chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary oedema, Pyrexia, Respiratory syncytial virus test negative, Respiratory viral panel, Right ventricular dilatation
Clinical narrative: Patient discharged after (3) day inpatient admission.  The patient is a 51-year-old lady who presented to the hospital with chief complaint of worsening shortness of breath and cough.  The patient has the past medical history of type 2 diabetes mellitus, hypertension, psoriasis on methotrexate, GERD, hypothyroidism, chronic obstructive pulmonary disease, morbid is 3 common current tobacco abuse.  The patient stated she had developed the symptoms on Tuesday in the form of intermittent productive cough, progressive worsening shortness of breath, intermittent wheezing intermittent fevers and chills with nasal congestion, sore throat and decreased appetite, nausea, myalgia, generalized weakness and fatigue.  Denies any loss of taste or smell.  The patient also complained of some pleuritic chest pain.  Denies any recent medication changes patient is fully vaccinated and received a booster in August.  The patient does not use oxygen at home for her chronic obstructive pulmonary disease.  Denies any lightheadedness or dizziness or headache abdominal pain.  She did have some a minor bilateral pedal edema over the last few days.  Sh patient was found to be hypoxic with tachycardia and hypertension in the emergency department.  She was started on 3 L of nasal cannula to maintain her oxygen saturation.  She was found to have positive COVID PCR.  X-ray chest showed finding suggestive of pulmonary edema a bilateral mixed interstitial/airspace pneumonia.  She was started on IV Solu-Medrol and nebulizer treatments.  He was also started on Lasix.  The she underwent a CT angiogram of the thorax which did not reveal any pulmonary embolism.  However the multifocal tree-in-bud opacity, lung nodularity and interstitial thickening which is similar to the prior exams.  Concern for sarcoidosis was raised.  There was also evidence of right small pleural effusion and small pericardial effusion.  Patient also was found to have worsening mild mediastinal and hilar adenopathy is likely reactive.  She was started on a remdesivir as well for COVID.  Pulmonary service was consulted for concerns of lymphadenopathy, sarcoidosis expressed on the CT scan.Patient was seen by Pulmonary and they will follow her up as outpatient.Further workup once she recovers with repeat CT chest after 3 months.  Patient did well overall.  Her diabetes was managed.  She was subsequently discharged home
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Right ventricular failure, SARS-CoV-2 test positive, Sarcoidosis, Spinal osteoarthritis, Stroke volume
Clinical narrative: Patient discharged after (3) day inpatient admission.  The patient is a 51-year-old lady who presented to the hospital with chief complaint of worsening shortness of breath and cough.  The patient has the past medical history of type 2 diabetes mellitus, hypertension, psoriasis on methotrexate, GERD, hypothyroidism, chronic obstructive pulmonary disease, morbid is 3 common current tobacco abuse.  The patient stated she had developed the symptoms on Tuesday in the form of intermittent productive cough, progressive worsening shortness of breath, intermittent wheezing intermittent fevers and chills with nasal congestion, sore throat and decreased appetite, nausea, myalgia, generalized weakness and fatigue.  Denies any loss of taste or smell.  The patient also complained of some pleuritic chest pain.  Denies any recent medication changes patient is fully vaccinated and received a booster in August.  The patient does not use oxygen at home for her chronic obstructive pulmonary disease.  Denies any lightheadedness or dizziness or headache abdominal pain.  She did have some a minor bilateral pedal edema over the last few days.  Sh patient was found to be hypoxic with tachycardia and hypertension in the emergency department.  She was started on 3 L of nasal cannula to maintain her oxygen saturation.  She was found to have positive COVID PCR.  X-ray chest showed finding suggestive of pulmonary edema a bilateral mixed interstitial/airspace pneumonia.  She was started on IV Solu-Medrol and nebulizer treatments.  He was also started on Lasix.  The she underwent a CT angiogram of the thorax which did not reveal any pulmonary embolism.  However the multifocal tree-in-bud opacity, lung nodularity and interstitial thickening which is similar to the prior exams.  Concern for sarcoidosis was raised.  There was also evidence of right small pleural effusion and small pericardial effusion.  Patient also was found to have worsening mild mediastinal and hilar adenopathy is likely reactive.  She was started on a remdesivir as well for COVID.  Pulmonary service was consulted for concerns of lymphadenopathy, sarcoidosis expressed on the CT scan.Patient was seen by Pulmonary and they will follow her up as outpatient.Further workup once she recovers with repeat CT chest after 3 months.  Patient did well overall.  Her diabetes was managed.  She was subsequently discharged home
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Tachycardia, Tricuspid valve incompetence, Wheezing
