chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: Nausea, Pulmonary mass, Red blood cells urine positive, Urinary tract infection, Urine analysis abnormal
Clinical narrative: Patient is a 84 y.o. female admitted to the hospital on 12/8/2022 for generalized weakness in the setting of UTI and COVID-19.    Discharge Diagnosis and Associated Hospital Course   COVID-19 infection Acute bronchitis - Diagnosed 12/8/2022. Cough, generalized weakness, nausea. Prescribed Molnupiravir as PCP felt Paxlovid would interact with her low dose Eliquis, however patient had not started taking medication - CTAP peribronchial thickening and right middle lobe which could represent bronchitis - She will finish course of oral azithromycin, has 2 days left - ID was consulted 12/10 as Molnupiravir was not on formulary, felt patient would be okay to take Paxlovid instead.  Unfortunately this was not started by pharmacy staff and patient did not receive while in the hospital.  I did discuss this at length with patient on 12/11--risks and benefits. She does not want to begin Paxlovid, which does seem reasonable as her symptoms started about 5 days ago.  Her symptoms are improving with supportive care, she has no significant respiratory symptoms, and she has not required oxygen during her entire hospitalization. She reports she does not plan on taking molnupiravir and has tessalon prescribed by PCP.  She has requested discharge home.   Urinary tract infection - Present on admission. Reporting generalized weakness fatigue nausea vomiting - UA abnormal with large RBCs, elevated WBC, moderate leuk esterase. Urine  - Urine culture was negative. She did complete 3 day course of rocephin.   Generalized weakness - Secondary to active infection - PT/OT consultations--OK to discharge without additional therapy, doing well   Hypokalemia - Mild at 3.4, replaced   Essential hypertension -Poorly controlled here. Continue on losartan and metoprolol at discharge -I would like her to follow-up with her PCP in 1 to 2 weeks after resolution of her acute illness as her blood pressure medications may need to be adjusted at that time   Right lung nodule - Incidental finding. Right lower lobe nodule measuring 0.8 cm on CTAP. - Consider dedicated nonemergent outpatient CT of the chest for further evaluation   Paroxysmal atrial fibrillation - Continue on metoprolol and Eliquis at the time of discharge  Coronary artery disease - Status post stent placement to LAD in 2015.  EF 60% - On aspirin and zetia, continue on admission
Age: 84.0
Sex: F
Vaccine: COVID19-2
Symptoms: Urine leukocyte esterase positive, Vomiting, White blood cells urine positive
Clinical narrative: Patient is a 84 y.o. female admitted to the hospital on 12/8/2022 for generalized weakness in the setting of UTI and COVID-19.    Discharge Diagnosis and Associated Hospital Course   COVID-19 infection Acute bronchitis - Diagnosed 12/8/2022. Cough, generalized weakness, nausea. Prescribed Molnupiravir as PCP felt Paxlovid would interact with her low dose Eliquis, however patient had not started taking medication - CTAP peribronchial thickening and right middle lobe which could represent bronchitis - She will finish course of oral azithromycin, has 2 days left - ID was consulted 12/10 as Molnupiravir was not on formulary, felt patient would be okay to take Paxlovid instead.  Unfortunately this was not started by pharmacy staff and patient did not receive while in the hospital.  I did discuss this at length with patient on 12/11--risks and benefits. She does not want to begin Paxlovid, which does seem reasonable as her symptoms started about 5 days ago.  Her symptoms are improving with supportive care, she has no significant respiratory symptoms, and she has not required oxygen during her entire hospitalization. She reports she does not plan on taking molnupiravir and has tessalon prescribed by PCP.  She has requested discharge home.   Urinary tract infection - Present on admission. Reporting generalized weakness fatigue nausea vomiting - UA abnormal with large RBCs, elevated WBC, moderate leuk esterase. Urine  - Urine culture was negative. She did complete 3 day course of rocephin.   Generalized weakness - Secondary to active infection - PT/OT consultations--OK to discharge without additional therapy, doing well   Hypokalemia - Mild at 3.4, replaced   Essential hypertension -Poorly controlled here. Continue on losartan and metoprolol at discharge -I would like her to follow-up with her PCP in 1 to 2 weeks after resolution of her acute illness as her blood pressure medications may need to be adjusted at that time   Right lung nodule - Incidental finding. Right lower lobe nodule measuring 0.8 cm on CTAP. - Consider dedicated nonemergent outpatient CT of the chest for further evaluation   Paroxysmal atrial fibrillation - Continue on metoprolol and Eliquis at the time of discharge  Coronary artery disease - Status post stent placement to LAD in 2015.  EF 60% - On aspirin and zetia, continue on admission
Age: 48.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood test normal, Cardiac flutter, Chest discomfort, Condition aggravated, Fall
Clinical narrative: 12/20/22 I was on my rowing machine doing a moderate row and felt significant pressure in my chest. I pushed past that. Then I felt it again, I felt fluttering and fell over. My husband said I was unresponsive and stopped breathing for less than a minute. I came back around over the course of about 15 minutes. I saw my doctor on 12/22/22. I had blood work which was normal. On 12/23/22 I had blood work done. I did not have a heart attack. I had blood work which was normal. My doctor said it was most probably a Prinzmetal event. He wants me to see a cardiologist.
