Age: 77.0
Sex: M
Vaccine: FLUA3
Symptoms: Blood sodium normal, Blood urea normal, Carbon dioxide decreased, Computerised tomogram abnormal, Differential white blood cell count
Clinical narrative: Timeline September 8, 2019 Received Fluad TVS 2019-2020 SYR  (65 YR UP) Adjuvant Rt arm at Pharmacy September 12, 2019 Awakened with enlarged mass in left side of neck and itching in area; no fever September 13, 2019 Office Visit with APRN Walk-In Clinic      started on     clindamycin 300 mg capsule    Commonly known as: CLEOCIN     Take 1 capsule (300 mg total) by mouth 3 times a day for 7 days.    PrescribedSeptember 13, 2019    Approved by APRN    Quantity21 capsules      AND    triamcinolone 0.1 % cream    Commonly known as: KENALOG     Apply bid prn in a thin coat on affected area x 7-10. avoid chronic use.    PrescribedSeptember 13, 2019     September 8, 2019 Received Fluad TVS 2019-2020 SYR  (65 YR UP) Adjuvant Rt arm at Pharmacy September 12, 2019 Awakened with enlarged mass in left side of neck and itching in area; no fever September 13, 2019 Office Visit with APRN Walk-In Clinic    started on     clindamycin 300 mg capsule    Commonly known as: CLEOCIN     Take 1 capsule (300 mg total) by mouth 3 times a day for 7 days.    PrescribedSeptember 13, 2019    Approved by APRN    Quantity21 capsules      AND    triamcinolone 0.1 % cream    Commonly known as: KENALOG     Apply bid prn in a thin coat on affected area x 7-10. avoid chronic use.    PrescribedSeptember 13, 2019    Approved by  APRN    Quantity15 g     Quantity15 g got US neck-- US NECK SOFT TISSUE - Final result (09/13/2019 10:20 AM) US NECK SOFT TISSUE - Final result (09/13/2019 10:20 AM) Specimen    US NECK SOFT TISSUE - Final result (09/13/2019 10:20 AM) Impressions Performed At   There is subcutaneous edema seen in the area of concern below the   patient's left ear.    US NECK SOFT TISSUE - Final result (09/13/2019 10:20 AM) Narrative Performed At ULTRASOUND OF THE POSTOPERATIVE NECK    TECHNIQUE: Grayscale and color Doppler evaluation of the   infra-auricular area of the left neck was performed.    INDICATION: Swelling. Possible bee sting.    COMPARISON: None    FINDINGS: There is some subcutaneous edema seen within the area of   the patient's swelling below his left ear.    There is no evidence of pathologic regional lymphadenopathy.   US NECK SOFT TISSUE - Final result (09/13/2019 10:20 AM) Procedure Note Interface, Radiology Results In - 09/13/2019 10:28 AM  ULTRASOUND OF THE POSTOPERATIVE NECK  TECHNIQUE: Grayscale and color Doppler evaluation of the infra-auricular area of the left neck was performed.  INDICATION: Swelling. Possible bee sting.  COMPARISON: None  FINDINGS: There is some subcutaneous edema seen within the area of the patient's swelling below his left ear.  There is no evidence of pathologic regional lymphadenopathy.  IMPRESSION:  There is subcutaneous edema seen in the area of concern below the patient's left ear.  Electronically signed on 9/13/2019 10:26 AM   US NECK SOFT TISSUE - Final result (09/13/2019 10:20 AM) Performing Organization Address City/State/Zipcode Phone Number      September 14, 2019 Developed measles-like rash with itching over trunk of body, visited walkin clinic    no change in treatment plan; no fever September 16, 2019 Saw PCP Dr.--no fever; CT scan of neck done  CT SOFT TISSUE NECK W CONTRAST - Final result (09/16/2019 5:29 PM) CT SOFT TISSUE NECK W CONTRAST - Final result (09/16/2019 5:29 PM) Specimen    CT SOFT TISSUE NECK W CONTRAST - Final result (09/16/2019 5:29 PM)  Impressions Performed At   Areas of fat stranding centered around two lymph nodes deep to the   left sternocleidomastoid mastoid and in the left submandibular region   as described in the findings. Findings likely reflect an inflammatory   or infectious etiology given adjacent enlargement of the musculature   and fat stranding. However, malignancy, possibly lymphoma or   metastatic disease, cannot be excluded and follow-up imaging is   recommended after treatment to ensure resolution.    I, have reviewed the images and verify the   above interpretation on 9/17/2019 10:52 AM.    