chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Pathogen resistance, Pyrexia, SARS-CoV-2 test positive, Sepsis, Urine analysis normal
Clinical narrative: Patient is an 80 year old  female with a history of Myasthenia Gravis, Parkinson's disease, recurrent UTIs with admission for Sepsis secondary to  ESBL E. coli in March 2023, who presented from her SNF  to hospital 9/1/23 with weakness, fatigue, nausea and emesis. On presentation, SBP less than 90 mmHg. Tested positive for COVID-19. CXR and CT Abdomen/Pelvis  nonacute.    1. Myasthenia Gravis: concern for mild exacerbation with primary symptom generalized weakness. No dysphagia or respiratory symptoms. Likely due to COVID-19 infection. Follows with Neuro (Dr.). On Imuran, Prednisone 20 mg and Vyvgart infusions. IVIG started 9/1/23 x 5 . Held Imuran, continued Prednisone. Vyvgart will need to be delayed due to IVIG. Monitored VC/NIF Q4H while hospitalized, stable. Neurology  followed.  2. COVID-19 infection: 1 week of symptoms, nausea/vomiting  and fatigue. On 2L in ED for O2 sat of 91%, weaned to room air with sats mid 90s. s/p Decadron IV and Remdesivir in ED, no further need for Decadron or Remdesivir given lack of hypoxia, LFT elevation and onset of symptoms more than 5 days prior to admission. Admit CXR nonacute. Monitored with continuous pulse Ox while hospitalized. Pulmonary hygiene. 3. Leukocytosis: WBC 18, denied infectious symptoms. Could be reactive from above. Urinalysis  benign. Blood culture  9/1/23 NGTD. Monitored CBC and fever curve while hospitalized. Trend down slowly. 4. Elevated Liver Enzymes: AST 281, ALT 50 on admit. Admit CT Abdomen/Pelvis  nonacute. Resolved with supportive care. 5. Hypotension: SBP less than 90 on admit, lactate normal. Resolved with IVF bolus. BP higher as well, likely autonomic dysfunction. Avoid wide fluctuations in BP. BP stable at the time of discharge.  6. Parkinson's Disease: per history; continued Sinemet.  7. Overactive Bladder: home Myrbetriq was stopped as outpatient.  8. Obesity: BMI 34. Lifestyle modifications.  9. Lower Extremity Wound: present on admission. Wound care. ET RN followed.  10. Code status: Full code, discussed on admit.  11. VTE  Prophylaxis: Lovenox.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Vomiting, White blood cell count increased
Clinical narrative: Patient is an 80 year old  female with a history of Myasthenia Gravis, Parkinson's disease, recurrent UTIs with admission for Sepsis secondary to  ESBL E. coli in March 2023, who presented from her SNF  to hospital 9/1/23 with weakness, fatigue, nausea and emesis. On presentation, SBP less than 90 mmHg. Tested positive for COVID-19. CXR and CT Abdomen/Pelvis  nonacute.    1. Myasthenia Gravis: concern for mild exacerbation with primary symptom generalized weakness. No dysphagia or respiratory symptoms. Likely due to COVID-19 infection. Follows with Neuro (Dr.). On Imuran, Prednisone 20 mg and Vyvgart infusions. IVIG started 9/1/23 x 5 . Held Imuran, continued Prednisone. Vyvgart will need to be delayed due to IVIG. Monitored VC/NIF Q4H while hospitalized, stable. Neurology  followed.  2. COVID-19 infection: 1 week of symptoms, nausea/vomiting  and fatigue. On 2L in ED for O2 sat of 91%, weaned to room air with sats mid 90s. s/p Decadron IV and Remdesivir in ED, no further need for Decadron or Remdesivir given lack of hypoxia, LFT elevation and onset of symptoms more than 5 days prior to admission. Admit CXR nonacute. Monitored with continuous pulse Ox while hospitalized. Pulmonary hygiene. 3. Leukocytosis: WBC 18, denied infectious symptoms. Could be reactive from above. Urinalysis  benign. Blood culture  9/1/23 NGTD. Monitored CBC and fever curve while hospitalized. Trend down slowly. 4. Elevated Liver Enzymes: AST 281, ALT 50 on admit. Admit CT Abdomen/Pelvis  nonacute. Resolved with supportive care. 5. Hypotension: SBP less than 90 on admit, lactate normal. Resolved with IVF bolus. BP higher as well, likely autonomic dysfunction. Avoid wide fluctuations in BP. BP stable at the time of discharge.  6. Parkinson's Disease: per history; continued Sinemet.  7. Overactive Bladder: home Myrbetriq was stopped as outpatient.  8. Obesity: BMI 34. Lifestyle modifications.  9. Lower Extremity Wound: present on admission. Wound care. ET RN followed.  10. Code status: Full code, discussed on admit.  11. VTE  Prophylaxis: Lovenox.
