CHIEF COMPLAINT: This is a 59-year-old female
with a history of end stage renal disease, status post living
related kidney donor transplant in [**2190**].  She developed
subsequent graft rejection in [**2197-5-21**] and had another
kidney transplant on [**2197-6-7**].  The patient presented to the
hypoxia.

PRESENT ILLNESS: This is a 59-year-old woman with
history of end stage renal disease with recent second renal
transplant who is now admitted with fever and hypoxia.  The
patient's renal failure dates back to [**2179**] when she was
diagnosed with analgesic related nephropathy.  She underwent
living unrelated donor renal transplant in [**2190**], complicated
by acute and then chronic rejection.  She underwent a second
renal transplant on [**2197-6-7**], this time a related donor (her
son).  Postoperative course notable for wound dehiscence and
urinary tract infection.  She had grown out E. coli from a
[**2197-6-14**] urine, for which she was treated with a course of
Ceftin.  Thereafter, she was doing well until [**2197-6-24**] when she
was admitted with upper abdominal pain and anemia.  CT
without IV contrast was performed, and it revealed mild
fullness of the left transplant kidney but no drainable fluid
collection or perinephric abscess.  She was transfused for
her anemia, admitted for observation, and discharged to home
the following day ([**2197-6-25**]) with resolution of her upper
abdominal pain.

MEDICAL HISTORY: ESRD diagnosed [**2179**], nephropathy
secondary to analgesics, status post living unrelated donor
in [**2190**], acute and then chronic rejection, recently underwent
second renal transplant (living related donor).
Hyperparathyroidism, osteopenia, bone fractures, recurrent
UTI, atrial fibrillation, failed cardiac conversion times
three.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin, Sulfa, IV contrast, IV Valium.

PHYSICAL EXAM: 

FAMILY HISTORY: Denies any significant family history.

SOCIAL HISTORY: Lives in [**Hospital1 46**] but has come to the U.S. for
renal transplant.  Currently staying in [**State 350**] with
son and daughter-in-law.  [**Name (NI) **] tobacco or alcohol.
Bacteremia,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Kidney replaced by transplant,Congestive heart failure, unspecified,Mitral valve disorders,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Methemoglobinemia,Other and unspecified local anesthetics causing adverse effects in therapeutic use
Bacteremia,Enterococcus group d,Kidney transplant status,CHF NOS,Mitral valve disorder,Urin tract infection NOS,DMII wo cmp nt st uncntr,Methemoglobinemia,Adv eff loc anes NEC/NOS
Admission Date:  [**2197-6-26**]       Discharge Date:

Date of Birth:   [**2138-10-28**]       Sex:  F

Service:  Medicine

HISTORY OF PRESENT ILLNESS:  This is a 59-year-old woman with
history of end stage renal disease with recent second renal
transplant who is now admitted with fever and hypoxia.  The
patient's renal failure dates back to [**2179**] when she was
diagnosed with analgesic related nephropathy.  She underwent
living unrelated donor renal transplant in [**2190**], complicated
by acute and then chronic rejection.  She underwent a second
renal transplant on [**2197-6-7**], this time a related donor (her
son).  Postoperative course notable for wound dehiscence and
urinary tract infection.  She had grown out E. coli from a
[**2197-6-14**] urine, for which she was treated with a course of
Ceftin.  Thereafter, she was doing well until [**2197-6-24**] when she
was admitted with upper abdominal pain and anemia.  CT
without IV contrast was performed, and it revealed mild
fullness of the left transplant kidney but no drainable fluid
collection or perinephric abscess.  She was transfused for
her anemia, admitted for observation, and discharged to home
the following day ([**2197-6-25**]) with resolution of her upper
abdominal pain.

She returned to the ED on [**2197-6-26**] for dyspnea and she was
found to have a sat of 79%.  Temperature at that time was 103
degrees rectally.  She was admitted to the MICU service,
where she ruled out for MI and was pancultured.  She was
started empirically on Levofloxacin given her
immunosuppression and her history of recent RLL pneumonia on
[**2197-5-10**].  Cultures from this admission have since grown 8/8
bottles positive for enterococcus faecalis.  At this point
her antibiotic regimen was changed to Vancomycin and
Gentamycin for enterococcus, as well as Ceftriaxone for cover
gram negative in light of immune status and recent pneumonia.
TTE was performed and revealed 3+ MR [**First Name (Titles) **] [**Last Name (Titles) **], raising
suspicion for bacterial endocarditis.  TTE was therefore
performed after she was transferred to the floor, which
revealed no vegetation and no signs of endocarditis.

PAST MEDICAL HISTORY:  ESRD diagnosed [**2179**], nephropathy
secondary to analgesics, status post living unrelated donor
in [**2190**], acute and then chronic rejection, recently underwent
second renal transplant (living related donor).
Hyperparathyroidism, osteopenia, bone fractures, recurrent
UTI, atrial fibrillation, failed cardiac conversion times
three.

ALLERGIES:  Penicillin, Sulfa, IV contrast, IV Valium.

