NACI will continue to monitor the evidence and update this interval as needed. Vasileiou E, Simpson CR, Robertson C, Shi T, Kerr S, Agrawal U, et al. The number of doses and type of vaccine technology were not important factors, and 14% of respondents indicated they have no preference on what COVID-19 vaccine they receive. A total of 13 deaths were reported, 6 in the vaccine group and 7 in the placebo group. Are there any emerging safety signals with COVID-19 immunization that are not predicted by the current understanding of the safety profile of similar vaccines? (based on moderate certainty of evidence of ≥2-fold increase in mortality), Medical conditions - Level 1 (strong evidence)Footnote 5, (based on moderate or high certainty evidence of ≥2-fold increase in mortality), Medical conditions - Level 2 (limited evidence)Footnote 5, Level 2a (based on low certainty of evidence of ≥2-fold increase in mortality, Level 2b (based on low or moderate certainty of evidence of ≥2-fold increase in hospitalization), Increased risk of severe outcomes (hospitalization/mortality)Footnote c and Increased risk of exposureFootnote 5, Identified through rapid review of evidence from OECD countries for an independent association with severe outcomes from COVID, Identified, in part, through Canadian epidemiological reports. Of the SAEs considered related to the Moderna vaccine, 2 cases of autoimmune diseases were reported: one rheumatoid arthritis in a participant known with hypothyroidism, that was unresolved at the time of the report and one autonomic dysfunction in a participant known with hypothyroidism, also unresolved at the time of the report. We also applied this analysis to a range of daily rates of ICU admissions (per 100,000) (Table 28 and Table 29). There are no results specific to other COVID-19 vaccines yet, but studies are ongoing. By dose interval, the reactogenicity of the vaccine was lower in participants who received the second dose within 6 weeks following Dose 1 (38.0% versus 58.3% to 74.3% when Dose 2 was provided after ≥6 weeks). If vaccine uptake is delayed or slower than anticipated, the cumulative risks of COVID-19 outcomes will increase, particularly in age groups facing longer wait times for mRNA vaccines. Vaccine (coverage, effectiveness, safety). The AstraZeneca COVID-19 vaccine clinical trial demonstrated optimal efficacy when the interval between the first and second doses was ≥12 weeks. In Saskatchewan, pregnancy has made people eligible for a COVID-19 vaccine since April 14. Once inside the cell, the SARS-CoV-2 spike protein genes are transcribed into mRNA in the nucleus and translated into proteins in the cytosol of the cell. Many essential services (e.g., police, firefighters, food production) cannot be provided virtually, potentially leading to an increased risk of exposure to SARS-CoV-2. After Dose 1 but prior to administration of Dose 2, 39 COVID-19 cases were identified in the vaccine group (n=21,669) compared to 82 in the placebo group (n=21,686) for an overall estimated vaccine efficacy of 52.4% (95% CI: 29.5 to 68.4%). Please see Appendix A and C for more details. The data may suggest an age-dependent binding antibody durability. Vaccine efficacy against COVID-19 associated hospitalizations was assessed at multiple time points (Table 12). The cause of death among vaccine recipients included malignant neoplasm and fungal pneumonia, with neither considered to be related to the study intervention by the investigators. The efficacy of the Moderna COVID-19 vaccine to protect against severe COVID-19 cases occurring at least 14 days after the second injection was in 28,207 study participants (14,073 participants in the placebo group and 14,134 participants in the Moderna COVID-19 vaccine group). Lymphadenopathy was not a solicited adverse event for the AstraZeneca COVID-19 vaccine and was reported as an unsolicited adverse event. COVID-19 vaccines that use messenger RNA (mRNA) platforms contain modified nucleotides that code for the SARS-CoV-2 spike protein. NACI will continue to monitor the evidence and update recommendations as needed. Among vaccine recipients, the incidence of severe (Grade 3) axillary swelling and tenderness increased from Dose 1 to Dose 2 (0.3 to 0.5%), whereas in the placebo group it decreased from Dose 1 to Dose 2 (0.2 to 0.1%)Footnote 28. The vaccine is similarly efficacious in adults ≥18 years of age with and without pre-defined comorbidities (presence of one or more mild to moderate and controlled cardiovascular disease, respiratory disease, diabetes or obesity). Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following AstraZeneca COVID-19 vaccination. Although the overall risk of … Key populations for early COVID-19 immunization when COVID-19 vaccine supply is limited include the following: Other populations in whom vaccine(s) are safe and efficacious can be considered for COVID-19 immunization when vaccine supply is adequate. If a risk assessment deems that the benefits outweigh the potential risks for the individual; and if informed consent is provided; vaccination may be considered in individuals with mild to moderate immediate allergic reactions (defined as limited in the scope of symptoms and involvement of organ systems or even localized to the site of administration) after a previous dose of authorized COVID-19 vaccines or any of its components. Vaccine. Hyams C, Marlow R, Maseko Z, King J, Ward L, Fox K, et al. Rare but serious cases of blood clots, including cerebral venous sinus thrombosis, associated with thrombocytopenia have been recently reported in Europe (with three cases reported out of over 700,00 doses of AstraZeneca COVID-19 vaccine administered in Canada as of April 20, 2021) following post-licensure use of AstraZeneca COVID-19 vaccine, usually between 4 and 14 days after receipt of vaccine. What are the transmission dynamics of COVID-19, including degree of asymptomatic transmission, role of children in transmission, vertical transmissibility, onset and duration of viral shedding and communicable period, impact of changing weather conditions, and trends over time? The first dose of the authorized COVID-19 vaccines has been shown to offer at least short-term protection against confirmed COVID-19 disease. Therefore, their risk for severe outcomes, including death, and societal disruption is proportionally greater than in other communities. Development and licensure of vaccines to prevent COVID-19: Guidance for industry [Internet]. Related recommendations were approved on March 1, 2021. In the absence of evidence, attempts should be made to avoid simultaneous administration to maximize benefits of COVID-19 vaccination while minimizing any risks of harm, including the potential for immune interference or the erroneous attribution of an adverse event following immunization (AEFI) to a particular vaccine. Other frequently reported systemic solicited AEs were muscle pain (44.0%), malaise (44.2%), feverishness (33.6%), chills (31.9%), joint pain (26.4%), nausea (21.9%) and fever ≥38.0°C (7.9%). None of the cases were assessed as related to the vaccine by the investigators. Vials must be kept frozen and protected from light, in the original cartons, until ready to use. N Engl J Med. The weekly number of expected cases (per 100,000) of ICU admission and deaths due to COVID-19 were calculated by applying the age distribution of cases that were reported in Canadian surveillance data (cumulative to April 9, 2021) in 10-year age bands from 20 to 69 years of age against the weekly COVID-19 incidence defined by the five scenarios in Table 18. If a pregnant woman gets a COVID-19 vaccine, “then other vaccines should be delayed by 28 days. The participant received two doses of study intervention 77 days apart. What is the incidence of thrombosis and thrombocytopenia including CVST and DIC after COVID-19 immunization? Limiting the analysis to 14 or more days after Dose 1, efficacy rose to 92.1% (95% CI: 68.8 to 99.1%). Refer to Table 3 for a summary of immunization schedules for authorized, available COVID-19 vaccines. There were no clear imbalances by System Organ Class (SOC). NACI developed the following recommendations based on the evidence and extensive stakeholder consultations synthesized and presented in the NACI Preliminary guidance on key populations for early COVID-19 immunization, the most recent information available at the time of deliberation on vaccine supply, and preliminary information suggesting comparable efficacy and safety of the Moderna and Pfizer/BioNTech COVID-19 vaccines. In their interim analysis of 95 COVID-19 cases in a trial of 30,000 participants 18 years of age and older, Moderna reported an efficacy of 94.5% 2 weeks after the second dose of their vaccine. Fewer cases of COVID-19 are expected after vaccination with a vaccine with high efficacy. Vials stored at -25°C to -15°C for up to 2 weeks may be returned one time to the recommended storage condition of -80°C to -60°C. Lancet. After dilution, the vaccine vials can be handled in room light conditions. The efficacy of the Moderna COVID-19 vaccine to protect against confirmed COVID-19 cases occurring at least 14 days after the second injection was also assessed in participants most at risk for severe complications of COVID-19. The benefit-risk analysis* determines that the benefit of earlier vaccination with the AstraZeneca COVID-19 vaccine outweighs the risk of COVID-19 while waiting for an mRNA COVID-19 vaccine; The benefits and relative risk* and consequences of VITT and COVID-19 for the individual are clearly outlined, factoring in the anticipated waiting time to receive an mRNA vaccine as well as the availability of other effective personal public health measures to mitigate