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Muscle disorder
Clinical narrative: muscle control issues
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Appendicectomy, Fatigue, Feeling abnormal, Headache, Impaired gastric emptying
Clinical narrative: Starting about a week or two after injection I started getting sick. I was vomiting all the time. I was having severe headaches. I was fatigued and my body felt like it was shutting down. Since 2022 I have been fighting to find someone to help me when I found a doctor who finally has gotten me on the path to getting answers. Since the vaccine I now have gastroparesis, liver disease, I have had my appendix removed and now seeing a colon surgeon and a neurologist..
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Liver disorder, Malaise, Nerve conduction studies abnormal, Neuropathy peripheral, Vomiting
Clinical narrative: Starting about a week or two after injection I started getting sick. I was vomiting all the time. I was having severe headaches. I was fatigued and my body felt like it was shutting down. Since 2022 I have been fighting to find someone to help me when I found a doctor who finally has gotten me on the path to getting answers. Since the vaccine I now have gastroparesis, liver disease, I have had my appendix removed and now seeing a colon surgeon and a neurologist..
Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: Injection site rash, Injection site warmth, Rash, Rash erythematous
Clinical narrative: Per patient, rash appeared about 6 to 8 hours after vaccine was administered.  Patient complained of rash on left arm, area below injections site.  Area was red, about 2 to 3 inches wide and 5 or 6 inches in length, wrapped around from outer to inner part of arm (front side).  Complained that area felt warm to touch.  No rash anywhere else, no shortness of breath or difficulty breathing.  Advised that this may be an expected side effect from vaccine, and advised to see a physician for a second opinion.
Age: 57.0
Sex: F
Vaccine: RSV
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: GIVEN PRIOR TO 60 YEARS OF AGE
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram cerebral abnormal, Aphasia, Blood creatinine increased, COVID-19
Clinical narrative: Patient is a 95 y.o. male who presented from home on is a 95 y.o. male who presented from home on 9/12/2023 with confusion. Patient recently diagnosed with COVID was receiving Paxlovid as outpatient.  Was found to be hypoxic on presentation to the hospital with fever.  Chest x-ray revealed minimal basilar opacity.  Patient was started on dexamethasone and remdesivir due to hypoxia with significant improvement in his symptoms.  Was afebrile and asymptomatic on the day of discharge.  Based on discussion with wife at the bedside they elected to be discharged today.  Patient will be discharged with dexamethasone.  Received 2 days of remdesivir and 2 days of Paxlovid prior to hospitalization.  Based on discussion with clinical pharmacist Paxlovid no longer indicated.         Assessment and Plan   Acute metabolic toxic encephalopathy -Presented with aphasia.  Was found to be febrile on presentation.   -Etiology in setting of acute medical illness  -Metabolic and infectious work-up otherwise unremarkable  -Head CT unremarkable.  CTA head with severe stenosis of proximal left posterior cerebral artery moderate to severe stenosis and to branch of left middle cerebral artery -Patient with no other accompanying drug interactions while taking Paxlovid.  He is currently back to his baseline answering all questions appropriately. -Neurologic exam unremarkable -Delirium precautions, sleep hygiene. -PT OT consulted patient will be discharged home with home health     COVID-19 infection Acute respiratory failure with hypoxia - Presented with: Confusion, aphasia - Symptom onset: 9/10 - Positive COVID-19: 9/10 at home - Vaccination status: Vaccinated with Pfizer with last dose 11/2021 x3 - CXR on admission showed minimal by lateral basilar opacity - Oxygen status: O2 sat 88% on room air, placed on nasal cannula - Decadron: Initiated - Remdesivir: Initiated.  -Dry lung strategy.  Received spot diuresis with Lasix IV -Lung exam within normal on the day of discharge. -No current indication for antibiotic therapy. -Pulmonary hygiene   Fever -In setting of COVID-19 infection. -No clinical concern for bacterial pneumonia.  Given onset of symptoms was on Sunday.  Chest x-ray findings as well as physical exam -Currently afebrile -Continue treatment as above   CKD 3B -Baseline creatinine appears to be 1.7?1.9 -Creatinine on admission 1.78. -Continue to monitor urinary output and creatinine. -Renally dose for GFR less than 30. Hypertension -Blood pressure controlled currently -Takes amlodipine, lisinopril, and metoprolol in the home setting. -Continue his home regimen.   Hyperlipidemia -Resume statin   OSA -CPAP ordered.   Hx of TIA -Per review of chart -Continue home ASA.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Cerebral artery stenosis, Chest X-ray abnormal, Computerised tomogram head normal, Confusional state, Diuretic therapy
