Patent Application
20230321352
The present invention relates to a simplified drug preparation and drug delivery device. The device allows connecting one or more receptacle(s) of primary constituents to a fluid circuit in an automated manner.
The fluid circuit of the invention allows performing a reconstitution and/or an injection of the drug contained in constituent receptacles. Furthermore, the automated device according to the invention can activate electronic functions for starting the drug preparation and drug delivery mechanism and possibly the connection of the power supply battery for example.
Conventionally, the reconstruction of drug requires two vials (one for a lyophilized drug and one for a diluent), a syringe and two needles. This requires training and experience. Therefore, a patient might be at risk of under or overdosing in the event of improper use or mishandling, which might be dramatic depending on the reconstituted drug. Manufacturers will sometimes fill the vials with excess up to 35% in order to compensate for drug losses due to the inability to recover the entire dose, this might lead to excessive or inaccurate dilution prior to administration to the patient.
Some existing products can provide professionals and non-professionals with safe, practical and easy-to-use systems to reconstitute and administer injectable formulations. These systems are provided either as versatile solutions or as components for specialized use. Many reconstitution systems can be customized to currently marketed drugs without changing the manufacturing processes or the packaging components.
They are provided in the form of total systems that can be packaged with filled drug vials and reconstitution components. In general, these systems consist of a plastic device that connects a drug vial to a diluent receptacle, which may be a prefilled syringe, a vial or an infusion bag. However, these solutions do not allow addressing problems of use under difficult conditions for the user, or for non-trained users, and possibly for which the preparation of an injection remains too complex (pediatrics, geriatrics, disabilities, etc.).
To solve this problem, a second approach has emerged with the development of dual chamber syringes that provide a lyophilized drug and a diluent in a single unit. The reconstruction is achieved by pressing on the plunger of the syringe, forcing the diluent through a channel and into the second chamber, where it mixes with the drug to create a solution. Afterwards, the drug may be injected with an attached needle or may be transferred via a so-called Luer connection. These systems offer many advantages for the end user but are nevertheless not very widespread given regulatory and industrial impacts as regards production methods related to this new primary receptacle. The involvement of the patient on a delicate gesture implies a new risk of preparation error.
Thus, the document EP2822526 is known disclosing a drug reconstitution device comprising a disposable liquid transfer unit and a reusable control and drive unit removably connectable to the liquid transfer unit, the liquid transfer unit comprising a housing, a docking interface configured to couple first and/or second constituent element receptacles to the housing, and a pump motor and a fluid flow circuit configured to transfer liquid from the first constituent element receptacle to the second constituent element receptacle. The control and drive unit comprises a pump drive configured to drive the pump motor during a liquid transfer action, the pump drive comprising a transmission output coupling removably engaged with a transmission input coupling of the pump motor when the liquid transfer unit and the control and drive unit are connected. However, this described solution is a preparation platform, which requires recovering the primary receptacle in which the drug has been reconstituted and subsequently using a syringe for carrying out the transfer. This device requires that the user inserts the receptacles by himself into the device: i.e. he applies a sufficiently strong force to pierce the septa, inserts the receptacles in the correct order, then activates the device. If the reconstitution is automated, ignition and final administration still involve human intervention.
An alternative is also offered by the document EP2654938 which discloses a device for mixing at least two constituents originating from at least two separate reservoirs. It comprises at least two distinct orifices able to be connected to said reservoirs, a motor pump, a fluid selector comprising at least one network of through channels able to communicate at least one of said orifices and said pump, said fluid selector being arranged so as to be movable between several positions to selectively allow, by means of said pump, a transfer of at least one constituent from one orifice to the other orifice or to said pump and a mixing of said obtained mixture. This system does not address the technical problems that might be caused by a self-injector device preloaded for a long period of time before use thereof on a patient.
Hence, there is no device addressing the need for automation of the reconstitution and allowing for a reliable fluidic mixing with the strict minimum intervention of the user.
Nor is there any device that is compatible with any combination of receptacles while enabling control of the speed, the time and the fluidic mixing. Indeed, under some particular conditions such as pathologies related to medical emergencies (anaphylactic shock, epileptic seizures, myocardial infarction, cerebrovascular accident) may be sought to reduce the preparation times in order to limit errors or improper uses related to stress and/or to improve the performance through a time saving when taking care of the patients.