Clinical narrative: Patient discharged after (3) day inpatient admission.  The patient is a 51-year-old lady who presented to the hospital with chief complaint of worsening shortness of breath and cough.  The patient has the past medical history of type 2 diabetes mellitus, hypertension, psoriasis on methotrexate, GERD, hypothyroidism, chronic obstructive pulmonary disease, morbid is 3 common current tobacco abuse.  The patient stated she had developed the symptoms on Tuesday in the form of intermittent productive cough, progressive worsening shortness of breath, intermittent wheezing intermittent fevers and chills with nasal congestion, sore throat and decreased appetite, nausea, myalgia, generalized weakness and fatigue.  Denies any loss of taste or smell.  The patient also complained of some pleuritic chest pain.  Denies any recent medication changes patient is fully vaccinated and received a booster in August.  The patient does not use oxygen at home for her chronic obstructive pulmonary disease.  Denies any lightheadedness or dizziness or headache abdominal pain.  She did have some a minor bilateral pedal edema over the last few days.  Sh patient was found to be hypoxic with tachycardia and hypertension in the emergency department.  She was started on 3 L of nasal cannula to maintain her oxygen saturation.  She was found to have positive COVID PCR.  X-ray chest showed finding suggestive of pulmonary edema a bilateral mixed interstitial/airspace pneumonia.  She was started on IV Solu-Medrol and nebulizer treatments.  He was also started on Lasix.  The she underwent a CT angiogram of the thorax which did not reveal any pulmonary embolism.  However the multifocal tree-in-bud opacity, lung nodularity and interstitial thickening which is similar to the prior exams.  Concern for sarcoidosis was raised.  There was also evidence of right small pleural effusion and small pericardial effusion.  Patient also was found to have worsening mild mediastinal and hilar adenopathy is likely reactive.  She was started on a remdesivir as well for COVID.  Pulmonary service was consulted for concerns of lymphadenopathy, sarcoidosis expressed on the CT scan.Patient was seen by Pulmonary and they will follow her up as outpatient.Further workup once she recovers with repeat CT chest after 3 months.  Patient did well overall.  Her diabetes was managed.  She was subsequently discharged home
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Biopsy, Cyst, Dysmenorrhoea, Heavy menstrual bleeding, Intermenstrual bleeding
Clinical narrative: I have developed irregular and severe menstrual symptoms which is very odd considering my age of 51,  Heavy flow, longer flows, spotting in-between, cysts, cramps
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Menstruation irregular, Oligomenorrhoea, Ultrasound scan
Clinical narrative: I have developed irregular and severe menstrual symptoms which is very odd considering my age of 51,  Heavy flow, longer flows, spotting in-between, cysts, cramps
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Antimicrobial susceptibility test, Aortic valve thickening, Asthenia, Atelectasis, Blood culture negative
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Blood potassium increased, Blood thyroid stimulating hormone increased, Bradycardia, Brain oedema, COVID-19
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cardiomegaly, Cerebral atrophy, Cerebral small vessel ischaemic disease, Cerebrosclerosis
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Culture positive, Depressed level of consciousness
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Echocardiogram abnormal, Ejection fraction normal, Electrocardiogram QRS complex normal, Electrocardiogram T wave normal, Escherichia infection
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Escherichia test positive, Heart rate abnormal, Hiatus hernia, Hyperkalaemia, Hypothermia
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Intervertebral disc degeneration, Left atrial dilatation, Lung disorder, Lung opacity
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Mental status changes, Mitral valve calcification, Mitral valve incompetence, Mouth breathing, Mucosal hypertrophy
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Pleural effusion, Pleural fibrosis, Pleural thickening, Pulmonary valve disease, Right atrial dilatation
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Right ventricular dilatation, Right ventricular dysfunction, SARS-CoV-2 test positive, Scoliosis, Sepsis
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Shock, Swelling face, Thyroid function test, Tricuspid valve incompetence, Urinary tract infection
Clinical narrative: Patient currently an inpatient at (4) days   H& P:Pt is a 91 y.o. female who presents today with vague complaint of weakness and AMS. She is found to have a UTI, as well as Covid (+) with small right basilar airspace density. She is admitted for sepsis due to UTI, with comorbid AKI on CKD, hypothyroidism, HFpEF, atrial fibrillation on Coumadin. Her INR is supratherapeutic >8. Later in ED course, she is found to be profoundly bradycardic and hypothermic; she is given Ca gluconate, IV levothyroxine with some improvement. She is given warmed fluids and started on Bair Hugger. Her alertness improves somewhat, and her HR improves into 50-60's. She is made DNR per discussion with son over phone; he is planning to see her tomorrow.   