Clinical narrative: Patient is a 95 y.o. male who presented from home on is a 95 y.o. male who presented from home on 9/12/2023 with confusion. Patient recently diagnosed with COVID was receiving Paxlovid as outpatient.  Was found to be hypoxic on presentation to the hospital with fever.  Chest x-ray revealed minimal basilar opacity.  Patient was started on dexamethasone and remdesivir due to hypoxia with significant improvement in his symptoms.  Was afebrile and asymptomatic on the day of discharge.  Based on discussion with wife at the bedside they elected to be discharged today.  Patient will be discharged with dexamethasone.  Received 2 days of remdesivir and 2 days of Paxlovid prior to hospitalization.  Based on discussion with clinical pharmacist Paxlovid no longer indicated.         Assessment and Plan   Acute metabolic toxic encephalopathy -Presented with aphasia.  Was found to be febrile on presentation.   -Etiology in setting of acute medical illness  -Metabolic and infectious work-up otherwise unremarkable  -Head CT unremarkable.  CTA head with severe stenosis of proximal left posterior cerebral artery moderate to severe stenosis and to branch of left middle cerebral artery -Patient with no other accompanying drug interactions while taking Paxlovid.  He is currently back to his baseline answering all questions appropriately. -Neurologic exam unremarkable -Delirium precautions, sleep hygiene. -PT OT consulted patient will be discharged home with home health     COVID-19 infection Acute respiratory failure with hypoxia - Presented with: Confusion, aphasia - Symptom onset: 9/10 - Positive COVID-19: 9/10 at home - Vaccination status: Vaccinated with Pfizer with last dose 11/2021 x3 - CXR on admission showed minimal by lateral basilar opacity - Oxygen status: O2 sat 88% on room air, placed on nasal cannula - Decadron: Initiated - Remdesivir: Initiated.  -Dry lung strategy.  Received spot diuresis with Lasix IV -Lung exam within normal on the day of discharge. -No current indication for antibiotic therapy. -Pulmonary hygiene   Fever -In setting of COVID-19 infection. -No clinical concern for bacterial pneumonia.  Given onset of symptoms was on Sunday.  Chest x-ray findings as well as physical exam -Currently afebrile -Continue treatment as above   CKD 3B -Baseline creatinine appears to be 1.7?1.9 -Creatinine on admission 1.78. -Continue to monitor urinary output and creatinine. -Renally dose for GFR less than 30. Hypertension -Blood pressure controlled currently -Takes amlodipine, lisinopril, and metoprolol in the home setting. -Continue his home regimen.   Hyperlipidemia -Resume statin   OSA -CPAP ordered.   Hx of TIA -Per review of chart -Continue home ASA.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Glomerular filtration rate decreased, Hypoxia, Illness, Metabolic function test normal, Neurological examination normal
Clinical narrative: Patient is a 95 y.o. male who presented from home on is a 95 y.o. male who presented from home on 9/12/2023 with confusion. Patient recently diagnosed with COVID was receiving Paxlovid as outpatient.  Was found to be hypoxic on presentation to the hospital with fever.  Chest x-ray revealed minimal basilar opacity.  Patient was started on dexamethasone and remdesivir due to hypoxia with significant improvement in his symptoms.  Was afebrile and asymptomatic on the day of discharge.  Based on discussion with wife at the bedside they elected to be discharged today.  Patient will be discharged with dexamethasone.  Received 2 days of remdesivir and 2 days of Paxlovid prior to hospitalization.  Based on discussion with clinical pharmacist Paxlovid no longer indicated.         Assessment and Plan   Acute metabolic toxic encephalopathy -Presented with aphasia.  Was found to be febrile on presentation.   -Etiology in setting of acute medical illness  -Metabolic and infectious work-up otherwise unremarkable  -Head CT unremarkable.  