[
 {
  "topic": "rf_acs",
  "id": "cdc-heart-attack",
  "publisher": "CDC",
  "title": "About Heart Attack Symptoms, Risk, and Recovery",
  "url": "https://www.cdc.gov/heart-disease/about/heart-attack.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "The major symptoms of a heart attack are: Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. Feeling weak, light-headed, or faint. You may also break into a cold sweat. Pain or discomfort in the jaw, neck, or back. Pain or discomfort in one or both arms or shoulders. Shortness of breath. This often comes along with chest discomfort, but shortness of breath also can happen before chest discomfort. Other symptoms of a heart attack could include unusual or unexplained tiredness and nausea or vomiting. Women are more likely to have these other symptoms.",
  "page_updated": "2023-10-26",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF).",
  "page_file": "cdc-heart-attack.txt",
  "page_sha256": "4d6b5c6cbd50f02fcdcaa01410d6b4363f82dee16af4b427e14fd3f9fc546ec7"
 },
 {
  "topic": "rf_acs",
  "id": "nhlbi-angina",
  "publisher": "NHLBI",
  "title": "Angina (Chest Pain) - Symptoms",
  "url": "https://www.nhlbi.nih.gov/health/angina/symptoms",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Stable angina; Pain that occurs during physical activity or mental stress; Pattern of symptoms that has not changed in the last 2 months; Pain that is relieved by rest or medicines; Symptoms that go away within 5 minutes Unstable angina; Changes in your stable angina symptoms; Pain that lasts longer than 20 minutes or goes away and then comes back; Pain that grows worse; Pain that is not relieved by rest or medicines; Pain during rest or sleep; Intense pain",
  "page_updated": "2023-07-10",
  "notes": "NIH institute page. Stable vs unstable angina features.",
  "page_file": "nhlbi-angina.txt",
  "page_sha256": "2c4f7eb808c3ce58e1a4bb1078f5800293ec4bacce46202b7e3d812978030b96"
 },
 {
  "topic": "rf_pe",
  "id": "cdc-vte",
  "publisher": "CDC",
  "title": "About Venous Thromboembolism (Blood Clots)",
  "url": "https://www.cdc.gov/blood-clots/about/index.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "You can have a PE without any symptoms of a DVT. Signs and symptoms of PE can include: Difficulty breathing; Faster than normal or irregular heartbeat; Chest pain or discomfort, which usually worsens with a deep breath or coughing; Cough or coughing up blood; Very low blood pressure, lightheadedness, or fainting If you have any of these signs or symptoms, you should seek medical help immediately. Risk factors Almost anyone can have a DVT/PE. However, certain factors can increase the chance of having this condition. Factors that increase the risk of developing DVT/PE include those associated with an ; Injury to a vein; Slow blood flow caused by limited movement; Certain chronic medical illnesses, older age, family history, and other health factors; Increased levels of estrogen, a hormone that plays a key role in a female's reproductive health",
  "page_updated": "2025-03-05",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF). The stray ' ; ' after 'associated with an' is where the page's bullet list starts. The guessed /blood-clots/signs-symptoms/ URL was 404; PE signs and risk factors are on the About page; the DVT limb signs (swelling, pain or tenderness, warmth, redness) are on the same page just before this excerpt.",
  "page_file": "cdc-vte.txt",
  "page_sha256": "f463748d7f0a97993fbb73b4df9315f5dfed94057b8ab44eea38c06909c7fc68"
 },
 {
  "topic": "rf_pe",
  "id": "nhlbi-vte",
  "publisher": "NHLBI",
  "title": "Venous Thromboembolism - Symptoms",
  "url": "https://www.nhlbi.nih.gov/health/venous-thromboembolism/symptoms",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Deep vein thrombosis (DVT) should be taken seriously, as it may lead to a life-threatening pulmonary embolism (PE). Symptoms of VTE can include: Swollen and tender legs that are painful to the touch, if you have blood clots that block blood flow to your leg veins (deep vein thrombosis or DVT); Shortness of breath and pain when breathing, if you have a blood clot that travels to the lungs (pulmonary embolism) The symptoms of VTE are not the same for everyone. Sometimes VTE does not cause symptoms until serious complications develop.",
  "page_updated": "2022-09-19",
  "notes": "NIH institute page.",
  "page_file": "nhlbi-vte.txt",
  "page_sha256": "a9fca8e964fd6d094e9a4cf48d4ade83bf5100f166ff136b5c918036328970b0"
 },
 {
  "topic": "rf_stroke",
  "id": "cdc-stroke",
  "publisher": "CDC",
  "title": "Signs and Symptoms of Stroke",
  "url": "https://www.cdc.gov/stroke/signs-symptoms/index.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "What are the signs of stroke in men and women? Sudden trouble walking, dizziness, loss of balance, or lack of coordination. Sudden trouble seeing. Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden severe headache with no known cause. Call 9-1-1 right away if you or someone else has any of these symptoms.",
  "page_updated": "2026-05-19",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF).",
  "page_file": "cdc-stroke.txt",
  "page_sha256": "56a54caaa27d45395e209c0aaafce92780fb29822aee5718d9247d9e8bd8f986"
 },
 {
  "topic": "rf_stroke",
  "id": "ninds-tia",
  "publisher": "NINDS",
  "title": "Transient Ischemic Attack (TIA)",
