125742 45 S211 M5 c4591001 interim ado invest signature

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INVESTIGATOR DECLARATION 
Clinical Study Report 
 
 
Protocol Number:  C4591001 
 
Report Title: Interim Report – Adolescents: A Phase 1/2/3, Placebo-Controlled, Randomized, 
Observer-Blind, Dose-Finding Study to Evaluate the Safety, Tolerability, Immunogenicity, and 
Efficacy of SARS-COV-2 RNA Vaccine Candidates Against COVID-19 in Healthy Individuals 
 
Clinical Lead:  John L. Perez, MD, MBA, MA 
 
Date of the Report:  14 April 2021 
 I, Dr. Stephen J. Thomas, the undersigned, have read the above-referenced clinical study report 
for study C4591001, which I have undertaken with Pfizer. 
 
I confirm that to the best of my knowledge, it accurately describes the conduct and results of the study. 
 
 
Signed:          
  Stephen J. Thomas, MD 
 State University of New York  
 Upstate Medical University 
  Date:   14 April 2021 
 
 
The above lead investigator is acting as coordinator and signing on behalf of all centers involved in the above study. 
Infectious Disease s Division  
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090177e196cc8019\Approved\Approved On: 16-Apr-2021 09:34 (GMT)
FDA-CBER-2022-5812-0224077