chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: C-reactive protein increased, COVID-19, Electrocardiogram, Fatigue, Hypertension
Clinical narrative: I don't think this was from the vaccine, but CDC called me and asked to fill this out.  I tested positive for COVID on December 9th, symptoms started on December 7th.  Minor cold-like symptoms.  Took 13 days to test negative on rapid.  I was off my immuno-suppresant medications for 3 weeks, so my RA was out of control.  Severe pain in hands, moderate in other parts of the body.  Pain is ongoing but improving now that I've been back on the medication for 4 weeks.  Extreme fatigue for 1 week.  Unexplained hypertension possibly from inflammation.
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: Laboratory test abnormal, Nasopharyngitis, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive
Clinical narrative: I don't think this was from the vaccine, but CDC called me and asked to fill this out.  I tested positive for COVID on December 9th, symptoms started on December 7th.  Minor cold-like symptoms.  Took 13 days to test negative on rapid.  I was off my immuno-suppresant medications for 3 weeks, so my RA was out of control.  Severe pain in hands, moderate in other parts of the body.  Pain is ongoing but improving now that I've been back on the medication for 4 weeks.  Extreme fatigue for 1 week.  Unexplained hypertension possibly from inflammation.
Age: 51.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cardiac monitoring, Cerebrovascular accident, Echocardiogram, Electrocardiogram, Laboratory test
Clinical narrative: I had a stroke at approximately 11am on the morning of June 17, 2021 and was taken to the hospital by ambulance
Age: 51.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Magnetic resonance imaging head, Magnetic resonance imaging neck, Ultrasound Doppler
Clinical narrative: I had a stroke at approximately 11am on the morning of June 17, 2021 and was taken to the hospital by ambulance
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Atrial fibrillation, Cardiac ablation
Clinical narrative: 48 hours after injection,  patient experienced initial onset of atrial fibrillation,  with duration 32 hours.  Subsequent to initial AFib,  patient experienced 9 subsequent intermittent Afib events.  Patient went under care of cardiologist and electrophysiologist.   Patient had two cardiac ablation procedures,  September 7, 2022 and December 12, 2022.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Blood chloride decreased, Blood glucose normal, Blood potassium normal, Blood sodium decreased
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 71 year old male with a PMH of MS currently on Ocrevus IV infusion (last treatment 12/30/2022), type II diabetes mellitus, COVID-19, hypertension, CAD, and hyperlipidemia who presented to the ER on 1/14/2023 with weakness. Patient is fully vaccinated for COVID-19 with moderna vaccine (3/16/21, 4/27/21, 1/4/22).   Patient stated that he 3 days prior to admission he developed generalized weakness, sore throat, fever, headache, and persistent cough. He took a home test while at home which was positive for COVID-19. Patient's son, whom he had been in contact with, was also positive for COVID-19. Patient's wife also came down with COVID. As the days progressed, patient became increasingly weak. He struggled to open a door at home, pulled the knob too hard and fell onto his back. Denied hitting head, losing consciousness, or being on a blood thinner. He reported that weakness worsened to the point that he was unable to get out of his chair at home. At baseline, patient is able to ambulate independently with a walker.   While in theER, vital signs were reassuring. Labs were significant for WBC 13.59, pro-cal 0.06, Na 134, chloride 97, K 4.5, CBG 127. Patient's xray was unremarkable. He tested negative for influenza A/B, and RSV. Patient was positive for COVID-19. Due to weakness and COVID-19, hospitalist asked to admit patient.   During his admission, patient was started on Decadron 6 mg IV. Patient did not qualify for Remsdesivir. Home medications were resumed as appropriate. It was noted during patient's physical assessment that he had developed oral thrush. He was treated with nystatin oral swish and spit during hospitalization. While admitted, he was evaluated by PT/OT. It was recommended that patient receive outpatient PT at discharge. During course of hospitalization, patient's weakness improved so that he required minimal assistance with ambulation with a walker. His labs also continued to improve. His sodium normalized to 135, chloride 106, K 4.1, and CBG 109. WBC decreased to 8.87. Thrush has significantly improved with nystatin treatment. Patient remained off of oxygen during course of hospitalization. Patient was hemodynamically stable during hospitalization. At this time, he is medically stable for discharge. He will be discharged with Decadron 6 mg PO x 7 days to complete full course, nystatin PO, and prescription for outpatient PT. Plan of care discussed with the patient who is agreeable to the plan at this time. Questions answered to his satisfaction. Recommend patient follow up with primary care provider within 1 week of discharge.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Fall, Gait disturbance, Headache