A device enabling the automation and the standardization of the preparation and administration of drugs, using primary receptacles in a “so-called ready-to-use preloaded” state, simple to use by reducing the human action to its strict minimum, is not disclosed by the prior art.
The present invention has been developed in order to solve the aforementioned problems. Thus, the invention relates to a drug preparation and drug delivery device comprising a drug preparation unit comprising at least two receptacles able to contain constituents to be mixed, at least one of the receptacles being movable in said drug preparation unit, a means for administering the drug, such as an injection or spray means, a fluid circuit able to fluidly connect the at least two receptacles and the administration means, the connection of the fluid circuit with the at least two receptacles being done by means of at least two piercing means when said at least two receptacles move from an initial position to a position of contact with said at least two corresponding piercing means, an electromechanical assembly for fluidly driving the constituents within the fluid circuit, the electromechanical assembly (900) being able to activate the fluid circuit (700, 700′), by means of a motor pump (710). The present invention being characterized in that said drug preparation unit comprises a release mechanism comprising a compressed drive spring which, when it is released, is able to generate a movement according to an axis A1 of at least one of the movable receptacles towards at least one of said piercing means to create the fluid connection with the fluid circuit.
Thus, the device according to the invention allows for a viable technological offer regardless of the type of receptacle used.
Furthermore, it is known that the connection of a receptacle to a fluid circuit might be difficult for users with low dexterity, for example injured, ill or old persons, because the fluid connection throughout a needle might require significant force. In the present invention, the device is designed so as to simplify the action of the user and reduce the force or torque required to cause the fluid connection.
In a preferred embodiment, the drug preparation and drug delivery device according to the invention further comprises a motor pump connected to said fluid circuit for circulating at least one of the constituents in said fluid circuit once the fluid connection is created.
Preferably, the drug preparation and drug delivery device according to the invention is such that, the drug preparation unit comprises: a cradle comprising a first planar wall perpendicular to an axis A1 parallel to the movement of said receptacles and, a carriage movably mounted in said drug preparation unit and abutting on the at least one of the receptacles, said carriage comprising a second planar wall parallel to the first planar wall of the cradle, said drive spring being compressed between said first planar wall of the cradle and said second planar wall of the carriage so that the release of the compressed drive spring moves the at least one receptacle by means of the carriage towards at least one of said piercing means.
Thus, the prior art generally uses prefilled syringes, making the presence of a fluidic system unnecessary because the prefilled syringe is the fluidic system. The invention allows preserving the quality of the drug in the receptacle until the time of reconstitution. Said reconstitution being obtained thanks to the movable carriage enabling the movement of the receptacle towards the fluid circuit only when necessary.
In another preferred embodiment, the drug preparation and drug delivery device according to the invention is such that the release mechanism comprises: a receptacle support extending in the direction A1 coaxially with the compressed drive spring, said support comprising at least two elastic means for fastening said receptacles, an intermediate part removably securing the receptacle support to the compressed drive spring, said attachment being done using an elastic clamp belonging to the receptacle support and elastically retaining a first push rod belonging to said intermediate part, so that the force exerted by the spring necessary to detach the intermediate part and the receptacle support is greater than or equal to the force necessary to move at least one of the movable receptacles.
Therefore, the at least two receptacles carried by the receptacle support are first moved simultaneously and then, once the fluid connection has been obtained, detachment can take place.
In a preferred embodiment, at least one of the two receptacles is closed by a shutter able to move under the effect of an external push in order to expel its constituent, and wherein, said intermediate part comprises a second push rod extending parallel to the thrust axis A1 of the receptacles along said axis A1 of the shutter 620 in order to exert a force on said shutter 620 after detachment between the intermediate part 460 and the receptacle support 450.
The push on the stopper after detachment allows assisting with emptying the constituent contained in the receptacle with a shutter. Above all, by using carpules as receptacle, the reconstitution is possible independently of the orientation of the device while enabling a fluid mixing and not a simple transfer of constituents.
According to another preferred embodiment, the drug preparation and drug delivery device according to the invention comprises an activation unit able to occupy an inactive position in which the compressed drive spring is held and an active position in which the compressed drive spring is released. Thanks to the device according to the invention, in a single action, it is possible to obtain the fluid connection and the electronic activation enabling the reconstitution and possibly the distribution. This complete automation is particularly suited to emergency applications or use in a stress situation, and possibly to use by persons with disabilities.
