chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase normal, Basophil count normal, Basophil percentage decreased, Bilirubin conjugated
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Bilirubin urine, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood chloride normal
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea normal
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Blood urine absent, Calcium ionised, Carbon dioxide normal, Chest pain, Chills
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Chromaturia, Cough, Decreased appetite, Diarrhoea, Eosinophil count decreased
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Glomerular filtration rate normal, Glucose urine present, Granulocyte percentage, Haematocrit normal, Haemoglobin normal
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Hypophagia, Immature granulocyte count, Lipase normal, Lymphocyte count, Lymphocyte percentage
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume normal, Mean platelet volume normal, Monocyte count
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Monocyte percentage, Nausea, Neutrophil count, Neutrophil percentage, Nitrite urine absent
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Pain, Pain in extremity, Platelet count normal, Protein total, Protein urine absent
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Red blood cell count normal, Red cell distribution width increased, Specific gravity urine normal, Urine abnormality, Urine ketone body absent
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Urine leukocyte esterase, Urobilinogen urine, Vomiting, White blood cell count normal, pH urine normal
Clinical narrative: Pt comes after a recent zoster vaccine 5/30/23.  Per pt sooner after the same day after 3-4 h pt started having chills, body aches, intense arm and posterior L chest pain.  The day after she develop severe n/v/watery diarrhea x6 episodes. The day after per pt had some cough but resolved after 1 day.  Only able to drink fluids.  No appetite.  Self limited after 6 days.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Hypotension
Clinical narrative: HYPOTENSION
Age: 44.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Diabetic ketoacidosis, Nausea, Oropharyngeal pain, SARS-CoV-2 test positive
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED /BOOSTED AND COVID POSITIVE. PT FOUND TO BE COVID POSITIVE TO HAVE A SORE THROAT AND NAUSEA DURING ADMISSION. PT WAS ADMITTED FOR INTRACTABLE ABDOMINAL, SUSPEC D/T DIABETIC KETOACIDOSIS. NO TX MEDICATION NOTED FOR COVID 19.
Age: 44.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Vaccine breakthrough infection
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED /BOOSTED AND COVID POSITIVE. PT FOUND TO BE COVID POSITIVE TO HAVE A SORE THROAT AND NAUSEA DURING ADMISSION. PT WAS ADMITTED FOR INTRACTABLE ABDOMINAL, SUSPEC D/T DIABETIC KETOACIDOSIS. NO TX MEDICATION NOTED FOR COVID 19.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: C-reactive protein increased, COVID-19, Computerised tomogram normal, Cough, Diarrhoea
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED WITH PFIZER, COVID POSITIVE. Patient is a 49-year-old very pleasant gentleman with history of HIV, undetectable viral load, and CD4 count of just about 200. He is on Genvoya.  He has been having cough and congestion and had tested negative for COVID-19 two weeks ago, but then he started spiking fevers and was having vomiting and diarrhea and hence came to the emergency room.  His temperature was 101.3 last evening, TACYCARDIA 130BPM..  He is afebrile this morning.  He is oxygenating at 100% on room air.  He denies any chest pain.  He was started on remdesivir and dexamethasone.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Serum ferritin increased, Tachycardia
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED WITH PFIZER, COVID POSITIVE. Patient is a 49-year-old very pleasant gentleman with history of HIV, undetectable viral load, and CD4 count of just about 200. He is on Genvoya.  He has been having cough and congestion and had tested negative for COVID-19 two weeks ago, but then he started spiking fevers and was having vomiting and diarrhea and hence came to the emergency room.  His temperature was 101.3 last evening, TACYCARDIA 130BPM..  He is afebrile this morning.  He is oxygenating at 100% on room air.  He denies any chest pain.  He was started on remdesivir and dexamethasone.
Age: 47.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Vaccine breakthrough infection, Vomiting
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED WITH PFIZER, COVID POSITIVE. Patient is a 49-year-old very pleasant gentleman with history of HIV, undetectable viral load, and CD4 count of just about 200. He is on Genvoya.  He has been having cough and congestion and had tested negative for COVID-19 two weeks ago, but then he started spiking fevers and was having vomiting and diarrhea and hence came to the emergency room.  His temperature was 101.3 last evening, TACYCARDIA 130BPM..  He is afebrile this morning.  He is oxygenating at 100% on room air.  He denies any chest pain.  He was started on remdesivir and dexamethasone.