  "url": "https://www.ninds.nih.gov/health-information/disorders/transient-ischemic-attack-tia",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "TIA symptoms are similar to those of stroke. Most symptoms of a TIA happen suddenly and usually go away within an hour, although they may last for up to 24 hours. Symptoms can include: Numbness or weakness in the face, arm, or leg, especially on one side of the body; Trouble seeing in one or both eyes, or double vision; Problems with walking, dizziness; Confusion; Difficulty talking or understanding speech; Loss of balance and coordination There’s no immediate way to tell whether symptoms are from a TIA or a stroke. That’s why it’s important for a person experiencing them to get emergency medical care right away.",
  "page_updated": "2026-03-13",
  "notes": "NIH institute page. Requested URL /disorders/transient-ischemic-attack redirected here. The NINDS stroke hub page (/health-information/stroke) has only navigation text, so the TIA page is used.",
  "page_file": "ninds-tia.txt",
  "page_sha256": "bb02287c379f2b7fa4c0961cacc38290808ae6f91e209446639eca109ef0247f"
 },
 {
  "topic": "rf_headache",
  "id": "ninds-headache",
  "publisher": "NINDS",
  "title": "Headache",
  "url": "https://www.ninds.nih.gov/health-information/disorders/headache",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "A sudden, severe headache, possibly with a stiff neck; A severe headache with fever, nausea, or vomiting that’s not related to another illness; A person experiencing their \"first\" or \"worst\" headache that also has confusion, weakness, double vision, or loss of consciousness; A headache that gets worse over days or weeks or changes in pattern or behavior; Headaches in children that keep coming back; A headache after a brain injury; A headache with loss of sensation or weakness in any part of the body—this could be a sign of a stroke; A headache with convulsions (shaking) or trouble breathing; Two or more headaches a week; A constant headache in someone who hasn’t had headaches before, especially if they’re over age 50; New headaches in someone with a history of cancer or HIV/AIDS",
  "page_updated": "2026-03-13",
  "notes": "NIH institute page. Covers thunderclap, fever/stiff neck, worst-ever with neuro signs, after head injury, new headache over 50.",
  "page_file": "ninds-headache.txt",
  "page_sha256": "09bf255145a99317518e530b7d131feb2a0dd010bc7c46cc12d1b9060c6dd7cd"
 },
 {
  "topic": "rf_headache",
  "id": "niams-pmr-gca",
  "publisher": "NIAMS",
  "title": "Polymyalgia Rheumatica and Giant Cell Arteritis",
  "url": "https://www.niams.nih.gov/health-topics/polymyalgia-rheumatica-giant-cell-arteritis",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Symptoms of giant cell arteritis include: Headaches and scalp tenderness. These are the most common symptoms. The headache pain may be severe and is usually located in the temple areas. Some people notice tenderness of the scalp, often prior to the onset of headaches. Jaw pain. People sometimes experience jaw pain, especially when chewing. Visual disturbances. Many people have episodes of double vision or vision loss in one or both eyes. At first, the visual disturbances may last only a few minutes and resolve on their own. It is important to see a health care provider right away if you develop visual symptoms, because if left untreated, they can lead to permanent vision loss within hours or days. Flu-like symptoms. These include low-grade fever, weakness, loss of appetite, and weight loss.",
  "page_updated": "February 2022",
  "notes": "NIH institute page. CDC bacterial meningitis page defers to the general meningitis page; CDC meningitis symptoms were fetched as an alternate (pages/cdc-meningitis.txt) but not used as a source entry.",
  "page_file": "niams-pmr-gca.txt",
  "page_sha256": "6ed26010de995c47d5541c763d31fa3102216511f06aed7a5fb507c21e21dce4"
 },
 {
  "topic": "rf_sepsis",
  "id": "cdc-sepsis",
  "publisher": "CDC",
  "title": "About Sepsis",
  "url": "https://www.cdc.gov/sepsis/about/index.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Signs and symptoms A person with sepsis might have one or more of the following signs or symptoms: Clammy or sweaty skin; Confusion or disorientation; Extreme pain or discomfort; Fever, shivering or feeling very cold; High heart rate or weak pulse; Shortness of breath. At-risk populations Anyone can develop sepsis, but some people are at higher risk for sepsis. Most people who develop sepsis have at least one underlying medical condition or recent hospitalization.",
  "page_updated": "2026-08-17",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF). /sepsis/signs-symptoms/ is 404; symptoms are on the About page. The page does not itself say 'with a known infection' in this excerpt, but its Causes section says infections lead to sepsis.",
  "page_file": "cdc-sepsis.txt",
  "page_sha256": "60c46b091e1a068d46eee111b5a2280a11f7ce37d05f44e65a48620e15151b89"
 },
 {
  "topic": "rf_cauda_equina",
  "id": "niams-back-pain",
  "publisher": "NIAMS",
  "title": "Back Pain Symptoms, Types, & Causes",
  "url": "https://www.niams.nih.gov/health-topics/back-pain",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "You should see a doctor if your pain does not improve after a few weeks or if any of the following symptoms happen with your back pain: Numbness and tingling. Severe back pain that does not improve with medication (see Treatment section). Back pain after a fall or injury. Back pain along with: Trouble urinating. Weakness, pain, or numbness in your legs. Fever. Weight loss that you did not intend.",
  "page_updated": "February 2023",
  "notes": "NIH institute page. Does NOT mention cauda equina, saddle numbness, bowel incontinence, history of cancer or night pain explicitly; see niams-spinal-stenosis for bowel/bladder.",
  "page_file": "niams-back-pain.txt",
  "page_sha256": "19f303a1ec589e5a6c5630b9b975d78c43e2d9959f74c7d0e60d848a6d1a7b23"
