chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulation drug level above therapeutic, Bradycardia, COVID-19, Chest X-ray abnormal
Clinical narrative: Patient is a 81 y.o. male patient of Private MD with a history of Covid 19   Discharge Diagnoses:   Assessment/Plan: Patient is a 81 y.o. male who presented to local General Hospital 2/9/2023 with shortness of breath      1. Acute respiratory failure Most likely 2/2 covid and bibasilar consolidation Procalcitonin neg. ATBs stopped Add decadron 6mg daily Patient tested positive for COVID-19 on 2/9.  Patient was seen by pulmonology.  -Patient does qualify for home oxygen   2. Covid-19 Virus Infection Date of onset of symptoms:  unknown Symptoms present on admission: Hypoxemia Date of covid positive test:  2/9/23 Vaccination status:  vaccinated. Imaging:   bibasilar consolidation on CXR Oxygen requirements on admission:   3L Current oxygen requirements:  2L Medical therapy: azithro, rocephin, decadron Consultants following:  Pulmonary Anticipated special isolation end date  TBD   3. Hypotension -Hold home BP medications for now.   4. Supratherapeutic INR -No active bleeding. Will not reverse as level under 6 and patient has a valve.  Now 4.5 5. Bradycardia -Heart rate dropped and cardiology was consulted.  Noted episodes of bradycardia while sleeping.  Echocardiogram was performed
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Echocardiogram, Heart rate decreased, Hypotension, Hypoxia
Clinical narrative: Patient is a 81 y.o. male patient of Private MD with a history of Covid 19   Discharge Diagnoses:   Assessment/Plan: Patient is a 81 y.o. male who presented to local General Hospital 2/9/2023 with shortness of breath      1. Acute respiratory failure Most likely 2/2 covid and bibasilar consolidation Procalcitonin neg. ATBs stopped Add decadron 6mg daily Patient tested positive for COVID-19 on 2/9.  Patient was seen by pulmonology.  -Patient does qualify for home oxygen   2. Covid-19 Virus Infection Date of onset of symptoms:  unknown Symptoms present on admission: Hypoxemia Date of covid positive test:  2/9/23 Vaccination status:  vaccinated. Imaging:   bibasilar consolidation on CXR Oxygen requirements on admission:   3L Current oxygen requirements:  2L Medical therapy: azithro, rocephin, decadron Consultants following:  Pulmonary Anticipated special isolation end date  TBD   3. Hypotension -Hold home BP medications for now.   4. Supratherapeutic INR -No active bleeding. Will not reverse as level under 6 and patient has a valve.  Now 4.5 5. Bradycardia -Heart rate dropped and cardiology was consulted.  Noted episodes of bradycardia while sleeping.  Echocardiogram was performed
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Lung consolidation, SARS-CoV-2 test positive
Clinical narrative: Patient is a 81 y.o. male patient of Private MD with a history of Covid 19   Discharge Diagnoses:   Assessment/Plan: Patient is a 81 y.o. male who presented to local General Hospital 2/9/2023 with shortness of breath      1. Acute respiratory failure Most likely 2/2 covid and bibasilar consolidation Procalcitonin neg. ATBs stopped Add decadron 6mg daily Patient tested positive for COVID-19 on 2/9.  Patient was seen by pulmonology.  -Patient does qualify for home oxygen   2. Covid-19 Virus Infection Date of onset of symptoms:  unknown Symptoms present on admission: Hypoxemia Date of covid positive test:  2/9/23 Vaccination status:  vaccinated. Imaging:   bibasilar consolidation on CXR Oxygen requirements on admission:   3L Current oxygen requirements:  2L Medical therapy: azithro, rocephin, decadron Consultants following:  Pulmonary Anticipated special isolation end date  TBD   3. Hypotension -Hold home BP medications for now.   4. Supratherapeutic INR -No active bleeding. Will not reverse as level under 6 and patient has a valve.  Now 4.5 5. Bradycardia -Heart rate dropped and cardiology was consulted.  Noted episodes of bradycardia while sleeping.  Echocardiogram was performed
