vf]k kZrft x'g ;Sg] cjfl~5t 36gf

Adverse Event Following

Immunization(AEFI)

-डा.ललित कार्की ,मे.अ.,आठौ तह

प्रा.स्वा.के प्रमुख
 vf]k nufPkl5 x'g;Sg] cjflR5t 36gf
(Adverse Events Following Immunization)

vf]k nufPkl5 x'g]

• s'g} klg :jf:Yo ;DaGwL 36gf, oBlk o; k|sf/sf 36gf
vf]ksf] sf/0faf6
h;nfO{
ePsf] gx'g klg ;S5
• vf]ksf] sf/0faf6 xf] eGg] ljZjf;
ul/Psf], /
• hg;d'bfosf]
o:tf rf;f]sf]
cjflG5t 36gfx? vf]klaifo
nufPkl5 ck|Toflzt lrGx NfIf0f,
c;fdfGo k|of]uzfnf kl/0ffd jf /f]usf] ?kdf b]vfkb{5g\ .
 vf]k kZrft x'g ;Sg] cjfl~5t 36gfsf
k|sf/ jf cj:yfx?
(Types Of AEFI)
• ;fdfGo k|sf/sf 36gfx? (Non-serious or Minor
AEFI)
• ulDe/ k|sf/sf cjfl~5t 36gfx? (Serious AEFI)
 
s=;fdfGo k|sf/sf cjfl~5t 36gfx? (Non-serious or Minor AEFI)
;fwf/0f tyf ;fdfGo k|ltlqmofx? JolQmsf] z/L/df
cGt/lglxt k|lt/f]wfTds zlQmn] EoflS;g nufO;s]kl5 ;f]
;+u k|ltlqmof ubf{ b]vf kb{5g\ . o;k|sf/sf cjfl~5t
36gfx? ;fdfGotof cfkm} x/fP/ hfG5g\ . o:tf 36gfx?
sf] :yflgo :t/df g} Joj:yfkg tyf pkrf/ ug{ ;lsG5 . h:t}
a9L Hj/f] cfPdf jf b'v]df kf/fl;6fdf]n lbg ;lsG5 .
;fdfGoto x'g] 36gfx?
;fdfGo Hj/f] cfpg]
;"O{ nufPsf] 7fp+df b'Vg] ,/ftf] x'g]
jf ;'lGgg]
aRrf s]lx ;do ?g] , lemhf] dfGg]
lj=l;=hL= nufPsf] 7fp+df kfSg]
 ;fdfGo k|sf/sf cjfl~5t 36gfx? (Non-serious or Minor
AEFI)
Aoj:yfkg M
o:tf 36gfx? cfkm} sdx'b} hfG5g\, ;fdfGo c;/x? hl6n x'g af6
arfpg tyf vf]k ;]jfdf x'g ;Sg] 8/ qf; / gs/fTds l:ylt cfpg glbg
M
vf]k ;]jf ;+u} o:tf] cj:yf x'g ;S5 elg k|To]s cleefjs nfO{
;fdfGo c;/sf] af/]df k/fdz{ ug'{ kb{5
nIf0f cg';f/ pkrf/ ug]{ h:t} M Hj/f] cfP jf b'v] jf /ftf] eP
jf ;'lGgPdf Hj/f] / b'Vg sd ug]{ cf}iflw lbg]
k]|if0f ug'{ kg]{ ePdf tTsfn pko'Qm :yfgdf k7fpg]
o:tf 36gfx?sf] :jo+d ;]ljsf , cleefjs jf cGo dfWod af6 ;d]t
cg'udg ug]{
 o; k|sf/sf cjfl~5t 36gfx?sf] ljj/0f vf]k /lhi6/df (HMIS 2.26)
clen]v ug'{ kb{5 .
v=ulDe/ k|sf/sf cjfl~5t 36gfx? (Serious AEFI)
vf]k kZrft ulDe/ k|sf/sf cjfl~5t 36gfx? klg x'g ;S5g ,
o:tf 36\gfx? af6 Hofg hf]lvddf x'g] ;fy} Hofg} klg
hfg ;S5 —
vf]k kZrft ePsf lgDg cj:yfx?nfO[{ ulDe/ 36gfsf] ?
kdf lng' kb{5
!= c:ktfn egf{ ug'{kg]{ x'g' jf nfdf] ;do;Dd
c:ktfndf egf{ eP/ a:g' kg]{ x'g'
@= Hofg g} hfg ;Sg] hf]lvd x'g' .
#= ckfË x'g' jf czQmtf x'g'
$= hGdhft ljsnfË jf ckfË hGdg'
%= d[To' x'g'
 
 CIOMS/ WHO cause specific definition of AEFIs
1 2 3 4 5
Vaccine Vaccine quality Immunization Immunization
product- defect-related error-related anxiety-related Coincidental
related reaction reaction reaction event
reaction

An AEFI that is
caused or
precipitated by
An AEFI that is
An AEFI that is a vaccine that
caused by
caused or is due to one An AEFI that is
An AEFI arising something
precipitated by or more caused by
from anxiety other than the
a vaccine due quality defects Inappropriate
about the vaccine
to one or more of the vaccine vaccine
immunization. product,
of the product handling,
immunization
inherent including its prescribing or
error or
properties of administration administration
immunization
the vaccine device as .
anxiety
product. provided by
the
manufacturer.

AEFI Basic concepts Module B | May 2013 | 6

 CIOMS/ WHO cause specific definition of AEFIs
1 2 3 4 5
Vaccine Vaccine quality Immunization Immunization
product- defect-related error-related anxiety-related Coincidental
related reaction reaction reaction event
reaction

EXAMPLE
Failure by the EXAMPLE
EXAMPLE EXAMPLE A fever after
EXAMPLE manufacturer vaccination
Extensive Transmission Vasovagal (temporal
to
limb swelling of infection by syncope in an association)
completely
following DTP contaminated adolescent and malarial
inactivate a
vaccination. multidose following parasite
lot of
vial. vaccination. isolated from
inactivated
polio vaccine blood.
leads to cases
of paralytic
polio.

