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| Inspection Nr | 1409005.015 |
| Investigation Nr | 117205.015 |
| Line Nr | 1 |
| Age | 21 |
| Sex | M |
| Nature of Injury | |
| Part of Body | |
| Source of Injury | |
| Event Type | Card-Vasc/Resp Fail. |
| Environmental Factor | |
| Human Factor | |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned |
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