CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 62-year-old
Caucasian male with a complex medical history including
multiple myeloma diagnosed in [**2136**], now status post XRT and
undergoing treatment with Decadron and thalidomide, status
post laminectomy at L4, S1, and a left epidural tumor removal
in [**2147-7-14**] complicated by months of hospitalization
for various wound infections and debridements who presents
with serous drainage from his back.

MEDICAL HISTORY: 1.  Multiple myeloma with XRT and Decadron in the past, now
on thalidomide.
2.  Status post laminectomy, L4-S1, and left epidural tumor
removal in [**2147-7-14**], complicated by three to four
months of hospitalizations and various complications
including MRSA debridement with flap closure, left parietal
CVA, atrial arrhythmias, and a bilateral V-Y fasciocutaneous
flap.
3.  DVT in [**2147-1-14**].
4.  Sick sinus syndrome/atrial fibrillation, currently
followed by a cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**].
5.  C. difficile colitis.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient currently lives with his fiance.
He denied tobacco or alcohol use.
Other postoperative infection,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Cellulitis and abscess of trunk,Unspecified septicemia,Systemic inflammatory response syndrome, unspecified,Intestinal infection due to Clostridium difficile,Multiple myeloma, without mention of having achieved remission
Other postop infection,Mth sus Stph aur els/NOS,Cellulitis of trunk,Septicemia NOS,SIRS, NOS,Int inf clstrdium dfcile,Mult mye w/o achv rmson
Admission Date:  [**2148-2-5**]       Discharge Date: [**2148-2-9**]

Date of Birth:   [**2086-10-30**]       Sex:  M

Service:  [**Location (un) 259**]

HISTORY OF THE PRESENT ILLNESS:  This is a 62-year-old
Caucasian male with a complex medical history including
multiple myeloma diagnosed in [**2136**], now status post XRT and
undergoing treatment with Decadron and thalidomide, status
post laminectomy at L4, S1, and a left epidural tumor removal
in [**2147-7-14**] complicated by months of hospitalization
for various wound infections and debridements who presents
with serous drainage from his back.

The patient underwent a laminectomy at L4-S1 and left
epidural tumor removal in [**2147-7-14**] and was subsequently
readmitted for fevers/wound infection with gram-negative rods
and MRSA complicated by sepsis.  The patient underwent a
debridement with flap closure of the lumbar incision in
[**2147-8-14**].  He was prescribed at that time with six
weeks of vancomycin and subsequently suffered a left parietal
cerebrovascular accident, atrial arrhythmias, and sick sinus
syndrome, with continual leakage from his flap site
eventually requiring a bilateral V-Y fasciocutaneous flap in
[**2147-10-14**] by Dr. [**First Name (STitle) **] of Plastic Surgery.

The patient is now transferred to [**Hospital1 18**] from [**Hospital1 1474**] where
he presented with a one day history of serous drainage from
his lower back.  At [**Hospital1 1474**], the patient was afebrile with a
blood pressure of 96/56 at his baseline with a heart rate in
the 160s, in atrial fibrillation without ischemic EKG
changes.  The patient was given 20 mg IV and 50 mg IV of
Diltiazem and 60 mg p.o. of Diltiazem with the heart rate
decreasing to the 100s and a systolic blood pressure
decreasing to 78.  The patient was then hydrated with IV
fluids and given 3 grams of IV Unasyn, 2 mg of Dilaudid and
transferred for a question of sepsis.

On arrival to [**Hospital1 18**], the patient was noted to be afebrile
with warm skin and nontoxic appearing.  His heart rate was
noted to be irregularly/irregular in the 110s with a systolic
blood pressure between 80 and 95.  The patient was noted to
have slightly slurred speech thought secondary to Dilaudid.
The patient was evaluated by Neurosurgery who noted a 1 cm
ulcer over the area of his back flap without pus but with
evidence of serous drainage.  The patient's back was also
notable for mild erythema and the plan was for reevaluation
by Plastic Surgery the following morning.

On admission, the patient denied bowel or bladder
incontinence, focal weakness, or loss of sensation,
headaches, chest pain, palpitations, shortness of breath,
fevers, chills, night sweats.