Electronically signed on 09/17/2019 10:52  CT SOFT TISSUE NECK W CONTRAST - Final result (09/16/2019 5:29 PM) Narrative Performed At CT NECK WITH CONTRAST    HISTORY: R22.1; Localized swelling, mass and lump, neck  COMPARISON: PET scan 12/20/2018, ultrasound 9/13/2019  TECHNIQUE: Spiral CT of the neck was performed following the   intravenous administration of IV contrast. Coronal and sagittal   reformatted images were generated.  INTRAVENOUS CONTRAST ADMINISTRATION (mL Omnipaque 350): 100  DOSE REPORT (Total DLP mGy*cm): 879    FINDINGS:    There is a region of fat stranding that measures approximately 2.9 x   1.5 cm centered about a left IIB lymph node which measures   approximately 4 mm. In the left submandibular area there is another   approximately 4 mm level IB lymph node at the center of a 1.6 x 2.4   cm area of fat stranding.  There is adjacent overlying asymmetric   thickening of the left platysma.  A few additional mildly prominent   left cervical chain lymph nodes are also present, none of which are   pathologically enlarged.    There are no pathologically enlarged right cervical lymph nodes or   areas of surrounding fat stranding.    The nasopharynx and oropharynx are unremarkable.  There is a cystic   focus along the anterior right aspect of the epiglottis which   measures 7 x 4 mm in greatest axial dimension likely representing a   vallecular cyst as it encroaches into the right vallecula.  The   airway remains patent.    There is mild multifocal calcific atherosclerosis.    1.3 cm lipoma overlying the superior medial left trapezius.    Lung apices are clear. Status post left temporoparietal craniotomy   with an area of encephalomalacia the left temporal lobe. No air-fluid   levels in the paranasal sinuses or mastoid air cells. Moderate   degenerative changes of the cervical spine. Small hypodense nodules   in the thyroid.    CT SOFT TISSUE NECK W CONTRAST - Final result (09/16/2019 5:29 PM) Procedure Note Interface, Radiology Results In - 09/17/2019 10:54 AM  CT NECK WITH CONTRAST  HISTORY: R22.1; Localized swelling, mass and lump, neck COMPARISON: PET scan 12/20/2018, ultrasound 9/13/2019 TECHNIQUE: Spiral CT of the neck was performed following the intravenous administration of IV contrast. Coronal and sagittal reformatted images were generated. INTRAVENOUS CONTRAST ADMINISTRATION (mL Omnipaque 350): 100 DOSE REPORT (Total DLP mGy*cm): 879  FINDINGS:  There is a region of fat stranding that measures approximately 2.9 x 1.5 cm centered about a left IIB lymph node which measures approximately 4 mm. In the left submandibular area there is another approximately 4 mm level IB lymph node at the center of a 1.6 x 2.4 cm area of fat stranding. There is adjacent overlying asymmetric thickening of the left platysma. A few additional mildly prominent left cervical chain lymph nodes are also present, none of which are pathologically enlarged.  There are no pathologically enlarged right cervical lymph nodes or areas of surrounding fat stranding.  The nasopharynx and oropharynx are unremarkable. There is a cystic focus along the anterior right aspect of the epiglottis which measures 7 x 4 mm in greatest axial dimension likely representing a vallecular cyst as it encroaches into the right vallecula. The airway remains patent.  There is mild multifocal calcific atherosclerosis.  1.3 cm lipoma overlying the superior medial left trapezius.  Lung apices are clear. Status post left temporoparietal craniotomy with an area of encephalomalacia the left temporal lobe. No air-fluid levels in the paranasal sinuses or mastoid air cells. Moderate degenerative changes of the cervical spine. Small hypodense nodules in the thyroid.  IMPRESSION:  Areas of fat stranding centered around two lymph nodes deep to the left sternocleidomastoid mastoid and in the left submandibular region as described in the findings. Findings likely reflect an inflammatory or infectious etiology given adjacent enlargement of the musculature and fat stranding. However, malignancy, possibly lymphoma or metastatic disease, cannot be excluded and follow-up imaging is recommended after treatment to ensure resolution.  I, have reviewed the images and verify the above interpretation on 9/17/2019 10:52 AM.  