chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, COVID-19 pneumonia, Chest discomfort, Computerised tomogram thorax abnormal, Cough
Clinical narrative: Patient is a pleasant 77-year-old male presented to the emergency department a chief complaint of flulike symptoms including cough, fever, myalgias, chest tightness, abdominal pain, diarrhea that been ongoing since 10/15/2023.  Patient reports that his wife is at home and has been diagnosed with COVID-19, currently on Paxlovid.  Patient reports he has been increasingly short of breath, a productive cough of sputum that has been blood-tinged but is noted to be minimal.  He has taken Tessalon Perles and coughing has ceased.  Patient reports that he is normally very active, but is increasingly weak but denies any falls or trauma.  Sinus sitting at bedside and states that the whole family was camping last weekend, and he had felt ill a few days ago.  Patient also notes that his granddaughter was found to be positive for strep throat within the last week.  Denies any tobacco, alcohol illicit drug use.  Denies any chronic cardiovascular or pulmonary conditions.  He denies any lightheadedness, dizziness, nausea/vomiting, melena, or hematochezia.   Work-up in the ED: As above patient to be positive for COVID-19 pneumonia and exhibited hypoxia with ambulation down to 85%.  Currently on 2 L nasal cannula to maintain oxygen saturation above 90%.  Was given loading dose of Decadron, ceftriaxone, and azithromycin in the ED.  Patient is noted to have slight worsening of renal function with GFR 53, CRT 1.37, and BUN 23, but does not meet criteria for AKI.  CT findings as above.  At this current time patient is hemodynamically stable and will be admitted under the hospitalist service for further work-up continuation of care.   Clinical Summary   Patient was admitted to the medical surgical unit due to acute hypoxic respiratory failure secondary to COVID-19 infection with probable pneumonitis with evidence of tracheal wall thickening and thickening of the mainstem bronchi.  Patient had no reoccurrence of hemoptysis.  He was placed on remdesivir and dexamethasone.  The following morning patient was feeling significantly improved, no longer requiring oxygen and requesting discharge.  I personally ambulated the patient in the room and he had no SPO2 less than 90% with ambulation and conversation.  Discussed Paxlovid with patient who wished to proceed with therapy.  Medications were reviewed and patient was instructed to stop his statin until completion of Paxlovid.  He was also given steroid and short course antibiotic related to the tracheal inflammation.  I have asked that he follow-up with pulmonology in regards to the CT findings of tracheal wall and maintenance stem bronchi thickening which may warrant biopsy in the future.  He did have some mild to moderate thrombocytopenia likely related to COVID.  I have asked him to recheck lab works in 1 week.     Discharge diagnosis Acute hypoxic respiratory failure, secondary to COVID-19 pneumonitis without consolidating pneumonia Hemoptysis Hypertension Hyperlipidemia
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Diarrhoea, Dyspnoea, Glomerular filtration rate decreased, Haemoptysis, Hyperlipidaemia
Clinical narrative: Patient is a pleasant 77-year-old male presented to the emergency department a chief complaint of flulike symptoms including cough, fever, myalgias, chest tightness, abdominal pain, diarrhea that been ongoing since 10/15/2023.  Patient reports that his wife is at home and has been diagnosed with COVID-19, currently on Paxlovid.  Patient reports he has been increasingly short of breath, a productive cough of sputum that has been blood-tinged but is noted to be minimal.  He has taken Tessalon Perles and coughing has ceased.  Patient reports that he is normally very active, but is increasingly weak but denies any falls or trauma.  Sinus sitting at bedside and states that the whole family was camping last weekend, and he had felt ill a few days ago.  Patient also notes that his granddaughter was found to be positive for strep throat within the last week.  Denies any tobacco, alcohol illicit drug use.  Denies any chronic cardiovascular or pulmonary conditions.  He denies any lightheadedness, dizziness, nausea/vomiting, melena, or hematochezia.   Work-up in the ED: As above patient to be positive for COVID-19 pneumonia and exhibited hypoxia with ambulation down to 85%.  Currently on 2 L nasal cannula to maintain oxygen saturation above 90%.  Was given loading dose of Decadron, ceftriaxone, and azithromycin in the ED.  Patient is noted to have slight worsening of renal function with GFR 53, CRT 1.37, and BUN 23, but does not meet criteria for AKI.  CT findings as above.  At this current time patient is hemodynamically stable and will be admitted under the hospitalist service for further work-up continuation of care.   Clinical Summary   Patient was admitted to the medical surgical unit due to acute hypoxic respiratory failure secondary to COVID-19 infection with probable pneumonitis with evidence of tracheal wall thickening and thickening of the mainstem bronchi.  Patient had no reoccurrence of hemoptysis.  He was placed on remdesivir and dexamethasone.  The following morning patient was feeling significantly improved, no longer requiring oxygen and requesting discharge.  I personally ambulated the patient in the room and he had no SPO2 less than 90% with ambulation and conversation.  Discussed Paxlovid with patient who wished to proceed with therapy.  Medications were reviewed and patient was instructed to stop his statin until completion of Paxlovid.  He was also given steroid and short course antibiotic related to the tracheal inflammation.  I have asked that he follow-up with pulmonology in regards to the CT findings of tracheal wall and maintenance stem bronchi thickening which may warrant biopsy in the future.  He did have some mild to moderate thrombocytopenia likely related to COVID.  I have asked him to recheck lab works in 1 week.     Discharge diagnosis Acute hypoxic respiratory failure, secondary to COVID-19 pneumonitis without consolidating pneumonia Hemoptysis Hypertension Hyperlipidemia
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypertension, Hypoxia, Influenza like illness, Laboratory test, Malaise