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 71 year old male with a PMH of MS currently on Ocrevus IV infusion (last treatment 12/30/2022), type II diabetes mellitus, COVID-19, hypertension, CAD, and hyperlipidemia who presented to the ER on 1/14/2023 with weakness. Patient is fully vaccinated for COVID-19 with moderna vaccine (3/16/21, 4/27/21, 1/4/22).   Patient stated that he 3 days prior to admission he developed generalized weakness, sore throat, fever, headache, and persistent cough. He took a home test while at home which was positive for COVID-19. Patient's son, whom he had been in contact with, was also positive for COVID-19. Patient's wife also came down with COVID. As the days progressed, patient became increasingly weak. He struggled to open a door at home, pulled the knob too hard and fell onto his back. Denied hitting head, losing consciousness, or being on a blood thinner. He reported that weakness worsened to the point that he was unable to get out of his chair at home. At baseline, patient is able to ambulate independently with a walker.   While in theER, vital signs were reassuring. Labs were significant for WBC 13.59, pro-cal 0.06, Na 134, chloride 97, K 4.5, CBG 127. Patient's xray was unremarkable. He tested negative for influenza A/B, and RSV. Patient was positive for COVID-19. Due to weakness and COVID-19, hospitalist asked to admit patient.   During his admission, patient was started on Decadron 6 mg IV. Patient did not qualify for Remsdesivir. Home medications were resumed as appropriate. It was noted during patient's physical assessment that he had developed oral thrush. He was treated with nystatin oral swish and spit during hospitalization. While admitted, he was evaluated by PT/OT. It was recommended that patient receive outpatient PT at discharge. During course of hospitalization, patient's weakness improved so that he required minimal assistance with ambulation with a walker. His labs also continued to improve. His sodium normalized to 135, chloride 106, K 4.1, and CBG 109. WBC decreased to 8.87. Thrush has significantly improved with nystatin treatment. Patient remained off of oxygen during course of hospitalization. Patient was hemodynamically stable during hospitalization. At this time, he is medically stable for discharge. He will be discharged with Decadron 6 mg PO x 7 days to complete full course, nystatin PO, and prescription for outpatient PT. Plan of care discussed with the patient who is agreeable to the plan at this time. Questions answered to his satisfaction. Recommend patient follow up with primary care provider within 1 week of discharge.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Influenza A virus test negative, Influenza B virus test, Laboratory test abnormal, Mobility decreased, Oral candidiasis
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 71 year old male with a PMH of MS currently on Ocrevus IV infusion (last treatment 12/30/2022), type II diabetes mellitus, COVID-19, hypertension, CAD, and hyperlipidemia who presented to the ER on 1/14/2023 with weakness. Patient is fully vaccinated for COVID-19 with moderna vaccine (3/16/21, 4/27/21, 1/4/22).   Patient stated that he 3 days prior to admission he developed generalized weakness, sore throat, fever, headache, and persistent cough. He took a home test while at home which was positive for COVID-19. Patient's son, whom he had been in contact with, was also positive for COVID-19. Patient's wife also came down with COVID. As the days progressed, patient became increasingly weak. He struggled to open a door at home, pulled the knob too hard and fell onto his back. Denied hitting head, losing consciousness, or being on a blood thinner. He reported that weakness worsened to the point that he was unable to get out of his chair at home. At baseline, patient is able to ambulate independently with a walker.   While in theER, vital signs were reassuring. Labs were significant for WBC 13.59, pro-cal 0.06, Na 134, chloride 97, K 4.5, CBG 127. Patient's xray was unremarkable. He tested negative for influenza A/B, and RSV. Patient was positive for COVID-19. Due to weakness and COVID-19, hospitalist asked to admit patient.   During his admission, patient was started on Decadron 6 mg IV. Patient did not qualify for Remsdesivir. Home medications were resumed as appropriate. It was noted during patient's physical assessment that he had developed oral thrush. He was treated with nystatin oral swish and spit during hospitalization. While admitted, he was evaluated by PT/OT. It was recommended that patient receive outpatient PT at discharge. During course of hospitalization, patient's weakness improved so that he required minimal assistance with ambulation with a walker. His labs also continued to improve. His sodium normalized to 135, chloride 106, K 4.1, and CBG 109. WBC decreased to 8.87. Thrush has significantly improved with nystatin treatment. Patient remained off of oxygen during course of hospitalization. Patient was hemodynamically stable during hospitalization. At this time, he is medically stable for discharge. He will be discharged with Decadron 6 mg PO x 7 days to complete full course, nystatin PO, and prescription for outpatient PT. Plan of care discussed with the patient who is agreeable to the plan at this time. Questions answered to his satisfaction. Recommend patient follow up with primary care provider within 1 week of discharge.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Oropharyngeal pain, Procalcitonin, Pyrexia, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 71 year old male with a PMH of MS currently on Ocrevus IV infusion (last treatment 12/30/2022), type II diabetes mellitus, COVID-19, hypertension, CAD, and hyperlipidemia who presented to the ER on 1/14/2023 with weakness. Patient is fully vaccinated for COVID-19 with moderna vaccine (3/16/21, 4/27/21, 1/4/22).   Patient stated that he 3 days prior to admission he developed generalized weakness, sore throat, fever, headache, and persistent cough. He took a home test while at home which was positive for COVID-19. Patient's son, whom he had been in contact with, was also positive for COVID-19. Patient's wife also came down with COVID. As the days progressed, patient became increasingly weak. He struggled to open a door at home, pulled the knob too hard and fell onto his back. Denied hitting head, losing consciousness, or being on a blood thinner. He reported that weakness worsened to the point that he was unable to get out of his chair at home. At baseline, patient is able to ambulate independently with a walker.   