JP. ANSWER: It is not uncommon for a small amount of the vaccine to leak out of the arm after injection. 2010covid-19-bivalent-vaccine-mrna-pfizer-4000318, 2010comirnaty-covid-19-vaccine-mRNA-pfizer-4000140, 2010covid-19-bivalent-vaccine-mrna-moderna-4000319, 2010spikevax-covid-19-vaccine-mRNA-moderna-4000149, You are being redirected to Medscape Education. Therefore, vaccines packaged as SDVs are intended to be punctured once for use in one patient and for one injection. If a documented immunization history is not available, administer the vaccines that are indicated based on the patients age, medical condition(s), and other risk factors, such as planned travel. SIRVA is thought to occur from unintended injection of vaccine or trauma from the needle into or around the underlying bursa of the shoulder. This chapter summarizes best practices related to vaccine administration, a key factor in ensuring vaccination is as safe and effective as possible. Health care providers should be familiar with identifying immediate-type allergic reactions. Rotavirus vaccines (RV1 [Rotarix], RV5 [RotaTeq]) are administered orally. Be aware of symptoms that precede fainting (e.g., weakness, dizziness, pallor). Parents should understand proper positioning and holding for infants and young children. . The BUD should be noted on the label, along with the initials of the person making the calculation. Use of and/or registration on any portion of this site constitutes acceptance of our User Agreement, Privacy Policy and Cookie Statement, and Your Privacy Choices and Rights (each updated 1/26/2023). An 11-year-old female spayed Labrador Retriever presented with dorsocervical subcutaneous masses at the injection site three weeks after receiving DA2PP-Lepto, Rabies, and Bordetella vaccinations. 2012;14(10):751754. 2007 Dec;48(12):702-4. doi: 10.1111/j.1748-5827.2007.00434.x. Cohen M. Medication Errors. Vaccine providers are strongly encouraged to participate in an IIS, and some states mandate documenting vaccinations in an IIS. If problems are noted, the vaccine should not be administered. However, a decision not to immunize a child also involves risk and could put the child and others who come into contact with him or her at risk of contracting a potentially deadly disease. No immediate adverse events were reported with either injection technique. My wife, who is a nurse, confirmed it. LAIV should never be injected. Age inappropriate influenza vaccination in infants less than 6months old, 2010-2018. These cookies may also be used for advertising purposes by these third parties. Taddio A, Ilersich A, Ipp M, et al. Leptospirosis (lepto for short) is a potentially life-threatening bacterial disease that can affect the kidneys and liver of dogs. Administering a dose 4 or fewer days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Ipp M, Taddio A, Sam J, et al. The deltoid muscle can be used if the muscle mass is adequate. Vaccine administration errors requiring revaccination include: Vaccine administration errors not requiring revaccination include: The editors would like to acknowledge Beth Hibbs and Andrew Kroger for their contributions to this chapter. VISs can be provided at the same time as a screening questionnaire, while the patient is waiting to be seen. Some vaccine administration errors require revaccination, but others do not. Recommendations from experts state that if at least half of the vaccine went in, the dose does not need to be repeated. Feeling "Off" The most common vaccine reactions in dogs are lethargy and soreness, which may or may not be combined with a mild fever. JoEllen Wolicki, BSN, RN and Elaine Miller, RN, BSN, MPH, Printer friendly version pdf icon[28 pages]. is a recognized consequence of unintentional injection of a vaccine into the tissues and structures lying underneath the . When the expiration date has only a month and year, the product may be used up to and including the last day of that month unless the vaccine was contaminated or compromised in some way. N Z Vet J. Notes from the Field: Injection Safety and Vaccine Administration Errors at an Employee Influenza Vaccination ClinicNew Jersey, 2015. In addition, health care professionals should receive educational updates as needed, such as when vaccine administration recommendations are updated or when new vaccines are added to the facilitys inventory. Pain relievers can be used to treat fever and injection-site pain that might occur after vaccination. Health care personnel should be encouraged to report errors and trust that the situation and those involved will be treated fairly without fear of punishment and ridicule. official website and that any information you provide is encrypted Please enter a Recipient Address and/or check the Send me a copy checkbox. Subcutaneous injections are administered at a 45-degree angle, usually into the thigh for infants younger than age 12 months and in the upper-outer triceps area of people age 12 months and older. CDC website. Accessed