In an alternative according to the invention, the drug preparation and drug delivery device is such that the activation unit comprises a retaining element able to be driven by said activation unit from a position for holding the spring in its compressed state to a position for releasing the spring, said position for releasing the spring being obtainable by a rotation or a translation of said activation unit by a user. This allows for an easier activation because it requires a minimum of effort and operations.
In another embodiment, the drug preparation and drug delivery device according to the invention is such that the activation unit comprises an electronic board provided with an optical, magnetic or contact type electronic switch, able to wake up the electromechanical assembly for motorized driving of the pump.
Thus, in a single action, it is possible to obtain the fluid connection and the electronic activation enabling the reconstitution and possibly the delivery.
According to another embodiment, the drug preparation and drug delivery device according to the invention is such that the fluid circuit comprises a network of fluid channels extending in a plane and connected to the at least two receptacles and the administration means via channels to reduce bulk in the device.
According to one alternative, the drug preparation and drug delivery device according to the invention is such that the fluid circuit comprises a network of fluid channels extending at the periphery of a central part so as to also reduce bulk and reduce the dead volumes in the fluid path.
According to a preferred embodiment, the drug preparation and drug delivery device according to the invention is such that a first assembly including the fluid circuit, the at least two receptacles and the administration means is disposable whereas a second assembly including the release mechanism, the motor pump and the electromechanical assembly (900) for driving thereof is reusable.
This allows for a high modularity in terms of use since the disposable assembly can be designed as a consumable that is associated with the reusable assembly.
According to a preferred embodiment, the drug preparation and drug delivery device according to the invention is such that it comprises a fluid selector able to selectively connect the at least two receptacles (600) and the administration means (721).
The invention also relates to a method for automated preparation and delivery of a drug using a device as described before, the method comprising the following steps: providing a drug preparation unit comprising at least two receptacles, one comprising a drug in a hydrated or dehydrated form and the other one a solvent, providing a means for administering the drug, such as an injection or spray means, providing a fluid circuit able to fluidly connect the at least two receptacles and the administration means, the connection of the fluid circuit with the at least two receptacles being done by means of at least two piercing means when said at least two receptacles move from an initial position to a position of contact with said at least two corresponding piercing means, providing an electromechanical assembly for fluidly driving the constituents within the fluid circuit, characterized in that the automated preparation and the delivery of the drug comprises the release of a release mechanism comprising a compressed drive spring which, when it is released, generates a movement according to an axis A1 of at least one of the movable receptacles towards at least one of said piercing means to create the fluid connection with the fluid circuit.
According to a preferred embodiment, the method for automated preparation and delivery of a drug according to the invention comprises a step in which electronic activation causes the fluidic drive of the constituents within the fluid circuit and the administration of the drug.
Thus, in a single action, it is possible to obtain the fluid connection and the electronic activation enabling the reconstitution and possibly the delivery. This complete automation is particularly suitable to emergency applications or use in a stress situation, and possibly to use by persons with disabilities.
According to another preferred embodiment, the method for automated preparation and delivery of a drug according to the invention comprises a step in which the electronic activation is done during the movement of at least one of the movable receptacles by means of a switch over the movement path of said receptacles.
Thus, in a single action, it is possible to obtain the fluid connection and the electronic activation enabling the reconstitution and possibly the delivery.
Hence, the invention allows standardizing drug preparation and injection operations in order to ensure the safety of the patient, the quality of the reconstitution, and limit the costs/loss and waste of pharmaceutical active ingredients. It has a particular interest for products sensitive by their instability in liquid form, and having to be reconstituted rapidly before injection: this kind of device allows dividing the preparation time before injection by at least three.
The automation thus obtained allows for a greater reliability of the operation, limiting product losses, bringing the treatment closer to the patient by allowing doing without caregivers and administering the treatments at home for example.
In the present invention, the terms hereinbelow are defined as follows:
The invention will be better understood, and other aims, details, features and advantages thereof will appear more clearly upon reading the following detailed explanatory description of embodiments of the invention provided as purely illustrative and non-limiting examples, with reference to the appended schematic drawings.
