chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Hypervolaemia, Hypoxia, Left ventricular failure, N-terminal prohormone brain natriuretic peptide increased
Clinical narrative: Patient is a 69 y.o. female with a past medical history significant for HFrEF, CKD, CAD, DVT, GERD, HLD, HTN, hythyroidism, MVR, PAD s/p AKA, afib on coumadin, and T2DM who presented to RMH 11/10/2023 after transfer from ED for shortness of breath. She was found to be hypoxic requiring supplemental O2. COVID-19 was positive on admission. Additionally she appeared fluid overloaded and had a NT-pro BNP of 35k on admission. She was started on IV diuresis for presumed HFrEF exacerbation and declined steroid treatment for COVID infection. Her hospital stay was complicated by supra-therapeutic INR and her home coumadin was held. She developed an AKI on CKD that stabilized with titration of her diuretic therapy. Her oxygen requirement improved and she is stable to discharge home with close follow up and increased dose of torsemide.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Patient is a 69 y.o. female with a past medical history significant for HFrEF, CKD, CAD, DVT, GERD, HLD, HTN, hythyroidism, MVR, PAD s/p AKA, afib on coumadin, and T2DM who presented to RMH 11/10/2023 after transfer from ED for shortness of breath. She was found to be hypoxic requiring supplemental O2. COVID-19 was positive on admission. Additionally she appeared fluid overloaded and had a NT-pro BNP of 35k on admission. She was started on IV diuresis for presumed HFrEF exacerbation and declined steroid treatment for COVID infection. Her hospital stay was complicated by supra-therapeutic INR and her home coumadin was held. She developed an AKI on CKD that stabilized with titration of her diuretic therapy. Her oxygen requirement improved and she is stable to discharge home with close follow up and increased dose of torsemide.
Age: 68.0
Sex: M
Vaccine: VARZOS
Symptoms: Unevaluable event
Clinical narrative: none
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Electromyogram, Endoscopy normal, Genitourinary symptom, Hypophagia, Hypotension
Clinical narrative: Patient is a 39 y.o. female with a history of CVID on IVIG, IgA deficiency, aseptic meningitis, chronic pain, adrenal insufficiency, asthma, pancytopenia, Behcet's, and CLABSI who presented to Hospital 10/31/2023 with fever starting 10/26/23 and upper respiratory symptoms starting 10/27/23 with Tmax 104 at home. Tested positive for COVID 19 on 10/30/23 outpatient. Admit labs with acute on chronic pancytopenia, Cr 1.18. CXR non-acute.    1. COVID 19: Symptom onset 10/26/23 with fever. Cough, congestion followed. Tested positive 10/30/23. Not on O2, CXR non-acute. ID consulted to evaluate for therapeutics given immunocompromised state. Complete 5 day course of Paxlovid. 2. Sepsis, likely due to viral infection: Suspect secondary to above however with history of multiple CLABSI and L chest port in place, high fever, also with urinary symptoms, will continue broad spectrum antibiotics for now with Vanco/Zosyn. ID following. Blood cx NGTD. Continue IVF. Culture negative, so Abx stopped. 3. AKI: Mild, admit Cr 1.18, baseline Cr 0.8. Suspect pre-renal with poor PO intake with above. Resolved. 4. History of CLABSI: Multiple episodes of bacteremia related to indwelling port in the past, most recently 7/2023. Resumed PTA doxycycline. 5. CVID: diagnosed 2004. Follows with Dr. (Immunology) and ID. On weekly IVIG infusions qFridays. Allergy and Immunology previously followed while inpatient for consideration of IVIG. Patient plans to discharge 11/3/23 to receive home IVIG infusion as previously. 6. Oropharyngeal/Esophageal Candidiasis: With chronic dysphagia and odynophagia. Follows with GI, Dr. (ID) and ENT. S/p caspofungin in the past. Restarted on micafungin IV outpatient per ENT, ID consulted to assist with continuation. Repeat scope with ENT 11/2/23 unremarkable. Recommended stopping Micafungin, but patient insisted on completing course. 7. Pancytopenia: Baseline WBC 2?3, baseline PLT 40?60 and baseline Hgb 11?12.  Admit labs within baseline range. Monitor.  8. Acute on Chronic Pain: With migraines and neuropathy. Follows with neurology at facility s/p nerve decompressions 3/2023.  Aimovig scheduled first of every month for migraine prevention, held. OARRS reviewed, home oxycodone continued on admit.  9. Secondary Adrenal Insufficiency: continued home dose of hydrocortisone during hospitalization. Increased dose of steroids for 2 days after discussion with patient's endocrinologist. 10. Sjogren's, Bechcets, and Hashimotos: Home Plaquenil continued, steroids as above.  11. Baseline reduced mobility POA: Noted 7/2023 admit when patient underwent EMG and MG was considered. Pt followed up with neuromuscular specialist at Clinic and MG ruled out per patient/family. Walks with cane at baseline.  12. HTN: Per history, held home meds for soft BP and AKI on admit. Monitor and resume as indicated.  13. Abnormal CT: CT PE outpatient on 10/28/23 noted no PE, pulmonary web in LLL, possible subtle chronic sequela of PE, pulmonary nodule. Recommend outpatient follow up for repeat scan in 3-6 months outpatient.
