chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: Angiogram pulmonary abnormal, Blood gases normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: PRESENTING PROBLEM: COPD with acute exacerbation [J44.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 67 y.o. male past medical history COPD, tobacco abuse, HTN, HLD, CAD, PAD and prior history of PE on Eliquis who presents with SOB and cough.   In the Emergency Department, Patient tested positive for COVID 19, RSV and Flu were neg. He had CTA chest that showed no PE and pneumonia but showed some mild bronchial inflammation and mild emphysema. There was also incidental findings of pulmonary nodules. He had CXR neg for acute process as well but showed COPD. Labs were unremarkable in the ER including VBG and BNP. He remained on room air in the ER and his vitals were stable other than occasional tachypnea. He was given solumedrol and multiple inhalers in the ER. He was admitted to the hospitalist team for COPD and COVID. Patient was continued on chronic obstructive pulmonary disease treatment with inhalers and systemic steroids.  Tobacco abuse was treated with Nicoderm patch.  He was encouraged to adhere to complete cessation from smoking tobacco.  Sputum culture revealed Haemophilus influenzae with moderate be WBC count.  He was initiated on Augmentin oral therapy which will be continued for total course 5 days.  He was continued on systemic steroids and remdesivir.  Supplemental oxygen was rapidly weaned.  He was continued on antitussives and mucolytics.  He was noted to desaturate with exertion but had adequate oxygenation at rest on room air.  Home O2 evaluation performed and patient qualified for 2 L supplemental oxygen with activity.  MSW/CM consulted for discharge planning and outpatient DME.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days.  Outpatient pulmonology. Patient voiced understanding was agreeable with plan of care discharge.
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea, Emphysema
Clinical narrative: PRESENTING PROBLEM: COPD with acute exacerbation [J44.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 67 y.o. male past medical history COPD, tobacco abuse, HTN, HLD, CAD, PAD and prior history of PE on Eliquis who presents with SOB and cough.   In the Emergency Department, Patient tested positive for COVID 19, RSV and Flu were neg. He had CTA chest that showed no PE and pneumonia but showed some mild bronchial inflammation and mild emphysema. There was also incidental findings of pulmonary nodules. He had CXR neg for acute process as well but showed COPD. Labs were unremarkable in the ER including VBG and BNP. He remained on room air in the ER and his vitals were stable other than occasional tachypnea. He was given solumedrol and multiple inhalers in the ER. He was admitted to the hospitalist team for COPD and COVID. Patient was continued on chronic obstructive pulmonary disease treatment with inhalers and systemic steroids.  Tobacco abuse was treated with Nicoderm patch.  He was encouraged to adhere to complete cessation from smoking tobacco.  Sputum culture revealed Haemophilus influenzae with moderate be WBC count.  He was initiated on Augmentin oral therapy which will be continued for total course 5 days.  He was continued on systemic steroids and remdesivir.  Supplemental oxygen was rapidly weaned.  He was continued on antitussives and mucolytics.  He was noted to desaturate with exertion but had adequate oxygenation at rest on room air.  Home O2 evaluation performed and patient qualified for 2 L supplemental oxygen with activity.  MSW/CM consulted for discharge planning and outpatient DME.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days.  Outpatient pulmonology. Patient voiced understanding was agreeable with plan of care discharge.
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: Haemophilus test positive, Influenza virus test negative, Laboratory test normal, Metabolic function test normal, Oxygen saturation decreased
Clinical narrative: PRESENTING PROBLEM: COPD with acute exacerbation [J44.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 67 y.o. male past medical history COPD, tobacco abuse, HTN, HLD, CAD, PAD and prior history of PE on Eliquis who presents with SOB and cough.   In the Emergency Department, Patient tested positive for COVID 19, RSV and Flu were neg. He had CTA chest that showed no PE and pneumonia but showed some mild bronchial inflammation and mild emphysema. There was also incidental findings of pulmonary nodules. He had CXR neg for acute process as well but showed COPD. Labs were unremarkable in the ER including VBG and BNP. He remained on room air in the ER and his vitals were stable other than occasional tachypnea. He was given solumedrol and multiple inhalers in the ER. He was admitted to the hospitalist team for COPD and COVID. Patient was continued on chronic obstructive pulmonary disease treatment with inhalers and systemic steroids.  Tobacco abuse was treated with Nicoderm patch.  He was encouraged to adhere to complete cessation from smoking tobacco.  Sputum culture revealed Haemophilus influenzae with moderate be WBC count.  He was initiated on Augmentin oral therapy which will be continued for total course 5 days.  He was continued on systemic steroids and remdesivir.  Supplemental oxygen was rapidly weaned.  He was continued on antitussives and mucolytics.  He was noted to desaturate with exertion but had adequate oxygenation at rest on room air.  Home O2 evaluation performed and patient qualified for 2 L supplemental oxygen with activity.  MSW/CM consulted for discharge planning and outpatient DME.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days.  Outpatient pulmonology. Patient voiced understanding was agreeable with plan of care discharge.
