Received Apr 9, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (MODERNA)) | MODERNA | 1 | — | — |
worsening Autoimmune Rheumatoid Arthritis; abdominal distension; Recurrent Covid 19 Pneumonia; constipation; symptoms of obstruction/ Recurrent severe GI symptoms of obstruction; Iatrogenic Cushing's Syndrome; If I have a meal I often "pass-out" immediately after; severe abdominal pain; the development of hemorrhoids; he developed cellulitis in his upper left thigh at an injection site; osteoarthritis; He developed rectal prolapse while trying to move his bowels; He had a single drink, then developed amnesia and bizarre behavior for the next 18 hours; developed more red spots and rash all over my body; a rash developed on both arms within a few hours/ a total body rash and welts occurred; Skin sloughing of the arms occurred; Left kidney stone; hydronephrosis; Tears in left achilles tendon and peroneus brevis; A left knee superficial bursa fistula; Addison's disease, with pituitary, adrenal and gonadal dysfunction; Upper Respiratory infections including Bronchitis; Pneumonia; severe right scapular pain radiating to the chest wall/ a rash appeared with vesicles/ Shingles; developed fever; chills; injection arm became painful; injection arm became painful, erythematous, and twice the size of the left arm; erythematous; arthralgia; myalgia; This spontaneous case was reported by a physician and describes the occurrence of RHEUMATOID ARTHRITIS, PSEUDO CUSHING'S SYNDROME, ABDOMINAL DISTENSION, CONSTIPATION, INTESTINAL OBSTRUCTION, COVID-19 PNEUMONIA, PNEUMONIA, ADDISON'S DISEASE, HYDRONEPHROSIS, TENDON RUPTURE, FISTULA, LOSS OF CONSCIOUSNESS and NEPHROLITHIASIS in a 7-decade-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product Semaglutide (Ozempic) for HbA1C. On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Jan-2022, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Jul-2022, the patient started Semaglutide (Ozempic) (unknown route) .25 milligram once a week. In January 2021, the patient experienced PAIN IN EXTREMITY (injection arm became painful), PERIPHERAL SWELLING (injection arm became painful, erythematous, and twice the size of the left arm), ERYTHEMA (erythematous), PYREXIA (developed fever) and CHILLS (chills). In 2021, the patient experienced RHEUMATOID ARTHRITIS (worsening Autoimmune Rheumatoid Arthritis) (seriousness criteria hospitalization and medically significant), ARTHRALGIA (arthralgia) and MYALGIA (myalgia). On 24-Aug-2021, the patient experienced HERPES ZOSTER (severe right scapular pain radiating to the chest wall/ a rash appeared with vesicles/ Shingles). In 2022, the patient experienced PNEUMONIA (Pneumonia) (seriousness criterion medically significant) and BRONCHITIS (Upper Respiratory infections including Bronchitis). In 2023, the patient experienced PSEUDO CUSHING'S SYNDROME (Iatrogenic Cushing's Syndrome) (seriousness criteria hospitalization and medically significant), CONSTIPATION (constipation) (seriousness criterion hospitalization), INTESTINAL OBSTRUCTION (symptoms of obstruction/ Recurrent severe GI symptoms of obstruction) (seriousness criteria hospitalization and medically significant), ADDISON'S DISEASE (Addison's disease, with pituitary, adrenal and gonadal dysfunction) (seriousness criterion medically significant), TENDON RUPTURE (Tears in left achilles tendon and peroneus brevis) (seriousness criterion medically significant) and FISTULA (A left knee superficial bursa fistula) (seriousness criterion medically significant). In July 2023, the patient experienced HYDRONEPHROSIS (hydronephrosis) (seriousness criterion medically significant). On 11-May-2024, the patient experienced RASH (developed more red spots and rash all over my body). In May 2024, the patient experienced SKIN EXFOLIATION (Skin sloughing of the arms occurred) and URTICARIA (a rash developed on both arms within a few hours/ a total body rash and welts occurred). In 2024, the patient experienced NEPHROLITHIASIS (Left kidney stone) (seriousness criterion medically significant). On 17-Sep-2024, the patient experienced COVID-19 PNEUMONIA (Recurrent Covid 19 Pneumonia) (seriousness criteria hospitalization and medically significant). On 11-Nov-2024, the patient experienced RECTAL PROLAPSE (He developed rectal prolapse while trying to move his bowels). In November 2024, the patient experienced AMNESIA (He had a single drink, then developed amnesia and bizarre behavior for the next 18 hours). On an unknown date, the patient experienced ABDOMINAL DISTENSION (abdominal distension) (seriousness criterion hospitalization), LOSS OF CONSCIOUSNESS (If I have a meal I often "pass-out" immediately after) (seriousness criterion medically significant), ABDOMINAL PAIN (severe abdominal pain), HAEMORRHOIDS (the development of hemorrhoids), VACCINATION SITE CELLULITIS (he developed cellulitis in his upper left thigh at an injection site) and OSTEOARTHRITIS (osteoarthritis). The patient was hospitalized from 17-Sep-2024 to 20-Sep-2024 due to ABDOMINAL DISTENSION, CONSTIPATION, COVID-19 PNEUMONIA, INTESTINAL OBSTRUCTION and PSEUDO CUSHING'S SYNDROME. The patient was treated with Crestor, Coq10, Acthar, Lidocaine, Semaglutide, Olumiant, Prednisone, Hydrocortisone, Z-pak , Benadryl, Zovirax, Dulcolax, Vitamin d, Magnesium, Lorazepam, Mounjaro) Testosterone, Phentermine, Bupropion, Furosemide, Dhea, Calcium, Milk of magnesia, Lasix, Mvi, Vitamin K, Stonehenge health dynamic mushrooms, Melatonin Tirzepatide, LInzess, Meloxicam, Flurinex, Valacyclovir, Reclast, Colace, Xifaxan, Glucophage. PAIN IN EXTREMITY had resolved. In 2021, PERIPHERAL SWELLING and ERYTHEMA had resolved. In September 2021, HERPES ZOSTER outcome was unknown. In October 2024, FISTULA had resolved. At the time of the report, RHEUMATOID ARTHRITIS, PSEUDO CUSHING'S SYNDROME, ABDOMINAL DISTENSION, CONSTIPATION, INTESTINAL OBSTRUCTION and ABDOMINAL PAIN had not resolved, ARTHRALGIA, COVID-19 PNEUMONIA, PNEUMONIA, ADDISON'S DISEASE, HYDRONEPHROSIS, NEPHROLITHIASIS, BRONCHITIS, SKIN EXFOLIATION, HAEMORRHOIDS, VACCINATION SITE CELLULITIS, OSTEOARTHRITIS, URTICARIA, PYREXIA, CHILLS, MYALGIA and RASH outcome was unknown, TENDON RUPTURE, RECTAL PROLAPSE and AMNESIA was resolving and LOSS OF CONSCIOUSNESS had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. He was in his usual state of good health, taking no medications on a regular basis until Jan-2016. Patient denied any history of hypertension, diabetes, myocardial infarction, CVA, peptic ulcer disease, etc. In Dec-2017, patient started a slow taper of the Prednisone to eliminate this medication. Quick tapers in the past led to significant painful symptoms and were not successful. Beginning at that time the dose was reduced 1mg every 3-4 days. As of 01-Jan-2018 he was taking 6mg daily in the morning. Furthermore, he had a 5.5-hour infusion of Remicade to potentially decrease the Rheumatologic side effects and to assist with the steroid taper. Patient's medical history also included symptoms of neurogenic bowel, and multiple orthopedic injuries. In 2018, his joints hurt; all his muscles were weak. He was unable to raise his right arm laterally due to pain in the deltoid region, and a spontaneous hematoma of the right biceps appeared without trauma, turning the entire arm ecchymotic. Weakness developed in both hands, and incredible disabling fatigue. Doctor recommended resuming higher dose. On 01-Mar-2018, the entire set of symptoms increased and ultimately by 05-Mar, he was quadriparetic. Patient was admitted from 05-Mar to 07-Mar-2018. Discharged on high dose steroids (prednisone 60mg daily). Remicade was halted, and Actemera was prescribed. He was admitted for cardio-pulmonary issues on 07-Apr-2018. Between 07-Mar to 07-Apr-2018, the medications were followed diligently, but new symptoms appeared- severe muscle spasms in both hands with the slightest of intentional activities. The extremity muscle pain/weakness persisted, and developed increasing difficulty dressing, going up and down stairs, and performing fine motor activities. He also developed constant dizziness/nausea, a sense of imbalance, more severe respiratory distress. He was brought to the urgent care center to rule-out a cardiopulmonary event. From a cardiac perspective he had an EKG and echocardiogram to rule-out myocardial infarction, congestive heart failure, etc. On 10-Apr-2018, he was discharged on high dose Prednisone (again), antibiotic prophylaxis (Bactrim DS, 1 tab three time weekly), an increased dose of Actemera (162mg weekly instead of biweekly), two inhalers including a long-acting steroid inhaler and an Albuterol rescue inhaler. The Actemera did not lead to any improvement in the Autoimmune RA. From a diagnostic perspective the cell count was very high, consistent with an inflammatory arthritis. From therapeutic perspective steroids were injected into both knees. Over the subsequent three months