Clinical narrative: Patient is a pleasant 77-year-old male presented to the emergency department a chief complaint of flulike symptoms including cough, fever, myalgias, chest tightness, abdominal pain, diarrhea that been ongoing since 10/15/2023.  Patient reports that his wife is at home and has been diagnosed with COVID-19, currently on Paxlovid.  Patient reports he has been increasingly short of breath, a productive cough of sputum that has been blood-tinged but is noted to be minimal.  He has taken Tessalon Perles and coughing has ceased.  Patient reports that he is normally very active, but is increasingly weak but denies any falls or trauma.  Sinus sitting at bedside and states that the whole family was camping last weekend, and he had felt ill a few days ago.  Patient also notes that his granddaughter was found to be positive for strep throat within the last week.  Denies any tobacco, alcohol illicit drug use.  Denies any chronic cardiovascular or pulmonary conditions.  He denies any lightheadedness, dizziness, nausea/vomiting, melena, or hematochezia.   Work-up in the ED: As above patient to be positive for COVID-19 pneumonia and exhibited hypoxia with ambulation down to 85%.  Currently on 2 L nasal cannula to maintain oxygen saturation above 90%.  Was given loading dose of Decadron, ceftriaxone, and azithromycin in the ED.  Patient is noted to have slight worsening of renal function with GFR 53, CRT 1.37, and BUN 23, but does not meet criteria for AKI.  CT findings as above.  At this current time patient is hemodynamically stable and will be admitted under the hospitalist service for further work-up continuation of care.   Clinical Summary   Patient was admitted to the medical surgical unit due to acute hypoxic respiratory failure secondary to COVID-19 infection with probable pneumonitis with evidence of tracheal wall thickening and thickening of the mainstem bronchi.  Patient had no reoccurrence of hemoptysis.  He was placed on remdesivir and dexamethasone.  The following morning patient was feeling significantly improved, no longer requiring oxygen and requesting discharge.  I personally ambulated the patient in the room and he had no SPO2 less than 90% with ambulation and conversation.  Discussed Paxlovid with patient who wished to proceed with therapy.  Medications were reviewed and patient was instructed to stop his statin until completion of Paxlovid.  He was also given steroid and short course antibiotic related to the tracheal inflammation.  I have asked that he follow-up with pulmonology in regards to the CT findings of tracheal wall and maintenance stem bronchi thickening which may warrant biopsy in the future.  He did have some mild to moderate thrombocytopenia likely related to COVID.  I have asked him to recheck lab works in 1 week.     Discharge diagnosis Acute hypoxic respiratory failure, secondary to COVID-19 pneumonitis without consolidating pneumonia Hemoptysis Hypertension Hyperlipidemia
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Myalgia, Productive cough, Pyrexia, Renal impairment, SARS-CoV-2 test positive
Clinical narrative: Patient is a pleasant 77-year-old male presented to the emergency department a chief complaint of flulike symptoms including cough, fever, myalgias, chest tightness, abdominal pain, diarrhea that been ongoing since 10/15/2023.  Patient reports that his wife is at home and has been diagnosed with COVID-19, currently on Paxlovid.  Patient reports he has been increasingly short of breath, a productive cough of sputum that has been blood-tinged but is noted to be minimal.  He has taken Tessalon Perles and coughing has ceased.  Patient reports that he is normally very active, but is increasingly weak but denies any falls or trauma.  Sinus sitting at bedside and states that the whole family was camping last weekend, and he had felt ill a few days ago.  Patient also notes that his granddaughter was found to be positive for strep throat within the last week.  Denies any tobacco, alcohol illicit drug use.  Denies any chronic cardiovascular or pulmonary conditions.  He denies any lightheadedness, dizziness, nausea/vomiting, melena, or hematochezia.   Work-up in the ED: As above patient to be positive for COVID-19 pneumonia and exhibited hypoxia with ambulation down to 85%.  Currently on 2 L nasal cannula to maintain oxygen saturation above 90%.  Was given loading dose of Decadron, ceftriaxone, and azithromycin in the ED.  Patient is noted to have slight worsening of renal function with GFR 53, CRT 1.37, and BUN 23, but does not meet criteria for AKI.  CT findings as above.  At this current time patient is hemodynamically stable and will be admitted under the hospitalist service for further work-up continuation of care.   Clinical Summary   Patient was admitted to the medical surgical unit due to acute hypoxic respiratory failure secondary to COVID-19 infection with probable pneumonitis with evidence of tracheal wall thickening and thickening of the mainstem bronchi.  Patient had no reoccurrence of hemoptysis.  He was placed on remdesivir and dexamethasone.  The following morning patient was feeling significantly improved, no longer requiring oxygen and requesting discharge.  I personally ambulated the patient in the room and he had no SPO2 less than 90% with ambulation and conversation.  Discussed Paxlovid with patient who wished to proceed with therapy.  Medications were reviewed and patient was instructed to stop his statin until completion of Paxlovid.  He was also given steroid and short course antibiotic related to the tracheal inflammation.  I have asked that he follow-up with pulmonology in regards to the CT findings of tracheal wall and maintenance stem bronchi thickening which may warrant biopsy in the future.  He did have some mild to moderate thrombocytopenia likely related to COVID.  I have asked him to recheck lab works in 1 week.     Discharge diagnosis Acute hypoxic respiratory failure, secondary to COVID-19 pneumonitis without consolidating pneumonia Hemoptysis Hypertension Hyperlipidemia
Age: 0.33
Sex: M
Vaccine: RV5
Symptoms: Immediate post-injection reaction, Rash
Clinical narrative: IMMEDIATELY AFTER RECEIVING THE VACCINE THE BABY BROKE OUT INTO A RASH ON ARMS, LEGS, AND TRUNK.  BENADRYL WAS GIVEN IN OFFICE.