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain, Acute respiratory failure, Bile culture positive, Bilirubin conjugated increased, Blood bilirubin increased
Clinical narrative: The patient is a 85 y.o. male patient of MD with history of atrial fibrillation, congestive heart failure with reduced ejection fraction, COPD, OSA noncompliant with CPAP, hypertension, hyperlipidemia presented to the ED with 3-day history of abdominal pain.   Sepsis, POA Acute cholecystitis WBC 21, afebrile.  Lactic acid 1.5. Direct bilirubin 0.7, total bilirubin 2.7.  LFTs otherwise normal. CT abdomen pelvis: Findings compatible with acute cholecystitis with distended inflamed gallbladder containing multiple gallstones.  No biliary duct dilatation. Right upper quadrant ultrasound:Thickened gallbladder wall with cholelithiasis but patient was not tender over the gallbladder.  Given the findings of ultrasound and CT examination findings are suspicious for acute cholecystitis Initially on cefazolin and Flagyl Bile cultures from drain grew E faecalis, abx switched to Vancomycin 2/17 (penicillin allergy) Further management of cholecystitis per surgical team - have signed off, f/u in surgery clinic in 1 week Keep perc chole drain in place until general surgery follow-up Continue PO Levaquin x 5 days per ID final recommendations Stable to discharge   Covid-19 Virus Infection Acute hypoxic respiratory failure - resolved Date of onset of symptoms: Unknown. Symptoms present on admission: Hypoxia present on admission. Date of covid positive test: 2/15 Vaccination status: vaccinated Imaging: Chest x-ray the lung volumes are diminished and there is opacity obscuring the left lateral aspect of the left lung base.Atelectasis and/or infiltrate could have this appearance Oxygen requirements on admission: 3 L Current oxygen requirements: room air Medical therapy: decadron and remdesivir Consultants following: ID Anticipated special isolation end date: 02/25    Paroxysmal Atrial fibrillation S/p AV node ablation and CRT-P placement in May 2020. Is chronically on Eliquis. Eliquis held for cholecystostomy procedure. Cholecystostomy tube has bloodstained fluid. Resumed Eliquis per surgery   Chronic HFrEF Echo February 2022: EF 36%.  Mild to moderate mitral valve regurgitation. He is on Coreg, lisinopril, Lasix at home. Holding Lasix in the setting of sepsis. Resumed Coreg at a lower dose 3.125 mg twice daily.  Takes 25 mg twice daily at home. Uptitrated coreg dose 02/20 sec to elevated BP BP stable   CAD  Status post CABG x3 in June 2020  Continue aspirin, statin.   OSA Not on CPAP.   Acute metabolic encephalopathy - resolved Patient apparently very somnolent after the cholecystostomy tube placement. Fully alert and oriented as of 2/16
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Blood lactic acid, Blood pressure increased, COVID-19, Chest X-ray abnormal, Cholangiostomy
Clinical narrative: The patient is a 85 y.o. male patient of MD with history of atrial fibrillation, congestive heart failure with reduced ejection fraction, COPD, OSA noncompliant with CPAP, hypertension, hyperlipidemia presented to the ED with 3-day history of abdominal pain.   Sepsis, POA Acute cholecystitis WBC 21, afebrile.  Lactic acid 1.5. Direct bilirubin 0.7, total bilirubin 2.7.  LFTs otherwise normal. CT abdomen pelvis: Findings compatible with acute cholecystitis with distended inflamed gallbladder containing multiple gallstones.  No biliary duct dilatation. Right upper quadrant ultrasound:Thickened gallbladder wall with cholelithiasis but patient was not tender over the gallbladder.  