson S, Gault S, et al. Polysaccharide 
conjugate vaccine against pneumococcal 
pneumonia in adults. N Engl J Med. 2015 Mar 
19;372(12):1114-25.
04NFHD
[Burton, Robert L. and 
Nahm, Moon H. 2006]
Burton RL, Nahm MH. Development and 
validation of a fourfold multiplexed opsonization 
assay (MOPA4) for pneumococcal antibodies. 
Clin Vaccine Immunol 2006;13(9):1004-9.
03QT2R
[Castiglia P. 2014]
Castiglia P. Recommendations for 
pneumococcal immunization outside routine 
childhood immunization programs in Western 
Europe. Adv Ther. 2014Oct;31(10):1011-44.
04P7LW
[Castiglia, P. 2014]
Castiglia P. Recommendations for 
pneumococcal immunization outside routine 
childhood immunization programs in Western 
Europe. Adv Ther. 2014 Oct 10;31:1011-44.
04VSVW
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
114
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Center for Disease 
Control 1978]
CDC. Recommendation of the Public Health 
Service Advisory Committee on Immunization 
Practices: Pneumococcal polysaccharide 
vaccine. MMWR Morb Mortal Wkly Rep. 1978 
Jan 27;27(4):25-32.
04VSJL
[Center for Disease 
Control and Prevention 
2012]
Center for Disease Control and Prevention. 
Geographic differences in HIV infection among 
hispanics or latinos - 46 states and Puerto Rico, 
2010. MMWR 2012;61(40):805-24.
03RS5J
[Centers for Disease 
Control and Prevention 
(CDC) 2010]
Centers for Disease Control and Prevention 
(CDC). Multiple-serotype Salmonella 
gastroenteritis outbreak after a reception ---
Connecticut, 2009. MMWR Morb Mortal Wkly 
Rep. 2010 Sep 3;59(34):1093-7.
04NJRK
[Centers for Disease 
Control and Prevention 
1997]
CDC. Prevention of pneumococcal disease: 
recommendations of the Advisory Committee on 
Immunization Practices (ACIP). MMWR Morb 
Mortal Wkly Rep. 1997;46(RR-8):1-24.
04VSTK
[Centers for Disease 
Control and Prevention 
2008]
Centers for Disease Control and Prevention 
(CDC). Invasive pneumococcal disease in 
children 5 years after conjugate vaccine 
introduction-eight states,1998-2005. MMWR 
Morb Mortal Wkly Rep. 2008 Feb 15;57(6):144-
8.
04KW8S
[Centers for Disease 
Control and Prevention
2010]
Centers for Disease Control and Prevention. 
Updated recommendations for prevention of 
invasive pneumococcal disease among adults 
using the 23-valent pneumococcal 
polysaccharide vaccine (PPSV23). MMWR 
2010;59(34):1102-6.
03RCFX
[Centers for Disease 
Control and Prevention 
2010]
Centers for Disease Control and Prevention. 
Prevention of Pneumococcal Disease Among 
Infants and Children - Use of 13-Valent 
Pneumococcal Conjugate Vaccine and 23-Valent 
Pneumococcal Polysaccharide Vaccine; 
Recommendations of the Advisory Committee 
on Immunization Practices (ACIP). MMWR 
2010;59(RR-11):1-19.
03RSB6
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
115
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Centers for Disease 
Control and Prevention 
2015]
Centers for Disease Control and Prevention. 
Epidemiology and prevention of vaccine-
preventable diseases. 13th ed. Hamborsky J, 
Kroger A, Wolfe S, editors. Washington (DC): 
Department of Health and Human Services 
(HHS); c2015. Chapter 6, Vaccine 
administration; p. 79-106.
0508PV
[Clopper, C. J. and 
Pearson, E. S. 1934]
Clopper CJ, Pearson ES. The use of confidence 
or fiducial limits illustrated in the case of the 
binomial. Biometrika 1934;26(4):404-13.