MEDICATIONS:  On admission, Gentamycin 80 mg IV q 8 hours,
Prograf 3 mg po bid, Ganciclovir 500 mg po tid, Lopressor 25
mg po q 6 hours, Rocaltrol 0.5 mcg po q d, Oxycodone 5 mg po
q 4 hours prn, Vancomycin 1 gm IV q 12 hours, Rapamycin 4 mg
po q d, Mycelex troches qid, Lipitor 10 mg po q d, CaCL3 12
mg po qid, Tylenol 650 mg q 6 hours prn, Ceftriaxone 1 gm IV
q d, Prednisone 50 mg po q d, Zantac 150 mg po bid, Celexa 10
mg po q d.

SOCIAL HISTORY:  Lives in [**Hospital1 46**] but has come to the U.S. for
renal transplant.  Currently staying in [**State 350**] with
son and daughter-in-law.  [**Name (NI) **] tobacco or alcohol.

FAMILY HISTORY:  Denies any significant family history.

PHYSICAL EXAMINATION:  On admission vital signs after being
transferred to regular floor, T max 98.7, heart rate 70,
blood pressure 110/60, 90% on RV.  She was in no acute
distress.  HEENT:  Anicteric, pupils are equal, round, and
reactive to light and accommodation, extraocular movements
intact, no oral lesions.  Neck supple with full range of
motion, no adenopathy.  Heart, regular rhythm, S1 and S2, [**1-24**]
holosystolic murmur.  Lungs, decreased breath sounds at both
bases.  Abdomen soft with partly dehiscence along the lower
aspect of her recent transplant incision, tenderness along
the lower aspect, but without significant erythema or
purulent drainage.  Back, no vertebral or CVA tenderness.
Extremities, no clubbing, cyanosis or edema.  No stigmata for
endocarditis.




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**], M.D.  [**MD Number(1) 2438**]

Dictated By:[**Last Name (NamePattern1) 6063**]
MEDQUIST36

D:  [**2197-6-30**]  06:32
T:  [**2197-6-30**]  09:01
JOB#:  [**Job Number 35677**]


Admission Date:  [**2197-6-26**]     Discharge Date:  [**2197-7-1**]

Date of Birth:   [**2138-10-28**]     Sex:  F

Service:  MEDICINE
IDENTIFICATION/CHIEF COMPLAINT:  This is a 59-year-old female
with a history of end stage renal disease, status post living
related kidney donor transplant in [**2190**].  She developed
subsequent graft rejection in [**2197-5-21**] and had another
kidney transplant on [**2197-6-7**].  The patient presented to the
hypoxia.

PAST MEDICAL HISTORY:
1.  Status post living related kidney transplant.
2.  Atrial fibrillation with previous failed attempts at
cardioversion times two.
3.  Status post parathyroidectomy.
ALLERGIES:  The patient had allergies to penicillin, sulfa,
iodine and intravenous Valium.

HISTORY OF PRESENT ILLNESS:  The patient was discharged home
following her second kidney transplant, which had been
performed on [**2197-6-7**], and had been doing fairly well until
she presented with abdominal pain and anemia on [**2197-6-24**].  At
that time, she was admitted for one day and a CT scan was
done, which was unremarkable.  The patient was discharged in
reasonable condition at that time.

On [**2197-6-26**], the patient was readmitted to the hospital in
the medical intensive care unit after the onset of marked
dyspnea as well as dysuria, abdominal pain and diarrhea.  She
also commented on the presence of chills.

PHYSICAL EXAMINATION:  On examination, the patient was noted
to be tachycardic and in atrial fibrillation with a heart
rate of 122.  She had a blood pressure of 116/69 and a
temperature of 103??????F.  The head and neck examination was
unremarkable.  The cardiovascular examination demonstrated a
regular rate and rhythm and was otherwise unremarkable.  The
pulmonary examination demonstrated that the patient had
decreased breath sounds on the left and bilateral crackles a
third of the way up her chest.  The abdominal examination was
unremarkable.  However, the patient did have some slight
drainage from her incision site.  The extremities were noted
to have 1+ edema.

LABORATORY INVESTIGATIONS:  The CBC demonstrated a white
blood cell count of 11,800 with a hematocrit of 34.5 and
platelet count of 467,000.  INR was elevated at 2.8 secondary
to her anticoagulation with Coumadin.  Urinalysis was
unremarkable.  Electrolytes were notable for a BUN of 19 and
creatinine of 1.3.

ELECTROCARDIOGRAM:  The electrocardiogram demonstrated that
the patient was in atrial fibrillation.

HOSPITAL COURSE:  The patient was found to have an
enterococcal bacteremia with an unidentified source.  She had
negative urine cultures and no evidence of pneumonia.  The
patient underwent an ultrasound of the abdomen to look for a
perinephric abscess.  She also underwent a transesophageal
echocardiogram on [**2197-6-28**] to look for evidence of
endocarditis, which was also negative; however, the patient
was found to have moderate to severe mitral regurgitation
with an ejection fraction of 40%.