Age: 48.0
Sex: F
Vaccine: COVID19-2
Symptoms: Prinzmetal angina, Respiratory arrest, Unresponsive to stimuli
Clinical narrative: 12/20/22 I was on my rowing machine doing a moderate row and felt significant pressure in my chest. I pushed past that. Then I felt it again, I felt fluttering and fell over. My husband said I was unresponsive and stopped breathing for less than a minute. I came back around over the course of about 15 minutes. I saw my doctor on 12/22/22. I had blood work which was normal. On 12/23/22 I had blood work done. I did not have a heart attack. I had blood work which was normal. My doctor said it was most probably a Prinzmetal event. He wants me to see a cardiologist.
Age: 29.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: The patient was given a dose of the undiluted (Gray cap) Pfizer COVID-19 Bivalent booster that was not stored in an ultra-cold temperature freezer and was instead stored in the regular freezer (between -30 to -20 F). It was moved out of the regular freezer to the refrigerator after more than 3 weeks in the regular freezer. The doses were then used after more than 24 hours in the refrigerator. We have contacted Pfizer about this and according to their studies they provided, they are not able to support the temperature excursions that occurred. As per CDC guidance, the recommendation is to re-vaccinate the individual with the full authorized dose of any Bivalent vaccine (either Pfizer or Moderna) and we have communicated with the patient for re-vaccination.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Diarrhoea, Fatigue, Muscular weakness, Oropharyngeal pain
Clinical narrative: On 12/07/2022, I had a slight sore throat, I thought I was not drinking enough water, so I increased my intake of water. By 12/11/22 I had major head congestion and was starting to feel fatigued, I used a home COVID-19 test that came back positive. I called my doctor and had a telehealth visit. I was prescribed Paxlovid that I started taking on 12/12/22. I started feeling back to my normal self by the end of the end. I did have some loose stools during the week of taking the Paxlovid, and I have weak legs two days. But I am testing negative.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: On 12/07/2022, I had a slight sore throat, I thought I was not drinking enough water, so I increased my intake of water. By 12/11/22 I had major head congestion and was starting to feel fatigued, I used a home COVID-19 test that came back positive. I called my doctor and had a telehealth visit. I was prescribed Paxlovid that I started taking on 12/12/22. I started feeling back to my normal self by the end of the end. I did have some loose stools during the week of taking the Paxlovid, and I have weak legs two days. But I am testing negative.
Age: 9.0
Sex: F
Vaccine: COVID19-2
Symptoms: Dizziness, Loss of consciousness, Vomiting
Clinical narrative: patient became dizzy and passed out for 2 to 3 seconds. came to and still felt dizzy. drank dome water, vomited then felt much better. Mother stated that she has passed out before however marked no on VAR for previous reaction or fainting/dizziness to a vaccine
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Antimicrobial susceptibility test, COVID-19, Chest X-ray normal, Cystitis, Escherichia test