Age: 11.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 2.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Patient was administered expired vaccine; expiration date sticker 12/18/2023, given 12/19/2023
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac arrest, Endotracheal intubation, Implantable defibrillator insertion, Intensive care, Laboratory test
Clinical narrative: Cardiac arrest
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Ventricular assist device insertion
Clinical narrative: Cardiac arrest
Age: 6.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 70.0
Sex: F
Vaccine: RSV, TDAP
Symptoms: Asthenia, Cough, Dyspnoea, Guillain-Barre syndrome, Hypoaesthesia
Clinical narrative: On 12/19, pt reported shortness of breath, coughing, bilateral hand numbness, frequent throat clearing. Presented to hospital on 12/20 with progressive tingling of extremities, weakness. MRI spine and brain negative for obvious etiology. Patient had progressive respiratory distress so initiated treatment with high dose methylprednisolone and IVIG for presumed Guillan Barre. Patient continued to have progressive symptoms so initiated PLEX on 12/21. Outcome not yet known.
Age: 70.0
Sex: F
Vaccine: RSV, TDAP
Symptoms: Immunoglobulin therapy, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal, Paraesthesia, Respiratory distress
Clinical narrative: On 12/19, pt reported shortness of breath, coughing, bilateral hand numbness, frequent throat clearing. Presented to hospital on 12/20 with progressive tingling of extremities, weakness. MRI spine and brain negative for obvious etiology. Patient had progressive respiratory distress so initiated treatment with high dose methylprednisolone and IVIG for presumed Guillan Barre. Patient continued to have progressive symptoms so initiated PLEX on 12/21. Outcome not yet known.
Age: 70.0
Sex: F
Vaccine: RSV, TDAP
Symptoms: Throat clearing
Clinical narrative: On 12/19, pt reported shortness of breath, coughing, bilateral hand numbness, frequent throat clearing. Presented to hospital on 12/20 with progressive tingling of extremities, weakness. MRI spine and brain negative for obvious etiology. Patient had progressive respiratory distress so initiated treatment with high dose methylprednisolone and IVIG for presumed Guillan Barre. Patient continued to have progressive symptoms so initiated PLEX on 12/21. Outcome not yet known.
Age: 87.0
Sex: F
Vaccine: FLU4
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Blood albumin decreased, Blood alkaline phosphatase increased
Clinical narrative: Patient presented to ED with generalized weakness 1 day after getting her flu shot.   Per patient and daughters statements, patient was fine prior to flu vaccination and able to ambulate with a cane.  The next day, patient had generalized weakness and was unable to move out of her bed without assistance.  Denies fever, chills, chest pain, palpitations, shortness of breath, nausea, vomiting, abdominal pain, difficulty urinating, falls, loss of consciousness.   In the ED, patient AAO x 4, in no acute distress.  Patient states she is fine except for her generalized weakness.
Age: 87.0
Sex: F
Vaccine: FLU4
Symptoms: Blood creatine phosphokinase increased, Blood glucose normal, Blood lactic acid, Full blood count normal, Glomerular filtration rate decreased
Clinical narrative: Patient presented to ED with generalized weakness 1 day after getting her flu shot.   Per patient and daughters statements, patient was fine prior to flu vaccination and able to ambulate with a cane.  The next day, patient had generalized weakness and was unable to move out of her bed without assistance.  Denies fever, chills, chest pain, palpitations, shortness of breath, nausea, vomiting, abdominal pain, difficulty urinating, falls, loss of consciousness.   In the ED, patient AAO x 4, in no acute distress.  Patient states she is fine except for her generalized weakness.
Age: 87.0
Sex: F
Vaccine: FLU4
Symptoms: Metabolic function test, Mobility decreased
Clinical narrative: Patient presented to ED with generalized weakness 1 day after getting her flu shot.   Per patient and daughters statements, patient was fine prior to flu vaccination and able to ambulate with a cane.  The next day, patient had generalized weakness and was unable to move out of her bed without assistance.  Denies fever, chills, chest pain, palpitations, shortness of breath, nausea, vomiting, abdominal pain, difficulty urinating, falls, loss of consciousness.   In the ED, patient AAO x 4, in no acute distress.  Patient states she is fine except for her generalized weakness.