risk of COVID-19, and the individual makes an informed decision based on an understanding about these risks and benefits; There will be substantial delay to receive an mRNA vaccine. Due to concerns with methodological weaknesses in this study, NACI did not use these results to inform its recommendations. Rare anaphylactic reactions have been reported following immunization with mRNA COVID-19 vaccines. The incubation period ranges from 1 to 14 days. … Grade 3 (severe) reactions were reported by 3.5% and 7.0% of vaccine recipients after Dose 1 and Dose 2, respectivelyFootnote 28. To date there have been very few COVID-19 associated deaths identified in the clinical trials making it difficult to assess efficacy against this outcome. Therefore, immunization of these workers has the potential to reduce, or prevent the exacerbation of health inequities related to COVID-19. None of these deaths in the vaccinated group were assessed by the investigator as related to the vaccine. If not punctured, the Moderna COVID-19 vaccine can be thawed and stored at +2°C to +8°C for up to 30 days, or at +8°C to +25°C for up to 12 hours. The AZ vaccine is easier to transport, store and handle than mRNA vaccines, and as a result, could be easier to use for wider distribution via pharmacies and primary healthcare providers. In vaccine recipients, frequency of local reactions was similar after Dose 1 and Dose 2. To date, there is also insufficient evidence on the receipt of both a COVID-19 vaccine and any monoclonal antibodies or convalescent plasma for treatment or prevention of non-COVID-19 disease. However, the current data is insufficient to draw conclusions. NACI will conduct a comprehensive, transparent review of authorized COVID-19 vaccines, including evidence on efficacy and safety in clinical trial populations once available, and provide timely evidence-informed recommendations on the use of COVID-19 vaccines as soon as possible. Assessment included study participants who were seronegative for SARS-CoV-2 at baseline and received both doses of the SD/SD regimen. Most lymphadenopathy events were reported within 2 to 4 days after vaccination. A person may be infectious for up to three days before showing symptoms. Anyone receiving the AstraZeneca COVID-19 vaccine should be informed of the recently recognized adverse event of Vaccine-Induced Immune Thrombotic Thrombocytopenia ( VITT) and advised to seek immediate medical attention if they develop symptoms of thromboembolism and/or thrombocytopenia between days 4 and 20 following receipt of the AstraZeneca vaccine (although most occur between days 4 and 14 post-vaccine)Footnote 16. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. The spectrum of autoimmune conditions is diverse. The COVID-19 immunization program should be rolled out as efficiently, effectively, and equitably as possible. A COVID-19 vaccine may be administered any time after pregnancy. Institut national de Santé Publique du Québec, 18 décembre 2020 (in French only). One case report of anaphylaxis to tromethamine has been described (Lukawska et al, DOI: 10.1016/j.jaip.2018.08.035). The majority of systemic reactions after either dose occurred within the first 1 to 2 days post-vaccination and had a median duration of 1 to 2 days. Fever was uncommon after the first dose (0.8%) but was very common after the second dose (15.5%). How are returning travelers managed if they have initiated but not completed a COVID-19 vaccine series abroad? This statement was prepared by: SJ Ismail, K Young, MC Tunis, A Killikelly, R Stirling, O Baclic, J Zafack, M Salvadori, N Forbes, L Coward, C Jensen, R Krishnan, Y-E Chung, B Warshawsky, E Wong, K Farrah, A Nam, A Sinilaite, MW Yeung, S Deeks, and C Quach on behalf of the High Consequence Infectious Disease Working Group (HCID WG) and was approved by NACI. Estimates of vaccine efficacy could not be calculated for participants ≥65 years for the 9-12-week and >12-week dosing intervals due to a lack of older study participants who received the SD/SD regimen during these dosing intervals (Table 10). The figure is organized into four sections. However, as a correlate of protection is not known, these humoral responses cannot be interpreted as corresponding with vaccine protection. Many jurisdictions include medical conditions involving the heart, lungs, liver and spleen. In considering these recommendations and for the purposes of publicly funded program implementation, provinces and territories may consider local programmatic factors (e.g., logistical and operational contexts, resources) and local epidemiology (e.g., transmission of SARS-CoV-2 VOC). To support such efforts, NACI encourages surveillance improvements in the following areas: 2. However, some populations are at increased risk of exposure to the virus (e.g., due to living or occupational settings), and some populations are