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pneumonitis, Respiratory syncytial virus test negative, SARS-CoV-2 test positive, Sputum culture positive, Tachypnoea
Clinical narrative: PRESENTING PROBLEM: COPD with acute exacerbation [J44.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 67 y.o. male past medical history COPD, tobacco abuse, HTN, HLD, CAD, PAD and prior history of PE on Eliquis who presents with SOB and cough.   In the Emergency Department, Patient tested positive for COVID 19, RSV and Flu were neg. He had CTA chest that showed no PE and pneumonia but showed some mild bronchial inflammation and mild emphysema. There was also incidental findings of pulmonary nodules. He had CXR neg for acute process as well but showed COPD. Labs were unremarkable in the ER including VBG and BNP. He remained on room air in the ER and his vitals were stable other than occasional tachypnea. He was given solumedrol and multiple inhalers in the ER. He was admitted to the hospitalist team for COPD and COVID. Patient was continued on chronic obstructive pulmonary disease treatment with inhalers and systemic steroids.  Tobacco abuse was treated with Nicoderm patch.  He was encouraged to adhere to complete cessation from smoking tobacco.  Sputum culture revealed Haemophilus influenzae with moderate be WBC count.  He was initiated on Augmentin oral therapy which will be continued for total course 5 days.  He was continued on systemic steroids and remdesivir.  Supplemental oxygen was rapidly weaned.  He was continued on antitussives and mucolytics.  He was noted to desaturate with exertion but had adequate oxygenation at rest on room air.  Home O2 evaluation performed and patient qualified for 2 L supplemental oxygen with activity.  MSW/CM consulted for discharge planning and outpatient DME.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days.  Outpatient pulmonology. Patient voiced understanding was agreeable with plan of care discharge.
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: White blood cell count
Clinical narrative: PRESENTING PROBLEM: COPD with acute exacerbation [J44.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 67 y.o. male past medical history COPD, tobacco abuse, HTN, HLD, CAD, PAD and prior history of PE on Eliquis who presents with SOB and cough.   In the Emergency Department, Patient tested positive for COVID 19, RSV and Flu were neg. He had CTA chest that showed no PE and pneumonia but showed some mild bronchial inflammation and mild emphysema. There was also incidental findings of pulmonary nodules. He had CXR neg for acute process as well but showed COPD. Labs were unremarkable in the ER including VBG and BNP. He remained on room air in the ER and his vitals were stable other than occasional tachypnea. He was given solumedrol and multiple inhalers in the ER. He was admitted to the hospitalist team for COPD and COVID. Patient was continued on chronic obstructive pulmonary disease treatment with inhalers and systemic steroids.  Tobacco abuse was treated with Nicoderm patch.  He was encouraged to adhere to complete cessation from smoking tobacco.  Sputum culture revealed Haemophilus influenzae with moderate be WBC count.  He was initiated on Augmentin oral therapy which will be continued for total course 5 days.  He was continued on systemic steroids and remdesivir.  Supplemental oxygen was rapidly weaned.  He was continued on antitussives and mucolytics.  He was noted to desaturate with exertion but had adequate oxygenation at rest on room air.  Home O2 evaluation performed and patient qualified for 2 L supplemental oxygen with activity.  MSW/CM consulted for discharge planning and outpatient DME.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days.  Outpatient pulmonology. Patient voiced understanding was agreeable with plan of care discharge.
Age: 54.0
Sex: F
Vaccine: COVID19-2
Symptoms: Aphonia, Body temperature increased, Dyspnoea, Influenza virus test negative, Middle insomnia
Clinical narrative: I woke up at night and could not breathe and my husband took me to the hospital and I was diagnosed with double pneumonia, after I was home my temperature went up to 102 degrees but the doctors office was full and busy for the next four days then afterwards I lost my voice for about thirteen days.
