chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Headache, International normalised ratio increased, Lung disorder, Lung infiltration, Lung opacity
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/29, Pfizer, dose #1 (Non-agency) 02/20, Pfizer, dose #2 (Non-agency) 08/03 pt cc: cough, fatigue, headache, dyspnea, severe weakness, chills, diarrhea, exposure: possible wife or daughter 08/06 COVID swab, result: detected 08/06 ED admit dx: covid pna admit to medicine LOS: 2 days 08/12 Another ED admission with direction admission to medicine dx: COVID19 with progressively worsening 08/24 CXR impression: Similar left tension pneumothorax. Redemonstrated left-sided chest tube has its tip projecting over central left lung zone. 08/25 fungitel interpretation negative result: 31 08/26 PT result 14.6, APTT result: 39.3, INR result 1.30, antiXa unfrac 0.32 08/26 lactic acid result: 2.02 08/26 procalcitonin result: 0.55 08/26 troponin i result: 2.469 08/26 MRSA result: not detected 08/27 SARS-CoV-IgG result: 2.23 08/29 CXR impression: Limited study. Increased moderate pneumomediastinum. ET tube tip about 4.4 cm above the carina. No obvious pneumothorax seen. Extensive airspace disease on the left appears mildly increased. Mild right perihilar infiltrate appears similar 08/30 CXR impression: Slight further increase in pneumomediastinum. 2. More prominent burden of airspace opacities, as above. 3. Tubes and lines as above. 08/31 ABG (ventilator) i-Ph 7.17, I-pco2 47.5, i-Po2 72, iHCO3 17.2, 08/31 FIBRINOGEN result: 161 08/31 DDIMER result: 14.59 08/31 ESR 4 08/31 lactic acid 8.13 08/31 ANTI-XA UFH result: 0.26 08/31 decease
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Mechanical ventilation, PCO2 increased, PO2 decreased, Pneumomediastinum, Pneumothorax
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/29, Pfizer, dose #1 (Non-agency) 02/20, Pfizer, dose #2 (Non-agency) 08/03 pt cc: cough, fatigue, headache, dyspnea, severe weakness, chills, diarrhea, exposure: possible wife or daughter 08/06 COVID swab, result: detected 08/06 ED admit dx: covid pna admit to medicine LOS: 2 days 08/12 Another ED admission with direction admission to medicine dx: COVID19 with progressively worsening 08/24 CXR impression: Similar left tension pneumothorax. Redemonstrated left-sided chest tube has its tip projecting over central left lung zone. 08/25 fungitel interpretation negative result: 31 08/26 PT result 14.6, APTT result: 39.3, INR result 1.30, antiXa unfrac 0.32 08/26 lactic acid result: 2.02 08/26 procalcitonin result: 0.55 08/26 troponin i result: 2.469 08/26 MRSA result: not detected 08/27 SARS-CoV-IgG result: 2.23 08/29 CXR impression: Limited study. Increased moderate pneumomediastinum. ET tube tip about 4.4 cm above the carina. No obvious pneumothorax seen. Extensive airspace disease on the left appears mildly increased. Mild right perihilar infiltrate appears similar 08/30 CXR impression: Slight further increase in pneumomediastinum. 2. More prominent burden of airspace opacities, as above. 3. Tubes and lines as above. 08/31 ABG (ventilator) i-Ph 7.17, I-pco2 47.5, i-Po2 72, iHCO3 17.2, 08/31 FIBRINOGEN result: 161 08/31 DDIMER result: 14.59 08/31 ESR 4 08/31 lactic acid 8.13 08/31 ANTI-XA UFH result: 0.26 08/31 decease
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Procalcitonin, Prothrombin time prolonged, Red blood cell sedimentation rate normal, SARS-CoV-2 antibody test, SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/29, Pfizer, dose #1 (Non-agency) 02/20, Pfizer, dose #2 (Non-agency) 08/03 pt cc: cough, fatigue, headache, dyspnea, severe weakness, chills, diarrhea, exposure: possible wife or daughter 08/06 COVID swab, result: detected 08/06 ED admit dx: covid pna admit to medicine LOS: 2 days 08/12 Another ED admission with direction admission to medicine dx: COVID19 with progressively worsening 08/24 CXR impression: Similar left tension pneumothorax. Redemonstrated