chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Adult failure to thrive, Ammonia normal, Ankle fracture, Blood thyroid stimulating hormone normal, COVID-19
Clinical narrative: Patient is a 88 y.o. female patient of DO with history of hypertension, hyperlipidemia, anxiety and depression, now presented to Hospital with right bimalleolar ankle fracture.   Discharge Delay  COVID-19 Infection  Patient medically cleared for discharge 11/29 however incidentally positive for COVID Plan to remain inpatient through isolation period and then discharge to SNF 12/10 Discontinue isolation - ECF today     Fall Right bimalleolar fracturea Failure to thrive  XR showed  There is an obliquely oriented fracture through the distal fibula.  Mild lateral offset of the distal fracture fragment.  There also is a transverse fracture through the medial malleolus with mild lateral offset of the distal fracture fragment.  The talus is mildly shifted laterally and anteriorly relative to the tibial plafond.  Ortho consulted, recommend conservative mgmt. NWB RLE. Pain control and therapy PT/OT rec 5-7d/week. SW consulted, accepted at facility.  Noted posterior cervical ecchymosis, suspect 2/2 fall and now on blood thinners.   Acute cystitis with hematuria - Resolved Hemodynamically stable, does not appear septic at this time UA equivocal. Urine culture + E coli  Completed IV Rocephin -- > PO keflex x5d - finished therapy    Delirium - Improved CT head non acute, shows chronic microvascular ischemic changes  Likely multifactorial in setting of UTI, hospital delirium + pain medication and COVID infection  TSH, B12, ammonia unremarkable  Limit psychoactive medications where able Supportive care    Enlarged Thyroid CT noted Inhomogeneous low-density enlargement of the left lobe of the thyroid allowing for streak artifacts.  Recommend nonemergent thyroid ultrasound  Thyroid US asymmetrically enlarged left lobe of the thyroid gland and atrophy of the right lobe of the thyroid gland. The echotexture is heterogeneous.  No nodules are identified in the thyroid gland.  TSH wnl  No further inpatient work up warranted at this time    Hypokalemia - Resolved Monitor   Chronic Back Pain  Lumbar Spinal Stenosis Continue home norco BID    Hypertension Continue home Norvasc.  Hyperlipidemia Continue home pravastatin.   Anxiety and depression Continue home Prozac.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Cerebral small vessel ischaemic disease, Computerised tomogram abnormal, Computerised tomogram head abnormal, Culture urine positive, Cystitis
Clinical narrative: Patient is a 88 y.o. female patient of DO with history of hypertension, hyperlipidemia, anxiety and depression, now presented to Hospital with right bimalleolar ankle fracture.   Discharge Delay  COVID-19 Infection  Patient medically cleared for discharge 11/29 however incidentally positive for COVID Plan to remain inpatient through isolation period and then discharge to SNF 12/10 Discontinue isolation - ECF today     Fall Right bimalleolar fracturea Failure to thrive  XR showed  There is an obliquely oriented fracture through the distal fibula.  Mild lateral offset of the distal fracture fragment.  There also is a transverse fracture through the medial malleolus with mild lateral offset of the distal fracture fragment.  The talus is mildly shifted laterally and anteriorly relative to the tibial plafond.  Ortho consulted, recommend conservative mgmt. NWB RLE. Pain control and therapy PT/OT rec 5-7d/week. SW consulted, accepted at facility.  Noted posterior cervical ecchymosis, suspect 2/2 fall and now on blood thinners.   Acute cystitis with hematuria - Resolved Hemodynamically stable, does not appear septic at this time UA equivocal. Urine culture + E coli  Completed IV Rocephin -- > PO keflex x5d - finished therapy    Delirium - Improved CT head non acute, shows chronic microvascular ischemic changes  Likely multifactorial in setting of UTI, hospital delirium + pain medication and COVID infection  TSH, B12, ammonia unremarkable  Limit psychoactive medications where able Supportive care    Enlarged Thyroid CT noted Inhomogeneous low-density enlargement of the left lobe of the thyroid allowing for streak artifacts.  Recommend nonemergent thyroid ultrasound  Thyroid US asymmetrically enlarged left lobe of the thyroid gland and atrophy of the right lobe of the thyroid gland. The echotexture is heterogeneous.  No nodules are identified in the thyroid gland.  TSH wnl  No further inpatient work up warranted at this time    Hypokalemia - Resolved Monitor   Chronic Back Pain  Lumbar Spinal Stenosis Continue home norco BID    Hypertension Continue home Norvasc.  Hyperlipidemia Continue home pravastatin.   Anxiety and depression Continue home Prozac.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Delirium, Ecchymosis, Escherichia test positive, Fall, Fibula fracture