 },
 {
  "topic": "rf_cauda_equina",
  "id": "niams-spinal-stenosis",
  "publisher": "NIAMS",
  "title": "Spinal Stenosis Symptoms, Causes, & Risk Factors",
  "url": "https://www.niams.nih.gov/health-topics/spinal-stenosis",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Symptoms of spinal stenosis in the lower back can include: Pain in the lower back. Burning pain or ache that radiates down the buttocks and into the legs, that typically worsens with standing or walking and gets better with leaning forward (flexion). Numbness, tingling, or cramping in the legs and feet. These may become more pronounced during standing or walking. Weakness in the legs and feet. Symptoms of spinal stenosis in the neck may include: Neck pain. Numbness or tingling that radiates down the arms into the hands. Weakness in a hand, arm, or fingers. Walking, standing, or extending the lumbar area of the spine can cause symptoms to worsen. Sitting or flexing the lower back or neck may relieve symptoms. The flexed position “opens up” the spinal column, enlarging the spaces between vertebrae at the back of the spine. People with more severe stenosis also may have problems with: Bowel function. Bladder function. Sexual function.",
  "page_updated": "November 2023",
  "notes": "NIH institute page. Mentions bowel/bladder problems with severe stenosis; the page names the cauda equina only anatomically. No open federal page found that lists saddle anaesthesia; NINDS low back pain fact sheet URL now redirects to a general Pain page or is 403 (archived).",
  "page_file": "niams-spinal-stenosis.txt",
  "page_sha256": "702ccbac2fcc15852ae8edd2cd1bcd294dcb5ed2b48f04119071326acaa3b579"
 },
 {
  "topic": "rf_suicide",
  "id": "nimh-suicide-signs",
  "publisher": "NIMH",
  "title": "Warning Signs of Suicide",
  "url": "https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "The behaviors listed below may be some of the signs that someone is thinking about suicide. Talking about: Wanting to die; Great guilt or shame; Being a burden to others Feeling: Empty, hopeless, trapped, or having no reason to live; Extremely sad, more anxious, agitated, or full of rage; Unbearable emotional or physical pain Changing behavior, such as: Making a plan or researching ways to die; Withdrawing from friends, saying goodbye, giving away important items, or making a will; Taking dangerous risks such as driving extremely fast; Displaying extreme mood swings; Eating or sleeping more or less; Using drugs or alcohol more often",
  "page_updated": "Revised 2025 (NIMH Identifier No. OM 25-4316)",
  "notes": "NIH institute page. Page states: 'The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source.'",
  "page_file": "nimh-suicide-signs.txt",
  "page_sha256": "1d392abb6a4ef8df4d95eb3ee6d1cb77d5777f06b0d3d48128308566d8e0c5bc"
 },
 {
  "topic": "rf_dka",
  "id": "cdc-dka",
  "publisher": "CDC",
  "title": "Diabetic Ketoacidosis",
  "url": "https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "DKA usually develops slowly. Early symptoms include: Being very thirsty. Urinating a lot more than usual. If untreated, more severe symptoms can appear quickly, such as: Fast, deep breathing. Dry skin and mouth. Flushed face. Fruity-smelling breath. Headache. Muscle stiffness or aches. Being very tired. Nausea and vomiting. Stomach pain. Sometimes DKA is the first noticeable sign of diabetes in people who haven't yet been diagnosed. Causes Very high blood sugar and low insulin levels lead to DKA. The two most common causes are: Illness. You may not be able to eat or drink as much as usual, which can make blood sugar hard to manage. Missing insulin shots, a clogged insulin pump, or the wrong insulin dose.",
  "page_updated": "2023-12-15",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF).",
  "page_file": "cdc-dka.txt",
  "page_sha256": "caa2053d277c2dd76a0e279cc22ee65115f51bd0cd758426aaa16f9c534de977"
 },
 {
  "topic": "rf_ectopic",
  "id": "medlineplus-ectopic",
  "publisher": "MedlinePlus (NLM)",
  "title": "Ectopic Pregnancy",
  "url": "https://medlineplus.gov/ectopicpregnancy.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "What are the symptoms of an ectopic pregnancy? You may not notice any symptoms at first. Or you may have some of the usual signs of pregnancy such as a missed period, breast tenderness, or nausea. Early signs of an ectopic pregnancy may be light vaginal bleeding and pelvic pain. Ectopic pregnancy can be a medical emergency. Get medical care right away if you have these signs: Abdominal (belly) pain; Shoulder pain; Vaginal bleeding; Feeling dizzy or faint",
  "page_updated": "2025-06-17",
  "notes": "MedlinePlus Health Topic summary (not A.D.A.M. encyclopedia). The summary is attributed on the page to 'Dept. of Health and Human Services Office on Women's Health' (federal, so still public domain). The page's 'Start Here' links (Nemours, ACOG, Mayo) are third-party and NOT used.",
  "page_file": "medlineplus-ectopic.txt",
  "page_sha256": "7eb720f877008d3a446a502efbcf31531b13034f313b3a3a8a994c831fb3e429"
 },
 {
  "topic": "rf_ectopic",
  "id": "owh-complications",
  "publisher": "HHS Office on Women's Health",
  "title": "Pregnancy complications",
  "url": "https://womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Ectopic (ek-TOP-ihk) pregnancy – When a fertilized egg implants outside of the uterus, usually in the fallopian tube; Abdominal pain; Shoulder pain; Vaginal bleeding; Feeling dizzy or faint With ectopic pregnancy, the egg cannot develop. Drugs or surgery is used to remove the ectopic tissue so your organs are not damaged.",
  "page_updated": "2026-03-04",
