Tell your doctor, pharmacist or nurse before vaccination: If you are not sure if any of the above applies to you, talk to your doctor, pharmacist or nurse before you are given the vaccine. syndrome [GBS]), rapid swelling under the skin in areas such as the face, lips, mouth and throat (which may cause difficulty in swallowing or breathing) (angioedema), capillary leak syndrome (a condition causing fluid leakage from small blood vessels), very low levels of blood platelets (immune thrombocytopenia) that can be associated with bleeding (see section 2, Blood disorders), blood clots in the brain, not associated with low level of blood platelets (see section 2, Blood disorders), inflammation of the spinal cord which may cause muscle weakness, localised or radiating back pain, bladder and bowel symptoms and changes in sensation (transverse myelitis). The solution is colourless to slightly brown, clear to slightly opaque. %PDF-1.7 % 0000093244 00000 n <>/Metadata 30 0 R>> Water dilutes the vaccine's ingredients, to make sure they are at the right level of concentration. 0000003715 00000 n 0000004124 00000 n endobj are no data yet for Omicron. 0000015344 00000 n What COVID-19 Vaccine AstraZeneca is and what it is used for COVID-19 Vaccine AstraZeneca is a vaccine used for preventing COVID-19, caused by a virus called coronavirus (SARS-CoV-2). Andrew Pollard has been leading the Oxford vaccine clinical trials in the UK, Brazil, and South Africa. endstream endobj startxref 0 %%EOF 72 0 obj <>>> endobj 95 0 obj <> stream No serious adverse events were reported with AZD1222, and reactions were lessened with the use of prophylactic paracetamol. Possible side effects 5. 0000003094 00000 n CoronaVac is an inactivated vaccine. Published: 2021-05-07. 18 June 2021. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. You may access the guidance document here. Nijmegen, 6545CG endstream endobj 347 0 obj <>/Metadata 343 0 R/Outlines 30 0 R/OutputIntents[<>]/Pages 342 0 R/StructTreeRoot 38 0 R/Type/Catalog>> endobj 348 0 obj <>/Font<>>>/Fields[]>> endobj 349 0 obj <. The AstraZeneca vaccine is safe and effective at protecting people from the extremely serious risks of COVID-19, including death, hospitalization and severe disease. Once the vaccine has undergone Phase 3 testing, the manufacturer can apply for a license from regulatory authorities (like the FDA in the US) to make the vaccine available for public use. 2.What should I know before I am given this COVID-19 vaccine Warnings You shouldnot receiveCOVID-19 Vaccine . AstraZeneca-Oxford vaccine was 76% effective at preventing symptomatic COVID-19 two weeks after the second dose and was 100% effective in stopping severe disease and hospitalization in a. What COVID-19 Vaccine AstraZeneca is and what it is used for, What you need to know before you are given COVID-19 Vaccine AstraZeneca, How COVID-19 Vaccine AstraZeneca is given, How to store COVID-19 Vaccine AstraZeneca, Contents of the pack and other information, Check benefits and financial support you can get, Find out about the Energy Bills Support Scheme, Regulatory approval of COVID-19 Vaccine AstraZeneca, Package leaflet: Information for the recipient, nationalarchives.gov.uk/doc/open-government-licence/version/3. 0000024916 00000 n information about the risks of COVID-19 in pregnancy, the likely benefits of vaccination in the local epidemiological context, and the current limitations of safety data in pregnant women. 0000007190 00000 n Oxford-AstraZeneca COVID-19 vaccine efficacy. 0000098749 00000 n Vaxzevria is a vaccine for preventing coronavirus disease 2019 (COVID-19) in people aged 18 years and older. Company: AstraZeneca Discard the vial and do not combine residual vaccine from multiple vials. 4.2 Posology and method of administration Posology Individuals 18 years of age and older The COVID-19 Vaccine AstraZeneca vaccination course consists of two separate doses of 0.5 ml each. /Root 55 0 R Vaccines are generally very safe and their study involves a rigorous process. 