Age: 54.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pneumonia, SARS-CoV-2 test negative
Clinical narrative: I woke up at night and could not breathe and my husband took me to the hospital and I was diagnosed with double pneumonia, after I was home my temperature went up to 102 degrees but the doctors office was full and busy for the next four days then afterwards I lost my voice for about thirteen days.
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered, Medication error
Clinical narrative: Medication error: Monovalent Covid-19 vaccine given instead of Bivalent covid-vaccine. Pharmacy has identifed root causes of the error and is putting mitigation strategies into place including barcode scanning to minimize chances of error re-occuring. A total of 3 patients have been impacted by this error.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatinine normal, COVID-19, Computerised tomogram abdomen abnormal, Dehydration, Diarrhoea
Clinical narrative: Patient is a 79 y.o. female patient of PRIVATE MD with history of  anemia, CAD S/P CABG, CHF, CKD, GERD, HLD, HTN, multiple myeloma, large B-cell lymphoma, renal cell carcinoma S/P right partial nephrectomy, mitral regurgitation S/P MVR, and thrombocytopenia  presented with nausea vomiting   Covid-19 Virus Infection Intractable nausea vomiting Date of onset of symptoms: 12/22/2022 Symptoms present on admission: Nausea vomiting and diarrhea Date of covid positive test: 12/23/2022 Vaccination status: vaccinated Imaging: CT abdomen and pelvis showed enteritis Oxygen requirements on admission: Room air Current oxygen requirements: Room air Medical therapy: not indicated Consultants following: None Anticipated special isolation end date: 12/27/2022 Antiemetics Gentle IV hydration Clear liquids advance as tolerated   Nausea and vomiting 2/2 enteritis: Resolved CT scan abdomen showed patient having enteritis Patient nausea vomiting and diarrhea have resolved.  Patient is doing well.  Patient was to be discharged home and will be discharged with advised to follow-up with PCP.   CAD Chronic congestive heart failure Continue home medications   Type 2 diabetes on long-term insulin use Continue NPH 70/30,  Continue insulin sliding scale Last A1c 8.5   Multiple myeloma History of RCC non-Hodgkin lymphoma Stable   CKD-IIIb Creatinine at baseline Monitor renal function and electrolytes IVF to correct dehydration   QT prolongation Avoid QT prolonging medications
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram QT prolonged, Enteritis, Glycosylated haemoglobin normal, Nausea, SARS-CoV-2 test positive
Clinical narrative: Patient is a 79 y.o. female patient of PRIVATE MD with history of  anemia, CAD S/P CABG, CHF, CKD, GERD, HLD, HTN, multiple myeloma, large B-cell lymphoma, renal cell carcinoma S/P right partial nephrectomy, mitral regurgitation S/P MVR, and thrombocytopenia  presented with nausea vomiting   Covid-19 Virus Infection Intractable nausea vomiting Date of onset of symptoms: 12/22/2022 Symptoms present on admission: Nausea vomiting and diarrhea Date of covid positive test: 12/23/2022 Vaccination status: vaccinated Imaging: CT abdomen and pelvis showed enteritis Oxygen requirements on admission: Room air Current oxygen requirements: Room air Medical therapy: not indicated Consultants following: None Anticipated special isolation end date: 12/27/2022 Antiemetics Gentle IV hydration Clear liquids advance as tolerated   Nausea and vomiting 2/2 enteritis: Resolved CT scan abdomen showed patient having enteritis Patient nausea vomiting and diarrhea have resolved.  Patient is doing well.  Patient was to be discharged home and will be discharged with advised to follow-up with PCP.   CAD Chronic congestive heart failure Continue home medications   Type 2 diabetes on long-term insulin use Continue NPH 70/30,  Continue insulin sliding scale Last A1c 8.5   Multiple myeloma History of RCC non-Hodgkin lymphoma Stable   CKD-IIIb Creatinine at baseline Monitor renal function and electrolytes IVF to correct dehydration   QT prolongation Avoid QT prolonging medications
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Vomiting
