chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 45.0
Sex: F
Vaccine: TDAP
Symptoms: Arthralgia, Axillary pain, Injection site nodule, Neck pain, Pain
Clinical narrative: On 4/24/23 I received a call from patient reporting that she had initial soreness with a knot. She stated that a few days pain started to run up her neck and shoulder. She reported that the Knot became the size of half an egg at injection site. 4/23/23 she stated the pain in her neck was better but that is moved to under her arm pit. She called asking if this was normal . I told her that a knot and soreness can be normal but her symptoms seen more than the expected reaction. I then called CDNS and as her opinion on this. CDNS stated that was more of a reaction than normal and recommended she see her pcp. CDNS also ask I do a VARS report on this. I called the pt and told her the CDNS recommended she go to her pcp for evaluation. I ask that she let me know what her pcp said and she stated that she would. I also told her I would be doing a VARS report and explained to her what that was. RN
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angina unstable, Cerebral artery occlusion, Cerebrovascular accident
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE UNSTABLE ANGINA ACUTE STROKE DUE TO OCCLUSION OF LEFT MIDDLE CEREBRAL ARTERY ACUTE RESPIRATORY FAILURE
Age: 16.0
Sex: F
Vaccine: HPV9, MNQ
Symptoms: Injection site nodule, Injection site warmth
Clinical narrative: Patient received MenQuadfii vaccine RD and HPV vaccine LD 03/28/2023. Patient mother called 04/13 and stated child noticed a knot at the place of injection site on LD. patient did not notice the knot until about 3 days ago (4/10/23). mother states it is also warm to touch. patient denies any other problems a this time. patient instructed she can follow up with pcp if she experiences any other problems.
Age: 96.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Asthenia, Blood culture negative, COVID-19, Condition aggravated, Confusional state
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO   Admission Date: 4/29/2023 Discharge Date: 05/02/2023    HOSPITAL PROBLEMS: 1. Acute metabolic encephalopathy 2. Subacute COVID infection 3. Abnormal UA   Stable medical conditions 4. Dementia 5. Hypothyroidism 6. Chronic constipation  PRESENTING PROBLEM: Confusion, weakness, fatigue. Recent Covid infection treated with Paxlovid.  HOSPITAL COURSE: Patient was admitted to the general medicine service for acute metabolic encephalopathy secondary to subacute COVID infection verses urinary tract infection.  She did not qualify for IV remdesivir, she had completed Paxlovid outpatient.  She was treated with supportive care including IV fluids.  She was initially given 1 dose of 1gram IV Rocephin for possible urinary tract infection, her initial sample was not enough to send for culture, repeat urine culture with no growth at time of discharge.  Blood cultures x2 with no growth at 48 hours at discharge.  IV fluids were discontinued and she was able to eat and drink on her own, no urinary complaints, and her confusion improved per family. Daughter had no acute concerns on day of discharge.   Patient worked with PT and OT who felt she would benefit from subacute rehab, her family agreed that she would benefit from a course of therapy.  She will be discharged to Facility
Age: 96.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Constipation, Culture urine negative, Dementia, Fatigue, Hypothyroidism
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO   Admission Date: 4/29/2023 Discharge Date: 05/02/2023    HOSPITAL PROBLEMS: 1. Acute metabolic encephalopathy 2. Subacute COVID infection 3. Abnormal UA   Stable medical conditions 4. Dementia 5. Hypothyroidism 6. Chronic constipation  PRESENTING PROBLEM: Confusion, weakness, fatigue. Recent Covid infection treated with Paxlovid.  HOSPITAL COURSE: Patient was admitted to the general medicine service for acute metabolic encephalopathy secondary to subacute COVID infection verses urinary tract infection.  She did not qualify for IV remdesivir, she had completed Paxlovid outpatient.  She was treated with supportive care including IV fluids.  She was initially given 1 dose of 1gram IV Rocephin for possible urinary tract infection, her initial sample was not enough to send for culture, repeat urine culture with no growth at time of discharge.  Blood cultures x2 with no growth at 48 hours at discharge.  IV fluids were discontinued and she was able to eat and drink on her own, no urinary complaints, and her confusion improved per family. Daughter had no acute concerns on day of discharge.   Patient worked with PT and OT who felt she would benefit from subacute rehab, her family agreed that she would benefit from a course of therapy.  She will be discharged to Facility
Age: 96.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Metabolic encephalopathy, Urinary tract infection, Urine analysis abnormal
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO   Admission Date: 4/29/2023 Discharge Date: 05/02/2023    HOSPITAL PROBLEMS: 1. Acute metabolic encephalopathy 2. Subacute COVID infection 3. Abnormal UA   Stable medical conditions 4. Dementia 5. Hypothyroidism 6. Chronic constipation  PRESENTING PROBLEM: Confusion, weakness, fatigue. Recent Covid infection treated with Paxlovid.  HOSPITAL COURSE: Patient was admitted to the general medicine service for acute metabolic encephalopathy secondary to subacute COVID infection verses urinary tract infection.  She did not qualify for IV remdesivir, she had completed Paxlovid outpatient.  She was treated with supportive care including IV fluids.  She was initially given 1 dose of 1gram IV Rocephin for possible urinary tract infection, her initial sample was not enough to send for culture, repeat urine culture with no growth at time of discharge.  Blood cultures x2 with no growth at 48 hours at discharge.  IV fluids were discontinued and she was able to eat and drink on her own, no urinary complaints, and her confusion improved per family. Daughter had no acute concerns on day of discharge.   Patient worked with PT and OT who felt she would benefit from subacute rehab, her family agreed that she would benefit from a course of therapy.  She will be discharged to Facility
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal discomfort, Abdominal pain upper, Blood test, Colonoscopy, Diarrhoea
Clinical narrative: I experienced soreness in my arm, tiredness for a couple days but then a month later I start experiencing gastrointestinal issues with pain in my stomach, acid reflux and broken up and loose bowel movements.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Fatigue, Gastrooesophageal reflux disease, Pain in extremity
Clinical narrative: I experienced soreness in my arm, tiredness for a couple days but then a month later I start experiencing gastrointestinal issues with pain in my stomach, acid reflux and broken up and loose bowel movements.