left-sided chest tube has its tip projecting over central left lung zone. 08/25 fungitel interpretation negative result: 31 08/26 PT result 14.6, APTT result: 39.3, INR result 1.30, antiXa unfrac 0.32 08/26 lactic acid result: 2.02 08/26 procalcitonin result: 0.55 08/26 troponin i result: 2.469 08/26 MRSA result: not detected 08/27 SARS-CoV-IgG result: 2.23 08/29 CXR impression: Limited study. Increased moderate pneumomediastinum. ET tube tip about 4.4 cm above the carina. No obvious pneumothorax seen. Extensive airspace disease on the left appears mildly increased. Mild right perihilar infiltrate appears similar 08/30 CXR impression: Slight further increase in pneumomediastinum. 2. More prominent burden of airspace opacities, as above. 3. Tubes and lines as above. 08/31 ABG (ventilator) i-Ph 7.17, I-pco2 47.5, i-Po2 72, iHCO3 17.2, 08/31 FIBRINOGEN result: 161 08/31 DDIMER result: 14.59 08/31 ESR 4 08/31 lactic acid 8.13 08/31 ANTI-XA UFH result: 0.26 08/31 decease
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Staphylococcus test negative, Troponin I increased
Clinical narrative: Narrative: COVID infection following COVID vaccine series 01/29, Pfizer, dose #1 (Non-agency) 02/20, Pfizer, dose #2 (Non-agency) 08/03 pt cc: cough, fatigue, headache, dyspnea, severe weakness, chills, diarrhea, exposure: possible wife or daughter 08/06 COVID swab, result: detected 08/06 ED admit dx: covid pna admit to medicine LOS: 2 days 08/12 Another ED admission with direction admission to medicine dx: COVID19 with progressively worsening 08/24 CXR impression: Similar left tension pneumothorax. Redemonstrated left-sided chest tube has its tip projecting over central left lung zone. 08/25 fungitel interpretation negative result: 31 08/26 PT result 14.6, APTT result: 39.3, INR result 1.30, antiXa unfrac 0.32 08/26 lactic acid result: 2.02 08/26 procalcitonin result: 0.55 08/26 troponin i result: 2.469 08/26 MRSA result: not detected 08/27 SARS-CoV-IgG result: 2.23 08/29 CXR impression: Limited study. Increased moderate pneumomediastinum. ET tube tip about 4.4 cm above the carina. No obvious pneumothorax seen. Extensive airspace disease on the left appears mildly increased. Mild right perihilar infiltrate appears similar 08/30 CXR impression: Slight further increase in pneumomediastinum. 2. More prominent burden of airspace opacities, as above. 3. Tubes and lines as above. 08/31 ABG (ventilator) i-Ph 7.17, I-pco2 47.5, i-Po2 72, iHCO3 17.2, 08/31 FIBRINOGEN result: 161 08/31 DDIMER result: 14.59 08/31 ESR 4 08/31 lactic acid 8.13 08/31 ANTI-XA UFH result: 0.26 08/31 decease
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Death, Endocarditis
Clinical narrative: Narrative: 79yo male previously at rehab facility was admitted to hospital for endocarditis on 6/30/21. Pt died on 7/26/21 at hospital (outside facility). Pt had received one dose of covid vaccine - moderna on 3/2/21. Vaccine is not related to pt's death.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  75 yo with PROBLEM LIST: Glaucoma Hypertension Hyperlipidemia Diabetes Type II with neuropathy Tobacco use/smoker COPD Neoplasm of uncertain behavior of adrenal gland H/O prostate cancer died on 9/15/2021. pt received most of his care outside agency so little information available of circumstances of pt death. Pt receive one covid vaccine (J&J) on 3/30/21 from outside agency. Likely this death is not related to the covid vaccine given pt's age, comorbidities & long time span between date of death & covid vaccine.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Blood fibrinogen increased, C-reactive protein increased, COVID-19