In these drawings:
The present invention relates to a device for delivering a liquid product and it will be better understood upon reading the following figures, which are a non-limiting illustration of the invention.
In
The assembly 900 contains at least one motor intended to activate the motor pump 710 and all of the electronic elements including the activation means as described hereinabove. More particularly, the electronic assembly 900 may comprise in particular an optical, magnetic or contact type electronic switch, able to wake up the electromechanical assembly 900 for the motorized drive of the pump 710.
At least one of the primary receptacles 600, 600′ is preloaded. In the case of two drug constituents to be mixed, the two primary receptacles 600, 600′ are preloaded. Thus, they already include the drugs or drug elements intended to be administered. This allows getting rid of the different steps of connection of receptacles which may conventionally require forces greater than 30N (sometimes up to 60N). For some pathologies or some conditions and/or situations (for example a very alienating momentary condition such as a migraine attack, or a stress situation, or medical emergency), or age categories, this stress may become a real brake on the proper progress of the activation of an auto-injector. Therefore, the activation mode and the device 2 according to the present invention aims to make the starting action of the device 2 more reliable.
The entire device is contained in a shell C composed of two complementary portions (cf.
The electromechanical assembly 900 and the motor pump 710 are fastened directly or via a support part in the shell C. The fluid circuit 700 may be assembled with the electromechanical assembly 900 or coupled to the shell C. The assembly of the fluid circuit 700 may be permanent or removable in order to be able to discard it if it is soiled and is not intended to be reused. As illustrated in the exploded view of
The device according to the invention may include a first disposable assembly including the fluid circuit 700, the motor pump 710 and the receptacles 600, 600′ and a second reusable assembly including the electromechanical assembly 900 able to drive the pump 710 and the fluid circuit 700, the first disposable assembly and the second reusable assembly being arranged so as to be connectable and detachable respectively from one another.
For example, in the case where the device uses two receptacles, the first receptacle may, for example, contain a fluid solvent and the second receptacle may contain a solid powder or a lyophilized product.
In such a case, the advantage of the electromechanical assembly 900 is the ability to parameterize a mixing sequence defined, inter alia, by:
In the case where only one of the two primary receptacles 600, 600′ includes a drug, this possibly enables the suction of a body fluid before being mixed with the preloaded drug then administered again by the device 2.
The electromechanical unit 900 also allows, by means of the motor pump 710, controlling an accurate dose to be injected, this dose possibly being smaller than the volume of fluid contained in the primary receptacles 600, 600′. Thus, this allows adapting to a wide variety of patients. This confers a certain advantage over devices intended to administer the entire content of their receptacle, for example until the pressure within the receptacle becomes insufficient to expel the content.
The motor pump 710 also allows circulating fluid in the fluid circuit while avoiding any sudden actuation, such as a spring or piston activation, requiring a given force that some patients cannot impart.
The drug preparation unit 200 also comprises, within it, a carriage 400 in the form of a planar part extending in a plane parallel to that of the first planar wall 302 of the cradle 300.
A drive spring 500 is compressed between the first planar wall 302 of the cradle 300 and the carriage 400. The drive spring 500 has an axis coincident with the axis A1 of longitudinal extension of the drug preparation unit 200. The accurate operation of the spring is described later on.
On the face opposite to that in contact with the drive spring 500, the carriage 400 bears against the planar base of the first primary receptacle 600, which herein has a cylindrical shape with the axis A1. It should be noted that the first primary receptacle 600 is associated with the carriage 400. Thus, the first primary receptacle 600 is movable within the cradle 300, and therefore within the drug preparation unit 200.
A second primary receptacle 600′ is comprised in the drug preparation unit 200. The two primary receptacles referenced 600, 600′ are in
At its distal end with respect to that in contact with the carriage 400, each primary receptacle 600, 600′ comprises a corresponding septum 601, 601 allowing hermetically closing said primary receptacle 600, 600′. This also allows permanently preserving the preloaded content of each primary receptacle 600, 600′.
In this first embodiment, the two primary receptacles 600, 600′ are movable. Only the second primary receptacle 600′ comprises a removable bottom, enabling the compression of the fluid.
In
The fluid circuit 700 facing the primary receptacles 600, 600′ is replicated in
In the embodiment illustrated in
As already mentioned above, the fluid(s) can circulate in both directions in the fluid circuit 700, allowing for an efficient mixing by several back-and-forth movements.
