chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Sepsis, Septic shock, Troponin increased, Ultrasound abdomen normal
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Ventricular hypokinesia
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 77.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chills, Headache, Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion
Clinical narrative: Cold like symptom, headache, chills, sore throat and sinus and chest congestion.
Age: 77.0
Sex: M
Vaccine: COVID19-2
Symptoms: Sinus congestion
Clinical narrative: Cold like symptom, headache, chills, sore throat and sinus and chest congestion.
Age: 56.0
Sex: M
Vaccine: COVID19, FLUC4
Symptoms: Vaccination error, Wrong technique in product usage process
Clinical narrative: Medication error- patient was given an injection with no vaccine, the injection only contained air.
Age: 40.0
Sex: M
Vaccine: COVID19-2
Symptoms: Lethargy, Pyrexia
Clinical narrative: Lethargic,  Fever of 101.4
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Angiogram pulmonary abnormal, Blood creatinine, COVID-19, Catheterisation cardiac abnormal
Clinical narrative: Patient is a 64 y.o. male patient of CNP with history of hypertension, hyperlipidemia, type 2 diabetes mellitus, diabetic neuropathy, morbid obesity, obstructive sleep apnea, diastolic congestive heart failure, bilateral lower extremity venous insufficiency, severe degenerative disc, lumbar spinal stenosis, right hip osteoarthritis, restless leg syndrome, migraine presented to Hospital with chest pain.   Acute kidney injury Patient had a heart catheterization 9/15 resolved    Cough-  Shortness of breath - resolving COVID-19 infection COVID-positive on admission CTA chest shows mild emphysema, negative PE Isolation S/p remdesivir S/p decadron On RA, no acute signs of respiratory decompensation   Covid-19 Virus Infection Date of onset of symptoms: week prior to 9-12-2023 Symptoms present on admission: SOB chest pain  Date of covid positive test: 9-12-2023 Vaccination status: unknown Imaging: negative  Oxygen requirements on admission: no Current oxygen requirements: weaned  Medical therapy: remdesivir   Episode of nonsustained V. Tach S/ left heart cath - no chest pain Recurrent episode of nonsustained V. tach  Given concern of NSVT and chest pain 30-day event monitor ordered   Chest pain resolved History of HF  Unsure chest pain from cardiac origin versus COVID Troponin negative EKG WNL Continue Bumex 1 mg, metoprolol, lisinopril On 9/15 cardiac cath showed nonobstructive coronary disease and normal LV filling pressures Type 2 insulin-dependent diabetes mellitus Insulin home dose  Keep BG between 140-180    Right hip osteoarthritis Severe physical deconditioning Chronic fatigue syndrome PT OT Tylenol as needed   Hypertension Lisinopril   Dyslipidemia Statin     Restless leg syndrome Requip     morbid obesity Body mass index 49 OSA CPAP   CKD stage IIIa Baseline creatinine 1.6    monitor
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chest pain, Chronic fatigue syndrome, Coronary artery disease, Cough, Dyspnoea
Clinical narrative: Patient is a 64 y.o. male patient of CNP with history of hypertension, hyperlipidemia, type 2 diabetes mellitus, diabetic neuropathy, morbid obesity, obstructive sleep apnea, diastolic congestive heart failure, bilateral lower extremity venous insufficiency, severe degenerative disc, lumbar spinal stenosis, right hip osteoarthritis, restless leg syndrome, migraine presented to Hospital with chest pain.   Acute kidney injury Patient had a heart catheterization 9/15 resolved    Cough-  Shortness of breath - resolving COVID-19 infection COVID-positive on admission CTA chest shows mild emphysema, negative PE Isolation S/p remdesivir S/p decadron On RA, no acute signs of respiratory decompensation   Covid-19 Virus Infection Date of onset of symptoms: week prior to 9-12-2023 Symptoms present on admission: SOB chest pain  Date of covid positive test: 9-12-2023 Vaccination status: unknown Imaging: negative  Oxygen requirements on admission: no Current oxygen requirements: weaned  Medical therapy: remdesivir   Episode of nonsustained V. Tach S/ left heart cath - no chest pain Recurrent episode of nonsustained V. tach  Given concern of NSVT and chest pain 30-day event monitor ordered   Chest pain resolved History of HF  Unsure chest pain from cardiac origin versus COVID Troponin negative EKG WNL Continue Bumex 1 mg, metoprolol, lisinopril On 9/15 cardiac cath showed nonobstructive coronary disease and normal LV filling pressures Type 2 insulin-dependent diabetes mellitus Insulin home dose  Keep BG between 140-180    Right hip osteoarthritis Severe physical deconditioning Chronic fatigue syndrome PT OT Tylenol as needed   Hypertension Lisinopril   Dyslipidemia Statin     Restless leg syndrome Requip     morbid obesity Body mass index 49 OSA CPAP   CKD stage IIIa Baseline creatinine 1.6    monitor
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Electrocardiogram normal, Emphysema, Imaging procedure, Physical deconditioning, SARS-CoV-2 test positive
