chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 6.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Patient received toddler primary series dose when she was supposed to receive pediatric primary series dose.
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: The nurse administered Regular Pfizer Covid vaccine in error. The patient should have received the Pfizer Bivalent Covid Vaccine.
Age: 76.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered, No adverse event
Clinical narrative: The patient has not had any adverse effects that are known. The nurse administered regular Pfizer Covid 19 vaccine dose in error where the Pfizer Bivalent COVID 19 Vaccine should have been given.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: The nurse administered Regular Pfizer Covid vaccine in error. The patient should have received the Pfizer Bivalent Covid Vaccine.
Age: 42.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered, Product administration error
Clinical narrative: The patient should have been administered Pfizer Bivalent Covid Vaccine and the nurse administered Regular Pfizer Covid Vaccine in error.
Age: 55.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered, No adverse event, Product administration error
Clinical narrative: The patient has not had any adverse effects that are known. The nurse administered regular Pfizer Covid 19 vaccine dose in error where the Pfizer Bivalent COVID 19 Vaccine should have been given.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation error, Underdose
Clinical narrative: Patient was administered vaccine that was found to be over diluted on reconstitution.
Age: 83.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered, No adverse event
Clinical narrative: The patient has not had any adverse effects that are known. The nurse administered regular Pfizer Covid 19 vaccine dose in error where the Pfizer Bivalent COVID 19 Vaccine should have been given.
Age: 71.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered, No adverse event, Product administration error
Clinical narrative: The patient has not had any adverse effects that are known. The nurse administered regular Pfizer Covid 19 vaccine dose in error where the Pfizer Bivalent COVID 19 Vaccine should have been given.
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation error
Clinical narrative: Patient was administered vaccine that was found to be over diluted on reconstitution.
Age: 5.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation error
Clinical narrative: Patient was administered vaccine that was found to be over diluted on reconstitution.
Sex: F
Vaccine: COVID19-2
Symptoms: Dizziness
Clinical narrative: Client felt dizzy and lightheaded.  No syncope.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Fatigue, Malaise, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: Generalized malaise; fatigue; mild fever lasted 2-3 days.
Age: 5.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation error, Underdose
Clinical narrative: Patient was administered vaccine that was found to be over diluted on reconstitution.
Age: 62.0
Sex: F
Vaccine: VARZOS
Symptoms: Lip swelling, Urticaria
Clinical narrative: Urticaria starting at ankles, rising to involve knees and wrists, then lip swelling.    Symptoms completely resolved within 48 hours (with Benadryl).
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute kidney injury, COVID-19, Death, Dehydration, Fall
Clinical narrative: This is an instance of breakthrough COVID-19 after which death occurred. The individual was vaccinated with the Moderna product on 02/17/2021, 03/17/2021, and 11/04/2021. They had recently been hospitalized 09/14/2022-09/30/2022 after suffering complications of a L1 compression fracture after a fall. They were discharged to a skilled nursing facility after this hospitalization. They tested positive for COVID-19 on 10/05/2022, when they were admitted to the hospital for dehydration and management of respiratory symptoms. The individual had many underlying medical conditions. They were found to have an acute kidney injury. They were discharged back to skilled nursing facility on 10/08/2022. They died on 10/15/2022. I see no indication they were hospitalized closer to the death date.
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Lumbar vertebral fracture, Respiratory symptom, SARS-CoV-2 test positive, Spinal compression fracture, Vaccine breakthrough infection
Clinical narrative: This is an instance of breakthrough COVID-19 after which death occurred. The individual was vaccinated with the Moderna product on 02/17/2021, 03/17/2021, and 11/04/2021. They had recently been hospitalized 09/14/2022-09/30/2022 after suffering complications of a L1 compression fracture after a fall. They were discharged to a skilled nursing facility after this hospitalization. They tested positive for COVID-19 on 10/05/2022, when they were admitted to the hospital for dehydration and management of respiratory symptoms. The individual had many underlying medical conditions. They were found to have an acute kidney injury. They were discharged back to skilled nursing facility on 10/08/2022. They died on 10/15/2022. I see no indication they were hospitalized closer to the death date.