CTA head with severe stenosis of proximal left posterior cerebral artery moderate to severe stenosis and to branch of left middle cerebral artery -Patient with no other accompanying drug interactions while taking Paxlovid.  He is currently back to his baseline answering all questions appropriately. -Neurologic exam unremarkable -Delirium precautions, sleep hygiene. -PT OT consulted patient will be discharged home with home health     COVID-19 infection Acute respiratory failure with hypoxia - Presented with: Confusion, aphasia - Symptom onset: 9/10 - Positive COVID-19: 9/10 at home - Vaccination status: Vaccinated with Pfizer with last dose 11/2021 x3 - CXR on admission showed minimal by lateral basilar opacity - Oxygen status: O2 sat 88% on room air, placed on nasal cannula - Decadron: Initiated - Remdesivir: Initiated.  -Dry lung strategy.  Received spot diuresis with Lasix IV -Lung exam within normal on the day of discharge. -No current indication for antibiotic therapy. -Pulmonary hygiene   Fever -In setting of COVID-19 infection. -No clinical concern for bacterial pneumonia.  Given onset of symptoms was on Sunday.  Chest x-ray findings as well as physical exam -Currently afebrile -Continue treatment as above   CKD 3B -Baseline creatinine appears to be 1.7?1.9 -Creatinine on admission 1.78. -Continue to monitor urinary output and creatinine. -Renally dose for GFR less than 30. Hypertension -Blood pressure controlled currently -Takes amlodipine, lisinopril, and metoprolol in the home setting. -Continue his home regimen.   Hyperlipidemia -Resume statin   OSA -CPAP ordered.   Hx of TIA -Per review of chart -Continue home ASA.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, Toxic encephalopathy, Urine output
Clinical narrative: Patient is a 95 y.o. male who presented from home on is a 95 y.o. male who presented from home on 9/12/2023 with confusion. Patient recently diagnosed with COVID was receiving Paxlovid as outpatient.  Was found to be hypoxic on presentation to the hospital with fever.  Chest x-ray revealed minimal basilar opacity.  Patient was started on dexamethasone and remdesivir due to hypoxia with significant improvement in his symptoms.  Was afebrile and asymptomatic on the day of discharge.  Based on discussion with wife at the bedside they elected to be discharged today.  Patient will be discharged with dexamethasone.  Received 2 days of remdesivir and 2 days of Paxlovid prior to hospitalization.  Based on discussion with clinical pharmacist Paxlovid no longer indicated.         Assessment and Plan   Acute metabolic toxic encephalopathy -Presented with aphasia.  Was found to be febrile on presentation.   -Etiology in setting of acute medical illness  -Metabolic and infectious work-up otherwise unremarkable  -Head CT unremarkable.  CTA head with severe stenosis of proximal left posterior cerebral artery moderate to severe stenosis and to branch of left middle cerebral artery -Patient with no other accompanying drug interactions while taking Paxlovid.  He is currently back to his baseline answering all questions appropriately. -Neurologic exam unremarkable -Delirium precautions, sleep hygiene. -PT OT consulted patient will be discharged home with home health     COVID-19 infection Acute respiratory failure with hypoxia - Presented with: Confusion, aphasia - Symptom onset: 9/10 - Positive COVID-19: 9/10 at home - Vaccination status: Vaccinated with Pfizer with last dose 11/2021 x3 - CXR on admission showed minimal by lateral basilar opacity - Oxygen status: O2 sat 88% on room air, placed on nasal cannula - Decadron: Initiated - Remdesivir: Initiated.  -Dry lung strategy.  Received spot diuresis with Lasix IV -Lung exam within normal on the day of discharge. -No current indication for antibiotic therapy. -Pulmonary hygiene   Fever -In setting of COVID-19 infection. -No clinical concern for bacterial pneumonia.  Given onset of symptoms was on Sunday.  Chest x-ray findings as well as physical exam -Currently afebrile -Continue treatment as above   CKD 3B -Baseline creatinine appears to be 1.7?1.9 -Creatinine on admission 1.78. -Continue to monitor urinary output and creatinine. -Renally dose for GFR less than 30. Hypertension -Blood pressure controlled currently -Takes amlodipine, lisinopril, and metoprolol in the home setting. -Continue his home regimen.   Hyperlipidemia -Resume statin   OSA -CPAP ordered.   Hx of TIA -Per review of chart -Continue home ASA.
