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epinephrine injection

Pronunciation

Generic Name: epinephrine injection (EP i NEF rin)
Brand Name: Adrenaclick Two-Pack, Adrenalin, Auvi-Q, EpiPen 2-Pak, EpiPen JR 2-Pak, EPIsnap, ...show all 26 brand names

What is epinephrine injection?

Epinephrine is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction.

Epinephrine injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis.

Epinephrine auto-injectors may be kept on hand for self-injection by a person with a history of an severe allergic reaction.

Epinephrine injection may also be used for purposes not listed in this medication guide.

What is the most important information I should know about epinephrine injection?

Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction. After the injection you will need to receive further treatment and observation.

What should I discuss with my healthcare provider before using epinephrine injection?

Before using epinephrine, tell your doctor if any past use of this medicine caused an allergic reaction to get worse.

To make sure epinephrine injection is safe for you, tell your doctor if you have:

  • heart disease or high blood pressure;

  • asthma;

  • Parkinson's disease;

  • depression or mental illness;

  • a thyroid or adrenal gland disorder; or

  • diabetes (you may need to adjust your dose of insulin or other diabetes medication after using epinephrine injection).

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether epinephrine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

In an emergency situation it may not be possible to tell your caregivers if you are pregnant or breast feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication.

How should I use epinephrine injection?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Epinephrine is injected into the muscle of your outer thigh. In an emergency, this injection can be given through your clothing.

Your medicine may also come with a "trainer pen." The trainer pen contains no medicine and no needle. It is only for non-emergency use to practice giving yourself an epinephrine injection. Do not use a trainer pen to treat an allergic reaction.

The auto-injector device is a disposable single-use system that comes with patient instructions for safe and effective use. Do not inject this medicine if you do not understand these instructions.

Do not remove the safety cap until you are ready to use the auto-injector. Never put your fingers over the injector tip when removing the safety cap or after the safety cap has been removed.

To use an epinephrine auto-injector:

  • Form a fist around the auto-injector with the tip pointing down. Pull off the safety cap.

  • Place the tip against the fleshy portion of your outer thigh. You may give the injection directly through your clothing.

  • Push the auto-injector firmly against your thigh to release the needle that injects the dose of epinephrine. Hold the auto-injector in place for 10 seconds after activation.

  • Remove the auto-injector from your thigh and massage the area gently. Carefully re-insert the used device needle-first into the carrying tube. Re-cap the tube and take it with you to the emergency room so that anyone who treats you will know how much epinephrine you have received.

  • Use an auto-injector only one time. Do not try to reinsert an auto-injector a second time if the needle has come out of your skin before the full 10 seconds. If the needle is bent from the first use, it may cause serious injury to your skin.

Seek emergency medical attention after any use of epinephrine to treat a severe allergic reaction. The effects of epinephrine may wear off after 10 or 20 minutes. You will need to receive further treatment and observation.

Do not use epinephrine injection if it has changed colors or has particles in it, or if the expiration date on the label has passed. Call your pharmacist for a new prescription.

Store at room temperature away from moisture, heat, and light. Do not refrigerate or freeze this medication, and do not store it in a car.

What happens if I miss a dose?

Since epinephrine is normally used only as needed in an emergency, you are not likely to be on a dosing schedule. Do not use repeat doses of epinephrine without a doctor's advice.

What happens if I overdose?

Seek emergency medical attention right away after any use of epinephrine injection.

Symptoms of an epinephrine overdose may include worsened breathing trouble, sudden numbness or weakness on one side of the body, slurred speech, problems with vision or balance, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

What should I avoid while using epinephrine injection?

Do not inject epinephrine into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh.

Accidentally injecting epinephrine into your hands or feet may result in a loss of blood flow to those areas, and resulting numbness.

Epinephrine injection side effects

Before using epinephrine, tell your doctor if any past use of this medicine caused an allergic reaction to get worse.

Call your doctor at once if you notice pain, swelling, warmth, redness, or other signs of infection around the area where you gave an injection.

