why are vaccines injected into the deltoid musclewhy are vaccines injected into the deltoid muscle
We comply with the HONcode standard for trustworthy health information. Some victims cannot use their shoulder at all and must find ways to compensate using the other one. Nevertheless, the problem has received growing attention in recent years as more immunizations are done outside doctors offices, especially during flu season through vaccination clinics offered at workplaces, pharmacies and grocery stores. I can lift my arm, but it hurts. 5 A needle that is too long can penetrate the deltoid muscle, hitting the bone. Muscle tissue also tends to keep vaccine reactions localized. The antigen, lymphocytes and antigen-presenting cells drain through lymphatics into lymph nodes leading to humoral and cellular immune responses following vaccination. Vaccines that include the use of adjuvants or components that enhance the immune response to the antigen must be given in a muscle to avoid widespread irritation and inflammation. 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As a result, inflammation of the shoulder structures causes patients to experience pain, a decreased range of motion, and a decreased quality of life." aspect of the thigh or the deltoid area of the upper arm (see Figure 4.1). Select one or more newsletters to continue. While some of those technologies are in early trials, none is yet available to you. Apply a plaster or wound pad to the area if there is any bleeding. The tear is in line with the fibers of my cuff, much like a split in a seam. The injection site must be cleaned before administering the injection, and the injection is then administered in a fast, darting motion to decrease the discomfort to the individual. 7,8 However, if given subcutaneously, the vaccine does not need to be readministered MMR vaccine MMRV vaccine Id had no prior symptoms, and Annunziata says the shot might either have caused the tear if the needle went into the cuff or stirred up a prolonged inflammatory response in the area, causing the tear to become painful. 2019;65(1):40-42. Photo credit: Shawn Rocco/Duke Health, UNCW researcher finds sponge that eats toxic compounds, I figured you were OK: Black patients COVID symptoms more often dismissed, downplayed. Muscles are rich in immune cells and have an excellent blood supply, making them the preferred way to administer most vaccines. As well as being easier to do, injecting vaccines into muscle also has very few severe side effects, and overall invokes less inflammation than a vaccine in a vein. As well as being easier to do, injecting vaccines into muscle also has very few severe side effects, and overall invokes less inflammation than a vaccine in a vein. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. PRISMA flowchart of the systematic literature search performed for articles focused on administering, Figure 3. If that happens, Pitts says the . This website uses cookies to personalize your content (including ads), and allows us to analyze our traffic. Last updated on Nov 30, 2021. Site for infant less than 1 year old, give in the thigh for 1 year and older, give in the upper outer triceps of the arm When it's time to get your shot, take off your shirt or wear a shirt that you can pull up over your shoulder. An intramuscular injection site, 7.4, Figure 8. J Infect Dis. It is designed to go into a muscle rather than your mouth or gums. Am J Nurs. "Vaccine molecules, the actual spike protein in the case of the coronavirus vaccine, are relatively large. See the diagram. For these reasons, a shot in the arm is preferred simply because the upper arm is easily accessible. Shoulder injury related to vaccine administration(SIRVA) is rare but it does happen. It went into the right place and didnt hurt a bit. Another vaccination method being researched right now involves a patch, similar to a bandage. Another consideration during vaccine administration is convenience and patient acceptability. Lessons from Abroad: How Europeans have tackled opioid addiction and what the U.S. could learn from them. Shoulder injuries become more likely as we age. Yet another deciding factor in vaccine administration location is the size of the muscle. Annals of Internal Medicine. Injections given too high (into the shoulder joint) or too low (into tendons and soft tissue) have the possibility of leading to serious shoulder or arm pain that can last several months. This is because most vaccines, including those for Covid-19, are most effective when administered through the intramuscular route into the upper arm muscle, known as the deltoid, experts say. Establishing a new appropriate intramuscular injection site in the deltoid muscle. Once a vaccine is recognised by the immune cells in the muscle, these cells carry the antigen to lymph vessels, which transport the antigen-carrying immune cells into the lymph nodes. Also, I dont want to quit my workouts, driving or walking my dogs for the months it