Age: 66.0
Sex: F
Vaccine: PNC20
Symptoms: Fatigue, Pain in extremity, Vomiting
Clinical narrative: Friday pneumonia vaccine in clinic- 5 days ago Had some fatigue and a sore arm on the first couple days. 3 later started vomiting- looks acidy and watery. Vomited multiple times yesterday and today. Has been able to drink water. No diarrhea. Has been urinating 3-4 times a day still.  Taking ibuprofen which has been helpful, as well as her scheduled hydrocodone- acetaminophen 5 times daily. H Has also been taking excedrin. Was prescribed zofran to help with sumptoms
Age: 24.0
Sex: M
Vaccine: COVID19, FLUR4
Symptoms: Syncope
Clinical narrative: After the patient received two vaccinations, Comirnaty and Flublok. The patient fainted while still in the vaccination chair. I aroused the patient back to consciousness. I walked him to another chair then he fainted again. I aroused him again then laid him on the floor for 15 minutes. Had him stand slowly; he said he was fine; he appeared to be fine. He left the pharmacy.
Age: 84.0
Sex: F
Vaccine: FLU4
Symptoms: Death
Clinical narrative: expired
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Asthenia, Atelectasis, Blood creatinine increased
Clinical narrative: Patient is a 61 y.o. male patient of DO with history of MS, DVT, obesity presented to Hospital with generalized weakness and cough. Problem based management in the hospital is as follows:   Covid-19 Virus Infection Acute hypoxic respiratory failure, resolved Generalized weakness, POA, due to COVID-19 infection Date of onset of symptoms: 9/6/23 Symptoms present on admission: cough and fatigue Date of covid positive test: 9/8/23 Vaccination status: vaccinated Imaging: chest xray - Small to mild effusion in the left lung base with atelectasis.  Slight atelectasis in right lung base.  Oxygen requirements on admission: NA Current oxygen requirements: Room air.  Medical therapy: Was on dexamethasone and remdesivir, completed remdesivir.  Discharged on dexamethasone taper Consultants following: ID - appreciate recommendations Anticipated special isolation end date: 9/18/23 Continue aggressive pulmonary toilet - incentive spirometry, acapella, out of bed, deep breathing PT/OT/UM consulted for disposition planning   History of pulmonary embolism/DVT Continued Xarelto   History of multiple sclerosis Follows at multiple sclerosis clinic On Ocrelizumab infusions   CKD stage III Creatinine 1.5, baseline is about 1.4 Avoid nephrotoxic agents Monitor renal function   Hypertension Continued Coreg   Chronic pain syndrome Continued Cymbalta and gabapentin   Obesity BMI 35.57 kg per metered squared
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Chronic kidney disease, Cough, Fatigue
Clinical narrative: Patient is a 61 y.o. male patient of DO with history of MS, DVT, obesity presented to Hospital with generalized weakness and cough. Problem based management in the hospital is as follows:   Covid-19 Virus Infection Acute hypoxic respiratory failure, resolved Generalized weakness, POA, due to COVID-19 infection Date of onset of symptoms: 9/6/23 Symptoms present on admission: cough and fatigue Date of covid positive test: 9/8/23 Vaccination status: vaccinated Imaging: chest xray - Small to mild effusion in the left lung base with atelectasis.  Slight atelectasis in right lung base.  Oxygen requirements on admission: NA Current oxygen requirements: Room air.  Medical therapy: Was on dexamethasone and remdesivir, completed remdesivir.  Discharged on dexamethasone taper Consultants following: ID - appreciate recommendations Anticipated special isolation end date: 9/18/23 Continue aggressive pulmonary toilet - incentive spirometry, acapella, out of bed, deep breathing PT/OT/UM consulted for disposition planning   History of pulmonary embolism/DVT Continued Xarelto   History of multiple sclerosis Follows at multiple sclerosis clinic On Ocrelizumab infusions   CKD stage III Creatinine 1.5, baseline is about 1.4 Avoid nephrotoxic agents Monitor renal function   Hypertension Continued Coreg   Chronic pain syndrome Continued Cymbalta and gabapentin   Obesity BMI 35.57 kg per metered squared
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Hypertension, Incentive spirometry, Pain, Pleural effusion, SARS-CoV-2 test positive
