CHIEF COMPLAINT: Pulmonary Embolism

PRESENT ILLNESS: Patient is a 61 yo female with PMH of metastatic ovarian CA and
recently diagnosed DVT on lovenox presents with right sided CP
and SOB to [**Hospital1 **] [**Location (un) 620**] found to have a large right pulmonary
artery PE and pulmonary infaract as well as several small PE's
in right lower pulmonary artery as well as left lower lobe.  Of
note, she was seen in Heme/onc clinic on [**5-16**] and was found to
have a RLE DVT and was started on lovenox.  She received a dose
of pemetrexed on [**5-21**] and was diagnosed with a UTI and started on
ciprofloxacin. The morning of admission, she developed acute
right-sided CP radiating to the right flank and right back with
SOB.  She presented to [**Hospital1 **] [**Location (un) 620**] and was found to have
pulmonary as above.  She was started on heparin and tranferred
to [**Hospital1 18**] for IVC filter placement.
.
In the ED, T 97.5 BP 94/71 HR 87 R 16 O2 sats O2 sats 99 % on
RA.  She received morphine 2 mg IV x1, dilaudid 1 mg IV x 3,
dilaudid 2 mg IV x 1, ciprofloxacin 400 mg IV x1, zofran 4 mg IV
x1 and was started on a heparin drip.  She had an IVC filter
placed by interventional radiology.  Currently she denies CP and
SOB, and her only complaint is being tired.
.
ROS: Denies fevers, chills, dysuria, hematuria, BRBPR,
hematochezia, melena. She does report being SOB and anxious on
dexamethasone which she was taking before and after her alimta.
Also, she had urinary frequency over the past week prior to
being started ciprofloxacin. Over the past2 months she reports
weight loss and feeling exhausted doing basic ADLs.

MEDICAL HISTORY: Onc history:
Advanced ovarian cancer orginally diagnosed in [**2186**] with stage
IIIC, grade III papillary serous ovarian cancer s/p suboptimal
debulking surgery. She received 6 cycles of carboplatin and
taxol in [**2187**], doxil 6 cycles in [**2188**]. Her CA-125 began to
increase and she was then started on 8 more cycles of doxil. She
was then started on tamoxifen. Most recently she was started on
gemcitabine of which she completed 1 cycle last dose on [**4-30**].
She completed radiation on [**4-6**]. Given that she seemed to be
progressing through these therapies she received first dose of
pemetrexed on [**5-21**]. She has mets to lungs, liver, mediastinum,
soft tissue as well as bilateral hydronephrosis

MEDICATION ON ADMISSION: Medications:
Ciprofloxacin 500 mg PO twice a day (started in [**5-22**])
Enoxaparin 60 mg SC twice a day
Lorazepam 0.5 mg Tablet [**12-14**] Tablet(s) by mouth every 4 hours as
needed for nausea/ insomnia
Folic Acid 0.8 mg PO daily
Iron 325 mg PO every other day
Loperamide [Imodium A-D] 2 mg Tablet 1 Tablet(s) by mouth as
needed for diarrhea
Multivitamin
Omega-3 Fatty Acids [Fish Oil] 1,000 mg Capsule 1 Capsule(s) by
mouth daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Thin

FAMILY HISTORY: .
FH: Maternal aunt with breast cancer.  No family
history of ovarian or colon cancer

SOCIAL HISTORY: SH: Lives with husband. [**Name (NI) **] smoking, ETOH, drugs.
Other pulmonary embolism and infarction,Urinary tract infection, site not specified,Malignant neoplasm of liver, secondary,Hydronephrosis,Malignant neoplasm of ovary,Other ureteric obstruction,Nausea alone,Personal history of venous thrombosis and embolism,Iron deficiency anemia, unspecified,Family history of malignant neoplasm of breast
Pulm embol/infarct NEC,Urin tract infection NOS,Second malig neo liver,Hydronephrosis,Malign neopl ovary,Ureteric obstruction NEC,Nausea alone,Hx-ven thrombosis/embols,Iron defic anemia NOS,Family hx-breast malig
Admission Date:  [**2192-5-26**]              Discharge Date:   [**2192-5-31**]

Date of Birth:  [**2131-1-20**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3619**]
Chief Complaint:
Pulmonary Embolism

