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If appropriate, the blood supplier may prevent the transfusion of other products from the same donor(s). Complete areas which are not included in your internal hospital work-up and attach work-up. Do you suspect this reaction is the result of an attribute specific to the donor or the blood product? Yes or suspected: Reaction did not result in fatality: Complete this form and forward to the blood supplier(s). Reaction resulted in fatality: Complete this form, forward to the blood supplier(.

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