Clinical narrative: Patient is a 61 y.o. male patient of DO with history of MS, DVT, obesity presented to Hospital with generalized weakness and cough. Problem based management in the hospital is as follows:   Covid-19 Virus Infection Acute hypoxic respiratory failure, resolved Generalized weakness, POA, due to COVID-19 infection Date of onset of symptoms: 9/6/23 Symptoms present on admission: cough and fatigue Date of covid positive test: 9/8/23 Vaccination status: vaccinated Imaging: chest xray - Small to mild effusion in the left lung base with atelectasis.  Slight atelectasis in right lung base.  Oxygen requirements on admission: NA Current oxygen requirements: Room air.  Medical therapy: Was on dexamethasone and remdesivir, completed remdesivir.  Discharged on dexamethasone taper Consultants following: ID - appreciate recommendations Anticipated special isolation end date: 9/18/23 Continue aggressive pulmonary toilet - incentive spirometry, acapella, out of bed, deep breathing PT/OT/UM consulted for disposition planning   History of pulmonary embolism/DVT Continued Xarelto   History of multiple sclerosis Follows at multiple sclerosis clinic On Ocrelizumab infusions   CKD stage III Creatinine 1.5, baseline is about 1.4 Avoid nephrotoxic agents Monitor renal function   Hypertension Continued Coreg   Chronic pain syndrome Continued Cymbalta and gabapentin   Obesity BMI 35.57 kg per metered squared
Age: 63.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Injection site pain, Limb discomfort, Oedema peripheral
Clinical narrative: The day after vaccination injection site sore. On Friday morning soreness  not as bad at injection site.I noticed discomfort in armpit later upon examining underarm area and noticed visible swelling in armpit. I contacted primary care physician via portal to ask if swelling was common. No response.
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Abscess, Acute respiratory failure, Alanine aminotransferase increased, Anticoagulant therapy, Aphasia
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Aspartate aminotransferase increased, Asthenia, Back pain, Blood pressure increased, COVID-19
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Computerised tomogram abdomen normal, Computerised tomogram neck, Computerised tomogram normal, Computerised tomogram spine, Computerised tomogram spine abnormal
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Computerised tomogram thorax abnormal, Condition aggravated, Cough, Encephalopathy, Facet joint syndrome
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Gait disturbance, Hypertransaminasaemia, Imaging procedure, International normalised ratio increased, Lumbar radiculopathy
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Magnetic resonance imaging head normal, Magnetic resonance imaging spinal abnormal, Physical deconditioning, Pulmonary mass, Pyrexia
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Sepsis, Seroma, Spinal operation, Spinal osteoarthritis
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Spondylolisthesis, Toxic encephalopathy, Urine analysis normal, Vertebral foraminal stenosis, Vertebral lateral recess stenosis
Clinical narrative: Patient is a 82 y.o. male admitted to the hospital on 9/3/2023 for weakness, expressive aphasia.  Patient found to have abscess due to COVID-19.  Patient was treated supportively.  His acute hypoxic respiratory failure resolved with dexamethasone and he was on room air at the time of discharge.  Imaging completed did not show any evidence of CVA.  Patient was discharged on hospital day 4 in stable condition with PCP follow-up.  His dexamethasone was discontinued prior to discharge.  It was felt the risk of delirium, adverse effects from interactions with dexamethasone/warfarin outweighed the benefit. Sepsis due to COVID-19 Infection- POA resolved - Presented with: Encephalopathy, fevers, cough - Symptom onset: Unclear. - Positive COVID-19: 9/4 at RMH - Vaccination status: Vaccinated with Pfizer with last dose 9/2022 - CT Chest on admission showed Pulm nodules previously known, no sign of PNA - Oxygen status: Room air - Decadron: Yes, discontinued prior to discharge - Remdesivir: No.  -UA-no infection. CT C/A/P-no acute abnormality.    