Age: 1.25
Sex: M
Vaccine: DTAP, FLU4, HIBV, PNC20
Symptoms: Product preparation error
Clinical narrative: HIB was reconstituted with sterile water diluent rather than the provided normal saline 0.4% diluent.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Asthenia, Blood creatinine increased, Blood gases normal, Blood lactic acid
Clinical narrative: Patient is a 77 y.o. male patient CNP with history of Hypopituitarism, Essential HTN, Legal Blindness, Memory Impairment, HPL who presented to Medical Center with Dehydration, Diarrhea, Cough, Generalized Weakness and was found to have COVID infection and AKI .   Covid-19 Virus Infection Date of onset of symptoms: 10/26 Symptoms present on admission: cough, diarrhea, N/V, fatigue, weakness, sore throat Date of covid positive test: 10/28 Vaccination status: vaccinated Imaging: CXR 10/28 negative Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated - is getting increased home steriod Consultants following: none Anticipated special isolation end date: 11/6 Does not meet sepsis criteria on admission WBC 14, VBG unremarkable, LA 2 Supportive care PT/OT   Nausea, Vomiting - Resolved  Loose Stool Secondary to covid Negative Lipase, LFTs No loose stool day of admission Poor po intake Zofran prn, imodium prn   Hypopituitarism Hypothyroidism TSH low, free T4 normal on admission Continue synthroid Resume home prednisone   Hypokalemia Replaced IV, recheck tomorrow Mag, phos normal Now resolved AKI - Resolved Secondary to GI lossess, poor po intake Cr 1.8 on admission, no prior hx of kidney disease Improving s/p hydration, Cr 1.49 > 0.94 Monitor closely   Essential HTN Normotensive on admission with home med  for 2 days Hypertensive this morning, resumed Norvasc
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Blood magnesium normal, Blood phosphorus normal, Blood thyroid stimulating hormone decreased, COVID-19, Chest X-ray normal
Clinical narrative: Patient is a 77 y.o. male patient CNP with history of Hypopituitarism, Essential HTN, Legal Blindness, Memory Impairment, HPL who presented to Medical Center with Dehydration, Diarrhea, Cough, Generalized Weakness and was found to have COVID infection and AKI .   Covid-19 Virus Infection Date of onset of symptoms: 10/26 Symptoms present on admission: cough, diarrhea, N/V, fatigue, weakness, sore throat Date of covid positive test: 10/28 Vaccination status: vaccinated Imaging: CXR 10/28 negative Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated - is getting increased home steriod Consultants following: none Anticipated special isolation end date: 11/6 Does not meet sepsis criteria on admission WBC 14, VBG unremarkable, LA 2 Supportive care PT/OT   Nausea, Vomiting - Resolved  Loose Stool Secondary to covid Negative Lipase, LFTs No loose stool day of admission Poor po intake Zofran prn, imodium prn   Hypopituitarism Hypothyroidism TSH low, free T4 normal on admission Continue synthroid Resume home prednisone   Hypokalemia Replaced IV, recheck tomorrow Mag, phos normal Now resolved AKI - Resolved Secondary to GI lossess, poor po intake Cr 1.8 on admission, no prior hx of kidney disease Improving s/p hydration, Cr 1.49 > 0.94 Monitor closely   Essential HTN Normotensive on admission with home med  for 2 days Hypertensive this morning, resumed Norvasc
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Cough, Dehydration, Diarrhoea, Fatigue, Hypokalaemia
Clinical narrative: Patient is a 77 y.o. male patient CNP with history of Hypopituitarism, Essential HTN, Legal Blindness, Memory Impairment, HPL who presented to Medical Center with Dehydration, Diarrhea, Cough, Generalized Weakness and was found to have COVID infection and AKI .   Covid-19 Virus Infection Date of onset of symptoms: 10/26 Symptoms present on admission: cough, diarrhea, N/V, fatigue, weakness, sore throat Date of covid positive test: 10/28 Vaccination status: vaccinated Imaging: CXR 10/28 negative Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated - is getting increased home steriod Consultants following: none Anticipated special isolation end date: 11/6 Does not meet sepsis criteria on admission WBC 14, VBG unremarkable, LA 2 Supportive care PT/OT   Nausea, Vomiting - Resolved  Loose Stool Secondary to covid Negative Lipase, LFTs No loose stool day of admission Poor po intake Zofran prn, imodium prn   Hypopituitarism Hypothyroidism TSH low, free T4 normal on admission Continue synthroid Resume home prednisone   Hypokalemia Replaced IV, recheck tomorrow Mag, phos normal Now resolved AKI - Resolved Secondary to GI lossess, poor po intake Cr 1.8 on admission, no prior hx of kidney disease Improving s/p hydration, Cr 1.49 > 0.94 Monitor closely   Essential HTN Normotensive on admission with home med  for 2 days Hypertensive this morning, resumed Norvasc
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Hypophagia, Hypopituitarism, Hypothyroidism, Lipase, Liver function test
Clinical narrative: Patient is a 77 y.o. male patient CNP with history of Hypopituitarism, Essential HTN, Legal Blindness, Memory Impairment, HPL who presented to Medical Center with Dehydration, Diarrhea, Cough, Generalized Weakness and was found to have COVID infection and AKI .   Covid-19 Virus Infection Date of onset of symptoms: 10/26 Symptoms present on admission: cough, diarrhea, N/V, fatigue, weakness, sore throat Date of covid positive test: 10/28 Vaccination status: vaccinated Imaging: CXR 10/28 negative Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated - is getting increased home steriod Consultants following: none Anticipated special isolation end date: 11/6 Does not meet sepsis criteria on admission WBC 14, VBG unremarkable, LA 2 Supportive care PT/OT   Nausea, Vomiting - Resolved  Loose Stool Secondary to covid Negative Lipase, LFTs No loose stool day of admission Poor po intake Zofran prn, imodium prn   Hypopituitarism Hypothyroidism TSH low, free T4 normal on admission Continue synthroid Resume home prednisone   Hypokalemia Replaced IV, recheck tomorrow Mag, phos normal Now resolved AKI - Resolved Secondary to GI lossess, poor po intake Cr 1.8 on admission, no prior hx of kidney disease Improving s/p hydration, Cr 1.49 > 0.94 Monitor closely   Essential HTN Normotensive on admission with home med  for 2 days Hypertensive this morning, resumed Norvasc