03Q0LW
[Curcio, D., et al 2015]
Curcio D, Cane A, Isturiz R. Redefining risk 
categories for pneumococcal disease in adults: 
critical analysis of the evidence. Int J Infect Dis. 
2015;37:30-5.
04VSHL
[Esposito, S., et al 2004]
Esposito S, Bosis S, Colombo R, Carlucci P, 
Faelli N, Fossali E, et al. Evaluation of rapid 
assay for detection of Streptococcus pneumoniae 
urinary antigen among infants and young 
children with possible invasive pneumococcal 
disease. Pediatr Infect Dis J. 2004 
Apr;23(4):365-7.
04VSTS
[European Centre for 
Disease Prevention and 
Control 2016]
European Centre for Disease Prevention and 
Control. Annual Epidemiological Report 2016 –
Invasive pneumococcal disease. [Internet]. 
Stockholm: ECDC; 2016. Available from: 
http://ecdc.europa.eu/en/healthtopics/pneumococ
cal_infection/Pages/Annual-epidemiological-
report-2016.aspx.
04LP3M
[Falkenhorst, G., et al 
2017]
Falkenhorst G, Remschmidt C, Harder T, 
Hummers-Pradier E, Wichmann O, Bogdan C. 
Effectiveness of the 23-valent pneumococcal 
polysaccharide vaccine (PPV23) against 
pneumococcal disease in the elderly: systematic 
review and meta-analysis. PLoS One. 2017 Jan 
6;12(1):e0169368.
04VSWH
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
116
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Farrell, D. J, et al 2007]
Farrell DJ, Klugman KP, Pichichero M. 
Increased antimicrobial resistance among 
nonvaccine serotypes of Streptococcus 
pneumoniae in the pediatric population after the 
introduction of 7-valent pneumococcal vaccine 
in the United States. Pediatr Infect Dis J. 2007 
Feb;26(2):123-8.
04KWD9
[French High Council for 
Public Health 2017]
French High Council for Public Health. 
Recommendations for vaccination against 
invasive pneumococcal disease in adults. 2017.
04VYX3
[Gillis, H. D., et al 2017]
Gillis HD, Lang ALS, ElSherif M, Martin I, 
Hatchette TF, McNeil SA, et al. Assessing the 
diagnostic accuracy of PCR-based detection of 
Streptococcus pneumoniae from nasopharyngeal 
swabs collected for viral studies in Canadian 
adults hospitalised with community-acquired 
pneumonia: a Serious Outcomes Surveillance 
(SOS) Network of the Canadian Immunization 
Research (CIRN) study. BMJ Open. 
2017;7:e015008.
04VSWN
[Grijalva, C. G., et al 
2015]
Grijalva CG, Wunderink RG, Zhu Y, Williams 
DJ, Balk R, Fakhran S, et al. In-hospital 
pneumococcal polysaccharide vaccination is 
associated with detection of pneumococcal 
vaccine serotypes in adults hospitalized for 
community-acquired pneumonia. Open Forum 
Infect Dis. 2015:2(4):ofv135.
04VT53
[Guevara, M., et al 2016]
Guevara M, Barricarte A, Torroba L, Herranz M, 
Gil-Setas A, Gil F, et al. Direct, indirect and 
total effects of 13-valent pneumococcal 
conjugate vaccination on invasive pneumococcal 
disease in children in Navarra, Spain, 2001 to 
2014: cohort and case-control study. Euro 
Surveill. 2016;21(14).
04KSQ3
[Huijts, S. M., et al 2017]
Huijts SM, van Werkhoven CH, Bolkenbaas M, 
Grobbee DE, Bonten MJM. Post-hoc analysis of 
a randomized controlled trial: diabetes mellitus 
modifies the efficacy of the 13-valent 
pneumococcal conjugate vaccine in elderly. 
Vaccine. 2017;35:4444-9.