Clinical narrative: Assessment and Plan Patient is a 82 y.o. female patient of DO with history of asthma essential hypertension chronic pain dyslipidemia bilateral lower extremity presented with altered mental status   Acute metabolic Encephalopathy (resolved) Covid-19 Virus Infection Date of onset of symptoms: 12/9/2022 Symptoms present on admission: Altered mental status and fatigue Date of covid positive test: 12/10/2022 Imaging: Chest x-ray negative for pneumonia Oxygen requirements on admission: Room air Current oxygen requirements: None Medical therapy: Paxlovid started 12/12 (age, asthma history) to complete 5 day total course Consultants following: ID econsult Anticipated special isolation end date: 12/19/2022   Acute Cystitis Pyuria, ESBL E coli Dosed with fosfomycin 12/13   Asthma, unspecified On albuterol as needed (at home) Oxygen supplementation as needed Not in acute exacerbation   Essential hypertension Continue home medications (amlodipine, lopressor)   GERD PPI   Dyslipidemia On pravastatin at home, resumed   Chronic pain Continue home narcotics  Peripheral vascular disease DVT (unclear occurrence) On Eliquis aspirin and statin at home Venous duplex 9/2022 negative Changed to lovenox 12/12 when Paxlovid started to avoid/minimize interactions Hold Eliquis until 12/17/22 and continue lovenox until 12/17/22
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Malaise, Mental status changes, Metabolic encephalopathy, Pyuria
Clinical narrative: Assessment and Plan Patient is a 82 y.o. female patient of DO with history of asthma essential hypertension chronic pain dyslipidemia bilateral lower extremity presented with altered mental status   Acute metabolic Encephalopathy (resolved) Covid-19 Virus Infection Date of onset of symptoms: 12/9/2022 Symptoms present on admission: Altered mental status and fatigue Date of covid positive test: 12/10/2022 Imaging: Chest x-ray negative for pneumonia Oxygen requirements on admission: Room air Current oxygen requirements: None Medical therapy: Paxlovid started 12/12 (age, asthma history) to complete 5 day total course Consultants following: ID econsult Anticipated special isolation end date: 12/19/2022   Acute Cystitis Pyuria, ESBL E coli Dosed with fosfomycin 12/13   Asthma, unspecified On albuterol as needed (at home) Oxygen supplementation as needed Not in acute exacerbation   Essential hypertension Continue home medications (amlodipine, lopressor)   GERD PPI   Dyslipidemia On pravastatin at home, resumed   Chronic pain Continue home narcotics  Peripheral vascular disease DVT (unclear occurrence) On Eliquis aspirin and statin at home Venous duplex 9/2022 negative Changed to lovenox 12/12 when Paxlovid started to avoid/minimize interactions Hold Eliquis until 12/17/22 and continue lovenox until 12/17/22
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Ultrasound Doppler normal
Clinical narrative: Assessment and Plan Patient is a 82 y.o. female patient of DO with history of asthma essential hypertension chronic pain dyslipidemia bilateral lower extremity presented with altered mental status   Acute metabolic Encephalopathy (resolved) Covid-19 Virus Infection Date of onset of symptoms: 12/9/2022 Symptoms present on admission: Altered mental status and fatigue Date of covid positive test: 12/10/2022 Imaging: Chest x-ray negative for pneumonia Oxygen requirements on admission: Room air Current oxygen requirements: None Medical therapy: Paxlovid started 12/12 (age, asthma history) to complete 5 day total course Consultants following: ID econsult Anticipated special isolation end date: 12/19/2022   Acute Cystitis Pyuria, ESBL E coli Dosed with fosfomycin 12/13   Asthma, unspecified On albuterol as needed (at home) Oxygen supplementation as needed Not in acute exacerbation   Essential hypertension Continue home medications (amlodipine, lopressor)   GERD PPI   Dyslipidemia On pravastatin at home, resumed   Chronic pain Continue home narcotics  Peripheral vascular disease DVT (unclear occurrence) On Eliquis aspirin and statin at home Venous duplex 9/2022 negative Changed to lovenox 12/12 when Paxlovid started to avoid/minimize interactions Hold Eliquis until 12/17/22 and continue lovenox until 12/17/22
Age: 35.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Inadvertent administration past the 30-day Use by Date of the Moderna vaccine. No Symptoms to report as no adverse event was reported.
