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| Inspection Nr | 1480867.015 |
| Investigation Nr | 127313.015 |
| Line Nr | 12 |
| Age | 40 |
| Sex | M |
| Nature of Injury | |
| Part of Body | |
| Source of Injury | |
| Event Type | Other |
| Environmental Factor | |
| Human Factor | |
| Occupation | Occupation Not Listed |
| Degree of Injury | Hospitalized injury |
| Task Assigned |
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