---
title: Efficacy of a Plant-derived Quadrivalent Virus-like Particle (VLP) Vaccine in the Elderly
nct_id: NCT03739112
overall_status: COMPLETED
phase: PHASE3
sponsor: Medicago
study_type: INTERVENTIONAL
primary_condition: Virus Diseases
countries: United States, Canada, Finland, Germany, Thailand
canonical_url: "https://parkinsonspathways.com/agent/trials/NCT03739112.md"
clinicaltrials_gov: "https://clinicaltrials.gov/study/NCT03739112"
ct_last_update_post_date: 2023-06-23
last_seen_at: "2026-05-12T06:29:36.585Z"
source: ClinicalTrials.gov (mirrored, no enrichment)
---
# Efficacy of a Plant-derived Quadrivalent Virus-like Particle (VLP) Vaccine in the Elderly

**Official Title:** A Randomized, Observer-blind, Active Comparator-controlled, Multicenter, Phase 3 Study to Assess the Efficacy, Safety, and Immunogenicity of a Plant-derived Quadrivalent VLP Influenza Vaccine in Adults 65 Years of Age and Older

**NCT ID:** [NCT03739112](https://clinicaltrials.gov/study/NCT03739112)

## Key Facts

- **Status:** COMPLETED
- **Phase:** PHASE3
- **Study Type:** INTERVENTIONAL
- **Target Enrollment:** 12794
- **Lead Sponsor:** Medicago
- **Conditions:** Virus Diseases, RNA Virus Infections, Respiratory Tract Diseases, Respiratory Tract Infections
- **Start Date:** 2018-09-18
- **Completion Date:** 2019-07-16
- **CT.gov Last Update:** 2023-06-23

## Brief Summary

This Phase 3 study was intended to assess the relative efficacy of the Quadrivalent VLP Influenza Vaccine during the 2018-2019 influenza season compared to a licensed vaccine in elderly adults 65 years of age and older. One dose of VLP Influenza Vaccine (30 μg/strain) or of Comparator (15 μg/strain) was to be administered to 12,738 participants.

## Detailed Description

This randomized, observer-blind, active-controlled multicenter, Phase 3 study was conducted at multiple sites. The composition of the Quadrivalent VLP Influenza Vaccine used in this study included a mix of recombinant H1, H3, and two B hemagglutinin proteins expressed as VLPs for the 2018-2019 influenza virus strains.

A total of 12,794 healthy male and female participants aged 65 years and older were randomized in a 1:1 ratio into one of two parallel treatment groups, such that 6,396 participants were randomized to receive the Quadrivalent VLP Influenza Vaccine at a dose of 30 μg/strain and 6,398 participants were randomized to receive the comparator. Within the two treatment groups, participants were stratified by site and two age groups (65-74 years of age and 75 years of age and older in a 2:1 ratio).

Participants participated in this study for approximately nine months, during which a first visit was scheduled on Day 0 for screening and vaccine administration.

## Eligibility

- **Minimum age:** 65 Years
- **Sex:** ALL
- **Healthy Volunteers:** Yes

```
Inclusion Criteria:

1. Participants must have read, understood, and signed the informed consent form (ICF) prior to participating in the study; participants must also complete study-related procedures and communicate with the study staff at visits and by phone during the study;
2. Participants must have a body mass index (BMI) ≤35 kg/m\^2;
3. Participants are considered by the Investigator to be reliable and likely to cooperate with the assessment procedures and be available for the duration of the study;
4. Male and female participants must be 65 years of age and older at the Screening/Vaccination visit (Visit 1);
5. Participants must be non-institutionalized (e.g. not living in rehabilitation centres or old-age homes; living in an elderly community is acceptable) and have no acute or evolving medical problems prior to study participation and no clinically relevant abnormalities that could jeopardize participant safety or interfere with study assessments, as assessed by the Principal Investigator or sub-Investigator (thereafter referred as Investigator) and determined by medical history, physical examination, and vital signs;

Note: Participants with a pre-existing chronic disease are allowed to participate if the disease is stable and, according to the Investigator's judgment, the condition is unlikely to confound the results of the study or pose additional risk to the participant by participating in the study. Stable disease is generally defined as no new onset or exacerbation of pre-existing chronic disease three months prior to vaccination. Based on the Investigator's judgment, a participant with more recent stabilization of a disease could also be eligible.

Exclusion Criteria:

1. According to the Investigator's opinion, history of an ongoing acute or evolving medical or neuropsychiatric illness. 'Evolving' was defined as:

   * Requiring a new medical or surgical treatment during the three months prior to study vaccine administration unless the criteria outlined in inclusion criterion no. 5 can be met (i.e. the Investigator can justify inclusion based upon the innocuous nature of medical/surgical events and/or treatments);
   * Requiring any significant change in a chronic medication (i.e. drug, dose, frequency) during the three months prior to study vaccine administration due to uncontrolled symptoms or drug toxicity unless the innocuous nature of the medication change meets the criteria outlined in inclusion criterion no. 5 and is appropriately justified by the Investigator.
2. Any medical or neuropsychiatric condition or any history of excessive alcohol use or drug abuse that would render the participant unable to provide informed consent or unable to provide valid safety observations and reporting, including methadone (methadone as treatment for opioid dependence may be acceptable if the participant has been otherwise opioid-free for at least three years);
3. Any autoimmune disease other than hypothyroidism on stable replacement therapy (including, but not limited to rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, type 1 diabetes, and inflammatory bowel disease) or any confirmed or suspected immunosuppressive condition or immunodeficiency including known or suspected human immunodeficiency virus (HIV), Hepatitis B or C infection, the presence of lymphoproliferative disease;
4. Any history of status asthmaticus or ongoing serious problems with asthma, hospitalization for asthma control, or recurrent asthma episodes requiring medical attention in the last three years (one or more episodes per year);
5. Administration or planned administration of any non-influenza vaccine within 30 days prior to randomization up to blood sampling on Day 21. Immunization on an emergency basis was evaluated case-by-case by the Investigator;
6. Administration of any adjuvanted or investigational influenza vaccine within one year prior to randomization or planned administration prior to the completion of the study;
7. Administration of any 'standard', non-adjuvanted influenza vaccine (e.g. live attenuated trivalent/quadrivalent inactivated influenza vaccine or split trivalent/quadrivalent inactivated influenza vaccine administered by intranasal, intradermal, or IM route) within six months prior to randomization and up to completion of the study;
8. Use of any investigational or non-registered product within 30 days or five half-lives, whichever is longer, prior to randomization or planned use during the study period. Participants may not participate in any other investigational or marketed drug study while participating in this study until after the study;
9. Treatment with systemic glucocorticoids at a dose exceeding 10 mg of prednisone (or equivalent) per day for more than seven consecutive days or for ten or more days in total, within one month of study vaccine administration; any other cytotoxic or immunosuppressant drug, or any immunoglobulin preparation within three months of vaccination and until the completion of the study. Low doses of nasal or inhaled glucocorticoids are allowed. Topical steroids are permitted;
10. Any significant disorder of coagulation including, but not limited to, treatment with warfarin derivatives or heparin. Persons receiving prophylactic anti-platelet medications (e.g. low-dose aspirin \[no more than 100 mg/day\]), and without a clinically apparent bleeding tendency are eligible. Participants treated with new generation drugs that do not increase the risk of IM bleeding (e.g. clopidogrel) are also eligible;
11. History of allergy to any of the constituents of the Quadrivalent VLP Influenza Vaccine, any components of the active comparator quadrivalent vaccine, or tobacco;
12. History of anaphylactic allergic reactions to plants or plants components (including fruits and nuts);
13. Use of antihistamines within 48 hours prior to study vaccination;
14. Daily use of large doses of medication for pain control or inflammation (e.g. opioids, nonsteroidal anti-inflammatory drugs \[NSAIDs\]). Use of a singular regular dose either in the morning or at bedtime would not be exclusionary;
15. Use of prophylactic medications (e.g. acetaminophen/paracetamol, aspirin, naproxen, or ibuprofen) within 24 hours of randomization to prevent or pre-empt symptoms due to vaccination;
16. Planned use of influenza antiviral treatment medication before the collection of nasopharyngeal (NP) swabs (e.g. oseltamivir, zanamivir, rapivab);
17. Have a rash, dermatological condition, tattoos, muscle mass, or any other abnormalities at the injection site that may interfere with injection site reaction rating;
18. Participants who have received a blood transfusion within 90 days prior to study vaccination;
19. Participants with abnormal vital signs (systolic blood pressure \[BP\] ≥ 150 mmHg and/or diastolic BP ≥ 95 mmHg for individuals taking antihypertensive medication and ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg for individuals not taking antihypertensive medication; heart rate \[HR\] ≤ 45 beats/min and ≥ 100 beats/min) evaluated by an Investigator to be clinically significant. A participant with abnormal vital signs results may be included in the study based on Investigator's judgment (e.g. a resting HR ≤ 45 in highly trained athletes);
20. Presence of any febrile illness (including an oral temperature \[OT\] ≥ 38.0 ˚C within 24 hours prior to vaccination;
21. Cancer or treatment for cancer within three years prior to study vaccine administration. Persons with a history of cancer who are disease-free without treatment for three years or more are eligible. However, individuals with conditions such as treated and uncomplicated basal cell carcinoma of the skin or non-treated, non-disseminated local prostate cancer may be eligible;
22. Participants identified as an Investigator or employee of the Investigator or clinical site with direct involvement in the proposed study, or identified as an immediate family member (i.e. parent, spouse) of the Investigator or any employee of Medicago (or their family members);
23. Participants with a history of Guillain-Barré Syndrome.
```