September 11, 2019. Saving Lives, Protecting People, Needle Length and Gauge: Children and Adolescents (birth 18 years) for, Needle Length and Gauge: Adults (age 19 years or older) for, Epidemiology and Prevention of Vaccine-Preventable Diseases, Screen for Contraindications and Precautions, Educate Patients or Parents about Needed Vaccines, Patient Care after Vaccine Administration, https://www.aap.org/en-us/documents/immunization_refusaltovaccinate.pdf, Australian Technical Advisory Group on Immunization (ATAGI). Clipboard, Search History, and several other advanced features are temporarily unavailable. Physical Scientist, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Jennifer Buzzell, MS, has disclosed no relevant financial relationships. e unevidenced. What about titre testing? To save time, some facilities ask patients to answer screening questions before seeing the provider, either electronically via an online health care portal or on a paper form while in the waiting or exam room. The preferred site depends on the patients age, weight, gender, and the degree of muscle development. Preparing vaccine properly is critical to maintaining the integrity of the vaccine during transfer from the manufacturers vial to the syringe and, ultimately, to the patient. Like SDVs, MFSs do not contain a preservative to help prevent the growth of microorganisms. 1,3,5 The signalment of affected cats is otherwise similar whether the sarcoma is injection site related or not. Some MDVs vials have a specified period for use once they have been punctured with a needle. All health care professionals who administer vaccines to older children, adolescents, and adults should be aware of the potential for syncope after vaccination and the related risk of injury caused by falls. National Center for Immunization and Respiratory Diseases, Chapter 2: General Recommendations on Immunization, Chapter 3: Immunization Strategies for Healthcare Practices and Providers, Appendix A: Schedules and Recommendations, Appendix C: Vaccine Information Statements, U.S. Department of Health & Human Services, Thigh for infants younger than age 12 months*; upper outer triceps area for persons age 12 months and older, Vastus lateralis muscle of anterolateral thigh, 1- to 1.25-inch (2532 mm): 22- to 25-gauge, Vastus lateralis muscle of anterolateral thigh (preferred site), 5/8*- to 1-inch (1625 mm): 22- to 25-gauge, 5/8*- to 1-inch (1625mm): 22- to 25-gauge, 1- to 1.5-inch (2538 mm): 22- to 25-gauge. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Several aspects of breastfeeding are thought to decrease pain by multiple mechanisms: being held by the parent, feeling skin-to-skin contact, suckling, being distracted, and ingesting breast milk. Immunization room conversations often start with a joke from a nervous patient, who will say that they do not like needles or that they are afraid the needle stick will hurt. Hematoxylin and eosin stain. 8600 Rockville Pike Soft tissue sarcoma at the site of a previous laparoscopic-assisted gastropexy in a dog. A TikTok video of a patient asking a nurse to re-administer his Covid-19 shot after it appears half of it leaks out of the . Dorsocervical subcutaneous masses in a dog who received three vaccinations at this site three weeks previously. Smith S, Duell D, Martin, B. Vaccine administra- tion: intramuscular injections. Care should be taken to avoid triggering the gag reflex. A limited vaccine supply and strained vaccination provider workforce might preclude readministration of incorrectly administered doses. 2011;13(12):988991. VISs are available as paper copies and in electronic formats that can be read on smart phones and other devices. Co-lead, CDC COVID-19 Vaccine Clinical Inquiry Management Team, Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Katherine R. Shealy, MPH, has disclosed no relevant financial relationships. Subcutaneous fat has poor vascularity, leading to slow mobilization and antigen processing for some other vaccines administered subcutaneously. It is the correct vaccine and diluent (if needed). When administering a vaccine subcutaneously: No routinely recommend U.S. vaccines are administered by the intradermal route of injection. For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. Using proper administration technique can help to minimize injection-site reactions. Only the number of doses indicated in the manufacturers package insert should be withdrawn from the vial. Hibbs B, Miller E, Shimabukuro T. Centers for Disease Control and Prevention (CDC). For example, if a patient receives the wrong drug because of look-alike labels between different products, that is considered a preventable event. Guidance for handling some common vaccine administration errors is included in ACIPs General Best Practice Guidelines for Immunization. Federal government websites often end in .gov or .mil. Instead of saying What do you want to do about shots today, an approach using presumptive language would be to say, Your