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This is VAERS ID 83517

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 83517
VAERS Form:
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958102 / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, CONVULS GRAND MAL, COMA, ENCEPHALOPATHY, EDEMA BRAIN

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type':

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 12/8/2009

VAERS ID: 83517 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-11 1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 INFLUENZA (SEASONAL) (FLUSHIELD 95-96) / WYETH WYETH PHARMACEUTICALS, INC 4958102 / - - / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema, BRAIN SYND ACUTE, CONVULS GRAND MAL, COMA, ENCEPHALOPATHY, EDEMA BRAIN

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': (blank) 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 8/31/2010

VAERS ID: 83517 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 95-96) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4958102 / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 7/7/2013

VAERS ID: 83517 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 5/14/2017

VAERS ID: 83517 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 9/14/2017

VAERS ID: 83517 Before After
VAERS Form:(blank) 1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / - UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 2/14/2018

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 6/14/2018

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 8/14/2018

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 9/14/2018

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 10/14/2018

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 12/24/2020

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 12/30/2020

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 5/7/2021

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;


Changed on 5/14/2021

VAERS ID: 83517 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Arizona
Vaccinated:1995-10-27
Onset:1995-10-31
Submitted:1996-02-21
Entered:1996-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958102 / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Coma, Delirium, Drug ineffective, Encephalopathy, Grand mal convulsion, Hydrocephalus, Infection, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 82     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI, d; fever
Preexisting Conditions: premature at 6 mo gestation;severe bronchopulmonary dysplasia requiring intubation/tracheostomy;hypotonia accompanying sz activity in oct 95;d,URI,fever;
Allergies:
Diagnostic Lab Data: CT & MRI head - severe white matter disease & hydrocephalus;
CDC 'Split Type': 896052006L

Write-up: pt recv vax;31oct95 devel fever of 106 & exp sz lasting over 1 hr;adm to hosp;exp "oth sz & coma intermittently";this resulted in "3/4 brain damage per grandma;devel encephalopathy & hydrocephalus per MD;

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