Major Surgical or Invasive Procedure:
IVC Filter

History of Present Illness:
Patient is a 61 yo female with PMH of metastatic ovarian CA and
recently diagnosed DVT on lovenox presents with right sided CP
and SOB to [**Hospital1 **] [**Location (un) 620**] found to have a large right pulmonary
artery PE and pulmonary infaract as well as several small PE's
in right lower pulmonary artery as well as left lower lobe.  Of
note, she was seen in Heme/onc clinic on [**5-16**] and was found to
have a RLE DVT and was started on lovenox.  She received a dose
of pemetrexed on [**5-21**] and was diagnosed with a UTI and started on
ciprofloxacin. The morning of admission, she developed acute
right-sided CP radiating to the right flank and right back with
SOB.  She presented to [**Hospital1 **] [**Location (un) 620**] and was found to have
pulmonary as above.  She was started on heparin and tranferred
to [**Hospital1 18**] for IVC filter placement.
.
In the ED, T 97.5 BP 94/71 HR 87 R 16 O2 sats O2 sats 99 % on
RA.  She received morphine 2 mg IV x1, dilaudid 1 mg IV x 3,
dilaudid 2 mg IV x 1, ciprofloxacin 400 mg IV x1, zofran 4 mg IV
x1 and was started on a heparin drip.  She had an IVC filter
placed by interventional radiology.  Currently she denies CP and
SOB, and her only complaint is being tired.
.
ROS: Denies fevers, chills, dysuria, hematuria, BRBPR,
hematochezia, melena. She does report being SOB and anxious on
dexamethasone which she was taking before and after her alimta.
Also, she had urinary frequency over the past week prior to
being started ciprofloxacin. Over the past2 months she reports
weight loss and feeling exhausted doing basic ADLs.


Past Medical History:
Onc history:
Advanced ovarian cancer orginally diagnosed in [**2186**] with stage
IIIC, grade III papillary serous ovarian cancer s/p suboptimal
debulking surgery. She received 6 cycles of carboplatin and
taxol in [**2187**], doxil 6 cycles in [**2188**]. Her CA-125 began to
increase and she was then started on 8 more cycles of doxil. She
was then started on tamoxifen. Most recently she was started on
gemcitabine of which she completed 1 cycle last dose on [**4-30**].
She completed radiation on [**4-6**]. Given that she seemed to be
progressing through these therapies she received first dose of
pemetrexed on [**5-21**]. She has mets to lungs, liver, mediastinum,
soft tissue as well as bilateral hydronephrosis

Iron deficiency anemia.
DVT
Colonoscopy in [**2-/2191**] with bleeding rectal mass. Biopsy
inconclusive

Social History:
SH: Lives with husband. [**Name (NI) **] smoking, ETOH, drugs.

.


Family History:
.
FH: Maternal aunt with breast cancer.  No family
history of ovarian or colon cancer

Physical Exam:
General Appearance: Thin

Eyes / Conjunctiva: PERRL, Conjunctiva pale

Head, Ears, Nose, Throat: Normocephalic

Cardiovascular: (S1: Normal), (S2: Normal)

Peripheral Vascular: (Right radial pulse: Not assessed), (Left
radial pulse: Not assessed), (Right DP pulse: Present), (Left DP
pulse: Present)

Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Wheezes : , Rhonchorous: bilateral bases R>L)

Skin:  Not assessed

Neurologic: Responds to: Not assessed, Movement: Not assessed,
Tone: Not assessed





Pertinent Results:
Imaging:
CT head : 1. No acute intracranial process.
2. No evidence of edema to suggest an underlying mass lesion.
However, of note, CT is not as sensitive as MR [**First Name (Titles) **] [**Last Name (Titles) 54340**] of
intracranial metastatic disease.
.
CTA and CT abd/pelvis:

1. LARGE CENTRAL RIGHT MAIN PULMONARY EMBOLI.  THERE IS FLOW
DISTAL TO THE LARGE CENTRAL THROMBUS.  FAIRLY EXTENSIVE EMBOLI
ARE NOTED IN THE  RIGHT LOWER PULMONARY ARTERY AS WELL.  Wedge
shaped consolidation in right lower lobe concerning for
infarctionTHERE ARE SMALL LEFT LOWER LOBE PULMONARY ARTERIAL
EMBOLI.

2. FINDINGS CONSISTENT WITH DIFFUSE METASTATIC DISEASE WITH
NUMEROUS METASTASIS THROUGHOUT THE LIVER. MEDIASTINAL AND HILAR
ADENOPATHY AND A LARGE RIGHT LOWER QUADRANT PELVIC MASS.