While in theER, vital signs were reassuring. Labs were significant for WBC 13.59, pro-cal 0.06, Na 134, chloride 97, K 4.5, CBG 127. Patient's xray was unremarkable. He tested negative for influenza A/B, and RSV. Patient was positive for COVID-19. Due to weakness and COVID-19, hospitalist asked to admit patient.   During his admission, patient was started on Decadron 6 mg IV. Patient did not qualify for Remsdesivir. Home medications were resumed as appropriate. It was noted during patient's physical assessment that he had developed oral thrush. He was treated with nystatin oral swish and spit during hospitalization. While admitted, he was evaluated by PT/OT. It was recommended that patient receive outpatient PT at discharge. During course of hospitalization, patient's weakness improved so that he required minimal assistance with ambulation with a walker. His labs also continued to improve. His sodium normalized to 135, chloride 106, K 4.1, and CBG 109. WBC decreased to 8.87. Thrush has significantly improved with nystatin treatment. Patient remained off of oxygen during course of hospitalization. Patient was hemodynamically stable during hospitalization. At this time, he is medically stable for discharge. He will be discharged with Decadron 6 mg PO x 7 days to complete full course, nystatin PO, and prescription for outpatient PT. Plan of care discussed with the patient who is agreeable to the plan at this time. Questions answered to his satisfaction. Recommend patient follow up with primary care provider within 1 week of discharge.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Walking aid user, White blood cell count increased, X-ray normal
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 71 year old male with a PMH of MS currently on Ocrevus IV infusion (last treatment 12/30/2022), type II diabetes mellitus, COVID-19, hypertension, CAD, and hyperlipidemia who presented to the ER on 1/14/2023 with weakness. Patient is fully vaccinated for COVID-19 with moderna vaccine (3/16/21, 4/27/21, 1/4/22).   Patient stated that he 3 days prior to admission he developed generalized weakness, sore throat, fever, headache, and persistent cough. He took a home test while at home which was positive for COVID-19. Patient's son, whom he had been in contact with, was also positive for COVID-19. Patient's wife also came down with COVID. As the days progressed, patient became increasingly weak. He struggled to open a door at home, pulled the knob too hard and fell onto his back. Denied hitting head, losing consciousness, or being on a blood thinner. He reported that weakness worsened to the point that he was unable to get out of his chair at home. At baseline, patient is able to ambulate independently with a walker.   While in theER, vital signs were reassuring. Labs were significant for WBC 13.59, pro-cal 0.06, Na 134, chloride 97, K 4.5, CBG 127. Patient's xray was unremarkable. He tested negative for influenza A/B, and RSV. Patient was positive for COVID-19. Due to weakness and COVID-19, hospitalist asked to admit patient.   During his admission, patient was started on Decadron 6 mg IV. Patient did not qualify for Remsdesivir. Home medications were resumed as appropriate. It was noted during patient's physical assessment that he had developed oral thrush. He was treated with nystatin oral swish and spit during hospitalization. While admitted, he was evaluated by PT/OT. It was recommended that patient receive outpatient PT at discharge. During course of hospitalization, patient's weakness improved so that he required minimal assistance with ambulation with a walker. His labs also continued to improve. His sodium normalized to 135, chloride 106, K 4.1, and CBG 109. WBC decreased to 8.87. Thrush has significantly improved with nystatin treatment. Patient remained off of oxygen during course of hospitalization. Patient was hemodynamically stable during hospitalization. At this time, he is medically stable for discharge. He will be discharged with Decadron 6 mg PO x 7 days to complete full course, nystatin PO, and prescription for outpatient PT. Plan of care discussed with the patient who is agreeable to the plan at this time. Questions answered to his satisfaction. Recommend patient follow up with primary care provider within 1 week of discharge.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood culture negative, Blood lactic acid, COVID-19, Chest X-ray normal, Computerised tomogram head normal
Clinical narrative: PRESENTING PROBLEM: Severe sepsis (HCC) [A41.9, R65.20] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is a 64 y.o. female who presented to the emergency department with complaints of headache and nausea.  Patient has a past medical history of tobacco abuse, chronic obstructive pulmonary disease, NSTEMI, hypertension, hyperlipidemia, GERD, depression, chronic neck and back pain, and anxiety. Patient states that the day of admission she got up from a couch, and walked toward a recliner where her  boyfriend was and felt dizzy, her legs gave out, and she fell to the floor.  She also endorsed a headache, nausea, diarrhea, shortness of breath increased from baseline, low appetite, and fatigue.  She denies fever and chills.  She presented to the emergency department for evaluation.  In the emergency department, patient was hypotensive, blood pressure was 62/36, tachycardic, and tachypneic.  She was afebrile and did not require supplemental oxygen.  She met criteria for severe sepsis with unknown source.  Complete blood count was unremarkable and CMP were remarkable for hypokalemia.  Lactic acid was 0.9.  Influenza a and B and RSV were negative.  COVID-19 was positive.  EKG shows normal sinus rhythm.  CT of the head showed no acute intracranial abnormality.  A chest x-ray was obtained which showed no acute cardiopulmonary disease.  Differentials for hypotension include dehydration, antihypertensive medications, or developing infection.  Despite 3 L of IV fluid resuscitation, patient's MAP remained under 65. A norepinephrine infusion was initiated in the emergency department.  Patient was admitted for further evaluation and management of severe sepsis of unknown etiology.   Patient was quickly able to be weaned off of Levophed.  Her blood pressures remain stable.  She was given 1 L of IV fluid bolus.  Blood pressure stable without any maintenance fluids.  Patient's blood cultures remained negative.  No etiology could be found for her shock.  Infective workup was negative.  Patient was asymptomatic.  Suspect hypovolemia leading to syncope.  Patient was discharged home in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Decreased appetite, Diarrhoea, Dizziness, Dyspnoea, Electrocardiogram normal