Age: 17.0
Sex: F
Vaccine: COVID19-2
Symptoms: Inappropriate schedule of product administration, No adverse event
Clinical narrative: Patient was previously administered the Pfizer Monovalent vaccine number 1 in the series on 04/14/2023, 3 weeks prior, and was given the Pfizer Bivalent as 2nd dose in series prior to the 8 week recommended time frame. No adverse signs or symptoms have occurred. Pfizer was notified and recommendation is revaccination of Pfizer Bivalent 1 dose in 8 weeks from administration date of 05/06/2023
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Anaemia, Blood magnesium decreased, Blood potassium decreased, Chest X-ray abnormal, Condition aggravated
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 4/28/2023 Discharge Date: 5/2/2023   Clinical Narrative: This is a 75 year old gentleman who is status post a stem cell transplant for myelodysplasia and also has history of B cell lymphoma treated with Rituxan. He presented with fever of 39.5 and altered mental status with findings of sepsis and bibasilar pneumonia.   He was treated with doxycycline and Cefepime and by discharge had complete clearing of his chest x-ray. Sputum culture did not reveal the pathogen. He received a total of 4 days of IV antibiotics, and he was discharged with 3 additional days of Ceftin to complete 7 days treatment. Because of the immunocompromised state with recurrent pneumonia, he was given and additional 5 days of Ceftin to keep and start at the onset of a respiratory infection, and he was instructed in that instance to also seek medical care immediately.   Other issues included symptomatic anemia with hgb 7.5. Iron saturation was borderline low at 15% and he was started on Ferrous sulfate supplement at discharge. Also he had low potassium and magnesium levels and was started on supplementation for those as well.
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Haemoglobin decreased, Mental status changes, Pneumonia, Pyrexia, Sepsis
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 4/28/2023 Discharge Date: 5/2/2023   Clinical Narrative: This is a 75 year old gentleman who is status post a stem cell transplant for myelodysplasia and also has history of B cell lymphoma treated with Rituxan. He presented with fever of 39.5 and altered mental status with findings of sepsis and bibasilar pneumonia.   He was treated with doxycycline and Cefepime and by discharge had complete clearing of his chest x-ray. Sputum culture did not reveal the pathogen. He received a total of 4 days of IV antibiotics, and he was discharged with 3 additional days of Ceftin to complete 7 days treatment. Because of the immunocompromised state with recurrent pneumonia, he was given and additional 5 days of Ceftin to keep and start at the onset of a respiratory infection, and he was instructed in that instance to also seek medical care immediately.   Other issues included symptomatic anemia with hgb 7.5. Iron saturation was borderline low at 15% and he was started on Ferrous sulfate supplement at discharge. Also he had low potassium and magnesium levels and was started on supplementation for those as well.
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Sputum culture, Transferrin saturation decreased
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 4/28/2023 Discharge Date: 5/2/2023   Clinical Narrative: This is a 75 year old gentleman who is status post a stem cell transplant for myelodysplasia and also has history of B cell lymphoma treated with Rituxan. He presented with fever of 39.5 and altered mental status with findings of sepsis and bibasilar pneumonia.   He was treated with doxycycline and Cefepime and by discharge had complete clearing of his chest x-ray. Sputum culture did not reveal the pathogen. He received a total of 4 days of IV antibiotics, and he was discharged with 3 additional days of Ceftin to complete 7 days treatment. Because of the immunocompromised state with recurrent pneumonia, he was given and additional 5 days of Ceftin to keep and start at the onset of a respiratory infection, and he was instructed in that instance to also seek medical care immediately.   Other issues included symptomatic anemia with hgb 7.5. Iron saturation was borderline low at 15% and he was started on Ferrous sulfate supplement at discharge. Also he had low potassium and magnesium levels and was started on supplementation for those as well.