Given the findings of ultrasound and CT examination findings are suspicious for acute cholecystitis Initially on cefazolin and Flagyl Bile cultures from drain grew E faecalis, abx switched to Vancomycin 2/17 (penicillin allergy) Further management of cholecystitis per surgical team - have signed off, f/u in surgery clinic in 1 week Keep perc chole drain in place until general surgery follow-up Continue PO Levaquin x 5 days per ID final recommendations Stable to discharge   Covid-19 Virus Infection Acute hypoxic respiratory failure - resolved Date of onset of symptoms: Unknown. Symptoms present on admission: Hypoxia present on admission. Date of covid positive test: 2/15 Vaccination status: vaccinated Imaging: Chest x-ray the lung volumes are diminished and there is opacity obscuring the left lateral aspect of the left lung base.Atelectasis and/or infiltrate could have this appearance Oxygen requirements on admission: 3 L Current oxygen requirements: room air Medical therapy: decadron and remdesivir Consultants following: ID Anticipated special isolation end date: 02/25    Paroxysmal Atrial fibrillation S/p AV node ablation and CRT-P placement in May 2020. Is chronically on Eliquis. Eliquis held for cholecystostomy procedure. Cholecystostomy tube has bloodstained fluid. Resumed Eliquis per surgery   Chronic HFrEF Echo February 2022: EF 36%.  Mild to moderate mitral valve regurgitation. He is on Coreg, lisinopril, Lasix at home. Holding Lasix in the setting of sepsis. Resumed Coreg at a lower dose 3.125 mg twice daily.  Takes 25 mg twice daily at home. Uptitrated coreg dose 02/20 sec to elevated BP BP stable   CAD  Status post CABG x3 in June 2020  Continue aspirin, statin.   OSA Not on CPAP.   Acute metabolic encephalopathy - resolved Patient apparently very somnolent after the cholecystostomy tube placement. Fully alert and oriented as of 2/16
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Cholecystitis, Cholecystitis acute, Cholecystostomy, Cholelithiasis, Computerised tomogram abdomen abnormal
Clinical narrative: The patient is a 85 y.o. male patient of MD with history of atrial fibrillation, congestive heart failure with reduced ejection fraction, COPD, OSA noncompliant with CPAP, hypertension, hyperlipidemia presented to the ED with 3-day history of abdominal pain.   Sepsis, POA Acute cholecystitis WBC 21, afebrile.  Lactic acid 1.5. Direct bilirubin 0.7, total bilirubin 2.7.  LFTs otherwise normal. CT abdomen pelvis: Findings compatible with acute cholecystitis with distended inflamed gallbladder containing multiple gallstones.  No biliary duct dilatation. Right upper quadrant ultrasound:Thickened gallbladder wall with cholelithiasis but patient was not tender over the gallbladder.  Given the findings of ultrasound and CT examination findings are suspicious for acute cholecystitis Initially on cefazolin and Flagyl Bile cultures from drain grew E faecalis, abx switched to Vancomycin 2/17 (penicillin allergy) Further management of cholecystitis per surgical team - have signed off, f/u in surgery clinic in 1 week Keep perc chole drain in place until general surgery follow-up Continue PO Levaquin x 5 days per ID final recommendations Stable to discharge   Covid-19 Virus Infection Acute hypoxic respiratory failure - resolved Date of onset of symptoms: Unknown. Symptoms present on admission: Hypoxia present on admission. Date of covid positive test: 2/15 Vaccination status: vaccinated Imaging: Chest x-ray the lung volumes are diminished and there is opacity obscuring the left lateral aspect of the left lung base.Atelectasis and/or infiltrate could have this appearance Oxygen requirements on admission: 3 L Current oxygen requirements: room air Medical therapy: decadron and remdesivir Consultants following: ID Anticipated special isolation end date: 02/25    Paroxysmal Atrial fibrillation S/p AV node ablation and CRT-P placement in May 2020. Is chronically on Eliquis. Eliquis held for cholecystostomy procedure. Cholecystostomy tube has bloodstained fluid. Resumed Eliquis per surgery   Chronic HFrEF Echo February 2022: EF 36%.  Mild to moderate mitral valve regurgitation. He is on Coreg, lisinopril, Lasix at home. Holding Lasix in the setting of sepsis. Resumed Coreg at a lower dose 3.125 mg twice daily.  Takes 25 mg twice daily at home. Uptitrated coreg dose 02/20 sec to elevated BP BP stable   CAD  Status post CABG x3 in June 2020  Continue aspirin, statin.   OSA Not on CPAP.   Acute metabolic encephalopathy - resolved Patient apparently very somnolent after the cholecystostomy tube placement. Fully alert and oriented as of 2/16