Common side effects may include:

  • fast or pounding heartbeats;

  • pale skin, sweating;

  • nausea and vomiting;

  • dizziness;

  • weakness or tremors;

  • throbbing headache; or

  • feeling nervous, anxious, or fearful.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Epinephrine injection dosing information

Usual Adult Dose for Asystole:

Injectable Solution of 0.1 mg/mL (1:10,000):
-IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
-Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
-Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:
-Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:
-IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
-Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Ventricular Fibrillation:

Injectable Solution of 0.1 mg/mL (1:10,000):
-IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
-Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
-Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:
-Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:
-IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
-Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Ventricular Tachycardia:

Injectable Solution of 0.1 mg/mL (1:10,000):
-IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
-Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
-Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:
-Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:
-IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
-Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Cardiac Arrest:

Injectable Solution of 0.1 mg/mL (1:10,000):
-IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
-Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
-Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:
-Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:
-IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
-Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Asthma -- Acute:

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Use: For the treatment of acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous administration of other solutions of the drug

Usual Adult Dose for Allergic Reaction:

Auto-Injector:
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:
-The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.
-More than 2 sequential doses should only be administered under direct medical supervision.
-The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care.

Injectable Solution of 1 mg/mL (1:1000):
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:
-For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
-Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
-The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Convenience Kit 1 mg/mL (1:1000):
0.2 to 1 mg IM or subcutaneous

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Adult Dose for Anaphylaxis:

Auto-Injector:
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:
-The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.
-More than 2 sequential doses should only be administered under direct medical supervision.
-The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care.

Injectable Solution of 1 mg/mL (1:1000):
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:
-For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
-Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
-The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Convenience Kit 1 mg/mL (1:1000):
0.2 to 1 mg IM or subcutaneous

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Adult Dose for Pupillary Dilation:

Injectable Solution of 1 mg/mL (1:1000):
-Intraocular: Dilute 1 mL of the 1 mg/mL single-use vial (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to a concentration of 1:100,000 to 1:1,000,000 (10 mcg/mL to 1 mcg/mL) and use the irrigating solution as needed for the surgical procedure
-Intracameral: Following dilution in an ophthalmic irrigating fluid, the solution may also be injected intracamerally as a bolus dose of 0.1 mL at a dilution of 1:100,000 to 1:400,000 (10 mcg/mL to 2.5 mcg/mL)

Comments:
-The 30 mL multiple-dose vial is not for ophthalmic use and only the 1 mL single-use vial should be used for ophthalmic administration.
-Do not use if the solution is colored, cloudy, or contains particulate matter.

Use: For the induction and maintenance of mydriasis during intraocular surgery

Usual Adult Dose for Hypotension:

Injectable Solution of 1 mg/mL (1:1000): 0.05 to 2 mcg/kg/min IV and titrate to achieve desired mean arterial pressure (MAP)
-Dosage may be adjusted periodically, such as every 10 to 15 minutes in increments of 0.05 to 0.2 mcg/kg/min to achieve desired blood pressure goal

Comments:
-Must be diluted prior to use; consult manufacturer product information for appropriate dilution instructions.
-Correct blood volume depletion as fully as possible prior to administration; may be administered before and concurrently with blood volume replacement as an emergency measure.
-Continuous infusion is generally required over several hours or days until patient's hemodynamic status improves; the duration of perfusion or total cumulative dose cannot be known.
-Following hemodynamic stabilization, may wean incrementally over time, such as decreasing doses every 30 minutes over a 12 to 24 hour period.

Use: To increase mean arterial blood pressure in patients with hypotension associated with septic shock

Usual Adult Dose for Shock:

Injectable Solution of 1 mg/mL (1:1000): 0.05 to 2 mcg/kg/min IV and titrate to achieve desired mean arterial pressure (MAP)
-Dosage may be adjusted periodically, such as every 10 to 15 minutes in increments of 0.05 to 0.2 mcg/kg/min to achieve desired blood pressure goal

Comments:
-Must be diluted prior to use; consult manufacturer product information for appropriate dilution instructions.
-Correct blood volume depletion as fully as possible prior to administration; may be administered before and concurrently with blood volume replacement as an emergency measure.
-Continuous infusion is generally required over several hours or days until patient's hemodynamic status improves; the duration of perfusion or total cumulative dose cannot be known.
-Following hemodynamic stabilization, may wean incrementally over time, such as decreasing doses every 30 minutes over a 12 to 24 hour period.

Use: To increase mean arterial blood pressure in patients with hypotension associated with septic shock

Usual Adult Dose for Bradyarrhythmia:

The manufacturer gives no specific dosing instructions.