0000132021 00000 n The Oxford-AstraZeneca vaccine contains no common food allergens such as milk, wheat, egg, peanuts, tree nuts, or shellfish, or their by-products. In the meantime, we must maintain and strengthen public health and social measures that work: masking, physical distancing, handwashing, respiratory and cough hygiene, avoiding crowds, and ensuring good ventilation. In all participants, a T-cell response was induced, peaking by day 14, and maintained two months after injection. Wed like to set additional cookies to understand how you use GOV.UK, remember your settings and improve government services. We also use cookies set by other sites to help us deliver content from their services. The vaccine was administered as two doses of 5 x10 10 viral particles four weeks apart. Route of administration Intramuscular injection. No data are currently available in individuals with a weakened immune system or who are taking chronic treatment that suppresses or prevents immune responses. The second key step in these reactions is caused by EDTA, a calcium-binding agent and stabilizer that is added to the AstraZeneca vaccine. If you get any side effects, talk to your doctor, pharmacist or nurse. The last nine ingredients on the list are called 'excipients.' The final stage (Phase III) provides the vaccine to thousands of people from the target population to see how safe and effective it is. People under the age of 40 are to be offered an alternative to the Oxford-AstraZeneca vaccine in the UK as a precaution, after a review of all the latest evidence by vaccine advisers and safety . 548 0 obj <> endobj In the trial, 543 participants received AZD1222 (56 also received a prophylactic dose of the pain killer paracetamol), and 534 received MenACWY, a comparator meningococcal conjugate vaccine. endstream endobj 780 0 obj <. A booster dose may be considered 4 6 months after completion of the primary vaccination series, starting with the higher priority-use groups, in accordance with the WHO Prioritization Roadmap. hb```(1A;B% In someone age 55 - 59 who is diagnosed with COVID-19, the risks of hospitalization for Dont include personal or financial information like your National Insurance number or credit card details. You cannot usually choose which vaccine you have. 0000015637 00000 n >!V9j5LYHCz. ;BV 0000103790 00000 n WHO does not recommend pregnancy testing prior to vaccination. As with any new medicine in the UK this product will be closely monitored to allow quick identification of new safety information. 71 0 obj <> endobj 97 0 obj <>/Filter/FlateDecode/ID[(g\344kPbb\247F\260\2010\356\240|\314\024) (g\344kPbb\247F\260\2010\356\240|\314\024)]/Index[71 27]/Info 69 0 R/Length 82/Prev 165766/Root 72 0 R/Size 98/Type/XRef/W[1 3 1]>> stream This webpage was updated on 5 January 2022 to update the latest guidance and ensure consistency of information and formatting. Preliminary findings highlight the urgent need for a coordinated approach for surveillance and evaluation of variants and their potential impact on vaccine effectiveness. Some excipients are added to a vaccine for a specific purpose. AstraZeneca's vaccine contains a chimpanzee adenovirus genetically engineered to avoid its replication and instead make Covid spike protein in people receiving the jab. . As new data become available, WHO will update recommendations accordingly. xVN@}W#E{I HTJB+!`)m;:KQyX99se Consumer Information. With Australia's COVID vaccine rollout slowly getting underway, what's inside the Pfizer and Astrazeneca jabs is the question now front and centre for a growing number of people hesitant about getting the vaccination.. Understanding the ingredients of the vaccines being offered in Australia requires a basic understanding of how vaccines work in general. 0000014217 00000 n 57 40 If you get any side effects, talk to your doctor, pharmacist or nurse. A new investigational treatment for COVID-19: Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. %%EOF i; "32tBa;CC'd&@u^?^02/g`8Ea?U L-histidine hydrochloride monohydrate (amino acid) Magnesium chloride hexahydrate (salt) Polysorbate 80 (surfactant) Ethanol (alcohol) Sucrose (sugar) Sodium chloride (salt) Disodium edetate dihydrate (salt) Water for injections (diluent) The vaccine does not include any human or animal products, thimerosal, gelatin, or formaldehyde. 