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Form Approved OMB No. 09200666 Exp. Date: 12/31/22 www.cdc.gov/nhsnHemovigilance Module Adverse Reaction Transfusion Related Acute Lung Injury *Required for saving×Facility ID#: NHS Adverse Reaction

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The form approved OMB number refers to a specific form that has been approved by the Office of Management and Budget (OMB), indicating that it meets the requirements for federal data collection.

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