Clinical narrative: Patient is a 88 y.o. female patient of DO with history of hypertension, hyperlipidemia, anxiety and depression, now presented to Hospital with right bimalleolar ankle fracture.   Discharge Delay  COVID-19 Infection  Patient medically cleared for discharge 11/29 however incidentally positive for COVID Plan to remain inpatient through isolation period and then discharge to SNF 12/10 Discontinue isolation - ECF today     Fall Right bimalleolar fracturea Failure to thrive  XR showed  There is an obliquely oriented fracture through the distal fibula.  Mild lateral offset of the distal fracture fragment.  There also is a transverse fracture through the medial malleolus with mild lateral offset of the distal fracture fragment.  The talus is mildly shifted laterally and anteriorly relative to the tibial plafond.  Ortho consulted, recommend conservative mgmt. NWB RLE. Pain control and therapy PT/OT rec 5-7d/week. SW consulted, accepted at facility.  Noted posterior cervical ecchymosis, suspect 2/2 fall and now on blood thinners.   Acute cystitis with hematuria - Resolved Hemodynamically stable, does not appear septic at this time UA equivocal. Urine culture + E coli  Completed IV Rocephin -- > PO keflex x5d - finished therapy    Delirium - Improved CT head non acute, shows chronic microvascular ischemic changes  Likely multifactorial in setting of UTI, hospital delirium + pain medication and COVID infection  TSH, B12, ammonia unremarkable  Limit psychoactive medications where able Supportive care    Enlarged Thyroid CT noted Inhomogeneous low-density enlargement of the left lobe of the thyroid allowing for streak artifacts.  Recommend nonemergent thyroid ultrasound  Thyroid US asymmetrically enlarged left lobe of the thyroid gland and atrophy of the right lobe of the thyroid gland. The echotexture is heterogeneous.  No nodules are identified in the thyroid gland.  TSH wnl  No further inpatient work up warranted at this time    Hypokalemia - Resolved Monitor   Chronic Back Pain  Lumbar Spinal Stenosis Continue home norco BID    Hypertension Continue home Norvasc.  Hyperlipidemia Continue home pravastatin.   Anxiety and depression Continue home Prozac.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Fracture displacement, Goitre, Haematuria, Hypokalaemia, Imaging procedure artifact
Clinical narrative: Patient is a 88 y.o. female patient of DO with history of hypertension, hyperlipidemia, anxiety and depression, now presented to Hospital with right bimalleolar ankle fracture.   Discharge Delay  COVID-19 Infection  Patient medically cleared for discharge 11/29 however incidentally positive for COVID Plan to remain inpatient through isolation period and then discharge to SNF 12/10 Discontinue isolation - ECF today     Fall Right bimalleolar fracturea Failure to thrive  XR showed  There is an obliquely oriented fracture through the distal fibula.  Mild lateral offset of the distal fracture fragment.  There also is a transverse fracture through the medial malleolus with mild lateral offset of the distal fracture fragment.  The talus is mildly shifted laterally and anteriorly relative to the tibial plafond.  Ortho consulted, recommend conservative mgmt. NWB RLE. Pain control and therapy PT/OT rec 5-7d/week. SW consulted, accepted at facility.  Noted posterior cervical ecchymosis, suspect 2/2 fall and now on blood thinners.   Acute cystitis with hematuria - Resolved Hemodynamically stable, does not appear septic at this time UA equivocal. Urine culture + E coli  Completed IV Rocephin -- > PO keflex x5d - finished therapy    Delirium - Improved CT head non acute, shows chronic microvascular ischemic changes  Likely multifactorial in setting of UTI, hospital delirium + pain medication and COVID infection  TSH, B12, ammonia unremarkable  Limit psychoactive medications where able Supportive care    Enlarged Thyroid CT noted Inhomogeneous low-density enlargement of the left lobe of the thyroid allowing for streak artifacts.  Recommend nonemergent thyroid ultrasound  Thyroid US asymmetrically enlarged left lobe of the thyroid gland and atrophy of the right lobe of the thyroid gland. The echotexture is heterogeneous.  No nodules are identified in the thyroid gland.  TSH wnl  No further inpatient work up warranted at this time    Hypokalemia - Resolved Monitor   Chronic Back Pain  Lumbar Spinal Stenosis Continue home norco BID    Hypertension Continue home Norvasc.  Hyperlipidemia Continue home pravastatin.   Anxiety and depression Continue home Prozac.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Thyroid atrophy, Ultrasound thyroid abnormal, Urinary tract infection, Urine analysis