0000053643 00000 n When autocomplete results are available use up and down arrows to review and enter to select. AstraZeneca vs. Sinovac side effects. No data are currently available on the use of COVID-19 Vaccine AstraZeneca in children and adolescents younger than 18 years of age. 0000013285 00000 n 0000001605 00000 n Generic name: SARS-CoV-2 vaccine Pharmaceutical giant AstraZeneca and its partner Oxford University released preliminary results from its phase 3 Covid-19 vaccine trials on Monday, which found that the company's vaccine,. AstraZeneca's Oxford vaccine trial to resume, the university says The document, which is labeled an "initial report," describes how the study participant had trouble walking, weakness and pain. Side effects for many of the vaccines currently available for COVID-19 are similar, with injection site pain and soreness leading the most common reactions . Countries should Vaccine ingredients; Nucleic acid and viral vector vaccines explained . _:);~6`Tgx_A/`d`G,~#V?]|j~^9jfWu?g8uN~Tg'~^'G%|S>#Z{,gcOgg"Q27v}IyaM|"6ocj Getty Images. It's only capable of delivering the DNA," he said. 0000004648 00000 n According to the vaccine's safety profile within the product information, the most common side effects include mild-to-moderate symptoms of one or more of the following: headache (52.6%) fatigue . After withdrawing the final dose, some liquid may remain in the vial. Information about the Moderna bivalent coronavirus vaccine, including vaccine ingredients, is available: Vaccine Maker Halts Trial Following Unexplained Illness in Volunteer, Details Emerge on Unexplained Illness in AstraZeneca COVID Vaccine Trial, A Study of a Candidate COVID-19 Vaccine (COV001), New Vaxzevria Data Further Support its Use as Third Dose Booster, Vaxzevria Significantly Boosted Antibody Levels Against Omicron, Vaxzevria is Highly Effective After One Dose Against Severe Disease or Hospitalisation Caused by Beta and Delta Variants of Concern, Vaxzevria Induced Immunity for at Least One Year Following a Single Dose and Strong Immune Responses Following Either a Late Second Dose or a Third Dose, COVID-19 Vaccine AstraZeneca Effective Against Delta (Indian) Variant, AstraZeneca COVID-19 Vaccine Vaxzevria Authorised for Emergency Use in Japan, AZD1222 US Phase III Primary Analysis Confirms Safety and Efficacy, AZD1222 US Phase III trial Met Primary Efficacy Endpoint in Preventing COVID-19 at Interim Analysis, UK and EU Regulatory Agencies Confirm COVID-19 Vaccine AstraZeneca is Safe and Effective, Update on the Safety of COVID-19 Vaccine AstraZeneca, AstraZeneca Advances Mass Global Rollout of COVID-19 Vaccine Through COVAX, AstraZeneca COVID-19 Vaccine Authorised for Emergency Use by the World Health Organization, COVID-19 Vaccine AstraZeneca Confirms 100% Protection Against Severe Disease, Hospitalisation and Death in the Primary Analysis of Phase III Trials, COVID-19 Vaccine AstraZeneca Authorised for Use in the EU, COVID-19 Vaccine AstraZeneca Recommended for Use in the EU, Serum Institute of India Obtains Emergency Use Authorisation in India for AstraZenecas COVID-19 Vaccine, AstraZenecas COVID-19 Vaccine Authorised for Emergency Supply in the UK, AZD1222 Oxford Phase III Trials Interim Analysis Results Published in The Lancet, AZD1222 Vaccine Met Primary Efficacy Endpoint in Preventing COVID-19, FDA Authorises Restart of the COVID-19 AZD1222 Vaccine US Phase III Trial, COVID-19 Vaccine AZD1222 Clinical Trial Resumed in Japan, Follows Restart of Trials in the UK, Brazil, South Africa and India, COVID-19 Vaccine AZD1222 Clinical Trials Resumed in the UK, Statement on AstraZeneca Oxford SARS-CoV-2 Vaccine, AZD1222, COVID-19 Vaccine Trials Temporary Pause, AstraZenecas Scientific and Social Commitment for COVID-19 Vaccine AZD1222, Development of COVID-19 Vaccine AZD1222 Expands into US Phase III Clinical Trial Across All Adult Age Groups, AstraZeneca Australia & New Zealand Response to the COVID-19 Pandemic, AstraZeneca Concludes Agreement with the European Commission for the Supply of up to 400 Million Doses of AZD1222 COVID-19 Vaccine, COVID-19 Vaccine AZD1222 Showed Robust Immune Responses in All Participants in Phase I/II Trial, Cobra Signs Supply Agreement with AstraZeneca for Manufacture of COVID-19 Vaccine Candidate, AstraZeneca to Supply Europe With Up To 400 Million Doses of Oxford Universitys COVID-19 Vaccine At No Profit, AstraZeneca Takes Next Steps Towards Broad and Equitable