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Enterococcus test positive, Gallbladder disorder, Gallbladder enlargement, Hypoxia, Liver function test normal
Clinical narrative: The patient is a 85 y.o. male patient of MD with history of atrial fibrillation, congestive heart failure with reduced ejection fraction, COPD, OSA noncompliant with CPAP, hypertension, hyperlipidemia presented to the ED with 3-day history of abdominal pain.   Sepsis, POA Acute cholecystitis WBC 21, afebrile.  Lactic acid 1.5. Direct bilirubin 0.7, total bilirubin 2.7.  LFTs otherwise normal. CT abdomen pelvis: Findings compatible with acute cholecystitis with distended inflamed gallbladder containing multiple gallstones.  No biliary duct dilatation. Right upper quadrant ultrasound:Thickened gallbladder wall with cholelithiasis but patient was not tender over the gallbladder.  Given the findings of ultrasound and CT examination findings are suspicious for acute cholecystitis Initially on cefazolin and Flagyl Bile cultures from drain grew E faecalis, abx switched to Vancomycin 2/17 (penicillin allergy) Further management of cholecystitis per surgical team - have signed off, f/u in surgery clinic in 1 week Keep perc chole drain in place until general surgery follow-up Continue PO Levaquin x 5 days per ID final recommendations Stable to discharge   Covid-19 Virus Infection Acute hypoxic respiratory failure - resolved Date of onset of symptoms: Unknown. Symptoms present on admission: Hypoxia present on admission. Date of covid positive test: 2/15 Vaccination status: vaccinated Imaging: Chest x-ray the lung volumes are diminished and there is opacity obscuring the left lateral aspect of the left lung base.Atelectasis and/or infiltrate could have this appearance Oxygen requirements on admission: 3 L Current oxygen requirements: room air Medical therapy: decadron and remdesivir Consultants following: ID Anticipated special isolation end date: 02/25    Paroxysmal Atrial fibrillation S/p AV node ablation and CRT-P placement in May 2020. Is chronically on Eliquis. Eliquis held for cholecystostomy procedure. Cholecystostomy tube has bloodstained fluid. Resumed Eliquis per surgery   Chronic HFrEF Echo February 2022: EF 36%.  Mild to moderate mitral valve regurgitation. He is on Coreg, lisinopril, Lasix at home. Holding Lasix in the setting of sepsis. Resumed Coreg at a lower dose 3.125 mg twice daily.  Takes 25 mg twice daily at home. Uptitrated coreg dose 02/20 sec to elevated BP BP stable   CAD  Status post CABG x3 in June 2020  Continue aspirin, statin.   OSA Not on CPAP.   Acute metabolic encephalopathy - resolved Patient apparently very somnolent after the cholecystostomy tube placement. Fully alert and oriented as of 2/16
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Lung opacity, Metabolic encephalopathy, Mitral valve incompetence, SARS-CoV-2 test positive, Sepsis
Clinical narrative: The patient is a 85 y.o. male patient of MD with history of atrial fibrillation, congestive heart failure with reduced ejection fraction, COPD, OSA noncompliant with CPAP, hypertension, hyperlipidemia presented to the ED with 3-day history of abdominal pain.   Sepsis, POA Acute cholecystitis WBC 21, afebrile.  Lactic acid 1.5. Direct bilirubin 0.7, total bilirubin 2.7.  LFTs otherwise normal. CT abdomen pelvis: Findings compatible with acute cholecystitis with distended inflamed gallbladder containing multiple gallstones.  No biliary duct dilatation. Right upper quadrant ultrasound:Thickened gallbladder wall with cholelithiasis but patient was not tender over the gallbladder.  