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/04 Janssen, dose #1 private sector, non-agency 08/16 pt cc: cough, headache, myalgias, fever,diarrhea exposure: unknown 08/18 COVID swab, result: detected 08/19 - 09/05 pt symptoms continue 08/25 cc: low oxygen levelc, dx:Acute hypoxic respiratory failure due to Covid 19 Pneumonia LOS: 7 days 08/25 CRP result: 21.583 08/26 Ferritin result: 876.2 08/25 ddimer result: 0.74 08/25 SARS-COV-2 IGG result 0:05 8/25 SARS-CoV-2 AB, spike result: >25.00 08/25 CXR impression: Moderate bilateral perihilar and peripheral infiltrates suspicious for infection. Covid pneumonia can have this appearance. Recommend clinical correlation. 08/26 FIBRINOGEN result: 480 08/26 DDIMER result: 1.16 08/26 ESR result: 97 08/26 CTA PE impression: No obvious pulmonary embolus. 2. Extensive bilateral changes of COVID 19 pneumonia, involving all pulmonary lobes. 3. Right lower paratracheal adenopathy is potentially reactive. 08/27 SARS-COV-2 IGG result 0.06 08/27 FIBRINOGEN result: 378 08/27DDIMER result: 1.23 08/27 ESR result: 92 08/28 FIBRINOGEN result: 378 08/28 DDIMER result: 1.40 08/28 ESR result: 93 H 08/28 SARS-COV-2 TOTAL AB, SPIKE SEMI QN result: >2500.0 H 08/28 DDIMER result: 1.52 08/29 CTA PE impression: 1. No definite evidence for pulmonary embolus.2. Similar bilateral groundglass opacities, consistent with COVID pneumonia. 08/30 DDIMER result: 2.27 H 08/31FIBRINOGEN result: 347 08/31 DDIMER result: 1.60 08/31 ESR result: 33 H 09/01 FIBRINOGEN result: 312 09/01 DDIMER result: 1.49 09/01 ESR 48 h 09/6 clinically resolved
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Cough, Diarrhoea, Fibrin D dimer
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/04 Janssen, dose #1 private sector, non-agency 08/16 pt cc: cough, headache, myalgias, fever,diarrhea exposure: unknown 08/18 COVID swab, result: detected 08/19 - 09/05 pt symptoms continue 08/25 cc: low oxygen levelc, dx:Acute hypoxic respiratory failure due to Covid 19 Pneumonia LOS: 7 days 08/25 CRP result: 21.583 08/26 Ferritin result: 876.2 08/25 ddimer result: 0.74 08/25 SARS-COV-2 IGG result 0:05 8/25 SARS-CoV-2 AB, spike result: >25.00 08/25 CXR impression: Moderate bilateral perihilar and peripheral infiltrates suspicious for infection. Covid pneumonia can have this appearance. Recommend clinical correlation. 08/26 FIBRINOGEN result: 480 08/26 DDIMER result: 1.16 08/26 ESR result: 97 08/26 CTA PE impression: No obvious pulmonary embolus. 2. Extensive bilateral changes of COVID 19 pneumonia, involving all pulmonary lobes. 3. Right lower paratracheal adenopathy is potentially reactive. 08/27 SARS-COV-2 IGG result 0.06 08/27 FIBRINOGEN result: 378 08/27DDIMER result: 1.23 08/27 ESR result: 92 08/28 FIBRINOGEN result: 378 08/28 DDIMER result: 1.40 08/28 ESR result: 93 H 08/28 SARS-COV-2 TOTAL AB, SPIKE SEMI QN result: >2500.0 H 08/28 DDIMER result: 1.52 08/29 CTA PE impression: 1. No definite evidence for pulmonary embolus.2. Similar bilateral groundglass opacities, consistent with COVID pneumonia. 08/30 DDIMER result: 2.27 H 08/31FIBRINOGEN result: 347 08/31 DDIMER result: 1.60 08/31 ESR result: 33 H 09/01 FIBRINOGEN result: 312 09/01 DDIMER result: 1.49 09/01 ESR 48 h 09/6 clinically resolved
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Headache, Lung infiltration, Lung opacity, Malaise, Myalgia
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/04 Janssen, dose #1 private sector, non-agency 08/16 pt cc: cough, headache, myalgias, fever,diarrhea exposure: unknown 08/18 COVID swab, result: detected 08/19 - 09/05 pt symptoms continue 08/25 cc: low oxygen levelc, dx:Acute hypoxic respiratory failure due to Covid 19 Pneumonia LOS: 7 days 08/25 CRP result: 21.583 08/26 Ferritin result: 876.2 08/25 ddimer result: 0.74 08/25 SARS-COV-2 IGG result 0:05 8/25 SARS-CoV-2 AB, spike result: >25.00 08/25 CXR impression: Moderate bilateral perihilar and peripheral infiltrates suspicious for infection. Covid pneumonia can have this appearance. Recommend clinical correlation. 08/26 FIBRINOGEN result: 480 08/26 DDIMER result: 1.16 08/26 ESR result: 97 08/26 CTA PE impression: No obvious pulmonary embolus. 2. Extensive bilateral changes of COVID 19 pneumonia, involving all pulmonary lobes. 