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Dizziness, Headache, Heart rate increased, Rash
Clinical narrative: Patient received first Moderna Vaccine on 11/09/2021. She reported on 6/1/23 a reaction to this dose. Her reactions include " a fast heartbeat; a bad rash all over your body; dizziness and weakness" "headache". Patient proceeded with her second dose on 12/13/2021 with no reported reactions.   Patient did not seek emergency treatment or any additional treatment in a Health facility. Please reach out to the patient for additional information if needed.
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Deep vein thrombosis, Lacunar stroke, Pulmonary embolism, Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE ACUTE LACUNAR STROKE, UNSPECIFIED TYPE AND ARTERY ACUTE DVT OF RIGHT TIBIAL VEIN ACUTE DVT OF RIGHT CALF, UNSPECIFIED VEIN ACUTE DVT OF LEFT CALF, UNSPECIFIED VEIN ACUTE DVT OF BILAT CALVES, UNSPECIFIED VEINS ACUTE PULMONARY EMBOLISM 1/25/2022 -- RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 46.0
Sex: M
Vaccine: COVID19
Symptoms: Pharyngeal swelling, Swelling face
Clinical narrative: Patient received second dose of Pfizer monovalent vaccine on 5/3/21. Patient reported a reaction to this dose on 6/5/23 of "Swelling of your face and throat". Patient did not seek additional treatment at a Health facility so we do not have any records of follow up.   Please contact patient for additional information if needed.
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Insomnia, Pruritus, Urticaria
Clinical narrative: Early am Thursday 6/1 began feeling intense itching and had trouble sleeping.  Took Benadryl and applied hydrocortisone cream to injection site.  Friday am 6/2 she called her GP and was advised to go to urgent care if symptoms worsened.  Friday pm hives developed all over body - patient went to urgent care and received steroid shot.  She was dispensed a steroid dose pack Friday PM and took as directed.  Called pharmacy to report adverse event on 6/5/23.  She reported that her sympotoms were resolved at this time.
Age: 43.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Hypoxia
Clinical narrative: ACUTE HYPOXEMIC RESPIRATORY FAILURE HYPOXIA
Age: 69.0
Sex: M
Vaccine: COVID19-2
Symptoms: Urticaria
Clinical narrative: Patient claims Hives started around 1130  ( 1 1/2 hours after vaccine)
Age: 54.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acoustic stimulation tests, Tinnitus
Clinical narrative: Persistent tinnitus symptoms started 4 days later in the morning of Monday, Sep 12, 2022 and have continued through the present date.
Age: 87.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Acute respiratory failure, C-reactive protein increased, COVID-19, Fibrin D dimer, Nasal congestion
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED and 2 BOOSTERS, COVID POSITIVE. . Diagnosis of  Acute respiratory failure with hypoxia due to fever from corona virus disease 2019 infection.  She has nasal congestion.  She is requiring supplemental oxygen at 1 L. MEDICATED WITH DECADRON.
Age: 87.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Procalcitonin, Prohormone brain natriuretic peptide increased, Pyrexia, SARS-CoV-2 test positive, Serum ferritin increased
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED and 2 BOOSTERS, COVID POSITIVE. . Diagnosis of  Acute respiratory failure with hypoxia due to fever from corona virus disease 2019 infection.  She has nasal congestion.  She is requiring supplemental oxygen at 1 L. MEDICATED WITH DECADRON.
Age: 87.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Vaccine breakthrough infection
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATED and 2 BOOSTERS, COVID POSITIVE. . Diagnosis of  Acute respiratory failure with hypoxia due to fever from corona virus disease 2019 infection.  She has nasal congestion.  She is requiring supplemental oxygen at 1 L. MEDICATED WITH DECADRON.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Coagulopathy
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE COAGULOPATHY, UNSPECIFIED TYPE
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram pulmonary, Bladder catheter replacement, Blood creatinine increased, Blood lactic acid
Clinical narrative: Discharge Physician: MD Primary Care Physician: DO  Date of Admission: 5/19/2023 Discharge Date: 5/23/2023   DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: Acute urinary tract infection [N39.0] Acute respiratory failure with hypoxia (HCC) [J96.01] Altered mental status, unspecified altered mental status type [R41.82]   Patient is a 75 y.o. male who presented with shortness of breath and altered mental status.  He has a pertinent medical history for type 2 diabetes, hypertension, CVA with right-sided hemiplegia, CKD, hyperlipidemia, CHF, and presence of suprapubic catheter.  Patient is a resident at long-term care facility where there he was noticed to have increased confusion and shortness of breath.  Per report from long-term care facility patient tested positive for COVID on 05/02/2023 and was removed from COVID precautions.  He was sent to the ER due to having oxygen saturation of 80% on room air and increased confusion.   In the ER, patient was initially placed on non-rebreather and subsequently weaned to 3 L nasal cannula.  Initial labs showed BUN 37, creatinine 2.16, BNP 656, lactic acid 2.3, WBC 14.17, hemoglobin 11.7, D-dimer 1020. He tested positive for COVID 19 in the ER.  Initially UA was obtained from old indwelling suprapubic catheter however this was replaced and repeat UA was obtained.  Blood cultures and urine culture pending.  A CTA thorax was obtained however examination was significantly limited due to respiratory motion, no pulmonary embolism given limited evaluation however cannot exclude pneumonia or pulmonary edema.  Patient was given DuoNebs and ceftriaxone in the ER.  Patient was admitted to the hospitalist service for further management of acute respiratory failure, acute cystitis, and COVID-19.     CT thorax was completed which showed mild mediastinal air and hilar adenopathy.  Recommend 3 month follow-up to exclude neoplastic adenopathy.   Patient reported using oxygen nightly and was able to maintain oxygen saturation on room air during day without difficulty.  Patient had improvement of cough and appetite.  Patient was discharged to skilled nursing facility, stable and in improved condition with close hospital follow-up.  On day of discharge patient had COVID testing which was negative.