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Atelectasis, Brain natriuretic peptide increased, COVID-19, Cardiomegaly
Clinical narrative: The patient is a 55-year-old female with history of Anxiety, Asthma, CHF, Obesity, OSA presented to the Medical Center with SOB, COVID.    Patient left against medical advice on 12/22/22 -- she did not sign AMA form (she refused to) and did not stay until I could go talk with her. She took out her own IV and left before the RN could even page me.   Acute COPD exacerbation Acute on chronic hypoxemic respiratory failure Pneumonia Possible heart failure Likely exacerbated by COVID infection Start scheduled and PRN bronchodilators Check echo as BNP is 412 on admission (baseline normal) Was weaned to as low as 1L NC in evening of 12/19 but by 12/20 AM was needing 5L Symbicort, daliresp, Decadron, Azithromycin and Omnicef. Pulm Toilet, IS.    Covid-19 Virus Infection Date of onset of symptoms: 12/05 Symptoms present on admission: Cough, SOB. Date of covid positive test: 12/14 other facility, Positive again 12/18 at the medical center.  Vaccination status: unvaccinated(only received the first dose, no further doses) Imaging: CXR with bibasilar patchy infiltrates and subsegmental atelectasis, cardiomegaly.  Oxygen requirements on admission: 4L NC Current oxygen requirements: 4L NC Medical therapy: steroids, rocephin, and zithromax,  Consultants following: ID consult for Paxlovid.  Anticipated special isolation end date: 12/24   Depression Celexa   HTN Hydrochlorothiazide   Neuropathy Gabapentin, tizanidine.     HLD Statin, ASA.     Obesity BMI 46
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea
Clinical narrative: The patient is a 55-year-old female with history of Anxiety, Asthma, CHF, Obesity, OSA presented to the Medical Center with SOB, COVID.    Patient left against medical advice on 12/22/22 -- she did not sign AMA form (she refused to) and did not stay until I could go talk with her. She took out her own IV and left before the RN could even page me.   Acute COPD exacerbation Acute on chronic hypoxemic respiratory failure Pneumonia Possible heart failure Likely exacerbated by COVID infection Start scheduled and PRN bronchodilators Check echo as BNP is 412 on admission (baseline normal) Was weaned to as low as 1L NC in evening of 12/19 but by 12/20 AM was needing 5L Symbicort, daliresp, Decadron, Azithromycin and Omnicef. Pulm Toilet, IS.    Covid-19 Virus Infection Date of onset of symptoms: 12/05 Symptoms present on admission: Cough, SOB. Date of covid positive test: 12/14 other facility, Positive again 12/18 at the medical center.  Vaccination status: unvaccinated(only received the first dose, no further doses) Imaging: CXR with bibasilar patchy infiltrates and subsegmental atelectasis, cardiomegaly.  Oxygen requirements on admission: 4L NC Current oxygen requirements: 4L NC Medical therapy: steroids, rocephin, and zithromax,  Consultants following: ID consult for Paxlovid.  Anticipated special isolation end date: 12/24   Depression Celexa   HTN Hydrochlorothiazide   Neuropathy Gabapentin, tizanidine.     HLD Statin, ASA.     Obesity BMI 46
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Intentional medical device removal by patient, Lung infiltration, Malaise, Pneumonia, Respiratory failure