Given the findings of ultrasound and CT examination findings are suspicious for acute cholecystitis Initially on cefazolin and Flagyl Bile cultures from drain grew E faecalis, abx switched to Vancomycin 2/17 (penicillin allergy) Further management of cholecystitis per surgical team - have signed off, f/u in surgery clinic in 1 week Keep perc chole drain in place until general surgery follow-up Continue PO Levaquin x 5 days per ID final recommendations Stable to discharge   Covid-19 Virus Infection Acute hypoxic respiratory failure - resolved Date of onset of symptoms: Unknown. Symptoms present on admission: Hypoxia present on admission. Date of covid positive test: 2/15 Vaccination status: vaccinated Imaging: Chest x-ray the lung volumes are diminished and there is opacity obscuring the left lateral aspect of the left lung base.Atelectasis and/or infiltrate could have this appearance Oxygen requirements on admission: 3 L Current oxygen requirements: room air Medical therapy: decadron and remdesivir Consultants following: ID Anticipated special isolation end date: 02/25    Paroxysmal Atrial fibrillation S/p AV node ablation and CRT-P placement in May 2020. Is chronically on Eliquis. Eliquis held for cholecystostomy procedure. Cholecystostomy tube has bloodstained fluid. Resumed Eliquis per surgery   Chronic HFrEF Echo February 2022: EF 36%.  Mild to moderate mitral valve regurgitation. He is on Coreg, lisinopril, Lasix at home. Holding Lasix in the setting of sepsis. Resumed Coreg at a lower dose 3.125 mg twice daily.  Takes 25 mg twice daily at home. Uptitrated coreg dose 02/20 sec to elevated BP BP stable   CAD  Status post CABG x3 in June 2020  Continue aspirin, statin.   OSA Not on CPAP.   Acute metabolic encephalopathy - resolved Patient apparently very somnolent after the cholecystostomy tube placement. Fully alert and oriented as of 2/16
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Somnolence, Total lung capacity decreased, Ultrasound abdomen abnormal, White blood cell count increased
Clinical narrative: The patient is a 85 y.o. male patient of MD with history of atrial fibrillation, congestive heart failure with reduced ejection fraction, COPD, OSA noncompliant with CPAP, hypertension, hyperlipidemia presented to the ED with 3-day history of abdominal pain.   Sepsis, POA Acute cholecystitis WBC 21, afebrile.  Lactic acid 1.5. Direct bilirubin 0.7, total bilirubin 2.7.  LFTs otherwise normal. CT abdomen pelvis: Findings compatible with acute cholecystitis with distended inflamed gallbladder containing multiple gallstones.  No biliary duct dilatation. Right upper quadrant ultrasound:Thickened gallbladder wall with cholelithiasis but patient was not tender over the gallbladder.  Given the findings of ultrasound and CT examination findings are suspicious for acute cholecystitis Initially on cefazolin and Flagyl Bile cultures from drain grew E faecalis, abx switched to Vancomycin 2/17 (penicillin allergy) Further management of cholecystitis per surgical team - have signed off, f/u in surgery clinic in 1 week Keep perc chole drain in place until general surgery follow-up Continue PO Levaquin x 5 days per ID final recommendations Stable to discharge   Covid-19 Virus Infection Acute hypoxic respiratory failure - resolved Date of onset of symptoms: Unknown. Symptoms present on admission: Hypoxia present on admission. Date of covid positive test: 2/15 Vaccination status: vaccinated Imaging: Chest x-ray the lung volumes are diminished and there is opacity obscuring the left lateral aspect of the left lung base.Atelectasis and/or infiltrate could have this appearance Oxygen requirements on admission: 3 L Current oxygen requirements: room air Medical therapy: decadron and remdesivir Consultants following: ID Anticipated special isolation end date: 02/25    Paroxysmal Atrial fibrillation S/p AV node ablation and CRT-P placement in May 2020. Is chronically on Eliquis. Eliquis held for cholecystostomy procedure. Cholecystostomy tube has bloodstained fluid. Resumed Eliquis per surgery   Chronic HFrEF Echo February 2022: EF 36%.  Mild to moderate mitral valve regurgitation. He is on Coreg, lisinopril, Lasix at home. Holding Lasix in the setting of sepsis. Resumed Coreg at a lower dose 3.125 mg twice daily.  Takes 25 mg twice daily at home. Uptitrated coreg dose 02/20 sec to elevated BP BP stable   CAD  Status post CABG x3 in June 2020  Continue aspirin, statin.   OSA Not on CPAP.   Acute metabolic encephalopathy - resolved Patient apparently very somnolent after the cholecystostomy tube placement. Fully alert and oriented as of 2/16