Clinical narrative: Patient is a 79 y.o. female patient of PRIVATE MD with history of  anemia, CAD S/P CABG, CHF, CKD, GERD, HLD, HTN, multiple myeloma, large B-cell lymphoma, renal cell carcinoma S/P right partial nephrectomy, mitral regurgitation S/P MVR, and thrombocytopenia  presented with nausea vomiting   Covid-19 Virus Infection Intractable nausea vomiting Date of onset of symptoms: 12/22/2022 Symptoms present on admission: Nausea vomiting and diarrhea Date of covid positive test: 12/23/2022 Vaccination status: vaccinated Imaging: CT abdomen and pelvis showed enteritis Oxygen requirements on admission: Room air Current oxygen requirements: Room air Medical therapy: not indicated Consultants following: None Anticipated special isolation end date: 12/27/2022 Antiemetics Gentle IV hydration Clear liquids advance as tolerated   Nausea and vomiting 2/2 enteritis: Resolved CT scan abdomen showed patient having enteritis Patient nausea vomiting and diarrhea have resolved.  Patient is doing well.  Patient was to be discharged home and will be discharged with advised to follow-up with PCP.   CAD Chronic congestive heart failure Continue home medications   Type 2 diabetes on long-term insulin use Continue NPH 70/30,  Continue insulin sliding scale Last A1c 8.5   Multiple myeloma History of RCC non-Hodgkin lymphoma Stable   CKD-IIIb Creatinine at baseline Monitor renal function and electrolytes IVF to correct dehydration   QT prolongation Avoid QT prolonging medications
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Balance disorder, COVID-19, Cough, Fatigue, Pain
Clinical narrative: On 12/18/2022 I was tired that evening and had a little bit of a cough. When I woke up the next day, I had a cough, and was achy and tired. I have a history of bronchitis, so coughs are not abnormal, but I never get a dry cough, and this was a dry cough. I then started feeling feverish. I tested myself for COVID-19 by the end of that day and it was positive. I contacted my doctor's office through a telehealth visit. They prescribed me PAXLOVID. I had a couple days of fever that spiked up to 102 along with coughing, congestion, aches and pains. I had some balance issues as well. I stopped all of my other medications while taking the PAXLOVID. The symptoms only lasted a few days except for the congestion. I took another at home COVID-19 test that Friday and it was negative. I confirmed those results with a PCR test before joining my family for Christmas that Sunday. My daughter informed me on 12/26/2022 that she was positive for COVID-19. I tested myself again on 12/27/2022 and was positive again. That time, I did not take PAXLOVID. At some point, I developed some sort of adverse taste, and everything tasted awful. I could still smell, but my taste was totally altered and that lasted a couple of weeks.
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Taste disorder
Clinical narrative: On 12/18/2022 I was tired that evening and had a little bit of a cough. When I woke up the next day, I had a cough, and was achy and tired. I have a history of bronchitis, so coughs are not abnormal, but I never get a dry cough, and this was a dry cough. I then started feeling feverish. I tested myself for COVID-19 by the end of that day and it was positive. I contacted my doctor's office through a telehealth visit. They prescribed me PAXLOVID. I had a couple days of fever that spiked up to 102 along with coughing, congestion, aches and pains. I had some balance issues as well. I stopped all of my other medications while taking the PAXLOVID. The symptoms only lasted a few days except for the congestion. I took another at home COVID-19 test that Friday and it was negative. I confirmed those results with a PCR test before joining my family for Christmas that Sunday. My daughter informed me on 12/26/2022 that she was positive for COVID-19. I tested myself again on 12/27/2022 and was positive again. That time, I did not take PAXLOVID. At some point, I developed some sort of adverse taste, and everything tasted awful. I could still smell, but my taste was totally altered and that lasted a couple of weeks.
Age: 2.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation error
Clinical narrative: The Pfizer covid vaccine 1st dose wasn't diluted...
Age: 57.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Condition aggravated, Eye pain, Scleritis
Clinical narrative: April 1, 2022, I had an episode of Scleritis.  October 1, 2022 I had the second episode of Scleritis. I went to the doctor and they put me on Celebrex and Prednisolone Eyedrops.  The third episode was December 8, 2023. Now they want to start injections of Methotrexate on Friday, once a week. It was getting better and the vaccine on 01/10/2023, made the Scleritis worse on 01/11/2023.  It presents with severe eye pain.