Clinical narrative: The patient is a 55-year-old female with history of Anxiety, Asthma, CHF, Obesity, OSA presented to the Medical Center with SOB, COVID.    Patient left against medical advice on 12/22/22 -- she did not sign AMA form (she refused to) and did not stay until I could go talk with her. She took out her own IV and left before the RN could even page me.   Acute COPD exacerbation Acute on chronic hypoxemic respiratory failure Pneumonia Possible heart failure Likely exacerbated by COVID infection Start scheduled and PRN bronchodilators Check echo as BNP is 412 on admission (baseline normal) Was weaned to as low as 1L NC in evening of 12/19 but by 12/20 AM was needing 5L Symbicort, daliresp, Decadron, Azithromycin and Omnicef. Pulm Toilet, IS.    Covid-19 Virus Infection Date of onset of symptoms: 12/05 Symptoms present on admission: Cough, SOB. Date of covid positive test: 12/14 other facility, Positive again 12/18 at the medical center.  Vaccination status: unvaccinated(only received the first dose, no further doses) Imaging: CXR with bibasilar patchy infiltrates and subsegmental atelectasis, cardiomegaly.  Oxygen requirements on admission: 4L NC Current oxygen requirements: 4L NC Medical therapy: steroids, rocephin, and zithromax,  Consultants following: ID consult for Paxlovid.  Anticipated special isolation end date: 12/24   Depression Celexa   HTN Hydrochlorothiazide   Neuropathy Gabapentin, tizanidine.     HLD Statin, ASA.     Obesity BMI 46
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: The patient is a 55-year-old female with history of Anxiety, Asthma, CHF, Obesity, OSA presented to the Medical Center with SOB, COVID.    Patient left against medical advice on 12/22/22 -- she did not sign AMA form (she refused to) and did not stay until I could go talk with her. She took out her own IV and left before the RN could even page me.   Acute COPD exacerbation Acute on chronic hypoxemic respiratory failure Pneumonia Possible heart failure Likely exacerbated by COVID infection Start scheduled and PRN bronchodilators Check echo as BNP is 412 on admission (baseline normal) Was weaned to as low as 1L NC in evening of 12/19 but by 12/20 AM was needing 5L Symbicort, daliresp, Decadron, Azithromycin and Omnicef. Pulm Toilet, IS.    Covid-19 Virus Infection Date of onset of symptoms: 12/05 Symptoms present on admission: Cough, SOB. Date of covid positive test: 12/14 other facility, Positive again 12/18 at the medical center.  Vaccination status: unvaccinated(only received the first dose, no further doses) Imaging: CXR with bibasilar patchy infiltrates and subsegmental atelectasis, cardiomegaly.  Oxygen requirements on admission: 4L NC Current oxygen requirements: 4L NC Medical therapy: steroids, rocephin, and zithromax,  Consultants following: ID consult for Paxlovid.  Anticipated special isolation end date: 12/24   Depression Celexa   HTN Hydrochlorothiazide   Neuropathy Gabapentin, tizanidine.     HLD Statin, ASA.     Obesity BMI 46
Age: 18.0
Sex: F
Vaccine: MENB
Symptoms: Decreased appetite, Dizziness, Fatigue, Head discomfort, Headache
Clinical narrative: Welt at injection site, warm to touch. Sore arm, fever, heavy head, neck stiffness and sharp pain, headache, dizziness, nausea. Loss of appetite, fatigue.
Age: 18.0
Sex: F
Vaccine: MENB
Symptoms: Injection site reaction, Injection site warmth, Musculoskeletal stiffness, Nausea, Neck pain
Clinical narrative: Welt at injection site, warm to touch. Sore arm, fever, heavy head, neck stiffness and sharp pain, headache, dizziness, nausea. Loss of appetite, fatigue.
Age: 18.0
Sex: F
Vaccine: MENB
Symptoms: Pain in extremity, Pyrexia, Urticaria
Clinical narrative: Welt at injection site, warm to touch. Sore arm, fever, heavy head, neck stiffness and sharp pain, headache, dizziness, nausea. Loss of appetite, fatigue.