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Malaise, Nausea, Oropharyngeal pain, SARS-CoV-2 test positive, Thyroxine free normal
Clinical narrative: Patient is a 77 y.o. male patient CNP with history of Hypopituitarism, Essential HTN, Legal Blindness, Memory Impairment, HPL who presented to Medical Center with Dehydration, Diarrhea, Cough, Generalized Weakness and was found to have COVID infection and AKI .   Covid-19 Virus Infection Date of onset of symptoms: 10/26 Symptoms present on admission: cough, diarrhea, N/V, fatigue, weakness, sore throat Date of covid positive test: 10/28 Vaccination status: vaccinated Imaging: CXR 10/28 negative Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated - is getting increased home steriod Consultants following: none Anticipated special isolation end date: 11/6 Does not meet sepsis criteria on admission WBC 14, VBG unremarkable, LA 2 Supportive care PT/OT   Nausea, Vomiting - Resolved  Loose Stool Secondary to covid Negative Lipase, LFTs No loose stool day of admission Poor po intake Zofran prn, imodium prn   Hypopituitarism Hypothyroidism TSH low, free T4 normal on admission Continue synthroid Resume home prednisone   Hypokalemia Replaced IV, recheck tomorrow Mag, phos normal Now resolved AKI - Resolved Secondary to GI lossess, poor po intake Cr 1.8 on admission, no prior hx of kidney disease Improving s/p hydration, Cr 1.49 > 0.94 Monitor closely   Essential HTN Normotensive on admission with home med  for 2 days Hypertensive this morning, resumed Norvasc
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Vomiting, White blood cell count increased
Clinical narrative: Patient is a 77 y.o. male patient CNP with history of Hypopituitarism, Essential HTN, Legal Blindness, Memory Impairment, HPL who presented to Medical Center with Dehydration, Diarrhea, Cough, Generalized Weakness and was found to have COVID infection and AKI .   Covid-19 Virus Infection Date of onset of symptoms: 10/26 Symptoms present on admission: cough, diarrhea, N/V, fatigue, weakness, sore throat Date of covid positive test: 10/28 Vaccination status: vaccinated Imaging: CXR 10/28 negative Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated - is getting increased home steriod Consultants following: none Anticipated special isolation end date: 11/6 Does not meet sepsis criteria on admission WBC 14, VBG unremarkable, LA 2 Supportive care PT/OT   Nausea, Vomiting - Resolved  Loose Stool Secondary to covid Negative Lipase, LFTs No loose stool day of admission Poor po intake Zofran prn, imodium prn   Hypopituitarism Hypothyroidism TSH low, free T4 normal on admission Continue synthroid Resume home prednisone   Hypokalemia Replaced IV, recheck tomorrow Mag, phos normal Now resolved AKI - Resolved Secondary to GI lossess, poor po intake Cr 1.8 on admission, no prior hx of kidney disease Improving s/p hydration, Cr 1.49 > 0.94 Monitor closely   Essential HTN Normotensive on admission with home med  for 2 days Hypertensive this morning, resumed Norvasc
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Blood creatinine increased, COVID-19, Cardiomegaly
Clinical narrative: Patient is a 86 y.o. female patient of, MD with history of paroxysmal atrial fibrillation, PSVT, hypothyroidism and CKD 3B presented to Hospital with complaints of persistent shortness of breath and cough following recent diagnosis of community-acquired pneumonia.   Acute respiratory failure with hypoxia COVID-19 with superimposed pneumonia Presented with: shortness of breath and cough Symptom onset: 10/16 Positive COVID-19: 10/23/23 at ED Vaccination status: Vaccinated, but no booster CXR on admission showed cardiomegaly with interstitial congestion Oxygen status: 1L -> room air  Decadron: Yes.  Remdesivir: Yes. Discontinued due to development of AKI. DVT prophylaxis: Eliquis 5 bid Serial COVID labs ordered: Yes Case Management/Social Services consulted: No IV lasix completed; fluid status appears euvolemic  Sputum culture and urine antigens negative; Zithromax, Rocephin discontinued Mucinex  Prednisone x3 days at equianalgesic dosing to complete 10 day total steroid treatment course  Continue mucolytic, prescription provided    PAF PSVT Follows with Cardiology Remains NSR on flecainide Continue Coreg and chronic anticoagulation with Eliquis   Essential hypertension Typically well controlled Continue Coreg Losartan continued in place of home Telmisartan (Micardis) during hospitalization Resume home med on discharge   Hyperlipidemia Chronic, Continue atorvastatin Acute kidney injury on CKD 3B Baseline creatinine around 1.4 Scr 1.36 -> 1.41 -> 1.71 -> 1.15 Remdesivir discontinued d/t AKI Urine labs ordered, but not collected. Further investigation held given Scr improvement.  Resolved
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Cough, Dyspnoea, Hypoxia, Pneumonia
Clinical narrative: Patient is a 86 y.o. female patient of, MD with history of paroxysmal atrial fibrillation, PSVT, hypothyroidism and CKD 3B presented to Hospital with complaints of persistent shortness of breath and cough following recent diagnosis of community-acquired pneumonia.   Acute respiratory failure with hypoxia COVID-19 with superimposed pneumonia Presented with: shortness of breath and cough Symptom onset: 10/16 Positive COVID-19: 10/23/23 at ED Vaccination status: Vaccinated, but no booster CXR on admission showed cardiomegaly with interstitial congestion Oxygen status: 1L -> room air  Decadron: Yes.  Remdesivir: Yes. Discontinued due to development of AKI. DVT prophylaxis: Eliquis 5 bid Serial COVID labs ordered: Yes Case Management/Social Services consulted: No IV lasix completed; fluid status appears euvolemic  Sputum culture and urine antigens negative; Zithromax, Rocephin discontinued Mucinex  Prednisone x3 days at equianalgesic dosing to complete 10 day total steroid treatment course  Continue mucolytic, prescription provided    PAF PSVT Follows with Cardiology Remains NSR on flecainide Continue Coreg and chronic anticoagulation with Eliquis   Essential hypertension Typically well controlled Continue Coreg Losartan continued in place of home Telmisartan (Micardis) during hospitalization Resume home med on discharge   Hyperlipidemia Chronic, Continue atorvastatin Acute kidney injury on CKD 3B Baseline creatinine around 1.4 Scr 1.36 -> 1.41 -> 1.71 -> 1.15 Remdesivir discontinued d/t AKI Urine labs ordered, but not collected. Further investigation held given Scr improvement.  Resolved