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood urea increased, Brain natriuretic peptide increased, COVID-19, Computerised tomogram thorax abnormal, Confusional state
Clinical narrative: Discharge Physician: MD Primary Care Physician: DO  Date of Admission: 5/19/2023 Discharge Date: 5/23/2023   DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: Acute urinary tract infection [N39.0] Acute respiratory failure with hypoxia (HCC) [J96.01] Altered mental status, unspecified altered mental status type [R41.82]   Patient is a 75 y.o. male who presented with shortness of breath and altered mental status.  He has a pertinent medical history for type 2 diabetes, hypertension, CVA with right-sided hemiplegia, CKD, hyperlipidemia, CHF, and presence of suprapubic catheter.  Patient is a resident at long-term care facility where there he was noticed to have increased confusion and shortness of breath.  Per report from long-term care facility patient tested positive for COVID on 05/02/2023 and was removed from COVID precautions.  He was sent to the ER due to having oxygen saturation of 80% on room air and increased confusion.   In the ER, patient was initially placed on non-rebreather and subsequently weaned to 3 L nasal cannula.  Initial labs showed BUN 37, creatinine 2.16, BNP 656, lactic acid 2.3, WBC 14.17, hemoglobin 11.7, D-dimer 1020. He tested positive for COVID 19 in the ER.  Initially UA was obtained from old indwelling suprapubic catheter however this was replaced and repeat UA was obtained.  Blood cultures and urine culture pending.  A CTA thorax was obtained however examination was significantly limited due to respiratory motion, no pulmonary embolism given limited evaluation however cannot exclude pneumonia or pulmonary edema.  Patient was given DuoNebs and ceftriaxone in the ER.  Patient was admitted to the hospitalist service for further management of acute respiratory failure, acute cystitis, and COVID-19.     CT thorax was completed which showed mild mediastinal air and hilar adenopathy.  Recommend 3 month follow-up to exclude neoplastic adenopathy.   Patient reported using oxygen nightly and was able to maintain oxygen saturation on room air during day without difficulty.  Patient had improvement of cough and appetite.  Patient was discharged to skilled nursing facility, stable and in improved condition with close hospital follow-up.  On day of discharge patient had COVID testing which was negative.
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Cough, Cystitis, Decreased appetite, Dyspnoea, Fibrin D dimer
Clinical narrative: Discharge Physician: MD Primary Care Physician: DO  Date of Admission: 5/19/2023 Discharge Date: 5/23/2023   DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: Acute urinary tract infection [N39.0] Acute respiratory failure with hypoxia (HCC) [J96.01] Altered mental status, unspecified altered mental status type [R41.82]   Patient is a 75 y.o. male who presented with shortness of breath and altered mental status.  He has a pertinent medical history for type 2 diabetes, hypertension, CVA with right-sided hemiplegia, CKD, hyperlipidemia, CHF, and presence of suprapubic catheter.  Patient is a resident at long-term care facility where there he was noticed to have increased confusion and shortness of breath.  Per report from long-term care facility patient tested positive for COVID on 05/02/2023 and was removed from COVID precautions.  He was sent to the ER due to having oxygen saturation of 80% on room air and increased confusion.   In the ER, patient was initially placed on non-rebreather and subsequently weaned to 3 L nasal cannula.  Initial labs showed BUN 37, creatinine 2.16, BNP 656, lactic acid 2.3, WBC 14.17, hemoglobin 11.7, D-dimer 1020. He tested positive for COVID 19 in the ER.  Initially UA was obtained from old indwelling suprapubic catheter however this was replaced and repeat UA was obtained.  Blood cultures and urine culture pending.  A CTA thorax was obtained however examination was significantly limited due to respiratory motion, no pulmonary embolism given limited evaluation however cannot exclude pneumonia or pulmonary edema.  Patient was given DuoNebs and ceftriaxone in the ER.  Patient was admitted to the hospitalist service for further management of acute respiratory failure, acute cystitis, and COVID-19.     CT thorax was completed which showed mild mediastinal air and hilar adenopathy.  Recommend 3 month follow-up to exclude neoplastic adenopathy.   Patient reported using oxygen nightly and was able to maintain oxygen saturation on room air during day without difficulty.  Patient had improvement of cough and appetite.  Patient was discharged to skilled nursing facility, stable and in improved condition with close hospital follow-up.  On day of discharge patient had COVID testing which was negative.