AEFI Basic concepts Module B | May 2013 | 7

 vf]k kZrft\ x'g;Sg] cjfl~5t 36gf sf] k|sf/ ÷sf/0f
(Adverse Events Following Immunization -AEFI)
-s_ vf]k pTkfbg;Fu ;DaGwLt k|ltlqmof
• EoflS;g pTkfbg ubf{ EoflS;gdf lglxt Ps jf PseGbf a9L
tTjsf] sf/0faf6 pTkGg x'g] cjfl~5t 36gf . EofS;Lg ;'/lIft
x'G5g\ t/ EoflS;gdf lglxt tTjx?sf] u'0fn] ubf{ slxn] sfFxL
cjfl~5t 36gf x'g] ;Defjgf x'G5 .
h:t} M PgfkmfOnflS;;\ M o:tf 36gfx? b]vf k/]df ;dodf g}
;DaGwLt lgsfodf k|ltj]bg ug'{sf] ;fy} :jf:Yosld{af6 ;d'lrt
Joj:yfkg ug'{kb{5 .
 Adjuvants
vaccine antigens, most often in
killed vaccine)
Stabilizers [Aluminium
(help the vaccine maintain its
effectiveness during storage)
salts]
[MgCl2, MgSO4] Antibiotics
(to prevent bacterial
contamination of the tissue
Antigen culture cells in which the viruses
are grown)
[Live, Killed, [Neomycin]
Purified, Preservatives
Inactivated (added to multidose vaccines to
prevent bacterial and fungal
toxin] growth)

[Thiomersal,
Formaldehyde
]
 vf]k kZrft\ x'g;Sg] cjfl~5t 36gf sf] k|sf/
(Adverse Events Following Immunization -AEFI)
-v_ EoflS;gsf] u'0f:t/;Fu ;DalGwt k|ltlqmof
• vf]k / vf]k lbg] ;fwg jf ;fdfu|Lsf]
u'0f:t/lxgtfsf] sf/0faf6 x'g] cjfl~5t 36gf . h:t}
vf]ksf] /ª, kl/df0f tyf cGo c:jfefljs cj:yf -lylu|
Psf], 9';L hd]sf], /fd|f];Fu g3'lng] cflb_
b]lvPdf To:tf] efonnfO{ k|of]u gu/L ;DaGwLt
lgsfodf vj/ u/L lkmtf{ ug'{kb{5 . To:t} 3f]ns,
1955- IPV-
l;l/Ghsf] xsdf 120,000klg
injected c;fdfGo
40,000 mild polio cj:yf h:t}M
200 paralysed
3f]nsdf 9';L 10 died b]lvPdf, l;l/Ghsf] vf]n
RoftLPsf] cflbdf k|of]u ug'{x'b}g .
 vf]k kZrft\ x'g;Sg] cjfl~5t 36gf sf] k|sf/
(Adverse Events Following Immunization -AEFI)
-u_ vf]k sfo{qmd ;+rfngsf] q'6Laf6 x'g]
k|ltlqmof
• vf]ksf] e08f/0f, ljt/0f, tof/L -3f]Ng] / tfGg] _ / vf]k
nufpg] ;dodf x'g] q'6Laf6 pTkGg x'g] cjfl~5t
36gf . h:t} M s]xL 306fleq Hj/f] cfpg], afGtf x'g] /
kfgL h:tf] kvfnf nfUg],aRrf lzlyn ,cw{r]t / cr]t
cj:yfdf k’g -toxic shock Syndrome_], ;'O{ lbPsf]
7f+p ;'lGgg] ,kfsg] cflb .
(vf]k e08f/0f, ljt/0f tyf vf]k tof/L ubf{ /
nufpFbf ckgfOg'kg]{ ;fjwfgLnfO{ s8fOsf
;fy lgjf{x u/]df z'Godf Nofpg ;lsG5 .)
sfo{qmd ;~rfngsf] qmddf x'g;Sg] q'6Lx? q'6Lx?
• vf]k ljt/0f tyf e09f/0fsf] qmddf plrt sf]N8r]g sfod gx'g'
• EoflS;g 3f]Nbf l;l/~h÷EoflS;g k|b"lift x'g'
• EoflS;g;Fu} pknAw u/fPsf] 3f]nsn] EoflS;g g3f]Ng', 3f]ns /
EoflS;gsf] tfkqmd ;dfg gx'g'
• 3f]n]s]f EoflS;g tf]lsPsf] ;do eGbf kl5 ;Dd k|of]u ug'{
• Pp6f vf]k s]Gb|df k|of]u u/]s]f EoflS;g csf]{ vf]k s]Gb|df k|
of]u ug'{
• 7Ls tl/sfn] ;"O{ glbg'
• s'g} sf/0f af6 b'lift ePsf] vf]k k|of]u ul/of]
 vf]k sfo{qmd sf] q'6L af6 x'g] AEFI af6 arfpg
• EoflS;g ;lx tfkqmddf e08f/0f ug]{,
• cfO; Kofs slG8zlgª u/L EoflS;g ljt/0f ug]{,
• ;lx 3f]nsaf6 EoflS;g tof/ ug]{,
• k|To]s efonnfO{ 3f]Ng Pp6f 3f]ns l;l/Gh k|of]u ug]{,
• P8L l;l/Ghaf6 vf]k nufpg] .
• vf]k tof/ ubf{ tyf ;]jf lbbf ;fjwfgL ckgfO{ ;'/lIft tl/sf ckgfpg]
ax' dfqf EoflS;g efon gLlt cg';f/ vf]k k|of]u ubf{
• Dofb gu'h|]sf],
• lelePd ! / @ df ePsf],
• k|To]s vf]ksf] dfqf tfGbf ;qmd0f/lxt tl/sfn] tfg]sf],
• EoflS;g efon kfgLdf g8'a]sf],
• Tf.kqmd ±@) ;]= b]lv ±*) ;]= ePsf] x'g'kb{5 .
o;/L vf]k sfo{qmd ;+rfngsf] q'6Laf6 x'g] Toxic Shock Syndrome h:tf uDeL/
vfnsf 36gfx?nfO{ lgd"{n kfg{ ;lsG5 .
 vf]k kZrft\ x'g;Sg] cjfl~5t 36gf
(Adverse Events Following Immunization -AEFI)

-3_ vf]kk|ltsf] lrGtf jf 8/sf] sf/0fn] x'g] k|ltlqmof

o; k|sf/sf cjflG5t 36gf vf]k nufpg] 8/ jf lrGtfaf6 pTkGg x'g ;S5 .
To;}n] vf]k ;]jf ;~rfng ug'{cl3 vf]ksf] dxTj / vf]ksf ;fdfGo k|lt
c;/jf/] vf]k lng] JolSt÷cleefjsnfO{ /fd|f];Fu k/fdz{ lbbf o:tf
36gfx? Go"g x'G5g\ .
 vf]k kZrft\ x'g;Sg] cjfl~5t 36gf
(Adverse Events Following Immunization -AEFI)