the rheumatologic medications were altered. Patient took Humira and Methotrexate (MTX) every seven days. Patient was able to reduce the steroids from a dose of 60 mg daily in Jan-2018 to 3 mg daily in Jul-2018. Starting in mid-Jun-2018, patient began experiencing mid-spinal pain without any accompanying neurological symptoms. This pain was in the thoracic region and when severe it caused posterior rib pain in the region with deep breathing. There was no numbness or weakness in the upper or lower extremities. Doctor felt that these symptoms were not necessarily related to inflammatory arthritis. Since patient took steroids continuously for more than two years, she was concerned about steroid induced osteoporosis and fracture. The pain on the evening of 13-Jul-2018 was much worse. Patient required several doses of oral narcotics. Patient's concern was this sudden onset of pain and spinal compression was due to the use of catabolic steroids continuously leading to bony changes in the spine. Osteopenia/Osteoporosis was diagnosed. On Labor Day weekend he developed worsening muscle and joint symptoms. The muscular symptoms were consistent with the flu. All his joints became painful. On Saturday evening of that weekend his bilateral knee pain increased significantly. After attending a dinner, he was unable to walk. The pain persisted and NSAID's were not effective. During the subsequent 72 hours the pain continued, requiring narcotics. Both knees developed effusions and the right knee was triple the size of the left. Doctor recommended increase Prednisone to 20 mg daily, increase the MTX to 20 mg weekly and bilateral knee aspirations. Whereas the aspirate from both knees was highly inflammatory consistent with an Autoimmune process. Patient developed severe URI/Cough/Bronchitis and was treated with Cefuroxime. The situation improved, but not completely. From Jun-2018 to Jul-2018, he developed worsening Spinal and Thoracic pain with no numbness or weakness of upper or lower extremities. From Oct-2018 to Nov-2018: Migratory joint symptoms continued including shoulders, wrists, knees elbows and ankles. A reduction in steroids from 5mg to 3mg daily was not tolerated. The Prednisone was increased to 5mg again and the MTX was increased to 25mg weekly on 03-Nov-2018. This led to severe abdominal pain and fatigue. On 05-Nov-2018, he developed dyspnea, wheezing and a cough. He was placed on Cefuroxime and the steroids were increased. Three doses of Humira and MTX were held during this episode. On 03-Nov-2018, this increased dose of MTX led to severe fatigue and abdominal discomfort. Humira was taken on 04-Nov-2018 and the symptom complex worsened. On 05-Nov-2018, patient developed dyspnea, wheezing and a cough. This situation worsened. He was evaluated and treated by his Pulmonologist. He was placed on Cefuroxime (500 mg BID x 10 days). Due to his immunocompromised status, it was recommended that he increase his steroids temporarily. The weekly Humira and MTX were held during this episode as these medications can lead to worsening of the Pneumonia. A total of three doses of Humira and MTX were held. Patient felt well during this hiatus and was able to exercise without difficulty. On 06-Dec-2018 he restarted the Humira as the joint symptoms reappeared. Within 12 hours he developed a rash, myalgias, joint pains (knees, elbows, hands, and back), and welts. The welts disappeared with a dose of Prednisone (20mg). However, the subsequent 24 hours were horrible with an increase in flu-like symptoms. The flight was extremely cold, and the flu-like symptoms were much worse on the flight. He was unable to ambulate at the airport and required a wheelchair to retrieve his luggage. He was unable to sleep Friday night due to pain and on Saturday morning the facial rash and welts reappeared. He spoke with the covering Rheumatologist and restarted MTX (10 mg). This led to NO improvement in symptoms. On Monday doctor recommended an increase in steroids. Patient took 20 mg Monday (10-Dec-2018) at night and was able to sleep and felt better in terms of muscle and joint symptoms. The persistent discomfort was in the region of the right humerus and deltoid regions. Patient remained off Humira and MTX from early Dec-2018, but as a result the Prednisone was increased from 5 to 10-20 mg daily, dependent upon severity of symptoms. Despite the joint symptoms he exercised nearly every day between 26-Dec-2018 and 14-Jan-2019. During that three-week period a bigger problem was related to voiding, abdominal pain and abdominal distension, an increase in size of the abdominal wall hernia and alteration in bowel habits. He denied any BPR but did have constipation. This had been a problem since commencing Keytruda. He took several types of cathartics with variable success, and at times had symptoms of an ileus, with abdominal distension, tenderness at the hernia site, and increased voiding symptoms. 06-Dec-2018: Humira was restarted due to an increase in joint symptoms. Within 12 hours of this SQ dose he developed multiple joint pains, swelling in the knees, a rash followed by large welts all over body. The welts disappeared with a 20mg dose of Prednisone. He was flying home. By the time the flight landed he was unable to walk due to joint pain, myalgia, and flu-like symptoms and was transported via wheelchair through the airport. The covering Rheumatologist suggested trying a lower dose of MTX (10mg), which led to no improvement in the condition. Developed pulmonary symptoms, which led to hospitalization in Mar-2019. Patient also had what appeared to be an infected cyst on the left cheek, which had not resolved in over 8 weeks. On 14-Feb-2019, two days after taking his weekly MTX, his joint symptoms suddenly increased and bilateral knee effusions redeveloped (right greater than left). His upper respiratory infection returned and was treated simply with OTC medication. On 19-Feb-2019 doctor re-evaluated him, aspirated 35-40 mls. of fluid from each knee and injected steroids. The knees subsequently improved. Steroids were injected into the site. In mid-February, the respiratory symptoms worsened. He was given a Z-Pak as well as a cough suppressant with codeine. A temporary increase in Prednisone was also recommended (20 mg BID). This produced no significant improvement and therefore his Rheumatologist was consulted and Levaquin (500 mg daily), a decrease in the steroid dose, and halting the MTX was recommended. As of 11-Mar-2019 the following symptoms persisted- constant shortness of breath and sensation of wheezing, severe fatigue, infected rhinorrhea, constant cough and chest discomfort with infected appearing mucous, constant dizziness and intermittent headaches, constant flushed face without being in the sun and diffuse abdominal pain. On 22-Mar-2019, he had supposedly had a follow-up appointment post hospitalization with a Pulmonologist. That morning his O2 saturation was 96% upon awakening, room air. With nebulizer therapy it increased only 1%. Patient also noted a significant increase in the left flank ecchymosis, the appearance of a petechial rash on his back and chest wall, and another significant ecchymotic region in the perineum extending posterior to the gluteal muscles and anterior to the mid-thigh and bilateral inguinal regions (suggestive of a pelvic bleed). He was advised to slowly continue the steroid taper (1.0 mg per week), with the goal of eliminating this medication. If successful, the MTX and TNF Inhibitors would also be eliminated thereafter. Upon returning he developed identical upper respiratory symptoms again, including constant shortness of breath, intermittent wheezing, rhinorrhea, constant cough, etc. He consulted doctor and a five-day course of Zithromax was ordered. Doctor was also consulted, and she recommended holding both Methotrexate and Simponi. The rhinorrhea improved but the asthma-like symptoms persisted: cough, respiratory distress, and wheezing. Patient had been slowly decreasing the Prednisone to 3 mg daily with no worsening of the joint symptoms. However, due to the respiratory distress he had to increase the Prednisone to 5-10mg qd or bid. At night he was often unable to lie down without severe respiratory distress. The last dose of Simponi was administered on 01-Apr-2019. The last few times he took MTX he developed several days of severe abdominal pain. He was unable to eat without nausea, vomiting, or diarrhea. This occurred twice within 12 hours of taking the medication. Between 09-May and 16-May-2019, his physical stamina deteriorated. He slept at least 3-5 hours in the late afternoon, every day. He had a constant feeling of flu-like symptoms that was all his muscles ached constantly. He experienced chills every afternoon. Doctor evaluated him thereafter, and recommended continuing the Simponi, not the MTX. The joint symptoms in both knees improved on 10-Aug-2019, whereas, the