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Anticoagulant therapy, Asthenia, Atrial fibrillation, COVID-19, Chronic kidney disease
Clinical narrative: Patient is a 85 y.o. male patient of DO with history of HLD, GERD, COPD, Prostrate cancer, BPH, Anxiety and depression, mild cognitive impairment  presented to Hospital with cough, congestion, weakness .   Clinical Summary   COVID-19   - Symptoms began 12/9 - Positive test 12/15 - No supplemental oxygen requirement - Patient was given steroids while hospitalized - Patient did not receive remdesivir   Newly Diagnosed A Fib   - EF 45& - Rate control excellent on Toprol XL 50 mg daily - Eliquis 2.5 mg BID started   CKD stage 3   - I hel d off on starting losartan due to mild hyperkalemia
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Cough, Hyperkalaemia, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: Patient is a 85 y.o. male patient of DO with history of HLD, GERD, COPD, Prostrate cancer, BPH, Anxiety and depression, mild cognitive impairment  presented to Hospital with cough, congestion, weakness .   Clinical Summary   COVID-19   - Symptoms began 12/9 - Positive test 12/15 - No supplemental oxygen requirement - Patient was given steroids while hospitalized - Patient did not receive remdesivir   Newly Diagnosed A Fib   - EF 45& - Rate control excellent on Toprol XL 50 mg daily - Eliquis 2.5 mg BID started   CKD stage 3   - I hel d off on starting losartan due to mild hyperkalemia
Age: 12.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Monovalent Pfizer 12+ was given instead of Bivalent pfizer vaccine 12+ (correct age group but was supposed to be bivalent booster )
Age: 5.0
Sex: F
Vaccine: COVID19-2
Symptoms: Incorrect product formulation administered, No adverse event
Clinical narrative: BIVALENT PEDS PFIZER 5-11 YO GIVEN AS FIRST DOSE INADVERTENTLY. CLIENT DID NOT HAVE ADVERSE REACTION. ACCORDING TO CDC INTERIM GUIDANCE, IT WAS NOT NECESSARY TO REPEAT THE DOSE. PARENT NOTIFIED OF ERROR, CORRECTED INFO IN VACCINE RECORDING SYSTEM TO REFLECT ACTUAL VACCINE GIVEN.
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Angiogram pulmonary normal, Anticoagulant therapy
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Bacteraemia, Blood culture positive, Blood gases abnormal, COVID-19, COVID-19 pneumonia
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Candida infection, Central venous catheterisation, Chest X-ray abnormal, Culture, Echocardiogram abnormal
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Gram stain positive, Haematuria, Hyperglycaemia, Hypernatraemia, Hypokalaemia
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Intensive care, Lactic acidosis, Leukocytosis, Lung infiltration, Lung opacity
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Malnutrition, PO2 decreased, Procalcitonin, Pulmonary hypertension, Pulmonary oedema
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Right atrial enlargement, Right ventricular enlargement, SARS-CoV-2 test positive, Septic shock, Toxic encephalopathy
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Viral sepsis
Clinical narrative: 86-year-old male presented with hypoxic respiratory failure.  Initial O2 saturation was around 70% on 5 L nasal cannula.  He was placed on 15 L nonrebreather and O2 saturation corrected to just above 90.  He met signs/symptoms of septic shock with viral sepsis.  He was started on Levophed therapy and found to have a PO2 of 38 on arterial blood gas.  Nasal swab was obtained and positive for COVID-19.  Chest x-ray revealed multifocal opacities/infiltrates.  He was started on dexamethasone, broad-spectrum antibiotics, and breathing treatments.  Initial admission was to intensive care unit. Admitted started on broad-spectrum antibiotics including vancomycin and cefepime.  Cultures were obtained as well as procalcitonin and antibiotics were de-escalated.  Confirmed COVID-19 infection required aggressive steroid therapy.  His acute renal failure on presentation was prohibitive of remdesivir therapy.  Echocardiogram was obtained on 12 7 with preserved ejection fraction noted.  He was noted to have right ventricular enlargement and right atrial enlargement with moderate pulmonary hypertension.  A CTA was obtained and negative for pulmonary embolism.  Initially he was treated with heparin infusion pending rule out of pulmonary embolism.  A left femoral central venous line was removed following 3 of 4 blood cultures positive for gram-positive cocci.  Vancomycin was continued throughout his inpatient stay based on this.  He was adequately fluid resuscitated with improvement in his lactic acidosis and his AKI.  Because of his leukocytosis and bacteremia he was not an appropriate candidate for baricitinib therapy.  Ultimately he has failed to respond to aggressive broad-spectrum antibiotics with O2 support and Decadron therapy.  Nebulizer therapies have been provided scheduled and as needed throughout his stay without significant provement in his pulmonary function.  He has been followed by pulmonary service.   Discharge diagnosis Acute respiratory failure with hypoxia Viral sepsis Septic shock ARDS COVID-19 pneumonia Possible superimposed bacterial pneumonia Acute toxic metabolic encephalopathy due to sepsis and hypoxia Pulmonary Edema on exam Blood culture contamination Pulmonary hypertension Acute Hypernatremia AKI Lactic acidosis Hypokalemia Thrush Hematuria Hyperglycemia Severe protein calorie malnutrition History of prostate cancer Normocytic anemia
