Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Monocyte count, Neutrophil count, Oxygen saturation, Platelet count, Polymyalgia rheumatica
Clinical narrative: PMR; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient.  A 68-year-old male patient received BNT162b2 (BNT162B2), on 01Apr2021 as dose 2, single (Lot number: ER8735) at the age of 67 years, in arm for covid-19 immunisation. The patient's relevant medical history included: "GERD" (unspecified if ongoing); "HAND SURGERY HX" (unspecified if ongoing), notes: Laterality , Right , 4th digit trigger release; "Known allergies: Penicillins" (unspecified if ongoing), notes: Penicillins and Bee Sting; "Known allergies: Bee Sting" (unspecified if ongoing), notes: Penicillins and Bee Sting; "Never Smoker" (unspecified if ongoing); "Smokeless tobacco: Never Used" (unspecified if ongoing), notes: No passive smoke exposure.; "Alcohol use: Yes" (unspecified if ongoing), notes: There is a history of alcohol use. consumed occasionally.; "Exposure to TB" (unspecified if ongoing), notes: Management: Drug therapy. The patient's medical history, reported also as family history included: "Kidney Disease" (unspecified if ongoing), notes: Relation: Mother; "Cancer" (unspecified if ongoing), notes: Relation: Father; "Cancer lung" (unspecified if ongoing), notes: Cancer lung, Relation: Father; "COPD" (unspecified if ongoing), notes: Relation: Mother; "Intestinal blockage" (unspecified if ongoing), notes: Relation: Mother; "Hypertension" (unspecified if ongoing), notes: Relation: Mother; "type of cancer" (unspecified if ongoing), notes: Paternal aunt; "Cancer colon" (unspecified if ongoing), notes: Uncle. Concomitant medication(s) included: OMEPRAZOLE oral, start date: 09Mar2021; TAMSULOSIN oral, start date: 30Apr2020, stop date: 30Apr2021; HYDROCODONE; PREDNISONE; EPINEPHRINE intramuscular, start date: 29Sep2020; ALFUZOSIN oral, start date: 29Apr2021; CICLOPIROX. Vaccination history included: BNT162b2 (DOSE 1, SINGLE, Product name /Manufacture: Pfizer EN6202), administration date: 09Mar2021, when the patient was 67-year-old, for Covid-19 Immunization, reaction(s): "PMR", "Joint pain neck, back ,shoulders, hips.", "Muscles, legs and buttocks pain", "legs and buttocks pain.", "Muscles, legs and buttocks pain.", "Weakness arms and legs", "Joint pain neck, back ,shoulders, hips.Muscles, legs and buttocks pain", "Joint pain neck, back ,shoulders, hips.Muscles, legs and buttocks pain", "Joint pain neck, back ,shoulders, hips.Muscles, legs and buttocks pain", "Joint pain neck, back ,shoulders, hips.Muscles, legs and buttocks pain-", "I had a bad reaction to Pfizer shot within 24 hours. lasted a long time". The following information was reported: POLYMYALGIA RHEUMATICA (disability, medically significant) with onset 30Sep2021, outcome "recovering", described as "PMR". The event "pmr" required physician office visit. The patient underwent the following laboratory tests and procedures: Alanine aminotransferase normal (3-40): (unspecified date) 18, notes: u/l; (unspecified date) 14; Alanine aminotransferase normal (9-46): (05Apr2021) 14, notes: 9 -46 U/L; Albumin globulin ratio (1.0-2.5): (05Apr2021) 1.3; Aldolase (normal high range <=8.1): (05Apr2021) 5.8 uL, notes: Units; U/L; Antibody test (normal high range <=5.0): (unspecified date) <0.4, notes: Units: u/mL; Antinuclear antibody: (unspecified date) Negative; (unspecified date) Negative, notes: Reference Range: NEGATIVE Lab: 299; Aspartate aminotransferase (normal high range <5): (unspecified date) <5 IU/ml, notes: This test was performed using t he GADQ5 ELISA method, which is standardized against the International reference preparation 97/550; Aspartate aminotransferase abnormal (10-35): (05Apr2021) 14, notes: 10 - 35 U/L; Basophil count (0-200): (05Apr2021) 26 cells/uL; Basophil count: (05Apr2021) 0.3 %; Blood albumin (3.6-5.1): (05Apr2021) 4.0, notes: 3.6 - 5.1 q/dL; Blood alkaline phosphatase (35-144): (05Apr2021) 88, notes: 35 - 144 U/L; Blood bilirubin (0.2-1.2): (05Apr2021) 0.6, notes: 0.2 - 1.2 mQ/dL; Blood calcium (8.6-10.3): (05Apr2021) 9.0, notes: 8.6 - 10.3 mQ/dL; Blood chloride (98-110): (05Apr2021) 104 mmol/L; Blood creatine phosphokinase (44-196): (05Apr2021) 78, notes: 44 - 196 U/L; Blood creatine phosphokinase (55-170): (05Apr2021) 35 (L), notes: Units: U/L; Blood creatinine (0. 