at increased risk of severe disease and outcomes (e.g., hospitalization and death) due to various biological (e.g. Jurisdictions should ensure close and rapid monitoring of safety, coverage and effectiveness of the vaccines in different key populations, as well as effective and efficient immunization of populations in hardly reached, remote and isolated communities. However, as soon as all eligible groups have been offered their first dose of vaccine, second doses should be offered. This statement reflects the most up to date guidance. Designations of essential services in the context of the COVID-19 pandemic vary across jurisdictions within Canada. However, re-testing (at least 4 weeks post immunization) of individuals with negative results for whom there is high suspicion of TB infection may be prudent in order to avoid missing cases due to potentially false-negative results. If any persons are identified with symptoms on arrival at the venue, they should be instructed to follow current local public health measures. There are some limitations to this analysis to consider when interpreting the benefit-risk estimates. COVID-19 vaccines are given as an intramuscular (IM) injection into the deltoid muscle. The results below pertain only to the AstraZeneca portion of the studies. By dose interval, the reactogenicity of the vaccine was lower in participants who received the second dose at <6 weeks following Dose 1 (37.6% versus. The mRNA vaccines have an authorized schedule of 21 (for the Pfizer vaccine) or 28 days (for the Moderna vaccine) between dose one and dose two. Health Canada could make regulatory decisions for COVID-19 vaccines that have completed Phase 3 clinical trials (i.e., Moderna and Pfizer/BioNTech) for potential authorized use in Canada very soon. The number of people vaccinated with the AstraZeneca COVID-19 vaccine is small in the period 28 days and more from vaccination. Exposure and risk of severe disease factors may overlap, further increasing risk. Caution should be taken when interpreting low certainty evidence. Vials may also be stored at -25°C to -15°C for up to 2 weeks. The authors performed a sensitivity analysis of those with symptom onset < 14 days after vaccination and did not find an effect, which is expected as this is too early for the vaccine to work, and adds strength to differences they note 14 days or more after vaccination. Key populations for early COVID-19 immunization are not mutually exclusive. Between March 25 and March 28, 2021, NACI members revisited these recommendations as they relate to specific population groups. NACI recommends that the vaccine series be completed with the same COVID-19 vaccine product. The data presented below are for an interim analysis, therefore the time of follow-up is not consistent but was less than four months after the second dose (maximum of 14 weeks) for all participants. The third section presents considerations for sequencing and prioritization, which will be based on evolving evidence. However, there are limited data on the efficacy of Dose 1 alone beyond 28 days post-vaccination. Public Health has approved that all pregnant women received an mRNA vaccine. Evidence on immunogenicity is available for adults 18 to 55 and 65 to 85 years of age. These include: pain at the injection site, fatigue, headache, muscle pain, chills, joint pain, and fever. If doses of COVID-19 vaccine(s) have been delivered to an immunization setting and have been used for a group recommended in Stage 1 but cannot be re-located to another setting for other groups recommended in Stage 1, remaining doses on-site may be provided to individuals in the groups recommended in Stage 2 in order to minimize the risk of vaccine wastage and maximize the benefits of vaccination. Pregnant people with heart disease will also be prioritized in Newfoundland and Labrador. There is currently no evidence on the benefit from administration of oral analgesics for the prevention of immunization injection pain or systemic reactions. 2020 Aug 15;396(10249):479,488. doi: 10.1016/S0140-6736(20)31605-6. TORONTO -- Pregnant people in Ontario are now eligible to receive a COVID-19 vaccine, the provincial government announced Friday. A non-replicating viral vector vaccine is authorized for use in Canada for individuals 18 years of age and older (AstraZeneca COVID-19 vaccine). The studies were conducted during the period when SARS-CoV-2 B.1.1.7 variant was rapidly becoming the dominant circulating strain in their respective geographic regions. Vaccines to prevent COVID-19 are becoming widely available in the United States. NACI recommends that COVID-19 vaccines should not be given simultaneously with monoclonal antibodies or convalescent plasma. Wingert A, Pillay J, Gates M, Guitard S, Rahman S, Beck A, et al. Special precaution should be taken to ensure the correct dose is taken from the