3. Right lower paratracheal adenopathy is potentially reactive. 08/27 SARS-COV-2 IGG result 0.06 08/27 FIBRINOGEN result: 378 08/27DDIMER result: 1.23 08/27 ESR result: 92 08/28 FIBRINOGEN result: 378 08/28 DDIMER result: 1.40 08/28 ESR result: 93 H 08/28 SARS-COV-2 TOTAL AB, SPIKE SEMI QN result: >2500.0 H 08/28 DDIMER result: 1.52 08/29 CTA PE impression: 1. No definite evidence for pulmonary embolus.2. Similar bilateral groundglass opacities, consistent with COVID pneumonia. 08/30 DDIMER result: 2.27 H 08/31FIBRINOGEN result: 347 08/31 DDIMER result: 1.60 08/31 ESR result: 33 H 09/01 FIBRINOGEN result: 312 09/01 DDIMER result: 1.49 09/01 ESR 48 h 09/6 clinically resolved
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Oxygen saturation decreased, Paratracheal lymphadenopathy, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/04 Janssen, dose #1 private sector, non-agency 08/16 pt cc: cough, headache, myalgias, fever,diarrhea exposure: unknown 08/18 COVID swab, result: detected 08/19 - 09/05 pt symptoms continue 08/25 cc: low oxygen levelc, dx:Acute hypoxic respiratory failure due to Covid 19 Pneumonia LOS: 7 days 08/25 CRP result: 21.583 08/26 Ferritin result: 876.2 08/25 ddimer result: 0.74 08/25 SARS-COV-2 IGG result 0:05 8/25 SARS-CoV-2 AB, spike result: >25.00 08/25 CXR impression: Moderate bilateral perihilar and peripheral infiltrates suspicious for infection. Covid pneumonia can have this appearance. Recommend clinical correlation. 08/26 FIBRINOGEN result: 480 08/26 DDIMER result: 1.16 08/26 ESR result: 97 08/26 CTA PE impression: No obvious pulmonary embolus. 2. Extensive bilateral changes of COVID 19 pneumonia, involving all pulmonary lobes. 3. Right lower paratracheal adenopathy is potentially reactive. 08/27 SARS-COV-2 IGG result 0.06 08/27 FIBRINOGEN result: 378 08/27DDIMER result: 1.23 08/27 ESR result: 92 08/28 FIBRINOGEN result: 378 08/28 DDIMER result: 1.40 08/28 ESR result: 93 H 08/28 SARS-COV-2 TOTAL AB, SPIKE SEMI QN result: >2500.0 H 08/28 DDIMER result: 1.52 08/29 CTA PE impression: 1. No definite evidence for pulmonary embolus.2. Similar bilateral groundglass opacities, consistent with COVID pneumonia. 08/30 DDIMER result: 2.27 H 08/31FIBRINOGEN result: 347 08/31 DDIMER result: 1.60 08/31 ESR result: 33 H 09/01 FIBRINOGEN result: 312 09/01 DDIMER result: 1.49 09/01 ESR 48 h 09/6 clinically resolved
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Serum ferritin increased
Clinical narrative: Narrative: COVID infection following COVID vaccine series 04/04 Janssen, dose #1 private sector, non-agency 08/16 pt cc: cough, headache, myalgias, fever,diarrhea exposure: unknown 08/18 COVID swab, result: detected 08/19 - 09/05 pt symptoms continue 08/25 cc: low oxygen levelc, dx:Acute hypoxic respiratory failure due to Covid 19 Pneumonia LOS: 7 days 08/25 CRP result: 21.583 08/26 Ferritin result: 876.2 08/25 ddimer result: 0.74 08/25 SARS-COV-2 IGG result 0:05 8/25 SARS-CoV-2 AB, spike result: >25.00 08/25 CXR impression: Moderate bilateral perihilar and peripheral infiltrates suspicious for infection. Covid pneumonia can have this appearance. Recommend clinical correlation. 08/26 FIBRINOGEN result: 480 08/26 DDIMER result: 1.16 08/26 ESR result: 97 08/26 CTA PE impression: No obvious pulmonary embolus. 2. Extensive bilateral changes of COVID 19 pneumonia, involving all pulmonary lobes. 3. Right lower paratracheal adenopathy is potentially reactive. 08/27 SARS-COV-2 IGG result 0.06 08/27 FIBRINOGEN result: 378 08/27DDIMER result: 1.23 08/27 ESR result: 92 08/28 FIBRINOGEN result: 378 08/28 DDIMER result: 1.40 08/28 ESR result: 93 H 08/28 SARS-COV-2 TOTAL AB, SPIKE SEMI QN result: >2500.0 H 08/28 DDIMER result: 1.52 08/29 CTA PE impression: 1. No definite evidence for pulmonary embolus.2. Similar bilateral groundglass opacities, consistent with COVID pneumonia. 08/30 DDIMER result: 2.27 H 08/31FIBRINOGEN result: 347 08/31 DDIMER result: 1.60 08/31 ESR result: 33 H 09/01 FIBRINOGEN result: 312 09/01 DDIMER result: 1.49 09/01 ESR 48 h 09/6 clinically resolved
