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Y and Infectious Diseases (NIAID) Date: Protocol Number: Investigator of Record Name: Clinical Research Site Name: Clinical Research Site Number: Investigational Product Name: Strength and Dosage Form: Package Size: Manufacturer: Lot Number(s): Required Storage Temperature: Box number(s) affected: Hereby we would like to inform you about a temperature excursion that occurred at site indicated above, that was reported on date: and occurred on date: . Te.

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