70-1.25): (05Apr2021) 1.09 mg/dl, notes: Comment: For patients >49 years of age, the reference limit for Creatinine is approximately 13% higher for certain people; Blood glucose (65-99): (05Apr2021) 97 mg/dl, notes: Fasting reference interval; Blood immunoglobulin A (70-320): (05Apr2021) 205 mg/dl, notes: Units: mg/dL; Blood immunoglobulin G: (05Apr2021) <1:64, notes: A. PHAGOCYTOPHIL.UM AB (IGG); Blood immunoglobulin G (600-1540): (05Apr2021) 1267 mg/dl, notes: Units: mg/dL; Blood immunoglobulin M: (05Apr2021) <1: 20; Blood immunoglobulin M (50-300): (05Apr2021) 111 mg/dl, notes: Units: mg/dL; Blood potassium (3.5-5.3): (unspecified date) 4.6 mmol/L; Blood pressure measurement: (unspecified date) 142/80, notes: BP 142/80; (unspecified date) 140/80, notes: BP 140/80; (05Apr2021) 160/90, notes: B.P: 160/90 B.P Site: Left arm BP Position: sitting B.P Cuff size: Regular Adult; Blood sodium (135-146): (05Apr2021) 139 mmol/L; Blood thyroid stimulating hormone (0.40-4.50): (05Apr2021) 2.01, notes: 0.40 - 4.50 mlU/L; Blood thyroid stimulating hormone (0.500-5.200): (05Apr2021) 1.005, notes: Units: mIU/L; Blood urea (7-25): (unspecified date) 16 mg/dl; (05Apr2021) 19 mg/dl; Blood uric acid (3.5-8.5): (05Apr2021) 5.6 mg/dl, notes: Units: mg/dL; Body height: (unspecified date) 176.5, notes: Ht 176.5 cm (5' 9.5"); Body mass index: (unspecified date) 33.89, notes: BMI 33.89 kg/m2; (unspecified date) 33.77, notes: 33.77 kg/m2; (05Apr2021) 34.21, notes: 34.21 kg/m2; Body temperature: (unspecified date) 97.5 Fahrenheit, notes: Temp 36.4 °C (97.5 degree F); (unspecified date) 98.2 Fahrenheit, notes: Temp 36.8 degree C (98.2 degree F); (05Apr2021) 98.8 Fahrenheit, notes: 37.1 degree C (98.8 degree F); Carbon dioxide (20-32): (05Apr2021) 29 mmol/L; C-reactive protein increased (normal high range <5): (unspecified date) 12.5 mg/l; (05Apr2021) 82 (H), notes: Units; mg/L; Creatine urine (6-22): (05Apr2021) 6 - 22 (calc), notes: NOT APPLICABLE 6 - 22 (calc); Eosinophil count (15-500): (05Apr2021) 299 cells/uL; Eosinophil count: (05Apr2021) 3.4 %; Globulin (1.9-3.7): (05Apr2021) 3.1 g/dl; Glomerular filtration rate: (05Apr2021) 70, notes: >OR= 60 ml/min/1.73m2; Haematocrit (38.5-50.0): (05Apr2021) 42.6 %; Haemoglobin (13.2-17.1): (05Apr2021) 14.4 g/dl; Heart rate: (unspecified date) 80; (05Apr2021) 69, notes: Pulse: 69; Immunology test: (05Apr2021) Normal, notes: Normal pattern. No monoclonal proteins detected; Infectious mononucleosis: (05Apr2021) 10.1 %; Lyme disease: (05Apr2021) <0.90; Lymphocyte count (850-3900): (05Apr2021) 1637 cells/uL; Lymphocyte count: (05Apr2021) 18.6 %; Mean cell haemoglobin (27.0-33.0): (05Apr2021) 29.0 pg; Mean cell haemoglobin concentration (32.0-36.0): (05Apr2021) 33.8 g/dl; Mean cell volume (80.0-100): (05Apr2021) 85.7, notes: Unit: fL; Mean platelet volume (7.5-12.5): (05Apr2021) 19.1, notes: Unit: fL; Monocyte count (200-950): (05Apr2021) 889 cells/uL; Neutrophil count (1500-7800): (05Apr2021) 5949 cells/uL; Neutrophil count: (05Apr2021) 67.6 %; Oxygen saturation: (unspecified date) 98 %; (05Apr2021) 98 %; Platelet count (140-400): (05Apr2021) 239, notes: Unit: Thousand/ul; Protein total: (05Apr2021) <0.2 mg/ml; Protein total (6.1-8.1): (05Apr2021) 7.1, notes: 