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A secondary objective was to examine independent predictors of grade\u2009\u2265\u20093 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1\u20135 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age\u2009&gt;\u200960 with osteoporosis, while none were grade\u2009\u2265\u20094, yielding an incidence of grade\u2009\u2265\u20093 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade\u2009\u2265\u20093 AEs using multiple logistic regression. 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