Age: 49.0
Sex: F
Vaccine: TDAP
Symptoms: Arthralgia, Blood test normal, Pain, Pain in extremity, Swelling
Clinical narrative: Patient state that she began to have severe arm/shoulder pain a few hours after administration. Patient decided to call their doctor and was seen. They gave the patient cephalexin and prednisone for the swelling/pain. After administration of the medication, patient reported that she began to feel better. However, have she finished the medication she stated that the pain was worse than when it was initially when the medication was started. Patient was then referred to a Sports medicine doctor which then explained how she could have "Frozen Shoulder" due to the injection.
Age: 49.0
Sex: F
Vaccine: TDAP
Symptoms: X-ray limb normal
Clinical narrative: Patient state that she began to have severe arm/shoulder pain a few hours after administration. Patient decided to call their doctor and was seen. They gave the patient cephalexin and prednisone for the swelling/pain. After administration of the medication, patient reported that she began to feel better. However, have she finished the medication she stated that the pain was worse than when it was initially when the medication was started. Patient was then referred to a Sports medicine doctor which then explained how she could have "Frozen Shoulder" due to the injection.
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood electrolytes, COVID-19, Electrolyte substitution therapy, Loss of personal independence in daily activities
Clinical narrative: Date of Admission: 4/26/2023 Discharge Date: 5/1/2023  PRESENTING PROBLEM: Generalized weakness History of dementia COVID-19 virus infection  COVID-19    HOSPITAL COURSE: 84-year-old man with a past medical history of atrial fibrillation on Xarelto, diastolic heart failure, vascular dementia presented with weakness and was found to have COVID-19 infection.  Patient was admitted to the hospitalist service due to concerns about safety returning home. Was living in independent living apartment with his wife who feels that she can no longer take care of him.  She was working on setting up memory care placement for patient in the same place where she has her independent living apartment.   Patient worked with physical therapy it was initially felt to be too weak to return home.  Family did not want patient to go to a subacute rehab facility while awaiting the end of his quarantine period for COVID.  Eventually the patient was able to become strong enough and the family was able to arrange private duty service as well as adult children to stay in the home so that patient and his wife have 24 hour care until diet is able to go to memory care unit.   Electrolytes were monitored and repleted throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up. Patient's wife voiced understanding was agreeable with plan of care discharge
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, Obstructive sleep apnoea syndrome
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE ADULT OBSTRUCTIVE SLEEP APNEA HYPOXIA
Age: 87.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood pressure increased, Blood sodium decreased, COVID-19, Decreased appetite, Fatigue
Clinical narrative: Discharge Provider:  DO Primary Care Provider at Discharge:  MD  Admission Date: 4/27/2023 Discharge Date: 04/29/2023  PRESENTING PROBLEM: Hyponatremia   HOSPITAL COURSE: Patient is an 88-year-old female who presented to the emergency department at the direction of the urgent care due to elevated blood pressure.  She had been feeling fatigued with decreased appetite and was found to be positive for COVID-19.  In the emergency department, patient was hypertensive otherwise vital signs were stable.  Lab work was obtained and revealed sodium of 126. She was admitted to the Internal Medicine Service.  Urine study suggestive of SIADH.  Patient had recently had her Prozac increased so this was decreased back to original dose for potential cause of hyponatremia.  She was fluid restricted and started on salt tabs.  Her hyponatremia did resolve during her hospital stay.  Salt tabs were discontinued.  She was recommended to continue a fluid restriction at discharge.  She was recommended to have repeat BMP in 5-7 days.  Her blood pressure improved with taking her home medications.  She was recommended follow up to primary care physician.  She was discharged home in stable condition.
Age: 87.0
Sex: F
Vaccine: COVID19-2
Symptoms: Fluid intake restriction, Hypertension, Hyponatraemia, Inappropriate antidiuretic hormone secretion, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider:  DO Primary Care Provider at Discharge:  MD  Admission Date: 4/27/2023 Discharge Date: 04/29/2023  PRESENTING PROBLEM: Hyponatremia   HOSPITAL COURSE: Patient is an 88-year-old female who presented to the emergency department at the direction of the urgent care due to elevated blood pressure.  She had been feeling fatigued with decreased appetite and was found to be positive for COVID-19.  In the emergency department, patient was hypertensive otherwise vital signs were stable.  Lab work was obtained and revealed sodium of 126. She was admitted to the Internal Medicine Service.  Urine study suggestive of SIADH.  Patient had recently had her Prozac increased so this was decreased back to original dose for potential cause of hyponatremia.  She was fluid restricted and started on salt tabs.  Her hyponatremia did resolve during her hospital stay.  Salt tabs were discontinued.  She was recommended to continue a fluid restriction at discharge.  She was recommended to have repeat BMP in 5-7 days.  Her blood pressure improved with taking her home medications.  She was recommended follow up to primary care physician.  She was discharged home in stable condition.
