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Erythritol Intake Form

Did you or a loved one suffer a cardiovascular event (e.g., heart attack, blood clot, or stroke) after regularly eating or drinking products that contain erythritol?

Personal Information (for you or your loved one)

Name:
What cardiovascular event did you or your love one suffer?
Please provide details and how much was consumed.
If yes, what diet?

Family History

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Thank you very much for providing this information.
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