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The FDA has released less than 10% of the requested documents, including Perfettis laboratory records, to a researcher at UC San Francisco

In terms of competitors, there are plenty of punches that can attach to keychains, including the Screwpop Cigar Punch 2.0 and the XIKAR 007Twist Punch Cutter, among many othersand there are some lighter adjustment toolsincluding the Visol Butane Purging and Flame Adjusting Lighter Tool but there is not another tool that combines both that I was able to find

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Immune System Disorders: anaphylactic/anaphylactoid reaction

Moreover, the RR for the heavy alcohol and heavy smoking group was 35.24 (95% CI, 23.1753.58), which was much higher than those of the heavy alcohol and non-smoking group and non-alcohol and heavy smoking group, indicating a multiplicative interaction