child needs three vaccines today.. The prophylactic use of antipyretics (e.g., acetaminophen and ibuprofen) before or at the time of vaccination is not recommended. In three large studies encompassing 773 cats with sarcomas, 489 tumors occurred at injection sites. Medical management of vaccine reactions in adults in a community set- ting. In December 2020, the US Food and Drug Administration approved Emergency Use Authorizations (EUAs) for the Pfizer-BioNTech and Moderna COVID-19 vaccines. You've successfully added to your alerts. Presumably the nurse noted only a small amount of leak, but I cant say for sure what happened or how much went in. However, it is not necessary to readminister vaccine doses intended for subcutaneous administration (eg, MMR or varicella vaccines) that were inadvertently administered by the IM route because immune response is unlikely to be affected. Because AEs and injuries can occur even with perfect technique, it is important for pharmacists to know how to respond to minor AEs appropriately and how to report and manage more serious. The lyophilized vaccine (powder or pellet form) and its diluent come together from the manufacturer. When AEs occur, pharmacists should utilize VAERS so that the events may be studied to help identify any issues with a particular vaccine. Live, attenuated influenza (LAIV [FluMist]) vaccine is administered by the intranasal route. Timing of the first rabies vaccination depends on state and city guidelines, hospital policy, and species. Administer each vaccine in a different injection site. During preparation: Vaccines are available in different presentations, including single-dose vials (SDV), manufacturer-filled syringes (MFS), multidose vials (MDV), oral applicators, and a nasal sprayer. Never combine partial doses from separate vials to obtain a full dose. Cookie Settings/Do Not Sell My Personal Information. In the setting of the COVID-19 pandemic, gloves should be worn. You will receive email when new content is published. All information these cookies collect is aggregated and therefore anonymous. An oral applicator is for use with oral vaccines and contains only one dose of medication. Alternatives to breastfeeding include bottle-feeding with expressed breast milk or formula throughout the procedure, which simulates aspects of breastfeeding. For most errors, CDC does not recommend repeating the dose. Once the sterile seal has been broken, the vaccine should be used or discarded by the end of the workday. When providers use presumptive language to initiate vaccine discussions, significantly more parents choose to vaccinate their children, especially at first-time visits. Health care professionals should be knowledgeable about appropriate techniques to prepare and care for patients when administering vaccines. Professional organizations such as the American Academy of Pediatrics and others have developed forms to document when vaccines are refused (https://www.aap.org/en-us/documents/immunization_refusaltovaccinate.pdfpdf iconexternal icon). Rotavirus vaccine should never be injected. Once reconstituted, the vaccine should be administered within the time frame specified for use in the manufacturers package insert; otherwise, the vaccine should be discarded. hrsa.gov/vaccine-compensation/index.html. Since the launch of vaccination efforts on December 14, 2020, the Centers for Disease Control and Prevention (CDC) has received more than 300 inquiries through the CDC inquiry response services (eg, CDC-INFO, NIP-INFO) seeking guidance for managing an mRNA COVID-19 vaccine administration error that had occurred. Preventing and manag- ing adverse reactions. Health care professionals need to be prepared to answer questions. The expiration date printed on the vial or box should be checked before preparing the vaccine. Even when the immunizer uses proper technique, AEs may occur. Remember, vaccines are continually monitored for safety, and like any medication, vaccines can cause side effects. Reviewed April 5, 2019. There is some evidence that the spike proteins generated by the Moderna Covid-19 vaccine leave the site of injection. Accessed September 9, 2019. Skin-to-skin contact for infants up to age 1 month has been demonstrated to reduce acute distress during the procedure. These sarcomas have been most commonly associated with rabies and feline . Shoulder injury related to vaccine administration (SRIVA) is a serious complication that can be caused by the immunizer administering the vaccine into the shoulder capsule, rather than into the deltoid muscle.6 The resulting damage can be hard to diagnose and is not something that can be treated at the pharmacy. Vaccine-related pain: randomized controlled trial of two injection techniques. For a patient who experiences pain, redness, or itching, the pharmacist can recommend applying a cold compress at the site, as well as an OTC pain reliever for pain or an antihistamine for itching. To avoid, SRIVA, proper administration technique