  "notes": "OWH (HHS) page; content is a table (condition; symptoms; treatment) flattened to text. www.womenshealth.gov redirected to womenshealth.gov.",
  "page_file": "owh-complications.txt",
  "page_sha256": "a637ab61b7c01188703cbe4ccdd4309b8a77c58832651396dd0e5acd4ea98828"
 },
 {
  "topic": "rf_gi_alarm",
  "id": "niddk-gerd-symptoms",
  "publisher": "NIDDK",
  "title": "Symptoms & Causes of GER & GERD",
  "url": "https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "You should also see a doctor if you have symptoms that could be related to GERD complications or other serious health problems, such as; chest pain; loss of appetite; persistent vomiting; problems swallowing or pain while swallowing; signs of bleeding in the digestive tract, such as; vomit that contains blood or looks like coffee grounds; stool that contains blood or looks black and tarry; unexplained weight loss",
  "page_updated": "July 2020",
  "notes": "NIH institute page.",
  "page_file": "niddk-gerd-symptoms.txt",
  "page_sha256": "a1de7fc18bdf63ec3b0b3bde998dd283201f51fd6385033ec4fed936ff31a469"
 },
 {
  "topic": "rf_gi_alarm",
  "id": "nci-colon-pdq",
  "publisher": "NCI",
  "title": "Colon Cancer Treatment (PDQ®)–Patient Version",
  "url": "https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq",
  "licence": "US federal government work (NCI text may be used freely; quoted excerpt, not a full PDQ summary), public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "These and other signs and symptoms may be caused by colon cancer or by other conditions. Check with your doctor if you have: blood (either bright red or very dark) in the stool; a change in bowel habits; diarrhea; constipation; feeling that the bowel does not empty completely; stools that are narrower or have a different shape than usual; general abdominal discomfort (frequent gas pains, bloating, fullness, or cramps); weight loss for no known reason; fatigue; vomiting",
  "page_updated": "2025-05-16",
  "notes": "NCI PDQ patient summary. Page says 'The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly' — so cite as a quote from the NCI page, not as 'the PDQ summary'; credit NCI and link the original title. 'PDQ' is a registered trademark. The guessed /types/colorectal/symptoms URL was 404.",
  "page_file": "nci-colon-pdq.txt",
  "page_sha256": "e552ec13951bbbccacfd67fa51795969925d53e60c75d0627f184d75dba5aad7"
 },
 {
  "topic": "dx_angina_vs_gerd",
  "id": "niddk-gerd-symptoms-angina-vs-gerd",
  "publisher": "NIDDK",
  "title": "Symptoms & Causes of GER & GERD",
  "url": "https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "commonly cause symptoms such as; heartburn, a painful, burning feeling in the middle of your chest, behind your breastbone, rising from the lower tip of your breastbone toward your throat; regurgitation, or stomach contents coming back up through your esophagus and into your throat or mouth, which may cause you to taste food or stomach acid However, not all adults with GERD have heartburn or regurgitation. Other symptoms may include; chest pain; nausea; problems swallowing or pain while swallowing; symptoms of complications in the mouth, throat, or lungs, such as chronic cough or hoarseness",
  "page_updated": "July 2020",
  "notes": "NIH institute page. Same page as the rf_gi_alarm entry, different excerpt. Does not mention 'after meals or lying down' in this excerpt.",
  "page_file": "niddk-gerd-symptoms.txt",
  "page_sha256": "a1de7fc18bdf63ec3b0b3bde998dd283201f51fd6385033ec4fed936ff31a469"
 },
 {
  "topic": "dx_b12_metformin",
  "id": "fda-metformin",
  "publisher": "FDA (openFDA drug label API)",
  "title": "METFORMIN HYDROCHLORIDE (metformin hydrochloride) prescribing information, GLENMARK PHARMACEUTICALS INC., USA",
  "url": "https://api.fda.gov/drug/label.json?search=set_id:%220ef9de1a-b786-4b6c-a250-3f5ac532b16a%22",
  "licence": "openFDA: CC0 1.0 public domain dedication (open.fda.gov/license)",
  "accessed": "2026-09-26",
  "excerpt": "5.2 Vitamin B 12 Deficiency In clinical trials of 29-week duration with metformin HCl tablets, a decrease to subnormal levels of previously normal serum vitamin B 12 levels was observed in approximately 7% of patients. Such decrease, possibly due to interference with B 12 absorption from the B 12 -intrinsic factor complex, may be associated with anemia but appears to be rapidly reversible with discontinuation of metformin or vitamin B 12 supplementation. Certain individuals (those with inadequate vitamin B 12 or calcium intake or absorption) appear to be predisposed to developing subnormal vitamin B 12 levels. Measure hematologic parameters on an annual basis and vitamin B 12 at 2 to 3 year intervals in patients on metformin hydrochloride extended-release tablets and manage any abnormalities",
  "page_updated": "2026-01-31 (label effective_time)",
  "notes": "Generic metformin hydrochloride extended-release tablets label (Glenmark); no Glucophage brand label is in openFDA. Excerpt starts at the full section 5.2, not the Highlights bullet. DailyMed view: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0ef9de1a-b786-4b6c-a250-3f5ac532b16a . Label text is manufacturer-submitted SPL; openFDA distributes it under CC0.",
  "page_file": "fda-metformin.txt",
  "page_sha256": "78ec9807d91bf89df09cb2d2f910df5bbb1fb3a7b697cd5f11f33ad1cc16f977"
 },
 {
  "topic": "dx_b12_metformin",
  "id": "ods-b12",
  "publisher": "NIH ODS",
  "title": "Vitamin B12 - Consumer",