Acute Respiratory Resp Failure with Hypoxia -Appears to be more in the setting of multifactorial deconditioning, recent back surgery, and weakness from COVID -Dexamethasone discontinued -Weaned off of O2   Acute toxic encephalopathy-resolved Aphasia-improved Gait imbalance-resolved Felt to be due to sepsis, COVID-19 infection. -Neurology followed: CT head normal, CT head and neck normal, MR brain normal. -Expressive aphasia improved substantially on 9/6. -PT/OT followed.  Health home care discharge.   Acute on chronic lower back pain-resolved Lumbar radiculopathy -Recent ESI at Ortho one on 8/29 which did not work as per patient's wife. -CT L-spine-degenerative changes of the lumbar spine most notably at L3-L4 where right facet arthrosis contributes to severe right subarticular recess stenosis and severe right foraminal stenosis. -Evaluated by neurosurgery. -MRI L-spine with post-surgical changes and a postoperative seroma. Anterolisthesis of L5-S1. No infected collections noted.   Transaminitis -AST 63, ALT 45, likely due to COVID -Resolved Mild neurocognitive disorder -Continue Namenda.   Paroxysmal atrial fibrillation Supratherapeutic INR -Controlled on metoprolol. -On Coumadin with INR 2.3, INR 3.6 9/4 -Continue Warfarin, dose per pharmacy   History of DVT and PE -In 2006. -On Coumadin.   History of CVA -With mild residual aphasia and left-sided weakness. -Resume Plavix   Hypertension -BP mildly elevated. -Resume BP meds
Age: 72.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: We received the childrens vaccine on 10/6/2023 when I was not at work.  I was not aware that we received the childrens vaccine.  In an effort to do the most efficient thing for our store due to being behind on all the rx ques I thought using the single dose vials would be most efficient when the most staff was one hand to use them up.  It was discovered when using the NDC for another patient that this was the children's dose due to the rx adjudicating. the patient returned and received the adult dosage according the CDC recommendations.
Age: 74.0
Sex: F
Vaccine: RSV
Symptoms: Contusion, Injection site haematoma, Pain in extremity, Peripheral swelling
Clinical narrative: Patient developed arm swelling and a bruised area on the skin. Arm has been sore and slightly swollen since reaction started. Patient did report that the arm is getting better but still presented today (10/6/2023) with a what appeared to be a hematoma on her arm near the injection site
Age: 73.0
Sex: F
Vaccine: RSV
Symptoms: Arthralgia, Headache, Influenza like illness, Musculoskeletal disorder
Clinical narrative: Flu like symptoms  Fierce headache Pain in joints Unable to lift right arm (not the site of the injection)
Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Agitation, Bacteraemia, Blood culture negative, COVID-19
Clinical narrative: Patient is a 80 y.o. female with history of Parkinsons disease, severe dementia s/p chronic PEG  admitted to the hospital on 9/3/2023 for encephalopathy, hypoxia. Intubated on arrival. Found to be COVID-19 positive. Concern for staph bacteremia, followed by ID with repeat blood cx NGTD. Extubated 9/06/2023. Discharged to home ECF on 9/11/2023 Acute respiratory failure with hypoxia -Intubated in the setting of hypoxia and altered mentation, COVID-19 may also be contributing -Intubated on admit, extubated 9/6/2023.  -Now on RA, treatment of steroids as outlined below   Severe sepsis -Sources include pulmonary or less likely bacteremia with coag negative staph.  She was previously treated with antibiotics, and infectious disease service followed, now off antibiotics   COVID-19 -Reportedly with symptom onset 8/30/2023. Tested positive at ECF on 9/01 -Previously treated at ECF with paxlovid. Held on admit as not able to crush through PEG -Continue decadron 6mg x10 day total   Abnormal CT scan, chest -Recommend repeat CT scan of the chest in 1 month to reevaluate.   Failure to thrive in adult -Severe baseline dementia and Parkinson's, with PEG for nutritional support. Required intubation during hospitalization  -Overall guarded prognosis.   Acute on chronic encephalopathy -Returned to baseline encephalopathy   Parkinsons disease -Continue home med   Hypertension Orthostatic hypotension -Likely exacerbated by agitation, steroid use -Held home florinef -Follow up on BP in 1 week   Hepatic cysts -Likely incidental finding on CT