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  71yo male with - COPD, hx of lung CA, s/p R. total pneumectomy, OSA - Dysphagia, hx squamous cell CA of soft neck tissues - Asymptomatic carotid artery stenosis, HLD, BLE edema - GERD, Osteoporosis, Vit D deficiency - BPH, bladder CA, anemia, weight loss, B12 deficiency - Cataracts s/p PHACO died at hospital on 9/15/2021. Pt had received covid vaccines on 2/18/21 & 3/18/21 from his local county health dept.. Likely death not related to covid vaccines given pt's age, existing medical problems & length of time between death and date of vaccines.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Intensive care, SARS-CoV-2 test positive
Clinical narrative: Narrative: 64yr patient direct admit due COVID+ with requests for ongoing medical management of COVID given s/p lung transplant status. History of bilateral lung transplant 2016 on immunosuppressant therapy. Received Moderna x 2 (Jan/Feb). Hospitalized x 1 day (ICU) then discharged for ongoing /close management through agency Transplant team. Symptoms upon transfer cough, no SOB, or other complaints. Remained on RA with SpO2 at 95% during hospitalization (did not require Oxygen). did not receive dexamethasone or other inpatient COVID therapeutics. Was stable for discharge.
Age: 84.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19 pneumonia, Cough, Fatigue, Hypoxia, Intensive care
Clinical narrative: Narrative: 84yr patient who presented to the ED on 9/14/2021 with a 2 ay history of congestion, runny nose, fatigue and cough, and productive of clear sputum following a recent travel history for a funeral (potential for exposure; dinner at a restaurant and funeral goers not wearing masks). (COVID related): In the ED was found to hypoxic to the low 80s with minimal movements. Was admitted to ICU for further care (on 2L oxygen via NC) given PMH acute hypoxic respiratory failure in the setting of COVID and known COPD & restrictive lung disease 2/2 resections due to metastatic colon cancer. Along with non-COVID clinical findings (see H&P note for non-COVID work up). Pertinent medical history: colon cancer metastatic to the lung s/p LUL and LLL wedge resection (2004), CAD s/p PCI RCA (2004), complete heart block s/p pacemaker (2018), CKD3, HTN, mixed obstructive (COPD) and restrictive lung disease, known thoracic aortic abdominal aneurysm. Received moderna vaccine x 2 (1/21 and 2/21). Hospitalized in  ICU for COVID PNA X 5 days; received dexamethasone and remdesivir (5 total doses) and was on supplemental oxygen (2L NC). discharge at day 5; stable.
Age: 84.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Productive cough, Respiratory tract congestion, Rhinorrhoea
Clinical narrative: Narrative: 84yr patient who presented to the ED on 9/14/2021 with a 2 ay history of congestion, runny nose, fatigue and cough, and productive of clear sputum following a recent travel history for a funeral (potential for exposure; dinner at a restaurant and funeral goers not wearing masks). (COVID related): In the ED was found to hypoxic to the low 80s with minimal movements. Was admitted to ICU for further care (on 2L oxygen via NC) given PMH acute hypoxic respiratory failure in the setting of COVID and known COPD & restrictive lung disease 2/2 resections due to metastatic colon cancer. Along with non-COVID clinical findings (see H&P note for non-COVID work up). Pertinent medical history: colon cancer metastatic to the lung s/p LUL and LLL wedge resection (2004), CAD s/p PCI RCA (2004), complete heart block s/p pacemaker (2018), CKD3, HTN, mixed obstructive (COPD) and restrictive lung disease, known thoracic aortic abdominal aneurysm. Received moderna vaccine x 2 (1/21 and 2/21). Hospitalized in  ICU for COVID PNA X 5 days; received dexamethasone and remdesivir (5 total doses) and was on supplemental oxygen (2L NC). discharge at day 5; stable.