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, Pancytopenia, Peripheral nerve operation, Pulmonary mass, Pyrexia
Clinical narrative: Patient is a 39 y.o. female with a history of CVID on IVIG, IgA deficiency, aseptic meningitis, chronic pain, adrenal insufficiency, asthma, pancytopenia, Behcet's, and CLABSI who presented to Hospital 10/31/2023 with fever starting 10/26/23 and upper respiratory symptoms starting 10/27/23 with Tmax 104 at home. Tested positive for COVID 19 on 10/30/23 outpatient. Admit labs with acute on chronic pancytopenia, Cr 1.18. CXR non-acute.    1. COVID 19: Symptom onset 10/26/23 with fever. Cough, congestion followed. Tested positive 10/30/23. Not on O2, CXR non-acute. ID consulted to evaluate for therapeutics given immunocompromised state. Complete 5 day course of Paxlovid. 2. Sepsis, likely due to viral infection: Suspect secondary to above however with history of multiple CLABSI and L chest port in place, high fever, also with urinary symptoms, will continue broad spectrum antibiotics for now with Vanco/Zosyn. ID following. Blood cx NGTD. Continue IVF. Culture negative, so Abx stopped. 3. AKI: Mild, admit Cr 1.18, baseline Cr 0.8. Suspect pre-renal with poor PO intake with above. Resolved. 4. History of CLABSI: Multiple episodes of bacteremia related to indwelling port in the past, most recently 7/2023. Resumed PTA doxycycline. 5. CVID: diagnosed 2004. Follows with Dr. (Immunology) and ID. On weekly IVIG infusions qFridays. Allergy and Immunology previously followed while inpatient for consideration of IVIG. Patient plans to discharge 11/3/23 to receive home IVIG infusion as previously. 6. Oropharyngeal/Esophageal Candidiasis: With chronic dysphagia and odynophagia. Follows with GI, Dr. (ID) and ENT. S/p caspofungin in the past. Restarted on micafungin IV outpatient per ENT, ID consulted to assist with continuation. Repeat scope with ENT 11/2/23 unremarkable. Recommended stopping Micafungin, but patient insisted on completing course. 7. Pancytopenia: Baseline WBC 2?3, baseline PLT 40?60 and baseline Hgb 11?12.  Admit labs within baseline range. Monitor.  8. Acute on Chronic Pain: With migraines and neuropathy. Follows with neurology at facility s/p nerve decompressions 3/2023.  Aimovig scheduled first of every month for migraine prevention, held. OARRS reviewed, home oxycodone continued on admit.  9. Secondary Adrenal Insufficiency: continued home dose of hydrocortisone during hospitalization. Increased dose of steroids for 2 days after discussion with patient's endocrinologist. 10. Sjogren's, Bechcets, and Hashimotos: Home Plaquenil continued, steroids as above.  11. Baseline reduced mobility POA: Noted 7/2023 admit when patient underwent EMG and MG was considered. Pt followed up with neuromuscular specialist at Clinic and MG ruled out per patient/family. Walks with cane at baseline.  12. HTN: Per history, held home meds for soft BP and AKI on admit. Monitor and resume as indicated.  13. Abnormal CT: CT PE outpatient on 10/28/23 noted no PE, pulmonary web in LLL, possible subtle chronic sequela of PE, pulmonary nodule. Recommend outpatient follow up for repeat scan in 3-6 months outpatient.