## Arms

- **Quadrivalent VLP Vaccine** (EXPERIMENTAL) — Participants received one intramuscular (IM) injection of 0.5 mL of 30 μg/strain of the Quadrivalent VLP Influenza Vaccine on Day 0.
- **Fluarix Quadrivalent® Comparator Vaccine** (ACTIVE_COMPARATOR) — Participants received one IM injection of 0.5 mL of 15 μg/strain of the Fluarix Quadrivalent® comparator vaccine on Day 0.

## Interventions

- **Quadrivalent VLP Vaccine** (BIOLOGICAL) — Single dose of a 30 µg/strain of Quadrivalent VLP Vaccine
- **Fluarix Quadrivalent® Comparator Vaccine** (BIOLOGICAL) — Single dose of a 15 μg/strain of Fluarix Quadrivalent® Comparator Vaccine

## Primary Outcomes

- **Number of Occurrences of Protocol-Defined Influenza-Like Illness (ILI) Due to Any Laboratory-Confirmed Influenza Strains** _(time frame: Day 14 (post-vaccination) up to ~9 months)_ — Occurrences of laboratory-confirmed ILI caused by any influenza viral strains was measured by reverse transcriptase polymerase chain reaction (RT-PCR). A participant was considered to have protocol-defined ILI if the participant met at least one of the following pre-defined respiratory symptoms: sore throat, cough, sputum production, wheezing, or difficulty breathing and at least one of the following systemic symptoms: fever (defined as a temperature \> 37.2 °C or \> 99.0 °F), chills, tiredness, headache or myalgia. The number of laboratory-confirmed ILI cases caused by any influenza strains are reported.