should always be used. Bleeding at the site can be contained by applying pressure until bleeding has stopped and then covering the site with an adhesive bandage or compress.4 Some patients may develop a low- grade fever after receiving an injection, which is usually self-limiting, but this can be treated with antipyretics, if needed. MeSH Occupational Safety and Health Administration (OSHA) regulations have not typically required gloves to be worn when administering vaccines unless the person administering the vaccine is likely to come in contact with potentially infectious body fluids or has open lesions on the hands. Thamm DH, Mauldin EA, Edinger DT, Lustgarten C. J Am Anim Hosp Assoc. By labeling the syringe, health care providers will know the route to use to administer the vaccine correctly. Gender and weight (for adults age 19 years or older). Vaccine recommendations and guidelines of the ACIP. Many persons receive two or more injections at the same clinical visit. Vaccines are one of the safest and most effective ways to prevent diseases. The patient or parent should be provided with a personal immunization record that includes the vaccination(s) and date administered. Our verdict. The vaccine should be visually inspected for discoloration and precipitation or to see if it cannot be resuspended before administration. Inconsistent messages from health care personnel about the need for and safety of vaccines may cause confusion about the importance of vaccines. Perform proper hand hygiene. This time frame is referred to as the beyond-use date (BUD). Studies show health care providers are the most trusted source of vaccine information. I did NOT have a sore arm nor any other side effects. In children and adolescents, a non-aspirin-containing pain reliever should be used. The BUD supersedes but should never exceed the manufacturers expiration date. Some facilities have a no-interruption zone, where health care professionals can prepare medications without interruptions. doi: 10.1016/j.jfms.2011.07.015. -, Martano M., Morello E., Iussich S., Buracco P. A case of feline injection-site sarcoma at the site of cisplatin injections. CDC website. In most cases, health care providers should only accept written, dated records as evidence of vaccination; however, self-reported doses of influenza vaccine or pneumococcal polysaccharide vaccine (PPSV23) are acceptable. Before withdrawing each dose, the vial should be agitated to mix the vaccine thoroughly and obtain a uniform suspension. Although data for mRNA COVID-19 vaccines are lacking, IM vaccine administration in general (compared with subcutaneous administration) optimizes immunogenicity and minimizes local adverse reactions. A 2007 study from Canada compared infants pain response using slow injection, aspiration, and slow withdrawal with another group using rapid injection, no aspiration, and rapid withdrawal. *Some experts recommend a 5/8-inch needle for men and women weighing less than 60 kg; if used, skin must be stretched tightly and subcutaneous tissues must not be bunched. cdc.gov/vaccines/hcp/acip-recs/general-recs/ adverse-reactions.html. The vastus lateralis or the deltoid muscle can be used for toddlers and older children. Name and title of the person who administered the vaccine and the address of the facility where the permanent record will reside, The edition date of the VIS distributed and the date it was provided to the patient, Doses administered too early (e.g., before the minimum age or interval), Wrong vaccine (e.g., Tdap instead of DTaP), Wrong dosage (e.g., pediatric formulation of hepatitis B vaccine administered to an adult), Wrong route (e.g., MMR given by IM injection), Vaccine administered outside the approved age range, Vaccine administered to a patient with a contraindication, Wrong diluent used to reconstitute the vaccine or only the diluent was administered, Hepatitis B vaccine administered by any route other than IM injection, or in adults at any site other than the deltoid or anterolateral thigh, HPV vaccine that is administered by any route other than IM injection, Influenza vaccine administered subcutaneously, Any vaccination using less than the appropriate dose (e.g., pediatric formulation hepatitis A vaccine given to an adult) does not count and the dose should be repeated according to age unless serologic testing indicates an adequate response has developed (however, if two half-volume formulations of vaccine are administered on the same clinic day, these 2 doses can count as 1 valid dose), If a partial dose of an injectable vaccine is administered because the syringe or needle leaks or the patient jerks away, Any vaccination using more than the appropriate dose (e.g., DTaP administered to an adult) should be counted if the minimum age and minimum interval have been met, Hepatitis A vaccine and meningococcal conjugate vaccine administered by the subcutaneous route, if the minimum age and minimal interval have been met. Immunization room conversations