Clinical narrative: Patient is a 64 y.o. male patient of CNP with history of hypertension, hyperlipidemia, type 2 diabetes mellitus, diabetic neuropathy, morbid obesity, obstructive sleep apnea, diastolic congestive heart failure, bilateral lower extremity venous insufficiency, severe degenerative disc, lumbar spinal stenosis, right hip osteoarthritis, restless leg syndrome, migraine presented to Hospital with chest pain.   Acute kidney injury Patient had a heart catheterization 9/15 resolved    Cough-  Shortness of breath - resolving COVID-19 infection COVID-positive on admission CTA chest shows mild emphysema, negative PE Isolation S/p remdesivir S/p decadron On RA, no acute signs of respiratory decompensation   Covid-19 Virus Infection Date of onset of symptoms: week prior to 9-12-2023 Symptoms present on admission: SOB chest pain  Date of covid positive test: 9-12-2023 Vaccination status: unknown Imaging: negative  Oxygen requirements on admission: no Current oxygen requirements: weaned  Medical therapy: remdesivir   Episode of nonsustained V. Tach S/ left heart cath - no chest pain Recurrent episode of nonsustained V. tach  Given concern of NSVT and chest pain 30-day event monitor ordered   Chest pain resolved History of HF  Unsure chest pain from cardiac origin versus COVID Troponin negative EKG WNL Continue Bumex 1 mg, metoprolol, lisinopril On 9/15 cardiac cath showed nonobstructive coronary disease and normal LV filling pressures Type 2 insulin-dependent diabetes mellitus Insulin home dose  Keep BG between 140-180    Right hip osteoarthritis Severe physical deconditioning Chronic fatigue syndrome PT OT Tylenol as needed   Hypertension Lisinopril   Dyslipidemia Statin     Restless leg syndrome Requip     morbid obesity Body mass index 49 OSA CPAP   CKD stage IIIa Baseline creatinine 1.6    monitor
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Troponin normal, Ventricular tachycardia
Clinical narrative: Patient is a 64 y.o. male patient of CNP with history of hypertension, hyperlipidemia, type 2 diabetes mellitus, diabetic neuropathy, morbid obesity, obstructive sleep apnea, diastolic congestive heart failure, bilateral lower extremity venous insufficiency, severe degenerative disc, lumbar spinal stenosis, right hip osteoarthritis, restless leg syndrome, migraine presented to Hospital with chest pain.   Acute kidney injury Patient had a heart catheterization 9/15 resolved    Cough-  Shortness of breath - resolving COVID-19 infection COVID-positive on admission CTA chest shows mild emphysema, negative PE Isolation S/p remdesivir S/p decadron On RA, no acute signs of respiratory decompensation   Covid-19 Virus Infection Date of onset of symptoms: week prior to 9-12-2023 Symptoms present on admission: SOB chest pain  Date of covid positive test: 9-12-2023 Vaccination status: unknown Imaging: negative  Oxygen requirements on admission: no Current oxygen requirements: weaned  Medical therapy: remdesivir   Episode of nonsustained V. Tach S/ left heart cath - no chest pain Recurrent episode of nonsustained V. tach  Given concern of NSVT and chest pain 30-day event monitor ordered   Chest pain resolved History of HF  Unsure chest pain from cardiac origin versus COVID Troponin negative EKG WNL Continue Bumex 1 mg, metoprolol, lisinopril On 9/15 cardiac cath showed nonobstructive coronary disease and normal LV filling pressures Type 2 insulin-dependent diabetes mellitus Insulin home dose  Keep BG between 140-180    Right hip osteoarthritis Severe physical deconditioning Chronic fatigue syndrome PT OT Tylenol as needed   Hypertension Lisinopril   Dyslipidemia Statin     Restless leg syndrome Requip     morbid obesity Body mass index 49 OSA CPAP   CKD stage IIIa Baseline creatinine 1.6    monitor
Age: 27.0
Sex: F
Vaccine: COVID19
Symptoms: Vaccination error, Wrong technique in product usage process
Clinical narrative: Medication error- patient was given an injection with no vaccine, the injection only contained air.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Arthralgia, Chills, Decreased appetite, Headache, Insomnia
Clinical narrative: Severe neuropathic foot pain. Severe joint and muscle pain requiring pain meds. Unable to sleep using zolpidem. When starting to fall asleep body twitches to wake up.   Headache. No appetite. Severe chills.  Had to use electric blanket.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Muscle twitching, Myalgia, Neuralgia, Pain in extremity
Clinical narrative: Severe neuropathic foot pain. Severe joint and muscle pain requiring pain meds. Unable to sleep using zolpidem. When starting to fall asleep body twitches to wake up.   Headache. No appetite. Severe chills.  Had to use electric blanket.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Medication error, Product dose omission issue
Clinical narrative: Medication error- patient was given an injection with no vaccine, the injection only contained air.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood creatine phosphokinase, Blood creatinine, COVID-19, Confusional state
Clinical narrative: Patient is a 76 y.o. female patient of DO with history of  CHF, CKD stage III-IV, CAD with prior CABG, multiple stents, hypertension, hyperlipidemia, OSA on CPAP, urine incontinence, insulin-dependent 2 diabetes, chronic weakness, osteoarthritis, degenerative changes, morbid obesity, who presented from home with generalized weakness, confusion. She was found to have COVID and rhabdomyolysis.  She received fluid resuscitation with improvement in her creatinine as well as her CK.  She remained hemodynamically stable throughout her hospitalization with improved mental status and never had any respiratory issues.  She worked with physical therapy and was able to ambulate 42 feet with a walker.  Ultimately, patient was hemodynamically stable and discharged home on 9/28.  Her husband who was also hospitalized at the same time was discharged the same day and they went home together.     Discharge diagnosis   Acute on chronic Encephalopathy, metabolic , resolved Hx of Dementia Non-traumatic Rhabdomyolysis Generalized Weakness Hypokalemia SARS-Covid-Positive  Vitamin D deficiency Chronic kidney disease stage IV CAD s/p CABG/stents Chronic elevated troponin Chronic HFpEF Morbid obesity Hypertension OSA on CPAP Hyperlipidemia Osteoarthritis Anxiety/depression