Age: 79.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Narrative:  Patient COVID-19 positive after receiving both doses of Moderna vaccine Jan/Feb 2021.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute myocardial infarction, Blood creatinine normal, Blood potassium normal, Blood sodium normal, Brain natriuretic peptide increased
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: C-reactive protein normal, Chest X-ray abnormal, Chest discomfort, Computerised tomogram thorax abnormal, Condition aggravated
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Fibrin D dimer, Haemoglobin normal
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Haemophagocytic lymphohistiocytosis, Immunisation reaction, Inflammatory marker increased, Intensive care, Lung consolidation
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Lung infiltration, Lung opacity, Myocarditis, Otitis media, Painful respiration
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Pneumonia, Productive cough, Pulmonary mass, Pyrexia, Rash
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Red blood cell sedimentation rate normal, SARS-CoV-2 test negative, Skin culture positive, Sputum discoloured, Staphylococcal infection
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 37.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Still's disease, Tachycardia, Troponin increased, White blood cell count normal
Clinical narrative: Narrative: Admission: 9/7/2021 Discharge: 9/17/2021 Acute Adult-Onset Still's Flare/Macrophage Activation Syndrome Diagnosis: 36yo female with h/o Adult Onset Still's disease (on Actemra every 2 weeks) and anxiety presented to the Emergency Dept 9/7/2021 with complaints of SOB. Patient stated that on 8/27/2021 she got the third (booster) dose of Pfizer COVID vaccine (2 previous Pfizer vaccinations were on 1/26/2021 and 2/16/2021 . Following this, she developed a productive cough and SOB and her symptoms got progressively worse. She endorsed significant SOB and chest pressure. She said it felt like something is sitting on her chest. She noted pain with inspiration. She endorsed productive cough of green sputum as well as fever up to 102 at home. Around the same time her son's teacher tested + for COVID, but she (the patient) had had 2 negative COVID tests in the past week. She was seen in the ED the previous day for these symptoms and was noted to have a pneumonia on CXR. She was started on Augmentin and given an albuterol inhaler. She says the inhaler helped a little, but the SOB and chest pressure got so bad today she had to come back to the ED on 9/7/2021. She denied vision changes, n/v, arm numbness/tingling, abdominal pain, diarrhea/constipation, dysuria, hematuria. She was admitted to the intensive care unit. On review of story and lack of risk factors, picture seemed more consistent with myocarditis; thought was secondary to the vaccine vs Still's dz. Rheumatology was consulted and believed vaccine was more likely etiology/higher on ddx, and requested Still's/MAS labs to trend. TTE was obtained with no evidence of myocarditis. MRI was not obtained as pt clinically was improving. Troponins rapidly downtrended. Pt was deemed stable for floor transfer on 9/9, with plan to c/w abx for LUL CAP/Otitis Media and obtain recs from rheum regarding new onset abd rash concerning for Still's flare on 9/9/21. Suspected Still's flare due to pulmonary infiltrate, type 2 NSTEMI, characteristic rashes and fever after 4 days of antibiotic treatment for CAP. There is concern for reactivation of Still's after COVID booster as well as Macrophage Activation Syndrome. Patient had improvement of her symptoms with Anakinra (started 9/13) and predisone (started on 9/10) with eventual downtrend of inflammatory markers. There was some initial concern for Acute generalized exanthematous pustulosis (AGEP) given concomitant abx treatment with Rocephin. However skin cx per derm showed coag neg staph and rash persisted despite d/c of abx. Thus rash was considered to be Still's related. The patient was discharged to home in stable condition.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative: 78 yo male with COPD, hx lung ca s/p lobectomy & on oxygen at home died at home on 6/26/21. Pt had received covid vaccines on 2/14/21 & 3/14/2021. This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Anticoagulant therapy, Anuria, Atrial fibrillation, Diuretic therapy