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory tract congestion, SARS-CoV-2 test positive, Sputum culture, Urine antigen test
Clinical narrative: Patient is a 86 y.o. female patient of, MD with history of paroxysmal atrial fibrillation, PSVT, hypothyroidism and CKD 3B presented to Hospital with complaints of persistent shortness of breath and cough following recent diagnosis of community-acquired pneumonia.   Acute respiratory failure with hypoxia COVID-19 with superimposed pneumonia Presented with: shortness of breath and cough Symptom onset: 10/16 Positive COVID-19: 10/23/23 at ED Vaccination status: Vaccinated, but no booster CXR on admission showed cardiomegaly with interstitial congestion Oxygen status: 1L -> room air  Decadron: Yes.  Remdesivir: Yes. Discontinued due to development of AKI. DVT prophylaxis: Eliquis 5 bid Serial COVID labs ordered: Yes Case Management/Social Services consulted: No IV lasix completed; fluid status appears euvolemic  Sputum culture and urine antigens negative; Zithromax, Rocephin discontinued Mucinex  Prednisone x3 days at equianalgesic dosing to complete 10 day total steroid treatment course  Continue mucolytic, prescription provided    PAF PSVT Follows with Cardiology Remains NSR on flecainide Continue Coreg and chronic anticoagulation with Eliquis   Essential hypertension Typically well controlled Continue Coreg Losartan continued in place of home Telmisartan (Micardis) during hospitalization Resume home med on discharge   Hyperlipidemia Chronic, Continue atorvastatin Acute kidney injury on CKD 3B Baseline creatinine around 1.4 Scr 1.36 -> 1.41 -> 1.71 -> 1.15 Remdesivir discontinued d/t AKI Urine labs ordered, but not collected. Further investigation held given Scr improvement.  Resolved
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Arrhythmia, Asthenia, Atrial fibrillation
Clinical narrative: 89 y.o. male patient of MD with history of osteoarthritis, hypertension, hyperlipidemia and CKD 3B who presented to  Hospital with nonproductive cough, generalized weakness with diminished appetite and exertional dyspnea; found to have COVID-19 and also acute arrhythmia.   Atrial fibrillation with rapid ventricular response New diagnosis in the setting of acute illness with COVID-19 infection No previously documented history of arrhythmia Likely 2/2 acute infection in the setting of COVID infection. Will continue holing off on echocardiogram (last was in 2020 with only mild AR and normal EF). Low threshold to repeat echocardiogram if dysrhythmia re-occurs to ensure no new structural or valvular abnormalities contributing. CHA2DS2-VASc score 3  Repeat EKG 10/24 with sinus rhythma + PVC's. IV Cardizem titrated off 10/24. Heparin gtt discontinued.  Resolved  Cardiac telemetry for continued monitoring Resolved   Acute respiratory failure with hypoxia COVID-19 infection Presented with: Nonproductive cough, exertional dyspnea, loss of appetite and generalized weakness Symptom onset: 10/20, but exposure to wife with symptom onset 10/16 Positive COVID-19: 10/23/2023 at ED Vaccination status: Vaccinated, but no recent booster CXR on admission showed no acute abnormalities Oxygen status: Low-flow NC Guidelines reviewed; given patient's respiratory stability without supplemental O2 support needs, IV Decadron discontinued.  Remdesivir discontinued in the setting of new onset AKI.  DVT prophylaxis: Heparin subq Case Management/Social Services consulted: No Now on room air   Acute kidney injury on CKD 3B Baseline creatinine fluctuates as high as 1.8 Scr 1.62 -> 1.51 -> 2.49 Urine studies ordered ACE-I held; hydrochlorothiazide held   Essential hypertension Typically well controlled Continue amlodipine Holding hydrochlorothiazide and ACE given mild AKI Increased Norvasc to 10mg   Hyperlipidemia Chronic, Continue Lipitor   Hypothyroidism Chronic, Continue levothyroxine
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Blood creatinine increased, COVID-19, Chest X-ray normal, Cough, Dyspnoea exertional
Clinical narrative: 89 y.o. male patient of MD with history of osteoarthritis, hypertension, hyperlipidemia and CKD 3B who presented to  Hospital with nonproductive cough, generalized weakness with diminished appetite and exertional dyspnea; found to have COVID-19 and also acute arrhythmia.   Atrial fibrillation with rapid ventricular response New diagnosis in the setting of acute illness with COVID-19 infection No previously documented history of arrhythmia Likely 2/2 acute infection in the setting of COVID infection. Will continue holing off on echocardiogram (last was in 2020 with only mild AR and normal EF). Low threshold to repeat echocardiogram if dysrhythmia re-occurs to ensure no new structural or valvular abnormalities contributing. CHA2DS2-VASc score 3  Repeat EKG 10/24 with sinus rhythma + PVC's. IV Cardizem titrated off 10/24. Heparin gtt discontinued.  Resolved  Cardiac telemetry for continued monitoring Resolved   Acute respiratory failure with hypoxia COVID-19 infection Presented with: Nonproductive cough, exertional dyspnea, loss of appetite and generalized weakness Symptom onset: 10/20, but exposure to wife with symptom onset 10/16 Positive COVID-19: 10/23/2023 at ED Vaccination status: Vaccinated, but no recent booster CXR on admission showed no acute abnormalities Oxygen status: Low-flow NC Guidelines reviewed; given patient's respiratory stability without supplemental O2 support needs, IV Decadron discontinued.  Remdesivir discontinued in the setting of new onset AKI.  DVT prophylaxis: Heparin subq Case Management/Social Services consulted: No Now on room air   Acute kidney injury on CKD 3B Baseline creatinine fluctuates as high as 1.8 Scr 1.62 -> 1.51 -> 2.49 Urine studies ordered ACE-I held; hydrochlorothiazide held   Essential hypertension Typically well controlled Continue amlodipine Holding hydrochlorothiazide and ACE given mild AKI Increased Norvasc to 10mg   Hyperlipidemia Chronic, Continue Lipitor   Hypothyroidism Chronic, Continue levothyroxine