Age: 37.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Half dose given
Age: 0.08
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV5
Symptoms: Breast feeding, Choking, Crying, Dyspnoea, Electroencephalogram normal
Clinical narrative: Previously healthy term (39 weeks) with uncomplicated pregnancy and delivery was 4.7kg and 8 wk.old on 12/22/22. Patient was breast fed female being seen for wellchild visit ~1100.  Pneumococcal conjugate vaccine 13-valent IM (PREVNAR 13) lot #FX0079 IM, HiB PRP-OMP conjugate vaccine 3 dose IM (PedvaxHIB) lot # W021181 Merck, DTaP HepB IPV combined vaccine IM (PEDIARIX) lot 9552X GSK, and rotavirus pentavalent (Rotateq) PO (lot # 1912556 Merck) were given ~1113.  During administration of 2ml dose of Rotateq,  CMA noted that patient appeared to choke on initial couple drops of vaccine.  Placement of administration device relative to patient's tongue and cheek was not reported.  After the event, the MD came in to assess infant who was initially breathing abnormally, taking small short breaths and was making gurgling noises. She began taking deeper breaths within ~10-15 seconds and she then had tachypnea for ~60 seconds afterward.  She was assessed and monitored and returned to baseline without tachypnea within 3-5 minutes. Lungs were reexamined and were clear without upper airway sounds. After ~10 minutes of infant being observed at her baseline, the remainder of the rotateq vaccine was given and was tolerated.  After discharge and going home, patient was lethargic.  Later in the day, pt reportedly became unresponsive and had no tone for 3-5 mins, prompting EMS activation.  In ED, care providers observed similar episodes where patient would stop crying suddenly, became pale and eyes stared off to the right without pt loss of muscle tone or any shaking.  Episodes are 5-15 seconds in duration and a precipitated by crying.  One observed episode was over 1 minute and associated with brief desaturations.  Patient was admitted for further evaluation and spell characterization.  EEG normal. Afebrile.   Patient was discharged home 12/23 per family preference with acetaminophen.  Diagnosis was Brief Resolved Unexplained Event.   No identified association with vaccinations and episodes as described.
Age: 0.08
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV5
Symptoms: Eye movement disorder, Increased bronchial secretion, Lethargy, Neonatal hypoxia, Pallor
Clinical narrative: Previously healthy term (39 weeks) with uncomplicated pregnancy and delivery was 4.7kg and 8 wk.old on 12/22/22. Patient was breast fed female being seen for wellchild visit ~1100.  Pneumococcal conjugate vaccine 13-valent IM (PREVNAR 13) lot #FX0079 IM, HiB PRP-OMP conjugate vaccine 3 dose IM (PedvaxHIB) lot # W021181 Merck, DTaP HepB IPV combined vaccine IM (PEDIARIX) lot 9552X GSK, and rotavirus pentavalent (Rotateq) PO (lot # 1912556 Merck) were given ~1113.  During administration of 2ml dose of Rotateq,  CMA noted that patient appeared to choke on initial couple drops of vaccine.  Placement of administration device relative to patient's tongue and cheek was not reported.  After the event, the MD came in to assess infant who was initially breathing abnormally, taking small short breaths and was making gurgling noises. She began taking deeper breaths within ~10-15 seconds and she then had tachypnea for ~60 seconds afterward.  She was assessed and monitored and returned to baseline without tachypnea within 3-5 minutes. Lungs were reexamined and were clear without upper airway sounds. After ~10 minutes of infant being observed at her baseline, the remainder of the rotateq vaccine was given and was tolerated.  After discharge and going home, patient was lethargic.  Later in the day, pt reportedly became unresponsive and had no tone for 3-5 mins, prompting EMS activation.  In ED, care providers observed similar episodes where patient would stop crying suddenly, became pale and eyes stared off to the right without pt loss of muscle tone or any shaking.  Episodes are 5-15 seconds in duration and a precipitated by crying.  One observed episode was over 1 minute and associated with brief desaturations.  Patient was admitted for further evaluation and spell characterization.  EEG normal. Afebrile.   Patient was discharged home 12/23 per family preference with acetaminophen.  Diagnosis was Brief Resolved Unexplained Event.   No identified association with vaccinations and episodes as described.