Age: 59.0
Sex: F
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: VACCINE REFIRGERATED INSTEAD OF FROZEN
Age: 14.0
Sex: F
Vaccine: FLU4, MENB
Symptoms: No adverse event, Wrong product administered
Clinical narrative: patient was in on the clinical schedule for influenza vaccine and HPV vaccine with orders in place.  MA pulled incorrect vaccine from refrigerator and administed Bexero without an order and it was supposed to be HPV.  Error discovered as unmatched order did not flow into the state immunization program.  I called manufacturer glaxo and me immunization program, completing a Vaers and there is currently no risk to the patient  in getting the incorrect vaccine.  it will need to be repeated after 16 years old.  MA made the error and called and reveiwed with the patients mom, provider aware and we will administer the hpv at her next visit.  Mom states no issues with any side effects or at the site.  Patient will have all vaccines double checked prior to giving at this time.  reviewed rights of administration with him.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Aortic aneurysm, Bladder catheterisation, Blood creatinine increased
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Blood iron abnormal, Blood loss anaemia, COVID-19, COVID-19 pneumonia, Cardiac failure acute
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Carotid artery stenosis, Chronic obstructive pulmonary disease, Colonoscopy abnormal, Condition aggravated, Critical illness
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Cytomegalovirus test negative, Diuretic therapy, Echocardiogram normal, Ejection fraction, Generalised oedema
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Haematuria, Haemodialysis, Haemofiltration, Haemoglobin decreased, Hypervolaemia
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Ischaemic skin ulcer, Left ventricular failure, Melaena, Nephrogenic anaemia
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Occult blood positive, Oesophagogastroduodenoscopy normal, Pneumonia, Pneumonia mycoplasmal, Pneumonia pseudomonal
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Positive airway pressure therapy, Pulmonary hypertension, Rectal ulcer, Red blood cell transfusion, Renal aneurysm
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Renal impairment, Renal tubular necrosis, SARS-CoV-2 test positive, Thrombocytopenia, Thrombosis
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Ultrasound kidney abnormal
Clinical narrative: Patient is a 68 y.o. female patient of MD with PMHx of COPD on 3 L O2 (baseline), CHF, pulm HTN, hyperthyroidism, CKD (baseline Cr 1.7-1.9), renal artery occlusion and infrarenal artery aneurysm, HTN, anxiety/depression, who was admitted to MC on 10/25/23 with COVID PNA and acute renal failure.   Acute on chronic respiratory failure with hypoxia  Requiring prolonged BiPAP and HHFNC  Secondary to Covid, COPD exacerbation, pneumonia, and possibly pulmonary edema S/p Veletri, steroids  Now back to 3-4 L O2 which is her baseline     COVID-19 PNA Mycoplasma and Pseudomonal PNA  Date of positive COVID19 test: 10/24  Vaccination status: unvaccinated Tociluzumab given 10/26,  steroid taper  Special isolation end date: 11/4 S/p CAP CTX/Azithromycin, Completed Cefepime and prolonged steroid taper    AKI on CKD ATN requiring dialysis  Oliguric, Cr on admit 8.00  S/p CRRT, then last HD 10/30  Continue to monitor renal function Renal function now remains stable    Hematuria In setting of AKI Foley in place Urology consulted, signed off 11/5 Recommended outpatient urology follow up    Acute blood loss anemia  Rectal Ulcer  Episode of melanotic stool 11/4 Hgb 5.7 on 11/2/23 -- transfused a total of pRBC x 2 during admission Occult stool positive GI followed  EGD 11/6 - no areas of bleeding found Colonoscopy 11/7 with rectal ulcers - likely ischemic in critically ill patient CMV negative on path     Peripheral Arterial Disease   Infrarenal AAA and L Carotid Stenosis  Renal artery ultrasound 10/26 - poorly visualized perfusion to L kidney, severe dilatation of infrarenal aortic aneurysm to 5.5 cm lateral. Noted mural thrombus.  Vascular surgery has now re evaluated  Non invasive studies ordered pre op, 90% left carotid stenosis noted  Planning for possible EVAR as outpatient, follow up with Dr. Continue home aspirin and atorvastatin Acute on chronic HFpEF Pulmonary HTN With volume overload and generalized edema  Per SOMC records Echocardiogram 10/27/23 - LVEF 60-65%, no significant valvular abnormalities Diuresed during admission, lasix was held for AKI but now back on PO lasix   COPD  Tobacco use disorder Without signs of acute exacerbation Continue home Dulera, PRN Duo Nebs Encouraged tobacco cessation, NRT ordered Completed prolonged steroid taper    Essential HTN Home metoprolol resumed at 50 instead of 100  Home Lasix  80 BID on hold, can resume if further edema or HTN  Holding home losartan till renal function stabilizes    Chronic Back Pain Spinal Stenosis Continue PRN oxy Hopeful to stop on discharge    GERD Controlled, resumed home PPI   Anemia in CKD Thrombocytopenia, POA, resolved Iron panel consistent with AICD   Hypothyroidism Continued home levothyroxine    Hyperglycemia PreDM In setting of steroids A1c at OSH - 6 On SSI, now stopped