Clinical narrative: PRESENTING PROBLEM: Severe sepsis (HCC) [A41.9, R65.20] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is a 64 y.o. female who presented to the emergency department with complaints of headache and nausea.  Patient has a past medical history of tobacco abuse, chronic obstructive pulmonary disease, NSTEMI, hypertension, hyperlipidemia, GERD, depression, chronic neck and back pain, and anxiety. Patient states that the day of admission she got up from a couch, and walked toward a recliner where her  boyfriend was and felt dizzy, her legs gave out, and she fell to the floor.  She also endorsed a headache, nausea, diarrhea, shortness of breath increased from baseline, low appetite, and fatigue.  She denies fever and chills.  She presented to the emergency department for evaluation.  In the emergency department, patient was hypotensive, blood pressure was 62/36, tachycardic, and tachypneic.  She was afebrile and did not require supplemental oxygen.  She met criteria for severe sepsis with unknown source.  Complete blood count was unremarkable and CMP were remarkable for hypokalemia.  Lactic acid was 0.9.  Influenza a and B and RSV were negative.  COVID-19 was positive.  EKG shows normal sinus rhythm.  CT of the head showed no acute intracranial abnormality.  A chest x-ray was obtained which showed no acute cardiopulmonary disease.  Differentials for hypotension include dehydration, antihypertensive medications, or developing infection.  Despite 3 L of IV fluid resuscitation, patient's MAP remained under 65. A norepinephrine infusion was initiated in the emergency department.  Patient was admitted for further evaluation and management of severe sepsis of unknown etiology.   Patient was quickly able to be weaned off of Levophed.  Her blood pressures remain stable.  She was given 1 L of IV fluid bolus.  Blood pressure stable without any maintenance fluids.  Patient's blood cultures remained negative.  No etiology could be found for her shock.  Infective workup was negative.  Patient was asymptomatic.  Suspect hypovolemia leading to syncope.  Patient was discharged home in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Fall, Fatigue, Full blood count normal, Headache, Hypokalaemia
Clinical narrative: PRESENTING PROBLEM: Severe sepsis (HCC) [A41.9, R65.20] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is a 64 y.o. female who presented to the emergency department with complaints of headache and nausea.  Patient has a past medical history of tobacco abuse, chronic obstructive pulmonary disease, NSTEMI, hypertension, hyperlipidemia, GERD, depression, chronic neck and back pain, and anxiety. Patient states that the day of admission she got up from a couch, and walked toward a recliner where her  boyfriend was and felt dizzy, her legs gave out, and she fell to the floor.  She also endorsed a headache, nausea, diarrhea, shortness of breath increased from baseline, low appetite, and fatigue.  She denies fever and chills.  She presented to the emergency department for evaluation.  In the emergency department, patient was hypotensive, blood pressure was 62/36, tachycardic, and tachypneic.  She was afebrile and did not require supplemental oxygen.  She met criteria for severe sepsis with unknown source.  Complete blood count was unremarkable and CMP were remarkable for hypokalemia.  Lactic acid was 0.9.  Influenza a and B and RSV were negative.  COVID-19 was positive.  EKG shows normal sinus rhythm.  CT of the head showed no acute intracranial abnormality.  A chest x-ray was obtained which showed no acute cardiopulmonary disease.  Differentials for hypotension include dehydration, antihypertensive medications, or developing infection.  Despite 3 L of IV fluid resuscitation, patient's MAP remained under 65. A norepinephrine infusion was initiated in the emergency department.  Patient was admitted for further evaluation and management of severe sepsis of unknown etiology.   Patient was quickly able to be weaned off of Levophed.  Her blood pressures remain stable.  She was given 1 L of IV fluid bolus.  Blood pressure stable without any maintenance fluids.  Patient's blood cultures remained negative.  No etiology could be found for her shock.  Infective workup was negative.  Patient was asymptomatic.  Suspect hypovolemia leading to syncope.  Patient was discharged home in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Hypotension, Hypovolaemia, Influenza A virus test negative, Influenza B virus test, Laboratory test normal