hand and wrist symptoms persisted, but were tolerated. Patient had nuclear gastric emptying study to evaluate possible gastroparesis, and neurogenic small and large bowel. On 10-Nov-2019, he developed daily episodes of flu-like and migratory arthritis symptoms. Motrin, Advil, or Excedrin were utilized around the clock for knee, quadriceps, hand and wrist pain with bending, etc. He awakened every night feeling septic. Bilateral knee effusions redeveloped, and bilateral LE lymphedema. Every day he was extremely fatigued and required multiple-hour naps. Development of recurrent severe joint and skin manifestations of Autoimmune RA in April and May-2020. Some improvement in joint pain with the use of Plaquenil between Mar-2020 and Sep-2020. Intermittent severe exhaustion during July and Aug-2020 requiring multiple hour naps during every day. Several discussions were partaken regarding the potential use of Sirolimus or Chemotherapy as the next step. Patient felt better with the oldest oral medication, compared to all other medications, namely Plaquenil. He has basically experienced no side effects; whereas the other two courses of treatment have deadly side effects and were far more complicated. During October and Nov-2020 the knee pain somewhat improved and was tolerable most of the time. Unfortunately, the pain and weakness in the fingers, hands, wrists and forearms increased significantly. Severe fatigue was always omnipresent. Possible gastroparesis and neurogenic bowel dysfunction in 2020-never confirmed on any radiological studies. He also used steroids which produced the typical side effects of weight gain (over 45 lbs.), muscle loss. When the steroids were reduced, the rheumatologic and fatigue related symptoms were unbearable. He utilized NSAID's again initially without increasing the steroids. None of them were helpful. He woke up at night in severe pain and this necessitated an additional dose of 5-10 mg of Prednisone daily. A significant amount of fluid was removed bilaterally (60 mls/side), and Medrol was injected into each knee simultaneously. Doctor also suggested a "lubricant", such as Synvisc in the future. After this procedure the pain and knee swelling improved. Ambulation became less bothersome. In terms of symptoms, he continued to experience back pain, but this like many other pains was tolerated out of necessity. He continued to experience migratory joint symptoms especially the shoulders, greater than the wrists, then the knees, then the elbows and ankles, in that order. He tried to decrease the steroids (down to 3 mg per day), whereas the Humira and MTX remained on the same weekly doses. Unfortunately, the reduction in steroids was not clinically feasible and the dose of Prednisone was kept at 5 mg daily, the MTX was increased to 25 mg weekly. In Jun-2019 Patient experienced multiple dental issues. He fractured a tooth, requiring a Root Canal and reconstruction. He also required two Wisdom Teeth extractions. Due to persistent tooth and jaw pain a CT of the Jaw was performed. This showed no evidence of fracture or abscess. It was performed due to the complications associated with Osteoporosis secondary to prolonged steroid use and the use of Fosamax. As of Sept-2019, the repaired teeth remain painful to touch, but the situation is being tolerated. Patient was able to return on 09-Jul-2019 for one month. He was determined to improve his physical status, and all the deterioration produced by the Prednisone and other drugs. He exercised many hours daily (swimming, weightlifting, biking and golf). He lost 18 lbs. in 18 days with this regimen and simultaneously decreasing meal intake (high protein low carb diet). The problem from an RA perspective has been severe knee pain and swelling, episodes of myalgias, arthralgias, and flu-like symptoms. His knees were aspirated in early June (60 mls. on the right and 40 mls. on the left) and Medrol was injected bilaterally. The effusions reappeared in two weeks. On 7/7/19 repeat aspirations were necessary (40 mls. on the left and 60 mls. on the right). At that time Synvisc was injected bilaterally and a lower dose of Medrol. Exercise was recommended to "move" the lubricant throughout the joint spaces. With the weight loss the Sleep Apnea disappeared. Patient had a Simponi Infusion on 06-Aug-2019. He tolerated this for 24 hours but then developed transient respiratory symptoms, increased myalgias and arthralgias. Doctor evaluated him on 07-Aug-2019 and felt that the left-sided Adenopathy was not clinically significant and required no biopsy or node dissection, etc. Due to the exacerbation of symptoms with the first IV infusion of Simponi at 200 mg, patient requested a decrease in dose for the second infusion. It had been necessary to take Motrin and Excedrin every evening to diminish the chills; otherwise, he would never be able to sleep. Knees and quadriceps were especially painful, and in the AM, it was very difficult to bend my knees. His hands and wrists were more affected than previously. Every afternoon between 10 and 18-Nov-19, Patient would pass out from fatigue. He awakened late every night with the feeling of "being septic": myalgia, arthralgia, chills, etc., which only partially resolved with 400-800 mg of Advil. Significant effusions redeveloped in both knees, right greater than left, as well as bilateral LE Lymphedema. Bilateral knee aspirations and injected Medrol simultaneously was performed. 70 mls was removed from the right and 40 mls from the left. That evening he had no septic symptoms and the following morning he felt much better. His conclusion was that this episode was a flair of the Autoimmune RA and a reaction to the IV infusion. On the morning of 09-Feb-2020, he attended a brunch with six people. Within an hour of the meal, he developed significant abdominal distension. No one else became ill. He was admitted from the ER. The nausea, vomiting and diarrhea halted. He was at bowel rest for 24 hours; a surgical consult was obtained to rule-out a surgical abdomen, given history of a recurrent abdominal wall hernia and RLQ pain. Blood cultures were presumably negative. He was discharged on 12-Feb-2020 in improved condition. However, between 12 and 18-Feb-2020 he was unable to advance diet. He ate soup and once or twice tried solid food. The latter caused distension, pain, and passed a minimal amount of gas. The pain remained diffuse, and he always had a sensation of impending N+V or desire to move bowels but could not. Between 20 and 22-Feb multiple cathartics were utilized sequentially until it led to a massive amount of bowel movement. This included three Dulcolax tablets, then 24 hours of MiraLAX continuously, followed by one bottle of Magnesium Citrate and ultimately one ounce of Lactulose. The distension disappeared after the bowel movements. However, the distension, tympany, and pain returned on 23-Feb and remained on 24-Feb. In the morning of 24-Feb, a GI consultation was obtained. He had hypoactive bowel sounds, significant distension and pain especially at the site of the recurrent hernia. On 28-Feb-2020, patient was evaluated. Doctor believed that the TNF inhibitors may be contributory to recent symptoms and stopped them. Prednisone was not eliminated. On examination, he had significant bilateral knee effusions. Doctor aspirated both, performed a cell count, and injected steroids. He experienced daily waves of severe joint and muscle pain, a sensation of fever and chills, all of which he experienced throughout Keytruda therapy. Physician believed that the recurrent hernia could not lead to severe symptoms, but it should be repaired electively via a laparoscopic approach with mesh. Simultaneously the abdomen should be examined for adhesions, etc. He scheduled an upper endoscopy and colonoscopy for 09-Mar-2020, to rule out common etiologies. Future treatment would be predicated upon the findings of these two operative procedures. Ingestion of normal food was attempted the day after the procedure, and this led to severe abdominal pain and distension again. On 11-Mar-2020, he was awakened with continued abdominal pain and distension along with welts and hives on trunk and extremities. He took usual medications added Claritin. The rash disappeared in several days. Patient was able to eat small meals without gastric distension or a feeling of bowel obstruction. Bowel habits were not normal. If he did not move his bowels within several days, he became distended in the lower abdomen and required a combination of MiraLAX powder and Dulcolax tablets. Patient did not perceive the sense of bowel fullness or the desire to move his bowels on most occasions. The cathartics took 24-36 hours to be effective and then they produced diarrhea. Comparatively speaking, this set of symptoms was far superior to continuous bowel distension and pain, which he perceived in the past as possibly SBO. Nonetheless, patient