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SAE: CHAIN PBSAMPatient Initials [ ][ ][ ]PB SAM Number [3][0] [ ][ ][ ]Serious Adverse Event A 1. SAE INITIAL DETAILS 1.1.DATE of SAE onset__ __ / __ __ / __ __ __ __ D/M/ Y Y Y Y1.2.DATE child seen

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Instructions for the serious refer to the guidelines and requirements that must be followed when filing specific forms or documents related to serious matters, typically legal or regulatory in nature.

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