-ª_ ;+of]uj; x'g] 36gf

EoflS;gleq /x]sf lglxt u'0fx?, sfo{qmd ;~rfngdf x'g;Sg] q'6L
jf vf]k k|ltsf] lrGtf jf 8/af6 geO{ cGo sf/0faf6 x'g ;Sg] cjfl~5t
36gf .
b}lgs h;f] ljleGg sf/0fn] afnaflnsfx? la/fdL x'g] / d[To' eO/xg]
cj:yf ePsf] xfd|f] b]zdf,
vf]k ;]jf k|bfg ubf{ vf]k kZrft aRrf cGo sf/0fn] l;ls:t la/fdL jf
d[To" ePdf To;sf] bf]if vf]k ;]jfnfO{ lbg] cj:yfnfO{ ;+of]uj;
x'g] cjfl~5t 36gf elgG5 .
To;}n] vf]k k|bfg ul/g] ;dodf afnaflnsfdf s'g} lsl;dsf] /f]u
ePdf, klxn] vf]k k|bfg ubf{ k|ltc;/ b]lvPsf] ePdf vf]k
lbg'x'b}g . t/ la/fdL afnaflnsfx? lgsf] eO;s]kl5 vf]k ;]jfsf] nflu
 vf]k nufPkl5 vf]ks} sf/0f af6 x'g] cjfl~5t 36gf / cf};t ;Defjgfx?

vf]k cjfl~5t 36gfx? ;Defjgf ;dofalw

la=;L=hL= Suppurative !,)) b]lv !,))) k| @ b]lv ^ dlxgf
Lymphadenitis- lt !),))))) hgf
luvf{ ;'lgg' tyf
luvf{df lkk cfpg'
_
Osteitis - x•Lsf] ; ! b]lv #,)) k| !b]lv ^ dlxgf
+s|d0f _ lt !),))))) hgf
Disseminated ! b]lv @ k| ! b]lv !@
BCG infection lt !),))))) hgf
-zl//df
km}lnPsf] 6LjL
hLjf0f' ;+s|d0f _
8L=kL=6L=– # 306f eGbf !,))) b]lv ^),))) k| ) b]lv @$ 306f
x]k aL–lxj a9Lsf] lg/Gt/ ? lt !),))))) hgf
jfO{
sDkg / a]xf]; *) b]lv %&) k| ) b]lv @ lbg
 vf]k nufPkl5 x'g] cjfl~5t 36gf / cf};t ;Defjgfx?

k|lts[of lalxg zf/Ll/s #) b]lv (() k| ) b]lv @$ 306f

n'nf] kgf x'g' lt !),))))) hgf
(Hypotonic hypo
responsive )
PgfkmfO{n]lS;; @) k|lt !),))))) hgf ) b]lv ! 306f
(Anaphylaxis)
dl:tissf] ;'hg ) b]lv ! k|lt !),))))) )b]lv @ lbg
(Encephalopathy) hgf
cf]=kL=le kf]lnof] EoflS;g ; ! eGbf sd k|lt $ b]lv #) lbg
+u ;DalGwt kIff3ft #),)),)))
cfO=lk=eL ;fdfGo lsl;dsf] Hj/f] ! k|lt !))) hgf eGbf –
#* l8u|L ;]lG6u|]8 ;Dd sd

;'O nufPsf] 7fFpdf #–!! k|lt !)) hgf –

;fdfGo ;'lGgg]
/ftf] ;fx|f] x'g] ! k|lt !)) hgf –
a9L b'Vg]] !$–@( k|lt !)) hgf –
 vf]k nufPkl5 x'g] cjfl~5t 36gf / cf};t ;Defjgfx?

lk=;L=eL= ;fdfGo lsl;dsf] Hj/f] ! k|lt !)) hgf eGbf

#* l8u| sd
L ;]lG6u|]8 ;Dd
;'O nufPsf] 7fFpdf !) k|lt !)) hgfdf
;fdfGo ;'lGgg]
bfb'/f—? Hj/f] cfO{ sDkg / k|lt # xhf/df ! ^ b]lv !@ lbg
a]nf (MR) a]xf]; hgf leq
(Febrile seizure )
k|of]uzfnfdf kl/If0f k|lt #) xhf/df ! hgf !% b]lv #%
ubf{ /utdf lbg leq
Kn]6n]6\;sf] ;+Vof
sd x'g'
(Thrombocytopenia)
PgfkmfOn]lS;; k|lt !) bz nfvdf ! tTsfn} b]lv !
(Anaphylaxis) hgf 306f leq
l6=8L= kfv'/fsf] g;fsf] ;'hg % b]lv !) k| @ b]lv #* lbg
(Brachial Neuritis ) lt !),))))) hgf
v=ulDe/ k|sf/sf cjfl~5t 36gfx? df b]vfkg]{ lrGxnIf0f /
cj:yf (Serious AEFI)
vf]k kZrft ulDe/ k|sf/sf cjfl~5t 36gfx? klg x'g ;S5g ,
o:tf 36\gfx? df lgDg cj:yfx? b]lvg ;S5 —
•Anaphylaxis
• ljleGg lrGx nIf0fx? b]vf kg]{ -pRr
Hj/f], ;"O{ lbPsf] 7fp+df w]/} /ftf] x'g],
w]/} ;'lGgP/ kfSg]_, Ps} :yfgdf w]/} hgf nfO{ Ps}
;dodf p:t} ;d:of b]vf kg'{
•;"O{ lbPsf] 7fp+af6 /ut jlu/xg'
•aRrf nfdf] ;do - @—# 3+6f eGbf w]/} _ ?O/xg]
•aRrfn] b'w r':g jf vfgf vfg g;s\g] jf sd ub}{ hfg]
•cGo c;fdfGo lrGx nIf0f, cj:yf b]vf kg]{ -sDkg /
v=ulDe/ k|sf/sf cjfl~5t 36gfx? df b]vfkg]{ lrGxnIf0f /
cj:yf(Serious AEFI)
#=
Anaphylaxis vf]k -;"O{ _ nufPsf] cfwf 306f leqdf
—
aRrfsf] zl//df lrnfpg] /ftf 8fj/ ,ljld/f cfpg], cg'xf/
zl// ;'lGgg] , l/Ëf6f nfUg] ,:jf; km]g{ ufx|f]
eO{ 3\of/3\of/ cfjfh cfpg', jfsjfsL cfpg], afGtf x'g], j]xf];
x'g]
-of] cj:yf vf]ksf] sf/0f af6 clt g} lj/n x'g] t/ 36gf ePdf clt
ulDe/ cj:yf cfpg ;Sg] x'G5 ,slxn]sflx+ s'g} sf/0fn] a]xf];
ePsf] /x]5 eg] klg lrGxnIf0f ldNbf] h'Nbf] x'g hfG5g\_
t;y{ M
a]xf]; / Anaphylaxis sf nIf0fx? ldNbf]–h'Nbf] x'g ;sg] ePsf]n]
5'§ofpg' h?/L x'G5 . lsgeg] Anaphylaxis ePsf] JolQmnfO{ t'?Gt
 Anaphylaxis
• Anaphylaxis lj/n} x'g] t/ ulDe/ k|sf/sf] P=O{=Pkm=cfO{=
xf] .
• o:tf] 36gf vf]k nufPsf] ! 306f leq -k|foM % ldg]6 b]lv
#) ldg]6 leq_ b]vf kb{5 .
• of] cj:yf 5'6\ofpg / o;sf] tTsfn Joj:yfkg ug{ g;lsPdf
JolQmsf] d[To' ;d]t x'g;S5 .
• vf]k nufP kl5 x'g] a]xf]; (Faint) / Anaphylaxis aLr leGgtf
5'§ofpg' h?/L x'G5 .
• vf]k nufPkl5 Analphylaxis ePdf t'?Gt Intramuscular Adrenaline
lbg'kg]{ x'G5 .
 a]xf]; (Faint) / Anaphylaxis df leGgtf
lrGx÷nIf0f a]xf]; x'g' (Faint) Anaphylaxis
k|foM u/L ;"O{ nufpFb}
z'?df b]lvg] k|foM u/L ;"O{ nufPsf] %
u/]s]f cj:yfdf jf ;"O{ nufO;s]
lrGx÷ nIf0fx? ldg]6 b]lv #) ldg]6 leq b]lvg]
kl5 tTsfn} b]lvg]
z/L/ km';|f] (Pale) x'Fb} hfg], ;'O{ nufPsf] jl/kl/ /ftf]
5fnfdf b]vfkg]
{ nIf0fx?
z/L/ lr;f] x'Fb} hfg], kl;gf x'g], ;'lgg], cg'xf/ / cfFvf ;'lgg] /
cfpg] / lzlyn x'g] z/L/e/L ljld/f cfpg]
Zjf; k|Zjf;df
;fdfGo jf nfdf]–nfdf] k|sf/n] 3\of/–3\of/ cfjfh ;'lgg] u/L ;f;
b]vfkg]
{ nIf0fx?
;f; km]g]{ km]g]{ (Inspiratory Stridor)
/St ;~rf/df
d'6'sf] w8sg sd x'g], /Qmrfk d'6'sf] w8sg a9\g] / /Qmrfk sd
b]vfkg]
sd x'g] t/ of] Ifl0fs x'G5 x'g] .
{ nIf0fx?
kfrg k|
0ffnLdf k]6 afpl8g], k]6 b'Vg], jfs–jfsL
jfs–jfsL nfUg], jfGtf x'g]
b]vfkg] nfUg], jfGtf h?/L
x'g] x'G5 . lsgeg]
a]xf]; / Anaphylaxis sf nIf0fx? ldNbf]–h'Nbf] x'G5g\ t/ 5'§ofpg'
{Anaphylaxis
nIf0fx? ePsf] JolQmnfO{ t'?Gt Adrenaline Injection lbg'kg]{ x'G5 eg] a]xf]; ePsf
:gfo' k|
JolQmnfO{ k"/}h:tf ;dfGo
sf]N6] kf/]/ ;'tfpg], zfGt jftfj/0fdf /fVg] a]xf];Joj:yfkg
x'g], sf]N6]
u/]kl5 cfkm}
 Anaphylaxis sf] lrGx tyf nIf0fx?
• hLp lrnfpg], z/L/df ljld/f cfpg], ;"O{ nufPsf]
7fpFdf ;'lgg], l/Ëf6f nfUg], udL{ dx;'; x'g]
• cg'xf/ ;'lgg] t/ gb'Vg], gfs aGb x'g], cfFvfaf6 cfFz'
cfpg], xfFR5\o' cfpg]
• :j/df kl/jt{g cfpg], jfs–jfs nfUg], jfGtf x'g]
• 3fF6L ;'lgg], ;f; km]g{ ufx|f] x'g], k]6 b'Vg]
• ;f; km]bf{ घ्यार घ्यार cfjfh cfpg], ;f; km]g{ ufx|f] x'g],
a]xf]; x'g], /Qmrfk sd x'g], gf8L l56f] rNg] / lgoldt
gx'g]
oL dfly pNn]v ul/Psf ulDe/ 36gfx?
cToGt} b'n{e jf cToGt} sd x'G5 / vf]k k|
of]usf] sf/0f jf6 gePsf] klg x'g ;S5 . oL k|
sf/sf 36gfx? b]lvPdf t'?Gt pkrf/,
Aoj:yfkg z'? ul/ tt\sfn ;DalGwt lgsfodf
vj/ ug]{ , @$ 306fleq ;DalGwt dflyNnf]
lgsfo tyf ;/f]sf/jfnf sfof{no lhNnf, k|b]z,
s]Gb|, WHO/IPD df k|ltj]bg ug]{ / cfaZos
pkrf/sf] nflu t'?Gt c:ktfn k|]if0f ug]{ .
Anaphylaxis tyfcGo ulDe/
36gfx? ePdf tTsfn ug'{kg]
{ pkrf/ tyf Aoj:yfkg
 Anaphylaxis ePdf tTsfn ug'{kg]{ pkrf/
• glhsdf cGo :jf:Yo sdL{ eP ;xof]usf] nflu t'?Gt vj/ ug]{
• lj/fdLnfO{ afofFtkm{ sf]N6] u/L ;'tfpg]
• lj/fdLsf] jl/kl/ le8 gug]{ / sl;nf] sk8f eP v's'nf] agfO lbg]
• ;'tfpFbf b'a} v'§f 6fpsf] eGbf dfly p7fpg]
• :jf; k|:jf;df cj/f]w eP x6fpg]
• Zjf; k|Zjf; / gf8Lsf] ult hfFr ug]{, d'6'sf] w8sg ;'Gg]
• lj/fdLsf] Carotid Pulse sf] ult 7Ls 5eg] lghnfO{ Anaphylaxis gePsf]
x'g;S5
• Zjf; k|Zjf; /f]lsPsf] ePdf / d'6'sf] w8\sg g;'lgPdf tTsfn s[ltd Zjf; k|
Zjf; k|lqmof (Cardio-Pulmonary Resuscitation) z'? ug]{
Cardio-Pulmonary
Resuscitation
ug]{ ljwL
Anaphylaxis ( AEFI) x'bf ug'{kg]{ Joj:yfkg / pkrf/
• cfjZos k/]df dflysf] pkrf/ bf]x¥ofpg] / pknAw ePdf clS;hg lbg]
• Anaphylaxis ePdf Inj Aderenaline I/M jf S/C lbg] t/ Ps k6sdf )=% ld=ln=
eGbf a9L lbg' x'b}g
• Inj. Adrenaline lbPkl5 Anaphylaxis sf] cj:yfdf l56} ;'wf/ cfpF5
• Inj. Adrenaline lbPsf] !)–@) ldg]6;Dd lj/fdLsf] cj:yfdf s'g} ;'wf/ gcfPdf
Inj Adrenaline bf]x¥ofpg' k5{ / a9Ldf hDdf # k6s lbg ;lsG5
• Inj Adrenaline 1:1000 Micogram concentration df1 ld=ln per Ampoule
df pknAw x'G5
• Inj Adrenaline lbgsf] nflu Insuline lbg] l;l/~h k|of]u ug'{ kb{5 ,of] l;l/~hdf
*) jf %) j6f wsf{ x'G5g\ / Ps wsf{ j/fj/ !=@% o'lg6 x'G5
• lj/fdLnfO{ Inj Hydrocortisone I/M lbg]
• lj/fdL xf];df cfO{;s]kl5 6fpsf] v'§fsf] ;tx eGbf tn u/fpg] /
lj/fdLnfO{ Gofgf] u/fO{ /fVg]
• lrlsT;ssf] lgu/fgL / ;Nnfxdf yk pkrf/ lg/Gt/ ug]{

h'g vf]k af6 o:tf] ePsf] xf], eljiodf k'g M Tof] vf]k lbg x'b}g / of] s'/f
cleefjsnfO{ atfpg' kb{5
 Inj Adrenaline sf] dfqf 0.01mg/kg, / maximum dose 0.5mg

^ jif{ ;Ddsf afnaflnsfsf] nflu

• olb !) wsf{ ePsf] ! ld=ln l;l/Gh ePdf
- )=!% ld=ln= -!%) dfOqmf]u|fd_ l;l/Ghsf] !=% wsf{
• olb *) wsf{ePsf] O{G;'lng l;l/Gh ePdf
- )=!% ld=ln= -!%) dfOqmf]u|fd_ Insulin l;l/Ghsf] !@ wsf{ (12 Unit)
• olb %) wsf{ ePsf] O{G;'lng jf= ! Pd=Pn= l;l/Gh ePdf
- )=!% ld=ln= -!%) dfOqmf]u|fd_ Insulin l;l/Ghsf] * wsf{ (8 Unit)
•  

= ^ b]lv !@ jif{;Ddsf afnaflnsfsf] nflu

olb !) wsf{ ePsf] ! ld=ln l;l/Gh ePdf
- )=# ld=ln= -#))dfOqmf]u|fd__ l;l/Ghsf] # wsf{
olb *) wsf{ ePsf] O{G;'lng l;l/Gh ePdf
- )=# ld=ln= -#))dfOqmf]u|fd_ Insulin l;l/Ghsf] @$ wsf{ (24 Unit)
olb %) wsf{ ePsf] O{G;'lng jf ! Pd=Pn= l;l/GhePdf
- )=# ld=ln= -#)) dfOqmf]u|fd_ Insulin l;l/Ghsf] !^ wsf{ (16 Unit)
 
 !@ jif{ eGbfdflysfafnaflnsfsfsf] nflu
• olb !) wsf{ ePsf] ! ld=ln l;l/Gh ePdf
- )=% ld=ln= -%))dfOqmf]u|fd_ l;l/Ghsf] % wsf{
• olb *) wsf{ ePsf] O{G;'lng l;l/Gh ePdf
- )=% ld=ln= -%))dfOqmf]u|fd_Insulinl;l/Ghsf] $) wsf{ (40 Unit)
• olb %) wsf{ ePsf] O{G;'lng l;l/Gh ePdf
- )=% ld=ln= -%)) dfOqmf]u|fd_Insulin l;l/Ghsf] @^ wsf{ (26 Unit)

 ;fjwfg M of] ;"O{ Ps k6sdf )=% ld=ln= eGbf a9L lbg' x'b}g
 Inj Hydrocortisone sf] pd]/ / dfqf
• ^ dlxgfeGbfsdpd]/sf afnaflnsfsf] nflu @% ldlnu|fd IM
• ^ dlxgfb]vL ^ jif{ ;Ddsfafnaflnsfsf] nflu %) ldlnu|fd IM
• ^ jif{ b]lv !@ jif{;Ddsf afnaflnsfsf] nflu !)) ldlnu|fd IM
• !@ jif{ eGbfdflysf afnaflnsfsf] nflu @)) ldlnu|fd IM
Inj Pheniramine Maleate (Avil) sf] dfqf
• ^ dlxgfeGbf sd pd]/sf afnaflnsfsf] nflu @%) dfOqmf]u|fd
k|lt s]=hL IM (250 microgram/kg IM)
• ^ dlxgfb]vL ^ jif{ ;Ddsf] afnaflnsfsf] nflu @=% ldlnu|fd
(0.5 ml. IM )
• ^ b]lv !@ jif{;Ddsf] afnaflnsfsf] nflu % ldlnu|fd (1 ml. IM )
• !@ jif{ eGbfdflysf] afnaflnsfsf] nflu !) ldlnu|fd (2 ml. IM )
gf]6M Inj. Adrenaline lbP/ lj/fdLsf] ;'wf/ ePdf
Hydrocortisone / Avil lbO{ t'?Gt k|]if0f ug{k5{ .
 P=O{=Pkm=cfO{= ls6 aS;df x'g'kg]
{ cf}ifwLx?sf]
• Injection Adrenaline- 2 Ampoules
;]6
• Injection Hydrocortisone (100 mg)- 2 Vials
• Injection Pheniramine Maleate- 2 Ampoules
• Tab. Paracetamol (500 mg)- 10 Tabs

1
• Inj. Cefotaxime 250 mg – 2 vial

-
fl e t
• Normal Saline/Ringer Lactate- 1/1 bottle each

Lea
• Insulin type Disposable Syringe (having 80 units/ml graduations) - 4 pc or

c ol
• 1ml syringe (with calibrations in 10 parts, each part 0.1 ml)– 4 pc or

roto
ms
• 1ml syringe (with calibrations in 50 parts)– 4 pc or

nt P
For
• Disposable Syringe (3 ml)- 4 pc

tme

ng
• Scalp vein/Butterfly Cannula set- 2 Sets

orti
re a
Rep
• I/V Drip set with Cannula- 2 Sets

FI T
• Cotton wool and Adhesive tape- 1 Each

FI
AE
AE
 Toxic Shock Syndrome sf] Aoj:yfkg

Toxic Shock Syndrome sf] lrGx nIf0f

• vf]k nufPsf] s]xL 306fleq Hj/f] cfpg], afGtf x'g] / kfgL
h:tf] kvfnf nfUg] ePdf Toxic Shock Syndrome ePsf] x'g ;S5
• o:tf] cj:yfdf I/V Drip (Normal Saline or Ringer Lactate) t'?Gt
z'?u/L Broad Spectrum Antibiotic h:t}– Injection Cefotaxime
lbO{ AEFI sf] pkrf/ x'g] s]Gb|df k|]if0f ug'{kb{5 .
(sfo{qmddf x'g] q'6L af6 x'g ;Sg] o:tf 36gf vf]k e08f/0f,
ljt/0f tyf vf]k tof/L ubf{ / nufpFbf ckgfOg'kg]{
;fjwfgLnfO{ s8fOsf ;fy lgjf{x u/]df z'Godf Nofpg ;lsG5
.)
 Inj. Cefotaxime sf] pd]/ / dfqf

• Inj. Cefotaxime: 50 mg/kg per dose IM or IV every 6 h for

7–10 days lbg' k5{ . Ps dfqf z'? ubf{ %) Pd=hL=
k|lt s]=hL=-h:t}M %s]=hL= sf] aRrf eP
%s]=hL=* %) Pd=hL==@%) Pd=hL=_ IM jf
IV lbg' kb{5 .

gf]6M Vein Open ug{ jf IV Fluid lbg sl7g ePdf t'?

Gt IM anibiotics lbO{ k|]if0f ug]{
P=O{=Pkm=cfO{= jf/]
cema9L ;hu xf]cf}+
 vf]k kZrft\ x'g;Sg] cjfl~5t 36gf
(Adverse Events Following Immunization -AEFI)
P=O=Pkm=cfO{= Aoj:yfkg / ;le{n]G;df vf]k sfo{stf{sf]
lhDd]jf/L
• vf]k lbPsf aRrfx?nfO{ vf]k ;]jf kl5 cfwf 306f hlt cjnf]sgsf] nflu /fVg'kb{5 .
• vf]k nufPsf aRrfx?df s]xL lbg;Dd P=O{=Pkm=cfO{= eP gePsf] hfgsf/L dlxnf
:jf:Yo :jo+ ;]ljsfx? dfkm{t cg'udg ug]{ .
• ;fdfGo k|sf/sf cjfl~5t 36gfx? h:t} vf]k lbPsf] 7fpFdf b'Vg], ;'lGgg], Hj/f]
cfpg] ePdf :yfgLo :jf:Yo ;+:yfdf pkrf/ ug]{ .
• uDeL/ k|s[ltsf P=O{=Pkm=cfO{= b]vfk/]df t'?Gt glhssf] :jf:Yo ;+:yf jf
lhNnf :jf:Yo sfof{nodf vj/ ug]{, t'?Gt pkrf/ z'/ ug]{ ;fy} pkrf/df d2t ug]{ ,/ k|
ltj]bg ug]{ .
• ;fdfGo / ulDe/ b'j} k|sf/sf 36gfx?sf] lgoldt tTsfn / dfl;s k|ltj]bg ug]{ .
• k|of]u ePsf] EolS;g efon csf{ ;];g ;Dd ;'/lIft /fVg] .
• P=O{=Pkm=cfO{ pkrf/sf] cf}iflw ls6aS; ;+w} tof/L cj:yfdf /fVg] .
• P=O{=Pkm=cfO{= cg';Gwfgdf vl6g] ;d'xnfO{ 36gfsf] cg';Gwfg / k|ltj]bg tof/
ug{ d2t ug]{ .
 vf]k kZrft x'g;Sg] cjfl~5t 36gfsf]
cg';Gwfg
• :jf:YosdL{n] tTsfn} k|ltj]bg k7fpg' kg]{ cjfl~5t 36gfx?sf]
k|ltj]bg kmf/d cg';f/ dflyNnf] lgsfodf t'?Gt k7fpg' kg]{
• ulDe/ k|sf/sf cjflR5t 36gfsf] dflyNnf] lgsfodf t'?Gt vj/
ug]{ / tt\sfn lhNnf÷:yflgo :t/ af6 cg';Gwfg z'? ug]{
• cfjZostf k/]df P=O{=Pkm=cfO{= ;DaGwL s]Gb|Lo
cg;Gwfg ;ldtLaf6 klg cg';Gwfg x'g]
• cg';Gwfg ubf{ cg';Gwfg kmf/ddf ;Dk"0f{ ljj/0f pNn]v
ug'{kg]{
• ;fdfGo k|sf/sf cjflR5t 36gf ePdf ;f] sf] ljj/0f vf]k /lhi6/
df clen]v /flv dfl;s HMIS 9.3 k|ltj]bg k7fpg]
 cjflR5t 36gfsf] pkrf/÷k|]if0fsf]
k"j{tof/L
• :jf=sf=n] lhNnfsf ;/sf/L, u}/;/sf/L / lghL c:ktfn /
lrlsT;s /x]sf k|fylds :jf:Yo s]Gb|x?sf] ;"lr tof/ ug]{
• cfjZostf cg';f/ tL :jf=;+=df P=O{=Pkm=cfO{=
Joj:yfkg s]Gb| lgwf{/0f ug]{
• P=Pkm=cfO{= Joj:yfkg s]Gb|df ! hgf
lrlsT;snfO{ ;+of]hs tf]Sg]
• k|To]s :jf:Yo ;+:yfdf / vf]ks]Gb| hf+bf
P=O{=Pkm=cfO{= ls6 aS; Aoj:yf ug]{ u/fpg]
• ;j} :jf:YosdL{x? nfO{ AEFI / Aoj:yfkg af/] a]nf
a]nf hfgsf/L u/fpg]
vf]k kZrft x'g;Sg] cjfl~5t 36gf /
;~rf/
vf]k kZrft\ x'g] cjfl~5t
36gf ;DalGw cg';Gwfgsf]
glthf gcfpGh]n cleefjs,
;d'bfo tyf ;+rf/sdL{;+u
/f]uLsf] jf:tjLs l:ytL ;do
;dodf tf]lsPsf] JolQm
dfkm{t hfgsf/L
u/fpg'kb{5 . o:tf JolQmx?
lhNnf jf s]Gb|df tf]lsPsf
x'G5g\ .
cg';Gwfgsf] glthf cfPkl5 dfq
cjfl~5t 36gfsf] jf:tljs
 vf]k kZrft x'g;Sg] cjfl~5t 36gf / ;~rf/
• vf]k kZrft ePsf s'g} klg cjflR5t 36gfsf] oyfy{ ljj/0f
;do–;dodf cleefjs, ;d'bfosf cu'jf / ;/f]sf/jfnf lgsfodf hfgsf/L
u/fpg' kb{5
• ;rf/sdL{n] rf;f] b]vfPdf ltgLx?nfO{ klg jf:tljs hfgsf/L
u/fpg' k5{
o; k|sf/sf] hfgsf/L tf]lsPsf] ! hgf JolQmaf6 dfq lbg'
h?/L x'G5 ,
t;y{ vf]k kZrft x'g;Sg] 36gfsf] jf/]df hfgsf/L lbg x/]s
txdf Ps hgf k|jStf tf]Sg' kb{5 .
vf]k ;]jfnfO{ ;kmntfk"j{s ;+rfng ug{df ;d'bfo, :jf:YosdL{, ;
+rf/sdL{sf] e"ldsf pNn]vgLo x'g] ePsf]n] tL
ju{–;d'bfonfO{ vf]k kZrft x'g;Sg] cjflR5t 36gfsf] jf/]df
 P=O{=Pkm=cfO{=sf] jf/]df hfgsf/L lbg] k|
jStfdf x'g'kg]{ u'0fx?
• vf]k ;]jf ;DaGwL lj:t[t hfgsf/L ePsf],
• vf]k kZrft x'g;Sg] cjflR5t 36gfsf] k|sf/ jf/] 1fg
ePsf],
• vf]k kZrft x'g;Sg] cjflR5t k|sf/sf] 36gf x'g] b/ jf/]
1fg ePsf],
• vf]k gnufpFbf /f]u nfUg ;Sg] hf]lvdsf] b/ jf/] 1fg
ePsf], /
• 36gfsf] jf/]df ;do–;dodf hfgsf/L lnO{ tYout s'/f
:ki6;Fu atfpg ;Sg]
 ofb ug'{xf];\, cleefjs / ;d'bfonfO{ slxNo} klg em'7f]
cfZjf;g lbg' x'b}g
AEFI reporting & Investigation Form
 vf]k nufPkl5 x'g]cj fl~5t 36gf -P=O{=Pkm
=c fO{=_ s f]k|lt j ]bg km
f/d
t Ts fn ul/g]k|lt j ]bg km
f/d
ldlt ; do
-s _ ; fwf/0f lj j /0f
:j f:Y
o;+
: yfs f]gfdM lhNnfs f]gfdM

