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1.
Where did the event take place?
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2.
Date of incident
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3.
Date of Report
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4.
Age of person with allergic reaction
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5.
What caused the allergic reaction?
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6.
Symptoms of the allergic reaction
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7.
Was the facility's delivery system used or the person's own delivery system?
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8.
Was more than one dose required?
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9.
Was 911 called?
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10.
Did the person go to the emergency room?
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11.
What was the outcome of this incident?
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