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Va.gov/ms completed Number of months on Untoward effects related to Hypersensitivity reaction Infection hepatotoxicity anti- antibody Other list Did any of these cause discontinuation of yes no May complete registry update as indicated for clinic follow-up i.e. change in status change in disease type MRI changes etc. Please FAX this form to Alicia Sloan MPH LICSW Research Coordinator Questions Email Alicia.Sloan va.gov Visit the MSCoE website at www. VA MS Center of Excellence version 06-09...

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