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Encephalopathy, Mental status changes, Metabolic encephalopathy, Rhabdomyolysis, Walking aid user
Clinical narrative: Patient is a 76 y.o. female patient of DO with history of  CHF, CKD stage III-IV, CAD with prior CABG, multiple stents, hypertension, hyperlipidemia, OSA on CPAP, urine incontinence, insulin-dependent 2 diabetes, chronic weakness, osteoarthritis, degenerative changes, morbid obesity, who presented from home with generalized weakness, confusion. She was found to have COVID and rhabdomyolysis.  She received fluid resuscitation with improvement in her creatinine as well as her CK.  She remained hemodynamically stable throughout her hospitalization with improved mental status and never had any respiratory issues.  She worked with physical therapy and was able to ambulate 42 feet with a walker.  Ultimately, patient was hemodynamically stable and discharged home on 9/28.  Her husband who was also hospitalized at the same time was discharged the same day and they went home together.     Discharge diagnosis   Acute on chronic Encephalopathy, metabolic , resolved Hx of Dementia Non-traumatic Rhabdomyolysis Generalized Weakness Hypokalemia SARS-Covid-Positive  Vitamin D deficiency Chronic kidney disease stage IV CAD s/p CABG/stents Chronic elevated troponin Chronic HFpEF Morbid obesity Hypertension OSA on CPAP Hyperlipidemia Osteoarthritis Anxiety/depression
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Feeding disorder, Feeling hot, Gait disturbance, Headache, Malaise
Clinical narrative: 101.  5 fever headache. cant eat can?t walk well hot feel ill.   had BOTH FLU AND MODERNA COVID VAX AT SAME TIME
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia
Clinical narrative: 101.  5 fever headache. cant eat can?t walk well hot feel ill.   had BOTH FLU AND MODERNA COVID VAX AT SAME TIME
Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Aortic valve incompetence, Blood sodium decreased, Blood thyroid stimulating hormone normal, Brain natriuretic peptide increased
Clinical narrative: Patient is a 89 y.o. female with history of COPD, CKD IV (with history of 1986 renal transplant) who presented from home (lives with daughter) on 9/20/2023 with shortness of breath and hypoxemia in the setting of COVID-19. Course complicated by hypotonic, hyponatremia possibly in setting of COVID. Nephrology followed, s/p 2 doses tolvaptan and with fluid restriction. She is medically stable for discharge home. Home healthcare was declined.   Acute respiratory failure with hypoxemia, resolved COVID-19 pneumonia - Positive COVID-19: 9/20 at ED - Vaccination status: Vaccinated with Moderna with last dose 2023 - Decadron: Yes. End date 9/28 on discharge - Remdesivir: Yes. end date 9/24 - E consult ID, appreciate recs; no need for home oxygen on discharge; stop decadron on discharge   Hypotonic Hyponatremia - in light of COVID infection and respiratory symptoms above; there does remain concern for SIADH - On admit, Na 123 with nadir of 114 (9/22/23), improving; s/p tolvaptan 9/23 and 9/24; Urine osm pending, urine Na mildly elevated, more consitent with SIADH; TSH wnl; low pre-test concern for cortisol deficiency given labs and pressures - Nephrology followed; will discharge with fluid restriction(1.2L), TID NaCl tablets, and increased home lasix to 40mg PO; daughter was aware of changes and agreeable to this management   Acute on Chronic HFpEF - History of HFpEF with previous hospitalization in 4/2023 for volume overload.  - 12/2022 limited Echo wih EF 65%, mild AS, mild-mod AR, and mild TR; Admit BNP 41.6 K (31.5 K, 1 month prior)  - resume home lasix as noted above   Presumed COPD History of tobacco abuse - Presumed COPD during last admission but no formal PFTs found. Has been following up with respiratory therapy in outpatient setting per the daughter. - Continue home inhalers on discharge; recommend formal PFTs   Hypothyroidism - Daughter confirms that patient takes 50 mcg of levothyroxine, but takes 2 tabs on Sundays. - Continue home synthroid     History of CVA - Continue aspirin.  No acute symptoms at this time.   CKD stage IV History of renal transplant 1986 History of interstitial nephritis - Continue home suppression therapy for now.  Continue to follow renal function.  Nephrology consulted as above   Hypertension, essential - Continue home medications as hemodynamics allow - Renal team added Norvasc daily. She is on Coreg 6.25 mg bid longer term; continue both on dischargeaseline creat 2, stable
Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal
Clinical narrative: Patient is a 89 y.o. female with history of COPD, CKD IV (with history of 1986 renal transplant) who presented from home (lives with daughter) on 9/20/2023 with shortness of breath and hypoxemia in the setting of COVID-19. Course complicated by hypotonic, hyponatremia possibly in setting of COVID. Nephrology followed, s/p 2 doses tolvaptan and with fluid restriction. She is medically stable for discharge home. Home healthcare was declined.   Acute respiratory failure with hypoxemia, resolved COVID-19 pneumonia - Positive COVID-19: 9/20 at ED - Vaccination status: Vaccinated with Moderna with last dose 2023 - Decadron: Yes. End date 9/28 on discharge - Remdesivir: Yes. end date 9/24 - E consult ID, appreciate recs; no need for home oxygen on discharge; stop decadron on discharge   Hypotonic Hyponatremia - in light of COVID infection and respiratory symptoms above; there does remain concern for SIADH - On admit, Na 123 with nadir of 114 (9/22/23), improving; s/p tolvaptan 9/23 and 9/24; Urine osm pending, urine Na mildly elevated, more consitent with SIADH; TSH wnl; low pre-test concern for cortisol deficiency given labs and pressures - Nephrology followed; will discharge with fluid restriction(1.2L), TID NaCl tablets, and increased home lasix to 40mg PO; daughter was aware of changes and agreeable to this management   Acute on Chronic HFpEF - History of HFpEF with previous hospitalization in 4/2023 for volume overload.  - 12/2022 limited Echo wih EF 65%, mild AS, mild-mod AR, and mild TR; Admit BNP 41.6 K (31.5 K, 1 month prior)  - resume home lasix as noted above   Presumed COPD History of tobacco abuse - Presumed COPD during last admission but no formal PFTs found. Has been following up with respiratory therapy in outpatient setting per the daughter. - Continue home inhalers on discharge; recommend formal PFTs   Hypothyroidism - Daughter confirms that patient takes 50 mcg of levothyroxine, but takes 2 tabs on Sundays. - Continue home synthroid     History of CVA - Continue aspirin.  No acute symptoms at this time.   CKD stage IV History of renal transplant 1986 History of interstitial nephritis - Continue home suppression therapy for now.  Continue to follow renal function.  Nephrology consulted as above   Hypertension, essential - Continue home medications as hemodynamics allow - Renal team added Norvasc daily. She is on Coreg 6.25 mg bid longer term; continue both on dischargeaseline creat 2, stable
Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Essential hypertension, Hypervolaemia, Hyponatraemia, Hypothyroidism, Hypotonia
Clinical narrative: Patient is a 89 y.o. female with history of COPD, CKD IV (with history of 1986 renal transplant) who presented from home (lives with daughter) on 9/20/2023 with shortness of breath and hypoxemia in the setting of COVID-19. Course complicated by hypotonic, hyponatremia possibly in setting of COVID. Nephrology followed, s/p 2 doses tolvaptan and with fluid restriction. She is medically stable for discharge home. Home healthcare was declined.   Acute respiratory failure with hypoxemia, resolved COVID-19 pneumonia - Positive COVID-19: 9/20 at ED - Vaccination status: Vaccinated with Moderna with last dose 2023 - Decadron: Yes. End date 9/28 on discharge - Remdesivir: Yes. end date 9/24 - E consult ID, appreciate recs; no need for home oxygen on discharge; stop decadron on discharge   Hypotonic Hyponatremia - in light of COVID infection and respiratory symptoms above; there does remain concern for SIADH - On admit, Na 123 with nadir of 114 (9/22/23), improving; s/p tolvaptan 9/23 and 9/24; Urine osm pending, urine Na mildly elevated, more consitent with SIADH; TSH wnl; low pre-test concern for cortisol deficiency given labs and pressures - Nephrology followed; will discharge with fluid restriction(1.2L), TID NaCl tablets, and increased home lasix to 40mg PO; daughter was aware of changes and agreeable to this management   Acute on Chronic HFpEF - History of HFpEF with previous hospitalization in 4/2023 for volume overload.  - 12/2022 limited Echo wih EF 65%, mild AS, mild-mod AR, and mild TR; Admit BNP 41.6 K (31.5 K, 1 month prior)  - resume home lasix as noted above   Presumed COPD History of tobacco abuse - Presumed COPD during last admission but no formal PFTs found. Has been following up with respiratory therapy in outpatient setting per the daughter. - Continue home inhalers on discharge; recommend formal PFTs   Hypothyroidism - Daughter confirms that patient takes 50 mcg of levothyroxine, but takes 2 tabs on Sundays. - Continue home synthroid     History of CVA - Continue aspirin.  No acute symptoms at this time.   CKD stage IV History of renal transplant 1986 History of interstitial nephritis - Continue home suppression therapy for now.  Continue to follow renal function.  Nephrology consulted as above   Hypertension, essential - Continue home medications as hemodynamics allow - Renal team added Norvasc daily. She is on Coreg 6.25 mg bid longer term; continue both on dischargeaseline creat 2, stable
Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Inappropriate antidiuretic hormone secretion, Respiratory symptom, SARS-CoV-2 test positive, Tricuspid valve incompetence
