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This is VAERS ID 1274185

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1274185
VAERS Form:2
Age:58.0
Sex:Female
Location:Oregon
Vaccinated:2021-04-27
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Bradykinesia, Death, Discomfort, Irritability, Loss of consciousness, Malaise, Memory impairment, Pain, Respiratory rate increased, Slow response to stimuli, Tenderness, Wheezing, Hypoacusis, Skin abrasion, Slow speech, Spinal retrolisthesis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PTA Home Medications Medication Sig ? acetaminophen (TYLENOL) 500 mg tablet Take 2 tablets by mouth 3 times daily After one week you may take 3 tablets by mouth three times a day as needed for pain.. ? albuterol 90 mcg/puff inhaler Inhale 2
Current Illness: On 4/12/21, the patient was involved in a motor vehicle accident. She reported pressing the gas pedal instead of the brakes at a red light, was hit be a car on the driver''s side, hit her head, and reported feeling dazed with a numb body immediately after. A friend on site reported the patient was acting confused. On presentation to the Emergency Department, she complained of headache, neck/back/elbow pain. The ED provider assessed the patient and ordered a CT of the head and cervical spine, and an Xray of the elbow and thoracic spine. Symptoms were consistent with a cervical/thoracic sprain/strain and concussion. She was discharged to home with instructions for supportive care and NSAIDs for pain.
Preexisting Conditions: Past Medical History: Diagnosis Date ? Acid reflux disease ? Adverse effect of anesthesia had severe post op pain unable to get under control ? Anxiety 1980 ? Arthritis 1990 knees ? Cancer (HCC) 89, 2000, 2012 mother and father ? Chronic kidney disease 2007 self- resolved ? COPD (chronic obstructive pulmonary disease) (HCC) chronic cough for more than 6 months ? Degeneration of lumbar intervertebral disc ? Depression 1980 self and sibling and parent ? Environmental allergies 1995 ? Fetal alcohol syndrome averbal until 4 yo ? GERD (gastroesophageal reflux disease) 1990 Resistant to omeprazole and pantoprazole. May be related to MTHFR mutation. ? Headache(784.0) Migraine. Was also hit in early life. ? Iron deficiency ? Medication overuse headache 10/12/2016 ? Memory loss 4/2014 Improved on Namenda ? Meralgia paresthetica 6/2014 Assoc with weight gain from psychotropic medications ? Migraines ? Ovarian cancer (HCC) 2019 ? PONV (postoperative nausea and vomiting) ? PTSD (post-traumatic stress disorder) ? Schizophrenia (HCC) Noted as treatment resistant, sees psychiatry. Mothe drank & took barbituates while pregnant. ? Sciatica In part provoked by piriformis ? Substance abuse (HCC) 1999 self ? Temporomandibular disorder ? Thyroid disease low thyroid ? TMJ (dislocation of temporomandibular joint) ? Tobacco use Past Surgical History: Procedure Laterality Date ? CERVICAL SPINE SURGERY Posterior 6/12/2020 Procedure: C4-7 POSTERIOR CERVICAL LAMINECTOMY INSTRUMENTATION AND FUSION; ? CERVICAL SPINE SURGERY Posterior 8/21/2020 Procedure: EXTENSION OF PRIOR FUSION C3 TO T2 ? COLONOSCOPY 6/14/2011 ? EGD AND COLONOSCOPY 2011 ? ELBOW SURGERY Right 1996 ? FOOT SURGERY Right 2008 ? HARDWARE REMOVAL N/A 8/21/2020 ? HERNIA REPAIR 1990 ? HIATAL HERNIA REPAIR N/A 1/6/2016 ? KNEE JOINT REPLACEMENT Right ? KNEE SURGERY Bilateral 1997, 1988, 1999, 2011, 2012 ? LUMBAR SPINE SURGERY N/A 12/6/2018 ? OTHER SURGICAL HISTORY 1980, 1998, 1999 Jaw Surgery ? OVARY REMOVAL Bilateral 2019 ? SIGMOIDOSCOPY N/A 1/20/2021 Procedure: SIGMOIDOSCOPY FLEXIBLE ? TOTAL HYSTERECTOMY Bilateral 8/22/2019 Procedure: SI ROBOTIC ASSISTED LAPAROSCOPIC HYSTERECTOMY WITH BILATERAL SALPINGO-OOPHERECTOMY; PERITONEAL STAGING BIOPSIES, BILATERAL PELVIC AND PERIAORTIC LYMPH NODE DISSECTION; OMENTECTOMY ? UPPER GASTROINTESTINAL ENDOSCOPY N/A 1/6/2016 ? UPPER GASTROINTESTINAL ENDOSCOPY N/A 5/19/2016 ? VENTRAL HERNIA REPAIR N/A 2/22/2021
Allergies: Allergies: is allergic to varenicline; amoxicillin; gabapentin; penicillins; cyclosporine; clavulanic acid; nsaids; paper tape [adhesive & tape]; and tetanus toxoid, adsorbed.