6.1 - 8.1 q/dl; Pulse abnormal: (05Apr2021) 69; Red blood cell count (4.20-5.80): (05Apr2021) 4.97, notes: Unit: Million/uL; Red blood cell sedimentation rate decreased (normal high range 20): (05Apr2021) 14, notes: < OR= 20 mm/h; Red blood cell sedimentation rate normal (normal high range <15): (05Apr2021) 32 (H), notes: Units: mm/hr; Red cell distribution width increased (11.0-15.0): (05Apr2021) 13.1 %; Respiration abnormal: (05Apr2021) 18; Rheumatoid factor (normal high range <4): (05Apr2021) <10, notes: Units: IU/mL; Weight: (unspecified date) 105.6, notes: Wt 105.6 kg (232 lb 12.8 oz); White blood cell count (3.8-10.8): (05Apr2021) 8.8, notes: Unit: Thousand/uL. Therapeutic measures were taken as a result of polymyalgia rheumatica.  Clinical information; Patient reporting that she have the second Pfizer vaccine on 01Apr2021. In closing, it should be noted that I would never take another covid vaccine. REASON FOR VISIT: Patient presents with: Joint Pain: Pt states joint pain and weakness states getting worse and worse, not sure exactly when it started but noticed after starting Flomax or after Pfizer covid vaccine. States concerned for Lyme disease.REVIEW OF SYSTEMS: Review of Systems 04/05/21 1309 160/90 Left Arm Sitting Regular Adult 69 18 37.1 degree C (98.8 degree F) Temporal 98% 106.6 kg (235 lb) 176.5 cm (5' 9.5") Constitutional: Positive for malaise/fatigue. Negative for chills and fever. Respiratory: Negative for cough and shortness of breath. Musculoskeletal: Positive for joint pain and myalgias. Skin: Negative for rash. Neurological: Negative for dizziness and headaches. Patient went under physical Examamination Constitutional: Normal appearance. He is not ill-appearing. Musculoskeletal: Right shoulder: Tenderness present ,Left shoulder: Tenderness present, Right hip: Tenderness present, Left hip: Tenderness present. Skin: Skin is warm. Neurological: No focal deficit present. Mental Status: He is alert. Cranial Nerves: No cranial nerve deficit. Sensory: No sensory deficit. Motor: No weakness. Coordination: Coordination normal. ASSESSMENT/PLAN: Diagnoses and all orders for this visit: Fatigue, unspecified type CBC + DIFF; Future COMP METABOLIC PANEL; Future TSH BLD; Future CONSULT TO FAMILY PRACTICE; Future, Polymyalgia (HCC) SEO RA TE WESTER GREN; Future, CK CREATINE KINASE; Future, LYME AB PANEL WBLOT; Future, Polyarthralgia SED RATE WESTERGREN; Future, LYME AB PANEL WBLOT; Future, Prednisone (DELTASONE) 10 mg tablet; 3 tab x 3 days, 2 tab x 3 days, 1 tab x 3 days There are no Patient Instructions on file for this visit. END of EHI Release report. HPI: Patient was recent seen at urgent care for history of progressively worsening pain in hips, shoulders, neck and back with associated muscle soreness and weakness in shoulder and hip muscles. Patient progressively had difficulties getting out of bed due to weakness. Responding currently very well since starting steroids with resolution of pains. Fatigue, and weakness. Performed labs yesterday pending to be resulted. Patient lives in rural area of NY with history of tick bite last year requiring treatment. Was recently started on Tamsulosin in January for BPH with associated nocturia and incomplete voids. Has noted significant improvement in symptoms. Completed Pfizer COVID19 vaccine series 1 week ago withCurrent Outpatient Medications on File Prior to Visit. Review of Systems Never used Yes Never Constitutional: Negative for chills, diaphoresis, fatigue and fever. Eyes: Negative for visual disturbance. Respiratory: Negative for cough and shortness of breath. Cardiovascular: Negative for chest pain, palpitations and leg swelling. Gastrointestinal: Negative for abdominal pain, constipation, diarrhea, nausea and vomiting. Endocrine: Negative for cold intolerance