Electronically signed on 9/17/2019 10:52 AM   CT SOFT TISSUE NECK W CONTRAST - Final result (09/16/2019 5:29 PM) Performing Organization Address City/State/Zipcode Phone Number and blood work done-- CREATININE - EXTERNAL MANUAL - Final result (09/16/2019 5:26 PM) CREATININE - EXTERNAL MANUAL - Final result (09/16/2019 5:26 PM) Component Value Ref Range Performed  Creatinine - Ext Man 1.2 0.5 - 1.5 mg/dL IMAGING    CREATININE - EXTERNAL MANUAL - Final result (09/16/2019 5:26 PM) Specimen Blood  CREATININE - EXTERNAL MANUAL - Final result (09/16/2019 5:26 PM) Performing Organization Address City/State/Zipcode Phone Number IMAGING         EGFR/EGFRAA - Final result (09/16/2019 4:56 PM) EGFR/EGFRAA - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed  eGFR >60Comment: Estimated glomerular filtration rate (eGFR) and eGRFAA are calculated using the IDMS MDRD equation which is recommended for use in normal healthy individuals 18-70 years of age and has not been validated in other populations. See eGFR in the Test Directory for additional information. ml/min/1.73 m2    eGFRAA >60Comment: Estimated glomerular filtration rate (eGFR) and GFRAA are calculated using the IDMS MDRD equation which is recommended for use in normal healthy individuals 18-70 years of age and has not been validated in other populations. See eGFR in the Test Directory for additional information. ml/min/1.73 m2 VUMC ESB    EGFR/EGFRAA - Final result (09/16/2019 4:56 PM) Specimen Blood  EGFR/EGFRAA - Final result (09/16/2019 4:56 PM) Performing Organization Address City/State/Zipcode Phone Number AUTO DIFF - Final result (09/16/2019 4:56 PM) AUTO DIFF - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed At  Neutrophils 65.0 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   %  LAB   Absolute Neutrophils 4.53 1.60 - 8.10 x10(3)/mcL LAB   Lymphs 13.3 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Lymphocytes 0.93 1.10 - 3.50 x10(3)/mcL LAB   Monocytes 11.9 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Monocytes 0.83 0.30 - 1.10 x10(3)/mcL VUMC CERNER LAB   Eosinophils 8.5 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Eosinophils 0.59 0.00 - 0.50 x10(3)/mcL LAB   Basophils 0.6 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Basophils 0.04 0.01 - 0.08 x10(3)/mcL LAB   Imm Gran Automated 0.7 % LAB   Absolute Imm Gran Automated 0.05Comment:  AUTO DIFF - Final result (09/16/2019 4:56 PM) Specimen Blood  AUTO DIFF - Final result (09/16/2019 4:56 PM) Performing Organization Address City/State/Zipcode Phone Number EHRLICHIA AB PANEL (EHRLICHIA CHAFFEENSIS IGG/IGM) - Final result (09/16/2019 4:56 PM) EHRLICHIA AB PANEL (EHRLICHIA CHAFFEENSIS IGG/IGM) - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed  Ehrlichia chaffeensis IgG Antibody <1:64 Comment: INTERPRETIVE INFORMATION: Ehrlichia Chaffeensis IgG Ab   Less than 1:64 ....... Negative: No significant level of                          Ehrlichia chaffeensis IgG antibody                          detected.   1:64-1:128 ........... Equivocal: Questionable presence                          of Ehrlichia chaffeensis IgG                          antibody detected. Repeat testing                          in 10-14 days may be helpful.   1:256 or greater ..... Positive: Presence of IgG antibody                          to Ehrlichia chaffeensis detected,                          suggestive of current or past                          infection. Seroconversion between acute and convalescent sera is considered strong evidence of recent infection. The best evidence for infection is a significant change (fourfold difference in titer) on two appropriately timed specimens, where both tests are done in the same laboratory at the same time. Test developed and characteristics determined Laboratories. See Compliance Statement B: <1:64 LAB   Ehrlichia chaffeensis IgM Antibody < 1:16 Comment: INTERPRETIVE INFORMATION: Ehrlichia Chaffeensis IgM Ab   Less than 1:16 ....... Negative - No significant level                          of Ehrlichia chaffeensis IgM                          antibody detected.   