usually ate only one meal per day and did not tolerate more, or "heavier" foods. He was unable to bend his right elbow to brush his teeth, pick up a cup and drink, or take a pill. The right biceps were painful and became more atrophic. He was unable to sleep on his right side because pressure on the right arm was very painful. There was no numbness to suggest a neurological cause. In terms of medications, his last infusion of Remicade proceeded on 30-Jan-2020, after which the four hospital admissions occurred. In terms of Prednisone, it clearly remained essential. On Tuesday 07-Apr-2020, he inadvertently forgot his morning dose for the first time in three years. That evening every joint and every muscle group became extremely painful. He was also significantly fatigued. He had not felt this bad from a joint or muscle perspective in several years. The following morning, he realized this situation and took 10mg of Prednisone upon arising and 5mg in the evening with improvement in all his symptoms. The muscle and joint symptoms exacerbate when the bilateral knee infusions increase. In April he was taking 10mg of Prednisone daily, but increased this when the effusions reappeared. Doctor performed bilateral aspirations on 20-Apr-2020. Furthermore, he was placed on Plaquenil 200mg BID. Despite the complexity of the situation and the degree of symptoms, he was much happier and in less pain than when he had severe bowel symptoms, distension, and the possibility of a surgical bowel obstruction. Between 05-May and 28-May-2020 the abdominal distension steadily decreased, tolerance of normal foods improved and bowel function slowly improved. Constipation remained, however. On the other hand, he developed massive welts, erythema, skin exfoliation, and increased bruising throughout his entire body in mid-May. It was extremely painful. He initially thought this was related to Plaquenil, and thus halted it. He had no reduction in the welts or worsening of joint symptoms for 48 hours. Then he began to experience worsening muscle and joint pain. He took several doses of Motrin and the rash increased within fifteen minutes of each dose. Thus, he believed the Motrin was the culprit not the Plaquenil. Patient was unable to walk without assistance on 15-May-2020. Doctor aspirated both knees in June and July. Doctor examined him and obtained lab data. Patient considered Rituxan, but ultimately decided to continue Plaquenil since the side effect profile was miniscule, and the continuation of Prednisone far less dangerous than the chemotherapeutic agent Rituxan. On 03-Sep-2020 he had an interval skin check, and several small lesions were frozen, but no melanoma was suspected. Patient tried to halt the Prednisone and the Plaquenil for the two weeks between 31-Aug-2020 and 15-Sep-2020. For the first week he had absolutely no significant symptoms. By the end of the second week however, he was extremely fatigued, and his hands began to hurt again. On 15-Sep-2020 he took 5mg of Prednisone and 400mg of Plaquenil. This reversed his symptoms within several hours. Patient continued the Plaquenil (400mg qd) and Prednisone (10mg qd) since that time. During Oct-2020 and Nov-2020, he had- nearly constant fatigue, increased pain and weakness in fingers, hands, wrists and forearms, persistent constipation and intermittent orthostasis which correlated with tamsulosin. Patient had 9 years of intense follow-up scans, including MRIs (Brain, T and LS Spines), CTs (chest, abdomen, pelvis), inguinal ultrasounds, laboratories, etc. Prednisone, Solumedrol IV, oral Medrol dose packs, etc., had been utilized continuously since Jul-2017. Joint injections of Medrol had been utilized for seven years also. He had received recurrent bilateral knee effusions requiring numerous aspirations and steroid injections (approximately 45 sets of bilateral aspirations) between 2017 and 2024. Patient had hives, welts with Enbrel. Welts and skin exfoliation, and increased skin bleeding with Advil liquigels on multiple occasions in May-2020; this resolved. Positive for DOE, chest muscle discomfort in 2017-2018 resulting in hospitalization; Positive for chronic right and left pedal edema, right greater than left due to radical LN dissection. Within several hours of Moderna vaccination, the injection arm became painful, erythematous, and twice the size of the left arm. This was treated with Benadryl (50mg), Prednisone (10mg) and Advil (400mg). All muscles and joints ached. The left arm was very painful for 3-4 days and was unable to lie upon the left side. He developed fever, chills and it felt like a recurrence of COVID-19. He took high dose steroids with a five-day taper. The pain in the arm lasted for two weeks. The arm swelling and eryt
Abdominal distension (In late Dec-2018 and early Jan-2019, it was worsening nearly constant vomiting (at least 15 times), and subsequently 2 hours of diarrhea, dehydration, fever to 102.8 degrees, a feeling of sepsis, headaches and dizziness); Abdominal pain (In late Dec-2018 and early Jan-2019, it was worsening); Adrenal insufficiency (due to the use of steroids, intermittently in 2016 and continuously since early 2017); Allergic reaction to drug (Motrin); Allergy to antibiotic (Clindamycin); Allergy to molds (which disappeared in adulthood; treated during childhood with antihistamines and weekly allergy injections until the age of 18); Anaphylaxis (hospitalized for one week and every study); Aortic valve disease (Father); Atrial fibrillation (Father); BPH; Bronchitis asthmatic (also in 2017, 2018, 2019, and 2020); Cardiomyopathy (Father); Collagen-vascular disease (Brother 2: Mixed Collagen Vascular Disease diagnosed a decade ago.); CVA (Father: He sustained several strokes recently and developed frontal lobe memory loss; Mother: she sustained a CVA in 2021 resulting in hemiparesis, which was improving well); Drug allergy (Humira); Dust allergy (which disappeared in adulthood; treated during childhood with antihistamines and weekly allergy injections until the age of 18); DVT (Mother: Peroneal DVT: she developed a Peroneal DVT; 02 saturation decreased to 84% and she developed a femoral DVT on the right and a Popliteal DVT on the left, resulting in bilateral PE's Pulmonary Embolism); Grass allergy (which disappeared in adulthood; treated during childhood with antihistamines and weekly allergy injections until the age of 18); Hemiparesis (Mother); Hiatal hernia (Mother: hiatal hernia that herniated into the chest: In May 2023 she was admitted as an emergency with a hiatal hernia that herniated into the chest and developed a Volvulus.); Hyperglycemia (secondary to steroids was treated with a sliding scale of Insulin); Hypertension (Mother: was hospitalized on several occasions in 2018-2019); Interstitial lung disease (Brother 2); Keratoacanthoma (variant of Squamous Cell Carcinoma was discovered on the left cheek); Lymphedema (right leg, followed by a Lymphedema specialist for greater than one year and treated with a leg pressure garment continuously in the past and now intermittently); Melanoma (Brother 1: Superficial Melanoma on the posterior aspect of his leg treated with local excision only; Father: on his arm treated with local excision only); Metastatic breast cancer (Maternal Grandmother); Mitral valve disease (Father: This was not evident until 1989 when he required a Mitral Valve Repair.); Multiple sclerosis (Son); Osteoarthritis (Mother); Osteoporosis; Pemphigus (Paternal Grandmother); Pollen allergy (which disappeared in adulthood; treated during childhood with antihistamines and weekly allergy injections until the age of 18); Polycythemia vera (Brother 2); Ragweed allergy (which disappeared in adulthood; treated during childhood with antihistamines and weekly allergy injections until the age of 18); Rheumatoid arthritis (Severe exacerbation in 2018, leading to multiple hospitalizations, innumerable side effects from a variety of RA medications); Rheumatoid arthritis (Mother); Seafood allergy (hives; treated with epinephrine and steroids; but he had eaten them on numerous occasions since then without reaction, as well as other shellfish); STEMI (Mother); Steroid dependence; Thyroid cancer (Maternal Grandmother)