and heat intolerance. Genitourinary: Positive for difficulty urinating (improved) and frequency (nocturia improved). Negative for hematuria. Musculoskeletal: Negative for arthralgias, back pain, gait problem, myalgias and neck pain. Neurological: Negative for weakness, light-headedness, numbness and headaches. Psychiatric/Behavioral: Negative for dysphoric mood and sleep disturbance. The patient is not nervous/anxious. Patient went Physical Exam Constitutional on unknown date Appearance: Normal appearance. HENT: Head: Normocephalic and atraumatic. Mouth/Throat, Pharynx: Oropharynx is clear. Eyes: Extraocular Movements: Extraocular movements intact. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulses: Normal pulses. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Abdominal: General: Abdomen is flat. Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. There is no mass. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right shoulder: Normal. Normal strength. Left shoulder: Normal. Normal strength. Right upper arm: Normal. Left upper arm: Normal. Right hand: Normal. Left hand: Normal. Cervical back: Normal, normal range of motion and neck supple. No rigidity or tenderness. Lumbar back: Normal. Right hip: Normal. Normal strength. Left hip: Normal. Normal strength. Right lower leg: Normal. Left lower leg: Normal Skin: Capillary Refill: Capillary refill takes less than 2 seconds. Findings: No rash. Neurological: General: No focal deficit present. Mental Status: He is alert and oriented to person, place, and time. Cranial Nerves: No cranial nerve deficit. Sensory: Sensation is intact.Motor: Motor function is intact. No weakness. Gait: Gait is intact. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. ASSESSMENT/PLAN: 1. Polymyalgia rheumatica syndrome, (primary diagnosis) Patient will be heading back home soon to continue Prednisone to follow-up with PCP for further assessment or symptoms if any relapse will review labs once resulted and notify patient reassess symptoms next week close to current course completion and consider additional 2-3 weeks more of steroids taper. 2. Polyarthralgia 3. Proximal limb muscle weakness resolved. 4. Benign prostatic hyperplasia with incomplete bladder emptying Stable. Improved Limit caffeine No fluids less than 2 hours prior to bedtime Continue med. 5. Gastroesophageal reflux disease, unspecified whether esophagitis present continue lifestyle modification-continue med. 6. Class 1 obesity due to excess calories with serious comorbidity and body mass index (BMI) of 33.0 to 33.9 in adult Newly diagnosed Diet and exercise for now. SEO RATE WESTERGREN: Component: WSR, ANA IFA is a first line screen for detecting the presence of up to approximately 150 autoantibodies in various autoimmune diseases. A negative ANA IFA result suggests an ANA-associated autoimmune disease is not present at this time, and does not reflex further. If there is high clinical suspicion for Sjogren's syndrome, testing for anti-SS-A/Ro antibody should be considered. Anti-Jo-1 antibody should be considered for clinically suspected inflammatory myopathies. Patient presents for Follow Up and Results. HPI: Patient not taking steroid at same time each day. Since last seen had flare of symptoms with hip pain, stiffness, and weakness after a 2 hours drive. Took his steroid dose due and symptoms later subsided. Patient unsure how long his symptoms will progress for and how long he may need to be on steroids for. Currently asymptomatic today. Review of Systems Constitutional: Negative for chills, diaphoresis, fatigue and fever. Respiratory: Negative for cough and shortness of breath.Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Negative for abdominal pain, nausea and vomiting. Musculoskeletal: Negative for arthralgias, gait problem, joint swelling and myalgias. Neurological: Negative for weakness and numbness. Physical Exam Constitutional: Appearance: Normal appearance. Eyes: Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulmonary: Effort Pulmonary effort is normal. Breath sounds: Normal breath sounds. Neurological: General: No focal deficit present. Mental Status: He is alert and oriented to person, place, and time. Mental status is at baseline. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. ASSESSMENT/PLAN: 1. Polyarthralgia (primary diagnosis) Extend Steroid taper, To try taking medication at the same time each day will notify of labsto follow-up with pcp to follow-up with rheum, if symptoms reoccur after steroid taper completion. seo rate westergren c-reactive protein (crp) sed rate westergren ana scrn reflex titer/pattern and ab cascade rheumatoid factor bl ccp antibody lgg dna ab os + conf bld sjogren abs ssa/ssb prednisone 10 mg tablet, 2. polymyalgia {hcc) - as above seo rate westergren c-reactive protein (crp) seo ra te westergren ana scrn reflex titer/pattern and ab cascade rheumatoid factor bl ccp antibody igg dna ab ds + conf bld sjogren abs ssa/ssb prednisone 10 mg tablet, 3.Proximal limb muscle weakness Prednisone 10 MG TABLET. Assessment Patient Plan: Assessment: Diffuse arthralgia. Description: Patient Plan: Labs done today to see Dr (Name withheld) at 2:30pm today in RH for consult. Assessment Patient Plan: Description: Myalgia (M79.10). Babesia Abs lgG lgM to be performed, CBC With Auto Diff to be performed, Complete Metabolic Profile (CMP) to be performed, Ehrlichia + Anaplasma (HGE + HME) Abs lgG, lgM to be performed, Magnesium to be performed, Rickettsia Abs (RMSF), lgG+lgM to be performed, Vitamin B12 (Cobalamin) to be performed and Vitamin D, 250H to be performed. Pain Management Plan: Pain Scale: 8/10. Method: Numeric Pain Intensity Scale. Location: all over. Onset 29Apr2021.Duration: 2 Days. Quality: aching, discomforting. Follow-up and Consult Information: Follow-up visit type: Office visit Instructions: Dr. (Name withheld) at 2:30 today the patient feels safe at home. The patient does not feel taken advantage of. Immunization status is up to date. Elevated antibody levels t o B. microti indicate exposure to the organism. Human babesiosis infection is transmitted by the bite of an infected Ixodes tick or less frequently from transfusion with blood from an infected donor. Definitive diagnosis is made by identifying intraerythrocytic organisms in peripheral blood. In patients with low parasitemia, antibody detection by IFA is recommended. IgG leve.ls greater than or equal to 1:1024 can be detected in acute phase patients with parasites in blood smears. The IFA as. Say can be used .as a s eroepidemiologic tool to study the frequency and distribution of B. microtiin endemic areas especially in persons with mixed infections also involving Borrelia burgdorferi. This test was developed and its analytical performance characteristics have been determined by (withheld). It has not been cleared or approved by the Food and Drug Administration. This assay has been validated pursuant to the regulations and is used for clinical purposes. Ehrlichia Chaffeensis has been identified as the Causative agent of Human Monocytic Ehrlichiosis {HME). Infected individuals produce specific antibodies to E. Chaffeensis that can be detected by an immunofluorescent antibody (IFA) test. Single IgG IFA titers of 1:64 or greater indicate exposure to E. Chaffeensis. A four-fold rise in IgG titers between acute and convalescent sample!!! and/ or the presence of IgM antibody against E. Chaffeensis suggest recent or current infection. This test was developed and its analytical performance characteristics have been determined by lab. It