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A teenager drowned while another suffered near drowning symptoms at Thompsons Bay on the Wild Coast on Wednesday afternoon.
Netcare 911's Chris Botha says a boy got into difficulty while swimming in a lagoon and his friend, who swam out to help him, ended up having to be rescued.
Botha says when they arrived at the scene, they found that the boys had been pulled out of the water and bystanders had started CPR on one of them.
Paramedics continued with advanced life support resuscitation for more than an hour, before the child was declared dead on scene.
The other boy was transported to hospital for further treatment.