PAST MEDICAL HISTORY:
1.  Multiple myeloma with XRT and Decadron in the past, now
on thalidomide.
2.  Status post laminectomy, L4-S1, and left epidural tumor
removal in [**2147-7-14**], complicated by three to four
months of hospitalizations and various complications
including MRSA debridement with flap closure, left parietal
CVA, atrial arrhythmias, and a bilateral V-Y fasciocutaneous
flap.
3.  DVT in [**2147-1-14**].
4.  Sick sinus syndrome/atrial fibrillation, currently
followed by a cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**].
5.  C. difficile colitis.

MEDICATIONS (OUTPATIENT):
1.  Duragesic 100 TP q. 72 hours.
2.  MSIR 15-30 q. four to six hours p.r.n.
3.  MS Contin 30 q. 12 hours.
4.  Neurontin 900 mg t.i.d.
5.  Coumadin 7 mg q.d.
6.  Dexamethasone 2 mg q. week.
7.  Thalidomide 200 q.d.
8.  Depakote 750 mg b.i.d.
9.  Vitamin D 400 units q.d.
10. Tums three tablets q.d.
11. Nystatin 15 milliliters swish and swallow q.d.

SOCIAL HISTORY:  The patient currently lives with his fiance.
He denied tobacco or alcohol use.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Temperature
98.4, BP 81-95/47-69, heart rate 98-129 (irregular),
respiratory rate 23, 100% on room air.  General:  The patient
is not toxic appearing, in no acute distress with warm
extremities.  HEENT:  The pupils were equal, round, and
reactive to light.  The extraocular movements were intact.
No evidence of conjunctival pallor.  Neck:  Supple, full
range of motion.  No lymphadenopathy or jugular venous
distention.  Pulmonary:  Clear to auscultation bilaterally.
Cardiovascular:  Tachy, irregularly/irregular without
evidence of murmurs.  Abdomen:  Soft, nontender,
nondistended, normoactive bowel sounds.  Extremities:  No
evidence of clubbing, cyanosis, or edema, mild pain with hip
flexion.  Rectal:  Good tone, Guaiac negative.  Neurologic:
No evidence of saddle anesthesia.  Cranial nerves II through
XII were intact.  No flaccid droop.  There was 5/5 strength
and sensation in all extremities.  Back:  Evidence of
erythema of the patient's lower back with serous drainage
from a 1 cm ulcer in the right lower back.  No evidence of
expressible pus.

LABORATORY/RADIOLOGIC DATA:  White blood cell count 11.3,
hematocrit 28.7, platelets 453,000.  Sodium 141, potassium
4.6, chloride 105, bicarbonate 33, BUN 8, creatinine 0.6,
glucose 80, lactate 1.4.  INR 8.0 (at [**Hospital1 1474**]).

U/A negative.

EKG revealed atrial fibrillation at 112 beats per minute,
normal axis, poor R wave progression, no ischemic ST-T wave
changes.

HOSPITAL COURSE:  1.  CARDIOVASCULAR:  On the night of
admission, the patient was noted to be hypotensive and
tachycardiac and was evaluated by the night float resident.
The patient was eventually transferred to the MICU with a
concern for sepsis.  The patient was briefly on
Neo-Synephrine for blood pressure control but after one day
was weaned off and was hemodynamically stable throughout the
remainder of his hospital stay.

The patient was evaluated with an echocardiogram on [**2148-2-7**] which was significant for an ejection fraction of
30-40%, decreased from a previous echocardiogram.  The
patient was continued on a beta blocker for rate control for
the recommendation of the Electrophysiology/Cardiology
Service who followed the patient throughout this admission.
Given his history of atrial fibrillation, the patient was
also maintained on Coumadin with a heparin drip until his INR
was therapeutic for 48 hours.  The Electrophysiology Consult
Service recommended the patient having a repeat
echocardiogram six weeks after discharge as well as possible
cardioversion after one month of therapeutic anticoagulation.