Age: 87.0
Sex: F
Vaccine: COVID19-2
Symptoms: Therapy change, Urine analysis abnormal
Clinical narrative: Discharge Provider:  DO Primary Care Provider at Discharge:  MD  Admission Date: 4/27/2023 Discharge Date: 04/29/2023  PRESENTING PROBLEM: Hyponatremia   HOSPITAL COURSE: Patient is an 88-year-old female who presented to the emergency department at the direction of the urgent care due to elevated blood pressure.  She had been feeling fatigued with decreased appetite and was found to be positive for COVID-19.  In the emergency department, patient was hypertensive otherwise vital signs were stable.  Lab work was obtained and revealed sodium of 126. She was admitted to the Internal Medicine Service.  Urine study suggestive of SIADH.  Patient had recently had her Prozac increased so this was decreased back to original dose for potential cause of hyponatremia.  She was fluid restricted and started on salt tabs.  Her hyponatremia did resolve during her hospital stay.  Salt tabs were discontinued.  She was recommended to continue a fluid restriction at discharge.  She was recommended to have repeat BMP in 5-7 days.  Her blood pressure improved with taking her home medications.  She was recommended follow up to primary care physician.  She was discharged home in stable condition.
Age: 70.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Fatigue, Malaise
Clinical narrative: I was congested, had a cough, achy, very tired, I took a home COVID-19 test, that came back positive. My wife and I both were positive, so we called and had a telehealth visit with our Physician Assistant to let her know about our positive test and symptoms. She prescribed Paxlovid that I was able to start that evening. In forty-eight hours, I started feeling better, it did take a couple of weeks before I was really feeling like myself.
Age: 70.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pain, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: I was congested, had a cough, achy, very tired, I took a home COVID-19 test, that came back positive. My wife and I both were positive, so we called and had a telehealth visit with our Physician Assistant to let her know about our positive test and symptoms. She prescribed Paxlovid that I was able to start that evening. In forty-eight hours, I started feeling better, it did take a couple of weeks before I was really feeling like myself.
Age: 36.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Dosage administed was 0.3ml, but 0.5ml is the correct dose.
Age: 72.0
Sex: F
Vaccine: PNC20
Symptoms: Injection site rash, Urticaria
Clinical narrative: Patient reported circular area of rash surrounding injection site and hives on face.
Age: 84.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Chest X-ray normal, Cough
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: PA  Admission Date: 4/25/2023  Discharge Date: 4/27/2023   DISCHARGE DIAGNOSES: 1. COVID-19 infection 2. Acute hypoxemic respiratory failure, resolved 3. Type 2 diabetes mellitus 4. Benign essential hypertension 5. GERD 6. Hypomagnesemia  HOSPITAL COURSE: Patient is an 85-year-old female with history of type 2 diabetes mellitus, hypertension and GERD who presented with cough, sore throat, and generalized weakness.  In the ED, she was hypoxemic and placed on 2 L oxygen.  Her chest x-ray showed no acute infiltrates.  She tested positive for COVID-19.  She was admitted to the hospitalist service for generalized weakness and COVID-19 infection.   Upon admission, she was continued on supplemental oxygen.  She was started on Remdesivir for her COVID-19 as well as Decadron 6 mg daily.  Labs and vital signs remained stable, and she was able to be weaned off oxygen by the morning of 4/27.   She was seen by PT and OT, who felt she was appropriate for return to her independent living facility.   She was felt stable for discharge on 4/27/23.  She will be discharge on 3 more days of oral Decadron for COVID-19.  She should follow-up with her PCP in 1 week.
Age: 84.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Hypomagnesaemia, Hypoxia, Laboratory test normal, Oropharyngeal pain, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: PA  Admission Date: 4/25/2023  Discharge Date: 4/27/2023   DISCHARGE DIAGNOSES: 1. COVID-19 infection 2. Acute hypoxemic respiratory failure, resolved 3. Type 2 diabetes mellitus 4. Benign essential hypertension 5. GERD 6. Hypomagnesemia  HOSPITAL COURSE: Patient is an 85-year-old female with history of type 2 diabetes mellitus, hypertension and GERD who presented with cough, sore throat, and generalized weakness.  In the ED, she was hypoxemic and placed on 2 L oxygen.  Her chest x-ray showed no acute infiltrates.  She tested positive for COVID-19.  She was admitted to the hospitalist service for generalized weakness and COVID-19 infection.   Upon admission, she was continued on supplemental oxygen.  She was started on Remdesivir for her COVID-19 as well as Decadron 6 mg daily.  Labs and vital signs remained stable, and she was able to be weaned off oxygen by the morning of 4/27.   She was seen by PT and OT, who felt she was appropriate for return to her independent living facility.   She was felt stable for discharge on 4/27/23.  She will be discharge on 3 more days of oral Decadron for COVID-19.  She should follow-up with her PCP in 1 week.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: a few weeks later I tested positive for covid.