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, COVID-19, Chest X-ray normal, Colectomy
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram abdomen, Condition aggravated, Coronary arterial stent insertion, Coronary artery disease, Duodenal ulcer
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Faeces discoloured, Full blood count abnormal, Glycosylated haemoglobin increased, Haematochezia, Haemoglobin decreased
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Haemostasis, Hypomagnesaemia, Hypophosphataemia, Hypoxia, Intestinal anastomosis
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Malnutrition, Melaena, Obstructive sleep apnoea syndrome, Oesophagogastroduodenoscopy abnormal, Percutaneous coronary intervention
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Postoperative respiratory failure, Red blood cell transfusion, Respiratory failure, SARS-CoV-2 test positive, Tachycardia
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Upper gastrointestinal haemorrhage
Clinical narrative: Patient is a 88 y.o. male patient of MD with history of CAD s/p stents, hypertension, hyperlipidemia, type 2 DM, chronic anemia presented with melena and black tarry stool   Acute on chronic anemia d/t ABLA with hemorrhagic shock Iron deficiency anemia Colon adenocarcinoma Presented with melena mixed with bright red blood S/p right hemicolectomy with ileocolic anastomosis on 2/9 per Dr. CT a/p on admission with post-surgical changes. Non-acute Initial CBC with Hgb 6.1 (from 7.4 week prior). Only improved to 6.5 after 2uPRBCs EGD 2/22 with 2 duodenal ulcers, hemostasis via epinephrine Has required 6 total units of PRBCs (5 units prior to EGD) Cont IV PPI bid, carafate Holding Plavix as risks > benefits (DES in 12/05/2022).  Per cardiology recommendation 11/2022: Continue aspirin 81 mg daily indefinitely and clopidogrel for 3 months  On empiric H pylori coverage Clinically UGIB is resolving. BMs normalizing,  no further tachy response.  Hgb 7.5-8,  stable over last few days Surgery following, recommending to hold ASA for 14 days and then resume   Acute hypoxic respiratory failure d/t COVID-19 infection AHRF multifactorial. Post-op resp insufficiency, poor O2 carrying capacity, COVID Tested positive 2/26. Symptom onset 2/26. Wife also positive. Vaccinated x2 Required 4L NC initially, , now down to room air CXR without vascular congestion or consolidation Cont supplemental O2 to maintain goal SpO2 > 92% Decadron 6mg daily for 10 days  Hold off on Remdesivir   Hypomagnesemia Hypophosphatemia Replaced.  CAD  s/p PCI of LAD with DES 12/09/2022   Per cardiology note from December patient was advised to continue DAPT for at least 3 months but according to patient was later instructed to stop aspirin and continue Plavix. Continue statin Holding plavix   Hypertension Held home blood pressure meds on admission as blood pressure soft.   Will restart   Hyperlipidemia Continue statin   Type 2 DM -A1c not at goal A1C 9.1 on 1/24/2023 on metformin, glipizide and pioglitazone at home Continue sliding scale and every 4 hours checks Lantus increased for hyperglycemia due to steroids.    Nocturnal Hypoxia Suspect OSA Recommend outpatient sleep study    Chronic urinary retention Has indwelling Foley catheter, will f/u with Dr  Continue Flomax   Severe protein caloric malnutrition
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Chills, Laboratory test abnormal, Malaise, Nasopharyngitis
Clinical narrative: Patient states she has been ill ever since she received her second dose of moderna shot. Cold symptoms, fever, chills, no energy to get out of bed. lab work values altered. she states she has seen mutiple specialists since (cardiologist, rheumatologist, gastroenterologist)  with no relief.