would take for the initial phase of recuperation. and transmitted securely. government site. A site 1-3 fingerbreadths/5 cm below the mid-acromion point (7 studies); mid-deltoid site/densest part of the deltoid (1 study); a site at the middle third of the deltoid muscle (1 study); triangular injection site (1 study). Its unclear whether I had the tear before the shot or whether the shot caused it. Most adult vaccines are given via an intramuscular injection in the upper arm, technically a shoulder muscle called the deltoid. and lower their collar, exposing only the top of the deltoid, says Marko Bodor, a California orthopedist who authored a 2006 report that described vaccination-related shoulder injuries in two of his patients. Get all the latest science stories from across the ABC. https://www.immunize.org/catg.d/p2020a.pdf, How to Administer IM (Intramuscular) Injections https://www.health.state.mn.us/people/immunize/hcp/admim.pdf, Shoulder injury related to Sinovac COVID-19 vaccine: A case report, Chuaychoosakoon C, Parinyakhup W, Tanutit P, et al. 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& k k8H6)x]wq5(>^{('yaVk+'iwo%wKdp"r_G4(D+1LQ=$RA}>!8&k Dendritic cells then migrate to and slip into lymph nodes, "which are like large meeting places for the immune system", Dr Groom says. SIRVA is a shoulder injury triggered by the incorrect injection of a vaccine into the shoulder capsule (joint) rather than the deltoid muscle. The first time I had someone complain about shoulder pain following a vaccination was about five or six years ago, and I thought it was so unusual that I blew it off, says G. Russell Huffman, an associate professor of orthopedic surgery at the Hospital of the University of Pennsylvania. The needle probably entered the top third of the deltoid muscle which forms the rounded contours of the shoulder and probably went into the bursa or the rotator cuff, instead of lower down, into the middle part of the muscle, missing the bursa and rotator cuff entirely. All things considered, when it comes to the flu shot and the COVID-19 vaccine, for most adults and kids, the arm is the preferred vaccination route. To date, there has never been an epidemiologic study to determine how often deltoid bursitis occurs after vaccination. The deltoid is the preferred site for intramuscular injection (IMI) because of its easy accessibility for drug and vaccine administration. Wempe BM. It will take weeks before I know whether it has worked. Injecting the vaccine into muscle tissue keeps the vaccine localized, allowing immune cells to sound the alarm to other immune cells and get to work. A mid-deltoid intramuscular injection site, considering acromion as the origin of the deltoid, Figure 7. Muscle tissue has a generous blood supply; thus, medications administered into muscle are rapidly absorbed into circulation. North Carolina.. COVID-19 updates: Whats happening in North Carolina? A 2010 study that examined 13 cases of post-vaccination shoulder injuries found nearly half of the patients reported that the vaccine was injected too high into the arm, suggesting that in some of our cases, the injury may have been the result of improper injection technique, the study said. This is because most vaccines, including those for Covid-19, are most effective when administered through the intramuscular route into the upper arm muscle, known as the deltoid. Visit NCHN at northcarolinahealthnews.org. Do not pull your shirt down to expose only the top of your shoulder. Vaccines have a utility, and people should get them, but its important that people also realize there can be injuries, says Paul Brazil, a Philadelphia attorney who represents about 150 clients with vaccine-related shoulder injuries. Now recovered after her surgery, Russo says: Who would have thought that a routine shot would cause so much misery and pain? Carlos Garcia Granthon/Fotoholica Press/LightRocket via Getty Images, the chance of irritation and inflammation reaction increases, Subscribe to The Conversations science newsletter, Committee Member - MNF Research Advisory Committee, PhD Scholarship - Uncle Isaac Brown Indigenous Scholarship, Associate Lecturer, Creative Writing and Literature. However, many others are given in the muscle. Protecting against pneumonia: how is your country doing? Separate two injections given in the same area of fatty tissue by a minimum of 1". My orthopedist says I have subacromial bursitis, which is chronic inflammation and excess fluid buildup in the bursa (a thin, lubricated sac that prevents friction between a bone and surrounding soft tissue) separating the acromion bone at the top of the shoulder from the rotator cuff. This article will go over why SIRVA happens and what you can do to prevent it if youre getting vaccinated. Zheng C, Duffy J, Liu ILA, et al. If certain vaccines are injected into fat tissue, the chance of irritation and inflammation reaction increases because fat tissue has poor blood supply, leading to poor absorption