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Fatigue, Malaise
Clinical narrative: Low fever 100.3 F, tiredness, feeling unwell
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Neuropathy peripheral
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE NEUROPATHY
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary embolism
Clinical narrative: ACUTE PULMONARY EMBOLISM
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated
Clinical narrative: Discharge Provider: MD Primary Care Physician at Discharge: DO  Admission Date: 4/22/2023  PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01]   HOSPITAL COURSE: Patient is a 85 y.o. with severe COPD on hospice who was found down this morning unresponsive by his family and brought into hospital where he was intubated and in shock. Labs consistent with shock liver, acute kidney injury, COVID positive. Difficulty with maintaining appropriate ventilation due to the severity of the COPD and auto-PEEP. Transferred to alternate facility.    After arrival his family reported that he did not want life support and did not want any invasive testing, he would be upset if he knew this was done. We discussed that with his worsening shock, severe underlying lung disease and multi organ system failure that this would not be a quick turnaround and he would require invasive monitoring and access to appropriately manage him. Upon further discussion the family (daughter and son) reported what we were doing was not consistent with his wishes and they wanted to transition to comfort care. There is one biologic child who was present, additional step-children who were not present, were in agreement. His wishes were well known to the family. Will plan to transition to comfort care measures. Anticipate initiating comfort care order set, no further lab studies, morphine GTT and prn Ativan, will plan to extubate with family at bedside. Date of Death: 4/22/23; Time of Death:  8:54 PM. Preliminary Cause of Death: COPD (chronic obstructive pulmonary disease) (HCC).
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Death, Endotracheal intubation, Ischaemic hepatitis, Laboratory test abnormal, Mechanical ventilation
Clinical narrative: Discharge Provider: MD Primary Care Physician at Discharge: DO  Admission Date: 4/22/2023  PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01]   HOSPITAL COURSE: Patient is a 85 y.o. with severe COPD on hospice who was found down this morning unresponsive by his family and brought into hospital where he was intubated and in shock. Labs consistent with shock liver, acute kidney injury, COVID positive. Difficulty with maintaining appropriate ventilation due to the severity of the COPD and auto-PEEP. Transferred to alternate facility.    After arrival his family reported that he did not want life support and did not want any invasive testing, he would be upset if he knew this was done. We discussed that with his worsening shock, severe underlying lung disease and multi organ system failure that this would not be a quick turnaround and he would require invasive monitoring and access to appropriately manage him. Upon further discussion the family (daughter and son) reported what we were doing was not consistent with his wishes and they wanted to transition to comfort care. There is one biologic child who was present, additional step-children who were not present, were in agreement. His wishes were well known to the family. Will plan to transition to comfort care measures. Anticipate initiating comfort care order set, no further lab studies, morphine GTT and prn Ativan, will plan to extubate with family at bedside. Date of Death: 4/22/23; Time of Death:  8:54 PM. Preliminary Cause of Death: COPD (chronic obstructive pulmonary disease) (HCC).
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Multiple organ dysfunction syndrome, Positive end-expiratory pressure, SARS-CoV-2 test positive, Shock, Unresponsive to stimuli
Clinical narrative: Discharge Provider: MD Primary Care Physician at Discharge: DO  Admission Date: 4/22/2023  PRESENTING PROBLEM: Acute hypoxemic respiratory failure (HCC) [J96.01]   HOSPITAL COURSE: Patient is a 85 y.o. with severe COPD on hospice who was found down this morning unresponsive by his family and brought into hospital where he was intubated and in shock. Labs consistent with shock liver, acute kidney injury, COVID positive. Difficulty with maintaining appropriate ventilation due to the severity of the COPD and auto-PEEP. Transferred to alternate facility.    After arrival his family reported that he did not want life support and did not want any invasive testing, he would be upset if he knew this was done. We discussed that with his worsening shock, severe underlying lung disease and multi organ system failure that this would not be a quick turnaround and he would require invasive monitoring and access to appropriately manage him. Upon further discussion the family (daughter and son) reported what we were doing was not consistent with his wishes and they wanted to transition to comfort care. There is one biologic child who was present, additional step-children who were not present, were in agreement. His wishes were well known to the family. Will plan to transition to comfort care measures. Anticipate initiating comfort care order set, no further lab studies, morphine GTT and prn Ativan, will plan to extubate with family at bedside. Date of Death: 4/22/23; Time of Death:  8:54 PM. Preliminary Cause of Death: COPD (chronic obstructive pulmonary disease) (HCC).
Age: 53.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Angiogram cerebral normal, Arteriogram carotid normal, Asthenia, Blood magnesium normal, Blood test normal
Clinical narrative: 8am on March 30, 2023 I took a tylenol cold and flu medication due to a mild cough I had developed overnight.  I felt fine otherwise, no fever.  I was tired but that is nothing really new.  At 9:30am I was at work performing a surgery (veterinarian) and at the end of the procedure I felt weak.  Then acute onset of dizziness and racing heart, followed by syncope.  Hands began tingling and fingers curled up and was unable to move myself up off floor or uncurl my hands.  Transported by ambulance to the nearest hospital ER.   I received IV fluids and a number of tests (bloodwork, xrays, CT, ECG) and all results were normal.  I was released to go home later that afternoon around 3:30pm and wore a Holter cardiac monitor for another 24 hrs.  I also had an MRI of my head on April 20, 2023. I have felt fine ever since.  No other issues.