2.  INFECTIOUS DISEASE:  The patient was admitted with serous
drainage from his lower back with an extensive history of
wound infections status post laminectomy and epidural tumor
removal.  Given the patient's tachycardia and hypotension,
there was a concern for sepsis.  The patient was transferred
to the MICU, as described previously.  The Plastic Surgery
and Neurosurgery teams were consulted and did not feel that
surgical excision or intervention was warranted and
recommended continuing antibiotics.  The Infectious Disease
Consult Service was contact[**Name (NI) **] and recommended vancomycin and
Meropenem for broad spectrum coverage.

An MRI performed was significant for increase in fluid
collection posterior to the body of S2 with residual fluid
pockets posterior to the previous operative site.  The
Interventional Radiation Consult Service was contact[**Name (NI) **] to
aspirate this fluid collection and the patient was taken for
a CT-guided aspiration on [**2148-2-9**], the results of
which are pending at the time of this dictation.  The patient
received a PICC line and will receive IV antibiotics for at
least four weeks given a concern for possible osteomyelitis.

The patient was also noted to have loose stools and a C.
difficile toxin came back negative and the patient was
treated with Flagyl.

3.  ONCOLOGY:  The patient was admitted with a history of
multiple myeloma on thalidomide and Decadron.  These
medications were continued.  An attempt was made to contact
the patient's oncologist, Dr. [**First Name (STitle) **], who referred us to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] who has yet to see the patient at the time of this
dictation.

4.  HEME:  The patient also has a history of anemia with a
stable hematocrit throughout this admission.  The patient
also has a history of a DVT and atrial fibrillation and was
continued on heparin and Coumadin as noted above until her
INR is therapeutic for 48 hours.

5.  FLUIDS, ELECTROLYTES, AND NUTRITION:  The patient was
placed on zinc and vitamin C for wound healing.  His sodium
was noted to increase throughout his stay in the MICU and
p.o. intake of free fluid was encouraged with a gradual
resolution of his hypernatremia.

6.  ENDOCRINE:  Given the patient's hypotension, there was a
concern for adrenal insufficiency in this patient who has
been on chronic steroids for his multiple myeloma.  [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**]
stim test was performed and the patient did not respond
appropriately according to the sepsis protocol and was placed
on three days of stress dose steroids for potential adrenal
insufficiency.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to a
rehabilitation facility.

DISCHARGE DIAGNOSIS:
1.  Draining sinus tract.
2.  Clostridium difficile colitis.
3.  Multiple myeloma.
4.  Sick sinus syndrome.
5.  Anemia.
6.  Adrenal insufficiency.

DISCHARGE MEDICATIONS:
1.  Gabapentin 900 mg p.o. t.i.d.
2.  Thalidomide 200 mg p.o. q.d.
3.  Divalproex sodium 250 mg p.o. t.i.d.
4.  Vitamin D3 400 units p.o. q.d.
5.  Calcium carbonate 500 mg p.o. q.i.d.
6.  Nystatin 5 milliliters p.o. q.i.d.
7.  Tylenol one to two tablets p.o. q. four to six hours
p.r.n.
8.  Colace 100 mg p.o. b.i.d. p.r.n.
9.  Senna one tablet p.o. b.i.d. p.r.n.
10. Bisacodyl 5 mg one to two tablets p.o. q.d. p.r.n.
11. Pantoprazole 40 mg p.o. q.d.
12. Dexamethasone 40 mg p.o. q. Friday.
13. Metoprolol 25 mg p.o. b.i.d.
14. Coumadin 6 mg p.o. q.h.s.
15. Ascorbic acid 500 mg p.o. b.i.d.
16. Zinc sulfate 220 mg p.o. q.d.
17. Vancomycin 1 gram IV q. 12 hours.
18. Flagyl 500 mg p.o. t.i.d.
19. Meropenem 1 gram IV q. eight hours.

FOLLOW-UP:  The patient has a follow-up appointment with Dr.
[**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) **] on [**2148-2-20**] at 10:00 a.m.  He also has
a scheduled echocardiogram on [**2148-3-25**] at 2:00 p.m. and
a follow-up appointment with cardiologist, Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 284**], on [**2148-4-1**] at 2:30 p.m.