Clinical narrative: Patient is a 88 y.o. female patient of DO with history of hypertension, hyperlipidemia, anxiety and depression, now presented to Hospital with right bimalleolar ankle fracture.   Discharge Delay  COVID-19 Infection  Patient medically cleared for discharge 11/29 however incidentally positive for COVID Plan to remain inpatient through isolation period and then discharge to SNF 12/10 Discontinue isolation - ECF today     Fall Right bimalleolar fracturea Failure to thrive  XR showed  There is an obliquely oriented fracture through the distal fibula.  Mild lateral offset of the distal fracture fragment.  There also is a transverse fracture through the medial malleolus with mild lateral offset of the distal fracture fragment.  The talus is mildly shifted laterally and anteriorly relative to the tibial plafond.  Ortho consulted, recommend conservative mgmt. NWB RLE. Pain control and therapy PT/OT rec 5-7d/week. SW consulted, accepted at facility.  Noted posterior cervical ecchymosis, suspect 2/2 fall and now on blood thinners.   Acute cystitis with hematuria - Resolved Hemodynamically stable, does not appear septic at this time UA equivocal. Urine culture + E coli  Completed IV Rocephin -- > PO keflex x5d - finished therapy    Delirium - Improved CT head non acute, shows chronic microvascular ischemic changes  Likely multifactorial in setting of UTI, hospital delirium + pain medication and COVID infection  TSH, B12, ammonia unremarkable  Limit psychoactive medications where able Supportive care    Enlarged Thyroid CT noted Inhomogeneous low-density enlargement of the left lobe of the thyroid allowing for streak artifacts.  Recommend nonemergent thyroid ultrasound  Thyroid US asymmetrically enlarged left lobe of the thyroid gland and atrophy of the right lobe of the thyroid gland. The echotexture is heterogeneous.  No nodules are identified in the thyroid gland.  TSH wnl  No further inpatient work up warranted at this time    Hypokalemia - Resolved Monitor   Chronic Back Pain  Lumbar Spinal Stenosis Continue home norco BID    Hypertension Continue home Norvasc.  Hyperlipidemia Continue home pravastatin.   Anxiety and depression Continue home Prozac.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Vitamin B12 normal, X-ray limb abnormal
Clinical narrative: Patient is a 88 y.o. female patient of DO with history of hypertension, hyperlipidemia, anxiety and depression, now presented to Hospital with right bimalleolar ankle fracture.   Discharge Delay  COVID-19 Infection  Patient medically cleared for discharge 11/29 however incidentally positive for COVID Plan to remain inpatient through isolation period and then discharge to SNF 12/10 Discontinue isolation - ECF today     Fall Right bimalleolar fracturea Failure to thrive  XR showed  There is an obliquely oriented fracture through the distal fibula.  Mild lateral offset of the distal fracture fragment.  There also is a transverse fracture through the medial malleolus with mild lateral offset of the distal fracture fragment.  The talus is mildly shifted laterally and anteriorly relative to the tibial plafond.  Ortho consulted, recommend conservative mgmt. NWB RLE. Pain control and therapy PT/OT rec 5-7d/week. SW consulted, accepted at facility.  Noted posterior cervical ecchymosis, suspect 2/2 fall and now on blood thinners.   Acute cystitis with hematuria - Resolved Hemodynamically stable, does not appear septic at this time UA equivocal. Urine culture + E coli  Completed IV Rocephin -- > PO keflex x5d - finished therapy    Delirium - Improved CT head non acute, shows chronic microvascular ischemic changes  Likely multifactorial in setting of UTI, hospital delirium + pain medication and COVID infection  TSH, B12, ammonia unremarkable  Limit psychoactive medications where able Supportive care    Enlarged Thyroid CT noted Inhomogeneous low-density enlargement of the left lobe of the thyroid allowing for streak artifacts.  Recommend nonemergent thyroid ultrasound  Thyroid US asymmetrically enlarged left lobe of the thyroid gland and atrophy of the right lobe of the thyroid gland. The echotexture is heterogeneous.  No nodules are identified in the thyroid gland.  TSH wnl  No further inpatient work up warranted at this time    Hypokalemia - Resolved Monitor   Chronic Back Pain  Lumbar Spinal Stenosis Continue home norco BID    Hypertension Continue home Norvasc.  Hyperlipidemia Continue home pravastatin.   Anxiety and depression Continue home Prozac.