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Aortic aneurysm, Benign prostatic hyperplasia, Blood sodium decreased, Body temperature increased
Clinical narrative: Patient is a pleasant 84-year-old male who presents to the emergency department today for chief complaint of shortness of breath.  He reports his symptoms have been ongoing for approximately 1 week.  He reports he was taken to home COVID test both of which have been negative.  He presented to urgent care this morning for evaluation at which time he was prompted to come to the emergency department as he was found to be hypoxic.  He reports that he normally walks approximately 2 miles per day, on his normal route he is noted that he is becoming increasingly dyspneic when normally he would not be.  He does endorse a dry cough, that is elicited with deep inspiration.  He denies any fever or chills.  He denies any current pulmonary dysfunction, denies any smoking history.  Patient states that he is fully vaccinated for COVID-19.  Denies any chest pain, palpitations, fever/chills, abdominal pain, nausea/vomiting, diarrhea/constipation ED work-up: Chest x-ray shows multifocal pneumonia with both lungs, with positive COVID-19 swab.  Does meet sepsis criteria.  CT of the chest shows no acute PE, but does note new 9 mm nodule in the left upper lung which is concerning for malignancy and is new from previous CT in 2006.  CBC and metabolic panel significant for WBC of 18.68, CRP 120, sodium 129.  Patient is hemodynamically stable at this time.  He is on 2 L nasal cannula with O2 saturation of approximately 93%.  He does have a T-max of 100.9 degrees while in the ED.  He was given 6 mg IV Decadron.  He is admitted under the hospitalist service for further work-up and continuation of care   Clinical Summary Patient did not qualify for remdesivir but did receive steroids.  Patient never required intubation, only NC and will be discharged home with oxygen.  Patient was noted to have a left upper lobe nodule and an ascending aortic aneurysm and patient is instructed to follow up with PCP.  Patient will be discharged with dexamethasone for a total of 10 days.  Patient did not require oxygen based on the 6 minute walk test prior to discharge.   Discharge diagnosis Acute hypoxic respiratory failure Sepsis, secondary to COVID-19 pneumonitis 9 mm left upper lobe nodule Hyponatremia Hypertension Hyperlipidemia GERD BPH OSA
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: C-reactive protein increased, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough
Clinical narrative: Patient is a pleasant 84-year-old male who presents to the emergency department today for chief complaint of shortness of breath.  He reports his symptoms have been ongoing for approximately 1 week.  He reports he was taken to home COVID test both of which have been negative.  He presented to urgent care this morning for evaluation at which time he was prompted to come to the emergency department as he was found to be hypoxic.  He reports that he normally walks approximately 2 miles per day, on his normal route he is noted that he is becoming increasingly dyspneic when normally he would not be.  He does endorse a dry cough, that is elicited with deep inspiration.  He denies any fever or chills.  He denies any current pulmonary dysfunction, denies any smoking history.  Patient states that he is fully vaccinated for COVID-19.  Denies any chest pain, palpitations, fever/chills, abdominal pain, nausea/vomiting, diarrhea/constipation ED work-up: Chest x-ray shows multifocal pneumonia with both lungs, with positive COVID-19 swab.  Does meet sepsis criteria.  CT of the chest shows no acute PE, but does note new 9 mm nodule in the left upper lung which is concerning for malignancy and is new from previous CT in 2006.  CBC and metabolic panel significant for WBC of 18.68, CRP 120, sodium 129.  Patient is hemodynamically stable at this time.  He is on 2 L nasal cannula with O2 saturation of approximately 93%.  He does have a T-max of 100.9 degrees while in the ED.  He was given 6 mg IV Decadron.  He is admitted under the hospitalist service for further work-up and continuation of care   Clinical Summary Patient did not qualify for remdesivir but did receive steroids.  Patient never required intubation, only NC and will be discharged home with oxygen.  Patient was noted to have a left upper lobe nodule and an ascending aortic aneurysm and patient is instructed to follow up with PCP.  Patient will be discharged with dexamethasone for a total of 10 days.  Patient did not require oxygen based on the 6 minute walk test prior to discharge.   Discharge diagnosis Acute hypoxic respiratory failure Sepsis, secondary to COVID-19 pneumonitis 9 mm left upper lobe nodule Hyponatremia Hypertension Hyperlipidemia GERD BPH OSA