Age: 28.0
Sex: F
Vaccine: COVID19-2
Symptoms: Dermatitis
Clinical narrative: Dermatitis
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Neurological symptom
Clinical narrative: stroke like symptoms
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Atrial fibrillation, Blood pressure increased, COVID-19, Chest X-ray normal
Clinical narrative: Patient is a 87 y.o. female admitted to the hospital on 12/21/2022 for acute respiratory failure with hypoxia secondary to COVID.    Discharge Diagnosis and Associated Hospital Course   Acute Respiratory Failure with Hypoxia COVID-19 - tested positive on Monday, 12/19 but the test was reportedly at her request - CXR clear - she is vaccinated, but they are unsure of when her most recent booster was given - Patient not a candidate for Paxlovid as she is onTikosyn  - completed decadron course and stable on RA    Paroxysmal A.fib - rate controlled - maintained on tikosyn - not on AC due to fall risk   R leg Wound - due to accidental trauma from wheelchair recently.  - continue local wound care.    Chronic Encephalopathy -on 12/22; Patient with comments related to death during encounter, asking about "if you can make me die sooner". -son had stated that the patient has had phases for years transiently of making comments of this nature such as wanting to ensure she passes away on a weekend to not inconvenience her children in interfering with their work -No behavioral medicine consultation needed at this time, recommend continued redirection and therapeutic listening. -yesterday and today patient did not make any similar comments, denies SI/HI   Hypertension - BP mildly elevated - continue home losartan   Chronic Pain - continue home gabapentin, robaxin, and PRN tramadol   GERD - continue PPI   Anxiety - continue celexa, dose decreased per pharmacy recommendation
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Encephalopathy, Injury, Limb injury, SARS-CoV-2 test positive, Wheelchair user
Clinical narrative: Patient is a 87 y.o. female admitted to the hospital on 12/21/2022 for acute respiratory failure with hypoxia secondary to COVID.    Discharge Diagnosis and Associated Hospital Course   Acute Respiratory Failure with Hypoxia COVID-19 - tested positive on Monday, 12/19 but the test was reportedly at her request - CXR clear - she is vaccinated, but they are unsure of when her most recent booster was given - Patient not a candidate for Paxlovid as she is onTikosyn  - completed decadron course and stable on RA    Paroxysmal A.fib - rate controlled - maintained on tikosyn - not on AC due to fall risk   R leg Wound - due to accidental trauma from wheelchair recently.  - continue local wound care.    Chronic Encephalopathy -on 12/22; Patient with comments related to death during encounter, asking about "if you can make me die sooner". -son had stated that the patient has had phases for years transiently of making comments of this nature such as wanting to ensure she passes away on a weekend to not inconvenience her children in interfering with their work -No behavioral medicine consultation needed at this time, recommend continued redirection and therapeutic listening. -yesterday and today patient did not make any similar comments, denies SI/HI   Hypertension - BP mildly elevated - continue home losartan   Chronic Pain - continue home gabapentin, robaxin, and PRN tramadol   GERD - continue PPI   Anxiety - continue celexa, dose decreased per pharmacy recommendation
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Wound treatment
Clinical narrative: Patient is a 87 y.o. female admitted to the hospital on 12/21/2022 for acute respiratory failure with hypoxia secondary to COVID.    Discharge Diagnosis and Associated Hospital Course   Acute Respiratory Failure with Hypoxia COVID-19 - tested positive on Monday, 12/19 but the test was reportedly at her request - CXR clear - she is vaccinated, but they are unsure of when her most recent booster was given - Patient not a candidate for Paxlovid as she is onTikosyn  - completed decadron course and stable on RA    Paroxysmal A.fib - rate controlled - maintained on tikosyn - not on AC due to fall risk   R leg Wound - due to accidental trauma from wheelchair recently.  - continue local wound care.    Chronic Encephalopathy -on 12/22; Patient with comments related to death during encounter, asking about "if you can make me die sooner". -son had stated that the patient has had phases for years transiently of making comments of this nature such as wanting to ensure she passes away on a weekend to not inconvenience her children in interfering with their work -No behavioral medicine consultation needed at this time, recommend continued redirection and therapeutic listening. -yesterday and today patient did not make any similar comments, denies SI/HI   Hypertension - BP mildly elevated - continue home losartan   Chronic Pain - continue home gabapentin, robaxin, and PRN tramadol   GERD - continue PPI   Anxiety - continue celexa, dose decreased per pharmacy recommendation
Age: 60.0
Sex: F
Vaccine: COVID19-2
Symptoms: Arthralgia, Discomfort, Injection site pain, Pain, Paraesthesia
Clinical narrative: Patient states that she felt a sharp pain in left arm on deltoid that radiated down to left wrist at time of injection.  Around 5:00pm her left deltoid felt ok but left wrist was feeling  tingling. Advised patient to ice arm for a couple of minutes if necessary and follow up with primary care doctor if wrist discomfort does not go away by 1/7/2023.