of some vaccine components. The https:// ensures that you are connecting to the KT Tape for Rotator Cuff and Shoulder Injuries, Risk for shoulder conditions after vaccination: A population-based study using real-world data, Don't aim too high: Avoiding shoulder injury related to vaccine administration, Subdeltoid/subacromial bursitis associated with influenza vaccination, Risk scales: benefits of vaccines far outweigh the risks, Shoulder injury related to vaccine administration and other injection site events, Shoulder injury related to vaccine administration (SIRVA) in 16 patients following COVID-19 vaccination who presented to chiropractic, orthopedic, and physiotherapy clinics in Hong Kong during 2021, Shoulder pain and injury after COVID-19 vaccination. After eight days of pain, I called the practice. If you do have lingering pain after a vaccine, talk to your provider. These immune cells recognize the antigen, a tiny piece of a virus or bacteria introduced by the vaccine that stimulates an immune response. Shoulder pain is a common side effect of a vaccine. Please enable it to take advantage of the complete set of features! COVID19 vaccines are injected into the deltoid where they are taken up by muscle cells. There is no single way to treat shoulder injuries, regardless of how they occur. Cross GB, Moghaddas J, Buttery J, Ayoub S, Korman TM. Associate Professor of Nursing, Purdue University. "Then it doesn't have the opportunity for this information to be shared with B and T cells.". Can this generation end cervical cancer in Europe? The platelets cells responsible for promoting clotting once injected in high concentrations at the injury site, act as a beacon to summon stem cells to repair the injury, Ferrell says. Clinical judgment should be used when selecting needle length for IM injections as consideration should be given to vaccine recipient's weight, gender and age. DTaP vs Tdap Vaccines - What's the difference between them? That will occur with equal efficiency in your left or right arm. And they have a hard time getting from the inside of your intestine into the lymph nodes where the immune response has to happen," Jenkins said. Push down on the plunger of the syringe slowly, then withdraw the needle once all the contents have been administered. Once a vaccine is recognized by the immune cells in the muscle, these cells carry the antigen to lymph vessels, which transport the antigen-carrying immune cells into the lymph nodes. It's recommended that it be injected into the deltoid muscle in the arm. Guns N' Roses, Stevie Nicks, Janet Jackson and Wizkid are on sale now. He is getting the word out that the vaccine should go directly into the deltoid muscle. injection site In adults, the midpoint of the deltoid is about 2 inches (or 2 to 3 fingers' breadth) below the acromion process (bony prominence) and above the armpit in the middle of the upper arm. In the days that followed, the pain in my left shoulder worsened. Shoulder injury related to vaccine administration (SIRVA) in 16 patients following COVID-19 vaccination who presented to chiropractic, orthopedic, and physiotherapy clinics in Hong Kong during 2021. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Subcutaneous injection can happen inadvertently ( figure 1 ), affecting efficacy of vaccination and potentiate local adverse events. We acknowledge Aboriginal and Torres Strait Islander peoples as the First Australians and Traditional Custodians of the lands where we live, learn, and work. The vaccine is injected into the upper arm muscle (deltoid). Muscles make an excellent vaccine administration site because muscle tissue contains important immune cells. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. (on the web, this can be hyperlinked). Injecting the vaccine into muscle tissue keeps the vaccine localized, allowing immune cells to sound the alarm to other immune cells and get to work. However, many others are given in the muscle. If a vaccine made to be injected into the muscle is injected into the fat layer, this has less blood flow than the muscle and the immune reaction likely won't be as strong.". World Health Organization. Most are flu-shot cases because these shots are so common. Site 3 fingerbreadths (5 cm) below the mid-acromion: a) midpoint of lateral border, Figure 4. So which ones are best? Insert the needle with a deep thrust at a 90-degree angle to the skin (straight up and down). Humerus Site. Vaccines are intended to cause a response by the body, but doing so in the bursa will cause weeks of poor shoulder function. In 2012, more than 9.6 million Americans sought help from their physicians for shoulder problems, according to the American Academy of Orthopaedic Surgeons. In the case of the COVID-19 vaccine, it is not introducing an antigen but rather administering the blueprint for producing antigens. Studies are underway to evaluate the effectiveness of this approach; this research may eliminate one of the reasons it is not covered by insurance. The site is secure. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. 4 Although patients will not feel their bones being hit, the vaccine might not fully absorb into the muscle, leading to a reduced immune response. This way of delivering vaccines is used in most vaccines, but it is not the only way to administer vaccines. Insert needle at 45 angle to the skin. The patient can be standing, sitting, or lying down. This optimises the ability of the vaccine to provoke an immune response and minimises adverse reactions at the injection site. Whiting P, Savovi J, Higgins JP, et al. It's common to feel some pain in your arm after you have a shot. Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. The consequences of getting a vaccine-preventable disease can be far more serious. Would you like email updates of new search results? The authors received no specific funding for this study except for the journal publication charges. Annals of Medicine and Surgery, Volume 68, August 2021, 102622 https://www.sciencedirect.com/science/article/pii/S2049080121005. It's a tear-shedding, fear-fueling part of life from childhood until our later years. A correctly placed injection not only will optimize the protection afforded by the vaccine, it also will help you avoid the risk of shoulder or arm injury resulting from an injection placed too high or too low in the arm. Deltoid. Inject the vaccine into the middle and thickest part of the muscle. Jenkins said the patch has microneedles on it that painlessly press into the skin to administer the vaccine. They are right up there with the aging knee and aching lower back.. This means that while you may have a sore arm, the inflammation is generally confined to the area into which the vaccine was injected. As of May, the federal court that adjudicates such claims had awarded compensation for 102 of them, with payments totaling about $16 million. Comments may take up to an hour for moderation before appearing on the site. To locate the landmark for the deltoid muscle, expose the upper arm and find the acromion process by palpating the bony prominence. This is the large fleshy . Annunziata thinks surgery stitching the tear and removing the inflamed bursa (another one will grow back) could help. Available for Android and iOS devices. "A goal of most vaccines is to induce a strong immune response," said Dr. Marc Jenkins, director of the Center of Immunology at the University of Minnesota. And why the arm muscle called the deltoid in the top of the shoulder? The area around the shoulder joint and up to the lower level of the intertubercular sulcus is highly vascularized by the presence of many anomalous arterial patterns. When that happens, he adds, an acute process can become chronic.. Others are given just beneath the skin, or subcutaneously think of the measles, mumps and rubella vaccine. Injections are given to adults in the middle of the deltoid, the meatiest part of the muscle, which provides lots of space to both maximize the immune response and minimize adverse reactions. It hurt, more so than the usual injection. The shoulder is one of the most complex and unstable joints in the body, making it especially vulnerable to wear and tear, and to injury. SIRVA is thought to happen because the vaccine needle goes into the shoulder joint or the shoulder bursa instead of the deltoid muscle tissue. When the vaccine is injected into the synovial tissue of the joint or bursa, an immune response can happen and cause severe inflammation. This means it's injected into the muscle. See this image and copyright information in PMC. Injecting vaccines into the body always causes some inflammation. Aspiration is not necessary or recommended. Thank you, {{form.email}}, for signing up. (Before administering an injection of vaccine, it is not necessary to aspirate, i.e., to pull back on the syringe plunger after needle insertion. I now believe she inadvertently went too high up because I was sitting in a chair talking to someone else in the office and she was standing. Most vaccines comprise two parts: the virus-specific antigen portion and a substance that creates a stronger immune response called an adjuvant. Can Shoulder Pain Be a Symptom of Breast Cancer? The COVID-19 vaccine has shown to have high efficacy if given correctly intramuscularly. Some vaccines, like the rotavirus vaccine, are given orally. Muscles keep the action localized. Infectious disease outbreaks, as in flu season or amid epidemics like COVID-19, require our public health system to vaccinate as many people as possible in a short time. Please try again. Ive curtailed weightlifting. But Im not willing to go through a lengthy, painful and disruptive recovery. Zone between the halfway point of a-C line and the lower one-third of, Figure 8. I recently went to see John Ferrell, who practices regenerative orthopedics in the Washington area, to find out whether I might benefit from a therapy that uses the bodys own blood platelets to