### Consensus consistency validation — 9 October 2026

Cutoff: 2026-10-09. Provider artifact: `consensus-browser-response.md` (verbatim, citation markers preserved), `browser-thread.json`, and `consensus-search-raw.json`. Consensus thread: [Grey Market Semaglutide Quality](https://consensus.app/search/grey-market-semaglutide-quality/c1g32nzwQZC3ZvX8UhO_CA/), Pro. The provider’s broad summary is directionally consistent with the narrow preregistered claim, but some wording (“frequently”, “fails … safety”) overgeneralizes from small product samples and pharmacovigilance reports; those formulations are not adopted as verified population-level facts.

#### Primary-source reconciliation

- **PMID 39509151; DOI 10.2196/65440; Ashraf et al. 2024, JMIR.** Directly procured six online purchases yielded three completed deliveries, all three of which were falsified/substandard; the paper reports peptide purity 7.7–14.37%, content 28.56–38.69% above label, and endotoxin in samples. Original package ledger source 1, study key `PMID39509151`, selected full-text body passages; already included. The Consensus report’s second citation, **PMID not resolved in its own metadata; DOI 10.1001/jamanetworkopen.2024.28280**, is a related Ashraf/Mackey research letter on online test purchases and risk assessment, not independent evidence of a second random market sample. Treat it as the same research/test-purchase evidence family unless exact methods establish independent sampling; do not add an independent study count.
- **PMID 41125326; DOI 10.1136/ejhpharm-2025-004656; Antonacci et al. 2025.** Primary case report documents a 31-year-old patient in hypoglycemic coma after a website-sourced product; toxicology identified insulin rather than semaglutide. Original package ledger source 51, already included. One verified case establishes a real counterfeit hazard, not frequency or prevalence.
- **PMID 42137313; DOI 10.3389/fphar.2026.1805842; Zinzi et al. 2026.** Primary EudraVigilance analysis (2018–2025 reports) retrieves 234 ICSRs related to *potential* counterfeit semaglutide and reports disproportionality signals. PubMed primary abstract checked. Not found in the frozen 51-source ledger by PMID/DOI; supplemental only, not counted in original source total. Voluntary reports lack exposure denominators and confirmed product authentication; they support a signal, not comparative incidence or causation.
- **PMID 39379664; DOI 10.1007/s11095-024-03771-6; Hach et al. 2024.** Analytical testing of follow-on GLP-1 products; original evidence ledger already contains it. Its sampling and product category do not establish market-wide grey-market prevalence or clinical consequences.

#### Claim/score judgement

SC1 regulated trial products effective (Ε): no change; Consensus did not add a new controlled regulated-product result. SC2 unregulated research-chemical supply reliably reproduces identity/purity/concentration/sterility (Β): no change; direct product testing and one falsified-product case remain specific samples/events. SC3 unregulated products reproduce clinical efficacy of trial products (Α): no change; no direct comparative efficacy trial was identified. The new 2026 pharmacovigilance report adds a signal but does not bridge authentication, denominator, or causal exposure gaps. Original score and counts remain **Α / Moderate; 51 reports, 55 verified claims**. No grade/scorecard patch proposed.

This reconciliation verifies provider-discovered citations against original primary records; it is not an independent blinded review. No Consensus evidence-strength tags were used as quality tiers.

#### Primary record links

[PMID 39509151](https://pubmed.ncbi.nlm.nih.gov/39509151/) · [PMID 41125326](https://pubmed.ncbi.nlm.nih.gov/41125326/) · [PMID 42137313](https://pubmed.ncbi.nlm.nih.gov/42137313/) · [PMID 39379664](https://pubmed.ncbi.nlm.nih.gov/39379664/)
- **PMID 42533250; DOI 10.1007/s11095-026-04146-9; Kopp et al. 2026.** Consensus keyword search/fetch surfaced this primary in-vitro study (raw tool record saved as `consensus-fetch-76090d1d936b5dc3bd8a635ced882462.json`); PubMed bibliographic record identifies publication in 2026, within cutoff. It examined follow-on/compounded GLP-1 products, distinct impurity profiles, and in-vitro peptide presentation with potential immunogenicity. This is **not** a directly tested grey-market online sample nor a patient immunogenicity/outcome study. Its findings are adjacent evidence only, and the authors include Novo Nordisk employees/shareholders. Not present in frozen `selected-records.json`; supplemental, outside original count.

This dated supplement adds source reconciliation to the original review. Its original narrative, registered scope, source inventory and grades remain historical records. No earlier adversarial approval has been verified for this edition at the supplement date. This provenance supplement has no separate approval and is not an independent or blinded adjudication. New sources described here are supplemental and are not counted in the original inventory.