CHIEF COMPLAINT: Fever, nausea and vomiting.

PRESENT ILLNESS: Ms. [**Known lastname 28926**] is a 42 year-old
female approximately seven weeks status post cadaveric renal
transplant with a postoperative course complicated by a
ureteral leak requiring nephrostomy tube placement and V.A.C.
care to wound as well as a line associated SVC syndrome
requiring Coumadinization.  The patient subsequently was
discharged to a rehabilitation center, but now returned to
[**Hospital1 69**] on [**2108-10-28**]
with several day history of fevers, nausea, vomiting.  Her
fevers were as high as 101.5.  She also reported decrease in
her urine output for one week.  Her wound care continued
with no notable signs of infection.  The patient continued to
have bowel movements without any evidence of diarrhea.  She
was without any abdominal pain, chest pain, shortness of
breath or any respiratory symptoms.  At presentation in the
Emergency Department her systolic blood pressure was noted to
be in the 90s requiring intravenous boluses.

MEDICAL HISTORY: 1.  Diabetes mellitus insulin dependent.
2.  End stage renal disease.
3.  Hypertension.
4.  Hypothyroidism.
5.  Left line associated SVC syndrome requiring
thrombolectomy and Coumadinization.

MEDICATION ON ADMISSION: 1.  Bactrim SS one tab po q day.
2.  CellCept 1 gram po b.i.d.
3.  Neurontin 100 mg po t.i.d.
4.  Lansoprazole 30 mg po q day.
5.  Valcyte 350 mg po q.o.d.
6.  NPH 22 b.i.d.
7.  Zinc 220 mg po q.d.
8.  Coumadin 4 mg po q day.
9.  Dulcolax 10 mg po b.i.d.
10.  Prograf 2 mg po b.i.d.
11.  Levoxyl 75 micrograms po q day.
12.  Celexa 20 mg po q day.
13.  Lipitor 10 mg po q day.
14.  Percocet one to two tabs po q 4 to 6 hours prn pain.
15.  Lopressor 75 mg po b.i.d.
16.  Lasix 40 mg po q day.
17.  Vitamin C 500 mg b.i.d.
18.  Prednisone 0.5 mg po q day.

ALLERGIES: Floxins and Vancomycin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is divorced on disability.  She denies
any ethanol or tobacco use.
Complications of transplanted kidney,Ulcer of ankle,Urinary tract infection, site not specified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Compl kidney transplant,Ulcer of ankle,Urin tract infection NOS,Abn react-org transplant,Long-term use anticoagul,DMII wo cmp nt st uncntr,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2108-10-28**]       Discharge Date:  [**2108-11-5**]

Date of Birth:   [**2066-7-8**]       Sex:  F

Service:  TRANSPLANT SURGERY

CHIEF COMPLAINT:  Fever, nausea and vomiting.

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 28926**] is a 42 year-old
female approximately seven weeks status post cadaveric renal
transplant with a postoperative course complicated by a
ureteral leak requiring nephrostomy tube placement and V.A.C.
care to wound as well as a line associated SVC syndrome
requiring Coumadinization.  The patient subsequently was
discharged to a rehabilitation center, but now returned to
[**Hospital1 69**] on [**2108-10-28**]
with several day history of fevers, nausea, vomiting.  Her
fevers were as high as 101.5.  She also reported decrease in
her urine output for one week.  Her wound care continued
with no notable signs of infection.  The patient continued to
have bowel movements without any evidence of diarrhea.  She
was without any abdominal pain, chest pain, shortness of
breath or any respiratory symptoms.  At presentation in the
Emergency Department her systolic blood pressure was noted to
be in the 90s requiring intravenous boluses.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus insulin dependent.
2.  End stage renal disease.
3.  Hypertension.
4.  Hypothyroidism.
5.  Left line associated SVC syndrome requiring
thrombolectomy and Coumadinization.

PAST SURGICAL HISTORY:
1.  Status post cadaveric renal transplant on [**2108-9-8**].
2.  Status post Perm-A-Cath in the right IJ.
3.  Status post AV fistula times three.
4.  Status post stenting of the right brachiocephalic and
SVC.
5.  Status post SVC thrombectomy on [**9-17**] and [**9-18**].

ALLERGIES:  Floxins and Vancomycin.

SOCIAL HISTORY:  She is divorced on disability.  She denies
any ethanol or tobacco use.