Access to Oxford Universitys COVID-19 Vaccine, AstraZeneca Advances Response to Global COVID-19 Challenge as it Receives First Commitments for Oxfords Potential New Vaccine, Investigational ChAdOx1 nCoV-19 Vaccine Protects Monkeys Against COVID-19 Pneumonia, AstraZeneca and Oxford University Announce Landmark Agreement for COVID-19 Vaccine. Overall, among the participants who received COVID-19 Vaccine AstraZeneca, 90.3% were aged 18 to 64 years and 9.7% were 65 years of age or older. << /Type /XRef /Filter /FlateDecode /Length 115 /W [ 1 3 1 ] /Index [ 53 36 ] See the end of section 4 for how to report side effects. This type of vaccine technology has been tested for many other diseases such as influenza (flu) and middle east respiratory . hbbd``b` $HpXAv DL) M Ms CZHto ) COVID-19 Vaccine AstraZeneca is given as an injection of 0.5 ml into a muscle (usually in the upper arm). It does not have a marketing authorisation, but this temporary authorisation grants permission for the medicine to be used for active immunisation of individuals aged 18 years and older for the prevention of coronavirus disease 2019 (COVID-19). hb``g``oc`c` @1v=k}u F'SUNZ 10 dose multidose vial (5 ml) with rubber stopper and aluminium overseal in a pack of 10 vials. Store in a refrigerator (2C to 8C). 0000132090 00000 n The Astra-Zeneca vaccine can be offered to people who have had COVID-19 in the past. Your doctor, pharmacist or nurse is responsible for storing this vaccine and disposing of any unused product correctly. The Oxford-AstraZeneca vaccine contains no thimerosal, mercury, or aluminum. It is important to remember the benefits of vaccination to give protection against COVID-19 still outweigh any potential risks. Extremely rare cases of blood clots with low levels of blood platelets (thrombosis with thrombocytopenia syndrome) have been observed following vaccination with COVID-19 Vaccine AstraZeneca. To help us improve GOV.UK, wed like to know more about your visit today. 0000107188 00000 n If side effects such as pain and/or fever are troublesome, medicines containing paracetamol can be taken. This medicine contains a very small amount of alcohol (2 mg of alcohol (ethanol) per dose of 0.5 ml). How to store COVID-19 Vaccine AstraZeneca 6. Further to this, SAGE recommends that severe and moderately immunocompromised persons should be offered an additional dose of vaccine. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected]. This Oxford-AstraZeneca vaccine uses the ChAdOx1 technology, which has been developed and optimised by the Jenner Institute over the last 10 years. If you have any further questions, ask your doctor, pharmacist or nurse. endstream It is important that you return for your second injection of COVID-19 Vaccine AstraZeneca. This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. 0000093171 00000 n The AstraZeneca vaccine remains a safe and effective choice to protect against COVID-19, and will protect against severe outcomes from getting infected with COVID-19, including illness, hospitalization and death. }wfydUj_mr\]]s=']O_Od>MdD.PHTpo Some of the side effects listed in section 4 may temporarily reduce your ability to drive and use machines. After COVID-19 immunization, it takes a few weeks for the body to build immunity so that you are protected from the virus. WASHINGTON Workers at a plant in Baltimore manufacturing two coronavirus vaccines accidentally conflated the ingredients several weeks ago . It will take only 2 minutes to fill in. Something went wrong while submitting the form. Updated on 13 June 2022 to ensure consistency of formatting. , ,p However, a causal relationship with the vaccine has neither been confirmed nor ruled out and more rigorous studies are needed to fully assess the significance of This is due to the fact that this group is less likely to respond adequately to vaccination following a standard primary Moderna bivalent COVID-19 vaccine. Six of the 28 died from their clotting complications. For countries considering heterologous schedules, WHO has made recommendations to ensure equivalent or favourable immunogenicity or vaccine effectiveness for heterologous versus homologous schedules: When considering booster vaccination after having been vaccinated with ChAdOx1-S [recombinant] COVID-19 [Astra Zeneca] vaccine for the primary series, SAGE considers using a different type of COVID-19 vaccine for a third dose a more favourable option. 