1:16 or greater ...... Positive - Presence of IgM                          antibody to Ehrlichia                          chaffeensis detected,                          suggestive of current or                          recent infection. While the presence of IgM antibodies suggest current or recent infection, low levels of IgM antibodies may occasionally persist for more than 12 months post-infection. A single IgM result should be interpreted with caution. Test developed and characteristics determined by lab Laboratories. See Compliance Statement B:   <1:16 LAB    EHRLICHIA AB PANEL (EHRLICHIA CHAFFEENSIS IGG/IGM) - Final result (09/16/2019 4:56 PM) Specimen Blood  EHRLICHIA AB PANEL (EHRLICHIA CHAFFEENSIS IGG/IGM) - Final result (09/16/2019 4:56 PM) Performing Organization Address City/State/Zipcode Phone Number RICKETTSIA RICKETTSII (ROCKY MOUNTAIN SPOTTED FEVER) ANTIBODY (ROCKY MOUNTAIN SPOTTED FEVER IGG/IGM) - Final result (09/16/2019 4:56 PM) RICKETTSIA RICKETTSII (ROCKY MOUNTAIN SPOTTED FEVER) ANTIBODY (ROCKY MOUNTAIN SPOTTED FEVER IGG/IGM) - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed  Rocky Mountain Spotted Fever Antibody IgG <1:64 Comment: INTERPRETIVE INFORMATION: Rickettsia rickettsii (Rocky Mtn.                           Spotted Fever) Ab, IgG          Less than 1:64 ....... Negative - No significant level of                          IgG antibody detected.   1:64 - 1:128 ......... Low Positive - Presence of IgG                          Antibody detected, suggestive of                          current or past infection.   1:256 or greater ..... Positive - Presence of IgG                          antibody detected, suggestive of                          current or past infection. Antibody reactivity to Rickettsia rickettsii antigen should be considered Spotted Fever group reactive. Other organisms within the group include R. akari, R. conorrii, R. australis and R. sibirica. Seroconversion, a fourfold or greater rise in antibody titer, between acute and convalescent sera is considered strong evidence of recent infection. Acute-phase specimens are collected during the first week of illness and convalescent-phase samples are generally obtained 2-4 weeks after resolution of illness. Ideally these samples should be tested simultaneously at the same facility. If the sample submitted was collected during the acute-phase of illness, submit a marked convalescent sample within 25 days for paired testing.  <1:64 LAB   Rocky Mountain Spotted Fever Antibody IgM <1:64 Comment: INTERPRETIVE INFORMATION: Rickettsia rickettsii (Rocky Mtn.                           Spotted Fever) Ab, IgM   Less than 1:64 ....... Negative - No significant level of                          IgM antibody detected.   1:64 or greater ...... Positive - Presence of IgM antibody                          detected, which may indicate a                          current or recent infection;                          however, low levels of IgM                          antibodies may occasionally persist                          for more than 12 months                          post-infection. Antibody reactivity to Rickettsia rickettsii antigen should be considered Spotted Fever group reactive. Other organisms within the group include R. akari, R. conorrii, R. australis and R. sibirica. Seroconversion, a fourfold or greater rise in antibody titer, between acute and convalescent sera is considered strong evidence of recent infection. Acute-phase specimens are collected during the first week of illness and convalescent-phase samples are generally obtained 2-4 weeks after resolution of illness. Ideally these samples should be tested simultaneously at the same facility. If the sample submitted was collected during the acute-phase of illness, submit a marked convalescent sample within 25 days for paired testing. The CDC does not use IgM results for routine diagnostic testing of Rocky Mountain Spotted Fever, as the response may not be specific for the agent (resulting in false positives) and the IgM response may be persistent from past infection. Performed by Laboratories,                             <1:64 LAB    RICKETTSIA RICKETTSII (ROCKY MOUNTAIN SPOTTED FEVER) ANTIBODY (ROCKY MOUNTAIN SPOTTED FEVER IGG/IGM) - Final result (09/16/2019 4:56 PM) Specimen Blood  RICKETTSIA RICKETTSII (ROCKY MOUNTAIN