Clinical narrative: Patient is a 89 y.o. female with history of COPD, CKD IV (with history of 1986 renal transplant) who presented from home (lives with daughter) on 9/20/2023 with shortness of breath and hypoxemia in the setting of COVID-19. Course complicated by hypotonic, hyponatremia possibly in setting of COVID. Nephrology followed, s/p 2 doses tolvaptan and with fluid restriction. She is medically stable for discharge home. Home healthcare was declined.   Acute respiratory failure with hypoxemia, resolved COVID-19 pneumonia - Positive COVID-19: 9/20 at ED - Vaccination status: Vaccinated with Moderna with last dose 2023 - Decadron: Yes. End date 9/28 on discharge - Remdesivir: Yes. end date 9/24 - E consult ID, appreciate recs; no need for home oxygen on discharge; stop decadron on discharge   Hypotonic Hyponatremia - in light of COVID infection and respiratory symptoms above; there does remain concern for SIADH - On admit, Na 123 with nadir of 114 (9/22/23), improving; s/p tolvaptan 9/23 and 9/24; Urine osm pending, urine Na mildly elevated, more consitent with SIADH; TSH wnl; low pre-test concern for cortisol deficiency given labs and pressures - Nephrology followed; will discharge with fluid restriction(1.2L), TID NaCl tablets, and increased home lasix to 40mg PO; daughter was aware of changes and agreeable to this management   Acute on Chronic HFpEF - History of HFpEF with previous hospitalization in 4/2023 for volume overload.  - 12/2022 limited Echo wih EF 65%, mild AS, mild-mod AR, and mild TR; Admit BNP 41.6 K (31.5 K, 1 month prior)  - resume home lasix as noted above   Presumed COPD History of tobacco abuse - Presumed COPD during last admission but no formal PFTs found. Has been following up with respiratory therapy in outpatient setting per the daughter. - Continue home inhalers on discharge; recommend formal PFTs   Hypothyroidism - Daughter confirms that patient takes 50 mcg of levothyroxine, but takes 2 tabs on Sundays. - Continue home synthroid     History of CVA - Continue aspirin.  No acute symptoms at this time.   CKD stage IV History of renal transplant 1986 History of interstitial nephritis - Continue home suppression therapy for now.  Continue to follow renal function.  Nephrology consulted as above   Hypertension, essential - Continue home medications as hemodynamics allow - Renal team added Norvasc daily. She is on Coreg 6.25 mg bid longer term; continue both on dischargeaseline creat 2, stable
Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Urine sodium increased
Clinical narrative: Patient is a 89 y.o. female with history of COPD, CKD IV (with history of 1986 renal transplant) who presented from home (lives with daughter) on 9/20/2023 with shortness of breath and hypoxemia in the setting of COVID-19. Course complicated by hypotonic, hyponatremia possibly in setting of COVID. Nephrology followed, s/p 2 doses tolvaptan and with fluid restriction. She is medically stable for discharge home. Home healthcare was declined.   Acute respiratory failure with hypoxemia, resolved COVID-19 pneumonia - Positive COVID-19: 9/20 at ED - Vaccination status: Vaccinated with Moderna with last dose 2023 - Decadron: Yes. End date 9/28 on discharge - Remdesivir: Yes. end date 9/24 - E consult ID, appreciate recs; no need for home oxygen on discharge; stop decadron on discharge   Hypotonic Hyponatremia - in light of COVID infection and respiratory symptoms above; there does remain concern for SIADH - On admit, Na 123 with nadir of 114 (9/22/23), improving; s/p tolvaptan 9/23 and 9/24; Urine osm pending, urine Na mildly elevated, more consitent with SIADH; TSH wnl; low pre-test concern for cortisol deficiency given labs and pressures - Nephrology followed; will discharge with fluid restriction(1.2L), TID NaCl tablets, and increased home lasix to 40mg PO; daughter was aware of changes and agreeable to this management   Acute on Chronic HFpEF - History of HFpEF with previous hospitalization in 4/2023 for volume overload.  - 12/2022 limited Echo wih EF 65%, mild AS, mild-mod AR, and mild TR; Admit BNP 41.6 K (31.5 K, 1 month prior)  - resume home lasix as noted above   Presumed COPD History of tobacco abuse - Presumed COPD during last admission but no formal PFTs found. Has been following up with respiratory therapy in outpatient setting per the daughter. - Continue home inhalers on discharge; recommend formal PFTs   Hypothyroidism - Daughter confirms that patient takes 50 mcg of levothyroxine, but takes 2 tabs on Sundays. - Continue home synthroid     History of CVA - Continue aspirin.  No acute symptoms at this time.   CKD stage IV History of renal transplant 1986 History of interstitial nephritis - Continue home suppression therapy for now.  Continue to follow renal function.  Nephrology consulted as above   Hypertension, essential - Continue home medications as hemodynamics allow - Renal team added Norvasc daily. She is on Coreg 6.25 mg bid longer term; continue both on dischargeaseline creat 2, stable
Age: 31.0
Sex: M
Vaccine: COVID19, FLUC4
Symptoms: Medication error
Clinical narrative: Medication error- patient was given an injection with no vaccine, the injection only contained air.
Age: 53.0
Sex: F
Vaccine: COVID19, FLUC4
Symptoms: Vaccination error, Wrong technique in product usage process
Clinical narrative: Medication error- patient was given an injection with no vaccine, the injection only contained air.
Age: 71.0
Sex: F
Vaccine: COVID19-2
Symptoms: Feeling abnormal, Headache, Hypotension, Loss of personal independence in daily activities, Muscular weakness
Clinical narrative: Thinking and thought process not normal, weakness in legs and arms, hypotension, head ache,  not my self, I normally swim daily, cook daily, I find it hard to do my normal task.