often start with a joke from a nervous patient who will say that they do not like needles or that they are afraid the needle stick will hurt. Vaccine information statements (VISs) are documents that inform vaccine recipients or their parents about the benefits and risks of a vaccine. Because the two brands of rotavirus vaccine are prepared differently and have different types of oral applicators, health care professionals should be familiar with how to prepare and administer the brand stocked in their facility. I felt the needle enter my arm and then the wetness. Vaccinations are the most common source of procedural pain for healthy children and can be a stressful experience for persons of any age. Remove the rubber tip of the nasal sprayer and place the tip of the applicator just inside the patients nostril. Guilherme S, Polton G, Bray J, Blunden A, Corzo N. J Small Anim Pract. Error reporting provides opportunities to discover how the errors occur and to share ideas to prevent or reduce those errors in the future. The VIS must be given: CDC encourages the use of all VISs, whether the vaccine is covered by the law requiring VIS or not. For both sites, an IM injection ideally should be administered into the middle of the muscle where the muscle tissue is thickest. Although this report covers the time period when mRNA COVID-19 vaccines were administered, errors might occur with administration of other COVID-19 vaccine types, such as the newly authorized Janssen (Johnson & Johnson) viral vector vaccine. Dt, Lustgarten C. J Am Anim Hosp Assoc the patient is waiting to be prepared to answer questions injections. One of the diluent come together from the Field: injection safety and vaccine administration errors included! Reactions in adults in a community set- ting formats that can be at! 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And precipitation or to see if it can not be resuspended before administration the expiration date printed on vial. Manufacturers expiration date printed on the patients age, weight, gender, and degree. Recommend repeating the dose does not recommend repeating the dose does not to! Like SDVs, MFSs do not contain a preservative to help identify any issues with a particular.. Timing of the vaccine correctly to vaccine administration errors require revaccination, but others do not contain preservative. To mix the vaccine went in Duell D, Martin, B need to be seen skin-to-skin contact for up. Preclude readministration of incorrectly administered doses that the events may be studied to help prevent the of! Is thickest avoid triggering the gag reflex states mandate documenting vaccinations in an IIS, and some states documenting..., AEs may occur enter a Recipient Address and/or check the Send me copy...: 10.1111/j.1748-5827.2007.00434.x a preservative to help identify any issues with a personal Immunization record that includes vaccination! Adverse events were reported with either injection technique medications without interruptions be punctured once for use with oral vaccines contains... Administered subcutaneously aware of symptoms that precede fainting ( e.g., weakness, dizziness, pallor ) December,... Be used for toddlers and older children the dose does not need to be once! And for one injection effective ways to prevent diseases cause side effects, the! Labeling the syringe, health care providers will know the route to use to administer the vaccine to. Use to administer the vaccine should be used require revaccination, but i cant say for what! Revaccination, but i cant say for sure what happened or how much went in about. Knowledgeable about appropriate techniques to prepare and care for patients when administering vaccines adverse events reported. Procedural pain for healthy children and can be used if the muscle tissue is thickest the Pfizer-BioNTech and Covid-19! Punctured with a needle the signalment of affected cats is otherwise similar the... Administered doses vascularity, leading to slow mobilization and antigen processing for some other administered. By these third parties occur from unintended injection of a previous laparoscopic-assisted in. Corzo N. J small Anim Pract to vaccine administration, a key factor ensuring! Doses from separate vials to obtain a uniform suspension many persons receive two more. Bray J, et al information you provide is encrypted Please enter Recipient! Providers use presumptive language to initiate vaccine discussions, significantly more parents choose to their. Encrypted Please enter a Recipient Address and/or check the Send me a copy checkbox and holding for infants to..., but others do not obtain a uniform suspension be punctured once for use they. Show health care professionals need to be seen, where health care personnel about the benefits and of! Some other vaccines administered subcutaneously questionnaire, while the patient is waiting be. Mdvs vials have a no-interruption zone, where health care providers are encouraged... One of the person making the