Clinical narrative: PRESENTING PROBLEM: Severe sepsis (HCC) [A41.9, R65.20] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is a 64 y.o. female who presented to the emergency department with complaints of headache and nausea.  Patient has a past medical history of tobacco abuse, chronic obstructive pulmonary disease, NSTEMI, hypertension, hyperlipidemia, GERD, depression, chronic neck and back pain, and anxiety. Patient states that the day of admission she got up from a couch, and walked toward a recliner where her  boyfriend was and felt dizzy, her legs gave out, and she fell to the floor.  She also endorsed a headache, nausea, diarrhea, shortness of breath increased from baseline, low appetite, and fatigue.  She denies fever and chills.  She presented to the emergency department for evaluation.  In the emergency department, patient was hypotensive, blood pressure was 62/36, tachycardic, and tachypneic.  She was afebrile and did not require supplemental oxygen.  She met criteria for severe sepsis with unknown source.  Complete blood count was unremarkable and CMP were remarkable for hypokalemia.  Lactic acid was 0.9.  Influenza a and B and RSV were negative.  COVID-19 was positive.  EKG shows normal sinus rhythm.  CT of the head showed no acute intracranial abnormality.  A chest x-ray was obtained which showed no acute cardiopulmonary disease.  Differentials for hypotension include dehydration, antihypertensive medications, or developing infection.  Despite 3 L of IV fluid resuscitation, patient's MAP remained under 65. A norepinephrine infusion was initiated in the emergency department.  Patient was admitted for further evaluation and management of severe sepsis of unknown etiology.   Patient was quickly able to be weaned off of Levophed.  Her blood pressures remain stable.  She was given 1 L of IV fluid bolus.  Blood pressure stable without any maintenance fluids.  Patient's blood cultures remained negative.  No etiology could be found for her shock.  Infective workup was negative.  Patient was asymptomatic.  Suspect hypovolemia leading to syncope.  Patient was discharged home in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Loss of control of legs, Metabolic function test abnormal, Nausea, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
Clinical narrative: PRESENTING PROBLEM: Severe sepsis (HCC) [A41.9, R65.20] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is a 64 y.o. female who presented to the emergency department with complaints of headache and nausea.  Patient has a past medical history of tobacco abuse, chronic obstructive pulmonary disease, NSTEMI, hypertension, hyperlipidemia, GERD, depression, chronic neck and back pain, and anxiety. Patient states that the day of admission she got up from a couch, and walked toward a recliner where her  boyfriend was and felt dizzy, her legs gave out, and she fell to the floor.  She also endorsed a headache, nausea, diarrhea, shortness of breath increased from baseline, low appetite, and fatigue.  She denies fever and chills.  She presented to the emergency department for evaluation.  In the emergency department, patient was hypotensive, blood pressure was 62/36, tachycardic, and tachypneic.  She was afebrile and did not require supplemental oxygen.  She met criteria for severe sepsis with unknown source.  Complete blood count was unremarkable and CMP were remarkable for hypokalemia.  Lactic acid was 0.9.  Influenza a and B and RSV were negative.  COVID-19 was positive.  EKG shows normal sinus rhythm.  CT of the head showed no acute intracranial abnormality.  A chest x-ray was obtained which showed no acute cardiopulmonary disease.  Differentials for hypotension include dehydration, antihypertensive medications, or developing infection.  Despite 3 L of IV fluid resuscitation, patient's MAP remained under 65. A norepinephrine infusion was initiated in the emergency department.  Patient was admitted for further evaluation and management of severe sepsis of unknown etiology.   Patient was quickly able to be weaned off of Levophed.  Her blood pressures remain stable.  She was given 1 L of IV fluid bolus.  Blood pressure stable without any maintenance fluids.  Patient's blood cultures remained negative.  No etiology could be found for her shock.  Infective workup was negative.  Patient was asymptomatic.  Suspect hypovolemia leading to syncope.  Patient was discharged home in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Sepsis, Shock, Syncope, Tachycardia, Tachypnoea
Clinical narrative: PRESENTING PROBLEM: Severe sepsis (HCC) [A41.9, R65.20] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is a 64 y.o. female who presented to the emergency department with complaints of headache and nausea.  Patient has a past medical history of tobacco abuse, chronic obstructive pulmonary disease, NSTEMI, hypertension, hyperlipidemia, GERD, depression, chronic neck and back pain, and anxiety. Patient states that the day of admission she got up from a couch, and walked toward a recliner where her  boyfriend was and felt dizzy, her legs gave out, and she fell to the floor.  She also endorsed a headache, nausea, diarrhea, shortness of breath increased from baseline, low appetite, and fatigue.  She denies fever and chills.  She presented to the emergency department for evaluation.  In the emergency department, patient was hypotensive, blood pressure was 62/36, tachycardic, and tachypneic.  She was afebrile and did not require supplemental oxygen.  She met criteria for severe sepsis with unknown source.  Complete blood count was unremarkable and CMP were remarkable for hypokalemia.  Lactic acid was 0.9.  Influenza a and B and RSV were negative.  COVID-19 was positive.  EKG shows normal sinus rhythm.  CT of the head showed no acute intracranial abnormality.  A chest x-ray was obtained which showed no acute cardiopulmonary disease.  Differentials for hypotension include dehydration, antihypertensive medications, or developing infection.  Despite 3 L of IV fluid resuscitation, patient's MAP remained under 65. A norepinephrine infusion was initiated in the emergency department.  Patient was admitted for further evaluation and management of severe sepsis of unknown etiology.   Patient was quickly able to be weaned off of Levophed.  Her blood pressures remain stable.  She was given 1 L of IV fluid bolus.  Blood pressure stable without any maintenance fluids.  Patient's blood cultures remained negative.  No etiology could be found for her shock.  Infective workup was negative.  Patient was asymptomatic.  Suspect hypovolemia leading to syncope.  Patient was discharged home in stable condition.