3. DELAYED EXCRETION WITHIN THE RIGHT KIDNEYS WITH SEVERE
HYDRONEPHROSIS AND CORTICAL THINNING.  THE OBSTRUCTION OF THE
RIGHT KIDNEY IS BEING CAUSED BY THE RIGHT LOWER QUADRANT PELVIC
MASS.

4. CHOLELITHIASIS.

5. SIGMOID DIVERTICULOSIS.

6. MILD ANASARCA AND MILD ASCITES
.
CXR [**2192-5-27**] - The cardiac size is within normal limits. Tortuous
aorta is present. Left lung is clear. Some opacities are present
within the right lower lobe which would be more characteristic
for aspiration pneumonia than for pulmonary embolus. The known
pulmonary metastases are not positively identified.

IMPRESSION: Opacities in right lower lobe not particularly
characteristics for pulmonary embolus.
.
[**2192-5-26**] 09:50AM   WBC-5.2 RBC-2.76* HGB-8.7* HCT-25.3* MCV-92
MCH-31.4 MCHC-34.3 RDW-16.0*
[**2192-5-26**] 09:50AM   NEUTS-93.2* BANDS-0 LYMPHS-5.8* MONOS-0.3*
EOS-0.4 BASOS-0.2
[**2192-5-26**] 09:50AM   PLT SMR-NORMAL PLT COUNT-195
[**2192-5-26**] 09:50AM   PT-14.2* PTT-70.5* INR(PT)-1.2*
[**2192-5-26**] 09:50AM   GLUCOSE-117* UREA N-22* CREAT-1.1 SODIUM-136
POTASSIUM-4.5 CHLORIDE-105 TOTAL CO2-19* ANION GAP-17
[**2192-5-26**] 09:50AM   CALCIUM-8.7 PHOSPHATE-3.2 MAGNESIUM-2.3
[**2192-5-26**] 11:30AM URINE  RBC-0-2 WBC-[**11-1**]* BACTERIA-MANY
YEAST-NONE EPI-0-2
[**2192-5-26**] 11:30AM URINE  BLOOD-NEG NITRITE-POS PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-TR
[**2192-5-26**] 11:30AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.045*
[**2192-5-30**] 05:40AM BLOOD WBC-5.7# RBC-3.11* Hgb-9.5* Hct-27.9*
MCV-90 MCH-30.6 MCHC-34.1 RDW-15.8* Plt Ct-68*
[**2192-5-28**] 06:50AM BLOOD WBC-1.4*# RBC-2.59* Hgb-8.0* Hct-24.4*
MCV-94 MCH-30.9 MCHC-32.8 RDW-15.5 Plt Ct-121*
[**2192-5-31**] 06:45AM BLOOD Neuts-75* Bands-2 Lymphs-11* Monos-11
Eos-1 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2192-5-31**] 06:45AM BLOOD Plt Ct-56*
[**2192-5-28**] 06:50AM BLOOD PT-14.8* PTT-77.9* INR(PT)-1.3*
[**2192-5-26**] 09:50AM BLOOD PT-14.2* PTT-70.5* INR(PT)-1.2*
[**2192-5-26**] 11:03PM BLOOD PTT-60.5*
[**2192-5-31**] 06:45AM BLOOD Glucose-85 UreaN-12 Creat-0.7 Na-136
K-4.0 Cl-104 HCO3-22 AnGap-14
[**2192-5-27**] 05:32AM BLOOD Glucose-91 UreaN-16 Creat-0.8 Na-133
K-4.1 Cl-105 HCO3-18* AnGap-14
[**2192-5-31**] 06:45AM BLOOD Calcium-9.1 Phos-1.9* Mg-2.0
[**2192-5-26**] 09:50AM BLOOD Calcium-8.7 Phos-3.2 Mg-2.3

[**2192-5-26**] 11:30 am URINE     Site: CLEAN CATCH

                            **FINAL REPORT [**2192-5-28**]**

   URINE CULTURE (Final [**2192-5-28**]):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------    16 I
AMPICILLIN/SULBACTAM--     4 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------    16 I
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------    64 I
PIPERACILLIN----------   <=4 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S