Diagnostic Lab Data: The following are the physical exam notes and CT/Xray results from the ED admission on 4/12/21: Physical Examination VITAL SIGNS: Patient Vitals for the past 24 hrs: BP Temp Temp src Pulse Resp SpO2 Weight 04/12/21 1423 116/64 37.1 C (98.7 F) Oral 68 14 95 % 67.6 kg (149 lb) Constitutional: Well-developed. No acute distress with non-toxic appearance. HENT: Normocephalic with no external evidence of trauma, tympanic membranes atraumatic. Eyes: PERRL, EOMI. Neck: anterior atraumatic. Respiratory: Bilateral breath sounds equal, clear to auscultation, no increased work of breathing, No respiratory distress. Cardiovascular: S1S2, Normal heart rate and rhythm. No murmur, rub, or gallop. Periphery is well-perfused. Chest: Atraumatic and nontender. No step-off, crepitus, deformity, or subcutaneous air. Abdomen: Atraumatic, +normoactive bowel sounds, Non tender all four quadrants, no hepatosplenomegaly or masses. Skin: Warm and dry. No rash. Musculoskeletal: Cervical and thoracic spine tender to palpation, and lumbar spine, nontender. There is no step-off, crepitus, deformity, or visible bruising. Cervical paraspinous musculature tender right and left, tender over right left trapezius, thoracic paraspinous musculature tender right and left, and lumbar paraspinous musculature nontender. Range of motion at the neck and back essentially normal but does reproduce discomfort for the patient. Straight leg raise is negative for reproducing any radicular symptoms. Abrasion to the left elbow over the olecranon with tenderness to palpation patient is able to fully flex and extend the elbow but it is painful. No tenderness to radial or ulnar styloid with normal range of motion of wrist, no tenderness normal range of motion of left shoulder. Neurologic: Cranial nerves 2-12 grossly intact, gait steady no ataxia. Patient has bilaterally equal grips,strength 5/5, sensation to light touch to UE/LE. Radiology: CT Head wo Contrast Result Date: 4/12/2021 CT HEAD WO CONTRAST 4/12/2021 6:26 PM INDICATION: Head trauma, mod-severe. COMPARISON: CT from 11/7/2020. TECHNIQUE: 5 mm axial images were obtained from the skull base through vertex. Dose reduction techniques were used including but not limited to automated exposure control (AEC), iterative reconstruction technique, and/or mA and/or kV dose adjustments based on patient size. FINDINGS: CEREBRUM: Mild periventricular and subcortical white matter hypodensities, unchanged. CEREBELLUM: Normal. BRAINSTEM: Normal. VENTRICLES AND EXTRA-AXIAL SPACES: Normal. SKULL/SCALP: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Normal. IMPRESSION: No acute intracranial abnormality. Dictated by: Lyudmila V Morozova M.D. on 4/12/2021 6:54 PM Electronically signed by: Lyudmila V Morozova M.D. on 4/12/2021 7:05 PM CT Cervical Spine wo Contrast Result Date: 4/12/2021 CT CERVICAL SPINE WO CONTRAST 4/12/2021 6:26 PM HISTORY: Neck pain, recent trauma; Neck Pain. COMPARISON: Radiograph from 12/9/2020. TECHNIQUE: Helical images through cervical spine were obtained. No intravenous contrast was administered. FINDINGS: Posterior spinal fusion extends from C3 through upper thoracic spine. There is minimal, grade 1, anterolisthesis of C2 on C3, unchanged compared to prior radiograph. There is approximately 2 mm retrolisthesis of C6 on C7, also probably similar. No definite acute fracture identified. No focal osseous destruction. There is facet hypertrophy. No prevertebral soft tissue edema is seen. Mild obscuration by hardware