Age: 71.0
Sex: F
Vaccine: COVID19-2
Symptoms: Thinking abnormal
Clinical narrative: Thinking and thought process not normal, weakness in legs and arms, hypotension, head ache,  not my self, I normally swim daily, cook daily, I find it hard to do my normal task.
Age: 16.0
Sex: M
Vaccine: FLU4
Symptoms: Incorrect dose administered, No adverse event
Clinical narrative: Patient was given 2 doses of flu vaccine by mistake. No initial side effects seen and patient did not report any side effects.
Age: 102.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Resident is asymptomatic  Tested positive during random testing
Age: 15.0
Sex: F
Vaccine: HPV9
Symptoms: Dizziness, Hyperhidrosis, Pallor
Clinical narrative: reports feeling faint, alert  with no loss of LOC, pale and mild diaphoresis. cool cloth applied and reported did not eat lunch prior to apt. water and snack provided. Symptoms resolved in few minutes left for home with parent without difficulty
Age: 31.0
Sex: F
Vaccine: RSV
Symptoms: Exposure during pregnancy, Pain
Clinical narrative: Pregnant individual received a sterile injection in left arm.  Experienced localized pain
Age: 29.0
Sex: F
Vaccine: COVID19, FLUC4
Symptoms: Arthralgia
Clinical narrative: Patient contacted our office 24 hours of receiving a vaccination. Patient was experiencing joint type pain at the shoulder. Denies radiating pain. Per patient the vaccine was given 2.5 finger width below the acromion process. Director suggested patient use NSAID's and Ice to reduce any swelling. Recommended seeing primary care provider if pain increases.  Followed up with Patient 48 hours after. Patient stated the pain has decreased, but not subsided. Patient is taking an NSAID and stated it has helped.
Age: 63.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Erythema, Myalgia, Skin warm
Clinical narrative: pt complained of red hot arm and muscle soreness. treatment was to use hot pad on arm and to take over the counter apap if there is a fever that develops.
Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Cold sweat, Myalgia, Sleep disorder, Somnolence
Clinical narrative: Sore muscles and joints, sleepy - common, have had with earlier Covid vaccinations I didn't run a temperature, but the 1st 3 night I woke up shortly after falling asleep in a cold sweat.
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Immediate post-injection reaction, Injection site erythema, Injection site induration, Injection site pain
Clinical narrative: Patient reported redness and induration of about 4 inches on right arm post administration of Spikevax from a week prior. She states pain started right after injection but has subsided. She only feels pain upon application of pressure and is improving with time. She was advised to seek medical attention if pain does not go away completely within the next couple of days.
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Abdominal distension, Acute kidney injury, Acute respiratory failure, Asthenia, Blood creatine
Clinical narrative: Patient is a 86 y.o. male patient of, MD with history of prostate cancer, history of chronic kidney disease stage III with baseline creatinine is 1.4 and GFR 40 to 45% a year ago, also history of hypertension hyperlipidemia diabetes mellitus obesity is here status post fall and weakness cough and shortness of breath was found to have COVID-19 positive hypoxic on arrival with oxygen saturation 88% at room air improved and stable at 2 L 95% oxygen saturation, noticed lactic acidosis of 4.7 and leukocytosis of 11,000 and concern of sepsis with SIRS criteria on arrival given broad-spectrum antibiotics as well chest x-ray showed infiltrates and concerning for pneumonia   Acute hypoxic respiratory failure COVID-19 respiratory infection Pneumonia in the setting of COVID infection Is placed on oxygen and stable with nasal cannula, we will keep the patient telemetry and check inflammatory markers infectious disease consult was placed,  start Decadron and remdesivir in the hospital .    On room air this am and in no distress ID consulted, agreeable with Decadron and remdesivir   Sepsis present on admission evidenced with  SIRS criteria with lactic acidosis at 4.7 and leukocytosis 11,000, and oxygen sat less than 90 on room air Source of sepsis covid pneumonia septic work-up in process included blood cultures urine culture,  given his abdominal distention CAT scan of the abdomen pelvis report reviewed negative for acute findingsLactic acid down to 1.8 WBC 9.16  Afebrile  In no distress    Acute kidney injury With creatinine up to 1.9 and baseline 1.4 a year ago, prerenal azotemia and COVID mediated AKI,  CT abdomen pelvis no hydronephrosis Held HCTZ and losartan Kidney function back to normal on 9/20   Hypertension Holding losartan and hydrochlorothiazide Home regimen is also including amlodipine we will follow the trend of blood pressure Restart losartan, hydrochlorothiazide and amlodipine on 9/21   Hyperlipidemia On Pravachol Diabetes mellitus uncontrolled A1c 8 Holding metformin given the low GFR and monitor blood glucose insulin sliding scale, home regimen is maintained on Lantus and fixed dose of insulin with meals
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood culture, Blood lactic acid, COVID-19, COVID-19 pneumonia, Cardiac telemetry