Age: 53.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Blood thyroid stimulating hormone normal, Brain natriuretic peptide normal, Computerised tomogram normal, Cough, Dizziness
Clinical narrative: 8am on March 30, 2023 I took a tylenol cold and flu medication due to a mild cough I had developed overnight.  I felt fine otherwise, no fever.  I was tired but that is nothing really new.  At 9:30am I was at work performing a surgery (veterinarian) and at the end of the procedure I felt weak.  Then acute onset of dizziness and racing heart, followed by syncope.  Hands began tingling and fingers curled up and was unable to move myself up off floor or uncurl my hands.  Transported by ambulance to the nearest hospital ER.   I received IV fluids and a number of tests (bloodwork, xrays, CT, ECG) and all results were normal.  I was released to go home later that afternoon around 3:30pm and wore a Holter cardiac monitor for another 24 hrs.  I also had an MRI of my head on April 20, 2023. I have felt fine ever since.  No other issues.
Age: 53.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Dyskinesia, Electrocardiogram ambulatory normal, Electrocardiogram normal, Fatigue, Full blood count normal
Clinical narrative: 8am on March 30, 2023 I took a tylenol cold and flu medication due to a mild cough I had developed overnight.  I felt fine otherwise, no fever.  I was tired but that is nothing really new.  At 9:30am I was at work performing a surgery (veterinarian) and at the end of the procedure I felt weak.  Then acute onset of dizziness and racing heart, followed by syncope.  Hands began tingling and fingers curled up and was unable to move myself up off floor or uncurl my hands.  Transported by ambulance to the nearest hospital ER.   I received IV fluids and a number of tests (bloodwork, xrays, CT, ECG) and all results were normal.  I was released to go home later that afternoon around 3:30pm and wore a Holter cardiac monitor for another 24 hrs.  I also had an MRI of my head on April 20, 2023. I have felt fine ever since.  No other issues.
Age: 53.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Laboratory test normal, Magnetic resonance imaging head normal, Mobility decreased, Palpitations, Paraesthesia
Clinical narrative: 8am on March 30, 2023 I took a tylenol cold and flu medication due to a mild cough I had developed overnight.  I felt fine otherwise, no fever.  I was tired but that is nothing really new.  At 9:30am I was at work performing a surgery (veterinarian) and at the end of the procedure I felt weak.  Then acute onset of dizziness and racing heart, followed by syncope.  Hands began tingling and fingers curled up and was unable to move myself up off floor or uncurl my hands.  Transported by ambulance to the nearest hospital ER.   I received IV fluids and a number of tests (bloodwork, xrays, CT, ECG) and all results were normal.  I was released to go home later that afternoon around 3:30pm and wore a Holter cardiac monitor for another 24 hrs.  I also had an MRI of my head on April 20, 2023. I have felt fine ever since.  No other issues.
Age: 53.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Scan with contrast normal, Syncope, Troponin I normal, X-ray normal
Clinical narrative: 8am on March 30, 2023 I took a tylenol cold and flu medication due to a mild cough I had developed overnight.  I felt fine otherwise, no fever.  I was tired but that is nothing really new.  At 9:30am I was at work performing a surgery (veterinarian) and at the end of the procedure I felt weak.  Then acute onset of dizziness and racing heart, followed by syncope.  Hands began tingling and fingers curled up and was unable to move myself up off floor or uncurl my hands.  Transported by ambulance to the nearest hospital ER.   I received IV fluids and a number of tests (bloodwork, xrays, CT, ECG) and all results were normal.  I was released to go home later that afternoon around 3:30pm and wore a Holter cardiac monitor for another 24 hrs.  I also had an MRI of my head on April 20, 2023. I have felt fine ever since.  No other issues.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Obstructive sleep apnoea syndrome, Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE ADULT OBSTRUCTIVE SLEEP APNEA, MILD 11/26/2022 -- RECURRENCE OF SAME SYMPTOMS
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Aortic aneurysm
Clinical narrative: ACUTE RESPIRATORY FAILURE 2/27/2022 ABDOMINAL AORTIC ANEURYSM, UNSPECIFIED PART
Age: 81.0
Sex: F
Vaccine: COVID19, FLUA4
Symptoms: Acute kidney injury, Asthenia, Blood electrolytes, COVID-19, Decreased appetite
Clinical narrative: Discharge Physician:  DO Primary Care Physician:  MD  Date of Admission: 4/18/2023 Discharge Date: 4/19/2023   PRESENTING PROBLEM: Generalized weakness  COVID-19    HOSPITAL COURSE: Patient is an 82 year old female with history hypothyroidism, GERD, anxiety, and essential tremors who presented with fatigue and loss of appetite. Her symptoms began on 4/16 and she was noted to become progressively more weak, her husband brought her to the ED as he was unable to care for her with her weakness. In the ED, she tested positive for COVID and was also found to have an AKI, her vital signs remained stable and she required no supplemental oxygen. The hospitalist team was consulted for admission as the patient was too weak to go home. The patient was admitted, she did have two episodes of vomiting but was also tolerating a diet. She worked with therapy and did well as was felt to be safe for discharge home with continued PT/OT. Overall, she stated that she felt much improved and was found to be medically stable for discharge to home. Due to her intermittent nausea and vomiting, she was given a small supply of Zofran.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. Patient voiced understanding was agreeable with plan of care discharge.