artifact. Lung apices are clear. IMPRESSION: No acute fracture. XR Elbow Left 2 Vw Result Date: 4/12/2021 XR ELBOW LEFT 2 VW; 4/12/2021 6:44 PM HISTORY: NECK PAIN; elbow pain. Motor vehicle accident COMPARISON: None. FINDINGS: Alignment is normal. No acute fracture or focal bone lesion. Joint spaces are maintained. No radiopaque soft tissue foreign body. IMPRESSION: No acute fracture or dislocation of the left elbow. XR Thoracic Spine 3 Vw Result Date: 4/12/2021 XR THORACIC SPINE 3 VW 4/12/2021 6:43 PM HISTORY: Back Pain. Motor vehicle accident COMPARISON: None. FINDINGS: Alignment is normal. Cervicothoracic spinal fusion hardware in place. Vertebral body heights are maintained. No acute displaced fracture. Disc spaces are normal. Regional soft tissues are unremarkable. IMPRESSION: No acute fracture or malalignment of the thoracic spine.
CDC 'Split Type':

Write-up: This was a 58 year old female who received her 1st dose Pfizer on 4/6/21 (Lot# EW0175) and 2nd dose Pfizer on 4/27/21 (Lot# EW0151). Of note, the patient was in a motor vehicle accident on 4/12/21 with a diagnosis of concussion and cervical/thoracic strain/sprain (see history under patient information). On 4/29/21, the patient''s sister contacted the patient''s primary care clinic with the following documented concern: "Pt''s sister calling to report that two days ago pt got 2nd dose Pfizer vaccine and has been sick. This morning they found her passed out against the her bedroom door. Pt reports that she can''t remember much other than going to the bathroom. Pt''s sister states that patient totaled her car a week ago, and that it was determined she had a concussion. "She hasn''t been herself since the wreck and I am very concerned." This caller recommenced the Ed or UC but caller denied stating that either needs to see her today. This writer is reaching out to nurse to see if they can advise from here." A RN assessed the patient virtually with the following documentation: "RN note: Call transferred from patient''s sister. Pt noted to be found on her floor this morning. Pt unsure if she hit her head. Spoke to patient. She reports body aches, and feeling weak. Pt is slow to answer questions, and had a lot of difficulty hearing me (sister did not have any difficulty hearing me). Pt is noted to have more rapid breathing, and some slight wheezing. Speech is clear when she is speaking. Sister gave patient water to drink. She drank out of bottle and was able to hold on her own (though had difficulty with this at first). Sister noted some water dripping down face, but was able to swallow okay. Sister also noted that patient''s lips seem to be pursed. Plan: Given recent concussion, and patients change in behavior per sister (pt more irritable, speaking more slowly, moving slowly, breathing faster, and wheezing), recommended patient be taken to the ED today--recommended ambulance since it took 2 men to help patient back to bed this morning. Sister states patient is not agreeable to going to ED at this time. Advised to try to encourage her to drink more fluids, and continue to monitor her sxs, and if any worsening, to call for ambulance transport. Sister agreeable to plan, and will discuss with sister, and recommend ED visit today." On 4/30/21, the patient''s sister contacted the clinic to inform them that the patient was found dead that morning. The medical examiner is completing the further investigation. If additional information is needed from the primary care physician for this patient.