SPOTTED FEVER) ANTIBODY (ROCKY MOUNTAIN SPOTTED FEVER IGG/IGM) - Final result (09/16/2019 4:56 PM)  Performing Organization Address City/State/Zipcode Phone Number CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/16/2019 4:56 PM) CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed White Blood Cells 7.0 3.9 - 10.7 x10(3)/mcL LAB   Red Blood Cells 4.37 4.50 - 6.00 x10(6)/mcL LAB   Hemoglobin 14.7 14.0 - 18.1 gm/dL LAB   Hematocrit 43 41 - 49 % LAB   Mean Cell Volume 99 81 - 98 fL LAB   Mean Cell Hemoglobin 33.6 27.0 - 32.0 pg LAB   Mean Cell Hemoglobin Concentration 33.9 31.0 - 35.0 gm/dL LAB   RDW SD 47.8 37.4 - 52.4 fL LAB   RDW CV 13.2 11.1 - 14.3 % LAB   Platelet 220 135 - 371 x10(3)/mcL LAB   Mean Platelet Volume 9.8 9.3 - 12.8 fL LAB   Nucleated RBC 0 /100 WBC LAB   Nucleated RBC Abs 0.00 x10(3)/mcL LAB   Auto Neutrophil Absolute 4.53Comment: This test was performed at: Laboratory, 1.60 - 8.10 x10(3)/mcL LAB    CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/16/2019 4:56 PM) Specimen Blood  CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/16/2019 4:56 PM) Performing Organization Address City/State/Zipcode Phone Number PSA - Final result (09/16/2019 4:56 PM) PSA - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed  Prostate Specific Antigen 1.19 Comment: PSA is used to assist in diagnosis and monitoring of prostate cancer. When used as an initial screening test, there is no universally accepted normal range for PSA. The PSA value should be interpreted in light of factors such as age, race, family history of prostate cancer, digital rectal examination result, and result of prior prostate biopsy. For more information on calculating prostate cancer risk based on these factors, see the Prostate Cancer Prevention Trial risk calculator.    ng/mL LAB    PSA - Final result (09/16/2019 4:56 PM) Specimen Blood  PSA - Final result (09/16/2019 4:56 PM) Performing Organization Address City/State/Zipcode Phone Number COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/16/2019 4:56 PM) COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/16/2019 4:56 PM) Component Value Ref Range Performed   Sodium Level 139 136 - 145 mmol/L LAB   Potassium Level 3.8Comment: Serum Potassium Reference Range = 3.5-5.1 mmol/L 3.3 - 4.8 mmol/L LAB   Chloride Level 107 98 - 107 mmol/L LAB   Carbon Dioxide 24 23 - 31 mmol/L LAB   Anion Gap 8   LAB   Glucose Level 113 70 - 99 mg/dL LAB   Blood Urea Nitrogen 17 8 - 26 mg/dL LAB   Creatinine Level 1.11 0.72 - 1.25 mg/dL LAB   Calcium Level Total 9.2 8.4 - 10.5 mg/dL LAB   Bilirubin Total 0.5Comment: Patients receiving indocyanine green for procedures will show falsely elevated total and direct bilirubin results until the drug is cleared. 0.2 - 1.2 mg/dL LAB   Albumin Level 4.0 3.2 - 4.6 gm/dL LAB   Protein Total 6.9Comment: Plasma samples are 0.3 - 0.5 g/dL higher than serum 6.0 - 8.3 gm/dL LAB   Alkaline Phosphatase 69 40 - 150 unit/L LAB   Aspartate Aminotransferase 19 5 - 40 unit/L LAB   Alanine Aminotransferase 27 0 - 55 unit/L  LAB    COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/16/2019 4:56 PM) Specimen Blood  COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/16/2019 4:56 PM) Performing Organization Address City/State/Zipcode Phone Number , no fever September 17, 2019 Photo documentation of rash taken by wife      September 18, 2019 Rash spread over entire front and back trunk, in to groin and upper legs, saw     Dr., dermatologist,  who repeated blood work  EGFR/EGFRAA - Final result (09/18/2019 10:26 AM) EGFR/EGFRAA - Final result (09/18/2019 10:26 AM) Component Value Ref Range Performed  eGFR >60Comment: Estimated glomerular filtration rate (eGFR) and eGFRAA are calculated using the IDMS MDRD equation which is recommended for use in normal healthy individuals 18-70 years of age and has not been validated in other populations. See eGFR in the Test Directory for additional information. ml/min/1.73 m2    eGFRAA >60Comment: Estimated glomerular filtration rate (eGFR) and eGRFAA are calculated using the IDMS MDRD equation which is recommended for use in normal healthy individuals 18-70 years of age and has not been validated in other populations. See eGFR in the