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Blood sodium abnormal, COVID-19, Computerised tomogram thorax abnormal, Cough, Dyspnoea
Clinical narrative: Patient is a 76 y.o. male patient of MD with a history of SOB.   Discharge Diagnoses:    COVID-19 - Presented with: cough and SOB - Symptom onset: 11/7 - Positive COVID-19: 11/8 at home - Vaccination status: Vaccinated with Pfizer with last dose 10/2021 History of pericarditis after the booster.  - CT Chest on admission showed L sided infiltrates and extensive adenopathy. Neg for PE.  - Oxygen status: Now asymptomatic on room air - Decadron: Yes. Expected end date 11/12 - Will continue home Paxlovid(started on 11/9) - Patient improved remarkably overnight with empiric antibiotics for community-acquired pneumonia as below along with IV steroids and albuterol inhaler.  He is stable on room air oxygen now without significant symptoms, denies any shortness of breath or chest pain.  Patient wants to go home today, ok to discharge from pulmonary, finish 1 week course of zithromax, no need for steroids on dc per pulmonary upon discharge and follow-up with PCP.   Pneumonia, L sided - Started on empiric rocephin/zithro to cover CAP, and decadron with significant improvement overnight along with albuterol inhaler.  He is asymptomatic on room air now and wants to go home.  Plan for discharge home on 1 week course of Zithromax per pulmonary and follow-up with PCP.   Lymphadenopathy - has extensive LAD of the chest significantly progressed compared to 12/2022. Concern this is related to his known myeloproliferative disorder.  Will need outpatient follow-up CT per pulmonary once acute issue resolves.   Metabolic Acidosis - mixed gapped and non-gapped.  - ED ordered course of bicarb.  Resolved on follow-up   Hyponatremia - admits to drinking a lot of water recently. Also possible the lung processes are driving some SIADH.  Repeat sodium back to normal   Thrombocytopenia - baseline is normal  - likely acute viral infection with underlying splenomegaly.  Platelet count stable.  Will need outpatient follow-up labs with PCP Myelofibrosis - follows with Dr, not on any treatment currently.  - has known splenomegaly   Hypothyroidism - continue armour thyroid   Gout - continue allopurinol
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Gout, Hyponatraemia, Hypothyroidism, Inappropriate antidiuretic hormone secretion, Lung infiltration
Clinical narrative: Patient is a 76 y.o. male patient of MD with a history of SOB.   Discharge Diagnoses:    COVID-19 - Presented with: cough and SOB - Symptom onset: 11/7 - Positive COVID-19: 11/8 at home - Vaccination status: Vaccinated with Pfizer with last dose 10/2021 History of pericarditis after the booster.  - CT Chest on admission showed L sided infiltrates and extensive adenopathy. Neg for PE.  - Oxygen status: Now asymptomatic on room air - Decadron: Yes. Expected end date 11/12 - Will continue home Paxlovid(started on 11/9) - Patient improved remarkably overnight with empiric antibiotics for community-acquired pneumonia as below along with IV steroids and albuterol inhaler.  He is stable on room air oxygen now without significant symptoms, denies any shortness of breath or chest pain.  Patient wants to go home today, ok to discharge from pulmonary, finish 1 week course of zithromax, no need for steroids on dc per pulmonary upon discharge and follow-up with PCP.   Pneumonia, L sided - Started on empiric rocephin/zithro to cover CAP, and decadron with significant improvement overnight along with albuterol inhaler.  He is asymptomatic on room air now and wants to go home.  Plan for discharge home on 1 week course of Zithromax per pulmonary and follow-up with PCP.   Lymphadenopathy - has extensive LAD of the chest significantly progressed compared to 12/2022. Concern this is related to his known myeloproliferative disorder.  Will need outpatient follow-up CT per pulmonary once acute issue resolves.   Metabolic Acidosis - mixed gapped and non-gapped.  - ED ordered course of bicarb.  Resolved on follow-up   Hyponatremia - admits to drinking a lot of water recently. Also possible the lung processes are driving some SIADH.  Repeat sodium back to normal   Thrombocytopenia - baseline is normal  - likely acute viral infection with underlying splenomegaly.  Platelet count stable.  Will need outpatient follow-up labs with PCP Myelofibrosis - follows with Dr, not on any treatment currently.  - has known splenomegaly   Hypothyroidism - continue armour thyroid   Gout - continue allopurinol
