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| Inspection Nr | 306030271 |
| Investigation Nr | 200290104 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Other |
| Part of Body | Othbodysys |
| Source of Injury | Other |
| Event Type | Card-Vasc/Resp Fail. |
| Environmental Factor | Other |
| Human Factor | Other |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |