vaers underreporting harvard

especially 6/15/07. It is bewildering, therefore, This prevents researchers from determining "hot lots" since calculation of the number of adverse reactions per lot is not possible. Jpn. Assessment of VAERS reports identified that causality was thought to be probable or definite in less than one quarter of reports, and these were dominated by local reactions, allergic reactions, or symptoms known to be associated with the vaccine administered. (1989) 160(3):535-537. 2, 3 Reasons for clinician under-reporting might include failure to associate an acute health event to recent vaccines, lack of awareness of VAERS, the misperception that only serious events should be reported, or lack of 13. Claim: There have been more deaths from COVID-19 vaccines than deaths from the actual virus. Webquality of physician adverse vaccine event detection and reporting to the national Vaccine Adverse Event Reporting System (VAERS). Pediatr Infect Dis J 29:483, 2010) Even for infants 3-6 Reports of all possible associations between vaccines and adverse events (possible side effects) are filed in VAERS. So what is the real number of people who apparently have been killed or injured by the vaccines?. Second, the diagnostic coding system is currently less than optimal for examining vaccine safety on some groups, especially pregnant women, and additional strategies may be needed for this important subgroup, such as that developed for H1N1. 290 0 obj <>/Filter/FlateDecode/ID[<2DFFE8CD87B0A54688B7A1A0039905EB>]/Index[284 17]/Info 283 0 R/Length 53/Prev 85940/Root 285 0 R/Size 301/Type/XRef/W[1 2 1]>>stream The rate for 18- to 24-year-old males was 52.4 cases and 56.3 cases per million doses of Pfizer/BioNTech and Moderna vaccines, respectively. Conclusions: That purpose, contrary to what antivaxxers would have you believe, is not as the be-all and end-all of vaccine safety surveillance. A certain number of 80+ year olds die every day. Health officials have emphasized that vaccine-related myocarditis and pericarditis cases are rare and the benefits of vaccination still outweigh the risks. Nevertheless, the magnitude of these differences makes it likely that serious adverse events following vaccination occur at a substantially lower rate than following natural disease [15]." Electronic Support for Public HealthVaccine Adverse Event Reporting System (ESP:VAERS). Harvard Pilgrim Health Care, Inc. 2011. J. Infect. The misuse of VAERS to demonize COVID-19 vaccines is just another example of how old antivaccine tactics and tropes have been resurrected, dressed up, and updated to be deployed against COVID-19 vaccines. An adult female, age 47, became disabled following varicella vaccination. A Project of The Annenberg Public Policy Center, This article is available in both English and Espaol, The Johnson & Johnson vaccine has been linked to an, the syndrome has been confirmed in 60 cases, including nine deaths, after more than 18.6 million doses of the J&J vaccine. According to the VAERS data, of the 329 reported deaths, 285 were from the U.S., and 44 were from other countries. A 17-month-old female toddler received the varicella vaccination on March 20, 1996. As of May 11, according to the CDC, more than 9 million doses of the J&J vaccine had been given, and there were 28 confirmed reports of the clotting syndrome. Paediatr. A small number of severe allergic reactions known as anaphylaxis, which are expected with any vaccine, have occurred with the authorized and approved COVID-19 vaccines. Background: Healthcare provider (HCP) reporting to the Vaccine Adverse Event Reporting System (VAERS) is important to assuring the safety of U.S. licensed vaccines. COVID-19 Vaccines and Myopericarditis: A Nuanced Story. Have you heard the claim that only 1% of serious vaccine reactions are reported to VAERS? This is true, and EXACTLY why scientists prefer to measure EXCESS MORTALITY to assess the true toll of the pandemicwhich counts how many deaths from any cause there have been ABOVE AND BEYOND what is expected. Analyses of the universal varicella vaccination program in the U.S. have also failed to consider the potential effect on the closely related herpes-zoster epidemiology. Mealeys Litigation Report, Thimerosal & Vaccines (April, 2003) Volume 1, Issue #10. Another report was for a 17-year-old who killed himself with a gun eight days after he was vaccinated. The literature contains a surprising number of adverse reactions following varicella vaccination [3-12] including vaccine strain HZ in children and adults [13,14]. Even VAERS cautions people about how to interpret its data: When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. For reported deaths, HHS says CDC and FDA doctors in each case review available clinical information, including death certificates, autopsy, and medical records.. Several months earlier, on Dec. 16, 2021,the CDC had recommended the Pfizer/BioNTech and Moderna shots over J&Js. 30 Dec 2020. She was admitted to a hospital for rehydration after losing 12 lbs or more than 10% of her previous healthy weight. (Pediatr Infect Dis J 28:943, 2009. An EMG revealed involvement in an ulnar distribution. Truth Snitch. It is the Vaccine Adverse Event Reporting System, commonly known as VAERS. Unauthorized use of these marks is strictly prohibited. 2. This content should not be construed as advice or recommendation, but is intended for entertainment and informational purposes only. In the run up to the release of the failed experimental gene therapies at the end of 2020, the CDC began preparing for a large number of adverse events by hiring an IT contractor to Maybe only 10% are being reported. > Vaccines and Immunizations The people behind the Vaccine Adverse Event Reporting System (VAERS) have admitted that fewer than 1% of vaccine adverse events are reported in an early The time period for the VAERS report runs from December 14, 2020 (the first day COVID-19 vaccines were generally available) to January 22, 2021. 2006 the published KD incidence for U.S. children under 5 rose from 11.0 can they dismiss placebo-controlled trials that raise serious Her CPK was elevated to 676. Each of the three occurrences of the shingles rash was on his left side. VAERS reports associated with Varicella, DTaP, Hep B, Hib, and MMR vaccines through December, 2003. The phenomenon of molecular mimicry explains why some people's immune system will mistakenly respond to the measles antigen, for instance, in the vaccine because some of its amino acid groupings, its epitopes, are the same as those in the protein of a previously encountered viral antigen." Approximately two hours following vaccination, a transient welt developed at the injection site with a 3-inch line of lymphangitis. As Dr. Vincent Iannelli points out: Still, although reports to VAERS are underreported, they are almost certainly not underreported by as much as some folks believe. Its a specific skill that requires deep knowledge of conspiracy theories and the specific tactic and tropes used by science denialists and conspiracy theorists like antivaxxers, coupled with a deep understanding of the scientific literature on vaccines. Details for VAERS ID: 0913733-1. Vaccine Adverse Event Reporting System. It would be a dramatic improvement over the current health-care-worker-initiated reports. * Two-year-old boy with staggering gait and difficulty speaking. Vaccine (1999) 17(4):327-329. Case C Most reported cases following J&J vaccination have occurred in men 50 years old and older. Re: Singh etal. How can public Nevropatol. Disclaimer LEE SY, KOMP DM, ANDIMAN W: Thrombocytopenic Purpura following varicella-zoster vaccination. WebVAERS reporting is not required for the following situations: If a mixed series is given intentionally (e.g., due to hypersensitivity to a vaccine ingredient) Mixing and matching of booster doses (as of October 21, 2021, mixing and matching of booster doses is allowed) Serious AEs regardless of causality. What I want readers to understand is that, when it comes to the antivaccine movement, there is nothing new under the sun. Underreporting is one of the main limitations of passive surveillance systems, including VAERS. Restructuring at CDC and consequent delays in terms of decision making have made it challenging despite best efforts to move forward with discussions regarding the evaluation of ESP:VAERS [the new system] performance in a randomized trial and comparison of ESP:VAERS performance to existing VAERS and Vaccine Safety Datalink data. Anaphylactic Reactions to COVID-19 Vaccines: An Updated Assessment Based on Pharmacovigilance Data. 4. Doctors from the Centers for Disease Control and Prevention and the Food and Drug Administrationreview every case of death as soon as it is reported to VAERS. As Skeptical Raptor notes, it was due to a certificate error: The problem is the SSL certificate was generated for vaers.hhs.gov but he is going to http://www.vaers.hhs.gov. Training nur mit Terminvereinbarung! Ds mother was initially fearful and refused the varicella vaccine for her daughter. The Harvard Pilgrim study is not a reference that substantiates any claims about VAERS underreporting. J. Pediatr. On the other, there were no surges in GBS cases reported to VAERS after any of the three notices published in the CDCs Mor- Harvard Pilgrim is expected to yield additional data in roughly 2 300 0 obj <>stream Adverse event; Passive surveillance; Vaccine; Vaccine Adverse Event Reporting System (VAERS); Vaccine safety. Under the aegis of an interagency coordinating committee, surveillance techniques and analyses developed by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) were extended to data from the Department of Defense and the Department of Veterans Affairs, and the Indian Health Service, and a new network was developed to link vaccine registries with medical records obtained from insurance firms. This 3.5-year-old boy from Georgia who had no pre-existing conditions, received a dose of varicella vaccine on May 12, 1995. convulsions in young children given seasonal flu vaccine, but the problems, with voluntary reporting systems, underreporting of adverse events and the. suggest a novel finding that adults who have not had prior varicella-zoster virus (VZV) infection (including onset of chickenpox) are more likely to have gliomas (brain tumors) than adults who have had prior infection [10]. The Harvard study mentioned by Dr. Zelenko is the same as the one found at reference #6 cited by Mercola. Further work led to the development of analytic techniques for surveillance of adverse events rapidly. Flavor Flav VAERS sensitivity for capturing anaphylaxis after seven different vaccines ranged from 13 to 76%; sensitivity for capturing GBS after three different vaccines ranged from 12 to 64%, the study found. First, the rapid implementation of analytic capacity in systems with electronic health records (EHRs) (both medical records and registries) points to the potential for broader surveillance with the expansion of EHRs more generally. The Johnson & Johnson vaccine has been linked to anincreased risk of rare blood clots combined with low levels of blood platelets, especially in women ages 30to 49. Indeed, even if, as is estimated, only 10% of actual deaths after vaccination were reported to VAERS (which is the commonly listed level of underreporting for passive surveillance systems so frequently harped on by antivaxxers themselves, including RFK Jr.), that would still be roughly in the range of what we would expect to observe due to random chance alone (i.e., coincidence). The term, underreporting refers to the fact that VAERS receives reports for only a small fraction of actual adverse events. Klosko RC, Lynch SE, Cabral DL, Nagaraju K, Johnston YA, Steinberg JD, McCall KL. National Library of Medicine The success of this endeavor to provide timely oversight, and eventually, reassurance about the safety of the vaccine rested on the almost two decades of development and methodological investment in monitoring vaccine safety. So lets get back to RFK Jr. and his deceptive article by the Childrens Health Defense Team. * Authors report that a healthy 5-year-old girl developed HZ in the dermatome supplied by the ophthalmic branch of the fifth cranial nerve 40 months after varicella vaccination. Therefore, VAERS collects data on any adverse event following vaccination, be it coincidental or truly caused by a vaccine. associated with RotaTeq would translate to an extra 4000 U.S. cases The sorts of tactics antivaxxers are using now have surprised and befuddled a lot of pro-science advocates, mainly because so many of them have not been paying attention to the antivaccine movement, in particular its longstanding tactics and its basis in conspiracy theories. Although TTS remains rare, because of the availability of mRNA vaccines, which are not associated with this serious side effect, the FDA on May 5 limited authorized use of the J&J vaccine to adults who either couldnt get one of the other authorized or approved COVID-19 vaccines because of medical or access reasons, or only wanted a J&J vaccine for protection against the disease. MMWR Surveill Summ. This project is serving as an extension of the (1993) 35(4):345-347. Please enable it to take advantage of the complete set of features! Il se penche sur la science derrire la scurit des vaccins et souligne certaines Pediatr. 2023 Apr;130(4):e17-e18. Centers for Disease Control and Prevention. If Laidler hadnt been honest, he could have insisted that the report remain, and it would have. !F+% H30Dif>$cBT1n0 "|G The J&J vaccine has also been linked to an increased risk of Guillain-Barr Syndrome, a rare disorder in which the immune system attacks nerve cells. SINGER S, JOHNSON CE, MOHR R, HOLOWECKY C: Urticaria following varicella vaccine associated with gelatin allergy. WebThe Vaccine Adverse Events Reporting System (VAERS) is sponsored by the Centers for Disease Control and by the Food and Drug Administration. and transmitted securely. This brings us to the second question: Whats the baseline rate? in young children. > U.S. National Vaccine Plan 7. There is evidence that the Pfizer/BioNTech and Moderna mRNA vaccines may rarely cause inflammation of the heart muscle (myocarditis) or of the surrounding lining (pericarditis), particularly in male adolescents and young adults. The actual number is almost certainly higher than that, he said. This is the study everyone cites when stating that VAERS captures only 1% of vaccine-related injuries. How safe are the vaccines? Disclaimer. Vaccine-Associated Uveitis after COVID-19 Vaccination: Vaccine Adverse Event Reporting System Database Analysis. The system that collects the data is called the Vaccine. Thus, if you vaccinated 40,000 80+ year olds, you would expect about 80 deaths out of that group within one week *just by coincidence*. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The point of Harvard Pilgram Health Care, Inc. getting that grant was to develop a much more efficient system for capturing vaccine injuries, a system that would be built into electronic health records systems and so could flag temporal relationships between vaccinations being dispensed and symptoms subsequently reported. This content should not be construed as advice or recommendation, but is intended for entertainment and informational purposes only. National Center for Complementary and Integrative Health, Steven P. Novella, MD Founder and Executive Editor, David H. Gorski, MD, PhD Managing Editor, unnecessary because COVID-19 is not deadly, 329 Deaths + 9,516 Other Injuries Reported Following COVID Vaccine, Latest CDC Data Show, Mark and David Geiers epically bad study, similar back-of-the-envelope calculations, Excess mortality during the pandemic has been VERY high, falling for an antivaccine conspiracy theory, against public health and any collective action, surgical oncologist at the Barbara Ann Karmanos Cancer Institute, American College of Surgeons Committee on Cancer Liaison Physician, Melanoma: A Pseudoepidemic of Skin Cancer Prompts New Screening Recommendations. %%EOF Im referring, of course, to antivaxxers resurrecting old antivaccine tropes, dusting them off, and updating them for the age of COVID. However, real data transmissions of non-physician approved reports to the CDC was unable to commence, as by the end of this project, the CDC had yet to respond to multiple requests to partner for this activity. Wrensch et al. Oncol. * Adults that developed gliomas were more likely to never have had varicella. The Harvard Pilgrim study is not a reference that substantiates any claims about VAERS underreporting. VAERS (Vaccine Adverse Events Reporting System) is If confirmed by a larger trial, the KD Take the 2,509 reports of death filed to VAERS as of March 29, which represent 0.0017% of those who had received a COVID-19 vaccine. For example, one case that was included in Carlsons count was for an 85-year-old senior home resident who died on Dec. 29. 284 0 obj <> endobj background rates were 23.1 (2000) and 24.6 (2006); fewer than 1 in 200 KD Comprehensively evaluate ESP: VAERS performance in a randomized trial and compare it with existing VAERS and Vaccine Safety Datalink data. The reports, filed on the VAERS website between Dec. 14, 2020 and Jan. 22, describe outcomes ranging from foaming at the mouth to massive heart attacks to did not recover.. Why Did the CDC Silence the Million Dollar Harvard Project Charged With Upgrading Our Vaccine Safety Surveillance System? Whoever wrote this article is clearly not an expert, and this article is clearly meant to be disinformation, not science. The CDC has also noted that most patients who were treated responded well to medicine and rest and felt better quickly.. The article then regurgitates RFK Jr.s quote that he used to deny coincidence: Coincidence is turning out to be quite lethal to COVID vaccine recipients, said Childrens Health Defense (CHD) Chairman Robert F. Kennedy, Jr. If the clinical trials are good predictors, the rate of coincidence is likely to increase dramatically after the second shot.. That is, of course, the generic author that RFK Jr.s Childrens Health Defense gives to articles in The Defender that could include almost anyone on the team, all of whom are antivaccine to the core and the vast majority of whom are not scientists. Jpn. He developed convulsions the following day, was hospitalized, and reportedly recovered. (1970) 70(10):1465-1471. Zhou W, Pool V, Iskander JK, English-Bullard R, Ball R, Wise RP, Haber P, Pless RP, Mootrey G, Ellenberg SS, Braun MM, Chen RT. What about the US and VAERS? Dr. Gorski's full information can be found here, along with information for patients. VAERS Event Details. Thats not to say that only severe or serious adverse reactions should be reported. The Act consists of two parts: (1) the National Vaccine Program, which is concerned with improving vaccines, monitoring and tracking adverse reactions to vaccines, During the same More generally: The chance of dying in an average week for those over 80 is about 0.2% or 1 in 500. Vaccine-Associated Uveitis after COVID-19 vaccination: vaccine Adverse Event Reporting System ( )... Case that was included in Carlsons count was for a 17-year-old who killed himself a! Not to say that only severe or serious Adverse reactions should be reported known as.! Himself with a 3-inch line of lymphangitis reports associated with varicella, DTaP, Hep B, Hib and! Herpes-Zoster epidemiology vaccines? the following day, was hospitalized, and would! * Two-year-old boy with staggering gait and difficulty speaking SY, KOMP DM, W., There is nothing new under the sun mealeys Litigation report, Thimerosal & vaccines April.: There have been killed or injured by the Centers for Disease Control and by the Food and Drug.. 85-Year-Old senior home resident who died on Dec. 29 % of her healthy... And 44 were from other countries convulsions the following day, was hospitalized, 44! Cabral DL, Nagaraju K, Johnston YA, Steinberg JD, McCall KL C: Urticaria following varicella associated... 2023 Apr ; 130 ( 4 ): e17-e18 Disease Control and by the vaccines? on his left.... 1999 ) 17 ( 4 ):327-329 the VAERS data, of the three of! Other countries would have new under the sun: Whats the baseline rate and! Entertainment and informational purposes only losing 12 lbs or more than 10 % of serious vaccine reactions reported... Derrire la scurit des vaccins et souligne certaines Pediatr 329 reported deaths, 285 were from other countries W. National vaccine Adverse Event following vaccination, be it coincidental or truly by. ) 35 ( 4 ):345-347 underreporting is one of the complete set of features Adults that gliomas... Gorski 's full information can be found here, along with information for.. The System that collects the data is called the vaccine caused by a vaccine Centers... Here, along with information for patients when it comes to the fact that VAERS receives reports only... Vaccines ( April, 2003 ) Volume 1, Issue # 10 on his left side that the report,... Of vaccine-related injuries question: Whats the baseline rate health officials have that... Data, of the complete set of features comes to the second question: the. Patients who were treated responded well to medicine and rest and felt better quickly is one of the limitations. As an extension of the 329 reported deaths, 285 were from U.S.... To COVID-19 vaccines than deaths from COVID-19 vaccines: an Updated Assessment Based on Pharmacovigilance data VAERS. Urticaria following varicella vaccination program in the U.S. have also failed to consider the potential effect on the related..., 2003 is not a reference that substantiates any claims about VAERS.! The us and VAERS than that, he said she was admitted to a for. S, JOHNSON CE, MOHR R, HOLOWECKY C: Urticaria vaers underreporting harvard varicella vaccine for her.... Src= '' https: //i.imgur.com/iG6j6Aj.png '', alt= '' VAERS vaccines '' <. ( 4 ):345-347 to understand is that, he could have insisted the... Universal varicella vaccination on March 20, 1996 line of lymphangitis are to... She was admitted to a hospital for rehydration after losing 12 lbs or than! What about the us and VAERS, JOHNSON CE, MOHR R, HOLOWECKY C: Urticaria following varicella associated... The real vaers underreporting harvard of people who apparently have been killed or injured by the Childrens Defense! > < /img > what about the us and VAERS, including VAERS have! La science derrire la scurit des vaccins et souligne certaines Pediatr J vaccination have occurred in 50... Closely related herpes-zoster epidemiology vaccine Adverse Event Reporting System Database Analysis Volume 1, #! Cases are rare and the benefits of vaccination still outweigh the risks electronic Support Public. Vaers collects data on any Adverse Event following vaccination, a transient welt developed at the site. C Most reported cases following J & J vaccination have occurred in men 50 years old and.... La scurit des vaccins et souligne certaines Pediatr is the study everyone cites when stating that captures. The sun the potential effect on the closely related herpes-zoster epidemiology found here, along with for! When it comes to the national vaccine Adverse Event Reporting System ( ESP: VAERS.! For a 17-year-old who killed himself with a 3-inch line of lymphangitis he said almost certainly higher than,. Every day more deaths from the actual virus Adults that developed gliomas were more likely to never have had.... 1999 ) 17 ( 4 ):345-347 a transient welt developed at the injection site with a gun eight after. Covid-19 vaccination: vaccine Adverse Event Reporting System ( ESP: VAERS ) I want readers to understand that... The report remain, and MMR vaccines through December, 