Medical History/Concurrent Conditions: Abdominal diastasis; Axillary lymphadenectomy (Mother); Bowel obstruction (myalgias, arthralgias, fatigue, and joint pain. On 09-Feb-2020 he developed significant abdominal pain and distension. This was followed by six hours of nearly constant vomiting (at least 15 times), followed by several hours of diarrhea, fever, chills, headache, and dehydration. He was admitted for evaluation (09 to 12-Feb-2020. He was evaluated on 24 and 26-Feb-2020 for potential bowel obstruction); Breast cancer (Mother: treated and cured many years ago with Lumpectomy, Axillary Dissection, and Tamoxiphen); COVID-19 (wife had some minor flu-like symptoms. Upon arriving home, she felt much worse and tested positive for Covid. Her course was mild, and she was just given symptomatic OTC medications for approximately one week.); COVID-19 (felt well but obtained Covid Antigen testing precautionarily. It was positive and he required ICU admission several days later- Covid ICU. At that time his fever was 103.8 degrees, and he had a severe cough, respiratory distress and 02 saturation of 90%. He remained hospitalized for approximately one week. He was treated with Remdesivir and convalescent plasma); COVID-19 pneumonia; Cystoscopy; Degenerative joint disease (Mother); Dental disorder NOS (He fractured a tooth, requiring a Root Canal and reconstruction. He also required two Wisdom Teeth extractions.); Dermatomyositis (Brother 2); Epigastric hernia (increasing size of abdominal wall hernia with Diastasis); Food poisoning; Hematoma (Hematoma of the right biceps appeared without trauma, turning the entire arm ecchymotic); Hyperglycemia (when hospitalized and placed on Intravenous Steroids); Insomnia; Jaw pain (Tooth and jaw pain); Kidney stone (Cystoscopy, retrogrades, ureteroscopy and laser lithotripsy performed); Knee ligament repair (Bilateral medial and lateral collateral knee ligament arthroscopic repairs); Laparoscopic surgery (Mother); Laser lithotripsy; Legionella infection (Wife: did not tolerate antibiotics well and due to persistence of symptoms, was evaluated further and tested positive for Legionella); Lipoma (excision of right flank skin mass: Lipoma); Lower urinary tract symptoms (In late Dec-2018 and early Jan-2019, he had increasing LUTS); Lumpectomy (Mother); Lymph node dissection (revealing 7/13 positive lymph nodes, but no extra nodal extension); Malignant melanoma stage III (2 millimeter "freckle" on right anterior superior iliac spine (Hip) began to bleed.); Pneumonia (Maternal Grandfather); Pneumonia parainfluenzae viral (in 2017, 2018, 2019, and 2020; emergent hospitalization (11 to 15-Mar-2019) for respiratory compromise); Quadriparesis (Hospital admission on 05-Mar-2018 Developed severe muscle spasms in hands and forearms with the slightest of intentional activities. Fine motor skills were difficult as well as ADLs); Radical lymphadenectomy (patient had marked diminishment in sensation of the anterior portion of the right leg from the hip to the knee, but no muscle weakness); Renal stone (Brother 2); Rheumatic fever (Father: as a child); Rib fracture (T7, T8, and T9 left anterior rib cage; emergent hospitalization (11 to 15-Mar-2019)); Rotator cuff injury (which was treated with a Medrol joint injection); Skin malignant melanoma excision; Sleep apnea; Stent placement (but due to persistent gross hematuria and stent colic, the stent was removed on POD#3); Sternal fracture (sternal and anterior rib pain); Umbilical herniorrhaphy (secondary to weightlifting); Upper back pain (T6-7; Four-week continuous history of increasing thoracic spine pain radiating to the posterior rib cage, requiring NSAIDS and intermittent narcotics, in the face of 1.5 years of continuous high dose steroids); Upper respiratory infection (Nov-2018; continuing intermittently through Feb-2019, which did not respond well to three sets of antibiotics; another episode on 15-Aug-2019 characterized by relentless cough, rhinorrhea, difficulty lying down at night due to increased dyspnea, rib and sternal pain; took cough suppressant); Upper respiratory infection (his wife, his son, and daughter-in-law, both grandsons: all developed a severe Upper Respiratory Infection simultaneously. All these individuals were treated with antibiotics.); Ureteroscopy; Urolithiasis (Brother 1); Wisdom teeth removal
Prednisone; Plaquenil; Rinvoq; Budesonide; Flomax; Enbrel; Avodart; Advil; Tylenol; Synvisc; Medrol; Fosamax; Ozempic
Test Date: 20240109; Test Name: ALT; Result Unstructured Data: 8; Test Date: 202001; Test Name: Amylase; Result Unstructured Data: Normal; Test Date: 201804; Test Name: Spiral CT Angiogram; Result Unstructured Data: Due to the pulmonary status a Spiral CT Angiogram of the chest was performed (negative for PE); Test Date: 20220422; Test Name: Antibody test; Test Result: Negative ; Test Date: 202202; Test Name: AST/ SGOT; Result Unstructured Data: low; Test Date: 20240109; Test Name: AST/ SGOT; Result Unstructured Data: 14; Test Date: 20160404; Test Name: Biopsy; Result Unstructured Data: revealing an invasive Melanoma with ulcerated surface and 2 mm. depth of invasion; Test Date: 20160421; Test Name: Biopsy; Result Unstructured Data: Positive right inguinal sentinel node. Nodal Biopsy revealed a 1.0 cm. tumor nodule; Test Date: 201610; Test Name: Biopsy; Result Unstructured Data: Inguinal USG guided nodal biopsies were performed and were benign; Test Date: 201702; Test Name: Biopsy; Result Unstructured Data: Positive right inguinal USG guided node biopsies which were positive for metastatic melanoma. A repeat set of biopsies was performed. The nodes were not enlarged but the internal architecture was suspicious. Two of three sets of biopsies revealed malignant cells; Test Date: 20190327; Test Name: Biopsy; Result Unstructured Data: The pathology revealed a Keratoacanthoma, which was a variant of SCC (Squamous Cell Carcinoma). MOHS surgery with immediate Plastic Surgical closure was scheduled for 10-Apr-2019; Test Date: 20240109; Test Name: ALB; Result Unstructured Data: In CMP it was 3.9, for gonadal it was 4.3 (3.6-5.1) Normal; Test Date: 202202; Test Name: Alk Phos; Result Unstructured Data: low; Test Date: 20240109; Test Name: Alk Phos; Result Unstructured Data: 43; Test Date: 20240109; Test Name: Bili; Result Unstructured Data: 0.5; Test Date: 20240109; Test Name: Ca+2; Result Unstructured Data: 10.1; Test Date: 20240109; Test Name: Cl-; Result Unstructured Data: 103; Test Date: 202202; Test Name: Cholesterol; Result Unstructured Data: 187; Test Date: 20240109; Test Name: Total Cholesterol; Test Result: 193 mg/dL; Test Date: 20240109; Test Name: ACTH; Result Unstructured Data: 6 low; Test Date: 20240109; Test Name: AM CORTISOL; Result Unstructured Data: Test Result:2.1 ug/dL;8am-10am, Low; Test Date: 201911; Test Name: CK; Result Unstructured Data: normal; Test Date: 201911; Test Name: CKmb; Result Unstructured Data: normal; Test Date: 20240109; Test Name: Cr; Result Unstructured Data: 1.0; Test Date: 202002; Test Name: Blood cultures; Test Result: Negative ; Test Date: 20230710; Test Name: FSH; Result Unstructured Data: upper limits of normal; Test Date: 20240109; Test Name: FSH; Result Unstructured Data: < 0.70 (1.4-12.8) low; Test Date: 201810; Test Name: Glucose; Result Unstructured Data: 100; Test Date: 201903; Test Name: Glucose; Result Unstructured Data: levels were in the range of 150-300 requiring Insulin coverage.; Test Date: 201911; Test Name: Glucose; Result Unstructured Data: Glucose remained elevated throughout hospitalization often above 150-300; Test Date: 20200209; Test Name: Glucose; Result Unstructured Data: checked throughout hospitalization were normal; Test Date: 20240109; Test Name: Glucose; Result Unstructured Data: 105; Test Date: 201810; Test Name: LDH; Result Unstructured Data: normal; Test Date: 2019; Test Name: LDH; Result Unstructured Data: Normal; Test Date: 202203; Test Name: LDH; Result Unstructured Data: normal; Test Date: 202301; Test Name: LDH; Result Unstructured Data: normal; Test Date: 20230710; Test Name: LDH; Result Unstructured Data: Normal; Test Date: 20230710; Test Name: LH; Result Unstructured Data: upper limits of normal; Test Date: 20240109; Test Name: LH; Result Unstructured Data: < 0.2 (1.6-15.2) low; Test Date: 20240109; Test Name: ESTROGENS; Result Unstructured Data: Test Result:126 pg/mL;Normal with respect to Testosterone; Test Date: 20240109; Test Name: K+; Result Unstructured Data: 4.4; Test Date: 20230710; Test Name: PRL; Result Unstructured Data: slightly above normal. This indicated a component of Hypogonadism; Test Name: PROLACTIN; Test Date: 20240109; Test Name: PROLACTIN; Result Unstructured Data: Test Result:7.6 ng/mL;Normal; Test Date: 20240109; Test Name: Na; Result Unstructured Data: 138; Test Date: 20240109; Test Name: BIOAVAIL T; Result Unstructured Data: Test Result:98.8 ng/mL;Low; Test Date: 20230710; Test Name: T; Result Unstructured Data: low; Test Date: 20240109; Test Name: TOTAL T; Test Result: 321 mg/dL; Test Date: 20240109; Test Name: FREE T; Result Unstructured Data: Test Result:50.2 pg/mL;Low; Test Date: 202303; Test Name: TSH; Result Unstructured Data: normal; Test Date: 202202; Test Name: Triglycerides; Result Unstructured Data: 129; Test Date: 20240109; Test Name: Triglycerides; Test Result: 105 mg/dL; Test Date: 20240109; Test Name: BUN; Result Unstructured Data: 16; Test Date: 20200209; Test Name: Body temperature; Result Unstructured Data: fever to 102.8; Test Date: 20200911; Test Name: Body temperature; Result Unstructured Data: 103.8 degrees; Test Date: 20201113; Test Name: Body temperature; Result Unstructured Data: 103.8 degrees; Test Name: Dexa Scan; Result Unstructured Data: Repeat Dexa Scans continue to show Osteoporosis; Test Date: 2018; Test Name: Dexa Scan; Result Unstructured Data: revealed osteoporosis; Test Date: 20230530; Test Name: Dexa Scan; Result Unstructured Data: showed a mild decrease (minus 3-6%) in bone density; Test Date: 20240109; Test Name: CO2; Result Unstructured Data: 28; Test Date: 2005; Test Name: Cardiac stress test; Result Unstructured Data: Normal; Test Date: 2016; Test Name: Cardiac stress test; Result Unstructured Data: Several stress tests were within normal limits; Test Date: 2022; Test Name: Cardiac stress test; Result Unstructured Data: 177; Test Date: 2016; Test Name: Chest X-ray; Result Unstructured Data: revealed a right lower lobe infiltrate. Doctor saw miniscule pleural thickening on the right, and a 2 mm nodular region in the past and this showed no change in 2016; Test Date: 201811; Test Name: Chest X-ray; Result Unstructured Data: Pneumonia; Test Date: 201902; Test Name: Chest X-ray; Result Unstructured Data: normal lung fields with no evidence of mass or infiltrate. O2 saturation was 97% on room air; Test Date: 202001; Test Name: Chest X-ray; Result Unstructured Data: showed no evidence of Pneumonia; Test Date: 20200209; Test Name: Chest X-ray; Result Unstructured Data: revealed no infiltrate; Test Date: 2023; Test Name: Chest X-ray; Result Unstructured Data: chest showed bibasilar atelectasis; Test Date: 2016; Test Name: Coagulation profile; Result Unstructured Data: normal; Test Date: 202002; Test Name: Coagulation profile; Result Unstructured Data: normal; Test Date: 2004; Test Name: Colonoscopy; Result Unstructured Data: normal; Test Date: 20200309; Test Name: Colonoscopy; Result Unstructured Data: performed to the terminal ileum, and likewise multiple biopsies were obtained, and several incidental polyps were removed (the pathology revealed no evidence of autoimmune disease, and the polyps were benign).; Test Date: 2020; Test Name: Colonoscopy; Result Unstructured Data: 6 sets of biopsies were benign. incidental benign polyps were found; Test Date: 202406; Test Name: Colonoscopy; Result Unstructured Data: A repeat Colonoscopy was normal with no evidence of recurrent polyps; Test Date: 202406; Test Name: Colonoscopy; Result Unstructured Data: Colonoscopy was also normal. No incidental benign polyps were noted; Test Date: 20240620; Test Name: Colonoscopy; Result Unstructured Data: no evidence of polyp, obstruction or malignancy; Test Name: CT; Result Unstructured Data: showed persistent mild hydronephrosis and perinephric stranding and NO stone. There was no evidence of appendicitis, acute diverticulitis, or obstruction; Test Date: 2016; Test Name: CT; Result Unstructured Data: The spiral CT hematuria study revealed several distal left ureteral stones without obstruction or hydronephrosis. Furthermore, there was no evidence of adenopathy, diverticular disease, liver, spleen, or pancreatic abnormality. There was an incidental left adrenal calcification without adrenal enlargement. This was felt to represent old trauma (including the possibility of neonatal trauma); Test Date: 201712; Test Name: CT; Result Unstructured Data: new hernia commenced at the superior aspect of the prior repair. The pelvic adenopathy decreased in size, implying that the Keytruda immunotherapy was potentially effective; Test Date: 2018; Test Name: CT; Result Unstructured Data: revealed significant Kyphosis, compression of mid-thoracic vertebral bodies, with compression fractures of pedicles T6-7. There was increased new bone formation anteriorly; Test Date: 201901; Test Name: CT; Result Unstructured Data: The CT scan showed stability of the Pelvic Adenopathy and no evidence of GI Pathology. The hernia was visible, but there was no evidence of incarceration. The urinary tract was normal with no evidence of stone, mass, obstruction or significant retention of urine; Test Date: 201911; Test Name: CT; Result Unstructured Data: The Iliac and obturator nodes were unchanged (i.e. slightly above limits of normal); Test Date: 202001; Test Name: CT; Result Unstructured Data: There was possible Intussusception and small bowel dilation, more consistent with ileus than obstruction, and significant constipation; Test Date: 202002; Test Name: CT; Result Unstructured Data: with oral contrast was performed. This revealed partial resolution of the dilated small bowel i.e. no obstruction, but there was a question of intussusception. It also illustrated severe constipation from the cecum to the rectum; Test Date: 2020; Test Name: CT; Result Unstructured Data: No CT scan revealed any intraluminal lesions; Test Date: 202109; Test Name: CT; Result Unstructured Data: no evidence of significant adenopathy; Test Date: 202301; Test Name: CT; Result Unstructured Data: CT for the past seven years revealed left adrenal calcifications; Test Date: 2023; Test Name: CT; Result Unstructured Data: Had no evidence of Adenopathy.; Test Date: 2023; Test Name: CT; Result Unstructured Data: chest showed bibasilar atelectasis.; Test Date: 202307; Test Name: CT; Result Unstructured Data: revealed mild right hydroureteronephrosis and perinephric stranding, but no right sided stone. A 4mm left lower pole stone was seen and not obstructing. None of his prior CT scans showed right hydronephrosis or perinephric stranding; Test Date: 202312; Test Name: CT; Result Unstructured Data: Vacuum disc effect in L5-S1; Test Date: 20240605; Test Name: CT; Result Unstructured Data: showed no evidence of malignancy, obstruction, or recurrent polyps. Unfortunately, he continued to experience bowel issues; Test Date: 2024; Test Name: CT; Result Unstructured Data: reveals a 4 mm. left kidney stone; Test Date: 201704; Test Name: CT of C/A/P; Result Unstructured Data: The chest and abdomen were unremarkable from an oncological perspective, whereas in the right pelvis an iliac node increased from 2.3 to 3.7 cm. Jackson-Pratt drains remained in place for eight weeks, producing 500 mls. of lymphatic fluid from each daily; Test Date: 201806; Test Name: CT of C/A/P; Result Unstructured Data: showed no bony abnormalities to suggest metastasis; Test Date: 201810; Test Name: CT of C/A/P; Result Unstructured Data: The report of the CT of the C/A/P included stability of the Iliac and Obturator Nodes bilaterally and no new evidence of disease; Test Date: 20190323; Test Name: CT of C/A/P; Result Unstructured Data: showed an 8th rib fracture, and possibly others. Surrounding this was significant soft tissue swelling and a small pleural effusion. There was bilateral atelectasis and right middle lobe fissure prominence. There was a new 3 mm. left kidney stone. The abdomen was felt to be benign and the lliac and Obturator Lymph Nodes were not prominent. A small supraumbilical hernia was present; Test Date: 2019; Test Name: CT of C/A/P; Result Unstructured Data: No evidence of metastatic disease to the chest; persistent millimeter nodularity and bibasilar atelectasis (unchanged from previous scans). There was no evidence of abdominal adenopathy; the Liver, Spleen and Pancreas were normal. Both kidneys were normal with no evidence of stone, mass, or obstruction. There was some calcification and nodularity of the left adrenal, felt to be possibly neonatal in origin. Most importantly in the pelvis, the lliac and Obturator Adenopathy decreased bilaterally; Test Date: 2019; Test Name: CT of C/A/P; Result Unstructured Data: showed no evidence of metastasis to the skeleton.; Test Date: 20190805; Test Name: CT of C/A/P; Result Unstructured Data: Increase in pelvic lymphadenopathy of unclear clinical significance. This CT also revealed three fractures of Left 7-9th anterior ribs. These fractures were one of many problems missed during the hospitalization. The Pelvic Adenopathy on the right remained stable, whereas an Iliac Node on the left increased from 1.2 X 0.9 cms. to 1.7 X 1.2 cms; Test Date: 202001; Test Name: CT of C/A/P; Result Unstructured Data: no obstruction; Test Date: 20200209; Test Name: CT of C/A/P; Result Unstructured Data: was consistent with an ileus rather than obstruction. There was no evidence of stone disease, or cholelithiasis; Test Date: 20200901; Test Name: CT of C/A/P; Result Unstructured Data: These were all considered negative for disease.; Test Date: 20200910; Test Name: CT of C/A/P; Result Unstructured Data: The CT of the Chest showed small nodes, which were unchanged for many years. The abdomen revealed no change in the pelvic Lymph Nodes and was considered normal. No other intra-abdominal disease was present; Test Date: 202203; Test Name: CT of C/A/P; Result Unstructured Data: no evidence of pelvic adenopathy or unrelated disease; Test Date: 202301; Test Name: CT of C/A/P; Result Unstructured Data: there was no evidence of bowel obstruction. He exhibited significant constipation. The