has not been cleared or approved by FDA. This a: say has been validated pursuant to the regulations and is used for clinical purposes Ana plasma phagocytophilum is the tick-borne agent causing Human Granulocytic: Ehrlichiosis (HGE). HGE is distinct and separate from Human Monocytic Ehrlichiosis {HME), caused by Ehrlichiachaffeensis. Serologic cross-reactivity between A. phagocytophilum and E. Chaffeensis is minimal (5-15%). This test was developed .and its analytical performance characteristics have been determined by the lab. It has not been cleared or approved by FDA. This assay has been validated pursuant to the regulations and is used for clinical purposes.Patient had the pleasure of participating in the care of our patient at request for a consultation. Follow-up and Consult Information: Duration: 3 weeks The 14-3-3eta protein is a marker of synovial inflammation that is released into synovial fluid and peripheral blood in rheumatoid arthritis (RA) and erosive psoriatic arthritis. One in five RF and CCP- seronegative early stage RA patients is found to be positive for 14- 3- 3eta protein. Patients with active joint RA disease have higher values of 14-3-3eta protein than those with inactive RA or psoriasis without arthritis. 14 -3-3eta protein has a 93% specificity in patients with RA. Values greater than or= 0.2 ng/mL are elevated and indicative of RA disease or erosive psoriatic arthritis. Values >0.50 ng/mL are associated with more aggressive RA disease and poorer outcomes. Unlike RF and CCP, 14.-3-3eta protein is a therapeutically modifiable marker to monitor response to therapy. A decrease in 14-3-3eta protein in response to DMARDs (disease-modifying antirheumatic drugs) and anti-TNF (tumor necrosis factor) drugs indicates better clinical outcomes; an increase is associated with worse outcomes despite apparent clinical remission. This test was developed and its analytical performance characteristics have been determined by (withheld). It has not been cleared or approved by FDA. This assay has been validated pursuant to the regulations and is used for clinical purposes. ANA IFA is a first line screen for detecting the presence of up to approximately 150 autoantibodies in various autoimmune diseases. A negative ANA IFA result suggests an ANA-associated autoimmune disease is not present at this fme, but is not definitive. H there is high clinical suspicion for Sjogren's syndrome. Testing for anti-SS-NRo antibody should be considered. Anti-Jo-1 antibody should be considered for clinically suspected inflammatory myopathies. AC-0: Negative International Consensus on ANA Patterns (link) {This link is being provided for information educational purposes only.) The 14-3-3 eta protein is a marker of synovial inflammation that is released into synovial fluid and peripheral blood in rheumatoid arthritis (RA) and erosive psoriatic arthritis. One in five RF and CCP seronegative early stage RA patients 15 found to be positive for 14-3-3eta protein. History of Present Illness: 1. Pains greatly improved with pred 20 extensive labs neg for sec dz ind ana rf ccp cpk gad tsh had sig icn esr/crp prior to steroids that normalized after n< patient tolerating medications as prescribed without significant side effects recent lab results reviewed with patient only current complaint is mod use related pain in R shoulder, Assessment/Plan Detail Type: Assessment Description Polymyalgia rheumatica Provider Plan Slow pred taper labs ptnov. Detail Type Assessment Description Chronic shoulder pain, unspecified laterality Provider Plan Conservative management reviewed with patient home exercise program reviewed with patient in detail and demonstrated, handout given inject pm Assessment ther Chronic Pai Assessment/Plan: 1. Detail Type: Assessment