## Secondary Outcomes

- **Number of Occurrences of Laboratory Confirmed Protocol-Defined Influenza-Like Illness (ILI) Caused by Vaccine-Matched Influenza Strains** _(time frame: Day 14 (post-vaccination) up to ~9 months)_
- **Number of Occurrences of Protocol-Defined Respiratory Illness Due to Any Laboratory-Confirmed Influenza Strains** _(time frame: Day 14 (post-vaccination) up to ~9 months)_
- **Number of Occurrences of Protocol-Defined Respiratory Illness Vaccine Caused by Vaccine-Matched Influenza Strains** _(time frame: Day 14 (post-vaccination) up to ~9 months)_
- **Number of Occurrences of Protocol-Defined ILI** _(time frame: Day 14 (post-vaccination) up to ~9 months)_
- **Number of Participants With at Least One Immediate Complaints** _(time frame: 15 minutes post vaccination)_
- **Number of Participants With at Least One Solicited Local and Systemic Reactions** _(time frame: Day 0 (post-vaccination) to Day 7)_
- **Number of Participants With ≥ Severe Solicited Local and Systemic Reaction** _(time frame: Day 0 (post-vaccination) to Day 7)_
- **Number of Participants With ≥ Severe Related Solicited Reactions** _(time frame: Day 0 (post-vaccination) to Day 7)_
- **Number of Participants With Unsolicited Treatment-Emergent Adverse Events (TEAEs)** _(time frame: Day 0 (post-vaccination) to Day 21)_
- **Number of Participants With ≥ Severe Unsolicited TEAEs** _(time frame: Day 0 (post-vaccination) to Day 21)_
- **Number of Participants With ≥ Severe Related Unsolicited Reactions** _(time frame: Day 0 (post-vaccination) to Day 21)_
- **Number of Participants With at Least One Serious Adverse Event (SAE)** _(time frame: Day 0 to ~9 months)_
- **Number of Occurrences of Death** _(time frame: Day 0 up to ~9 months)_
- **Number of Participants Who Withdrew Due to an AE** _(time frame: Day 0 up to ~9 months)_
- **Number of Participants With at Least One New Onset Chronic Diseases (NOCDs)** _(time frame: Day 0 up to ~9 months)_
- **Geometric Mean Titers (GMTs) of Hemagglutination Inhibition (HI) Antibody Response for Each Homologous and Heterologous Influenza Strain** _(time frame: Baseline (Day 0), Day 21)_
- **Percentage of Participants With Seroconversion Measured by HI Antibody Response for Each Homologous and Heterologous Strain** _(time frame: Day 0 (pre-vaccination) to Day 21)_
- **Percentage of Participants With Seroprotection Measured by HI Antibody Response for Each Homologous and Heterologous Strain** _(time frame: Baseline (Day 0), Day 21)_
- **Geometric Mean Fold Rise (GMFR) of HI Antibody Response for Each Homologous and Heterologous Strain** _(time frame: Baseline (Day 0), Day 21)_
- **GMTs of Microneutralization (MN) Antibody Response for Each Homologous Strain** _(time frame: Baseline (Day 0), Day 21)_
- **Percentage of Participants With Seroconversion Measured by MN Antibody Response for Each Homologous Strain** _(time frame: Day 0 (pre-vaccination) to Day 21)_
- **GMFR of MN Antibody Response for Each Homologous Strain** _(time frame: Baseline (Day 0), Day 21)_
- **Geometric Mean Areas (GMA) of Single Radial Hemolysis (SRH) Antibody Response for Each Homologous Strain** _(time frame: Baseline (Day 0), Day 21)_
- **Percentage of Participants With Seroconversion Measured by SRH Antibody Response for Each Homologous Strain** _(time frame: Day 0 (pre-vaccination) to Day 21)_
- **Percentage of Participants With Seroprotection Measured by SRH Antibody Response for Each Homologous Strain** _(time frame: Baseline (Day 0), Day 21)_
- **GMFR of SRH Antibody Response for Each Homologous Strain** _(time frame: Baseline (Day 0), Day 21)_