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Electrocardiogram abnormal, Hypoxia, SARS-CoV-2 test positive, Urine analysis, Ventricular extrasystoles
Clinical narrative: 89 y.o. male patient of MD with history of osteoarthritis, hypertension, hyperlipidemia and CKD 3B who presented to  Hospital with nonproductive cough, generalized weakness with diminished appetite and exertional dyspnea; found to have COVID-19 and also acute arrhythmia.   Atrial fibrillation with rapid ventricular response New diagnosis in the setting of acute illness with COVID-19 infection No previously documented history of arrhythmia Likely 2/2 acute infection in the setting of COVID infection. Will continue holing off on echocardiogram (last was in 2020 with only mild AR and normal EF). Low threshold to repeat echocardiogram if dysrhythmia re-occurs to ensure no new structural or valvular abnormalities contributing. CHA2DS2-VASc score 3  Repeat EKG 10/24 with sinus rhythma + PVC's. IV Cardizem titrated off 10/24. Heparin gtt discontinued.  Resolved  Cardiac telemetry for continued monitoring Resolved   Acute respiratory failure with hypoxia COVID-19 infection Presented with: Nonproductive cough, exertional dyspnea, loss of appetite and generalized weakness Symptom onset: 10/20, but exposure to wife with symptom onset 10/16 Positive COVID-19: 10/23/2023 at ED Vaccination status: Vaccinated, but no recent booster CXR on admission showed no acute abnormalities Oxygen status: Low-flow NC Guidelines reviewed; given patient's respiratory stability without supplemental O2 support needs, IV Decadron discontinued.  Remdesivir discontinued in the setting of new onset AKI.  DVT prophylaxis: Heparin subq Case Management/Social Services consulted: No Now on room air   Acute kidney injury on CKD 3B Baseline creatinine fluctuates as high as 1.8 Scr 1.62 -> 1.51 -> 2.49 Urine studies ordered ACE-I held; hydrochlorothiazide held   Essential hypertension Typically well controlled Continue amlodipine Holding hydrochlorothiazide and ACE given mild AKI Increased Norvasc to 10mg   Hyperlipidemia Chronic, Continue Lipitor   Hypothyroidism Chronic, Continue levothyroxine
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal pain, COVID-19, Colectomy, Colostomy, Diverticulitis intestinal perforated
Clinical narrative: Patient is a 56 y.o. female who presented to the hospital with  abdominal pain and was found to have perforated acute diverticulitis with  associated pneumoperitoneum. She underwent exploratory laparotomy with  sigmoidectomy and end colostomy on 9/18/23. Patient has a known history of  solitary transplanted kidney and nephrology was consulted post  operatively, resumed her home immunosuppresion. On POD2, patient developed  acute encephalopathy, hypotension, tachycardia, she was ultimately and  transported to the ICU on 9/20/23. She was initiated on CRRT as she  quickly went into renal failure. While in the ICU, she was initiated on  stress dose steroids, patient remained olgiuric and required several  pressors to augment blood pressure.  She was also found to be COVID + and  started on remdesevir and covid dosing decadron, she remained in  isolation, patient was extubated on 9/24/23. Throughout her ICU stay, from  an abdominal standpoint, patient progressed well, she had daily dressing  changes to her midline until a wound vac was placed. Her JP drain remained  serous, and she had adequate stoma output. When she was off pressors, her  tube feeds were advanced to goal, which she tolerated well.  CT CAP 9/29  was done in the context of increased WBC without cause and found  significant hydronephrosis in her newer L sided kidney transplant. She was  taken to VIR and had a drain placed 9/30. By 10/1 she was advanced to  regular diet with renal restrictions. During this time, the pt was kept  for observation as she waited on placement to a rehab facility. On 10/9,  patient's stoma was noted to be dusky and with mucocutaneous separation.  She was taken back to the operating room on 10/10 for revision of her  ostomy. Her wound vac was removed at this time and replaced with wet to  dry dressing. She tolerated the operation well and the ostomy had good  output by POD2. At time of discharge the patient was tolerating a diet,  producing urine through her nephrostomy tube, and had good stoma output.  Her pain was well controlled with oral medications. She was discharged to in-patient rehab. She was instructed to follow up with  ACS clinic  in 2 weeks.    Discharge Diagnoses:   Perforated sigmoid diverticulitis s/p Hartmann's procedure (Sigmoid colectomy with end colostomy)
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: Encephalopathy, Feeding tube user, Haemofiltration, Hydronephrosis, Hypotension
Clinical narrative: Patient is a 56 y.o. female who presented to the hospital with  abdominal pain and was found to have perforated acute diverticulitis with  associated pneumoperitoneum. She underwent exploratory laparotomy with  sigmoidectomy and end colostomy on 9/18/23. Patient has a known history of  solitary transplanted kidney and nephrology was consulted post  operatively, resumed her home immunosuppresion. On POD2, patient developed  acute encephalopathy, hypotension, tachycardia, she was ultimately and  transported to the ICU on 9/20/23. She was initiated on CRRT as she  quickly went into renal failure. While in the ICU, she was initiated on  stress dose steroids, patient remained olgiuric and required several  pressors to augment blood pressure.  She was also found to be COVID + and  started on remdesevir and covid dosing decadron, she remained in  isolation, patient was extubated on 9/24/23. Throughout her ICU stay, from  an abdominal standpoint, patient progressed well, she had daily dressing  changes to her midline until a wound vac was placed. Her JP drain remained  serous, and she had adequate stoma output. When she was off pressors, her  tube feeds were advanced to goal, which she tolerated well.  