Of note, the discharge medications and diagnoses are subject
to change according to subsequent discharge addendums.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5613**], M.D.  [**MD Number(2) 5614**]

Dictated By:[**Last Name (NamePattern1) 4950**]
MEDQUIST36

D:  [**2148-2-9**]  12:58
T:  [**2148-2-9**]  13:57
JOB#:  [**Job Number 46419**]


Admission Date:  [**2148-2-5**]       Discharge Date:  [**2148-3-4**]

Date of Birth:   [**2086-10-30**]       Sex:  M

Service:  [**Location (un) 259**]/MEDICINE

ADDENDUM TO PRIOR DISCHARGE SUMMARY:

1.  Infectious disease:  The patient continued on intravenous
Vancomycin to day 27 and remained afebrile and stable without
white blood cell count elevation and with negative
surveillance cultures.  He will require four weeks of
additional antibiotics treatment for his sacral abscess.  He
will be followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8697**] the Infectious Disease
Service.  The patient was known to be C-diff positive during
his hospital stay.  He was continued on Flagyl t.i.d. for
ongoing treatment of the possibility of C-diff while on
Vancomycin.  Prior to discharge the patient had serial C-diff
test negative.  The infectious disease team was consulted
again on [**2-29**] further recommendations for antibiotic
treatment in the setting of placement of a pacemaker.  They
recommended Ceftazidine q 8 hours times five doses to prevent
periprocedure infection in this patient with known sacral
abscess.  The patient has a follow up appointment with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8697**] in [**Month (only) 547**].  He will require continual CBC, liver
function tests and electrolyte monitoring at rehab.  In
regard to the sacral abscess the sinus tract present was
draining appropriately and healing well.  It will be managed
by Dr. [**First Name (STitle) **] as an outpatient.

2.  Cardiovascular:  The patient was hypotensive on admission
upon the initial transfer to the MICU he was placed on
pressors for one day and was weaned off and became
normotensive during his hospital stay on the floor.  His
blood pressure ranged an SBP of 90 to 100 generally.  An
echocardiogram prior to his MICU stay showed an ejection
fraction of 30 to 40%.  He was continued on a beta blocker.
He did experience occasional dizziness during his hospital
stay, however, he was never orthostatic.  His blood pressure
did drift down into the 80s on occasion, but was never
associated with specific symptoms.

In regard to his atrial fibrillation the patient was followed
by EP and was initially placed on a beta-blocker for rate
control with a plan for cardioversion in the future, however,
during his hospital stay the patient was found to have atrial
fibrillation with rapid ventricular response that was
minimally responsive to beta-blocker and then with the
addition of Diltiazem and transient periods two times with
nonrestrictive to Digoxin.  On [**2-20**] the patient was found
to be in atrial flutter and not atrial fibrillation.  Dr.
[**Last Name (STitle) 284**] of Electrophysiology ordered a transesophageal
echocardiogram, which ruled out clot and took the patient for
atrial flutter ablation on [**2-21**].  Digoxin and Coumadin
was started post procedure.  On [**2-22**] the patient was in
normal sinus rhythm with beta-blocker and Digoxin continuing.
Norpace was added 200 mg b.i.d. and daily electrocardiograms
were monitored for prolonged QT.  Over the next three days
the patient's Digoxin was discontinued and his Metoprolol was
decreased due to concerns of bradycardia and frequent pauses.
The Norpace was discontinued on [**2-25**].  The patient
remained with bradycardia and frequent pauses with occasional
palpitations.  On [**2-29**] the patient went into atrial
fibrillation with rapid ventricular response and was not
responsive to Lopressor intravenously or po.  Dr. [**Last Name (STitle) 284**]
made plans to place a pacer on [**3-1**], which was done
without complications.  The patient remained with a regular
rhythm throughout the remainder of his hospital stay.
Amiodarone was initiated and Coumadin was restarted without a
heparin bridge.  Per Dr.[**Name (NI) 3811**] recommendations the
patient will need follow up with Electrophysiology next week.
 He has an outpatient echocardiogram scheduled in [**Month (only) 547**].  He
will continue on Coumadin with a goal anticoagulation INR 2
to 3.