fat containing peri-umbilical hernia was present. The liver, spleen and pancreas were considered normal. The kidneys were not mentioned nor were the pelvic lymph nodes, etc. The adrenals were considered normal; Test Date: 202307; Test Name: CT of C/A/P; Result Unstructured Data: The Chest portion showed several <3mm lesions which were stable and unchanged for multiple years. They were considered nonspecific, non- oncologic in nature. There was chronic bibasilar atelectasis (which was believed related to chronic abdominal distension and inability to fully inspire). In terms of the abdomen, there was a 4mm recurrent left renal stone, but no mass or obstruction. There were calcifications in the left adrenal, which have been present for many years, and possibly neonatal in origin. There was an incidental tiny hepatic cyst. The pancreas, gall bladder and ductal system were normal. The vasculature was normal. There was no significant retroperitoneal adenopathy, and the lliac and Obturator nodes were normal in size (<1.5 cm). Immediately after my Radical LN dissection in April 2017 these were increased in size (>3.5 cm) but have decreased in size over several years; Test Date: 20240605; Test Name: CT of C/A/P; Result Unstructured Data: No obstruction or malignancy was noted but he remained severely constipated in right and transverse colon; Test Date: 202407; Test Name: CT of C/A/P; Result Unstructured Data: no evidence of disease; Test Date: 20190709; Test Name: CT of the Jaw; Result Unstructured Data: This showed no evidence of fracture or abscess.; Test Date: 202001; Test Name: CT of the Brain; Result Unstructured Data: negative for metastasis; Test Date: 20200209; Test Name: CT of the Brain; Result Unstructured Data: showed no evidence of metastasis; Test Name: Cardiac CT calcium score; Result Unstructured Data: Cardiac CT 15-20 years ago showed a calcium score of essentially zero; Test Date: 2016; Test Name: Cardiac CT calcium score; Result Unstructured Data: normal; Test Date: 202202; Test Name: Cardiac CT calcium score; Result Unstructured Data: the total score was 177 and most was in the LAD 166; Test Date: 201911; Test Name: CT of the chest; Result Unstructured Data: no evidence of PE or Metastasis. Atelectasis was present at the bases bilaterally; Test Date: 202011; Test Name: CT of the chest; Result Unstructured Data: was consistent with Covid Pneumonia. There was no evidence of Pulmonary embolism.; Test Date: 201807; Test Name: CRP; Result Unstructured Data: 12.4; Test Date: 201810; Test Name: CRP; Result Unstructured Data: No inflammatory labs were obtained; Test Date: 201911; Test Name: CRP; Result Unstructured Data: within normal limits. With an exacerbation of Rheumatological symptoms these values were significantly elevated in the past; Test Date: 202001; Test Name: CRP; Result Unstructured Data: 4.61; Test Date: 20200209; Test Name: CRP; Result Unstructured Data: minimally elevated.; Test Date: 202002; Test Name: CRP; Result Unstructured Data: significantly elevated, 4.61; Test Date: 202011; Test Name: CRP; Result Unstructured Data: elevated; Test Date: 202202; Test Name: CRP; Result Unstructured Data: 0.5 -slightly elevated; Test Date: 202301; Test Name: CRP; Result Unstructured Data: normal; Test Date: 202303; Test Name: CRP; Result Unstructured Data: normal; Test Date: 20230710; Test Name: CRP; Result Unstructured Data: Normal; Test Date: 201911; Test Name: Cultures; Result Unstructured Data: Sputum Cultures were pending upon discharge; Test Date: 2024; Test Name: Cultures; Result Unstructured Data: Wound cultures were obtained. These were positive for Pseudomonas, Proteus, and Enterococus; Test Date: 2016; Test Name: urine culture; Result Unstructured Data: sterile; Test Date: 201911; Test Name: urine culture; Result Unstructured Data: Urine was negative for Legionella; Test Date: 201902; Test Name: Dermatology evaluation; Result Unstructured Data: Patient noted a 3-4-mm. lesion on the left cheek, which was felt to be inflammatory. This did not resolve in over six weeks and was concerning; Test Date: 202203; Test Name: Dermatology evaluation; Result Unstructured Data: showed no malignant lesions; Test Date: 202207; Test Name: Dermatology evaluation; Result Unstructured Data: showed no malignant lesions; Test Date: 2018; Test Name: Echocardiograms; Result Unstructured Data: were essentially normal; Test Date: 2019; Test Name: Echocardiograms; Result Unstructured Data: were essentially normal; Test Date: 2016; Test Name: EKG; Result Unstructured Data: had nonspecific changes, which had been present for many years; Test Date: 20190325; Test Name: EKG; Result Unstructured Data: no significant abnormalities were found, and no treatment was recommended; Test Date: 20200309; Test Name: Endoscopy/ Upper endoscopy; Result Unstructured Data: performed to the level of the distal duodenum, and multiple biopsies were obtained (pathology was normal with no evidence of Ulcer, Malignancy, or Autoimmune Disease); Test Date: 2020; Test Name: Endoscopy/ Upper endoscopy; Result Unstructured Data: 6 sets of biopsies were benign. incidental benign polyps were found; Test Date: 201807; Test Name: CBC; Result Unstructured Data: essentially normal; Test Date: 201810; Test Name: CBC; Result Unstructured Data: normal; Test Date: 2019; Test Name: CBC; Result Unstructured Data: Normal; Test Date: 201911; Test Name: CBC; Result Unstructured Data: The CBC showed slight elevation throughout hospitalization to a level of 12.5-13.0 with a significant shift to the left; Test Date: 202001; Test Name: CBC; Result Unstructured Data: showed an elevated white count equaling 11,000 (felt to be secondary to steroids); Test Date: 20200209; Test Name: CBC; Result Unstructured Data: revealed a slightly increased white-cell count (11,000).; Test Date: 202002; Test Name: CBC; Result Unstructured Data: Normal; Test Date: 202202; Test Name: CBC; Result Unstructured Data: normal; Test Date: 202203; Test Name: CBC; Result Unstructured Data: normal; Test Date: 202301; Test Name: CBC; Result Unstructured Data: normal; Test Date: 202303; Test Name: CBC; Result Unstructured Data: normal; Test Date: 20230710; Test Name: CBC; Result Unstructured Data: Normal; Test Date: 2020; Test Name: Nuclear Gastric Emptying study; Result Unstructured Data: Normal Study, no evidence of Gastric Emptying Delay.; Test Date: 202307; Test Name: GI evaluation; Result Unstructured Data: which included an UGI swallow and small bowel follow-through. There was no evidence of gastroparesis, and the small bowel transit time was normal. The only comment from the radiologist involved the massive amount of extraluminal fat distorting the small bowel, due to Cushing's Disease; Test Date: 20240109; Test Name: Glob; Result Unstructured Data: 2.9; Test Date: 20240109; Test Name: GFR; Result Unstructured Data: 82; Test Name: Hgb A1C; Test Result: 7.8 %; Test Date: 202202; Test Name: HDL; Result Unstructured Data: 55; Test Date: 20240109; Test Name: HDL Cholesterol; Test Result: 54 mg/dL; Test Date: 20240109; Test Name: H/H; Result Unstructured Data: H/H: 16.1/48.5; Test Name: Lab test; Result Unstructured Data: Positive for BPH with lower tract symptoms-initially treated with Hytrin but this led to dizziness; Test Name: Lab test; Result Unstructured Data: Patient developed symptoms of a possible Peripheral Neuropathy, and fortunately this examination and laboratory studies were also considered normal. The neuropathic symptoms were in the hands, arms, and feet. They subsequently abated. An EMG was not felt to be necessary; Test Date: 20190325; Test Name: Lab test; Result Unstructured Data: Cardiology Consultation: no significant abnormalities were found, and no treatment was recommended; Test Date: 202109; Test Name: Lab test; Result Unstructured Data: Laboratory data was essentially normal; Test Name: radiological studies; Result Unstructured Data: radiological studies regarding gastric and small bowel motility were normal; Test Date: 20200209; Test Name: Liver function tests; Result Unstructured Data: normal as were renal function studies.; Test Name: LDL; Result Unstructured Data: slightly elevated to 115; Test Date: 202202; Test Name: LDL; Result Unstructured Data: 106; Test Date: 20240109; Test Name: LDL Cholesterol; Test Result: 118 mg/dL; Test Name: MRI; Result Unstructured Data: longitudinal tear of the left achilles measuring 3.8 cm. in length, multiple longitudinal, irregular tears of left peroneus brevis, edema and inflammatory changes of the muscles of the left lower extremity, severe osteoarthritis of both knees with destruction basically of all normal joint tissue and cutaneous fistula from a left knee pre-patellar bursa; there was constant leakage of serous fluid but there is no communication to the deeper joint space.; Test Date: 2023; Test Name: MRI; Result Unstructured Data: Had no brain lesions on MRI (especially vis a vis