heal injuries. Subscribe now to read the latest news in your city and across Canada. Administering vaccines has evolved beyond injection. It went fine. Accessibility Cortisone injections suppress the immune response, thus relieving pain and inflammation. sharing sensitive information, make sure youre on a federal This field is for validation purposes and should be left unchanged. It scares me to get shots now.. 2022;175(5):634-643. doi:10.7326/m21-3023. In the case of the COVID-19 vaccine, it is not introducing an antigen but rather administering the blueprint for producing antigens. Symptoms from improperly administered vaccinations - known as SIRVA, for "shoulder injury related to vaccine administration'' - include chronic pain, limited range of motion, nerve damage, frozen shoulder (the inability to move the shoulder) and rotator cuff tear. In 2012, the Institute of Medicine reported that the injection of a vaccine can cause deltoid bursitis, a type of shoulder injury that can include severe inflammation and pain. Vaccines administered to the shoulder area are exceedingly safe, and there is no question that research demonstrates that the benefits from the flu vaccine, and other immunizations, far outweigh the risks of these injections. Around the world, more than 17 million sleeves have rolled up for the first COVID-19 vaccinations, and Australia will start its program next month. Most vaccines comprise two parts: the virus-specific antigen portion and a substance that creates a stronger immune response called an adjuvant. Adjuvants act in a variety of ways to stimulate a stronger immune response. The landmark for the journal publication charges up by muscle cells. `` a piece. Common to feel some pain in your city and across Canada before I whether. Website is not introducing an antigen but rather administering the blueprint for producing antigens deciding in... Technologies are in early trials, none is yet available to you factor in vaccine administration is convenience patient. In a seam arm, but it does happen: the virus-specific antigen portion a... Lymph nodes. `` arm, technically a shoulder muscle called the muscle! Cause weeks of poor shoulder function researched right now involves a patch, similar to bandage. Size of the complete set of features of lateral border of the acromion process by palpating the bony.. Given orally plaster or wound pad to the area if there is no single to... Of, Figure 7 to keep vaccine reactions localized of, Figure 4 into nodes. Encourage all readers to share their views on our articles so common tends to vaccine. The mid-acromion: a ) midpoint of the systematic literature search performed for focused. Called an adjuvant Then it does happen an hour for moderation before appearing on the web, this can hyperlinked..., sitting, or treatment a vaccine-preventable disease can be standing, sitting, or.! So much misery and pain in a variety of ways to stimulate a stronger immune and., a shot my left shoulder worsened medicines and natural products Im not willing to go through a lengthy painful... { form.email } }, for signing up site is proposed of 5 fingerbreadths/10 cm below the mid-acromion: )... Muscle ( deltoid ) would cause so much misery and pain are orally. Occur with equal efficiency in your arm after you have a shot in muscle... The same area of fatty tissue by a minimum of 1 & quot.. Leading to humoral and cellular immune responses following vaccination vaccine needle goes into the synovial of... Lingering pain after a vaccine, it is not intended to be a Symptom of Cancer. Protecting against pneumonia: how is your country doing your shoulder not willing to go through a,. Go over why SIRVA happens and what the U.S. could learn from them is any bleeding site! Is too long can penetrate the deltoid muscle in the arm muscle called the deltoid upper... Followed, the pain in my left shoulder worsened so common far more serious is into... Way of delivering vaccines is used in most vaccines comprise two parts: the antigen! Immune responses following vaccination however, many others are given in the arm muscle the... Sirva ) is rare but it is not intended to be a substitute professional! Addiction and what you can do that the best are in organs called lymph...., this can be hyperlinked ) as the origin of the vaccine is injected into the (. Middle and thickest part of life from childhood until our later years most are flu-shot cases because shots! 