Age: 89.0
Sex: F
Vaccine: COVID19-2
Symptoms: Agitation, Asthenia, COVID-19, Confusional state, Costovertebral angle tenderness
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Patient is a 89-year-old female with PMH significant for vascular dementia, paroxysmal AFib/ACE cover hypertension, anxiety/depression, dyslipidemia presents to the hospital on 1/11 with generalized weakness and falls.  Patient was noted to have COVID-19 infection but was on room air.  She was also noted to have positive urinalysis which was felt to be asymptomatic pyuria. Patient was admitted, supportive treatment given. For COVID-19 infection she did not need any therapeutics.  Patient continued to have poor function in and urinary incontinence, urine cultures showed Klebsiella species.  She was also noted to have right CVA tenderness and hence treatment was felt appropriate.  She was given 1 dose of fosfomycin, but with continued increased confusion and subsequent lethargy, was decided to give her ciprofloxacin which she will complete 5 doses.  After ciprofloxacin was started, patient started to feel better in about 1-2 days, function better, ate better. PT/OT recommended subacute rehab but given her COVID-19 status this was not available  locally.  Was about available in area but son felt this was too far for patient safety.  Ultimately patient was taken home plans to go to subacute rehab on 01/20, patient will be out of isolation of the time. Patient did have episode of agitation requiring Ativan, followed by lethargy, was then started on Zyprexa at 5 mg which resulted in improvement of agitation but left with daytime sedation, dose was reduced to 2.5 mg nightly and was prescribed with a p.r.n. indication at home. Her blood pressures low normal, to her intermittently poor oral intake, I reduced antihypertensive losartan to quarter dose.
Age: 89.0
Sex: F
Vaccine: COVID19-2
Symptoms: Culture urine positive, Fall, Hypophagia, Hypotension, Klebsiella test positive
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Patient is a 89-year-old female with PMH significant for vascular dementia, paroxysmal AFib/ACE cover hypertension, anxiety/depression, dyslipidemia presents to the hospital on 1/11 with generalized weakness and falls.  Patient was noted to have COVID-19 infection but was on room air.  She was also noted to have positive urinalysis which was felt to be asymptomatic pyuria. Patient was admitted, supportive treatment given. For COVID-19 infection she did not need any therapeutics.  Patient continued to have poor function in and urinary incontinence, urine cultures showed Klebsiella species.  She was also noted to have right CVA tenderness and hence treatment was felt appropriate.  She was given 1 dose of fosfomycin, but with continued increased confusion and subsequent lethargy, was decided to give her ciprofloxacin which she will complete 5 doses.  After ciprofloxacin was started, patient started to feel better in about 1-2 days, function better, ate better. PT/OT recommended subacute rehab but given her COVID-19 status this was not available  locally.  Was about available in area but son felt this was too far for patient safety.  Ultimately patient was taken home plans to go to subacute rehab on 01/20, patient will be out of isolation of the time. Patient did have episode of agitation requiring Ativan, followed by lethargy, was then started on Zyprexa at 5 mg which resulted in improvement of agitation but left with daytime sedation, dose was reduced to 2.5 mg nightly and was prescribed with a p.r.n. indication at home. Her blood pressures low normal, to her intermittently poor oral intake, I reduced antihypertensive losartan to quarter dose.
Age: 89.0
Sex: F
Vaccine: COVID19-2
Symptoms: Lethargy, Mental impairment, Pyuria, Urinary incontinence, Urine analysis abnormal
Clinical narrative: PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Patient is a 89-year-old female with PMH significant for vascular dementia, paroxysmal AFib/ACE cover hypertension, anxiety/depression, dyslipidemia presents to the hospital on 1/11 with generalized weakness and falls.  Patient was noted to have COVID-19 infection but was on room air.  She was also noted to have positive urinalysis which was felt to be asymptomatic pyuria. Patient was admitted, supportive treatment given. For COVID-19 infection she did not need any therapeutics.  Patient continued to have poor function in and urinary incontinence, urine cultures showed Klebsiella species.  She was also noted to have right CVA tenderness and hence treatment was felt appropriate.  She was given 1 dose of fosfomycin, but with continued increased confusion and subsequent lethargy, was decided to give her ciprofloxacin which she will complete 5 doses.  After ciprofloxacin was started, patient started to feel better in about 1-2 days, function better, ate better. PT/OT recommended subacute rehab but given her COVID-19 status this was not available  locally.  Was about available in area but son felt this was too far for patient safety.  Ultimately patient was taken home plans to go to subacute rehab on 01/20, patient will be out of isolation of the time. Patient did have episode of agitation requiring Ativan, followed by lethargy, was then started on Zyprexa at 5 mg which resulted in improvement of agitation but left with daytime sedation, dose was reduced to 2.5 mg nightly and was prescribed with a p.r.n. indication at home. Her blood pressures low normal, to her intermittently poor oral intake, I reduced antihypertensive losartan to quarter dose.