MEDICATIONS ON ADMISSION:
1.  Bactrim SS one tab po q day.
2.  CellCept 1 gram po b.i.d.
3.  Neurontin 100 mg po t.i.d.
4.  Lansoprazole 30 mg po q day.
5.  Valcyte 350 mg po q.o.d.
6.  NPH 22 b.i.d.
7.  Zinc 220 mg po q.d.
8.  Coumadin 4 mg po q day.
9.  Dulcolax 10 mg po b.i.d.
10.  Prograf 2 mg po b.i.d.
11.  Levoxyl 75 micrograms po q day.
12.  Celexa 20 mg po q day.
13.  Lipitor 10 mg po q day.
14.  Percocet one to two tabs po q 4 to 6 hours prn pain.
15.  Lopressor 75 mg po b.i.d.
16.  Lasix 40 mg po q day.
17.  Vitamin C 500 mg b.i.d.
18.  Prednisone 0.5 mg po q day.

PHYSICAL EXAMINATION:  Temperature 98.9.  Blood pressure
131/46.  Heart rate 91.  Respiratory rate 17.  She was 100%
on 4 liters nasal cannula.  General, she was well developed,
well nourished lady in no acute distress.  Head, eyes, ears,
nose and throat normocephalic, atraumatic.  Anicteric.
Oropharynx without any lesions.  They were moist.  Neck was
supple.  Heart regular rate and rhythm.  Respirations clear
to auscultation bilaterally.  Abdomen soft, nontender,
nondistended.  Packed right lower quadrant wound.  The wound
was without any purulent drainage on removal of the V.A.C.
Extremities there was noted for some left ankle skin ulcer.

LABORATORIES ON ADMISSION:  White blood cell count 3.5,
hematocrit 37.1, platelets 155, sodium 136, potassium 5.0,
chloride 107, bicarb 18, BUN 42, creatinine 3.1, glucose 83.
[**Name (NI) 2591**] PT 20.8, PTT 37, INR 2.9.  Her urinalysis was notable
for moderate amounts of leukocyte esterase, negative nitrite,
21 to 50 white blood cell and moderate bacteria.  Chest x-ray
was negative.  Renal ultrasound was obtained, which was
negative for hydro.  There was no fluid collection.  There is
normal arterial wave forms and normal resistive indices.

HOSPITAL COURSE:  The patient is a 42 year-old female status
post cadaveric renal transplant on [**2108-9-8**] for end
stage renal disease secondary to diabetes mellitus who had a
postoperative course complicated by a ureteral leak requiring
nephrostomy as well as a V.A.C. to the wound.  During that
hospital stay had a line associated SVC syndrome requiring
thrombolectomy.  She returned from rehab on [**2108-10-28**]
to [**Hospital1 69**] with fevers and
nausea and vomiting as well as decreased urine output.  She
was noted to have a positive urinalysis.  Urine culture was
sent.  She was initially kept in the Intensive Care Unit for
close monitoring for urosepsis.  She was bolused and provided
with intravenous hydration and her blood pressure responded
appropriately.  Her urine output improved.  She was placed
initially on Zosyn for appropriate antimicrobial coverage.
Her urine culture was followed up, which indicated
Enterobacter cloacae, which was actually resistant to Zosyn
and sensitive to Levofloxacin.  At that point she was
switched over to a 14 day course of Levofloxacin.  The
patient continued with complaints of nausea and voting.  Her
Prograf was discontinued and the patient was switched onto
Imuran and by the time of discharge she was on a 150 mg po q
day.  Additionally, since admission the patient's Coumadin
dose had been held secondary to elevated INR, but by the time
of discharge the patient was placed on a Coumadin dose of 0.5
mg po q day and to have a regular biweekly laboratory blood
work drawn including close monitoring of her coagulation.
The patient underwent a nephrostogram, which indicated a
small anastomotic leak.  It was thought that it would be best
to keep the nephrostomy tube open for another four weeks and
to repeat the study at that time.  Renal function, however,
was improving and was noted to make adequate amount of urine
through the nephrostomy tube.  By the time of discharge on
hospital day nine the patient was tolerating a regular diet.
Her nausea and vomiting had resolved and she continued to
make excellent urine output.  She was on a immunosuppressant
regimen of Prednisone 5 mg po q day, Tacrolimus 1 mg po
b.i.d. as well as Imuran 150 mg po q day.

DISCHARGE STATUS:  To rehabilitation center.

DISCHARGE DIAGNOSES:
1.  Urosepsis/urinary tract infection.
2.  Hydration.