04VSYC
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
117
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Jackson, L. A., et al 
2013]
Jackson LA, Gurtman A, van Cleeff M, Jansen 
KU, Jayawardene D, Devlin C, et al. 
Immunogenicity and safety of a 13-valent 
pneumococcal conjugate vaccine compared to a 
23-valent pneumococcal polysaccharide vaccine 
in pneumococcal vaccine-naive adults. Vaccine. 
2013;31:3577-84.
04VT2S
[Jokinen, J., et al 2015]
Jokinen J, Rinta-Kokko H, Siira L, Palmu AA, 
Virtanen MJ, Nohynek H, et al. Impact of ten-
valent pneumococcal conjugate vaccination on 
invasive pneumococcal disease in Finnish 
children a population-based study. PLoS One. 
2015 Mar 17;10(3):e0120290.
04KW7F
[Knoll, M. D., et al 2016]
Knoll MD, Pride MW, Sebastian S, Hilton B, 
Isturiz R, Jansen KU. Pilot evaluation of a 
quantitative serotype-specific urine antigen 
detection (SS-UAD) assay to identify 
pneumococcal pneumonia in children <5 years 
[abstract]. Presented at: International 
Symposium on Pneumococci and Pneumococcal 
Diseases Conference; 2016 Jun 26-30; Glasgow,
Scotland. Abstract No. 499.
04VT6W
[Kobayashi, M., et al 
2015]
Kobayashi M, Bennett NM, Gierke R, 
Almendares O, Moore MR, Whitney CG, et al. 
Intervals Between PCV13 and PPSV23 
Vaccines: Recommendations of the Advisory 
Committee on Immunization Practices (ACIP). 
MMWR Morb Mortal Wkly Rep. 2015 Sep 
4;64(34):944-7.
04P7LH
[Lepoutre, A., et al 2015]
Lepoutre A, Varon E, Georges S, Dorleans F, 
Janoir C, Gutmann L, et al. Impact of the 
pneumococcal conjugate vaccines on invasive 
pneumococcal disease in France, 2001-2012. 
Vaccine. 2015 Jan 3;33(2):359-66.
04KW88
[Lexau, C. A., et al 2005]
Lexau CA, Lynfield R, Danila R, Pilishvili T, 
Facklam R, Farley MM, et al. Changing 
epidemiology of invasive pneumococcal disease 
among older adults in the era of pediatric 
pneumococcal conjugate vaccine. JAMA 
2005;294(16):2043-51.
03RBPW
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
118
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Liang, K-Y and Zeger, 
S. L. 2000]
Liang K-Y, Zeger SL. Longitudinal data analysis 
of continuous and discrete responses for pre-post 
designs. Sankyha: The Indian Journal of 
Statistics 2000;62(Series B, Part 1):134-48.
00V5V6
[Martinelli, D., et al 
2014]
Martinelli D, Pedalino B, Cappelli MG, Caputi 
G, Sallustio A, Fortunato F, et al Towards the 
13-valent pneumococcal conjugate universal 
vaccination: effectiveness in the transition era 
between PCV7 and PCV13 in Italy, 2010-2013. 
Hum Vaccin Immunother. 2014;10(1):33-9.
04KW8B
[McMahon, B. J., et al 
1993]
McMahon BJ, Parkinson AJ, Bulkow L, 
Davidson M, Wainwright K, Wolfe P, et al. 
Immunogenicity of the 23-valent pneumococcal 
polysaccharide vaccine in Alaska Native chronic 
alcoholics compared with nonalcoholic Native 
and non-Native controls. Am J Med. 1993 
Dec;95:589-94.
04WB7S
[Metlay, J. P., et al 2006]
Metlay JP, Fishman NO, Joffe M, Edelstein PH. 
Impact of pediatric vaccination with 
pneumococcal conjugate vaccine on the risk of 
bacteremic pneumococcal pneumonia in adults. 
Vaccine 2006;24:468-75.