The release mechanism 4 removably coupled to the compressed drive spring 500 comprises a hooked end 401 at its distal end, with respect to the carriage 400, of a foldable blade 402. The hooked end 401 is in abutting contact with the cradle 300 so as to limit its movement 4 of releasing the compressed drive spring 500 during translation thereof.
In this embodiment, the two primary receptacles 600, 600′ are movable. The bottom of each primary receptacle 600, 600′ is static.
Referring now to
In
In this embodiment, the stud 301 is retained by a hook 401′ able to rotate about an axis of rotation A2 to release it and enable the compressed drive spring 500 to move the second primary receptacle 600′, which is secured thereto, towards the needles 701, 701′. The first primary receptacle 600 is not represented. The stud 301 has a groove with a shape complementary to the opening of the hook 401′ enabling said hook 401′, when it is engaged, to block its movement of releasing the compressed drive spring 500. A release is obtained during the clockwise rotation of the hook 401′. The reconstituted mixture can be dispensed using an injection needle 721 after having circulated through the fluid circuit 700′.
The release of the compressed drive spring 500 is easier to understand with
It is entirely possible to consider, according to the invention, an embodiment where the release is done by translation of the retaining element 401, 401′ (hooked end or stud) rather than a rotation.
Furthermore, in an embodiment where there would be only one receptacle able to be moved, this would imply that the second receptacle is pre-connected, i.e. fluidly connected beforehand with the fluid circuit. This embodiment is not discarded.
Reference is now made to
The intermediate part 460 is disposed between the receptacle support 450 and the compressed drive spring 500. The intermediate part 460 removably secures the receptacle support 450 to the compressed drive spring 500.
This fastening is done, in
The axis of elongation of the push rod 451, the axis of the compressed drive spring 500, and the axis of elongation of the receptacle support 450 are coincident so that the force exerted by the spring is exerted at the elastic clamp. When the latter exceeds a given threshold F0, there is detachment between the intermediate part 460 and the receptacle support 450. It should be noted that the force needed to detach the intermediate part 460 and the receptacle support 450 is greater than or equal to the force needed to move at least one of the movable receptacles 600.
Thus, there is first a movement of the receptacle support 450, then contact with the support stop 453. Afterwards, there is detachment between the intermediate part 460 and the receptacle support 450 then, a distance d is able to be covered by the first push rod 451 which pushes against the receptacle support 450 to drive the latter and the receptacles 600 (not represented) that it would bring towards the needles 701 for fluid connection with the fluid circuit 700.
In a preferred embodiment of the release mechanism 4 according to the invention as illustrated in
The length L of the second push rod 462 is larger than the distance h separating the free end of the first push rod 451 and the stop surface on which said first push rod 451 bears to move the receptacle support 450. This also depends on the positioning height of the shutter 620 of the second receptacle 600′.
We will now describe a first embodiment of the fluid circuit 700 using
In
The fluid channels 733, 733′ are visible at the main surface of the central part 750. Hence, the fluid channels 733, 733′ are mostly in a plane 734. These channels are closed by one or more sealing plate(s) assembled by welding or heading to the central part 750. The fluid channels 733, 733′, are connected to the pump barrel 731 and to the dispenser barrel 732 via connection channels 735 to the plane 734 containing the fluid channels 733, 733′. The fluidic cassette 730 may also be made by plastic injection.
A second embodiment of the fluid circuit 700′ is illustrated using
In this second embodiment of the fluid circuit, the elements common to the devices illustrated in
In
Sealing between the central part 750 and the peripheral parts 753 is achieved by compressed elastomeric seals 754. This embodiment allows having a three-dimensional fluid circuit which has the advantage of reducing bulk and the dead volumes in the fluidic path.
In general, and not related to a particular embodiment according to the invention, at least one needle 701, metallic or plastic, can be connected to the fluid channels 733, 733′, 733″ of the fluidic cassette 730. The needles 701, 701′ allow drawing the constituents contained in the primary receptacles 600, 600′.
The pump 710 may be a rotary pump, an oscillating-rotary pump, or a linear piston pump. The pump 710 may be mono-directional or bi-directional. The latter is actuated in order to move the fluid between two primary receptacles 600, 600′ and/or to move the fluid between a primary receptacle 600, 600′ and the delivery means 721 which may be a needle but also a sprayer for example. This has a significant advantage, as indicated hereinabove.