la/fdLs f]gfd y/M

hG
d ldlt k'?if ÷ dlxnf
cleefj s s f]gfd÷ gft f M
la/fdLs f]k'/ f 7]ufgfMuf=lj =; =÷gu/kflns f÷pk gu/kflns f÷dxf gu/kflns f
j 8f g+
==============6f]n÷ufF p M========================3/ g+
====================km
f]g g+
==========
-v_ k|flj lws lj j /0f
vf]k lbPs f]ldlt M÷ ÷ ÷ nIf0f z '? ePs f]ldlt M÷ ÷ ÷
; do M ; do M
EoflS; g lbPs f]:yfg÷:j f:Y
o;+
: yfs f]gfd / 7]ufgf

EoflS; g lbg]:j f:Y

os dL{
s f]gfd kbM
vf]ks f]gfdM EoflS; g÷3f]n s df ePs f]pTkfbgs t f{n6 g+ = EoflS; g s f]Dofb ; ls g]ldlt M
!_ !_ !_
@ _ @_ @ _
#_ #_ #_
t Ts fn c g'; G
wfg r flxg]-s f/0f_ =================================================================================

c:kt fndf egf{ 5÷5}

g ldlt ÷; do

d[To'e Ps f] 5÷5}
g ldlt ÷; do
k|]if0f ePs f]; :+
yfs f]gfd ; f]lx ; do / s ]G
b| df To; k|s f/s f 36gf
36]s f] 5 -; Vof_÷5} g
k|lt j ]bg ug]{JolQm
s f]gfdM
kbM b:t vt M km
f]g g+ ldlt ÷; doM
gf]6 Mkmf/d k"0f{
?kdf el/; s ]kl5 oyf; So l56f] lhNnf -hg_ :j f:Y o s fof{
n o, If]qLo lgb]{
z gfno,
afn:j f:Yo dxfz fvfdf k7fpg] afn:j f:Y o dxfz fvf / lhNnf -hg_ :j f:Yo s fof{ n os f] K
ofS;
g÷; Dks {g= ===============================================
 vf]k nufPkl5 x'g]cj fl~5t 36gf -P=O{=Pkm
=cfO{=_ s f]cg'; G
wfg km
f/d
cg'; Gwfg ubf{; a}lj j /0fx? :ki6 ; +u eg'{xf]; \ -gk'u ePdf cs f]{kfgfdf n]v Lo; }; fy /fVg'xf]; \_=o; nfO{
lkm
N8 l/kf]6{ / P=O{=Pkm =cfO{= l/kf]6{ ; +
u} km fO{n ug'{xf]; \ . P=O{=Pkm
=cfO{= l/kf]{6 ePs f] @
$ 306fleq
cg'; Gwfg ul/g'kg]{5 .
-s _ ; fwf/0f lj j /0f P=O{=Pkm
=cfO{=s ]z cfO{=l8=gDa/M
+
:j f:Yo ; +
: yfs f]gfd M lhNnfs f]gfd M

la/fdLs f]gfd y/ M
hGd ldlt M k'?if ÷ dlxnf
cleefj s s f]gfd / gft f M
la/fdLs f]k'/ f 7]ufgf Muf=lj =; =÷g=kf=s f]gfd M
j 8f g+
=M 6f]n÷ufF pM 3/ g+
=M ; Dks {km
f]g g+
=M

-v_ EoflS; gs f]lj j /0fM

vf]ks f]gfd / z l//s f]s 'g EoflS; g EoflS; gs f]
vf]k lbPs f] EoflS; g 3f]ns 3f]ns s f]Dofb
efudf vf]k pTkfbg ug]{ Dofb gf£g]
dfqf* t /ls f n6 g+ = n6 g+ = gf£g]ldlt
lbPs f] s Dklg ldlt

* EoflS; gs f]s 'g dfqf lbPs f]xf]; f]pNn]v ug]{h:t }l8=lk=l6=–x]k aL@
, kf]lnof]@OToflb
vf]k lbPs f]ldlt / P=O{=Pkm
=cfO{=; "r gf k|fK
t u/]s f]
P=O{=Pkm
=cfO{=z '? ePs f]ldlt / ; do
; do ldlt / ; do