Clinical narrative: Patient is a 86 y.o. male patient of, MD with history of prostate cancer, history of chronic kidney disease stage III with baseline creatinine is 1.4 and GFR 40 to 45% a year ago, also history of hypertension hyperlipidemia diabetes mellitus obesity is here status post fall and weakness cough and shortness of breath was found to have COVID-19 positive hypoxic on arrival with oxygen saturation 88% at room air improved and stable at 2 L 95% oxygen saturation, noticed lactic acidosis of 4.7 and leukocytosis of 11,000 and concern of sepsis with SIRS criteria on arrival given broad-spectrum antibiotics as well chest x-ray showed infiltrates and concerning for pneumonia   Acute hypoxic respiratory failure COVID-19 respiratory infection Pneumonia in the setting of COVID infection Is placed on oxygen and stable with nasal cannula, we will keep the patient telemetry and check inflammatory markers infectious disease consult was placed,  start Decadron and remdesivir in the hospital .    On room air this am and in no distress ID consulted, agreeable with Decadron and remdesivir   Sepsis present on admission evidenced with  SIRS criteria with lactic acidosis at 4.7 and leukocytosis 11,000, and oxygen sat less than 90 on room air Source of sepsis covid pneumonia septic work-up in process included blood cultures urine culture,  given his abdominal distention CAT scan of the abdomen pelvis report reviewed negative for acute findingsLactic acid down to 1.8 WBC 9.16  Afebrile  In no distress    Acute kidney injury With creatinine up to 1.9 and baseline 1.4 a year ago, prerenal azotemia and COVID mediated AKI,  CT abdomen pelvis no hydronephrosis Held HCTZ and losartan Kidney function back to normal on 9/20   Hypertension Holding losartan and hydrochlorothiazide Home regimen is also including amlodipine we will follow the trend of blood pressure Restart losartan, hydrochlorothiazide and amlodipine on 9/21   Hyperlipidemia On Pravachol Diabetes mellitus uncontrolled A1c 8 Holding metformin given the low GFR and monitor blood glucose insulin sliding scale, home regimen is maintained on Lantus and fixed dose of insulin with meals
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chest X-ray abnormal, Computerised tomogram abdomen normal, Cough, Culture urine, Dyspnoea
Clinical narrative: Patient is a 86 y.o. male patient of, MD with history of prostate cancer, history of chronic kidney disease stage III with baseline creatinine is 1.4 and GFR 40 to 45% a year ago, also history of hypertension hyperlipidemia diabetes mellitus obesity is here status post fall and weakness cough and shortness of breath was found to have COVID-19 positive hypoxic on arrival with oxygen saturation 88% at room air improved and stable at 2 L 95% oxygen saturation, noticed lactic acidosis of 4.7 and leukocytosis of 11,000 and concern of sepsis with SIRS criteria on arrival given broad-spectrum antibiotics as well chest x-ray showed infiltrates and concerning for pneumonia   Acute hypoxic respiratory failure COVID-19 respiratory infection Pneumonia in the setting of COVID infection Is placed on oxygen and stable with nasal cannula, we will keep the patient telemetry and check inflammatory markers infectious disease consult was placed,  start Decadron and remdesivir in the hospital .    On room air this am and in no distress ID consulted, agreeable with Decadron and remdesivir   Sepsis present on admission evidenced with  SIRS criteria with lactic acidosis at 4.7 and leukocytosis 11,000, and oxygen sat less than 90 on room air Source of sepsis covid pneumonia septic work-up in process included blood cultures urine culture,  given his abdominal distention CAT scan of the abdomen pelvis report reviewed negative for acute findingsLactic acid down to 1.8 WBC 9.16  Afebrile  In no distress    Acute kidney injury With creatinine up to 1.9 and baseline 1.4 a year ago, prerenal azotemia and COVID mediated AKI,  CT abdomen pelvis no hydronephrosis Held HCTZ and losartan Kidney function back to normal on 9/20   Hypertension Holding losartan and hydrochlorothiazide Home regimen is also including amlodipine we will follow the trend of blood pressure Restart losartan, hydrochlorothiazide and amlodipine on 9/21   Hyperlipidemia On Pravachol Diabetes mellitus uncontrolled A1c 8 Holding metformin given the low GFR and monitor blood glucose insulin sliding scale, home regimen is maintained on Lantus and fixed dose of insulin with meals
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Fall, Glomerular filtration rate decreased, Glycosylated haemoglobin increased, Hypoxia, Lactic acidosis
Clinical narrative: Patient is a 86 y.o. male patient of, MD with history of prostate cancer, history of chronic kidney disease stage III with baseline creatinine is 1.4 and GFR 40 to 45% a year ago, also history of hypertension hyperlipidemia diabetes mellitus obesity is here status post fall and weakness cough and shortness of breath was found to have COVID-19 positive hypoxic on arrival with oxygen saturation 88% at room air improved and stable at 2 L 95% oxygen saturation, noticed lactic acidosis of 4.7 and leukocytosis of 11,000 and concern of sepsis with SIRS criteria on arrival given broad-spectrum antibiotics as well chest x-ray showed infiltrates and concerning for pneumonia   Acute hypoxic respiratory failure COVID-19 respiratory infection Pneumonia in the setting of COVID infection Is placed on oxygen and stable with nasal cannula, we will keep the patient telemetry and check inflammatory markers infectious disease consult was placed,  start Decadron and remdesivir in the hospital .    