3.  Oncology:  The patient has multiple myeloma and continued
Thalidomide and Decadron treatment per his usual protocol.
After discussing the case with Dr. [**Last Name (STitle) 2036**] the patient was
given a dose of Pamidronate 90 mg times one and 35 gram dose
of IVIG.  His calcium level remained stable after receiving
Pamidronate.

4.  Hematology:  The patient had mild anemia during his
hospital stay.  He is guaiac negative.  His hematocrit
remained stable.  He had a history of a deep venous
thrombosis and was kept therapeutic with anticoagulation for
the large majority of his hospital stay.  Lower extremity
ultrasound was obtained early in his hospital course to rule
out the presence of deep venous thrombosis.  When his INR did
fall below 2 he was bridged with Lovenox from [**2-28**]
through the 18th.  He continues on Coumadin for
anticoagulation at this point.

5.  Fluid, electrolytes and nutrition:  The patient was
continued on zinc and vitamin C to promote wound healing.

6.  Endocrine:  The patient was thought to have adrenal
insufficiency, but did respond to a cortisol stim test on
[**2-18**].  Baseline cortisol level was low at one point, but
on repeat testing was within normal limits.

7.  Access:  The patient had a left PICC line for the
majority of his hospital stay, however, this had to be
removed for pacer placement.  On [**3-1**] at right PICC was
placed on [**3-1**] following the procedure, however, this
initially tracked into the right IJ and therefore had to be
pulled back 6 cm.  On [**3-4**] the patient was brought to
interventional radiology for proper readjustment and
placement of the PICC in the SVC.

8.  Sacral wound:  The patient's sinus tract at the location
of his lumbosacral abscess continued to heal throughout his
hospital stay through the management of the plastic team
early in the hospital course and then through regular wound
care.  He will follow up with Dr. [**First Name (STitle) **] in regard to follow
up on this issue.

DISPOSITION:  The patient did well with physical therapy and
had dramatic improvement of his lower extremity strength
during his hospital stay.

DISCHARGE CONDITION:  Afebrile, stable, full lower extremity
strength, tolerating a full diet, asymptomatic.

DISCHARGE DIAGNOSES:
1.  Draining sinus tract of the lumbar vertebra sacral
abscess.  This abscess is C-diff colitis.
2.  Multiple myeloma with lytic bone lesions in the
lumbosacral spine.
3.  Sick sinus syndrome.
4.  Atrial fibrillation.
5.  Anemia.
6.  Adrenal insufficiency.

RECOMMENDED FOLLOW UP:  The patient was advised to contact
his nurse [**First Name8 (NamePattern2) 3639**] [**Name (NI) 402**] [**Last Name (NamePattern1) **] and Dr. [**Last Name (STitle) 2036**] for a
follow up appointment within the next two weeks for
management of his multiple myeloma, phone number
[**Telephone/Fax (1) 22**].  The patient has an echocardiogram scheduled on
[**2148-3-25**] at 2:00 p.m. the [**Hospital Ward Name 23**] Center Cardiac
Services [**Telephone/Fax (1) 128**] at 2:00 p.m.  The patient has an
appointment scheduled with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**] of
cardiology on [**4-1**] at 2:30 p.m. the [**Hospital Ward Name 23**] Building on
the [**Location (un) **].  He should schedule a follow up appointment
with her within one week for follow up regarding pacer
placement.  The patient will need to follow up with Dr.
[**First Name (STitle) **] of Plastic Surgery in regard to further management of
his sinus tract.  His phone number is [**Telephone/Fax (1) 1416**].  He will
need to schedule a follow up appointment in one to two weeks.
The patient will follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8697**] of
Infectious Disease on [**3-14**] at 10:30 a.m., phone number
[**Telephone/Fax (1) 457**].  Dr. [**Last Name (STitle) 8697**] will be managing weekly
laboratories including CBC, chem 7, liver function tests.