-u_ k|flj lws lj j /0f M

la/fdLs f]af/]df yk hfgs f/LM
lj ut df vf]k lb+
bf aRr fnfO{s 'g}k|lt lqm
of b]v f k/]s f]lyof]< lyof]÷ lyPg ÷ yfxf ePg lyof]
eg]pNn]v ug'{xf]; \=========
s ]aRr fdf cGo s 'g}Pnlh{5 < 5 ÷ 5g}÷ yfxf ePg
5 eg]pNn]v ug'{xf]; \=========
la/fdLs f]cj :yf Mlgs f]ePs f]÷ s ]lx ; 'wf/ ePs f]÷cj :yf lalu|b}uPs f]
d[To' ePs f]-ldlt , ; do / :yfg _ ===========
36gfs f]lj :t [lt s /0f M

pkr f/s f]lj j /0fM

k|of]uz fnfdf s 'g}cg'; Gwfg ul/Ps f]5< -/ut , lb; f, cflbs f]hfF
r _M 5 ÷ 5}g
olb 5 eg]s ]kQf nfu]s f]5<
kf]i6df6{d ul/Ps f]. 5 ÷ 5}g
olb 5 eg]s ]kQf nfu]s f]5<
s ]; d'bfod}uO{cg'; Gwfg yflnPs f]5< 5 ÷ 5}g

; f]xLvf]k ; ]; gdf b]lvPs f ldNbf h'Nbf 36gfx? -; Vof_===============

vf]k glnPs fdf b]lvPs f ldNbf h'Nbf 36gfx? -; Vof_=============== =

s ]vf]k ; ]; g÷vf]k s ]Gb|df vf]k lbg]t l/s f cj nf]s g ul/ cg'; Gwfg yflnPs f]5 < 5 ÷ 5}g
; f]xLefon af6 s lt hgfnfO{vf]k ; ]j f lbPs f]lyof]=====

s 'g cj :yfdf aRr fnfO{vf]k lbOPs f]lyof]<

klxn]÷ clGtds f]s ]lx dfqf afF ls ePs f]a]nfdf<,
klxn]÷ ; ]; gs f]cGTolt / s ]lx aRRffx? afF ls /x]s f]cj :yfdf<
s 'g l; l/~h k|of]u ul/Ps f]lyof]< ===========k"gMk|of]u ug{ldNg]-Knfli6s ÷Unf; _, ======Ps k6s
k|of]u u/]kl5 km \ofSg]=============P=l8=l; l/~h, =============cGo

olb k"gMk|of]u ug{ldNg]l; l/~h k|of]u u/]s f]ePdf Mlgd{lns [t k|lqm

of x]g'{xf]; \ M
pko'Qm÷ cg'ko'Qm÷ cj nf]s g gul/Ps f]

cg'ko'QmePdf pNn]v ug'{xf]; \M Roflt Ps f]÷ Dofb u'h |]s f]÷ lgd{lns [t gePs f]

:j f:Yo s fo{s t f{n]EoflS; g lbPs f]t /Ls fM pko'Qm÷ cg'ko'Qm÷

cg'ko'QmePdf pNn]v ug'{xf]; \M ==========================================
cj nf]s g gul/Ps f]
s f]N8r ]gs f]Joj :yfkg -s f]N8:6f]/ b]lv k|of]u ul/g]:yfg ; Dds f]_Mpko'Qm÷ cg'ko'Qmcg'ko'Qm
ePdf pNn]v ug'{xf]; \M===============
cj nf]s g gul/Ps f]

s ]EoflS; g lbg' eGbf cuf8LaRr fs f]:j f:Yos f]d'Nof°g ul/Ps f]lyof]<

lyof]÷lyPg÷yfxf ePg
of]:j f:Yo ; +: yfaf6 lj ut #) lbgdf cGo s 'g}P=O{=Pkm =cfO{k|lt j ]bg ePs f]lyof]ls <
lyof]÷lyPg÷yfxf ePg
olb k|lt j ]bg ePs f]eP s lt hgfdf < ==============================
-3_ n]v fhf]v fM
P=O{=Pkm
=cfO{x'gfs f]s f/0fx?s f]; f/f+
; Molb Ps eGbf a9Ls f/0fx? b]lvPdf aS; df lr Gx
nufpg'xf]; \ .
;+of]uj ; 36]s f
s fo{qm
ds f]q'6L EoflS; gs f]k|lt s 'n c; / :ki6 gePs f]
ldNbf]h'Nbf]; d:of
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c; /x? b]lvg' p:t }c; /x? .
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t /Ls fn]gu/]s f] .
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cg'; wfgs f]lgis if{M
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Dalwt .
 cj uL{s [t .
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EoflS; gs f]k|lt s 'n c; /M
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 x'g g; s g].  c; + Dalwt .  cj uL{s [t .
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fl/; M5  5}g olb 5 eg]pNn]v ug'{xf]; \M================

ykpkr f/s f]nflu l; km

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cg'; Gwfgaf6 s fo{s |d ; 'wf/ ug{s fnflu ul/Ps f l; km

fl/; x? M

ª _ cg'; G
wfg s t f{s f]lj j /0fM
cg'; Gwfg s t f{s f]gfdM kbM ; lxM
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cg'; Gwfg z '? ePs f]ldlt / ; doM=====================

cg'; Gwfg ; dfKt ePs f]ldlt / ; doM =======================

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:j f:Yo lgb]{z gfno t yf afn:j f:Yo dxfz fv fdf oyf; So l56f] dfW odaf6 k7fpg' kb{5 .
k|lt j ]bgs f]cfwf/df lhNnf -hg_ :j f:Yo s fof{non]cfj Zos s fo{ug'{kb{5 .
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$= vf]k nufpg' eGbf cufl8 g} w]/} j6f l;l/~hdf vf]k
e/]/ g/fVg ;fy efonsf] lasf]{df EoflS;g tfGg lgl8n
g/fVg]
%= tf]lsPsf] ;"O{ nufpg] :yfg afx]s cGoGq vf]k
 =====;'/lIft efonsf !# lgodx?
&= h]=O{= vf]k 3f]n]sf] ! 306f kl5 sbflk k|
of]u gug]{ .
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(= vf]k ;Fu k7fPsf] 3f]ns dfq ;f] EoflS;g
3f]Ng k|of]u ug]{ .
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3+6f Ps} tfkqmddf /x]sf] z'lglZrt u/]/ dfq
vf]k 3f]Ng]
!!=vf]k ljt/0f / 9'jfgL ubf{ cfO{;Kofs sl08;lg‹
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