Test Directory for additional information. ml/min/1.73 m2     EGFR/EGFRAA - Final result (09/18/2019 10:26 AM) Specimen Blood  EGFR/EGFRAA - Final result (09/18/2019 10:26 AM) Performing Organization Address City/State/Zipcode Phone Number   AUTO DIFF - Final result (09/18/2019 10:26 AM) AUTO DIFF - Final result (09/18/2019 10:26 AM) Component Value Ref Range Performed At  Neutrophils 65.8 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Neutrophils 4.14 1.60 - 8.10 x10(3)/mcL LAB   Lymphs 10.6 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Lymphocytes 0.67 1.10 - 3.50 x10(3)/mcL LAB   Monocytes 10.6 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Monocytes 0.67 0.30 - 1.10 x10(3)/mcL LAB   Eosinophils 11.6 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Eosinophils 0.73 0.00 - 0.50 x10(3)/mcL LAB   Basophils 0.8 Comment: Per CAP, reference ranges should not be reported for percent cell counts when reporting reference ranges for absolute number counts to prevent misinterpretation of WBC differential data.   % LAB   Absolute Basophils 0.05 0.01 - 0.08 x10(3)/mcL LAB   Imm Gran Automated 0.6 % LAB   Absolute Imm Gran Automated 0.04 0.00 - 0.03 x10(3)/mcL LAB    AUTO DIFF - Final result (09/18/2019 10:26 AM) Specimen Blood  AUTO DIFF - Final result (09/18/2019 10:26 AM) Performing Organization Address City/State/Zipcode Phone Number CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/18/2019 10:26 AM) CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/18/2019 10:26 AM) Component Value Ref Range Performed  White Blood Cells 6.3 3.9 - 10.7 x10(3)/mcL LAB   Red Blood Cells 4.70 4.50 - 6.00 x10(6)/mcL LAB   Hemoglobin 15.9 14.0 - 18.1 gm/dL LAB   Hematocrit 46 41 - 49 % LAB   Mean Cell Volume 98 81 - 98 fL LAB   Mean Cell Hemoglobin 33.8 27.0 - 32.0 pg LAB   Mean Cell Hemoglobin Concentration 34.4 31.0 - 35.0 gm/dL LAB   RDW SD 45.8 37.4 - 52.4 fL LAB   RDW CV 12.7 11.1 - 14.3 % LAB   Platelet 237 135 - 371 x10(3)/mcL LAB   Mean Platelet Volume 10.3 9.3 - 12.8 fL LAB   Nucleated RBC 0 /100 WBC LAB   Nucleated RBC Abs 0.00 x10(3)/mcL LAB   Auto Neutrophil Absolute 4.14 1.60 - 8.10 x10(3)/mcL LAB    CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/18/2019 10:26 AM) Specimen Blood  CBC WITH DIFFERENTIAL (CBC W/ DIFFERENTIAL) - Final result (09/18/2019 10:26 AM) Performing Organization Address City/State/Zipcode Phone Number COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/18/2019 10:26 AM) COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/18/2019 10:26 AM) Component Value Ref Range Performed Sodium Level 140 136 - 145 mmol/L LAB   Potassium Level 3.8Comment: Serum Potassium Reference Range = 3.5-5.1 mmol/L 3.3 - 4.8 mmol/L LAB   Chloride Level 106 98 - 107 mmol/L LAB   Carbon Dioxide 22 23 - 31 mmol/L LAB   Anion Gap 12  LAB   Glucose Level 93 70 - 99 mg/dL LAB   Blood Urea Nitrogen 18 8 - 26 mg/dL LAB   Creatinine Level 1.00 0.72 - 1.25 mg/dL LAB   Calcium Level Total 9.2 8.4 - 10.5 mg/dL LAB   Bilirubin Total 0.9Comment: Patients receiving indocyanine green for procedures will show falsely elevated total and direct bilirubin results until the drug is cleared. 0.2 - 1.2 mg/dL LAB   Albumin Level 4.0 3.2 - 4.6 gm/dL LAB   Protein Total 7.0Comment: Plasma samples are 0.3 - 0.5 g/dL higher than serum 6.0 - 8.3 gm/dL LAB   Alkaline Phosphatase 73 40 - 150 unit/L LAB   Aspartate Aminotransferase 23 5 - 40 unit/L LAB   Alanine Aminotransferase 27 0 - 55 unit/L LAB    COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/18/2019 10:26 AM) Specimen Blood  COMPREHENSIVE METABOLIC PANEL (CMP) - Final result (09/18/2019 10:26 AM) Performing Organization Address City/State/Zipcode Phone Number and did skin biopsy, no fever  Knee replacement surgery scheduled for Sept. 26 canceled indefinitely  September 23, 2019 Biopsy of rash inconclusive (report not available to patient), completed      antibiotics, neck mass decreased, referred to hematology/oncology re: possible     lymphoma appointment scheduled for 10/2/ 2019 September 30, 2019 (day 22) Rash remains over entire trunk, neck, arms, legs--fades a little during      sleep but becomes reddened again after awakening    Rash Photo documented by wife