ASSESSMENT / PLAN: Pneumonia due to COVID-19 virus Assessment & Plan -Initially normoxic, however becomes hypoxic later in evening -Renal function precludes Remdesivir -Start supportive care, steroids -Sats maintained on NC, but she breaths through mouth, so changed to NRB   Hyperkalemia Assessment & Plan -at 5.8, without T wave peaking or QRS widening -Could be cause of bradycardia -Still 5.8 after fluids; give 20mg Lasix IV x1   * Sepsis due to urinary tract infection Assessment & Plan -Culture collected 12/8 pan-susceptible E. Coli -Treat with Rocephin -She is hypothermic to 91F and bradycardic into 30's; unclear if sepsis is cause   Right frontal lobe lesion Assessment & Plan -Area of questionable edema right frontal lboe -I speak with Dr. of neurology who advises MRA and MRI w/ and w/out -This is deferred as she becomes bradycardic later in course    Acute renal failure superimposed on stage 3a chronic kidney disease Assessment & Plan -Likely prerenal d/t sepsis, bradycardia -Expect to improve as chronotropy, volume and metabolic status stabilize   Supratherapeutic INR Assessment & Plan -Coumadin on hold -INR still > 8 several hours after 5mg Vit K PO give -Give 10mg IV -CT head (-) hemorrhage   Permanent atrial fibrillation Assessment & Plan -On Toprol at home; this is held -On coumadin   Chronic heart failure with preserved ejection fraction Assessment & Plan -Does not appear to be in exacerbation  -Caution with fluids     Physical deconditioning Assessment & Plan -Consult PT/OT/CM, appreciate input   Unspecified hypothyroidism Assessment & Plan -Could be a form of myxedema coma; TSH is 11, TF 1.1 -She is profoundly hypothermic and bradyardic, puffy facies -Give loading dose 200mcg of levothyroxine, then 2 daily doses at 1.2 mcg/kg at about 80mcg -Bair hugger and warmed fluids
Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Vaccine given 6 days post expiry) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 041L20A) for COVID-19 vaccination.     No Medical History information was reported.   On 14-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No concomitant information was reported. No treatment information was reported.  No adverse event reported.   This case was linked to MOD-2021-395985 (Patient Link).
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Antibody test, Antinuclear antibody, Blood creatine phosphokinase, Blood thyroid stimulating hormone, C-reactive protein
Clinical narrative: Pfizer Moderna COVID?19 Vaccine EUA  Chronic urticaria beginning 8/1/2021, resistant to any medications, steroids or topical solutions.  Hives are whole body, red, swollen and itchy.
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: DNA antibody, Erythema, Full blood count, Haemoglobin, Helicobacter test
Clinical narrative: Pfizer Moderna COVID?19 Vaccine EUA  Chronic urticaria beginning 8/1/2021, resistant to any medications, steroids or topical solutions.  Hives are whole body, red, swollen and itchy.
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic function test, Pruritus, Red blood cell sedimentation rate, Rheumatoid factor, Skin swelling
Clinical narrative: Pfizer Moderna COVID?19 Vaccine EUA  Chronic urticaria beginning 8/1/2021, resistant to any medications, steroids or topical solutions.  Hives are whole body, red, swollen and itchy.
Age: 36.0
Sex: F
Vaccine: COVID19
Symptoms: Troponin, Urticaria chronic
Clinical narrative: Pfizer Moderna COVID?19 Vaccine EUA  Chronic urticaria beginning 8/1/2021, resistant to any medications, steroids or topical solutions.  Hives are whole body, red, swollen and itchy.
Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (vaccine given 6 days post expiry) in a 32-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 011L20A) for COVID-19 vaccination.     No Medical History information was reported.   On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No concomitant medication was reported by the reporter.  No treatment medication was reported by the reporter.   This case was linked to MOD-2021-395985 (Patient Link).
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: None- vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) in an 84-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 041L20A) for COVID-19 vaccination.     No Medical History information was reported.   On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications were reported.  No treatment medications were reported.   This case was linked to MOD-2021-395985 (Patient Link).
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: None- vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) in an 84-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 041L20A) for COVID-19 vaccination.     No Medical History information was reported.   On 28-Jan-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021,  after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No relevant concomitant product were reported No treatment medication was provided   This case was linked to MOD-2021-395985 (Patient Link).
Age: 28.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Vaccine given 6 days post expiry) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 011L20A) for COVID-19 vaccination.     No Medical History information was reported.   On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021,  after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (Vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Concomitant medication information was not provided by the reporter.  Treatment information was not provided by the reporter.   This case was linked to MOD-2021-395985 (Patient Link).
Age: 48.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: None- vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 011J20A) for COVID-19 vaccination.     No Medical History information was reported.   On 29-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No Concomitant product use was reported. No treatment information was provided.   This case was linked to MOD-2021-395985 (Patient Link).
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: None- vaccine given 6 days post expiry; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 046C21A and 011L20A) for COVID-19 vaccination.     No Medical History information was reported.   On 12-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Nov-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry). On 12-Nov-2021, EXPIRED PRODUCT ADMINISTERED (None- vaccine given 6 days post expiry) had resolved.        For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications information was reported.   This case was linked to MOD-2021-395985 (Patient Link).