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Haemoglobin decreased, Hilar lymphadenopathy, Lymphadenopathy mediastinal, Mental status changes, SARS-CoV-2 test positive
Clinical narrative: Discharge Physician: MD Primary Care Physician: DO  Date of Admission: 5/19/2023 Discharge Date: 5/23/2023   DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: Acute urinary tract infection [N39.0] Acute respiratory failure with hypoxia (HCC) [J96.01] Altered mental status, unspecified altered mental status type [R41.82]   Patient is a 75 y.o. male who presented with shortness of breath and altered mental status.  He has a pertinent medical history for type 2 diabetes, hypertension, CVA with right-sided hemiplegia, CKD, hyperlipidemia, CHF, and presence of suprapubic catheter.  Patient is a resident at long-term care facility where there he was noticed to have increased confusion and shortness of breath.  Per report from long-term care facility patient tested positive for COVID on 05/02/2023 and was removed from COVID precautions.  He was sent to the ER due to having oxygen saturation of 80% on room air and increased confusion.   In the ER, patient was initially placed on non-rebreather and subsequently weaned to 3 L nasal cannula.  Initial labs showed BUN 37, creatinine 2.16, BNP 656, lactic acid 2.3, WBC 14.17, hemoglobin 11.7, D-dimer 1020. He tested positive for COVID 19 in the ER.  Initially UA was obtained from old indwelling suprapubic catheter however this was replaced and repeat UA was obtained.  Blood cultures and urine culture pending.  A CTA thorax was obtained however examination was significantly limited due to respiratory motion, no pulmonary embolism given limited evaluation however cannot exclude pneumonia or pulmonary edema.  Patient was given DuoNebs and ceftriaxone in the ER.  Patient was admitted to the hospitalist service for further management of acute respiratory failure, acute cystitis, and COVID-19.     CT thorax was completed which showed mild mediastinal air and hilar adenopathy.  Recommend 3 month follow-up to exclude neoplastic adenopathy.   Patient reported using oxygen nightly and was able to maintain oxygen saturation on room air during day without difficulty.  Patient had improvement of cough and appetite.  Patient was discharged to skilled nursing facility, stable and in improved condition with close hospital follow-up.  On day of discharge patient had COVID testing which was negative.
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Urinary tract infection, Urine analysis, White blood cell count increased
Clinical narrative: Discharge Physician: MD Primary Care Physician: DO  Date of Admission: 5/19/2023 Discharge Date: 5/23/2023   DETAILS OF HOSPITAL STAY:   PRESENTING PROBLEM: Acute urinary tract infection [N39.0] Acute respiratory failure with hypoxia (HCC) [J96.01] Altered mental status, unspecified altered mental status type [R41.82]   Patient is a 75 y.o. male who presented with shortness of breath and altered mental status.  He has a pertinent medical history for type 2 diabetes, hypertension, CVA with right-sided hemiplegia, CKD, hyperlipidemia, CHF, and presence of suprapubic catheter.  Patient is a resident at long-term care facility where there he was noticed to have increased confusion and shortness of breath.  Per report from long-term care facility patient tested positive for COVID on 05/02/2023 and was removed from COVID precautions.  He was sent to the ER due to having oxygen saturation of 80% on room air and increased confusion.   In the ER, patient was initially placed on non-rebreather and subsequently weaned to 3 L nasal cannula.  Initial labs showed BUN 37, creatinine 2.16, BNP 656, lactic acid 2.3, WBC 14.17, hemoglobin 11.7, D-dimer 1020. He tested positive for COVID 19 in the ER.  Initially UA was obtained from old indwelling suprapubic catheter however this was replaced and repeat UA was obtained.  Blood cultures and urine culture pending.  A CTA thorax was obtained however examination was significantly limited due to respiratory motion, no pulmonary embolism given limited evaluation however cannot exclude pneumonia or pulmonary edema.  Patient was given DuoNebs and ceftriaxone in the ER.  Patient was admitted to the hospitalist service for further management of acute respiratory failure, acute cystitis, and COVID-19.     CT thorax was completed which showed mild mediastinal air and hilar adenopathy.  Recommend 3 month follow-up to exclude neoplastic adenopathy.   Patient reported using oxygen nightly and was able to maintain oxygen saturation on room air during day without difficulty.  Patient had improvement of cough and appetite.  Patient was discharged to skilled nursing facility, stable and in improved condition with close hospital follow-up.  On day of discharge patient had COVID testing which was negative.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Bacterial test positive, Blood culture positive, Blood immunoglobulin G decreased, COVID-19, Chest X-ray abnormal