Age: 81.0
Sex: F
Vaccine: COVID19, FLUA4
Symptoms: Electrolyte depletion, Electrolyte substitution therapy, Fatigue, Nausea, SARS-CoV-2 test positive
Clinical narrative: Discharge Physician:  DO Primary Care Physician:  MD  Date of Admission: 4/18/2023 Discharge Date: 4/19/2023   PRESENTING PROBLEM: Generalized weakness  COVID-19    HOSPITAL COURSE: Patient is an 82 year old female with history hypothyroidism, GERD, anxiety, and essential tremors who presented with fatigue and loss of appetite. Her symptoms began on 4/16 and she was noted to become progressively more weak, her husband brought her to the ED as he was unable to care for her with her weakness. In the ED, she tested positive for COVID and was also found to have an AKI, her vital signs remained stable and she required no supplemental oxygen. The hospitalist team was consulted for admission as the patient was too weak to go home. The patient was admitted, she did have two episodes of vomiting but was also tolerating a diet. She worked with therapy and did well as was felt to be safe for discharge home with continued PT/OT. Overall, she stated that she felt much improved and was found to be medically stable for discharge to home. Due to her intermittent nausea and vomiting, she was given a small supply of Zofran.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. Patient voiced understanding was agreeable with plan of care discharge.
Age: 81.0
Sex: F
Vaccine: COVID19, FLUA4
Symptoms: Vomiting
Clinical narrative: Discharge Physician:  DO Primary Care Physician:  MD  Date of Admission: 4/18/2023 Discharge Date: 4/19/2023   PRESENTING PROBLEM: Generalized weakness  COVID-19    HOSPITAL COURSE: Patient is an 82 year old female with history hypothyroidism, GERD, anxiety, and essential tremors who presented with fatigue and loss of appetite. Her symptoms began on 4/16 and she was noted to become progressively more weak, her husband brought her to the ED as he was unable to care for her with her weakness. In the ED, she tested positive for COVID and was also found to have an AKI, her vital signs remained stable and she required no supplemental oxygen. The hospitalist team was consulted for admission as the patient was too weak to go home. The patient was admitted, she did have two episodes of vomiting but was also tolerating a diet. She worked with therapy and did well as was felt to be safe for discharge home with continued PT/OT. Overall, she stated that she felt much improved and was found to be medically stable for discharge to home. Due to her intermittent nausea and vomiting, she was given a small supply of Zofran.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. Patient voiced understanding was agreeable with plan of care discharge.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Epilepsy, Hypotension, Idiopathic generalised epilepsy, Reversible ischaemic neurological deficit
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE EPILEPSY, GENERALIZED IDIOPATHIC CLONIC EPILEPSY EPILEPSY, UNSPECIFIED REVERSIBLE ISCHEMIC NEUROLOGIC DEFICIT SYNDROME HYPOTENSION 7/8/2022 &  8/20/2022  --  HOSP- HOSPITAL
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Cor pulmonale, Obstructive sleep apnoea syndrome, Respiratory failure
Clinical narrative: vaccine was administered outside of facility - reported by patient ? NO LOT NUMBER WERE SUPPLIED ----------------------------------------------------------------------------------------------------------------------- G47.33 OBSTRUCTIVE SLEEP APNEA 7/8/2021 ACUTE ON CHRONIC HYPERCAPNIC RESPIRATORY FAILURE J96.21 ACUTE ON CHRONIC HYPOXEMIC RESPIRATORY FAILURE 12/13/2021 ACUTE ON CHRONIC HYPERCAPNIC RESPIRATORY FAILURE J96.90 RESPIRATORY FAILURE, UNSPECIFIED ACUITY 12/24/2021 ACUTE ON CHRONIC HYPERCAPNIC RESPIRATORY FAILURE G47.33 OBSTRUCTIVE SLEEP APNEA 7/8/2021 COR PULMONALE J96.21 ACUTE ON CHRONIC HYPOXEMIC RESPIRATORY FAILURE 12/13/2021 COR PULMONALE J96.90 RESPIRATORY FAILURE, UNSPECIFIED ACUITY 12/24/2021 COR PULMONALE
Age: 2.0
Sex: M
Vaccine: COVID19-2, HEPA
Symptoms: Underdose, Wrong product administered
Clinical narrative: Patient was administered incorrect Moderna vaccine as the 2nd dose. Patient should of received the Moderna dark blue cap with gray border as the second dose. Pt was given a lower dose of the COVID vaccine recommended for his age and dose in series.
Age: 53.0
Sex: M
Vaccine: VARZOS, VARZOS
Symptoms: Pruritus, Rash
Clinical narrative: Rash, itchiness, "bumps" all over body.
Age: 53.0
Sex: M
Vaccine: VARZOS, VARZOS
Symptoms: Dry skin, HIV test negative, Pruritus, Rash, Rash pruritic
Clinical narrative: Rash, itchiness, "bumps" all over body.
Age: 53.0
Sex: M
Vaccine: VARZOS, VARZOS
Symptoms: Rash vesicular, Skin lesion, Treponema test negative
Clinical narrative: Rash, itchiness, "bumps" all over body.