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Lymphadenopathy, Metabolic acidosis, Myelofibrosis, Myeloproliferative neoplasm, Platelet count
Clinical narrative: Patient is a 76 y.o. male patient of MD with a history of SOB.   Discharge Diagnoses:    COVID-19 - Presented with: cough and SOB - Symptom onset: 11/7 - Positive COVID-19: 11/8 at home - Vaccination status: Vaccinated with Pfizer with last dose 10/2021 History of pericarditis after the booster.  - CT Chest on admission showed L sided infiltrates and extensive adenopathy. Neg for PE.  - Oxygen status: Now asymptomatic on room air - Decadron: Yes. Expected end date 11/12 - Will continue home Paxlovid(started on 11/9) - Patient improved remarkably overnight with empiric antibiotics for community-acquired pneumonia as below along with IV steroids and albuterol inhaler.  He is stable on room air oxygen now without significant symptoms, denies any shortness of breath or chest pain.  Patient wants to go home today, ok to discharge from pulmonary, finish 1 week course of zithromax, no need for steroids on dc per pulmonary upon discharge and follow-up with PCP.   Pneumonia, L sided - Started on empiric rocephin/zithro to cover CAP, and decadron with significant improvement overnight along with albuterol inhaler.  He is asymptomatic on room air now and wants to go home.  Plan for discharge home on 1 week course of Zithromax per pulmonary and follow-up with PCP.   Lymphadenopathy - has extensive LAD of the chest significantly progressed compared to 12/2022. Concern this is related to his known myeloproliferative disorder.  Will need outpatient follow-up CT per pulmonary once acute issue resolves.   Metabolic Acidosis - mixed gapped and non-gapped.  - ED ordered course of bicarb.  Resolved on follow-up   Hyponatremia - admits to drinking a lot of water recently. Also possible the lung processes are driving some SIADH.  Repeat sodium back to normal   Thrombocytopenia - baseline is normal  - likely acute viral infection with underlying splenomegaly.  Platelet count stable.  Will need outpatient follow-up labs with PCP Myelofibrosis - follows with Dr, not on any treatment currently.  - has known splenomegaly   Hypothyroidism - continue armour thyroid   Gout - continue allopurinol
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Pneumonia, SARS-CoV-2 test positive, Splenomegaly, Thrombocytopenia, Viral infection
Clinical narrative: Patient is a 76 y.o. male patient of MD with a history of SOB.   Discharge Diagnoses:    COVID-19 - Presented with: cough and SOB - Symptom onset: 11/7 - Positive COVID-19: 11/8 at home - Vaccination status: Vaccinated with Pfizer with last dose 10/2021 History of pericarditis after the booster.  - CT Chest on admission showed L sided infiltrates and extensive adenopathy. Neg for PE.  - Oxygen status: Now asymptomatic on room air - Decadron: Yes. Expected end date 11/12 - Will continue home Paxlovid(started on 11/9) - Patient improved remarkably overnight with empiric antibiotics for community-acquired pneumonia as below along with IV steroids and albuterol inhaler.  He is stable on room air oxygen now without significant symptoms, denies any shortness of breath or chest pain.  Patient wants to go home today, ok to discharge from pulmonary, finish 1 week course of zithromax, no need for steroids on dc per pulmonary upon discharge and follow-up with PCP.   Pneumonia, L sided - Started on empiric rocephin/zithro to cover CAP, and decadron with significant improvement overnight along with albuterol inhaler.  He is asymptomatic on room air now and wants to go home.  Plan for discharge home on 1 week course of Zithromax per pulmonary and follow-up with PCP.   Lymphadenopathy - has extensive LAD of the chest significantly progressed compared to 12/2022. Concern this is related to his known myeloproliferative disorder.  Will need outpatient follow-up CT per pulmonary once acute issue resolves.   Metabolic Acidosis - mixed gapped and non-gapped.  - ED ordered course of bicarb.  Resolved on follow-up   Hyponatremia - admits to drinking a lot of water recently. Also possible the lung processes are driving some SIADH.  Repeat sodium back to normal   Thrombocytopenia - baseline is normal  - likely acute viral infection with underlying splenomegaly.  Platelet count stable.  Will need outpatient follow-up labs with PCP Myelofibrosis - follows with Dr, not on any treatment currently.  - has known splenomegaly   Hypothyroidism - continue armour thyroid   Gout - continue allopurinol
Age: 62.0
Sex: M
Vaccine: VARZOS
Symptoms: Unevaluable event
Clinical narrative: Vaccine Refridgerated