Age: 11.0
Sex: M
Vaccine: COVID19
Symptoms: Product preparation error
Clinical narrative: Patient was administered vaccine that was found to be over diluted on reconstitution.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Anaemia, Anion gap, Aortic valve disease
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Aortic valve sclerosis, Atrial fibrillation, Blood bicarbonate normal, Blood culture negative, Blood glucose increased
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Blood loss anaemia, Blood pH decreased, COVID-19, Cardiac failure congestive, Cardiac valve vegetation
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Cardioversion, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Coronary artery stenosis
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Decubitus ulcer, Duodenal ulcer perforation, Dyspnoea, Echocardiogram abnormal, Glycosylated haemoglobin normal
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Haemoglobin decreased, Haemostasis, Hyperglycaemia, Hypotension, Intensive care
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Lambl's excrescences, Lung consolidation, Oesophagogastroduodenoscopy abnormal, Pneumonia viral, Red blood cell transfusion
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Renal impairment, Respiratory viral panel, SARS-CoV-2 test positive, Sinus rhythm, Staphylococcus test negative
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Type 2 diabetes mellitus, Urine antigen test
Clinical narrative: Clinical Summary Patient is a 67 y.o. female with a history of COPD, tobacco abuse, HFpEF, IDDM, CKD, PAF, and recent admission 12/3-12/8/22 at Hospital with AECOPD +CHF who presented to ER 12/10/22 with SOB. Patient found to have Afib with RVR complicated by COVID infection. Patient transferred to different Hospital 12/10/2022 for further management. Admitted to MICU, hospitalist assumed care.    1. Acute Hypoxic Respiratory Failure: required 6L NC on admission, suspect multifactorial in setting of anemia, Afib with RVR, COVID infection. Admit CT chest with bilateral lower lobe consolidations concerning for PNA. Urine antigens, respiratory PCR and MRSA swab negative. Continued decadron & zosyn through 12/16/22. On RA 12/14/22.  CCM followed. 2. Viral pneumonia: secondary to Covid 19. Test positive on 12/10. Vaccinated X3. Special isolation as per protocol. Continue standard dose of dexamethasone for 10 days.  3. P-Atrial Fibrillation with RVR: Presented HR in the 130-140s. Suspected secondary to multiple other medical problems. Held home coumadin on admission with concern for GI bleed as below. BB held given previous hypotension. Converted to NSR 12/12/22. Resume coumadin 12/18 if hgb stable. 4. Acute blood loss Anemia: Hgb 6.2 on admission with prior baseline ~11-13. Received 3U pRBC since admission, last 12/11/22.  EGD 12/12/22 with oozing cratered duodenal ulcer s/p clips.  GI followed, recommending to continue PPI for 12 weeks and repeat EGD in 3 months. Hold AC for at least 5d from intervention (until 12/18/22)  5. IDDM2 with Hyperglycemia: A1c 10/22 of 6.2. BG 500, pH 7.3, anion gap 24, bicarb 21. non-DKA insulin gtt transitioned to NPH/SSI on 12/13/22. 6. Aortic Valvular Abnormality: TTE 12/12/22 w/ EF 76%, moderate aortic valve sclerosis with mobile echodensity measuring 1cm x 0.5 cm in LVOT, probable Lambl's excrescence but cannot exclude vegetation. Bcx 12/10 negative. Cardiology recommended outpatient TEE.   7. AKI on CKD: baseline Cr ~1.5, Cr 2.01 on admission. Suspected pre-renal. S/p IVF and pRBC. Resolved.  