## Locations (104)

- (Site 225) Coastal Clinical Research, Mobile, Alabama, United States
- (Site 201) Clinical Research Consortium, Tempe, Arizona, United States
- (Site 213) Advanced Clinical Research, Banning, California, United States
- (Site 246) Paradigm Clinical Research / Pharmaseek, Redding, California, United States
- (Site 212) Benckmark Research, Sacramento, California, United States
- (Site 244) Paradigm Clinical Research Center Inc, San Diego, California, United States
- (Site 242) Paradigm Clinical Research Centers Inc, Wheat Ridge, Colorado, United States
- (Site 239) Alliance for Multispeciality Research, Coral Gables, Florida, United States
- (Site 222) Research Centers of America, Hollywood, Florida, United States
- (Site 221) St-Johns Center for Clinical Research, Ponte Vedra, Florida, United States
- (Site 231) QPS-MRA LLC, South Miami, Florida, United States
- (Site 251) Meridian Clinical Research, Richmond Hill, Georgia, United States
- (Site 240) Meridian Clinical Research LLC, Savannah, Georgia, United States
- (Site 223) Clinical Research Atlanta, Stockbridge, Georgia, United States
- (Site 249) Advanced Clinical Research, Meridian, Idaho, United States
- (Site 219) Heartland Research Associates LLC, Augusta, Kansas, United States
- (Site 234) Heartland Research Associates LLC, Newton, Kansas, United States
- (Site 215) Heartland Research Associates LLC, Wichita, Kansas, United States
- (Site 235) Heartland Research Associates LLC, Wichita, Kansas, United States
- (Site 241) Central Kentucky Reserach Associates, Lexington, Kentucky, United States
- (Site 203) Benchmark Research, Metairie, Louisiana, United States
- (Site 227) Sundande Clinical Research, St Louis, Missouri, United States
- (Site 226) Meridian Clinical Research LLC, Norfolk, Nebraska, United States
- (Site 211) Meridian Clinical Research, Omaha, Nebraska, United States
- (Site 209) United Medical Associates, Binghamton, New York, United States
- (Site 217) Regional Clinical Research inc, Endwell, New York, United States
- (Site 237) PMG Research of Cary LLC, Cary, North Carolina, United States
- (Site 230) PMG Research of Charlotte LLC, Charlotte, North Carolina, United States
- (Site 205) PMG Research of Rocky Mount LLC, Rocky Mount, North Carolina, United States
- (Site 236) PMG Research, Statesville, North Carolina, United States
- (Site 228) Research of Winston-Salem, Winston-Salem, North Carolina, United States
- (Site 233) Sterling Research Group, Cincinnati, Ohio, United States
- (Site 208) Sterling Research Group, Cincinnati, Ohio, United States
- (Site 245) Rapid Medical Research, Cleveland, Ohio, United States
- (Site 202) Aventiv Research Inc, Columbus, Ohio, United States
- (Site 207) Lynn Institute of Norman, Norman, Oklahoma, United States
- (Site 238) Tekton Research, Oklahoma City, Oklahoma, United States
- (Site 216) PMG Research of Charleston LLC, Mt. Pleasant, South Carolina, United States
- (Site 248) Coastal Carolina Research Center, Mt. Pleasant, South Carolina, United States
- (Site 201) Meridian Clinical Research, Dakota Dunes, South Dakota, United States
- (Site 247) New orleans Center for Clinical Research, Knoxville, Tennessee, United States
- (Site 206) Benchmark Research, Austin, Texas, United States
- (Site 218) Tekton Research Inc, Austin, Texas, United States
- (Site 214) Ventavia Research Group LLC, Fort Worth, Texas, United States
- (Site 224) Benchmark Research, Fort Worth, Texas, United States
- (Site 232) Benchmark Research, San Angelo, Texas, United States
- (Site 250) Clinical Trials of Texas Inc, San Antonio, Texas, United States
- (Site 204) Jean Brown Research, Salt Lake City, Utah, United States