Age: 27.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain, Deep vein thrombosis, Leukocytosis, Pulmonary embolism
Clinical narrative: Moderna vaccine was administered outside of clinic- reported by patient ? NO LOT NUMBER WERE SUPPLIED -------------------------------------------------------------------------------------------------------------------  PULMONARY EMBOLISM, UNSPECIFIED. 7/7/2021 ABDOMINAL PAIN  ACUTE DVT OF LEFT LEG, UNSPECIFIED VEIN 7/2/2021 ABDOMINAL PAIN  PULMONARY EMBOLISM, UNSPECIFIED. 7/7/2021 LEUKOCYTOSIS  ACUTE DVT OF LEFT LEG, UNSPECIFIED VEIN 7/2/2021 LEUKOCYTOSIS
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Blood glucose normal, Blood sodium decreased, COVID-19
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 4/17/2023 Discharge Date: Apr 22, 2023   PRESENTING PROBLEM: Acute respiratory failure with hypoxia (HCC) [J96.01] Acute congestive heart failure, unspecified heart failure type (HCC) [I50.9] AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: Patient is a 67 y.o. who presented to ED via EMS for shortness of breath.  Upon arrival to the ED, He required 2L nasal cannula after sats dropped down to 87% on room air. Significant lab work included mild hyponatremia of 133 and glucose of 138. Procal was WNL at 0.07 and proBNP was 119. D-dimer was mildly elevated at 530. Viral PCR was negative. Chest X-ray showed mild cardiomegaly and pulmonary vascular congestion without acute cardiopulmonary pathology. While in the ED patient received a 1x dose of IV lasix 40 mg.   Patient was admitted to internal medicine service for further workup and treatment of acute hypoxic respiratory failure.  Patient did become hypotensive with acute kidney injury with diuretic therapy.  He underwent an echocardiogram which showed preserved ejection fraction.  He had normal NT proBNP arguing against CHF.  He underwent a CT of the thorax which revealed a multifocal pneumonia.  Viral testing revealed COVID-19 as well as metapneumovirus.  Given his low blood pressures he was also covered empirically for bacterial pneumonia.  Patient was started on 6 mg of dexamethasone and albuterol for wheezing.  He will complete 5 days of Augmentin and azithromycin to cover community-acquired pneumonia.  He clinically improved and was weaned off of oxygen.   Patient underwent a swallow evaluation he was found have significant esophageal dysmotility.  He is tolerating diet and will follow-up with Gastroenterology as an outpatient as well as undergo a video swallow as an outpatient speech-language therapy.   He did exhibit desaturations at night, with sleep apnea suspected, outpatient sleep study recommended, he will discharge on supplemental oxygen to wear at night only.   In regards to his hypertension, patient had significant hypotension during hospitalization.  This has resolved, will hold metoprolol XL as well as losartan and continue hydrochlorothiazide at discharge.  Blood pressure medications can be resumed as tolerated as an outpatient.   Patient is clinically improved and is medically stable for transfer back to his adult foster care facility. He was needing 2 L O2 at night at time of discharge.
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Condition aggravated
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 4/17/2023 Discharge Date: Apr 22, 2023   PRESENTING PROBLEM: Acute respiratory failure with hypoxia (HCC) [J96.01] Acute congestive heart failure, unspecified heart failure type (HCC) [I50.9] AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: Patient is a 67 y.o. who presented to ED via EMS for shortness of breath.  Upon arrival to the ED, He required 2L nasal cannula after sats dropped down to 87% on room air. Significant lab work included mild hyponatremia of 133 and glucose of 138. Procal was WNL at 0.07 and proBNP was 119. D-dimer was mildly elevated at 530. Viral PCR was negative. Chest X-ray showed mild cardiomegaly and pulmonary vascular congestion without acute cardiopulmonary pathology. While in the ED patient received a 1x dose of IV lasix 40 mg.   Patient was admitted to internal medicine service for further workup and treatment of acute hypoxic respiratory failure.  Patient did become hypotensive with acute kidney injury with diuretic therapy.  He underwent an echocardiogram which showed preserved ejection fraction.  He had normal NT proBNP arguing against CHF.  He underwent a CT of the thorax which revealed a multifocal pneumonia.  Viral testing revealed COVID-19 as well as metapneumovirus.  Given his low blood pressures he was also covered empirically for bacterial pneumonia.  Patient was started on 6 mg of dexamethasone and albuterol for wheezing.  He will complete 5 days of Augmentin and azithromycin to cover community-acquired pneumonia.  He clinically improved and was weaned off of oxygen.   Patient underwent a swallow evaluation he was found have significant esophageal dysmotility.  He is tolerating diet and will follow-up with Gastroenterology as an outpatient as well as undergo a video swallow as an outpatient speech-language therapy.   He did exhibit desaturations at night, with sleep apnea suspected, outpatient sleep study recommended, he will discharge on supplemental oxygen to wear at night only.   In regards to his hypertension, patient had significant hypotension during hospitalization.  This has resolved, will hold metoprolol XL as well as losartan and continue hydrochlorothiazide at discharge.  Blood pressure medications can be resumed as tolerated as an outpatient.   Patient is clinically improved and is medically stable for transfer back to his adult foster care facility. He was needing 2 L O2 at night at time of discharge.