The fluid selector 720 is necessary for devices according to the invention allowing carrying out drug preparation and drug distribution or for devices according to the invention allowing carrying out reconstitution between primary receptacles 600, 600′ whose number is greater than or equal to two.
The fluid selector 720 is actuated in order to distribute the fluid between the different fluid channels 733, 733′, 733″. The fluid selector 720 may be rotary or linear. It includes at least two inlets and one outlet. The two inlets and the outlet are connected to a primary receptacle 600, 600′. An outlet may also be connected directly to an injection needle 721 or with a hose between the fluid selector 720 and the injection needle 721. In the case where the injection needle 721 is connected to the fluid selector 720 by a hose, it is possible to motorize the movement of the injection needle 721.
The electromechanical assembly 900 (cf.
In an alternative embodiment, the motors of the pump and of the fluid selector may be associated with a reduction gear. It is also possible to consider a pump docking system and a fluid selector docking system on the output axes of the pump and fluid selector motors. The pump and fluid selector docking systems may be plates, clips, suction cups, magnets, or bayonets. A single pump motor can be used if the movements of the pump and of the fluid selector are synchronized.
We will now describe in detail, thanks to
In this first embodiment, it is necessary to perform an action on the removable bottom of the second primary receptacle 600′ to facilitate the suction by the motor pump 710 of the second primary receptacle 600′ regardless of the position of the device 2. The device 2 according to the first embodiment has the advantage of not requiring complete push on the second primary receptacle 600′ but only “breaking” the sticking forces between the walls of the second primary receptacle 600′ and its removable bottom. These sticking forces may be greater with ageing of the device 2.
Thanks to the electromechanical assembly 900, the device 2 according to the present invention enables a decorrelation between the drug reconstitution and the injection. There is sequencing of the operations, which allows eliminating any risk of administration without being assured of the optimal reconstitution of the drug.
The operating kinematics of the second embodiment (that of
When the activation button 100 is activated by a user by a rotation or a translation, it moves the foldable blade 402, thereby releasing the retaining element 401, 401′.
As illustrated in
This action will release the compressed drive spring 500 thus generating a translational movement of the carriage 400 with the primary receptacles 600, 600′ in the cradle 300 towards the needles 701, 701′ (cf.
In a preferred embodiment, the drug delivery process is activated once the receptacle(s) is or are connected to the fluid circuit 700.
In order to trigger this delivery process, during the movement of the carriage 400 or at the end of its movement, the carriage 400 can wake up the electronics of the device according to the invention by actuating an electronic switch. The electronic switch may be a contact switch or an optical switch or possibly a magnetic switch.
Of course, the device comprises a battery, when the electronic switch is actuated, the battery can be connected to the electronics. Depending on the selected electronic switch, the battery may be: either partially connected to the electronics, which means that a slight electric current will be consumed by the electronics, or completely disconnected from the electronics, which means that there will be no power consumption, thereby lengthening the service life of the battery. In the case of a reusable device, it will be preferable to use a rechargeable battery.
It is essential to note that the two embodiments disclosed regarding the release mechanism 4 and the two embodiments regarding the planar and three-dimensional fluid circuits are mechanically independent and can therefore be combined to obtain configurations of the device according to the invention.
The device according to the invention intends the combination of the preparation and the administration by injection of drug products. If the subcutaneous pathways of a patient have been primarily explored, it is possible to consider to the least the intravenous and intramuscular pathways as other pathways.
The device according to the invention enables mixing between a constituent A and a constituent B. If the constituent A is the solvent and the constituent B the pharmaceutical active substance, it is possible to consider, as already mentioned, filling the first receptacle 600 with a body fluid: blood, lymph, or other non-circulating biological liquids (synovial, cerebrospinal, pleural...), for extra-corporeal homogenization of the active substance in a target liquid, for re-administrations via the appropriate injection mode according to the invention.
It is also possible to use the device according to the invention for mixing two liquids: in this case we will talk about a co-injection device. The field of application preferably remains healthcare and the medical sector.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2005330 | May 2020 | FR | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/FR2021/050908 | 5/20/2021 | WO |