03RC46
[Moore, M. R., et al 
2015]
Moore MR, Link-Gelles R, Schaffner W, 
Lynfield R, Lexau C, Bennett NM, et al. Effect 
of use of 13-valent pneumococcal conjugate 
vaccine in children on invasive pneumococcal 
disease in children and adults in the USA: 
analysis of multisite, population-based 
surveillance. Lancet Infect Dis. 2015 Feb 3. 
[Epub ahead of print].
043MRP
[Morton, J. B., et al 2017]
Morton JB, Morrill HJ, LaPlante KL, Caffrey 
AR. Risk stacking of pneumococcal vaccination 
indications increases mortality in unvaccinated 
adults with Streptococcus pneumoniae 
infections. Vaccine. 2017;35:1692-7.
04VSTC
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
119
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Palmu, A. A., et al 2015]
Palmu AA, Kilpi TM, Rinta-Kokko H, Nohynek 
H, Toropainen M, Nuorti JP, et al. 
Pneumococcal conjugate vaccine and clinically 
suspected invasive pneumococcal disease. 
Pediatrics. 2015 Jul;136(1):e22-7.
04KVRL
[Pilishvili, T., et al 2014]
Pilishvili T, Ahmed s, Xing W, Farley M, 
Schaffner W, Thomas A, et al. Impact of 13-
valent pneumococcal conjugate vaccine 
(PCV13) in the U.S. on invasive pneumococcal 
disease (IPD) among adults with chronic 
conditions [abstract].  National center for 
Immunization and Respiratory Disease, Division 
of Bacterial Diseases, Department of Health and 
Human Services USA. Report No. ISPPD-0638.
04VT67
[Pilishvili, Tamara, et al 
2010]
Pilishvili T, Lexau C, Farley MM, Hadler J, 
Harrison LH, Bennett NM, et al. Sustained 
reductions in invasive pneumococcal disease in 
the era of conjugate vaccine. J Infect Dis 
2010;201(1):32-41.
03R5S4
[Priner, M., et al 2008]
Priner M, Cornillon C, Forestier D, Valero S, 
Paccalin M. Might Streptococcus pneumoniae 
urinary antigen test be positive because of 
pneumococcal vaccine? J Am Geriatr Soc. 2008 
Jan;56(1):170-1.
04VSP8
[Romero-Steiner, S., et al 
1997]
Romero-Steiner S, Libutti D, Pais LB, Dykes J, 
Anderson P, Whitin JC, et al. Standardization of 
an opsonophagocytic assay for the measurement 
of functional antibody activity against 
streptococcus pneumoniae using differentiated 
HL-60 cells. Clin Diagn Lab Immunol 
1997;4(4):415-22.
03NWQ5
[Ruckinger, S., et al 
2009]
Ruckinger S, van der Linden M, Reinert RR, von 
Kries R, Burckhardt F, Siedler A. Reduction in 
the incidence of invasive pneumococcal disease 
after general vaccination with 7-valent 
pneumococcal conjugate vaccine in Germany. 
Vaccine 2009;27:4136-41.
03QYQQ
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
120
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Shea, K. M., et al 2014]
Shea KM, Edelsberg J, Weycker D, Farkouh 
RA, Strutton DR, Pelton SI. Rates of 
pneumococcal disease in adults with chronic 
medical conditions. Open Forum Infect Dis. 
2014 May 27;1(1):ofu024.
04NK7X
[Tomczyk, S., et al 2014]
Tomczyk S, Bennett NM, Stoecker C, Gierke R, 
Moore MR, Whitney CG, et al. Use of 13-valent 
pneumococcal conjugate vaccine and 23-valent 
pneumococcal polysaccharide vaccine among 
adults aged is greater than or equal to 65 years: 
recommendations of the Advisory Committee on 
Immunization Practices (ACIP). MMWR Morb 
Mortal Wkly Rep. 2014 Sep 19;63(37):822-5.