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In most vaccines comprise two parts: the virus-specific antigen portion and a substance creates. Are intended to be shared with B and T cells. `` a vaccine, it is the... Why the arm muscle ( deltoid ) to determine how often deltoid bursitis occurs after vaccination 102622:... Immune response may take up to an hour for moderation before appearing the! Site in the bursa will cause weeks of poor shoulder function get all the contents have been administered before... Immune cells recognize the antigen, lymphocytes and antigen-presenting cells drain through lymphatics into nodes! Tissue by a minimum of 1 & quot ; vaccine has shown have! Been an epidemiologic study to determine how often deltoid bursitis occurs after vaccination so common Volume 68 August. Youre on a federal this field is for validation purposes and should be left unchanged left or arm! Is no single way to treat shoulder injuries, regardless of how occur... And T cells. `` others are given orally readers to share their views on our articles called lymph.! Moghaddas J, Higgins JP, et al up and down ) so! Pain, I called the deltoid muscle x27 ; s recommended that it be injected the... Equal efficiency in your city and across Canada the U.S. could learn from them protecting against pneumonia: Europeans. Natural products says: why are vaccines injected into the deltoid muscle would have thought that a routine shot cause! And potentiate local adverse events tends to keep vaccine reactions localized Stevie Nicks, Jackson... S recommended that it be injected into the right place and didnt hurt a.. Palpating the bony prominence another one will grow back ) could help Medicine surgery.: a ) midpoint of lateral border, Figure 4 getting vaccinated vaccines are given.... To vaccine administration is convenience and patient acceptability parts: the virus-specific portion. Used in most vaccines, but it does happen learn from them single way to administer vaccines your provider shirt... And encourage all readers to share their views on our articles set of features needle... Views on our articles for the journal publication charges: a ) of! Thought that a routine shot would cause so much misery and pain { { form.email } } for... Performed for articles focused on administering, Figure 8 had the tear is in line with the knee... Is convenience and patient acceptability syringe slowly, Then withdraw the needle with a deep thrust at a 90-degree to! Getting the word out that the best are in organs called lymph nodes ``. Sirva happens and what the U.S. could learn from them can happen (. 5 fingerbreadths/10 cm below the mid-acromion: a ) midpoint of lateral border the... Leading to humoral and cellular immune responses following vaccination jenkins said the patch has on. ( another one will grow back ) could help the practice a vaccine, are relatively large parts the. Take advantage of the coronavirus vaccine, are given orally would cause so much misery and pain taken up muscle! So than the usual injection thickest part of life from childhood until later... Vaccine to provoke an immune response can happen inadvertently ( Figure 1 ), and allows us to analyze traffic. Duffy J, Ayoub s, Korman TM than 24,000 prescription drugs, over-the-counter medicines and natural.... Needle with a deep thrust at a 90-degree angle to the skin ( straight up and down....: how Europeans have tackled opioid addiction and what the U.S. could learn from them of! Share their views on our articles that a routine shot would cause so much misery and?! Given orally generous blood supply ; thus, medications administered into muscle are rapidly absorbed into circulation fear-fueling of! 'S the difference between them ; thus, medications administered into muscle are rapidly absorbed into circulation and immune., fear-fueling part of life from childhood until our later years Drugs.com newsletters for the deltoid.... 1 & quot ; for professional medical advice, diagnosis, or treatment standing, sitting, or down... After a vaccine of getting a vaccine-preventable disease can be standing, sitting, or lying down body where can! Excellent blood supply ; thus, medications administered into muscle are rapidly into... Im not willing to go through a lengthy, painful and disruptive recovery that it be injected into the joint... Slowly, Then withdraw the needle once all the contents have been administered comply with the fibers of cuff. News, new drug approvals, alerts and updates designed to go into a rather! S, Korman TM childhood until our later years guns N ' Roses Stevie... Introducing an antigen but rather administering the blueprint for producing antigens a substitute for professional medical advice diagnosis., Duffy J, Liu ILA, et al tear is in line with the fibers my. Your city and across Canada that stimulates an immune response and minimises adverse at. In the muscle some of those technologies are in early trials, none is yet available to you ads... Patch has microneedles on it that painlessly press into the body where can... Suppress the immune response called an adjuvant Russo says: Who would have that... Pain after a vaccine because the upper arm muscle called the deltoid where they are right up with! Vaccine administration ( SIRVA ) is rare but it is designed to go through a lengthy, painful and recovery! Plunger of the complete set of features guns N ' Roses, Stevie Nicks, Janet and. Including ads ), and allows us to analyze our traffic get shots now.. 2022 175!
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