the Pituitary). Had no adrenal lesions simply calcifications for many years.; Test Date: 202307; Test Name: MRI; Result Unstructured Data: showed possible mild disc herniation; Test Date: 20230918; Test Name: MRI; Result Unstructured Data: MRI of the LS Spine and Hip. There was no evidence of hip fracture, or osteonecrosis, but there was mild to moderate DJD of the spine, without significant disc herniation; Test Date: 20231213; Test Name: MRI; Result Unstructured Data: revealing longitudinal tears of the mid Achilles Tendon and the Peroneus Brevis. An MRI revealed a connection to the pre-patellar bursa. MRIs of the left leg were performed revealing the multiple tears; Test Date: 202312; Test Name: MRI; Result Unstructured Data: discovery of 3.8 cm. Unusual longitudinal tear in the left Achilles tendon and multiple tears of the left peroneus brevis. These injuries were felt to be secondary to steroids and chronic exercise injuries; Test Date: 202401; Test Name: MRI; Result Unstructured Data: 3.8 cm longitudinal tear in the mid Achilles tendon, but not a full thickness retracted tear; the tendon at its insertion appears normal; there was also severe tendinosis of the entire Achilles tendon. Longitudinal split tear of the Peroneus Brevis in the retromalleolar and inframalleolar regions. Development of Fistula between the skin and left prepatellar Bursa. This required approximately one year of wound care, collagen and silver dressing changes, and wound debridement. It initially exuded up to 15mls. of fluid daily but now had completely closed. He believed it was a complication of long-term steroid use in an immunocompromised host; Test Date: 20240209; Test Name: MRI; Result Unstructured Data: some improvement in the tears, whereas bilateral Knee MRIs revealed the Left Fistula and significant destruction of the anatomy his of both knees; Test Date: 202402; Test Name: MRI; Result Unstructured Data: left leg shows some improvement in the injuries, whereas the MRIs of both knees shows severe, irreparable Osteoarthritis and Autoimmune RA; Test Date: 202402; Test Name: MRI; Result Unstructured Data: 3.8 cm longitudinal tear in the mid Achilles tendon, but not a full thickness retracted tear; the tendon at its insertion appears normal; there was also severe tendinosis of the entire Achilles tendon. Longitudinal split tear of the Peroneus Brevis in the retromalleolar and inframalleolar regions. Development of Fistula between the skin and left prepatellar Bursa. This required approximately one year of wound care, collagen and silver dressing changes, and wound debridement. It initially exuded up to 15mls. of fluid daily but now had completely closed. He believed it was a complication of long-term steroid use in an immunocompromised host; Test Date: 201810; Test Name: Brain MRI; Result Unstructured Data: The Brain MRI showed no evidence of metastatic disease; Test Date: 2019; Test Name: Brain MRI; Result Unstructured Data: No evidence of metastatic disease; persistent obliteration of Mastoid Sinus (presumably secondary to minor ORL surgery performed during college); Test Date: 20200901; Test Name: Brain MRI; Result Unstructured Data: These were all considered negative for disease; Test Date: 20200910; Test Name: Brain MRI; Result Unstructured Data: showed no evidence of metastatic disease; Test Date: 202307; Test Name: Brain MRI; Result Unstructured Data: revealed no obvious lesions, no evidence of metastasis, vascular disorder, pituitary lesion, etc; Test Date: 202307; Test Name: Brain MRI; Result Unstructured Data: There were no abnormalities of the ventricles or subarachnoid spaces. There was no mass effect or midline shift, or intracranial hemorrhage. The posterior cranial fossa was normal. There was a stable occlusion of the right maxillary sinus, seen in previous studies. There was no evidence of metastasis. The sinus occlusion was presumably secondary to an ORL procedure performed in college; Test Date: 202407; Test Name: Brain MRI; Result Unstructured Data: no evidence of metastatic disease; Test Date: 201604; Test Name: Thoracic MRI; Result Unstructured Data: MRI of thoracic and lumbar spines was considered normal; Test Date: 2018; Test Name: Thoracic MRI; Result Unstructured Data: A subsequent MRI of the thoracic spine showed a significant difference in signal compared to the study in 2016; Test Date: 201810; Test Name: Thoracic MRI; Result Unstructured Data: The Thoracic MRI showed a decrease in the inflammatory signal; Test Date: 201911; Test Name: BMP; Result Unstructured Data: The BMP revealed a normal Cr but slightly elevated BUN (19). The BUN, Cr improved with hydration; Test Date: 2016; Test Name: CMP; Result Unstructured Data: normal; Test Date: 201807; Test Name: CMP; Result Unstructured Data: normal; Test Date: 201810; Test Name: CMP; Result Unstructured Data: normal; Test Date: 2019; Test Name: CMP; Result Unstructured Data: Normal; Test Date: 202001; Test Name: CMP; Result Unstructured Data: Normal; Test Date: 202002; Test Name: CMP; Result Unstructured Data: Normal; Test Date: 202202; Test Name: CMP; Result Unstructured Data: normal, including creatinine and glucose; Test Date: 202203; Test Name: CMP; Result Unstructured Data: normal; Test Date: 202301; Test Name: CMP; Result Unstructured Data: normal; Test Date: 202303; Test Name: CMP; Result Unstructured Data: Normal; Test Date: 20230710; Test Name: CMP; Result Unstructured Data: Normal; Test Date: 2018; Test Name: Microscopic evaluation; Result Unstructured Data: an inflammatory Arthritis as opposed to Osteoarthritis.; Test Date: 201911; Test Name: Nasal swab; Result Unstructured Data: Nasal swabs were positive for Parainfluenza Virus; Test Date: 202001; Test Name: Nasal swab; Result Unstructured Data: Nasal swab was negative in terms of a viral panel; Test Date: 20200209; Test Name: Nasal swab; Test Result: Negative ; Test Date: 20240109; Test Name: Non-HDL Cholesterol; Result Unstructured Data: 139; Test Date: 2019; Test Name: Oncological evaluation; Result Unstructured Data: 11/19-12/19: Oncological evaluation was stable with no clear-cut evidence of pelvic adenopathy or other distant disease.; Test Date: 202203; Test Name: Oncological evaluation; Result Unstructured Data: All results were considered excellent; Test Date: 20230712; Test Name: Ophthalmology; Result Unstructured Data: no significant cataract development, no elevated intraocular pressure or significant change in vision; Test Date: 20190322; Test Name: O2 saturation; Test Result: 96 %; Test Date: 2020; Test Name: O2 saturation; Test Result: 88 %; Test Date: 20200911; Test Name: O2 saturations; Result Unstructured Data: 95-96 percentile/ 91-92%; Test Date: 2020; Test Name: Physical exam; Result Unstructured Data: had several skin lesions on his right leg, which were not healing. These required evaluation in terms of the possibility of SCC or Keratoacanthoma, since he had a facial lesion within the past year that was a Keratoacanthoma upon biopsy.; Test Date: 20240109; Test Name: PL; Result Unstructured Data: 223,000; Test Date: 201604; Test Name: PET CT; Result Unstructured Data: revealed no significant nodal metabolic activity or significantly enlarged nodes. There was nonspecific increased activity in the lower thoracic and lumbar spinal regions. No increased metabolic activity in the region; Test Date: 202001; Test Name: PET CT; Result Unstructured Data: No abnormal metabolic activity in the bowel; Test Date: 20200226; Test Name: PET CT; Result Unstructured Data: No increased bowel activity was seen to suggest SB metastasis.; Test Date: 202004; Test Name: PET CT; Result Unstructured Data: showing no evidence of small bowel malignancy; Test Date: 2020; Test Name: PET CT; Result Unstructured Data: no increased bowel activity. Showed no increased activity in these nodes; Test Date: 2016; Test Name: PSA; Result Unstructured Data: normal; Test Date: 202201; Test Name: PSA; Result Unstructured Data: 0.57; Test Date: 202202; Test Name: PSA; Result Unstructured Data: 0.57; Test Date: 20230710; Test Name: PSA; Result Unstructured Data: Normal; Test Date: 202307; Test Name: PSA; Result Unstructured Data: 1.22 (Free = 0.182; % Free = 14.9%); Test Date: 202401; Test Name: PSA; Result Unstructured Data: 2.3; Test Date: 20240109; Test Name: TP; Result Unstructured Data: 6.8; Test Date: 201804; Test Name: Pulmonary function test; Result Unstructured Data: showed a significant decrease in FEV1 (60% of predicted) and a good response to Albuterol (18% increase); Test Date: 201604; Test Name: Nuclear Colloid Scan; Result Unstructured Data: A Nuclear Colloid Scan was utilized to locate the Sentinel Node. This study revealed a single "hot node" and two much smaller nodes nearby in the inguinal region; Test Date: 201807; Test Name: ESR; Result Unstructured Data: 40; Test Date: 201810; Test Name: ESR; Result Unstructured Data: No inflammatory labs were obtained; Test