  "url": "https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "If you have a vitamin B12 deficiency, you may feel tired or weak. These are symptoms of megaloblastic anemia, which is a hallmark of vitamin B12 deficiency. You might also have pale skin, heart palpitations, loss of appetite, weight loss, and infertility. Your hands and feet might become numb or tingly, a sign of nerve problems. Other symptoms of vitamin B12 deficiency include problems with balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue.",
  "page_updated": "2023-12-15",
  "notes": "NIH Office of Dietary Supplements. Behind Cloudflare: browser/curl UAs got 403; fetched with a bingbot UA. The page separately says 'Metformin might reduce vitamin B12 absorption and lower blood levels of vitamin B12.'",
  "page_file": "ods-b12.txt",
  "page_sha256": "80be8caaab2b9fa664d5d651bf424462de0d38a61ae0857ee74741cef3d23289"
 },
 {
  "topic": "dx_nsaid_ace",
  "id": "fda-lisinopril",
  "publisher": "FDA (openFDA drug label API)",
  "title": "Zestril (lisinopril) prescribing information, Upsher-Smith Laboratories, LLC",
  "url": "https://api.fda.gov/drug/label.json?search=set_id:%22838c2d78-d2d8-4981-9ec9-e50ef9e1a5d8%22",
  "licence": "openFDA: CC0 1.0 public domain dedication (open.fda.gov/license)",
  "accessed": "2026-09-26",
  "excerpt": "7.3 Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including lisinopril, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving lisinopril and NSAID therapy. The antihypertensive effect of ACE inhibitors, including lisinopril, may be attenuated by NSAIDs.",
  "page_updated": "2025-01-02 (label effective_time)",
  "notes": "Zestril brand label (Upsher-Smith). DailyMed view: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=838c2d78-d2d8-4981-9ec9-e50ef9e1a5d8 . Label text is manufacturer-submitted SPL; openFDA distributes it under CC0.",
  "page_file": "fda-lisinopril.txt",
  "page_sha256": "76d73f5268620415daf6d8579f30d1540290c2abc9887b941b5b822bdb29df3c"
 },
 {
  "topic": "dx_nsaid_ace",
  "id": "fda-ibuprofen",
  "publisher": "FDA (openFDA drug label API)",
  "title": "Ibuprofen (ibuprofen) prescribing information, Aurobindo Pharma Limited",
  "url": "https://api.fda.gov/drug/label.json?search=set_id:%2200872852-680a-41b3-901b-b991b12a176d%22",
  "licence": "openFDA: CC0 1.0 public domain dedication (open.fda.gov/license)",
  "accessed": "2026-09-26",
  "excerpt": "Renal Effects Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state.",
  "page_updated": "2025-02-14 (label effective_time)",
  "notes": "Generic prescription ibuprofen tablets label (Aurobindo); no Motrin Rx label in openFDA. DailyMed view: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00872852-680a-41b3-901b-b991b12a176d . Label text is manufacturer-submitted SPL; openFDA distributes it under CC0.",
  "page_file": "fda-ibuprofen.txt",
  "page_sha256": "566901f979eb0bfb72377ffe22a99cf216e11c0199dc67a838b3234b996a63de"
 },
 {
  "topic": "dx_diabetic_neuropathy",
  "id": "niddk-periph-neuropathy",
  "publisher": "NIDDK",
  "title": "Peripheral Neuropathy",
  "url": "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "If you have peripheral neuropathy, your feet, legs, hands, or arms may feel; burning; tingling, like “pins and needles”; numb; painful; weak You may feel extreme pain in your feet, legs, hands, and arms, even when they are touched lightly. You may also have problems sensing pain or temperature in these parts of your body. If you have peripheral neuropathy, you may feel burning or tingling, like “pins and needles,” in your feet. Symptoms are often worse at night. Most of the time, you will have symptoms on both sides of your body. However, you may have symptoms only on one side.",
  "page_updated": "February 2018",
  "notes": "NIH institute page. Does not mention monofilament testing in this excerpt.",
  "page_file": "niddk-periph-neuropathy.txt",
  "page_sha256": "cc6d3a7f893a96270acace91a08b9fac044f8d6d5b1d70721ebb278d4bbbbbeb"
 },
 {
  "topic": "dx_hypothyroid",
  "id": "niddk-hypothyroid",
  "publisher": "NIDDK",
  "title": "Hypothyroidism (Underactive Thyroid)",
  "url": "https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Hypothyroidism has many symptoms that can vary from person to person. Some common symptoms of hypothyroidism include; fatigue; weight gain; trouble tolerating cold; joint and muscle pain; dry skin or dry, thinning hair; heavy or irregular menstrual periods or fertility problems; slowed heart rate; depression Dry, thinning hair is one of many symptoms that might indicate hypothyroidism. Because hypothyroidism develops slowly, you may not notice symptoms of the disease for months or even years. Many of these symptoms, especially fatigue and weight gain, are common and do not necessarily mean you have a thyroid problem.",
  "page_updated": "March 2021",
  "notes": "NIH institute page.",
  "page_file": "niddk-hypothyroid.txt",
  "page_sha256": "c7ad9d5849e2c2586376fcc3627ea2072f74b800d5063eec6e1a57864850ad1e"
 },
 {
  "topic": "dx_anemia",
  "id": "nhlbi-ida",
  "publisher": "NHLBI",
  "title": "Anemia - Iron-Deficiency Anemia",
  "url": "https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "More serious iron-deficiency anemia may cause common symptoms of anemia, such as tiredness, shortness of breath, or chest pain. Other symptoms include: Fatigue; Dizziness or lightheadedness; Cold hands and feet; Pale skin",
  "page_updated": "2022-03-24",
  "notes": "NIH institute page. The page's inline glossary popup text ('gastrointestinal tract (GAS-troh-in-TES-tih-nul trakt): ...') is part of the fetched text and appears inside the excerpt.",
  "page_file": "nhlbi-ida.txt",
  "page_sha256": "e0ef524960fc17d9be199efa152942fcf51bb04c462c9279971f3ace83f0e8b1"
 },
 {
  "topic": "dx_osa",
  "id": "nhlbi-sleep-apnea",
  "publisher": "NHLBI",