Brief Hospital Course:
A/P: 61 yo female with metastatic ovarian cancer with recently
diagnosed DVT now with large right main pulmonary artery PE and
pulmonary infarct and small bilateral lower lobe PEs despite
anticoagulation with lovenox now s/p IVC filter placement
.
# PE: The patient presented with a large R main pulmonary artery
PE despite lovenox therapy. Upon arrival to [**Hospital1 18**] the pt was
taken to IR for placement of an IVC filter. She was started on a
heparin gtt and transfered to the ICU for monitoring given her
large clot burden. The pt remained HD stable overnight and was
transferred to the medical floor. There she remained stable on
room air. After another 24 hours, she was transitioned back to
lovenox which she will continue indefinitely. She was evaluated
by physical therapy and after several sessions, it was felt that
she was strong enough to return home with continued PT at home.
.
# UTI: The pt was started on cipro on [**5-22**] for UTI, but urine
culture reveals e. coli resistant to cipro. UA still grossly
positive and has hydronephrosis which has been noted in the
past. She was transitioned to ceftriaxone. Concern was given to
the development of pyelonephritis as the pt has known b/l
hydronephrosis. She has no current evidence of systemic toxicity
with no fevers and normal WBC. Her WBC cound dropped briefly to
the neutrapenic range, during which time she was transitioned to
cefepime. After her WBC count recovered with Neupogen and
sensitivities returned she was transitioned to Bactrim to
complete an anticipated 10 day total course.
.
# RUQ pain: The patient was also noted to have a RLL pulmonary
infarct on CTA which was causing her signficant pain with motion
and deep breathing. This was treated with PO dilaudid to good
effect. The pain was improving throughout admission.
 .
# Anemia: Known iron deficiency anemia. Her HCT drifted slowly
down during this admission, likely due to Gemzar. She received a
total of 2 units of PRBCs to good effect.
.
# Nausea: Seems to have this at baseline. Ativan with best
effect. Continued home ativan as well as PRN compazine and
zofran
.
# Metastatic ovarian CA: Has widely metastatic disease.
Currently receiving alimta.
She will follow up with her primary oncologist regarding further
treatment.
.
# FEN: regular diet
.
# Code: Spoke with patient and her husband and [**Name2 (NI) 41859**].  The
patient did not have a HCP prior to admission, but identified
her husband as the person who would be her HCP. She was givne
the HCP form to sign.  Additionally, we discussed her wishes,
and she said "I haven't hought about this."  She knows that "I
would not want to be kept alive dependent on machines." However,
she does say that she would want to give it a try for now.  I
explained that is she got intubated that it would most likley be
for worseing of her PE, which would be very grave and she would
likely not recover from this. She "wants to think about it." For
now, she is full code.
.


Medications on Admission:
Medications:
Ciprofloxacin 500 mg PO twice a day (started in [**5-22**])
Enoxaparin 60 mg SC twice a day
Lorazepam 0.5 mg Tablet [**12-14**] Tablet(s) by mouth every 4 hours as
needed for nausea/ insomnia
Folic Acid 0.8 mg PO daily
Iron 325 mg PO every other day
Loperamide [Imodium A-D] 2 mg Tablet 1 Tablet(s) by mouth as
needed for diarrhea
Multivitamin
Omega-3 Fatty Acids [Fish Oil] 1,000 mg Capsule 1 Capsule(s) by
mouth daily

Discharge Medications:
1. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours) as needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Omega-3 Fatty Acids     Capsule Sig: One (1) Capsule PO DAILY
(Daily).
4. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO EVERY OTHER DAY (Every Other Day).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): Hold for diarrhea.
Disp:*60 Tablet(s)* Refills:*2*
7. Enoxaparin 60 mg/0.6 mL Syringe Sig: One (1)  Subcutaneous
Q12H (every 12 hours).
8. Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
9. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
10. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Pulmonary Embolus
E.coli Urinary tract infection

Metastatic ovarian cancer


Discharge Condition:
All vital signs stable, afebrile, ambulatory


Discharge Instructions:
You were admitted with a clot in your lungs called a pulmonary
embolus. You had a filter placed in your inferior vena cava to
protect you from these in the future. You were started on IV
blood thinners in the hospital and transitioned to the blood
thinner called Lovenox that will be administered by a shot twice
a day. You will continue this medication until your oncologist
says you should stop. The pain on your right side is associated
with the blood clot and should continue to get better. We will
prescribe a medication called Dilaudid for you to take at home
to help the pain.

You were also found to have a urinary tract infection. This was
treated with IV antibiotics intitially and then you switched to
oral antitiotics. You will need to continue to take these
antibiotics (Bactrim or Trimethoprim/Sulfa) for several more
days to finish up treatment.

Please take all your medications as prescribed and make all of
your follow up appointments.