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Angiogram pulmonary abnormal, Atelectasis, Blood creatinine normal
Clinical narrative: Patient is a 22 y.o. male patient of MD with PMH of Chiari I Malformation, Developmental Delay, seizures presented to Hospital for AKI and hypoxia.    Covid-19 Virus Infection Acute hypoxemic respiratory failure Pneumonia Date of onset of symptoms: 11/24 Symptoms present on admission: nausea, not eating, hypoxia.        Date of covid positive test: 11/24 Vaccination status: vaccinated Imaging: CXR with moderate pneumonitis. CRP 28, procal 0.09, D-dimer 0.58 CTPA with no PE, pneumonia in bilaeral upper lobes, atelectasis of lower lobes. Medical therapy: IV dexamethasone in the hospital and DC home on oral dexamethasone.  Oxygen requirements on admission: 3L, was able to wean down to RA prior to discharge.  No O2 requirement at discharge Bronchodilators, Pulm toilet, mucolytic Initially started on zosyn, that was de-escalated to to rocephin and continued cefdinir at discharge to complete short course. Isolation completed prior to discharge   AKI (resolved) Admit Cr per POC labs at freestanding ED 2.01, normalized with hydration.   Hyper natremia - resolved Secondary to dehydration Free water via PEG tube Sodium prior to discharge 143     Acute metabolic encephalopathy -resolved Per mother he is typically awake and alert Mother at bedside attested that his mental status back to baseline.    Chiari I malformation Epilepsy Developmental delay Resume home banzel, clobazam, epidiolex, zoloft, zoisamide   Malnutrition Has not eaten in over a week PTA Parent's give boost at bedtime via tube feeds Dietitian consulted Tube feeds continued.
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Blood sodium normal, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Dehydration
Clinical narrative: Patient is a 22 y.o. male patient of MD with PMH of Chiari I Malformation, Developmental Delay, seizures presented to Hospital for AKI and hypoxia.    Covid-19 Virus Infection Acute hypoxemic respiratory failure Pneumonia Date of onset of symptoms: 11/24 Symptoms present on admission: nausea, not eating, hypoxia.        Date of covid positive test: 11/24 Vaccination status: vaccinated Imaging: CXR with moderate pneumonitis. CRP 28, procal 0.09, D-dimer 0.58 CTPA with no PE, pneumonia in bilaeral upper lobes, atelectasis of lower lobes. Medical therapy: IV dexamethasone in the hospital and DC home on oral dexamethasone.  Oxygen requirements on admission: 3L, was able to wean down to RA prior to discharge.  No O2 requirement at discharge Bronchodilators, Pulm toilet, mucolytic Initially started on zosyn, that was de-escalated to to rocephin and continued cefdinir at discharge to complete short course. Isolation completed prior to discharge   AKI (resolved) Admit Cr per POC labs at freestanding ED 2.01, normalized with hydration.   Hyper natremia - resolved Secondary to dehydration Free water via PEG tube Sodium prior to discharge 143     Acute metabolic encephalopathy -resolved Per mother he is typically awake and alert Mother at bedside attested that his mental status back to baseline.    Chiari I malformation Epilepsy Developmental delay Resume home banzel, clobazam, epidiolex, zoloft, zoisamide   Malnutrition Has not eaten in over a week PTA Parent's give boost at bedtime via tube feeds Dietitian consulted Tube feeds continued.
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Eating disorder, Fibrin D dimer, Hypernatraemia, Hypoxia, Malnutrition
Clinical narrative: Patient is a 22 y.o. male patient of MD with PMH of Chiari I Malformation, Developmental Delay, seizures presented to Hospital for AKI and hypoxia.    Covid-19 Virus Infection Acute hypoxemic respiratory failure Pneumonia Date of onset of symptoms: 11/24 Symptoms present on admission: nausea, not eating, hypoxia.        Date of covid positive test: 11/24 Vaccination status: vaccinated Imaging: CXR with moderate pneumonitis. CRP 28, procal 0.09, D-dimer 0.58 CTPA with no PE, pneumonia in bilaeral upper lobes, atelectasis of lower lobes. Medical therapy: IV dexamethasone in the hospital and DC home on oral dexamethasone.  Oxygen requirements on admission: 3L, was able to wean down to RA prior to discharge.  No O2 requirement at discharge Bronchodilators, Pulm toilet, mucolytic Initially started on zosyn, that was de-escalated to to rocephin and continued cefdinir at discharge to complete short course. Isolation completed prior to discharge   AKI (resolved) Admit Cr per POC labs at freestanding ED 2.01, normalized with hydration.   Hyper natremia - resolved Secondary to dehydration Free water via PEG tube Sodium prior to discharge 143     Acute metabolic encephalopathy -resolved Per mother he is typically awake and alert Mother at bedside attested that his mental status back to baseline.    Chiari I malformation Epilepsy Developmental delay Resume home banzel, clobazam, epidiolex, zoloft, zoisamide   Malnutrition Has not eaten in over a week PTA Parent's give boost at bedtime via tube feeds Dietitian consulted Tube feeds continued.