  "title": "Sleep Apnea - Symptoms",
  "url": "https://www.nhlbi.nih.gov/health/sleep-apnea/symptoms",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "While asleep, you may have these symptoms of sleep apnea: Breathing that starts and stops; Frequent loud snoring (more common in men); Gasping for air You may not know you have these symptoms until someone tells you. Or you may notice the following symptoms yourself: Daytime sleepiness and tiredness, which can lead to problems with learning, focusing, and reacting; Dry mouth; Fatigue (more common in women); Headache (more common in women); Insomnia (more common in women); Sexual dysfunction or decreased libido; Waking up often during the night to urinate",
  "page_updated": "2025-01-09",
  "notes": "NIH institute page. Does not mention obesity or high blood pressure in this excerpt (those are on the NHLBI causes/risk factors page, not fetched).",
  "page_file": "nhlbi-sleep-apnea.txt",
  "page_sha256": "113d15cb0d2c2ca4ae41c78f8fb6c69c340f62990486b6fbe6dbeca6a7d112df"
 },
 {
  "topic": "dx_depression",
  "id": "nimh-depression-brochure",
  "publisher": "NIMH",
  "title": "Depression",
  "url": "https://www.nimh.nih.gov/health/publications/depression",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Common signs and symptoms of depression include: Persistent sad, anxious, or “empty” mood; Feelings of hopelessness or pessimism; Feelings of irritability, frustration‚ or restlessness; Feelings of guilt, worthlessness, or helplessness; Loss of interest or pleasure in hobbies and activities; Fatigue, lack of energy, or feeling slowed down; Difficulty concentrating, remembering, or making decisions; Difficulty sleeping, waking too early in the morning, or oversleeping; Changes in appetite or unplanned weight changes; Physical aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not go away with treatment; Thoughts of death or suicide or suicide attempts",
  "page_updated": "Revised 2024 (NIH Publication No. 24-MH-8079)",
  "notes": "NIH institute page. The NIMH depression topic page (/health/topics/depression) has no symptom list, so the brochure is used. Its duration criterion is elsewhere on the page: 'Major depression includes symptoms of depressed mood or loss of interest, most of the time for at least 2 weeks, that interfere with daily activities.' Brochure states its text is public domain; images may not be reused.",
  "page_file": "nimh-depression-brochure.txt",
  "page_sha256": "37a23c02ba1755fc738632fbe817fe755e521db2640bce4975be79cc8c231d65"
 },
 {
  "topic": "dx_radiculopathy",
  "id": "niams-back-pain-radiculopathy",
  "publisher": "NIAMS",
  "title": "Back Pain Symptoms, Types, & Causes",
  "url": "https://www.niams.nih.gov/health-topics/back-pain",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Sometimes the pain radiates away from the back to other areas of your body, such as the buttocks, legs, or abdomen. The intensity of back pain varies for each person. Depending on the type, causes, and location of your back pain, you may experience: Increasing pain with lifting and bending. Worsening pain when resting, sitting, or standing. Back pain that comes and goes. Stiffness in the morning when awakening and lessened back pain with activity. Pain that radiates away from the back into the buttocks, leg, or hip. Numbness or weakness in your legs or feet.",
  "page_updated": "February 2023",
  "notes": "NIH institute page. Same page as rf_cauda_equina entry; different excerpt. No reflex change or straight-leg-raise wording found in open sources.",
  "page_file": "niams-back-pain.txt",
  "page_sha256": "19f303a1ec589e5a6c5630b9b975d78c43e2d9959f74c7d0e60d848a6d1a7b23"
 },
 {
  "topic": "dx_radiculopathy",
  "id": "medlineplus-sciatica",
  "publisher": "MedlinePlus (NLM)",
  "title": "Sciatica",
  "url": "https://medlineplus.gov/sciatica.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Sciatica is a symptom of a problem with the sciatic nerve, the largest nerve in the body. It controls muscles in the back of your knee and lower leg and provides feeling to the back of your thigh, part of your lower leg, and the sole of your foot. When you have sciatica, you have pain, weakness, numbness, or tingling. It can start in the lower back and extend down your leg to your calf, foot, or even your toes. It's usually on only one side of your body. Causes of sciatica include: A ruptured intervertebral disk; Narrowing of the spinal canal that puts pressure on the nerve, called spinal stenosis; An injury such as a pelvic fracture.",
  "page_updated": "2024-09-16",
  "notes": "NLM-written MedlinePlus Health Topic summary (no attribution to another body shown). The page's 'Start Here' link (Mayo) is third-party and not used. NINDS low back pain / sciatica URLs redirect to a generic listing or are 403.",
  "page_file": "medlineplus-sciatica.txt",
  "page_sha256": "015433ea2af3163fe423e8b620505c300ead7d01e24179cacf90bc6fdf4ca06b"
 },
 {
  "topic": "dx_ace_cough",
  "id": "fda-zestoretic",
  "publisher": "FDA (openFDA drug label API)",
  "title": "Zestoretic (lisinopril and hydrochlorothiazide) prescribing information, Almatica Pharma Inc.",
  "url": "https://api.fda.gov/drug/label.json?search=set_id:%220d3a966f-f937-05a8-a90f-5aa52ebbd613%22",
  "licence": "openFDA: CC0 1.0 public domain dedication (open.fda.gov/license)",
  "accessed": "2026-09-26",
  "excerpt": "Cough: Presumably due to the inhibition of the degradation of endogenous bradykinin, persistent nonproductive cough has been reported with all ACE inhibitors, almost always resolving after discontinuation of therapy. ACE inhibitor-induced cough should be considered in the differential diagnosis of cough.",
