Received Aug 13, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| PNC21 | PNEUMO (CAPVAXIVE) | MERCK & CO. INC. | 1 | Z006076 | IM / LA |
Pt was in pain immediately upon injecting of vaccine. Pt jumped and pulled away stating " it feels like you got it right in my muscle" A few hours later pt states her arm was sore and warm to the touch. The next day she was seen in office with painful left arm with bruising pooled by elbow. Provider evaluated pt and states " Cellulitis of upper arm with pain and bruising. Cellulitis starting and bruising above left elbow.
Family history of pulmonary embolism ICD-10-CM: Z82.49 ICD-9-CM: V17.49 8/13/2025 2. Seronegative rheumatoid arthritis (CMS-HCC) ICD-10-CM: M06.00 ICD-9-CM: 714.0 6/13/2025 Relevant Medications abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector 3. Shortness of breath ICD-10-CM: R06.02 ICD-9-CM: 786.05 3/28/2025 4. Nonrheumatic mitral valve regurgitation ICD-10-CM: I34.0 ICD-9-CM: 424.0 3/28/2025 5. Type 2 diabetes mellitus without complication, without long-term current use of insulin (CMS-HCC) ICD-10-CM: E11.9 ICD-9-CM: 250.00 2/26/2025 Relevant Medications semaglutide-Weight Management (WEGOVY) 2.4 MG/0.75ML subcutaneous solution rosuvastatin (CRESTOR) 10 MG tablet 6. Chronic neck pain ICD-10-CM: M54.2, G89.29 ICD-9-CM: 723.1, 338.29 1/31/2025 7. Rash ICD-10-CM: R21 ICD-9-CM: 782.1 1/31/2025 Relevant Medications betamethasone dipropionate 0.05 % cream 8. Complication of anesthesia ICD-10-CM: T88.59XA ICD-9-CM: 995.22 Unknown 9. Generalized edema ICD-10-CM: R60.1 ICD-9-CM: 782.3 11/27/2024 Relevant Medications furosemide (LASIX) 40 mg tablet 10. Urinary retention ICD-10-CM: R33.9 ICD-9-CM: 788.20 11/27/2024 11. Inflammatory polyarthritis (CMS-HCC) ICD-10-CM: M06.4 ICD-9-CM: 714.9 11/19/2024 Relevant Medications abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector 12. Class 2 severe obesity with body mass index (BMI) of 35 to 39.9 with serious comorbidity (CMS-HCC) ICD-10-CM: E66.812, E66.01 ICD-9-CM: 278.01 10/30/2024 Relevant Medications semaglutide-Weight Management (WEGOVY) 2.4 MG/0.75ML subcutaneous solution 13. Mild recurrent major depression ICD-10-CM: F33.0 ICD-9-CM: 296.31 10/30/2024 Relevant Medications gabapentin (NEURONTIN) 300 MG capsule citalopram (CELEXA) 40 mg tablet ARIPiprazole (ABILIFY) 20 mg tablet LORazepam (ATIVAN) 1 MG tablet 14. Coronary artery disease involving native coronary artery of native heart without angina pectoris ICD-10-CM: I25.10 ICD-9-CM: 414.01 9/13/2024 Relevant Medications furosemide (LASIX) 40 mg tablet semaglutide-Weight Management (WEGOVY) 2.4 MG/0.75ML subcutaneous solution amLODIPine (NORVASC) 5 MG tablet ELIQUIS 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet rosuvastatin (CRESTOR) 10 MG tablet 15. Abnormal CT of the chest ICD-10-CM: R93.89 ICD-9-CM: 793.2 8/28/2024 16. Current use of long term anticoagulation ICD-10-CM: Z79.01 ICD-9-CM: V58.61 7/18/2024 Relevant Medications ELIQUIS 5 MG tablet 17. Pneumonia ICD-10-CM: J18.9 ICD-9-CM: 486 7/12/2024 18. Claudication of both lower extremities ICD-10-CM: I73.9 ICD-9-CM: 443.9 6/11/2024 19. Chest pain, unspecified type ICD-10-CM: R07.9 ICD-9-CM: 786.50 6/11/2024 Relevant Medications amLODIPine (NORVASC) 5 MG tablet 20. History of CVA (cerebrovascular accident) without residual deficits ICD-10-CM: Z86.73 ICD-9-CM: V12.54 6/11/2024 Relevant Medications citalopram (CELEXA) 40 mg tablet furosemide (LASIX) 40 mg tablet semaglutide-Weight Management (WEGOVY) 2.4 MG/0.75ML subcutaneous solution amLODIPine (NORVASC) 5 MG tablet ELIQUIS 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet rosuvastatin (CRESTOR) 10 MG tablet 21. Paroxysmal atrial fibrillation (CMS-HCC) ICD-10-CM: I48.0 ICD-9-CM: 427.31 6/5/2024 Relevant Medications amLODIPine (NORVASC) 5 MG tablet ELIQUIS 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet 22. Chronic respiratory failure with hypoxia (CMS-HCC) ICD-10-CM: J96.11 ICD-9-CM: 518.83, 799.02 6/5/2024 23. Postural dizziness with presyncope ICD-10-CM: R42, R55 ICD-9-CM: 780.4, 780.2 6/5/2024 24. New onset of headaches ICD-10-CM: R51.9 ICD-9-CM: 784.0 6/5/2024 Relevant Medications gabapentin (NEURONTIN) 300 MG capsule citalopram (CELEXA) 40 mg tablet cyclobenzaprine (FLEXERIL) 10 MG tablet abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector amLODIPine (NORVASC) 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet HYDROcodone-acetaminophen (NORCO) 10-325 MG per tablet 25. Blurry vision, bilateral ICD-10-CM: H53.8 ICD-9-CM: 368.8 6/5/2024 26. Tardive dyskinesia ICD-10-CM: G24.01 ICD-9-CM: 333.85 4/22/2024 Relevant Medications benztropine (COGENTIN) 1 mg tablet 27. Hot flashes due to surgical menopause ICD-10-CM: E89.41 ICD-9-CM: 627.4 4/22/2024 28. Muscle spasm of back ICD-10-CM: M62.830 ICD-9-CM: 724.8 11/9/2023 Relevant Medications cyclobenzaprine (FLEXERIL) 10 MG tablet 29. Chronic right-sided low back pain with bilateral sciatica ICD-10-CM: M54.41, M54.42, G89.29 ICD-9-CM: 724.3, 724.2, 338.29 11/6/2023 Relevant Medications cyclobenzaprine (FLEXERIL) 10 MG tablet abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector HYDROcodone-acetaminophen (NORCO) 10-325 MG per tablet 30. Hypoxemia ICD-10-CM: R09.02 ICD-9-CM: 799.02 9/18/2023 31. Centrilobular emphysema (CMS-HCC) ICD-10-CM: J43.2 ICD-9-CM: 492.8 3/24/2023 Relevant Medications albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization budeson-glycopyrrol-formoterol (BREZTRI AEROSPHERE) 160-9-4.8 MCG/ACT inhaler albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler roflumilast (DALIRESP) 500 mcg tablet fluticasone (FLONASE) 50 MCG/ACT nasal spray 32. Chronic cluster headache, not intractable ICD-10-CM: G44.029 ICD-9-CM: 339.02 2/17/2022 Relevant Medications gabapentin (NEURONTIN) 300 MG capsule citalopram (CELEXA) 40 mg tablet cyclobenzaprine (FLEXERIL) 10 MG tablet abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector amLODIPine (NORVASC) 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet HYDROcodone-acetaminophen (NORCO) 10-325 MG per tablet 33. Abdominal pain, epigastric on PPI - protonix 40 mg/day ICD-10-CM: R10.13 ICD-9-CM: 789.06 2/17/2022 34. Allergy to multiple antibiotics ICD-10-CM: Z88.1 ICD-9-CM: V14.1 2/3/2022 35. Chronic wrist pain, right ICD-10-CM: M25.531, G89.29 ICD-9-CM: 719.43, 338.29 6/10/2021 36. GAD (generalized anxiety disorder) ICD-10-CM: F41.1 ICD-9-CM: 300.02 6/10/2021 Relevant Medications citalopram (CELEXA) 40 mg tablet LORazepam (ATIVAN) 1 MG tablet 37. Bipolar 2 disorder (CMS-HCC) ICD-10-CM: F31.81 ICD-9-CM: 296.89 6/10/2021 Relevant Medications gabapentin (NEURONTIN) 300 MG capsule citalopram (CELEXA) 40 mg tablet ARIPiprazole (ABILIFY) 20 mg tablet LORazepam (ATIVAN) 1 MG tablet 38. Long term prescription opiate use ICD-10-CM: Z79.891 ICD-9-CM: V58.69 3/10/2021 Relevant Medications naloxone (NARCAN) 4 mg/0.1 mL LIQD nasal liquid 39. History of methicillin resistant staphylococcus aureus (MRSA) ICD-10-CM: Z86.14 ICD-9-CM: V12.04 2/1/2021 40. Long-term use of high-risk medication ICD-10-CM: Z79.899 ICD-9-CM: V58.69 2/1/2021 Relevant Medications naloxone (NARCAN) 4 mg/0.1 mL LIQD nasal liquid 41. Chronic hand pain, unspecified laterality ICD-10-CM: M79.643, G89.29 ICD-9-CM: 729.5, 338.29 12/17/2020 42. Allergic rhinitis, unspecified seasonality, unspecified trigger ICD-10-CM: J30.9 ICD-9-CM: 477.9 6/3/2020 Relevant Medications cetirizine (ZYRTEC) 10 MG tablet 43. Gastric fistula ICD-10-CM: K31.6 ICD-9-CM: 537.4 3/16/2020 44. Chronic nausea ICD-10-CM: R11.0 ICD-9-CM: 787.02 8/26/2019 Relevant Medications ondansetron (ZOFRAN-ODT) 8 mg disintegrating tablet 45. Pure hypercholesterolemia ICD-10-CM: E78.00 ICD-9-CM: 272.0 8/26/2019 Relevant Medications rosuvastatin (CRESTOR) 10 MG tablet 46. Prediabetes ICD-10-CM: R73.03 ICD-9-CM: 790.29 7/25/2019 Relevant Medications rosuvastatin (CRESTOR) 10 MG tablet 47. Hoarseness ICD-10-CM: R49.0 ICD-9-CM: 784.42 6/4/2018 48. Vocal cord leukoplakia ICD-10-CM: J38.3 ICD-9-CM: 478.5 6/4/2018 49. Cyst on ear ICD-10-CM: Q18.1 ICD-9-CM: 706.2 6/4/2018 50. Diffuse TBI w LOC of unsp duration, sequela (HCC) age 16 yo ICD-10-CM: S06.2X9S ICD-9-CM: 907.0 4/13/2018 51. Depression ICD-10-CM: F32.A ICD-9-CM: 311 3/9/2018 Relevant Medications gabapentin (NEURONTIN) 300 MG capsule citalopram (CELEXA) 40 mg tablet ARIPiprazole (ABILIFY) 20 mg tablet LORazepam (ATIVAN) 1 MG tablet 52. Migraine with aura and without status migrainosus, not intractable ICD-10-CM: G43.109 ICD-9-CM: 346.00 3/9/2018 Relevant Medications gabapentin (NEURONTIN) 300 MG capsule citalopram (CELEXA) 40 mg tablet cyclobenzaprine (FLEXERIL) 10 MG tablet abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector amLODIPine (NORVASC) 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet HYDROcodone-acetaminophen (NORCO) 10-325 MG per tablet 53. Neuropathy ICD-10-CM: G62.9 ICD-9-CM: 355.9 3/9/2018 54. Essential hypertension ICD-10-CM: I10 ICD-9-CM: 401.9 2/27/2018 Relevant Medications furosemide (LASIX) 40 mg tablet