Changed on 5/14/2021

VAERS ID: 1274185 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:Oregon
Vaccinated:2021-04-27
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Bradykinesia, Death, Discomfort, Irritability, Loss of consciousness, Malaise, Memory impairment, Pain, Respiratory rate increased, Slow response to stimuli, Tenderness, Wheezing, Hypoacusis, Skin abrasion, Slow speech, Spinal retrolisthesis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PTA Home Medications Medication Sig ? acetaminophen (TYLENOL) 500 mg tablet Take 2 tablets by mouth 3 times daily After one week you may take 3 tablets by mouth three times a day as needed for pain.. ? albuterol 90 mcg/puff inhaler Inhale 2
Current Illness: On 4/12/21, the patient was involved in a motor vehicle accident. She reported pressing the gas pedal instead of the brakes at a red light, was hit be a car on the driver''s side, hit her head, and reported feeling dazed with a numb body immediately after. A friend on site reported the patient was acting confused. On presentation to the Emergency Department, she complained of headache, neck/back/elbow pain. The ED provider assessed the patient and ordered a CT of the head and cervical spine, and an Xray of the elbow and thoracic spine. Symptoms were consistent with a cervical/thoracic sprain/strain and concussion. She was discharged to home with instructions for supportive care and NSAIDs for pain.
Preexisting Conditions: Past Medical History: Diagnosis Date ? Acid reflux disease ? Adverse effect of anesthesia had severe post op pain unable to get under control ? Anxiety 1980 ? Arthritis 1990 knees ? Cancer (HCC) 89, 2000, 2012 mother and father ? Chronic kidney disease 2007 self- resolved ? COPD (chronic obstructive pulmonary disease) (HCC) chronic cough for more than 6 months ? Degeneration of lumbar intervertebral disc ? Depression 1980 self and sibling and parent ? Environmental allergies 1995 ? Fetal alcohol syndrome averbal until 4 yo ? GERD (gastroesophageal reflux disease) 1990 Resistant to omeprazole and pantoprazole. May be related to MTHFR mutation. ? Headache(784.0) Migraine. Was also hit in early life. ? Iron deficiency ? Medication overuse headache 10/12/2016 ? Memory loss 4/2014 Improved on Namenda ? Meralgia paresthetica 6/2014 Assoc with weight gain from psychotropic medications ? Migraines ? Ovarian cancer (HCC) 2019 ? PONV (postoperative nausea and vomiting) ? PTSD (post-traumatic stress disorder) ? Schizophrenia (HCC) Noted as treatment resistant, sees psychiatry. Mothe drank & took barbituates while pregnant. ? Sciatica In part provoked by piriformis ? Substance abuse (HCC) 1999 self ? Temporomandibular disorder ? Thyroid disease low thyroid ? TMJ (dislocation of temporomandibular joint) ? Tobacco use Past Surgical History: Procedure Laterality Date ? CERVICAL SPINE SURGERY Posterior 6/12/2020 Procedure: C4-7 POSTERIOR CERVICAL LAMINECTOMY INSTRUMENTATION AND FUSION; ? CERVICAL SPINE SURGERY Posterior 8/21/2020 Procedure: EXTENSION OF PRIOR FUSION C3 TO T2 ? COLONOSCOPY 6/14/2011 ? EGD AND COLONOSCOPY 2011 ? ELBOW SURGERY Right 1996 ? FOOT SURGERY Right 2008 ? HARDWARE REMOVAL N/A 8/21/2020 ? HERNIA REPAIR 1990 ? HIATAL HERNIA REPAIR N/A 1/6/2016 ? KNEE JOINT REPLACEMENT Right ? KNEE SURGERY Bilateral 1997, 1988, 1999, 2011, 2012 ? LUMBAR SPINE SURGERY N/A 12/6/2018 ? OTHER SURGICAL HISTORY 1980, 1998, 1999 Jaw Surgery ? OVARY REMOVAL Bilateral 2019 ? SIGMOIDOSCOPY N/A 1/20/2021 Procedure: SIGMOIDOSCOPY FLEXIBLE ? TOTAL HYSTERECTOMY Bilateral 8/22/2019 Procedure: SI ROBOTIC ASSISTED LAPAROSCOPIC HYSTERECTOMY WITH BILATERAL SALPINGO-OOPHERECTOMY; PERITONEAL STAGING BIOPSIES, BILATERAL PELVIC AND PERIAORTIC LYMPH NODE DISSECTION; OMENTECTOMY ? UPPER GASTROINTESTINAL ENDOSCOPY N/A 1/6/2016 ? UPPER GASTROINTESTINAL ENDOSCOPY N/A 5/19/2016 ? VENTRAL HERNIA REPAIR N/A 2/22/2021
Allergies: Allergies: is allergic to varenicline; amoxicillin; gabapentin; penicillins; cyclosporine; clavulanic acid; nsaids; paper tape [adhesive & tape]; and tetanus toxoid, adsorbed. adsorbed.