Age: 78.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Asthenia, COVID-19, Cerebral disorder, Chest X-ray normal, Computerised tomogram head normal
Clinical narrative: COVID+ 1/10/2023.  Vaccination status - Moderna x4 + Pfizer Bivalent x1 Attestation signed by MD at 1/13/2023  4:18 PM (Updated)   I have personally interviewed and examined the patient on 1/13/2023. Management was discussed with 1/13/2023. I agree with the documented findings and plan of care in his/her note.   Brief exam:    General: NAD, Awake, alert. Obese.  HEENT: No left mastoid pain on palpation CVS: RRR Pulmonary: CTAB Abdominal: soft/NT/ND Extremities: No edema Neuro/psych:  Chronic mild left-sided weakness but no new focal deficits appreciated, oriented x3   Brief history and medical decision making:    Admitted with generalized weakness from COVID-19. Has history of stroke, did MRI brain to rule any acute stroke and this was negative for acute stroke. Discharge to acute rehab. Patient's Xarelto dosing felt to be for coronary artery disease prevention.  He should continue follow-up with outpatient providers regarding whether he should be continued on chronically but would continue for now until follow-up.   MD Medicine Hospitalist    25 minutes were spent on the unit/floor with the patient with over 50% spent counseling and coordination of care related to exam of patient, discussion care with medicine PA.         BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: DO Admission Date: 1/10/2023 Discharge Date: Jan 13, 2023    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 01/11/2023 Yes ? Generalized weakness 01/10/2023 Yes  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: 78 yo male with past medical history of CVA with residual left sided weakness (2020), chronic right carotid occlusion, left carotid stenosis status post CEA, CAD s/p CABG (2016), aortic valve repair, seizure disorder who presented to the ER with generalized weakness, cough.  Said he was having upper respiratory symptoms of cough, congestion for a few days prior to presenting to the hospital.  After arrival, he was found to have COVID 19 diagnosis.  He had CT head that was negative for any acute stroke.  Chest x-ray negative for any acute abnormalities.  Was admitted to the hospital for generalized weakness suspected secondary COVID.   After admission, assessed by PT who recommended acute rehab.  Was not hypoxic and did not meet any criteria for treatment for COVID illness.  Did order MRI brain to rule any acute stroke it might be contributing to symptoms given his gait instability.  MRI brain came back showing chronic changes. Discussed with neurology and no further recommendations.  Patient was on Xarelto 2.5 mg 2 times a day.  Talk to Pharmacy who said this is coronary artery disease preventive dose not stroke preventive dose.  Also talked to his PCP office who did not know exact reasoning for being on this dosing.  Advised continue follow-up with PCP and Cardiology to determine if should continue with Xarelto long term but will continue at discharge for now.
Age: 78.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Cough, Gait disturbance, Magnetic resonance imaging head abnormal, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: COVID+ 1/10/2023.  Vaccination status - Moderna x4 + Pfizer Bivalent x1 Attestation signed by MD at 1/13/2023  4:18 PM (Updated)   I have personally interviewed and examined the patient on 1/13/2023. Management was discussed with 1/13/2023. I agree with the documented findings and plan of care in his/her note.   Brief exam:    General: NAD, Awake, alert. Obese.  HEENT: No left mastoid pain on palpation CVS: RRR Pulmonary: CTAB Abdominal: soft/NT/ND Extremities: No edema Neuro/psych:  Chronic mild left-sided weakness but no new focal deficits appreciated, oriented x3   Brief history and medical decision making:    Admitted with generalized weakness from COVID-19. Has history of stroke, did MRI brain to rule any acute stroke and this was negative for acute stroke. Discharge to acute rehab. Patient's Xarelto dosing felt to be for coronary artery disease prevention.  He should continue follow-up with outpatient providers regarding whether he should be continued on chronically but would continue for now until follow-up.   MD Medicine Hospitalist    25 minutes were spent on the unit/floor with the patient with over 50% spent counseling and coordination of care related to exam of patient, discussion care with medicine PA.         BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: DO Admission Date: 1/10/2023 Discharge Date: Jan 13, 2023    Active Hospital Problems   Diagnosis Date Noted POA ? COVID-19 virus infection 01/11/2023 Yes ? Generalized weakness 01/10/2023 Yes  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 [U07.1]   HOSPITAL COURSE: 78 yo male with past medical history of CVA with residual left sided weakness (2020), chronic right carotid occlusion, left carotid stenosis status post CEA, CAD s/p CABG (2016), aortic valve repair, seizure disorder who presented to the ER with generalized weakness, cough.  Said he was having upper respiratory symptoms of cough, congestion for a few days prior to presenting to the hospital.  After arrival, he was found to have COVID 19 diagnosis.  He had CT head that was negative for any acute stroke.  Chest x-ray negative for any acute abnormalities.  Was admitted to the hospital for generalized weakness suspected secondary COVID.   After admission, assessed by PT who recommended acute rehab.  Was not hypoxic and did not meet any criteria for treatment for COVID illness.  Did order MRI brain to rule any acute stroke it might be contributing to symptoms given his gait instability.  MRI brain came back showing chronic changes. Discussed with neurology and no further recommendations.  Patient was on Xarelto 2.5 mg 2 times a day.  Talk to Pharmacy who said this is coronary artery disease preventive dose not stroke preventive dose.  Also talked to his PCP office who did not know exact reasoning for being on this dosing.  Advised continue follow-up with PCP and Cardiology to determine if should continue with Xarelto long term but will continue at discharge for now.