- (Site 220) Advanced Clinical Research, West Jordan, Utah, United States
- (Site 229) Clinical Research Associates of Tidewater, Norfolk, Virginia, United States
- (Site 106) Colchester Research Group, Truro, Nova Scotia, Canada
- (Site 113) Dawson Road Family Medical Clinic, Guelph, Ontario, Canada
- (Site 110) Manna Research Inc., Toronto, Ontario, Canada
- (Site 103) Q & T Recherche Chicoutimi, Chicoutimi, Quebec, Canada
- (Site 105) Q & T Outaouais, Gatineau, Quebec, Canada
- (Site 107) Manna Research Inc., Lévis, Quebec, Canada
- (Site 109) Manna Research Inc. (Mirabel), Mirabel, Quebec, Canada
- (Site 108) Manna Research, Pointe-Claire, Quebec, Canada
- (Site 102) CHU de Québec - Université Laval, Québec, Quebec, Canada
- (site 101) Centre de Recherche St-Louis, Québec, Quebec, Canada
- (Site 110) Alpha Recherche Clinique, Québec, Quebec, Canada
- (Site 104) Q & T Recherche Sherbrooke, Sherbrooke, Quebec, Canada
- (Site 112) Medexa Recherche, Victoriaville, Quebec, Canada
- (Site 309) Espoo Vaccine Research Clinic, Espoo, Finland
- (Site 303) Helsinki South Vaccine Research Clinic, Helsinki, Finland
- (Site 308) Helsinki East Vaccine Research Center, Helsinki, Finland
- (Site 301) Jarvenpaa Vaccine Research Clinic, Jarvenpaa, Finland
- (Site 306) Kokkola Vaccine Research Clinic, Kokkola, Finland
- (Site 304) Oulu Vaccine Research Clinic, Oulu, Finland
- (Site 302) Tampere University Vaccine Research Center, Pori, Finland
- (Site 305) Seinaejoki Vaccine Research Clinic, Seinäjoki, Finland
- (Site 310) Tampere Vaccine Research Clinic, Tampere, Finland
- (Site 307) Turku Vaccine Research Center, Turku, Finland
- (Site 410) Emovis GmbH, Berlin, Germany
- (Site 418) Klinische Forschung Berlin GbR, Berlin, Germany
- (Site 422) Synexus Clinical Research GmbH, Berlin, Germany
- (Site 402) Synexus Clinical research GmbH, Bochum, Germany
- (Site 409) Gemeinschaftspraxis Dr. med Kleinecke-Pohl, Cologne, Germany
- (Site 401) Cardiologicum Dresden & Pirna, Dresden, Germany
- (Site 406) Diabetologische Germeinschafts praxis Faulman, Dresden, Germany
- (Site 405) Doktor Markus Faghih, Essen, Germany
- (Site 407) Klinisches Forschungszentrum Dr. Hagemann am Hausarztzer, Essen, Germany
- (Site 417) Medizentrum Essen-Borbeck, Essen, Germany
- (Site 414) Unterfrintroper Hausarztzentrum Klinische Forschung, Essen, Germany
- (SIte 404) Synexus Clinical Reserach GmbH, Frankfurt, Germany
- (Site 411) MedicoKIT GmbH, Goch, Germany
- (Site 425) Clinical Research Hamburg, Hamburg, Germany
- (Site 403) Praxis Dr. Med Cornelia Brauer, Hamburg, Germany
- (Site 408) Germeinsschaftspraxis Dr. med Christiane Klein/Minnich, Künzing, Germany
- (Site 421) SIBAmed Studienzentrum GmbH, Leipzig, Germany
- (Site 420) Synexus Clinical Research GmbH, Leipzig, Germany
- (Site 423) centrum fuer Diagnostik und Gesundheit, Munich, Germany
- (Site 413) Dr. Ingomar F.K. Naudts MD Office, Rodgau, Germany
- (Site 415) Praxisgemeinschaft Stuhr-Brinkum, Stuhr, Germany
- (Site 416) Praxis Dr. med Joachim Sauter, Wangen, Germany
- (Site 412) MALU-Medizinische Studien GmbH, Wardenburg, Germany
- (Site 424) Medislim GmbH, Weinheim, Germany
- (Site 603) Ramathibodi Hospital, Mahid - Division of Infectious Disease, Bangkok, Thailand
- (Site 606) Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- (Site 608) Phramongkutklao Hospital, Bangkok, Thailand
- (Site 609) Division of Tropical Pediatrics, Bangkok, Thailand
- (Site 601) Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- (Site 607) Srinagarind Hospital Khon Kaen University, Khon Kaen, Thailand
- (Site 605) Golden Jubilee Medical Center, Nakhon Pathom, Thailand