8. Constipation: CT A/P on admission with stool-filled colon and rectum with large amount of formed stool seen within the rectal vault. Bowel regimen in place.  9. CAD: per history. Heart cath 10/2022 with RCA stenosis however small in size therefore medical management recommended at that time. Continued home statin. Resumed home ASA.  10. HFpEF: per history. Admit TTE noted. Held home Lasix on admission with AKI. Resumed with improvement in renal function. 11. COPD: per history with recent exacerbation as above. No signs of acute exacerbation. Continued home inhaler.  12. Chronic Pain Syndrome with Opioid Dependence: per history. Continued home Percocet on admission (Rx reviewed). 13. Pressure ulcer: coccyx, stage II, pt reports present for weeks on 12/13/22.  Continued offloading.  ET RN followed 14. Tobacco Abuse: NRT ordered. Cessation recommended.
Age: 56.0
Sex: M
Vaccine: COVID19-2, FLUC4
Symptoms: Extra dose administered
Clinical narrative: Inadvertently administered Flu shot 10 days after Flu shot given.
Age: 8.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation error, Underdose
Clinical narrative: Patient was administered vaccine that was found to be over diluted on reconstitution.
Age: 46.0
Sex: M
Vaccine: COVID19-2
Symptoms: Inappropriate schedule of product administration, No adverse event
Clinical narrative: The patient was given the bivalent booster today 1/6/2023. His second dose of Moderna was given on 11/30/2022. The bivalent booster was administered prior to the two-month timeframe elapsing after his second dose. The patient did not exhibit any signs or symptoms of an adverse reaction.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Aortic dilatation, Atrial fibrillation, Blood potassium decreased
Clinical narrative: Clinical Summary Patient is a 82 y.o. female with a history of Afib, HTN, provoked PE who presented to the ED with cough, shortness of breath, found to have COVID 19 with hypoxic and was transferred to the ICU 12/15/2022 for further care and required HHFNC. Another HCF assumed care out of ICU.   1. Acute hypoxic respiratory failure: secondary to COVID 19. CTPA was negative for PE, with pulmonary edema and small Rt pleural effusion. Was initially on NRB then HHFNC and now weaned to RA. S/P diuresis. Home O2 evaluation completed no need for home o2.  2. COVID 19 pneumonia: vaccinated. Symptom onset 12/14. Positve on 12/15/22. Continued dexamethasone (started 12/15/22).  3. Afib: with brief episode of RVR on admission. Secondary to MR. Continued BB (pt stated she is not sure if she will continue this at home as how it makes her feel). Not on AC or antiarrythmic, stopped taking 1 year ago recommended continue AC and discuss with her PCP prior to stopping pt stated she is not sure if she will take it. Continue to monitor.  4. HTN: Per history. BP stable. Continued current medications (on half of home dose BB). Continue to monitor as outpatient 5. Hypokalemia: K 3.2. monitor and replace as needed. Resolved 6. Hyponatremia: Na 130. Improving. Resolved. 7. Elevated troponin: suspected demand ischemia secondary to hypoxia. Denies chest pain. Down trended. No further ischemic evaluation at this time 8. Reported weight loss: 10-12 lbs in the past year. May consider OP work up.  9. Incidental finding: Aortic root dilation seen on ECHO mild 3.5 cm. Recommend OP follow up with ECHO.