On room air this am and in no distress ID consulted, agreeable with Decadron and remdesivir   Sepsis present on admission evidenced with  SIRS criteria with lactic acidosis at 4.7 and leukocytosis 11,000, and oxygen sat less than 90 on room air Source of sepsis covid pneumonia septic work-up in process included blood cultures urine culture,  given his abdominal distention CAT scan of the abdomen pelvis report reviewed negative for acute findingsLactic acid down to 1.8 WBC 9.16  Afebrile  In no distress    Acute kidney injury With creatinine up to 1.9 and baseline 1.4 a year ago, prerenal azotemia and COVID mediated AKI,  CT abdomen pelvis no hydronephrosis Held HCTZ and losartan Kidney function back to normal on 9/20   Hypertension Holding losartan and hydrochlorothiazide Home regimen is also including amlodipine we will follow the trend of blood pressure Restart losartan, hydrochlorothiazide and amlodipine on 9/21   Hyperlipidemia On Pravachol Diabetes mellitus uncontrolled A1c 8 Holding metformin given the low GFR and monitor blood glucose insulin sliding scale, home regimen is maintained on Lantus and fixed dose of insulin with meals
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Leukocytosis, Lung infiltration, Renal impairment, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient is a 86 y.o. male patient of, MD with history of prostate cancer, history of chronic kidney disease stage III with baseline creatinine is 1.4 and GFR 40 to 45% a year ago, also history of hypertension hyperlipidemia diabetes mellitus obesity is here status post fall and weakness cough and shortness of breath was found to have COVID-19 positive hypoxic on arrival with oxygen saturation 88% at room air improved and stable at 2 L 95% oxygen saturation, noticed lactic acidosis of 4.7 and leukocytosis of 11,000 and concern of sepsis with SIRS criteria on arrival given broad-spectrum antibiotics as well chest x-ray showed infiltrates and concerning for pneumonia   Acute hypoxic respiratory failure COVID-19 respiratory infection Pneumonia in the setting of COVID infection Is placed on oxygen and stable with nasal cannula, we will keep the patient telemetry and check inflammatory markers infectious disease consult was placed,  start Decadron and remdesivir in the hospital .    On room air this am and in no distress ID consulted, agreeable with Decadron and remdesivir   Sepsis present on admission evidenced with  SIRS criteria with lactic acidosis at 4.7 and leukocytosis 11,000, and oxygen sat less than 90 on room air Source of sepsis covid pneumonia septic work-up in process included blood cultures urine culture,  given his abdominal distention CAT scan of the abdomen pelvis report reviewed negative for acute findingsLactic acid down to 1.8 WBC 9.16  Afebrile  In no distress    Acute kidney injury With creatinine up to 1.9 and baseline 1.4 a year ago, prerenal azotemia and COVID mediated AKI,  CT abdomen pelvis no hydronephrosis Held HCTZ and losartan Kidney function back to normal on 9/20   Hypertension Holding losartan and hydrochlorothiazide Home regimen is also including amlodipine we will follow the trend of blood pressure Restart losartan, hydrochlorothiazide and amlodipine on 9/21   Hyperlipidemia On Pravachol Diabetes mellitus uncontrolled A1c 8 Holding metformin given the low GFR and monitor blood glucose insulin sliding scale, home regimen is maintained on Lantus and fixed dose of insulin with meals
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Systemic inflammatory response syndrome, White blood cell count increased
Clinical narrative: Patient is a 86 y.o. male patient of, MD with history of prostate cancer, history of chronic kidney disease stage III with baseline creatinine is 1.4 and GFR 40 to 45% a year ago, also history of hypertension hyperlipidemia diabetes mellitus obesity is here status post fall and weakness cough and shortness of breath was found to have COVID-19 positive hypoxic on arrival with oxygen saturation 88% at room air improved and stable at 2 L 95% oxygen saturation, noticed lactic acidosis of 4.7 and leukocytosis of 11,000 and concern of sepsis with SIRS criteria on arrival given broad-spectrum antibiotics as well chest x-ray showed infiltrates and concerning for pneumonia   Acute hypoxic respiratory failure COVID-19 respiratory infection Pneumonia in the setting of COVID infection Is placed on oxygen and stable with nasal cannula, we will keep the patient telemetry and check inflammatory markers infectious disease consult was placed,  start Decadron and remdesivir in the hospital .    On room air this am and in no distress ID consulted, agreeable with Decadron and remdesivir   Sepsis present on admission evidenced with  SIRS criteria with lactic acidosis at 4.7 and leukocytosis 11,000, and oxygen sat less than 90 on room air Source of sepsis covid pneumonia septic work-up in process included blood cultures urine culture,  given his abdominal distention CAT scan of the abdomen pelvis report reviewed negative for acute findingsLactic acid down to 1.8 WBC 9.16  Afebrile  In no distress    Acute kidney injury With creatinine up to 1.9 and baseline 1.4 a year ago, prerenal azotemia and COVID mediated AKI,  CT abdomen pelvis no hydronephrosis Held HCTZ and losartan Kidney function back to normal on 9/20   Hypertension Holding losartan and hydrochlorothiazide Home regimen is also including amlodipine we will follow the trend of blood pressure Restart losartan, hydrochlorothiazide and amlodipine on 9/21   Hyperlipidemia On Pravachol Diabetes mellitus uncontrolled A1c 8 Holding metformin given the low GFR and monitor blood glucose insulin sliding scale, home regimen is maintained on Lantus and fixed dose of insulin with meals
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Nasopharyngitis, SARS-CoV-2 test positive
Clinical narrative: Resident presents with mild cold  like symptoms