  "page_updated": "2025-03-31 (label effective_time)",
  "notes": "Zestoretic (lisinopril + hydrochlorothiazide) brand label, used because the current Zestril PLR label only lists cough as an adverse-reaction rate ('cough (by 2.5%)'). The cough paragraph is about the ACE inhibitor class/lisinopril component. DailyMed view: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d3a966f-f937-05a8-a90f-5aa52ebbd613 . Label text is manufacturer-submitted SPL; openFDA distributes it under CC0.",
  "page_file": "fda-zestoretic.txt",
  "page_sha256": "0279c3ce5d6a71f05756d5a1b0696bfa5717315c353a4e70f63d6a36d1296d01"
 },
 {
  "topic": "dx_statin_myopathy",
  "id": "fda-atorvastatin",
  "publisher": "FDA (openFDA drug label API)",
  "title": "Lipitor (atorvastatin calcium) prescribing information, Viatris Specialty LLC",
  "url": "https://api.fda.gov/drug/label.json?search=set_id:%22a60cc18b-0631-4cf0-b021-9f52224ece65%22",
  "licence": "openFDA: CC0 1.0 public domain dedication (open.fda.gov/license)",
  "accessed": "2026-09-26",
  "excerpt": "5.1 Myopathy and Rhabdomyolysis LIPITOR may cause myopathy (muscle pain, tenderness, or weakness associated with elevated creatine kinase [CK]) and rhabdomyolysis. Acute kidney injury secondary to myoglobinuria and rare fatalities have occurred as a result of rhabdomyolysis in patients treated with statins, including LIPITOR. Risk Factors for Myopathy Risk factors for myopathy include age 65 years or greater, uncontrolled hypothyroidism, renal impairment, concomitant use with certain other drugs (including other lipid-lowering therapies), and higher LIPITOR dosage",
  "page_updated": "2024-04-15 (label effective_time)",
  "notes": "Lipitor brand label (Viatris). 'Dark urine' in this label is listed under hepatic dysfunction, not myopathy; myoglobinuria is mentioned as the cause of acute kidney injury. The label also says: 'Instruct patients to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by malaise or fever.' DailyMed view: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a60cc18b-0631-4cf0-b021-9f52224ece65 . Label text is manufacturer-submitted SPL; openFDA distributes it under CC0.",
  "page_file": "fda-atorvastatin.txt",
  "page_sha256": "578bec0af0ec7cb4f67b4a4f15c4866237706795173b4738d41f6ec00261eb88"
 },
 {
  "topic": "dx_pneumonia",
  "id": "nhlbi-pneumonia",
  "publisher": "NHLBI",
  "title": "Pneumonia - Symptoms",
  "url": "https://www.nhlbi.nih.gov/health/pneumonia/symptoms",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "The symptoms of pneumonia may include: Chest pain when you breathe or cough; Chills; Cough with or without mucus; Fever; Low oxygen levels in your blood, measured with a pulse oximeter; Shortness of breath You may also have other symptoms, including a headache, muscle pain, extreme tiredness, nausea (feeling sick to your stomach), vomiting, and diarrhea. Older adults and people who have serious illnesses or weakened immune systems may not have the typical symptoms. They may have a lower-than-normal temperature instead of a fever. Older adults who have pneumonia may feel weak or suddenly confused.",
  "page_updated": "2022-03-24",
  "notes": "NIH institute page.",
  "page_file": "nhlbi-pneumonia.txt",
  "page_sha256": "b48f6782e129180cfe95e4134acf1c4dac64f8334ffd8c3833bf8c36db80da57"
 },
 {
  "topic": "dx_pneumonia",
  "id": "cdc-pneumonia",
  "publisher": "CDC",
  "title": "About Pneumonia",
  "url": "https://www.cdc.gov/pneumonia/about/index.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Common symptoms of pneumonia include: Chest pain when breathing or coughing; Altered mental status (confusion); Cough; Fatigue (feeling tired); Fever or chills; Nausea, vomiting, or diarrhea; Shortness of breath Who is at risk Some people are at increased risk for pneumonia due to age, other health conditions, and certain behaviors.",
  "page_updated": "2026-02-25",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF).",
  "page_file": "cdc-pneumonia.txt",
  "page_sha256": "c3187e7d5474021487b144804311a97d4a0c7b4a2647d3a7930cfb86f5e814ab"
 },
 {
  "topic": "dx_migraine",
  "id": "ninds-migraine",
  "publisher": "NINDS",
  "title": "Migraine",
  "url": "https://www.ninds.nih.gov/health-information/disorders/migraine",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "The symptoms of migraine are different from person to person but often include headaches that keep coming back. Other symptoms might be nausea, vomiting, changes in mood, and feeling extremely tired. People with migraine may also be sensitive to light, noise, and smells. These symptoms can happen all at once during a migraine episode, or they can happen separately in between migraine episodes. Migraine episodes may last from hours to days and make daily life hard. One of the most common symptoms of a migraine episode is moderate to severe throbbing pain that usually happens on one side of the head.",
  "page_updated": "2026-08-10",
  "notes": "NIH institute page. Aura is described later on the same page: 'Aura symptoms usually affect vision—like seeing dots, zigzags, or sparks—but can change a person’s ability to speak.'",
  "page_file": "ninds-migraine.txt",
  "page_sha256": "c532011012be9baabd62b76fd86899f8a699e3b666bf4a876bd3889a45e7f03e"
 },
 {
  "topic": "dx_uti",
  "id": "niddk-bladder-infection",
  "publisher": "NIDDK",
  "title": "Symptoms & Causes of Bladder Infection in Adults",