CT CAP 9/29  was done in the context of increased WBC without cause and found  significant hydronephrosis in her newer L sided kidney transplant. She was  taken to VIR and had a drain placed 9/30. By 10/1 she was advanced to  regular diet with renal restrictions. During this time, the pt was kept  for observation as she waited on placement to a rehab facility. On 10/9,  patient's stoma was noted to be dusky and with mucocutaneous separation.  She was taken back to the operating room on 10/10 for revision of her  ostomy. Her wound vac was removed at this time and replaced with wet to  dry dressing. She tolerated the operation well and the ostomy had good  output by POD2. At time of discharge the patient was tolerating a diet,  producing urine through her nephrostomy tube, and had good stoma output.  Her pain was well controlled with oral medications. She was discharged to in-patient rehab. She was instructed to follow up with  ACS clinic  in 2 weeks.    Discharge Diagnoses:   Perforated sigmoid diverticulitis s/p Hartmann's procedure (Sigmoid colectomy with end colostomy)
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: Intensive care, Laparotomy, Nephrostomy, Pain, Pneumoperitoneum
Clinical narrative: Patient is a 56 y.o. female who presented to the hospital with  abdominal pain and was found to have perforated acute diverticulitis with  associated pneumoperitoneum. She underwent exploratory laparotomy with  sigmoidectomy and end colostomy on 9/18/23. Patient has a known history of  solitary transplanted kidney and nephrology was consulted post  operatively, resumed her home immunosuppresion. On POD2, patient developed  acute encephalopathy, hypotension, tachycardia, she was ultimately and  transported to the ICU on 9/20/23. She was initiated on CRRT as she  quickly went into renal failure. While in the ICU, she was initiated on  stress dose steroids, patient remained olgiuric and required several  pressors to augment blood pressure.  She was also found to be COVID + and  started on remdesevir and covid dosing decadron, she remained in  isolation, patient was extubated on 9/24/23. Throughout her ICU stay, from  an abdominal standpoint, patient progressed well, she had daily dressing  changes to her midline until a wound vac was placed. Her JP drain remained  serous, and she had adequate stoma output. When she was off pressors, her  tube feeds were advanced to goal, which she tolerated well.  CT CAP 9/29  was done in the context of increased WBC without cause and found  significant hydronephrosis in her newer L sided kidney transplant. She was  taken to VIR and had a drain placed 9/30. By 10/1 she was advanced to  regular diet with renal restrictions. During this time, the pt was kept  for observation as she waited on placement to a rehab facility. On 10/9,  patient's stoma was noted to be dusky and with mucocutaneous separation.  She was taken back to the operating room on 10/10 for revision of her  ostomy. Her wound vac was removed at this time and replaced with wet to  dry dressing. She tolerated the operation well and the ostomy had good  output by POD2. At time of discharge the patient was tolerating a diet,  producing urine through her nephrostomy tube, and had good stoma output.  Her pain was well controlled with oral medications. She was discharged to in-patient rehab. She was instructed to follow up with  ACS clinic  in 2 weeks.    Discharge Diagnoses:   Perforated sigmoid diverticulitis s/p Hartmann's procedure (Sigmoid colectomy with end colostomy)
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: Post procedural drainage, Renal failure, SARS-CoV-2 test positive, Stoma site mucocutaneous separation, Tachycardia
Clinical narrative: Patient is a 56 y.o. female who presented to the hospital with  abdominal pain and was found to have perforated acute diverticulitis with  associated pneumoperitoneum. She underwent exploratory laparotomy with  sigmoidectomy and end colostomy on 9/18/23. Patient has a known history of  solitary transplanted kidney and nephrology was consulted post  operatively, resumed her home immunosuppresion. On POD2, patient developed  acute encephalopathy, hypotension, tachycardia, she was ultimately and  transported to the ICU on 9/20/23. She was initiated on CRRT as she  quickly went into renal failure. While in the ICU, she was initiated on  stress dose steroids, patient remained olgiuric and required several  pressors to augment blood pressure.  She was also found to be COVID + and  started on remdesevir and covid dosing decadron, she remained in  isolation, patient was extubated on 9/24/23. Throughout her ICU stay, from  an abdominal standpoint, patient progressed well, she had daily dressing  changes to her midline until a wound vac was placed. Her JP drain remained  serous, and she had adequate stoma output. When she was off pressors, her  tube feeds were advanced to goal, which she tolerated well.  CT CAP 9/29  was done in the context of increased WBC without cause and found  significant hydronephrosis in her newer L sided kidney transplant. She was  taken to VIR and had a drain placed 9/30. By 10/1 she was advanced to  regular diet with renal restrictions. During this time, the pt was kept  for observation as she waited on placement to a rehab facility. On 10/9,  patient's stoma was noted to be dusky and with mucocutaneous separation.  She was taken back to the operating room on 10/10 for revision of her  ostomy. Her wound vac was removed at this time and replaced with wet to  dry dressing. She tolerated the operation well and the ostomy had good  output by POD2. At time of discharge the patient was tolerating a diet,  producing urine through her nephrostomy tube, and had good stoma output.  Her pain was well controlled with oral medications. She was discharged to in-patient rehab. She was instructed to follow up with  ACS clinic  in 2 weeks.    Discharge Diagnoses:   Perforated sigmoid diverticulitis s/p Hartmann's procedure (Sigmoid colectomy with end colostomy)