967 0 obj <>stream 55 0 obj The AstraZeneca vaccine has an efficacy of 72% against symptomatic SARS-CoV-2 infection, as shown by the primary analysis of data irrespective of interdose interval from trial participants who received 2 standard doses with an interval varying from about 4 to 12 weeks. No substantive data are available related to impact of the vaccine on transmission or viral shedding. The AstraZeneca vaccine is not a live virus vaccine, it is therefore biologically and clinically unlikely to pose a risk to the breastfeeding child. 0000006540 00000 n This product contains genetically modified organisms (GMOs). Results from a large clinical trial in the United States and South America indicate that AstraZeneca's COVID-19 vaccine, AZD1222, is well-tolerated and protects against symptomatic COVID-19 disease, including severe disease or hospitalization. 0000000016 00000 n Previous Name: ChAdOx1 nCoV-19 0000023338 00000 n 57 0 obj <> endobj xref Keep vials in outer carton to protect from light. Efficacy. 0000019840 00000 n %%EOF Download PDF. - Lipids: Nanolipids help deliver the mRNA to the vaccine recipient's cells. Vaccines, by Vaccine In addition to weakened or killed disease antigens (such as weakened, killed, or parts of viruses or bacteria), vaccines contain very small amounts of other ingredients - excipients. trailer <<082F7B1BF056430DB0F4C36E6FE6E521>]/Prev 207227>> startxref 0 %%EOF 96 0 obj <>stream Can they overcome their checkered past? 0000100169 00000 n Well send you a link to a feedback form. % /Size 89 /Prev 149222 %PDF-1.7 % Organization: Public Health Agency of Canada. 0000055209 00000 n To help pregnant women make this assessment, they should be provided with 0000054470 00000 n This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The results confirmed a single dose of AZD1222 resulted in a four-fold increase in antibodies to the SARS-CoV-2 virus spike protein in 95% of participants one month after injection. It causes the body to produce its own protection (antibodies) against the virus. dwS(V"2G %[CA+|}e9;(al-U c9.3T@k w There are limited data on the use of COVID-19 Vaccine AstraZeneca in pregnant or breastfeeding women. brain, liver, bowel, spleen). (, SARS-CoV-2 candidate vaccine ChAdOx1 nCoV-19 infection of human cell lines reveals a normal low range of viral backbone gene expression alongside very high levels of SARS-CoV-2 S glycoprotein expression (, ChAdOx1 nCoV-19 vaccination prevents SARS-CoV-2 pneumonia in rhesus macaques (, A single dose of ChAdOx1 MERS provides protective immunity in rhesus macaques (, Vaccines and Related Biological Products Advisory Committee 154th Meeting (, Information for UK recipients on COVID 19 Vaccine AstraZeneca (, Potential adjuvants for the development of a SARS-CoV-2 vaccine based on experimental results from similar coronaviruses (, What are the ingredients in the COVID-19 vaccines? Vaccine efficacy tended to be higher when the interval between doses was longer. b AV Q4 8=0 ) This webpage was updated on 13 June 2022 to ensure consistency of formatting. Authors Maria Deloria Knoll 1 , Chizoba Wonodi 2 Affiliations 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21231 USA. It can be life-threatening; If you have ever fainted following any needle injection; If you currently have a severe infection with a high temperature (over 38C). This includes any possible side effects not listed in this leaflet. "It can't give you an infection. 0000007231 00000 n Page last updated Thursday, May 26, 2022 Brand name: AZD1222 0000002358 00000 n Documents provided by AstraZeneca: Study Protocol [PDF] February 19, 2021 Statistical Analysis Plan [PDF] February 28, 2021 More Information Go to Additional Information: Statistical Analysis Plan (SAP) D8110C00001-CSP-amendment-6_Redacted.pdf CSR Synopsis Publications: CDC. Most people have been exposed to them in their lives. 0000003223 00000 n 0000001096 00000 n a severe headache that is not relieved with simple painkillers or is getting worse or feels worse when you lie down or bend over, an unusual headache that may be accompanied by blurred vision, confusion, difficulty with speech, weakness, drowsiness or seizures (fits), rash that looks like small bruises or bleeding under the skin beyond the injection site, or any unexplained bleeding. 