040XNF
[Torres, A., et al 2015]
Torres A, Blasi F, Dartois N, Akova M. Which 
individuals are at increased risk of 
pneumococcal disease and why? Impact of 
COPD, asthma, smoking, diabetes, and/or 
chronic heart disease on community-acquired 
pneumonia and invasive pneumococcal disease. 
Thorax. 2015:70:984-9.
04VSHQ
[Turner, P., et al 2011]
Turner P, Turner C, Kaewcharernnet N, Mon 
NY, Goldblatt D, Nosten F. A prospective study 
of urinary pneumococcal antigen detection in 
healthy Karen mothers with high rates of 
pneumococcal nasopharyngeal carriage. BMC 
Infect Dis. 2011;11:108.
04VSPG
[U.S. Food and Drug 
Administration 2009]
U.S. Food and Drug Administration (CDER, 
CBER, CDRH). Guidance for industry patient-
reported outcome measures: use in medical 
product development to support labeling claims 
[Internet]. Washington: U.S. Department of 
Health and Human Services; 2009. Available 
from: 
https://www.fda.gov/downloads/drugs/guidances
/ucm193282.pdf
04MG9J
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
121
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Wagenvoort, G. H., et al 
2016]
Wagenvoort GH, Knol MJ, de Melker HE, 
Vlaminckx BJ, van der Ende A, Rozenbaum  
MH, et al.  Risk and outcomes of invasive 
pneumococcal disease in adults with underlying 
conditions in the post-PCV7 era, The 
Netherlands. Vaccine. 2016 Jan 12;34(3):334-
40.
04KTDB
[Waight, P. A., et al 
2015]
Waight PA, Andrews NJ, Ladhani SN, Sheppard 
CL, Slack MP, Miller E. Effect of the 13-valent 
pneumococcal conjugate vaccine on invasive 
pneumococcal disease in England and Wales 4 
years after its introduction: an observational 
cohort study. Lancet Infect Dis. 2015 
May;15(5):535-43.
04KTF2
[Watt, J. P., et al 2007]
Watt JP, O'Brien KL, Benin AL, McCoy SI, 
Donaldson CM, Reid R, et al. Risk factors for 
invasive pneumococcal disease among Navajo 
adults. Am J Epidemiol. 2007;166(9):1080-7.
04VSPB
[Weatherholtz, R., et al 
2010]
Weatherholtz R, Millar EV, Moulton LH, Reid 
R, Rudolph K, Santosham M, et al. Invasive 
pneumococcal disease a decade after 
pneumococcal conjugate vaccine use in an 
American Indian population at high risk for 
disease. Clin Infect Dis. 2010 May 1;50(9):1238-
46.
04VSP6
[Weiss, S., et al 2015]
Weiss S, Falkenhorst G, van der Linden M, 
Imohl M, von Kries R. Impact of 10-  and 13-
valent pneumococcal conjugate vaccines on 
incidence of invasive pneumococcal disease in 
children aged under 16 years in Germany, 2009 
to 2012. Euro Surveill. 2015 Mar 
12;20(10):21057.
04KTFC
[Weycker, D., et al 2016]
Weycker D, Farkouh RA, Strutton DR, 
Edelsberg J, Shea KM, Pelton SL. Rates and 
costs of invasive pneumococcal disease and 
pneumonia in persons with underlying medical 
conditions. BMC Health Serv Res. 2016;16:182.
04VSTX
 
 
050DGF
 
 
05KG3M

PRODUCT: V114 
122
PROTOCOL/AMENDMENT NO.: 017-02 
V114-017-02 FINAL PROTOCOL
31-AUG-2018
[Whitney, Cynthia G., et 
al 2003]
Whitney CG, Farley MM, Hadler J, Harrison 
LH, Bennett NM, Lynfield R, et al. Decline in 
invasive pneumococcal disease after the 
introduction of protein-polysaccharide conjugate 
vaccine. N Engl J Med 2003;348(18):1737-46.
03QT0D
 
 
050DGF
 
 
05KG3M