Clinical narrative: Narrative: 70 year old MALE with a PMH significant for CLL and prior pulmonary embolism on chronic anticoagulation who now presents with complaints of a one week h/o increased SOB and generalized muscle weakness and numbness. In the ED he was noted to be in atrial fibrillation with a HR of 130-150. He was placed on a diltiazem gtt and is now admitted to the MICU for critical care monitoring and management. He presently denies chest pain, back or pleuritic pain, palpitations. and cough. He had a fever in the ED but denies chills presently. ASSESSMENT/PLAN: 1. Severe sepsis: Not in shock; Most likely due to pneumonia - Start ceftriaxone and azithromycin - Volume replete with crystalloid and colloid solutions 2. Pneumonia: CAP vs. Aspiration - As per #1 3. Pulmonary embolus: No sihns of pulmonary HTN or RV compromise presently - Continue anticoqagulation 4. Acute kidney injury: Most likely due to hypovolemia and sepsis - Volume replete - Start loop diuretics prn 6. Hyperkalemia - start calcium, HCO3, D50, IV regtular insulin, and Kayexylate - Start volume repletion as per #4 - Start loop diuretics prn 70 yo male with multiorgan failure including AKI. He presented to ER and was admitted with Afib/RVR and sepsis. He suffered a PEA arrest and required 3 pressors initially. He was was found to have Streptococcus on biofire. This morning he remains on epinephrine drip and levophed drip and has had no urine output and remains hyperkalemic. Temp ~103 Intubated, unresponsive, not on sedation Skin mottled, cool large ecchymoses on dependent areas of trunk No significant peripheral edema Patient is in multiorgan failure, has AKI undoubtedly in part secondary to ischemic ATN from sepsis and PEA arrest. He is now anuric. He is hyperkalemic with some peaking of T waves on EKG Discussed with ICU team, dialysis would be very high risk given hemodynamic instability, multiple pressor requirement. However, as discussed with team, will offer a trial given he is now anuric and hyperkalemic with EKG changes. However, would do so reluctantly given that dialysis may result in terminal event given current tenuous status and is very unlikely to change the outcome. Patient is not stable enough to transfer to another facility for CRRT as per ICU team.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Ecchymosis, Electrocardiogram T wave peaked, Endotracheal intubation, Hyperkalaemia
Clinical narrative: Narrative: 70 year old MALE with a PMH significant for CLL and prior pulmonary embolism on chronic anticoagulation who now presents with complaints of a one week h/o increased SOB and generalized muscle weakness and numbness. In the ED he was noted to be in atrial fibrillation with a HR of 130-150. He was placed on a diltiazem gtt and is now admitted to the MICU for critical care monitoring and management. He presently denies chest pain, back or pleuritic pain, palpitations. and cough. He had a fever in the ED but denies chills presently. ASSESSMENT/PLAN: 1. Severe sepsis: Not in shock; Most likely due to pneumonia - Start ceftriaxone and azithromycin - Volume replete with crystalloid and colloid solutions 2. Pneumonia: CAP vs. Aspiration - As per #1 3. Pulmonary embolus: No sihns of pulmonary HTN or RV compromise presently - Continue anticoqagulation 4. Acute kidney injury: Most likely due to hypovolemia and sepsis - Volume replete - Start loop diuretics prn 6. Hyperkalemia - start calcium, HCO3, D50, IV regtular insulin, and Kayexylate - Start volume repletion as per #4 - Start loop diuretics prn 70 yo male with multiorgan failure including AKI. He presented to ER and was admitted with Afib/RVR and sepsis. He suffered a PEA arrest and required 3 pressors initially. He was was found to have Streptococcus on biofire. This morning he remains on epinephrine drip and levophed drip and has had no urine output and remains hyperkalemic. Temp ~103 Intubated, unresponsive, not on sedation Skin mottled, cool large ecchymoses on dependent areas of trunk No significant peripheral edema Patient is in multiorgan failure, has AKI undoubtedly in part secondary to ischemic ATN from sepsis and PEA arrest. He is now anuric. He is hyperkalemic with some peaking of T waves on EKG Discussed with ICU team, dialysis would be very high risk given hemodynamic instability, multiple pressor requirement. However, as discussed with team, will offer a trial given he is now anuric and hyperkalemic with EKG changes. However, would do so reluctantly given that dialysis may result in terminal event given current tenuous status and is very unlikely to change the outcome. Patient is not stable enough to transfer to another facility for CRRT as per ICU team.