Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Peripheral swelling, SARS-CoV-2 test negative, Ultrasound Doppler, Urine analysis abnormal, Urine electrolytes normal
Clinical narrative: Received vaccine 3.24.21.  Had been incarcerated / in prison system until 4.7.21.  Complex past medical history.   4.10.21:  Went to ED on 4.10.21 - for hematuria. CHIEF COMPLAINT:  BLOOD IN URINE (patient reports hematuria an hour prior to arrival along with spitting up a large clot (hemoptysis). denies rectal bleeding at this time. denies being on a blood thinner. c/o back pain starting a few hours ago. HX aortic aneurysm and scheduled to get surgery in a few weeks. )Urinalysis returned showing moderate amount of blood was 73 RBCs.  Patient did not have frank hematuria on specimen.  Patient's laboratory work otherwise remains unremarkable.  Electrolytes within normal limits.  Patient has a stable hemoglobin of 13.8. CT scan showed evidence of acute aortic dissection.  There were scattered faint ground-glass opacities along the right upper lobe as well as left upper lobe.  COVID-19 testing was added on after results.  At this time I do not have a great explanation for the patient's hematuria.  I did instructed to follow up with Urology for further evaluation of this.  He is hemodynamically stable I do not believe further testing is warranted at this time.  Return precautions were discussed including urinary retention, large volume bleeding or any other concerning symptoms.  He voiced understanding of this and was discharged stable condition.  He was provided a work note as he is on probation and it is for her of his hospitalization at this time.  4.13.21:  Went to ED on 4.13.21:  CHIEF COMPLAINT:  LEG PAIN (pt c.o. right leg swelling/pain that started 3 days ago; had johnson&johnson vaccine on 3/24 and is concerned for blood clots; supposed to have surgery at the end of the month; recently seen for blood in urine; c.o. generalized body aches)42-year-old male presents with right calf pain and reported swelling.  On presentation patient is well-appearing and nontoxic, afebrile, hypertensive 134/113 with otherwise normal vital signs.  On exam, the patient has no swelling in the bilateral lower extremities, he does have very mild tenderness to palpation in the right posterior proximal calf just below the knee.  Remainder of physical examination is otherwise unremarkable.  Given history of blood clot and reported right calf pain, right lower extremity duplex venous ultrasound ordered to evaluate for DVT.  EKG was obtained on arrival, and showed normal sinus rhythm with no evidence of ST segment elevated for depression, no dysrhythmia, no comparison when compared with prior EKG from July 2019. Right lower extremity ultrasound showed no evidence of DVT.  I shared results of the workup with the patient and told him that there is no indication for further workup or treatment at this time.  I recommended Tylenol or Motrin as needed for right leg pain.  I recommended compression stockings as needed for right leg swelling.  I encouraged him to follow up with all specialists physicians as previously scheduled and with his primary care physician as needed.   Office visit 4.14.21:  Subjective:  a 42 yr.. male evaluated with a video visit on 4/14/2021 Currently he complains of headache, hot/cold flashes (no fever), nasal congestion, and Bilat ear pain. R leg is swollen.  The symptoms have been present for 2 day(s).  Was incarcerated - has been out for about week.  He denies a history of chills and fevers He has tried acetaminophen, Flonase for his symptoms. Sick Contacts: none known History is provided by patient There is history of asthma or recurrent respiratory infections. Went to the ER yesterday and 4/10 Had his J&J vaccine: 3/24 COVID19: negative 4/10