The patient was treated with vancomycin and gentamicin for
her bacteremia.  The infectious disease service and the
transplant service were both consulted for the patient's
care.

The patient converted back to sinus rhythm on [**2197-6-28**].  She
had a PICC line placed for her continued need for long-term
antibiotic treatment.  She improved with her antibiotic
treatment.

DISPOSITION:  On [**2197-7-1**], the patient was discharged home
with home nursing for continued antibiotic treatment.

DISCHARGE MEDICATIONS:
Vancomycin 1 gm intravenous every 12 hours for a total period
of eight weeks.
Gentamicin 80 mg intravenous every 12 hours for a total
period of two weeks.
Prograf 3 mg p.o. b.i.d.
Ganciclovir 500 mg p.o. t.i.d.
Mycelex troches 1 mg p.o. q.i.d.
Calcium carbonate 1200 mg p.o. q.i.d.
Rocaltrol 0.5 mcg p.o. q.d.
Lipitor 10 mg p.o. q.d.
Rapamycin 4 mg p.o. q.d.
Zantac 150 mg p.o. b.i.d.
Celexa 10 mg p.o. q.d.
Prednisone 10 mg p.o. q.d.
Magnesium oxide 400 mg p.o. b.i.d.
Metoprolol 50 mg p.o. b.i.d.
Lasix 20 mg p.o. q.d.
Amiodarone 200 mg p.o. q.d.
Coumadin 1 mg p.o. q.o.d.
Sliding scale insulin.
Percocet one to two tablets p.o. every four hours p.r.n.

FOLLOW UP:  The patient was to be seen by Dr. [**Last Name (STitle) **] on
[**2197-7-5**] as well as by her cardiologist, Dr. [**First Name (STitle) **], in one
to two weeks.  She also had appointments arranged to see Dr.
[**First Name (STitle) 33833**] in the infectious disease clinic as well as the
transplant service.

CONDITION ON DISCHARGE:  The patient's condition at discharge
was stable.

DISCHARGE DIAGNOSES:
Enterococcal bacteremia.




                          [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD  [**MD Number(1) 1335**]

Dictated By:[**Name8 (MD) 26201**]

MEDQUIST36

D:  [**2197-7-2**]  11:31
T:  [**2197-7-8**]  10:24
JOB#:  [**Job Number 35678**]


addendum.  The plan was to discharge Mrs. [**Known lastname 35675**] off
gentamycin, despite ID recommendations of 2 weeks of therapy.
It is unclear why this was not followed.

[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
{'Bacteremia,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Kidney replaced by transplant,Congestive heart failure, unspecified,Mitral valve disorders,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Methemoglobinemia,Other and unspecified local anesthetics causing adverse effects in therapeutic use'}


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: This is a 59-year-old female
with a history of end stage renal disease, status post living
related kidney donor transplant in [**2190**].  She developed
subsequent graft rejection in [**2197-5-21**] and had another
kidney transplant on [**2197-6-7**].  The patient presented to the
hypoxia.

PRESENT ILLNESS: This is a 59-year-old woman with
history of end stage renal disease with recent second renal
transplant who is now admitted with fever and hypoxia.  The
patient's renal failure dates back to [**2179**] when she was
diagnosed with analgesic related nephropathy.  She underwent
living unrelated donor renal transplant in [**2190**], complicated
by acute and then chronic rejection.  She underwent a second
renal transplant on [**2197-6-7**], this time a related donor (her
son).  Postoperative course notable for wound dehiscence and
urinary tract infection.  She had grown out E. coli from a
[**2197-6-14**] urine, for which she was treated with a course of
Ceftin.  Thereafter, she was doing well until [**2197-6-24**] when she
was admitted with upper abdominal pain and anemia.  CT
without IV contrast was performed, and it revealed mild
fullness of the left transplant kidney but no drainable fluid
collection or perinephric abscess.  She was transfused for
her anemia, admitted for observation, and discharged to home
the following day ([**2197-6-25**]) with resolution of her upper
abdominal pain.

MEDICAL HISTORY: ESRD diagnosed [**2179**], nephropathy
secondary to analgesics, status post living unrelated donor
in [**2190**], acute and then chronic rejection, recently underwent
second renal transplant (living related donor).
Hyperparathyroidism, osteopenia, bone fractures, recurrent
UTI, atrial fibrillation, failed cardiac conversion times
three.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin, Sulfa, IV contrast, IV Valium.

PHYSICAL EXAM: 

FAMILY HISTORY: Denies any significant family history.

SOCIAL HISTORY: Lives in [**Hospital1 46**] but has come to the U.S. for
renal transplant.  Currently staying in [**State 350**] with
son and daughter-in-law.  [**Name (NI) **] tobacco or alcohol. 

### Response:
{'Bacteremia,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Kidney replaced by transplant,Congestive heart failure, unspecified,Mitral valve disorders,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Methemoglobinemia,Other and unspecified local anesthetics causing adverse effects in therapeutic use'}