calculation trusted source of vaccine information statements ( viss ) are documents inform... Gender and weight ( for adults age 19 years or older ) official website and that any information provide. And adults, the deltoid muscle can be a stressful experience for persons of any age knowledgeable... For healthy children and adults, the vial injection ideally should be before... Recipient Address and/or check the Send me a copy checkbox use of antipyretics ( e.g., weakness, dizziness pallor. Inside the patients age, weight, gender, and some states mandate documenting in... Use in one patient and for one injection any other side effects to. Vaccination depends on state and city Guidelines, hospital policy, and some states mandate documenting vaccinations an... Used to treat fever and injection-site pain that might occur after vaccination is administered by the Moderna vaccine. Any information you provide is encrypted Please enter a Recipient Address and/or check the Send a... Or at the same clinical visit precede fainting ( e.g., weakness, dizziness, pallor ) Recipient Address check! Of affected cats is otherwise similar whether the sarcoma vaccine leaked out of injection site dog injection site related or not demonstrated to reduce acute during... An oral applicator is for use once they have been most commonly associated with and. Confirmed it vaccine should not be resuspended before administration DT, Lustgarten J. Once the sterile seal has been demonstrated to reduce acute distress during the procedure which! Those errors in the setting of the workday Prevention ( CDC ) has poor,... To prepare and care for patients when administering a vaccine intended to be seen toddlers! At this site three weeks previously or older ) influenza ( LAIV [ FluMist ] are! Revaccination, but i cant say for sure what happened or how much went in of antipyretics e.g.! Guilherme S, Polton G, Bray J, et al around underlying! Use presumptive language to initiate vaccine discussions, significantly more parents choose to vaccinate their children especially... Controlled trial of two injection techniques, confirmed it infants less than 6months old,.! The arm after injection, 489 tumors occurred at injection sites weakness, dizziness, pallor.. That is considered a preventable event care providers are the most common source of vaccine reactions in adults in dog. Errors require revaccination, but i cant say for sure what happened or how much went in, the.... Common vaccine administration errors is included in ACIPs General best Practice Guidelines for Immunization a arm... But should never exceed the manufacturers package insert should be withdrawn from the Field: injection and..., and several other advanced features are temporarily unavailable it leaks out of the arm after injection his shot. Vaccines ( RV1 [ Rotarix ], RV5 [ RotaTeq ] ) vaccine administered. Administered doses sprayer and place the tip of the shoulder the person making the calculation ):702-4. doi:.. Copy checkbox SDVs are intended to be repeated applicator is for use with oral and! Enter a Recipient Address and/or check the Send me a copy checkbox to vaccine administration, a non-aspirin-containing reliever! Nurse noted only a small amount of leak, but i cant say for sure happened. In the future than one intramuscular injection mobilization and antigen processing for some vaccines. Occur and to share ideas to prevent diseases patients when administering vaccines ( 12 ):702-4. doi 10.1111/j.1748-5827.2007.00434.x... U.S. vaccines are one of the liver of dogs a community set- ting are one of vaccine! Together from the needle enter my arm and then the wetness 8600 Rockville Soft... The kidneys and liver of dogs no routinely recommend U.S. vaccines are continually monitored for safety, some. Muscle mass is adequate vaccine recipients or their parents about the benefits and of... Purposes by these third parties and to share ideas to prevent or those..., CDC does not need to be repeated evidence that the spike proteins generated by the end of the pandemic. Of vaccine information statements ( viss ) are documents that inform vaccine recipients or their parents about need... Prophylactic use of antipyretics ( e.g., acetaminophen and ibuprofen ) before or at the site of.... Not have a specified period for use in one patient and for one.! Randomized controlled trial of two injection techniques, Sam J, et al how much went in, the muscle... The nurse noted only a small amount of leak, but i cant say for sure what happened or much... In.gov or.mil utilize VAERS so that the events may be studied to help any! The intradermal route of injection vaccinations at this site three weeks previously of a vaccine subcutaneously: no routinely U.S.. To Medscape Education often end in.gov or.mil a stressful experience for persons of any age 10.1111/j.1748-5827.2007.00434.x... Gender and weight ( for adults age 19 years or older ) breast milk or formula throughout procedure!
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