potassium chloride (K-DUR, KLOR-CON M) 20 mEq controlled release tablet amLODIPine (NORVASC) 5 MG tablet metoprolol tartrate (LOPRESSOR) 25 MG tablet rosuvastatin (CRESTOR) 10 MG tablet 55. Restless legs syndrome (RLS) ICD-10-CM: G25.81 ICD-9-CM: 333.94 2/27/2018 56. Voice hoarseness ICD-10-CM: R49.0 ICD-9-CM: 784.42 8/30/2016 57. Reinke's edema of vocal folds ICD-10-CM: J38.1 ICD-9-CM: 478.4 8/30/2016 58. Oropharyngeal dysphagia ICD-10-CM: R13.12 ICD-9-CM: 787.22 8/30/2016 59. Nasal septal perforation ICD-10-CM: J34.89 ICD-9-CM: 478.19 8/30/2016 60. S/P gastric bypass ICD-10-CM: Z98.84 ICD-9-CM: V45.86 6/20/2016 Relevant Medications semaglutide-Weight Management (WEGOVY) 2.4 MG/0.75ML subcutaneous solution 61. S/P digestive system surgery ICD-10-CM: Z98.890 ICD-9-CM: V45.89 6/20/2016 62. Raynaud disease ICD-10-CM: I73.00 ICD-9-CM: 443.0 5/17/2016 63. Insomnia, unspecified type ICD-10-CM: G47.00 ICD-9-CM: 780.52 2/5/2016 64. Tobacco use disorder ICD-10-CM: F17.200 ICD-9-CM: 305.1 8/7/2015 Relevant Medications ELIQUIS 5 MG tablet 65. Chronic constipation opiod induced ICD-10-CM: K59.09 ICD-9-CM: 564.00 4/27/2015 66. Asthma-COPD overlap syndrome (CMS-HCC) ICD-10-CM: J44.89 ICD-9-CM: 493.20 3/11/2015 Relevant Medications albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization budeson-glycopyrrol-formoterol (BREZTRI AEROSPHERE) 160-9-4.8 MCG/ACT inhaler albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler roflumilast (DALIRESP) 500 mcg tablet fluticasone (FLONASE) 50 MCG/ACT nasal spray 67. Herniation of lumbar intervertebral disc ( L-4-5) ICD-10-CM: M51.26 ICD-9-CM: 722.10 11/3/2014 Relevant Medications cyclobenzaprine (FLEXERIL) 10 MG tablet abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector HYDROcodone-acetaminophen (NORCO) 10-325 MG per tablet 68. ADD (attention deficit disorder) ICD-10-CM: F98.8 ICD-9-CM: 314.00 3/26/2013 Relevant Medications semaglutide-Weight Management (WEGOVY) 2.4 MG/0.75ML subcutaneous solution 69. Recurrent cold sores ICD-10-CM: B00.1 ICD-9-CM: 054.9 3/23/2011 70. Anxiety ICD-10-CM: F41.9 ICD-9-CM: 300.00 2/10/2011 Relevant Medications citalopram (CELEXA) 40 mg tablet LORazepam (ATIVAN) 1 MG tablet 71. GERD (gastroesophageal reflux disease) ICD-10-CM: K21.9 ICD-9-CM: 530.81 11/5/2009 Relevant Medications docusate (COLACE) 100 MG capsule miSOPROStol (CYTOTEC) 100 mcg tablet sucralfate (CARAFATE) 1 g tablet budeson-glycopyrrol-formoterol (BREZTRI AEROSPHERE) 160-9-4.8 MCG/ACT inhaler pantoprazole (PROTONIX) 40 mg enteric-coated tablet amLODIPine (NORVASC) 5 MG tablet levoFLOXacin (LEVAQUIN) 500 MG tablet 72. Fibromyalgia syndrome ICD-10-CM: M79.7 ICD-9-CM: 729.1 9/9/2008
abatacept (ORENCIA) 125 MG/ML subcutaneous auto-injector Inject 1 mL under the skin per week. albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization Take 3 mL by nebulization every 4 hours as needed for Wheezing. albuterol HFA (PROVENTIL HF