Diagnostic Lab Data: The following are the physical exam notes and CT/Xray results from the ED admission on 4/12/21: Physical Examination VITAL SIGNS: Patient Vitals for the past 24 hrs: BP Temp Temp src Pulse Resp SpO2 Weight 04/12/21 1423 116/64 37.1 C ?C (98.7 F) ?F) Oral 68 14 95 % 67.6 kg (149 lb) Constitutional: Well-developed. No acute distress with non-toxic appearance. HENT: Normocephalic with no external evidence of trauma, tympanic membranes atraumatic. Eyes: PERRL, EOMI. Neck: anterior atraumatic. Respiratory: Bilateral breath sounds equal, clear to auscultation, no increased work of breathing, No respiratory distress. Cardiovascular: S1S2, Normal heart rate and rhythm. No murmur, rub, or gallop. Periphery is well-perfused. Chest: Atraumatic and nontender. No step-off, crepitus, deformity, or subcutaneous air. Abdomen: Atraumatic, +normoactive bowel sounds, Non tender all four quadrants, no hepatosplenomegaly or masses. Skin: Warm and dry. No rash. Musculoskeletal: Cervical and thoracic spine tender to palpation, and lumbar spine, nontender. There is no step-off, crepitus, deformity, or visible bruising. Cervical paraspinous musculature tender right and left, tender over right left trapezius, thoracic paraspinous musculature tender right and left, and lumbar paraspinous musculature nontender. Range of motion at the neck and back essentially normal but does reproduce discomfort for the patient. Straight leg raise is negative for reproducing any radicular symptoms. Abrasion to the left elbow over the olecranon with tenderness to palpation patient is able to fully flex and extend the elbow but it is painful. No tenderness to radial or ulnar styloid with normal range of motion of wrist, no tenderness normal range of motion of left shoulder. Neurologic: Cranial nerves 2-12 grossly intact, gait steady no ataxia. Patient has bilaterally equal grips,strength 5/5, sensation to light touch to UE/LE. Radiology: CT Head wo Contrast Result Date: 4/12/2021 CT HEAD WO CONTRAST 4/12/2021 6:26 PM INDICATION: Head trauma, mod-severe. COMPARISON: CT from 11/7/2020. TECHNIQUE: 5 mm axial images were obtained from the skull base through vertex. Dose reduction techniques were used including but not limited to automated exposure control (AEC), iterative reconstruction technique, and/or mA and/or kV dose adjustments based on patient size. FINDINGS: CEREBRUM: Mild periventricular and subcortical white matter hypodensities, unchanged. CEREBELLUM: Normal. BRAINSTEM: Normal. VENTRICLES AND EXTRA-AXIAL SPACES: Normal. SKULL/SCALP: Normal. PARANASAL SINUSES AND MASTOID AIR CELLS: Normal. IMPRESSION: No acute intracranial abnormality. Dictated by: Lyudmila V Morozova M.D. on 4/12/2021 6:54 PM Electronically signed by: Lyudmila V Morozova M.D. on 4/12/2021 7:05 PM CT Cervical Spine wo Contrast Result Date: 4/12/2021 CT CERVICAL SPINE WO CONTRAST 4/12/2021 6:26 PM HISTORY: Neck pain, recent trauma; Neck Pain. COMPARISON: Radiograph from 12/9/2020. TECHNIQUE: Helical images through cervical spine were obtained. No intravenous contrast was administered. FINDINGS: Posterior spinal fusion extends from C3 through upper thoracic spine. There is minimal, grade 1, anterolisthesis of C2 on C3, unchanged compared to prior radiograph. There is approximately 2 mm retrolisthesis of C6 on C7, also probably similar. No definite acute fracture identified. No focal osseous destruction. There is facet hypertrophy. No prevertebral soft tissue edema is seen. Mild obscuration by hardware artifact. Lung apices are