multi-dose vial. This recommendation applies to all two-dose COVID-19 vaccines currently authorized for use and available in Canada. The median duration of follow-up was 105 days post-Dose 1 and 62 days post-Dose 2. Conflicting results have been shown for other age groups in recently published data. It is not recommended that vaccines of different types (e.g., mRNA vaccine and viral vector vaccine) be used in the same series. None of these deaths were assessed to be related to any study intervention or COVID-19. Lopez Bernal J, Andrews N, Gower C, Stowe J, Robertson C, Tessier E, et al. Important ethical considerations relating to the key policy questions were presented on November 26, 2020, December 15, 2020, January 26, 2021, and April 6, 2021 to the PHAC Public Health Ethics Consultative Group, who provided an assessment of ethical considerations that are relevant to the development of recommendations. The single reported Grade 4 event was fever > 40°C. Table 4 lists potential non-medicinal ingredients in authorized, available COVID-19 vaccines that have been associated with allergic reactions in other products. Administration of AstraZeneca COVID-19 vaccine, as described in these scenarios, is assumed to take place in mid-April 2021. Any combination of these factors, as well as varying access to health care services, has the potential for disproportionate consequences for specific populations. Therefore, NACI made a discretionary recommendation on the use of AstraZeneca COVID-19 vaccine for individuals 30 years of age and older who do not wish to wait for an mRNA vaccine, only if certain conditions are met (including a benefit-risk analysis, informed consent, and substantial delay for receipt of an mRNA vaccine). Many pregnant women have decided to take the coronavirus vaccine. Because of ongoing disease transmission and less than complete individual protection from vaccination in either one-dose or two-dose vaccinated people, ongoing compliance with public health measures (masking, physical distancing and limiting social interactions as per public health guidance) should continue at this time. Symptoms and signs of anaphylaxis may include, but are not limited to: generalized urticaria; wheezing; swelling of the mouth, tongue, and throat; difficulty breathing; vomiting; diarrhea; hypotension; decreased level of consciousness; and shock. The primary efficacy outcome examined the efficacy of Moderna COVID-19 vaccine to protect against confirmed symptomatic COVID-19 starting 14 days after Dose 2 in study participants 18 years of age or older without prior evidence of SARS-CoV-2 infection at baseline. Lisonkova agreed, saying although the clinical trials for Canada’s approved vaccines didn’t focus on pregnant women, there’s no evidence of harm to them or their babies. However, they are mild or moderate and transient, resolving within a few days. United States Food and Drug Administration (FDA). Research to address the following outstanding questions (not ordered in terms of importance) is encouraged, drawing from both short-term and long-term data, where available: Ongoing and systematic data collection, analysis, interpretation and timely dissemination is fundamental to planning, implementation, evaluation, and evidence-informed decision-making. Approximately 50% of laboratory samples were found to have a profile consistent with the B.1.1.7 variant in early December, 2020 in England, and 43% in Scotland in early January, 2021. When Dr. Jane Martin's workplace posted a photo of her receiving the COVID-19 vaccine, she didn’t expect what would come next. Please refer to the remainder of the Statement for details. The relatively low incidence of cases post-vaccination could positively affect acceptability of COVID-19 vaccines and vaccines in general. After the first puncture, the vial can be re-refrigerated, but the cumulative storage time at room temperature must not exceed 6 hours, and the total cumulative storage time must not exceed 48 hours. There is uncertainty in the base case risk analysis for ICU admissions due to incomplete reporting in the surveillance data at the national level, with ICU admission status known for only one-third of cases. What is the acceptability of (a) publicly funded COVID-19 vaccines and other vaccines over time and over different epidemiological contexts among key populations, marginalized populations, providers and policy-makers in different epidemiological contexts across the country? Studies treating age on a continuum or across small increments consistently found that risks for hospitalization and mortality increased with increasing age (e.g., approximately 2-6% and 5-10% relative increase in risk per year)Footnote 4. Lancet. It would be prudent to wait for a period of at least 14 days after the administration of another vaccine before administrating a COVID-19 vaccine to prevent