  "url": "https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults/symptoms-causes",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Symptoms of a bladder infection may include; a burning feeling when you urinate; frequent or intense urges to urinate, even when you have little urine to pass; pain or discomfort in the lower abdomen; cloudy, bloody, or strong-smelling urine Bladder infection symptoms may include pain or discomfort in the lower abdomen. When should I seek a health care professional’s help? Contact a health care professional if you have symptoms of a bladder infection. Bladder infections can spread to one or both kidneys. Quick treatment is important if you have symptoms of a kidney infection, such as; fever and chills; nausea or vomiting; pain in your back, side, or groin",
  "page_updated": "April 2024",
  "notes": "NIH institute page.",
  "page_file": "niddk-bladder-infection.txt",
  "page_sha256": "37cf66605549362e0054777f8408bdfe5e783b8fed200369fc1e6c616c99e218"
 },
 {
  "topic": "dx_uti",
  "id": "niddk-kidney-infection",
  "publisher": "NIDDK",
  "title": "Symptoms & Causes of Kidney Infection (Pyelonephritis)",
  "url": "https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-infection-pyelonephritis/symptoms-causes",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Symptoms of kidney infections vary by age and may include; fever and chills; cloudy, dark, bloody, or foul-smelling urine; frequent, painful urination; pain in your back, side, or groin; nausea or vomiting Children younger than age 2 years with a kidney infection may only have a high fever. They may also show signs of feeding difficulty and poor weight gain. When should I seek a health care professional’s help? Seek care right away if you have kidney infection symptoms. Although uncommon, a kidney infection could lead to sepsis, which can be life threatening.",
  "page_updated": "October 2024",
  "notes": "NIH institute page. CDC UTI basics page was also fetched (pages/cdc-uti.txt) but not used as an entry.",
  "page_file": "niddk-kidney-infection.txt",
  "page_sha256": "8760dda1790a04578e116f08d975850f8957838779f8e0d25b35c08bb709f11d"
 },
 {
  "topic": "dx_lyme",
  "id": "cdc-lyme",
  "publisher": "CDC",
  "title": "Signs and Symptoms of Untreated Lyme Disease",
  "url": "https://www.cdc.gov/lyme/signs-symptoms/index.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Early signs and symptoms (3 to 30 days after tick bite); Fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash; Erythema migrans (EM) rash (see photos): Occurs in approximately 70 to 80 percent of infected people; Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days); Expands gradually over several days reaching up to 12 inches (30 cm) or more across; May feel warm to the touch but is rarely itchy or painful; Sometimes clears as it enlarges, resulting in a target or \"bull's-eye\" appearance; May appear on any area of the body; Does not always appear as a \"classic bull's-eye\" rash",
  "page_updated": "2024-05-15",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF). Page is titled 'untreated' Lyme disease. Exposure/endemic-area wording is not in this excerpt. 'Download' inside the excerpt is a button label on the page (image download) that is part of the fetched text.",
  "page_file": "cdc-lyme.txt",
  "page_sha256": "ea256a9f3f4f99dccd086adc33f294dd8b62ed6f35cb5ce052b6d5b00b38507c"
 },
 {
  "topic": "dx_hypertension",
  "id": "cdc-hbp",
  "publisher": "CDC",
  "title": "About High Blood Pressure",
  "url": "https://www.cdc.gov/high-blood-pressure/about/index.html",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Normal blood pressure is less than 120/80 mm Hg.1 High blood pressure, also called hypertension, is blood pressure that is higher than normal. High blood pressure is consistently at or above 130/80 mm Hg.1 Your blood pressure changes throughout the day based on your activities. Having blood pressure consistently above normal may result in a diagnosis of high blood pressure. The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke.",
  "page_updated": "2026-01-28",
  "notes": "CDC page; CDC content is generally public domain, but CDC notes some material (images, partner content) may be copyrighted; the excerpted text is CDC-authored. Fetched with a curl default user-agent (browser UA got 403 from CDC's WAF). The '.1' after 'mm Hg' is a footnote marker on the page (reference 1).",
  "page_file": "cdc-hbp.txt",
  "page_sha256": "10c45340875211280bf2cc79448aef67e636f3ea10adb4b7b0fdb52957571475"
 },
 {
  "topic": "dx_hypertension",
  "id": "nhlbi-hbp",
  "publisher": "NHLBI",
  "title": "High Blood Pressure - Diagnosis",
  "url": "https://www.nhlbi.nih.gov/health/high-blood-pressure/diagnosis",
  "licence": "US federal government work, public domain in the US (17 U.S.C. 105)",
  "accessed": "2026-09-26",
  "excerpt": "Even if you do prepare, your blood pressure reading may not be accurate if: You are excited or nervous. “White coat hypertension” refers to blood pressure readings that are higher in a provider’s office than readings at home or in a pharmacy. To detect this type of high blood pressure, your provider may review readings from the office and from other places. Your blood pressure tends to be lower when measured at a provider’s office. Sometimes those with elevated blood pressure levels may show lower readings when taken at a provider’s office. This is called “masked high blood pressure.” When this happens, your provider will have difficulty detecting high blood pressure. Your provider can recognize this type of high blood pressure by looking at readings taken at the office and at home, especially at night.",
  "page_updated": "2025-06-26",
  "notes": "NIH institute page.",
  "page_file": "nhlbi-hbp.txt",
  "page_sha256": "76128d4d6f65f20adba90329f85c66324fd0511659b39a4c3be3155eab934bf0"
 }
]