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia
Clinical narrative: Patient states she has been ill ever since she received her second dose of moderna shot. Cold symptoms, fever, chills, no energy to get out of bed. lab work values altered. she states she has seen mutiple specialists since (cardiologist, rheumatologist, gastroenterologist)  with no relief.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Aortic aneurysm, Asthenia, Bronchiolitis
Clinical narrative: The patient is a 81 y.o. male patient of MD with history of past CVA, hypertension, and hyperlipidemia who presented to the Hospital with fatigue.   Acute hypoxic respiratory failure d/t COVID 19 infection Generalized Weakness Mainly symptoms of fatigue and generalized weakness at home Desaturated and initially placed on 5L NC, now off oxygen on RA Initial CBC with moderate leukocytosis (WBC 16.6), now 11.96 Unclear when symptoms started, but he states a few weeks. Vaccinated x1 (J&J) CTPA with no PE, some findings consistent with infectious bronchiolitis CRP elevated to 116 on arrival, now 47.6 Continue Decadron x10 days. Remdesivir not indicated PT/OT/CM consulted, appreciate assistance Discharged to SNF in stable condition, return precautions discussed Patient instructed to follow up with PCP    Abdominal Aortic Aneurysm Ascending Aortic Aneurysm Incidental findings on CTPA and CT abdomen/pelvis Ascending aneurysm stable with previous imaging Initially evaluated for transfer to hospital; however, per Vascular surgery this is not an acute issue AAA is only 3.5 x 3.6cm, does not meet cutoff for intervention. Stable 4.1 cm ascending AA.    Past CVA Hypertension Hyperlipidemia Cont losartan and metoprolol
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein increased, COVID-19, Computerised tomogram abdomen abnormal, Fatigue, Full blood count abnormal
Clinical narrative: The patient is a 81 y.o. male patient of MD with history of past CVA, hypertension, and hyperlipidemia who presented to the Hospital with fatigue.   Acute hypoxic respiratory failure d/t COVID 19 infection Generalized Weakness Mainly symptoms of fatigue and generalized weakness at home Desaturated and initially placed on 5L NC, now off oxygen on RA Initial CBC with moderate leukocytosis (WBC 16.6), now 11.96 Unclear when symptoms started, but he states a few weeks. Vaccinated x1 (J&J) CTPA with no PE, some findings consistent with infectious bronchiolitis CRP elevated to 116 on arrival, now 47.6 Continue Decadron x10 days. Remdesivir not indicated PT/OT/CM consulted, appreciate assistance Discharged to SNF in stable condition, return precautions discussed Patient instructed to follow up with PCP    Abdominal Aortic Aneurysm Ascending Aortic Aneurysm Incidental findings on CTPA and CT abdomen/pelvis Ascending aneurysm stable with previous imaging Initially evaluated for transfer to hospital; however, per Vascular surgery this is not an acute issue AAA is only 3.5 x 3.6cm, does not meet cutoff for intervention. Stable 4.1 cm ascending AA.    Past CVA Hypertension Hyperlipidemia Cont losartan and metoprolol
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Leukocytosis, Oxygen saturation decreased, White blood cell count increased
Clinical narrative: The patient is a 81 y.o. male patient of MD with history of past CVA, hypertension, and hyperlipidemia who presented to the Hospital with fatigue.   Acute hypoxic respiratory failure d/t COVID 19 infection Generalized Weakness Mainly symptoms of fatigue and generalized weakness at home Desaturated and initially placed on 5L NC, now off oxygen on RA Initial CBC with moderate leukocytosis (WBC 16.6), now 11.96 Unclear when symptoms started, but he states a few weeks. Vaccinated x1 (J&J) CTPA with no PE, some findings consistent with infectious bronchiolitis CRP elevated to 116 on arrival, now 47.6 Continue Decadron x10 days. Remdesivir not indicated PT/OT/CM consulted, appreciate assistance Discharged to SNF in stable condition, return precautions discussed Patient instructed to follow up with PCP    Abdominal Aortic Aneurysm Ascending Aortic Aneurysm Incidental findings on CTPA and CT abdomen/pelvis Ascending aneurysm stable with previous imaging Initially evaluated for transfer to hospital; however, per Vascular surgery this is not an acute issue AAA is only 3.5 x 3.6cm, does not meet cutoff for intervention. Stable 4.1 cm ascending AA.    Past CVA Hypertension Hyperlipidemia Cont losartan and metoprolol
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Amnesia, Bladder catheterisation, CSF shunt operation, Coma, Craniotomy
Clinical narrative: July 16, 2021 had a subarachnoid brain aneurysm.  Was sent to Hospital from another Hospital as he was critical care.  Had a craniotomy, in a coma for 30 days, got  pnenuoma, had a triachea put in, feeding tube and 40 days later a shunt put in.  He left the hospital on August 27, 2021 and went to Rehabilition center for 3 weeks until he could walk again.  Returned home from Rehab on 9/21/2021 with feeding tube, catheter, many prescriptions and rehab for months after.  Has much short term memory loss, takes many medications when he never had any, does not drive or work any more and needs me to get thru days.
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Gait inability, Gastrointestinal tube insertion, Impaired driving ability, Impaired work ability, Inflammation
Clinical narrative: July 16, 2021 had a subarachnoid brain aneurysm.  Was sent to Hospital from another Hospital as he was critical care.  Had a craniotomy, in a coma for 30 days, got  pnenuoma, had a triachea put in, feeding tube and 40 days later a shunt put in.  He left the hospital on August 27, 2021 and went to Rehabilition center for 3 weeks until he could walk again.  Returned home from Rehab on 9/21/2021 with feeding tube, catheter, many prescriptions and rehab for months after.  Has much short term memory loss, takes many medications when he never had any, does not drive or work any more and needs me to get thru days.