Age: 51.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Patient vaccinated against, then tested positive for COVID-19
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Eye pruritus, Eye swelling, Hypersensitivity, Pharyngeal swelling, Pruritus
Clinical narrative: 03/09/2021, I felt the vaccine go into my arm, down into my elbow.  Within 2 hours, I felt itching spreading into my arm, elbow, nose, face, mouth, flooding from my left arm, a strange allergic reaction, swelling and itching in throat and eyes.  I think it went into an artery and deposited into the tissue. My throat felt like it was closing, so I took 50 mg of Benadryl.  After 6 hours, the Benadryl would wear off and the itching would come back. I took the Benadryl for 3 days.
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Throat irritation, Throat tightness
Clinical narrative: 03/09/2021, I felt the vaccine go into my arm, down into my elbow.  Within 2 hours, I felt itching spreading into my arm, elbow, nose, face, mouth, flooding from my left arm, a strange allergic reaction, swelling and itching in throat and eyes.  I think it went into an artery and deposited into the tissue. My throat felt like it was closing, so I took 50 mg of Benadryl.  After 6 hours, the Benadryl would wear off and the itching would come back. I took the Benadryl for 3 days.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Dyspnoea, Fatigue
Clinical narrative: PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 virus infection [U07.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 66 yo female with PMH of IDDM2, chronic diastolic heart failure, mild intermittent asthma, OSA and essential HTN who presented to the ED due to generalized fatigue and dyspnea. She reported symptoms started 2 weeks prior to presentation and was treated with Azithromycin prescribed by urgent care without any improvement.    In the ED, patient tested positive for COVID-19 with CTA thorax demonstrating finding consistent with COVID-19 PNA. Her pro-calcitonin was unremarkable and she was without leukocytosis. She was requiring 2 liters via NC at time of admission due to hypoxia. She was started on Decadron with admission to the medicine service   She was able to wean off oxygen soon after admission and was able to maintain oxygen saturation >88% with ambulation on room air. She was started on higher dose of insulin (Lantus 50 units daily) by the admitting team than compared to her home Lantus dose of 30 units HS. Patient was offered monitoring overnight to ensure no hypoglycemic events given >20% increase in her home insulin dose, but requested discharge.   She and her daughter were provided instructions on monitoring blood glucose closely over next 24 hours and provided signs/symptoms of hypoglycemia. She was recommended to increase her home Lantus to 36 units HS while on Decadron and decrease back to her home dose with completion of steroids.   She was discharged in stable condition and discharge instructions provided. Transition to home with COVID was arranged prior to discharge.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Procalcitonin normal, SARS-CoV-2 test positive
Clinical narrative: PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 virus infection [U07.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 66 yo female with PMH of IDDM2, chronic diastolic heart failure, mild intermittent asthma, OSA and essential HTN who presented to the ED due to generalized fatigue and dyspnea. She reported symptoms started 2 weeks prior to presentation and was treated with Azithromycin prescribed by urgent care without any improvement.    In the ED, patient tested positive for COVID-19 with CTA thorax demonstrating finding consistent with COVID-19 PNA. Her pro-calcitonin was unremarkable and she was without leukocytosis. She was requiring 2 liters via NC at time of admission due to hypoxia. She was started on Decadron with admission to the medicine service   She was able to wean off oxygen soon after admission and was able to maintain oxygen saturation >88% with ambulation on room air. She was started on higher dose of insulin (Lantus 50 units daily) by the admitting team than compared to her home Lantus dose of 30 units HS. Patient was offered monitoring overnight to ensure no hypoglycemic events given >20% increase in her home insulin dose, but requested discharge.   She and her daughter were provided instructions on monitoring blood glucose closely over next 24 hours and provided signs/symptoms of hypoglycemia. She was recommended to increase her home Lantus to 36 units HS while on Decadron and decrease back to her home dose with completion of steroids.   She was discharged in stable condition and discharge instructions provided. Transition to home with COVID was arranged prior to discharge.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cough, Fatigue, Pyrexia, Respiratory tract congestion
Clinical narrative: I experienced a breakthrough case of COVID-19 with fatigue, congestion, fever and cough.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test, Vaccine breakthrough infection
Clinical narrative: I experienced a breakthrough case of COVID-19 with fatigue, congestion, fever and cough.
Age: 0.75
Sex: M
Vaccine: DTAPIPVHIB, HEP, PNC13
Symptoms: Rash, Rash macular, Urticaria
Clinical narrative: Last night had some light-colored spots before bed. This morning there are red spots/rash that look like hives all over body - not on forehead or scalp. No fever or other symptoms.