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Nausea, Pneumonia, Pneumonitis, Procalcitonin
Clinical narrative: Patient is a 22 y.o. male patient of MD with PMH of Chiari I Malformation, Developmental Delay, seizures presented to Hospital for AKI and hypoxia.    Covid-19 Virus Infection Acute hypoxemic respiratory failure Pneumonia Date of onset of symptoms: 11/24 Symptoms present on admission: nausea, not eating, hypoxia.        Date of covid positive test: 11/24 Vaccination status: vaccinated Imaging: CXR with moderate pneumonitis. CRP 28, procal 0.09, D-dimer 0.58 CTPA with no PE, pneumonia in bilaeral upper lobes, atelectasis of lower lobes. Medical therapy: IV dexamethasone in the hospital and DC home on oral dexamethasone.  Oxygen requirements on admission: 3L, was able to wean down to RA prior to discharge.  No O2 requirement at discharge Bronchodilators, Pulm toilet, mucolytic Initially started on zosyn, that was de-escalated to to rocephin and continued cefdinir at discharge to complete short course. Isolation completed prior to discharge   AKI (resolved) Admit Cr per POC labs at freestanding ED 2.01, normalized with hydration.   Hyper natremia - resolved Secondary to dehydration Free water via PEG tube Sodium prior to discharge 143     Acute metabolic encephalopathy -resolved Per mother he is typically awake and alert Mother at bedside attested that his mental status back to baseline.    Chiari I malformation Epilepsy Developmental delay Resume home banzel, clobazam, epidiolex, zoloft, zoisamide   Malnutrition Has not eaten in over a week PTA Parent's give boost at bedtime via tube feeds Dietitian consulted Tube feeds continued.
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Patient is a 22 y.o. male patient of MD with PMH of Chiari I Malformation, Developmental Delay, seizures presented to Hospital for AKI and hypoxia.    Covid-19 Virus Infection Acute hypoxemic respiratory failure Pneumonia Date of onset of symptoms: 11/24 Symptoms present on admission: nausea, not eating, hypoxia.        Date of covid positive test: 11/24 Vaccination status: vaccinated Imaging: CXR with moderate pneumonitis. CRP 28, procal 0.09, D-dimer 0.58 CTPA with no PE, pneumonia in bilaeral upper lobes, atelectasis of lower lobes. Medical therapy: IV dexamethasone in the hospital and DC home on oral dexamethasone.  Oxygen requirements on admission: 3L, was able to wean down to RA prior to discharge.  No O2 requirement at discharge Bronchodilators, Pulm toilet, mucolytic Initially started on zosyn, that was de-escalated to to rocephin and continued cefdinir at discharge to complete short course. Isolation completed prior to discharge   AKI (resolved) Admit Cr per POC labs at freestanding ED 2.01, normalized with hydration.   Hyper natremia - resolved Secondary to dehydration Free water via PEG tube Sodium prior to discharge 143     Acute metabolic encephalopathy -resolved Per mother he is typically awake and alert Mother at bedside attested that his mental status back to baseline.    Chiari I malformation Epilepsy Developmental delay Resume home banzel, clobazam, epidiolex, zoloft, zoisamide   Malnutrition Has not eaten in over a week PTA Parent's give boost at bedtime via tube feeds Dietitian consulted Tube feeds continued.
Age: 73.0
Sex: F
Vaccine: RSV
Symptoms: Emotional distress, Injection site pain, Nightmare, Pain
Clinical narrative: Unsure of which RSV vaccine I received at pharmacy. The shot was extremely painful (never happened before) and throbbing arm for about 5 minutes.  No redness/swelling etc later.  During night I had terrible nightmares, and the next a.m. was feeling emotionally very unsettled and "off".  I have a very even and stable personality, so these symptoms were very unusual.  (please don't write this off as a "hysterical old lady").  I still work as a lawyer and have no health problems and take no prescription meds.