MAJOR SURGICAL AND INVASIVE PROCEDURES:  PICC line placement
times two.  CT guided drainage of abscess of the lumbosacral
spine.  Atrial flutter ablation.  Pacemaker placement.

DISCHARGE MEDICATIONS:
1.  Gabapentin 300 mg three capsules po t.i.d.
2.  Thalidomide 50 mg capsule four capsules po q.d.
3.  Divalproex 250 mg EC po t.i.d.
4.  Cholecalciferol.
5.  Vitamin D3 400 units one tablet po q.d.
6.  Calcium carbonate 500 mg po q.i.d. prn.
7.  Nystatin suspension 5 milliliters po q.i.d. as needed.
8.  Acetaminophen 325 mg one to two tablets po q 4 to 6 hours
as needed.
9.  Docusate sodium 100 mg po b.i.d. as needed.
10.  Senna tablets 8.6 mg one tablet po b.i.d. as needed.
11.  Bisacodyl 5 mg tablet delayed release two tablets po
q.d.
12.  Pantoprazole sodium 40 mg po q.d.
13.  Dexamethasone 4 mg tablet 10 tablets po q Friday.
14.  Metoprolol tartrate 25 mg po b.i.d. hold for SBP less
then 90 and heart rate less then 60.
15.  Furosemide 20 mg po q.d.
16.  Oxycodone sustained release 20 mg po q 12 hours.
17.  Oxycodone 5 to 10 mg po q 4 to 6 hours prn.
18.  Magnesium oxide 400 mg po b.i.d.
19.  Metronidazole 500 mg po t.i.d. to continue seven days
beyond the completion of Vancomycin 1000 mg intravenous q 12
hours times four weeks.  Discuss with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8697**] the
duration of this course.
20.  Warfarin 5 mg po q.h.s.
21.  Amiodarone 400 mg po b.i.d. times 12 days and then
decrease to 400 mg po q.d.
22.  Simethicone 40 mg po q.i.d. prn.
23.  Zinc sulfate 220 mg po q.d.
24.  Vitamin C 500 mg tablet one tablet po b.i.d.

Please see final discharge summary in POE for complete list
of discharge medications.






                            [**First Name11 (Name Pattern1) 2515**] [**Last Name (NamePattern4) 4517**], M.D.  [**MD Number(1) 4521**]

Dictated By:[**Last Name (NamePattern1) 1615**]
MEDQUIST36

D:  [**2148-3-4**]  10:58
T:  [**2148-3-4**]  11:00
JOB#:  [**Job Number 46420**]
{'Other postoperative infection,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Cellulitis and abscess of trunk,Unspecified septicemia,Systemic inflammatory response syndrome, unspecified,Intestinal infection due to Clostridium difficile,Multiple myeloma, without mention of having achieved remission'}


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: 

PRESENT ILLNESS: This is a 62-year-old
Caucasian male with a complex medical history including
multiple myeloma diagnosed in [**2136**], now status post XRT and
undergoing treatment with Decadron and thalidomide, status
post laminectomy at L4, S1, and a left epidural tumor removal
in [**2147-7-14**] complicated by months of hospitalization
for various wound infections and debridements who presents
with serous drainage from his back.

MEDICAL HISTORY: 1.  Multiple myeloma with XRT and Decadron in the past, now
on thalidomide.
2.  Status post laminectomy, L4-S1, and left epidural tumor
removal in [**2147-7-14**], complicated by three to four
months of hospitalizations and various complications
including MRSA debridement with flap closure, left parietal
CVA, atrial arrhythmias, and a bilateral V-Y fasciocutaneous
flap.
3.  DVT in [**2147-1-14**].
4.  Sick sinus syndrome/atrial fibrillation, currently
followed by a cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**].
5.  C. difficile colitis.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient currently lives with his fiance.
He denied tobacco or alcohol use. 

### Response:
{'Other postoperative infection,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Cellulitis and abscess of trunk,Unspecified septicemia,Systemic inflammatory response syndrome, unspecified,Intestinal infection due to Clostridium difficile,Multiple myeloma, without mention of having achieved remission'}