clear. IMPRESSION: No acute fracture. XR Elbow Left 2 Vw Result Date: 4/12/2021 XR ELBOW LEFT 2 VW; 4/12/2021 6:44 PM HISTORY: NECK PAIN; elbow pain. Motor vehicle accident COMPARISON: None. FINDINGS: Alignment is normal. No acute fracture or focal bone lesion. Joint spaces are maintained. No radiopaque soft tissue foreign body. IMPRESSION: No acute fracture or dislocation of the left elbow. XR Thoracic Spine 3 Vw Result Date: 4/12/2021 XR THORACIC SPINE 3 VW 4/12/2021 6:43 PM HISTORY: Back Pain. Motor vehicle accident COMPARISON: None. FINDINGS: Alignment is normal. Cervicothoracic spinal fusion hardware in place. Vertebral body heights are maintained. No acute displaced fracture. Disc spaces are normal. Regional soft tissues are unremarkable. IMPRESSION: No acute fracture or malalignment of the thoracic spine.
CDC 'Split Type':

Write-up: This was a 58 year old female who received her 1st dose Pfizer on 4/6/21 (Lot# EW0175) and 2nd dose Pfizer on 4/27/21 (Lot# EW0151). Of note, the patient was in a motor vehicle accident on 4/12/21 with a diagnosis of concussion and cervical/thoracic strain/sprain (see history under patient information). On 4/29/21, the patient''s sister contacted the patient''s primary care clinic with the following documented concern: "Pt''s sister calling to report that two days ago pt got 2nd dose Pfizer vaccine and has been sick. This morning they found her passed out against the her bedroom door. Pt reports that she can''t remember much other than going to the bathroom. Pt''s sister states that patient totaled her car a week ago, and that it was determined she had a concussion. "She hasn''t been herself since the wreck and I am very concerned." This caller recommenced the Ed or UC but caller denied stating that either needs to see her today. This writer is reaching out to nurse to see if they can advise from here." A RN assessed the patient virtually with the following documentation: "RN note: Call transferred from patient''s sister. Pt noted to be found on her floor this morning. Pt unsure if she hit her head. Spoke to patient. She reports body aches, and feeling weak. Pt is slow to answer questions, and had a lot of difficulty hearing me (sister did not have any difficulty hearing me). Pt is noted to have more rapid breathing, and some slight wheezing. Speech is clear when she is speaking. Sister gave patient water to drink. She drank out of bottle and was able to hold on her own (though had difficulty with this at first). Sister noted some water dripping down face, but was able to swallow okay. Sister also noted that patient''s lips seem to be pursed. Plan: Given recent concussion, and patients change in behavior per sister (pt more irritable, speaking more slowly, moving slowly, breathing faster, and wheezing), recommended patient be taken to the ED today--recommended ambulance since it took 2 men to help patient back to bed this morning. Sister states patient is not agreeable to going to ED at this time. Advised to try to encourage her to drink more fluids, and continue to monitor her sxs, and if any worsening, to call for ambulance transport. Sister agreeable to plan, and will discuss with sister, and recommend ED visit today." On 4/30/21, the patient''s sister contacted the clinic to inform them that the patient was found dead that morning. The medical examiner is completing the further investigation. If additional information is needed from the primary care physician for this patient.

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