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Chills, Condition aggravated, Culture urine positive, Disease progression, Dyslipidaemia
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Escherichia bacteraemia, Escherichia test positive, Follicular lymphoma, Gastrooesophageal reflux disease, Headache
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: High-grade B-cell lymphoma, Hypertension, Hypogammaglobulinaemia, Hyponatraemia, Hypovolaemia
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Immunoglobulin therapy, Leukopenia, Nausea, Neutropenia, Nitrite urine present
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pancytopenia, Pneumonia, Polymerase chain reaction, Positron emission tomogram, Positron emission tomogram abnormal
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, SARS-CoV-2 test positive, Sepsis, Tachycardia, Urinary tract infection
Clinical narrative: DATE OF ADMISSION:  05/19/2023 DATE OF DISCHARGE:  05/24/2023 Hospital  PROVISIONAL DIAGNOSES 1. Sepsis. 2. COVID-19, asymptomatic. 3. High-grade B-cell lymphoma. 4. History of follicular lymphoma. 5. Nausea, vomiting. 6. Hypovolemic hyponatremia. 7. Hypogammaglobulinemia. 8. History of asthma. 9. Gastroesophageal reflux disease. 10. Dyslipidemia.   DISCHARGE DIAGNOSES 1. Sepsis secondary to Escherichia coli bacteremia. 2. Asymptomatic COVID-19. 3. High-grade B-cell lymphoma with progression. 4. Follicular lymphoma. 5. Headaches. 6. Hypogammaglobulinemia. 7. Hyponatremia. 8. Hypertension. 9. History of asthma. 10. Pancytopenia with neutropenia. 11. Gastroesophageal reflux disease. 12. Dyslipidemia.   CONDITION ON DISCHARGE Stable.   PROCEDURES PERFORMED None.   CONSULTATIONS Infectious Disease.   HOSPITAL COURSE The patient is a very pleasant 77-year-old female with past medical history as listed above including high-grade B-cell lymphoma with antecedent follicular lymphoma, status post CAR-T cell therapy in July 2022, on 4th line Revlimid and Monjuvi, who presented initially to our Same-Day Clinic with nausea, vomiting, then the following morning awoke with chills and fever of 101.  She had an outpatient PET scan the morning of admission that did not show obvious source for her fever, but did suggest progression of disease.  The patient was leukopenic, neutropenic, tachycardic, febrile on presentation.  Blood cultures were obtained on 05/19 and grew E coli.  Chest x-ray showed right lower lobe perihilar pneumonia.  The patient was asymptomatic.  UA with few bacteria and nitrites suggestive of UTI.  Urine culture was positive for E coli.  FilmArray was positive for COVID but cycle threshold was 24.7.  She was started on cefepime and Zithromax.  This was transitioned to Zosyn.  Infectious Disease was consulted to deescalate antibiotics to Rocephin.  Repeat UA was negative.  ID recommended transitioning to oral Bactrim DS 2 tabs b.i.d. to complete a 7-day course with end of therapy May 27.  The patient recently tested positive for COVID in March of 2023 and was asymptomatic at that time.  Again, her cycle threshold with this positive result was 24.7.  No therapy was indicated at this time per Infectious Disease and they recommended continuing supportive care.  Again, her PET-CT overall showed significant progression of disease.  Malignant Hematology attending reviewed prognosis and available palliative options including possible clinical trial and loncastuximab.  We will arrange followup with Dr. in a couple of weeks as an outpatient to further discuss.  She did receive IVIG on May 21 while hospitalized with a serum IgG level of 261.  Nausea, vomiting had resolved.  Overall, she did well during the course of the hospital stay and was felt medically stable for discharge to home on 05/24/2023.