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Intracranial aneurysm, Laboratory test, Loss of personal independence in daily activities, Pneumonia, Tracheostomy
Clinical narrative: July 16, 2021 had a subarachnoid brain aneurysm.  Was sent to Hospital from another Hospital as he was critical care.  Had a craniotomy, in a coma for 30 days, got  pnenuoma, had a triachea put in, feeding tube and 40 days later a shunt put in.  He left the hospital on August 27, 2021 and went to Rehabilition center for 3 weeks until he could walk again.  Returned home from Rehab on 9/21/2021 with feeding tube, catheter, many prescriptions and rehab for months after.  Has much short term memory loss, takes many medications when he never had any, does not drive or work any more and needs me to get thru days.
Age: 55.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood pressure fluctuation, Cardiac flutter, Chills, Dizziness, Extrasystoles
Clinical narrative: Beginning with the 1st shot, dizziness, face twitching, tachycardia, erratic BP, chills, and random sweats. With each of these shots, my symptoms worsened, leading to a 911 call with a HR of 169 from a dead sleep.   I've also been to the ER as my heart was skipping beats, fluttering.  With many other symptoms and a dozen Doctors to rule out everything possible.  I've finally been diagnosed with POTS syndrome on 03/16/2023. there is no cure and very little treatment available to me.   The outcome is poor as I can no longer work or drive.
Age: 55.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Hyperhidrosis, Impaired driving ability, Impaired work ability, Laboratory test, Muscle twitching
Clinical narrative: Beginning with the 1st shot, dizziness, face twitching, tachycardia, erratic BP, chills, and random sweats. With each of these shots, my symptoms worsened, leading to a 911 call with a HR of 169 from a dead sleep.   I've also been to the ER as my heart was skipping beats, fluttering.  With many other symptoms and a dozen Doctors to rule out everything possible.  I've finally been diagnosed with POTS syndrome on 03/16/2023. there is no cure and very little treatment available to me.   The outcome is poor as I can no longer work or drive.
Age: 55.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Postural orthostatic tachycardia syndrome, Tachycardia
Clinical narrative: Beginning with the 1st shot, dizziness, face twitching, tachycardia, erratic BP, chills, and random sweats. With each of these shots, my symptoms worsened, leading to a 911 call with a HR of 169 from a dead sleep.   I've also been to the ER as my heart was skipping beats, fluttering.  With many other symptoms and a dozen Doctors to rule out everything possible.  I've finally been diagnosed with POTS syndrome on 03/16/2023. there is no cure and very little treatment available to me.   The outcome is poor as I can no longer work or drive.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Back pain, Blood test, Computerised tomogram, Contusion, Death
Clinical narrative: Whole arm bruising; pain in back; red bruising on buttocks; hospitalization on 6/10/21 with CT scans and multiple blood tests/scans; diagnosed with Acquired Factor VIII Inhibitor; Prednisone (June - August 2021); Retuxan (2 doses - October 2021); Death (November 2021); multiple hospitalizations and blood transfusions, including two procedures for bleeding in stomach (August 2021).
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Erythema, Factor VIII inhibition, Gastric haemorrhage, Imaging procedure, Medical procedure
Clinical narrative: Whole arm bruising; pain in back; red bruising on buttocks; hospitalization on 6/10/21 with CT scans and multiple blood tests/scans; diagnosed with Acquired Factor VIII Inhibitor; Prednisone (June - August 2021); Retuxan (2 doses - October 2021); Death (November 2021); multiple hospitalizations and blood transfusions, including two procedures for bleeding in stomach (August 2021).
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Transfusion
Clinical narrative: Whole arm bruising; pain in back; red bruising on buttocks; hospitalization on 6/10/21 with CT scans and multiple blood tests/scans; diagnosed with Acquired Factor VIII Inhibitor; Prednisone (June - August 2021); Retuxan (2 doses - October 2021); Death (November 2021); multiple hospitalizations and blood transfusions, including two procedures for bleeding in stomach (August 2021).