Age: 0.33
Sex: M
Vaccine: DTAPIPVHIB, PNC15, RV5
Symptoms: Diarrhoea, Hypersomnia, Infant irritability
Clinical narrative: Mom reports diarrhea for 2 days after administration of 4 month old vaccines. Mom states pt is fussy and sleeping more. No blood in stool. Treatment: close obs, nutramigen formula, call for increased diarrhea, fever, blood in stool. decreased UO, or irritability. Will defer Rotateq #3
Age: 75.0
Sex: F
Vaccine: RSV
Symptoms: Chills, Diarrhoea, Pain, White blood cell count increased
Clinical narrative: PER PT, SHE STARTED TO HAVE BODY ACHE, CHILLS THE NEXT DAY AFTER SHE RECEIVED HER VACCINATION, THE SHE HAD DIARRHEA AFTER 3 DAYS.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Acute respiratory failure, Atelectasis, Atrial fibrillation, COVID-19 pneumonia
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Candida infection, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Depression
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Endotracheal intubation, Essential hypertension, Food refusal, Hypercapnia
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperglycaemia, Hyperlipidaemia, Hyponatraemia, Hypophagia, Hypothyroidism
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Ileus, Inflammatory marker increased, Leukocytosis, Lung opacity
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Oesophagitis, Oral pain, Pain, Pleural effusion, Pneumonia
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary congestion, Pulmonary oedema, Refusal of treatment by patient, Respiratory failure, SARS-CoV-2 test positive
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Septic shock, Staphylococcus test negative, Suicidal ideation
Clinical narrative: Patient is a 75 y.o. female patient of IV, MD with history of persistent Afib, HTN, OSA, HTN, HLD, COPD presented to hospital with SOB, admitted for hypoxic respiratory failure    Acute Respiratory Failure with Hypoxia and Hypercarbia, resolved CXR showed increasing opacification at the lung bases which may relate to pleural effusion and atelectasis, pulmonary vascular congestion and perihilar opacities are redemonstrated, related to edema or multifocal pneumonia Intubated On 11/16, extubated and weaned to NC Pulmon signed off RA 11/20   Septic Shock from COVID-19 PNA and CAP - Shock resolved Positive SIRS criteria, leukocytosis, elevated inflammatory markers  Started on Levo S/p Remdesivir and dexamethasone - stopped decadron 11/20 given weaned to RA and significant thrush Started on Vanc/cefepime/azithromycin - completion 11/20 COVID only test positive so far from micro standpoint MRSA probe negative so Vanc stopped Out of isolation 11/24   Suicidal Ideation Depression, Possible Adjustment disorder Pt called her children evening 11/21 and told them goodbyes. Children reported pt suicidal to RN Pt had been refusing medication 11/22 and not eating, refused PT 11/21 despite report of wanting to go home and being concerned about weakness Has poor insight , Suicide precautions and 1:1 ordered plus no AMA until seen by BH - since discontinued Consulted BH 11/2 - no concerns for lethality and suspected maladaptive personality and poor coping skills, Pt declined to increase Prozac Continued to encourage to participate in care including therapy No further report of SI Improving as clinical condition improves    Chronic Pain Abdominal Pain, resolved Ileus 11/23 Intermittent, acute on chronic abd pain  Restarted home norco and gabapentin Stable unrevealing workup    Persistent Afib Not on Eliquis due to hemoptysis Follows with Cardiology Resume home diltiazem     HTN, essential Held  home imdur, irbesartan, coreg due to shock Restarted coreg Restarted imdur and lower dose arb 11/20,  low normotensive and continued to hold CBB   Hyponatremia Poor po intake, drinking 3-4 L water per day with poor food intake due to mouth pain Nephrology evaluated  Improved with fluid restriction and increased food intake Ok for remove fluid restriction if she continues to improve  Ok to remain on SSRI given risk/benefit    Hyperglycemia ISS ordered, likely due to steriods, critical illness Resolved    Thrush Esophagitis Nystatin started 11/20, ongoing pain and making it difficult to eat Added diflucan x 14 11/21 plus viscous lidocaine Significantly improved exam, po intake improving  Proper inhaler technique discussed    HLD held home Lipitor while on diflucan, resumed    COPD Continue albuterol PRN and singular Restarted dulera, duonebs prn   Hypothyroidism Continued home synthroid