Description: Polymyalgia rheumatic Provider Plan cont pred taper add alleve/apap for pain consider mtx if worsens w taper advised to call if symptoms persist, worsen or new symptoms develop, 2. Assessment: Myalgia, 3. Assessment: Blurred vision, bilateral Provider Plan ddxinc iop, cataract. rec optho eval asap advised to call if symptoms persist, worsen or new symptoms develop doubt ta given in exam and esr, 4. Other: Orders Orders not associated to today's assessments, Plan Orders: CBC With Auto Diff to be performed, Complete Metabolic Profile (CMP) to be performed, CRP (C Reactive Protein) to be performed and SED Rate to be performed. Assessment/Plan Detail Type Assessment Description Polymyalgia rheumatica (M35.3), Provider Plan Description refusing pred taper and mtx at present will resume Naprosyn now. Assessment/Plan Detail Type 1. Assessment Description Polymyalgia rheumatica, Provider Plan Description med at present follow for recurrence labs ptnov, 2. Assessment Description Primary osteoarthritis involving multiple joints. Provider Plan Description conservative management reviewed with patient home exercise program reviewed with patient in deEil and demonstrated, handout given maximize exercise supplements apap prn advised to call if symptoms persist, worsen or new symptoms develop. Follow-up and Consult Information: History of Present Illness: PMR noinflam complaints off pred for greater than 6 mo all labs nl incl esr crp Mild manageable pain in teh R hip and b/l hands pain is described as dull/achy in character worse with use, better with rest not associated with any significant morning stiffness neurologic symptomatology, instability or history of trauma mild functional impairment secondary to symptoms Problem Description Essential hypertension. Onset Date on 24May2022. Problem Description. Abnormal EKG Onset Date 24May2022. Medications Medication Name epinephrine mg/O.3 mL injection, auto- injector Sig Description inject 0.3 milliliter by intramuscular route once as needed for anaphylaxis Started on 29Sep2020, losartan 25 mg tablet Sig Description take 1 tablet by oral route every day Started and on 25Jul2022, omeprazole 20 mg capsule, delayed release Sig Description 1 capsule PO daily 30 minutes before breakfast Started and refilled 11Oct2022 doxycycline Hyclate 100 mg tablet Sig Description take 1 tablet by oral route 2 times every day for 14 days Start Date on 11Oct2022 and Stop date on 24Oct2022 Pyridium 200 mg tablet Sig Description take 1 tablet by oral route 3 times every day after meals Start Date on 20Oct2022, oxybutynin chloride ER 5 mg tablet, extended release 24 hr Sig Description take 1 tablet by oral route every day Start Date on 20Oct2022. Assessment/Plan Detail Type: Assessment Description: Polymyalgia rheumatica, Detail Type: Assessment Provider Plan Description: conservative management reviewed with patient consider ortho if worsens. Medications Started on 11Oct2022 Medication with Doxycycline Hyclate 100 mg tablet Directions: take 1 tablet by oral route 2 times every day for 14 days Stopped on 24Oct2022 and Started on 29Sep2020 Medication with epinephrine 0.3 mg/0.3 ml injection, auto injector Directions: inject 0.3 mill11iter by intramuscular route once as needed for anaphylaxis, Started on 25Jul2022 Medication with losartan 25 mg tablet Directions: take 1 tablet by oral route everyday, Started on 11Oct2022 Medication with omeprazole 20 mg capsule , delayed release Directions: 1 capsule PO daily 30 minutes before breakfast, Started on 20Oct2022 Medication with oxybutynin chloride ER 5 mg tablet, extended release 24 hr Directions: take 1 tablet by oral route everyday, Started on 20Oct2022 Medication with Pyridium 200 mg tablet Directions: take 1 tablet by oral route 3 times every day after meals.