Age: 45.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Vena cava filter insertion, Vomiting
Clinical narrative: She has had 2 miscarriages in the past and a family history of aneurysm and stroke, she has had multiple pulmonary emboli and no known DVT of the legs or arms, has clotted on Coumadin but it was related to not having consistent therapeutic levels and has clotted on Xarelto and does have an IVC filter in place, with severe morbid obesity and limited mobility requiring a scooter  16 November 2010 she had a CT angiogram that showed multiple bilateral PE with mildly enlarged heart, she was treated with Coumadin for 6 months  Unfortunately 3 weeks after stopping Coumadin, she was diagnosed with pulmonary embolism at Medical Center in 2011 and placed back on Coumadin, unfortunately due to lack of insurance she had difficulty getting levels checked and remaining therapeutic and did have concomitant heavy menstrual bleeding as well, had difficulties with homelessness quite a bit in the past as well  7 January 2012 PE was diagnosed at Hospital, and an IVC filter was placed and she was recommended to stay on Coumadin and try to work on getting levels therapeutic, but again due to socioeconomic status this was not practical  In 2013 she was able to have a hysterectomy due to the ongoing heavy menstrual bleeding  A CT angiogram on 16 May 2014 showed extensive bilateral acute PE with evidence of pulmonary hypertension and right heart strain, and she was transitioned to Xarelto began May 2014   CT angiogram in January 2015 with no obvious PE, December 2015 with no obvious PE, May 2016 with no PE  Xarelto stopped 2017 due to lack of insurance  11 March 2018 CT angiogram showed small filling defect subsegmental left lower lobe pulmonary artery scar versus age indeterminate embolus?  With suggestion of a pulmonary hypertension, and was restarted back on Xarelto, obtained health insurance in 2018  Xarelto stopped March 2019 due to a brief lack of insurance  20 June 2019 CT angiogram with no evidence of PE, but after ED visit she restarted Xarelto 29 December 2019 CT angiogram with no evidence of PE 1 April 2020 KU admit for presumed Covid, sent home on accidental prolonged prescription for Xarelto 15 mg twice daily times probably about 6 months, after which it was continued at 20 mg daily 21 May 2020 VQ scan with low probability for PE 6 January 2021 CT angiogram with no evidence of PE, but she did have Covid infection in January 2021, with prolonged GI illness causing nausea and vomiting, she was unable to keep down her medications during January and April 2021 due to the ongoing emesis which was ultimately due to some abdominal abscesses, questionable UTI versus other source?  First Pfizer Covid vaccine 15 March 2021  3 April 2021 CT angiogram with questionable subsegmental pulmonary artery filling defects, no evidence of right heart strain, artifact versus emboli, and evidence of pulmonary hypertension, she continued Xarelto after her emesis was controlled  CT chest abdomen and pelvis 18 May 2021 with occasional bilateral nonocclusive pulmonary emboli right greater than left without heart strain, and enlargement of main pulmonary arteries suggestive of pulmonary hypertension, she was transitioned to Lovenox 150 mg twice daily, w/ weight 145 kg  Hyper coag work-up, there have been multiple, but in June 2014, protein C 92%, protein S 130%, Antithrombin 91%, beta-2 glycoprotein antibodies negative, anticardiolipin antibodies negative, hexagon lupus anticoagulant negative, DRVVT negative, factor V Leiden negative, and prothrombin gene mutation negative, there has been an intermittent low protein C and Antithrombin that were subsequently normal, may have been related to Coumadin and acute clot plus or minus heparin use, there had been 1+ DRVVT but 1 prior and one afterwards were negative, she tells me she had positive antiphospholipid antibodies in 2010, these have been requested, but nonetheless they have been negative since, and JAK2 testing has been negative in 2012 and 2014  recent CBC normal and creatinine normal at hematology follow-up June 2021, mammogram has been ordered, and a colonoscopy was done in 2013 and negative, she is followed by pulmonary for pulmonary hypertension, and has had reduced ejection fraction at 40 to 45%  next covid vaccine 6/28/2021  BLE u/s 9 Jul 2021 showed Extensive acute thrombus extending from the left external iliac vein distally to involve all 3 calf veins.   Acute deep vein thrombus within the right common femoral vein,  extending into the high greater saphenous vein.   13-15 Jul 2021 had thrombolysis and placement of IVC filter