## Recent Field Changes (last 30 days)

- `status.overallStatus` — added _(2026-05-12)_
- `status.primaryCompletionDate` — added _(2026-05-12)_
- `status.completionDate` — added _(2026-05-12)_
- `status.lastUpdatePostDate` — added _(2026-05-12)_
- `design.phases` — added _(2026-05-12)_
- `design.enrollmentCount` — added _(2026-05-12)_
- `eligibility.criteria` — added _(2026-05-12)_
- `eligibility.minAge` — added _(2026-05-12)_
- `eligibility.sex` — added _(2026-05-12)_
- `outcomes.primary` — added _(2026-05-12)_
- `outcomes.secondary` — added _(2026-05-12)_
- `armsInterventions.arms` — added _(2026-05-12)_
- `armsInterventions.interventions` — added _(2026-05-12)_
- `sponsor.lead` — added _(2026-05-12)_
- `results.hasResults` — added _(2026-05-12)_
- `locations.(site 225) coastal clinical research|mobile|alabama|united states` — added _(2026-05-12)_
- `locations.(site 201) clinical research consortium|tempe|arizona|united states` — added _(2026-05-12)_
- `locations.(site 213) advanced clinical research|banning|california|united states` — added _(2026-05-12)_
- `locations.(site 246) paradigm clinical research / pharmaseek|redding|california|united states` — added _(2026-05-12)_
- `locations.(site 212) benckmark research|sacramento|california|united states` — added _(2026-05-12)_
- `locations.(site 244) paradigm clinical research center inc|san diego|california|united states` — added _(2026-05-12)_
- `locations.(site 242) paradigm clinical research centers inc|wheat ridge|colorado|united states` — added _(2026-05-12)_
- `locations.(site 239) alliance for multispeciality research|coral gables|florida|united states` — added _(2026-05-12)_
- `locations.(site 222) research centers of america|hollywood|florida|united states` — added _(2026-05-12)_
- `locations.(site 221) st-johns center for clinical research|ponte vedra|florida|united states` — added _(2026-05-12)_
- `locations.(site 231) qps-mra llc|south miami|florida|united states` — added _(2026-05-12)_
- `locations.(site 251) meridian clinical research|richmond hill|georgia|united states` — added _(2026-05-12)_
- `locations.(site 240) meridian clinical research llc|savannah|georgia|united states` — added _(2026-05-12)_
- `locations.(site 223) clinical research atlanta|stockbridge|georgia|united states` — added _(2026-05-12)_
- `locations.(site 249) advanced clinical research|meridian|idaho|united states` — added _(2026-05-12)_
- `locations.(site 219) heartland research associates llc|augusta|kansas|united states` — added _(2026-05-12)_
- `locations.(site 234) heartland research associates llc|newton|kansas|united states` — added _(2026-05-12)_
- `locations.(site 215) heartland research associates llc|wichita|kansas|united states` — added _(2026-05-12)_
- `locations.(site 235) heartland research associates llc|wichita|kansas|united states` — added _(2026-05-12)_
- `locations.(site 241) central kentucky reserach associates|lexington|kentucky|united states` — added _(2026-05-12)_
- `locations.(site 203) benchmark research|metairie|louisiana|united states` — added _(2026-05-12)_
- `locations.(site 227) sundande clinical research|st louis|missouri|united states` — added _(2026-05-12)_
- `locations.(site 226) meridian clinical research llc|norfolk|nebraska|united states` — added _(2026-05-12)_
- `locations.(site 211) meridian clinical research|omaha|nebraska|united states` — added _(2026-05-12)_
- `locations.(site 209) united medical associates|binghamton|new york|united states` — added _(2026-05-12)_
- `locations.(site 217) regional clinical research inc|endwell|new york|united states` — added _(2026-05-12)_
- `locations.(site 237) pmg research of cary llc|cary|north carolina|united states` — added _(2026-05-12)_
- `locations.(site 230) pmg research of charlotte llc|charlotte|north carolina|united states` — added _(2026-05-12)_
- `locations.(site 205) pmg research of rocky mount llc|rocky mount|north carolina|united states` — added _(2026-05-12)_
- `locations.(site 236) pmg research|statesville|north carolina|united states` — added _(2026-05-12)_
- `locations.(site 228) research of winston-salem|winston-salem|north carolina|united states` — added _(2026-05-12)_
- `locations.(site 233) sterling research group|cincinnati|ohio|united states` — added _(2026-05-12)_
- `locations.(site 208) sterling research group|cincinnati|ohio|united states` — added _(2026-05-12)_
- `locations.(site 245) rapid medical research|cleveland|ohio|united states` — added _(2026-05-12)_
- `locations.(site 202) aventiv research inc|columbus|ohio|united states` — added _(2026-05-12)_

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