Please call your doctor if you experience any symptoms that are
concerning to you.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 2295**] [**Last Name (NamePattern1) 10917**], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2192-6-4**] 10:30
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2192-6-11**] 4:00
Provider: [**First Name8 (NamePattern2) 2295**] [**Last Name (NamePattern1) 10917**], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2192-6-11**] 4:30


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 3621**]
{'Other pulmonary embolism and infarction,Urinary tract infection, site not specified,Malignant neoplasm of liver, secondary,Hydronephrosis,Malignant neoplasm of ovary,Other ureteric obstruction,Nausea alone,Personal history of venous thrombosis and embolism,Iron deficiency anemia, unspecified,Family history of malignant neoplasm of breast'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Pulmonary Embolism

PRESENT ILLNESS: Patient is a 61 yo female with PMH of metastatic ovarian CA and
recently diagnosed DVT on lovenox presents with right sided CP
and SOB to [**Hospital1 **] [**Location (un) 620**] found to have a large right pulmonary
artery PE and pulmonary infaract as well as several small PE's
in right lower pulmonary artery as well as left lower lobe.  Of
note, she was seen in Heme/onc clinic on [**5-16**] and was found to
have a RLE DVT and was started on lovenox.  She received a dose
of pemetrexed on [**5-21**] and was diagnosed with a UTI and started on
ciprofloxacin. The morning of admission, she developed acute
right-sided CP radiating to the right flank and right back with
SOB.  She presented to [**Hospital1 **] [**Location (un) 620**] and was found to have
pulmonary as above.  She was started on heparin and tranferred
to [**Hospital1 18**] for IVC filter placement.
.
In the ED, T 97.5 BP 94/71 HR 87 R 16 O2 sats O2 sats 99 % on
RA.  She received morphine 2 mg IV x1, dilaudid 1 mg IV x 3,
dilaudid 2 mg IV x 1, ciprofloxacin 400 mg IV x1, zofran 4 mg IV
x1 and was started on a heparin drip.  She had an IVC filter
placed by interventional radiology.  Currently she denies CP and
SOB, and her only complaint is being tired.
.
ROS: Denies fevers, chills, dysuria, hematuria, BRBPR,
hematochezia, melena. She does report being SOB and anxious on
dexamethasone which she was taking before and after her alimta.
Also, she had urinary frequency over the past week prior to
being started ciprofloxacin. Over the past2 months she reports
weight loss and feeling exhausted doing basic ADLs.

MEDICAL HISTORY: Onc history:
Advanced ovarian cancer orginally diagnosed in [**2186**] with stage
IIIC, grade III papillary serous ovarian cancer s/p suboptimal
debulking surgery. She received 6 cycles of carboplatin and
taxol in [**2187**], doxil 6 cycles in [**2188**]. Her CA-125 began to
increase and she was then started on 8 more cycles of doxil. She
was then started on tamoxifen. Most recently she was started on
gemcitabine of which she completed 1 cycle last dose on [**4-30**].
She completed radiation on [**4-6**]. Given that she seemed to be
progressing through these therapies she received first dose of
pemetrexed on [**5-21**]. She has mets to lungs, liver, mediastinum,
soft tissue as well as bilateral hydronephrosis

MEDICATION ON ADMISSION: Medications:
Ciprofloxacin 500 mg PO twice a day (started in [**5-22**])
Enoxaparin 60 mg SC twice a day
Lorazepam 0.5 mg Tablet [**12-14**] Tablet(s) by mouth every 4 hours as
needed for nausea/ insomnia
Folic Acid 0.8 mg PO daily
Iron 325 mg PO every other day
Loperamide [Imodium A-D] 2 mg Tablet 1 Tablet(s) by mouth as
needed for diarrhea
Multivitamin
Omega-3 Fatty Acids [Fish Oil] 1,000 mg Capsule 1 Capsule(s) by
mouth daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Thin

FAMILY HISTORY: .
FH: Maternal aunt with breast cancer.  No family
history of ovarian or colon cancer

SOCIAL HISTORY: SH: Lives with husband. [**Name (NI) **] smoking, ETOH, drugs. 

### Response:
{'Other pulmonary embolism and infarction,Urinary tract infection, site not specified,Malignant neoplasm of liver, secondary,Hydronephrosis,Malignant neoplasm of ovary,Other ureteric obstruction,Nausea alone,Personal history of venous thrombosis and embolism,Iron deficiency anemia, unspecified,Family history of malignant neoplasm of breast'}