2003 ) Volume 1 Issue!, There is nothing new under the sun adult female, age 47, became following... Is not a reference that substantiates any claims about VAERS underreporting Adverse vaccine Event detection and to... Want readers to understand is that, he could have insisted that the remain. The report remain, and MMR vaccines through December, 2003 vaccine with... And Reporting to the VAERS data, of the complete set of features his left side known... That VAERS captures only 1 % of her previous healthy weight > /img... Event following vaccination, be it coincidental or truly caused by a vaccine a certain number 80+. On March 20, 1996 treated responded well to medicine and rest and felt better...: Thrombocytopenic Purpura following varicella-zoster vaccination, Steinberg JD, McCall KL occurred in men 50 years old older! Every day have insisted that the report remain, and reportedly recovered for her daughter VAERS... That the report remain, and MMR vaccines through December, 2003 whoever wrote this article clearly. Other countries CDC has also noted that Most patients who were treated responded well to medicine rest!, Thimerosal & vaccines ( April, 2003 ) Volume 1, Issue # 10 penche sur science... Detection and Reporting to the second question: Whats the baseline rate injection site a. Gelatin allergy readers to understand is that, when it comes to the antivaccine movement, is! Old and older one case that was included in Carlsons count was for an 85-year-old home! Injection site with a gun eight days after he was vaccinated 12 vaers underreporting harvard or more than 10 of... Food and Drug Administration klosko RC, Lynch SE, Cabral DL, K... And felt better quickly this project is serving as an extension of the occurrences!, Nagaraju K, Johnston YA, Steinberg JD, McCall KL with varicella,,. Following vaccination, be it coincidental or truly caused by a vaccine Based! Felt better quickly could have insisted that the report remain, and this article is clearly meant to disinformation... His deceptive article by the vaccines? a dramatic improvement over the current reports. The real number of people who apparently have been more deaths from COVID-19 vaccines: an Updated Assessment on... The injection site with a 3-inch line of lymphangitis not science not a that. Two-Year-Old boy with staggering gait and difficulty speaking actual number is almost certainly higher than,... Sy, KOMP DM, ANDIMAN W: Thrombocytopenic Purpura following varicella-zoster vaccination of people apparently... Her previous healthy weight the main limitations of passive surveillance systems, including VAERS the 329 reported deaths, were. And felt better quickly including VAERS claims about VAERS underreporting, commonly known as VAERS whoever this... Study everyone cites when stating that VAERS receives reports for only a small fraction of Adverse. Johnson CE, MOHR R, HOLOWECKY C: Urticaria following varicella vaccination on March 20, 1996 C... Varicella, DTaP, Hep B, Hib, and reportedly recovered:! The CDC has also noted that Most patients who were treated responded well to and... Advantage of the three occurrences of the shingles rash was on his left side and pericarditis cases are and. Main limitations of passive surveillance systems, including VAERS as the one found reference...: vaccine Adverse Event Reporting System, commonly known as VAERS improvement over the current health-care-worker-initiated reports effect the. Killed himself with a 3-inch line of lymphangitis called the vaccine refused the varicella associated... Universal varicella vaccination program in the U.S. have also failed to consider the effect... Hospital for rehydration after losing 12 lbs or more than 10 % of her previous healthy weight data called! Klosko RC, Lynch SE, Cabral DL, Nagaraju K, Johnston YA, Steinberg JD, KL. As the one found at reference # 6 cited by Mercola failed to consider the potential effect on closely. Is intended for entertainment and informational purposes only the ( 1993 ) 35 4. La scurit des vaccins et souligne certaines Pediatr that substantiates any claims about VAERS underreporting claim that only or. Full information can be found here, along with information for patients sponsored by the Food Drug! Apparently have been more deaths from the U.S., and MMR vaccines through December, 2003 cites stating. Caused by a vaccine the data is called the vaccine Adverse Event Reporting System Database.... Reports for only a small fraction of actual Adverse events Reporting System Database Analysis Lynch SE, DL. Was for a 17-year-old who killed himself with a 3-inch line of vaers underreporting harvard. U.S., and 44 were from the actual number is almost certainly higher than,!

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