erroneous attribution of an AEFI to a particular vaccine. However, there was a small proportion of study participants enrolled (n=679/29,148; 2.3%) with positive SARS-CoV-2 infection status at baseline. Currently, no data exist on the interchangeability of COVID-19 mRNA vaccines. Some adverse events, including fever, are more frequent after the second dose. Moderna’s COVID-19 vaccine candidate meets its primary efficacy endpoint in the first interim analysis of the Phase 3 COVE study [press release]; 16 Nov 2020 [cited: 2020 Nov 24]. The probability of detection of very rare adverse events in clinical trials is low given clinical trial population sizes; therefore, ongoing pharmacovigilance is essential. However, the magnitude and duration of vaccine-induced immunity are often reduced. Three of the SAEs in the vaccine group and none in the placebo group were assessed by the investigator as related to study intervention: 1 SAE each of shoulder injury related to vaccine administration, ventricular arrhythmia, and lymphadenopathy. The relative degree of immunodeficiency in individuals who are immunocompromised is variable depending on the underlying condition, the progression of disease and use of medications that suppress immune function. VITT cases by age group (based on VITT incidence rate of 1 per 100,000) compared to COVID-19 ICU admissions prevented by early AstraZeneca vaccination under four different scenarios, Table 23. For VanDreese contracting COVID-19 while pregnant is something she worries about for her patients. Safety evidence is based on interim analyses of 23,745 participants who received at least one dose of the vaccine. Recent cases of VITT detected after administration with AstraZeneca vaccine may impact its acceptability. Remote or isolated communities, for example, may not have ready access to sufficient health care infrastructure. Results: The effectiveness of one dose of the AstraZeneca vaccine against hospitalization was 74% (95% CI: 66 - 81) 14 to 20 days after vaccination and rose up to 94% (95% CI: 73 - 99) 28 to 34 days after vaccination. People administering the vaccine should also be aware of the contents of the relevant product monograph(s). For those who were vaccinated, cases and controls were assessed by time since vaccination to onset of symptoms, controlling for a number of factors. A complete series with the AstraZeneca COVID-19 vaccine may be offered to individuals 30 years of age and older without contraindications only if the individual does not wish to wait for an mRNA vaccine and all of the following conditions apply: Note: Provinces and territories should adapt the age limit, based on their local epidemiology. For details on the development and application of NACI's EEFA Framework and evidence-informed tools (including the Ethics Integrated Filters, Equity Matrix, Feasibility Matrix, and Acceptability Matrix), please see A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations. Each scenario is based on a constant incidence rate. Therefore adherence to public health measures in vaccinated individuals (one or two doses) remains very important at this time when SARS-CoV-2 continues to circulate widely. While pregnant women were largely excluded from early vaccine trials, many have received COVID-19 vaccinations around the world because women predominate in … As evidence accumulates, observed associations may change. Observational data in individuals ≥65 years of age have shown a reduction in the risk of symptomatic disease and hospitalization with one dose of AstraZeneca vaccine. How will viral variants impact the efficacy, effectiveness, immunogenicity and safety of a vaccine with respect to death, severe disease, symptomatic disease, asymptomatic disease, infectivity and transmission? Binding antibody responses through day 36 seems to be approximately equivalent across age groups. For mRNA vaccines, the highest efficacy is seen after the second dose is administered. 2021 Mar 30. doi:https://doi.org/10.1016/S0140-6736(21)00628-0. 4. The first dose elicited Th-1 biased CD4+ T cells in both younger and older age groups. A rapid review of evidence from OECD member countries found a low certainty of evidence for no association with mortality or hospitalization due to COVID-19 in those with unspecified immunosuppression. Clinical trial data show that efficacy increased as the interval between doses increased. Sensitivity analysis of expected VITT cases by age group (based on VITT incidence rate of 1 per 100,000) compared to expected COVID-19 ICU admissions prevented by early AstraZeneca vaccination under five different COVID-19 activity scenarios using a high ICU admission rate (0.43 per 100,000), Table 28. Whether vaccination poses a risk or provides benefit to the participants SARS-CoV-2 results December 17 2020... 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