DISCHARGE MEDICATIONS:
1.  Lipitor 10 mg po q day.
2.  Bactrim SS one tab po q day.
3.  Celexa 20 mg po q day.
4.  Colace 100 mg po b.i.d.
5.  Valcyte 450 mg po q day.
6.  Synthroid 75 micrograms one tab po q day.
7.  Vitamin C 500 mg po b.i.d.
8.  Zinc sulfate 220 mg one tab po q day.
9.  Tylenol one to two tabs po q 4 to 6 hours prn.
10.  Sulfa 500 mg one tab po b.i.d.
11.  Prednisone 5 mg one tab po q day.
12.  Albuterol one to two puffs inhalation q 6 hours prn.
13.  Robitussin 5 to 10 ml po q 6 hours prn.
14.  Reglan 10 mg one tab po t.i.d.
15.  Levofloxacin 250 mg one tab po q day for eight more days
for a total of 14 days treatment.
16.  Famotidine 200 mg one tab po q day.
17.  Imuran 150 mg po q day.
18.  Tequin one tab po b.i.d.
19.  Percocet one to two tabs po q 4 to 6 hours prn.
20.  Zofran 2 mg intravenously q 4 to 6 hours prn nausea and
vomiting.
21.  Benadryl 150 mg intravenously q 6 hours prn.
22.  Coumadin 0.5 mg one tab po q day.
23.  Insulin sliding scale.

FOLLOW UP:  The patient is to follow up with Dr. [**Last Name (STitle) **] on
Monday [**2108-11-12**] at the Transplant Center, telephone
number [**Telephone/Fax (1) 673**] at 2:40 p.m.  She is additionally to call
the Transplant Center for follow up appointments with Dr.
[**Last Name (STitle) **] as well as Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].  She is additionally to
have laboratories biweekly including CBC, chem 10, [**Last Name (NamePattern1) **],
liver function tests, amylase, lipase as well as Tacrolimus
levels in the a.m. before the a.m. dose is given.  She is to
continue to have V.A.C. treatment as well as nephrostomy care
at the rehabiltiatino center.


                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 707**], M.D.,Ph.D.
02-366

Dictated By:[**Last Name (STitle) 28927**]
MEDQUIST36

D:  [**2108-11-5**]  11:28
T:  [**2108-11-5**]  11:32
JOB#:  [**Job Number 28928**]
{'Complications of transplanted kidney,Ulcer of ankle,Urinary tract infection, site not specified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: Fever, nausea and vomiting.

PRESENT ILLNESS: Ms. [**Known lastname 28926**] is a 42 year-old
female approximately seven weeks status post cadaveric renal
transplant with a postoperative course complicated by a
ureteral leak requiring nephrostomy tube placement and V.A.C.
care to wound as well as a line associated SVC syndrome
requiring Coumadinization.  The patient subsequently was
discharged to a rehabilitation center, but now returned to
[**Hospital1 69**] on [**2108-10-28**]
with several day history of fevers, nausea, vomiting.  Her
fevers were as high as 101.5.  She also reported decrease in
her urine output for one week.  Her wound care continued
with no notable signs of infection.  The patient continued to
have bowel movements without any evidence of diarrhea.  She
was without any abdominal pain, chest pain, shortness of
breath or any respiratory symptoms.  At presentation in the
Emergency Department her systolic blood pressure was noted to
be in the 90s requiring intravenous boluses.

MEDICAL HISTORY: 1.  Diabetes mellitus insulin dependent.
2.  End stage renal disease.
3.  Hypertension.
4.  Hypothyroidism.
5.  Left line associated SVC syndrome requiring
thrombolectomy and Coumadinization.

MEDICATION ON ADMISSION: 1.  Bactrim SS one tab po q day.
2.  CellCept 1 gram po b.i.d.
3.  Neurontin 100 mg po t.i.d.
4.  Lansoprazole 30 mg po q day.
5.  Valcyte 350 mg po q.o.d.
6.  NPH 22 b.i.d.
7.  Zinc 220 mg po q.d.
8.  Coumadin 4 mg po q day.
9.  Dulcolax 10 mg po b.i.d.
10.  Prograf 2 mg po b.i.d.
11.  Levoxyl 75 micrograms po q day.
12.  Celexa 20 mg po q day.
13.  Lipitor 10 mg po q day.
14.  Percocet one to two tabs po q 4 to 6 hours prn pain.
15.  Lopressor 75 mg po b.i.d.
16.  Lasix 40 mg po q day.
17.  Vitamin C 500 mg b.i.d.
18.  Prednisone 0.5 mg po q day.

ALLERGIES: Floxins and Vancomycin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is divorced on disability.  She denies
any ethanol or tobacco use. 

### Response:
{'Complications of transplanted kidney,Ulcer of ankle,Urinary tract infection, site not specified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