The AHA recommends:
2 to 10 mcg/min IV and titrate to patient response
-Alternate dose: 0.1 to 0.5 mcg/kg/min (in a 70 kg patient, 7 to 35 mcg/min) IV; titrate to effect

Use: For patients with symptomatic bradycardia, particularly if associated with hypotension, for whom atropine may be inappropriate or after atropine fails

Usual Pediatric Dose for Cardiac Arrest:

The manufacturer gives no specific dosing instructions.

The AHA recommends:
Neonates:
-IV: 0.01 to 0.03 mg/kg (1:10,000 injectable solution) IV once
-Endotracheal: 0.05 to 0.1 mg/kg (1:10,000 injectable solution) via endotracheal route once may be reasonable while attempting to gain IV access

Comments:
-Due to lack of data to support endotracheal use, it is reasonable to provide medications via IV route as soon as venous access is established.

Infants and Children:
-IV or intraosseous: 0.01 mg/kg (0.1 mL/kg of 1:10,000 injectable solution) IV or intraosseous once; may repeat every 3 to 5 minutes
-Maximum dose: 1 mg

Endotracheal: 0.1 mg/kg (0.1 mL/kg of 1:1000 injectable solution) via endotracheal tube once, flush with 5 mL normal saline and follow with 5 ventilations; may repeat every 3 to 5 minutes
-Maximum dose: 2.5 mg

Use: For resuscitation in the pediatric patient

Usual Pediatric Dose for Allergic Reaction:

Auto-Injector:
15 to 30 kg: 0.15 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:
-Since the lowest dose of the auto-injector is 0.15 mg, consider using other injectable forms of this drug if doses lower than 0.15 mg are necessary.
-More than 2 sequential doses should only be administered under direct medical supervision.
-The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.

Injectable Solution of 1 mg/mL (1:1000):
Less than 30 kg: 0.01 mg/kg (0.01 mL/kg) of undiluted drug IM or subcutaneously into anterolateral aspect of thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.3 mg (0.3 mL)
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:
-For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
-Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
-The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
-Neonate: 0.01 mg/kg IV slowly once
-Infant: 0.05 mg IV slowly once; may repeat at 20 to 30 minute intervals as needed

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Pediatric Dose for Anaphylaxis:

Auto-Injector:
15 to 30 kg: 0.15 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:
-Since the lowest dose of the auto-injector is 0.15 mg, consider using other injectable forms of this drug if doses lower than 0.15 mg are necessary.
-More than 2 sequential doses should only be administered under direct medical supervision.
-The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.

Injectable Solution of 1 mg/mL (1:1000):
Less than 30 kg: 0.01 mg/kg (0.01 mL/kg) of undiluted drug IM or subcutaneously into anterolateral aspect of thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.3 mg (0.3 mL)
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed
-Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:
-For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
-Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
-The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
-Neonate: 0.01 mg/kg IV slowly once
-Infant: 0.05 mg IV slowly once; may repeat at 20 to 30 minute intervals as needed

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Pediatric Dose for Asthma -- Acute:

Injectable Solution of 0.1 mg/mL (1:10,000):
-Neonate: 0.01 mg/kg IV slowly once
-Infant: 0.05 mg IV slowly once; may repeat at 20 to 30 minute intervals as needed

Use: For the treatment of acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous administration of other solutions of the drug

Usual Pediatric Dose for Pupillary Dilation:

Injectable Solution of 1 mg/mL (1:1000):
-Intraocular: Dilute 1 mL of the 1 mg/mL single-use vial (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to a concentration of 1:100,000 to 1:1,000,000 (10 mcg/mL to 1 mcg/mL) and use the irrigating solution as needed for the surgical procedure
-Intracameral: Following dilution in an ophthalmic irrigating fluid, the solution may also be injected intracamerally as a bolus dose of 0.1 mL at a dilution of 1:100,000 to 1:400,000 (10 mcg/mL to 2.5 mcg/mL)

Comments:
-The 30 mL multiple-dose vial is not for ophthalmic use and only the 1 mL single-use vial should be used for ophthalmic administration.
-Do not use if the solution is colored, cloudy, or contains particulate matter.

Use: For the induction and maintenance of mydriasis during intraocular surgery

What other drugs will affect epinephrine injection?

Other drugs may interact with epinephrine injection, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about epinephrine injection.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.06. Revision Date: 2016-06-30, 3:00:07 PM.

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