BACTRIM Noted Status Severity Type Reaction 08/22/22 1536 ANP 04/03/07 Deleted Not Verified Unknown CEFPROZIL Noted Status Severity Type Reaction 11/23/20 1728 RPh 04/03/07 Active Medium Allergy Hives MORPHINE Noted Status Severity Type Reaction 08/22/22 1534 ANP 04/03/07 Active Medium Hives, Itching ERYTHROMYCIN Noted Status Severity Type Reaction 08/22/22 1535 ANP 04/03/07 Deleted Allergy SULFA ANTIBIOTICS Noted Status Severity Type Reaction 08/22/22 1536 ANP 09/24/09 Active Medium Allergy Hives, Itching, Swelling Comments: Bactrim CIPROFLOXACIN Noted Status Severity Type Reaction 11/23/20 1728 RPh 09/27/12 Active Side Effect Joint Pain Comments: Affects tendon SULFAMETHOXAZOLE-TRIMETHOPRIM Noted Status Severity Type Reaction 11/23/20 1824 CPHT 10/24/13 Deleted Medium Allergy Hives, Itching, Swelling ADHESIVE TAPE Noted Status Severity Type Reaction 11/29/21 0931 ATC 09/29/21 Active Low Rash CEFPROZIL Noted Status Severity Type Reaction 11/23/20 1728 RPh Deleted Comments: Other reaction(s): Hives QUINOLONES Noted Status Severity Type Reaction 11/23/20 1728 RPh Deleted ERYTHROMYCIN Noted Status Severity Type Reaction 11/19/24 0919 RMA 11/18/24 Active High Allergy Itching OTHER Noted Status Severity Type Reaction 11/23/20 1729 RPh Deleted Comments: Other reaction(s): ASTHMA, SINUSITIS pollen, dry wall dust CARBIDOPA-LEVODOPA Noted Status Severity Type Reaction 02/19/25 1629 EMT/P 05/17/18 Active Side Effect Nausea and Vomiting Comments: Sweating, lightheadedness, felt like she would pass out Sweating, lightheadedness, felt like she would pass out Sweating, lightheadedness, felt like she would pass out Sweating, lightheadedness, felt like she would pass out Sweating, lightheadedness, felt like she would pass out CEPHALEXIN Noted Status Severity Type Reaction 08/22/22 1535 ANP 10/28/19 Active Intolerance Other Comments: Tendinopathy; Keflex - OK to give 1 or 2 doses IV Ancef w/ surgery. MAB POLLEN Noted Status Severity Type Reaction 11/23/20 1728 RPh 11/23/20 Active High Allergy Asthma/Shortness of Breath Comments: Sinusitis DUST Noted Status Severity Type Reaction 11/23/20 1729 RPh 11/23/20 Active High Allergy Asthma/Shortness of Breath Comments: Dry wall dust. Sinusitis NSAIDS Noted Status Severity Type Reaction 08/22/22 1536 ANP 11/23/20 Active Side Effect Other Comments: Hx of bariatric surgery DOXYCYCLINE Noted Status Severity Type Reaction 10/06/22 1340 CMA 02/02/22 Active High Side Effect Headache AMOXICILLIN Noted Status Severity Type Reaction 08/22/22 1535 ANP 02/02/22 Deleted High TRIMETHOPRIM Noted Status Severity Type Reaction 11/19/24 0919 RMA 06/03/22 Active Medium Allergy Hives Comments: Other reaction(s): ITCHING/HIVES LATEX Noted Status Severity Type Reaction 08/22/22 1536 ANP 08/16/22 Active Skin Rashes/Hives OXYCODONE Noted Status Severity Type Reaction 09/06/22 1009 RMA 09/06/22 Active High Itching ISOSORBIDE Noted Status Severity Type Reaction 08/09/24 2136 MD 08/09/24 Active Allergy Itching, Headache ADHESIVE TAPE REMOVER PAD Noted Status Severity Type Reaction 08/28/24 1108 RMA 08/28/24 Active Allergy Rash