0000006617 00000 n Late-stage Phase II/III trials were conducted in the UK, Brazil, South Africa and the US. If you are immunocompromised and receive a third dose of COVID-19 Vaccine AstraZeneca, it may still not provide full immunity to COVID-19 and you should continue to maintain physical precautions to help prevent COVID-19. Additional Information If you have questions, visit the website or call the telephone number provided AstraZeneca is a member of Covax, a global initiative aiming to distribute two billion vaccine doses to 92 low- and middle-income countries at no more than $3 a dose. Such reactions may include a combination of any of the following symptoms: In clinical studies with the vaccine, fewer side effects were reported after the second dose and those that were reported were milder in nature when compared to after the first dose. 0000097788 00000 n Surfactants (also called 'emulsifiers') are excipients that can help make sure ingredients like oil and water stay together during the transportation and storage process. 56 0 obj 0000102152 00000 n 0000004762 00000 n 2021 Jan 9;397(10269):72-74. doi: 10.1016/S0140-6736(20)32623-4. %PDF-1.6 % <]/Prev 553136>> To get around the problem, scientists used virus from a chimpanzee to ensure people would not have any natural immunity to it. 0000009594 00000 n If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor, pharmacist or nurse for advice before you receive this vaccine. You will receive 2 injections. 346 65 Following widespread use of the vaccine there have been extremely rare reports of blood clots in combination with low level of blood platelets. . endstream endobj startxref Preservatives in this vaccine are disodium edetate dihydrate and ethanol. x]n@@eH%/Vu1]}sn\H6:ypen^mVU}m)QmB9ciMeT{ed#NtQwv/ ,6aYmk}*Oko8/q1(z h^ONc! Messenger RNA (mRNA) Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2. He tells Elisabeth Mahase how the Oxford vaccine came to be, how dosing was worked out, and whether it will stand up to the new variants. AZD1222 works by using a viral vector (ChAdOx1 - chimpanzee adenovirus Oxford 1) based on a weakened version of a common cold (adenovirus) virus that contains the genetic material of the SARS-CoV-2 virus spike protein. "Similar to the flu vaccine, the side effects are pretty mild, and the most common one is fatigue," says Malaty . However, a mild fever or infection, like a cold, are not reasons to delay vaccination; If you have ever had a condition known as heparin-induced thrombocytopenia and thrombosis (HITT or HIT type 2), or a blood clot in the sinus veins in the brain; If you have a problem with bleeding or bruising, or if you are taking a blood thinning medicine (anticoagulant); If your immune system does not work properly (immunodeficiency) or you are taking medicines that weaken the immune system (such as high-dose corticosteroids, immunosuppressants or cancer medicines). In countries with ongoing %%EOF Published March 31, 2021 Updated Aug. 1, 2021. The severity and intensity of local and systemic reactions was highest on day 1 after vaccination. LYpeP4 &=C&CBzLL3y20gah!A '1>ederj4+e@Zg Rc`TaPa`2R6r G2p T Nanolipid components of the Moderna vaccine include: (SM-102, 1,2-dimyristoyl-rac-glycero3- Available for Android and iOS devices. 0000021326 00000 n 0000025064 00000 n Here what's in the Pfizer and AstraZeneca jabs (. &Va(f+0&+FIcDHoL 0000055862 00000 n tenderness, pain, warmth, itching or bruising where the injection is given, swelling, redness or a lump at the injection site, flu-like symptoms, such as high temperature, sore throat, runny nose, cough and chills, sleepiness, feeling dizzy, or deep unresponsiveness and inactivity, excessive sweating, itchy skin, rash or hives. Testing prior to vaccination and adolescents younger than 18 years of age 40... 89 /Prev 149222 % PDF-1.7 % Organization: Public Health Agency of Canada are no data are available. He said be closely monitored to allow quick identification of new safety information vaccine recipient & # x27 s. 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