Age: 0.08
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV5
Symptoms: Respiration abnormal, Tachypnoea, Unresponsive to stimuli
Clinical narrative: Previously healthy term (39 weeks) with uncomplicated pregnancy and delivery was 4.7kg and 8 wk.old on 12/22/22. Patient was breast fed female being seen for wellchild visit ~1100.  Pneumococcal conjugate vaccine 13-valent IM (PREVNAR 13) lot #FX0079 IM, HiB PRP-OMP conjugate vaccine 3 dose IM (PedvaxHIB) lot # W021181 Merck, DTaP HepB IPV combined vaccine IM (PEDIARIX) lot 9552X GSK, and rotavirus pentavalent (Rotateq) PO (lot # 1912556 Merck) were given ~1113.  During administration of 2ml dose of Rotateq,  CMA noted that patient appeared to choke on initial couple drops of vaccine.  Placement of administration device relative to patient's tongue and cheek was not reported.  After the event, the MD came in to assess infant who was initially breathing abnormally, taking small short breaths and was making gurgling noises. She began taking deeper breaths within ~10-15 seconds and she then had tachypnea for ~60 seconds afterward.  She was assessed and monitored and returned to baseline without tachypnea within 3-5 minutes. Lungs were reexamined and were clear without upper airway sounds. After ~10 minutes of infant being observed at her baseline, the remainder of the rotateq vaccine was given and was tolerated.  After discharge and going home, patient was lethargic.  Later in the day, pt reportedly became unresponsive and had no tone for 3-5 mins, prompting EMS activation.  In ED, care providers observed similar episodes where patient would stop crying suddenly, became pale and eyes stared off to the right without pt loss of muscle tone or any shaking.  Episodes are 5-15 seconds in duration and a precipitated by crying.  One observed episode was over 1 minute and associated with brief desaturations.  Patient was admitted for further evaluation and spell characterization.  EEG normal. Afebrile.   Patient was discharged home 12/23 per family preference with acetaminophen.  Diagnosis was Brief Resolved Unexplained Event.   No identified association with vaccinations and episodes as described.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal pain, Asthenia, Computerised tomogram thorax abnormal, Confusional state, Cough
Clinical narrative: Pt presented with a cough on 10/13 and was admitted to a local Medical Center on 12/3/22 due to abd pain lasting  2 weeks, pt was dx with a PE, UTI and sepsis.  Pt was previously living on the dementia care unit and was ambulatory, she is now on enhanced level care at the HCF, very debilitated and weak. Transfer requires 2 at times and sometimes, lift. She is w/c bound essentially w/ ulcers. Very confused.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Echocardiogram abnormal, Pulmonary embolism, Right ventricular dysfunction, Sepsis, Ulcer
Clinical narrative: Pt presented with a cough on 10/13 and was admitted to a local Medical Center on 12/3/22 due to abd pain lasting  2 weeks, pt was dx with a PE, UTI and sepsis.  Pt was previously living on the dementia care unit and was ambulatory, she is now on enhanced level care at the HCF, very debilitated and weak. Transfer requires 2 at times and sometimes, lift. She is w/c bound essentially w/ ulcers. Very confused.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Urinary tract infection, Wheelchair user
Clinical narrative: Pt presented with a cough on 10/13 and was admitted to a local Medical Center on 12/3/22 due to abd pain lasting  2 weeks, pt was dx with a PE, UTI and sepsis.  Pt was previously living on the dementia care unit and was ambulatory, she is now on enhanced level care at the HCF, very debilitated and weak. Transfer requires 2 at times and sometimes, lift. She is w/c bound essentially w/ ulcers. Very confused.
Age: 8.0
Sex: M
Vaccine: COVID19-2
Symptoms: No adverse event
Clinical narrative: No adverse event reported
Age: 56.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Half dose given
Age: 61.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood potassium increased, Blood test, Brain scan normal, Headache, Magnetic resonance imaging
Clinical narrative: I think I just began to notice a very slight headache in the left temple area around the end of September 2022. It wasn't debilitating or keeping me from working, but it was constant. I had a physical with my doctor on 11/29/2022 where I mentioned the headaches to her. She listened to my neck and did some tests and sent me for a brain scan. Everything came back fine though. I still have the headache as well as some tingling in from the nose down on my face and on the back of my head. I did recently receive some ARESTIN gum injections though as well.
Age: 61.0
Sex: F
Vaccine: COVID19-2
Symptoms: Paraesthesia, Urine analysis normal
Clinical narrative: I think I just began to notice a very slight headache in the left temple area around the end of September 2022. It wasn't debilitating or keeping me from working, but it was constant. I had a physical with my doctor on 11/29/2022 where I mentioned the headaches to her. She listened to my neck and did some tests and sent me for a brain scan. Everything came back fine though. I still have the headache as well as some tingling in from the nose down on my face and on the back of my head. I did recently receive some ARESTIN gum injections though as well.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Abdominal pain upper, Acute kidney injury, Azotaemia, Biliary dilatation
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatinine increased, Blood culture negative, Blood glucose increased, COVID-19, Catheter placement
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Cholecystectomy, Cholecystitis acute, Cholelithiasis, Condition aggravated
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Delirium, Diabetes mellitus inadequate control, Diabetic nephropathy, Diabetic neuropathy, Encephalopathy
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Eye pain, Glycosylated haemoglobin increased, Haemodialysis, Helicobacter infection, Hyperglycaemia
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Hypertensive nephropathy, Hypophagia, Hypoxia, Lung infiltration, Mental status changes
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Nausea, Pleural effusion, Pneumonia, Post procedural hypotension, Procedural hypotension
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Productive cough, Pulmonary oedema, Pyrexia, Renal impairment, Renal tubular necrosis
Clinical narrative: Clinical Summary Patient is a 57 y.o. female with a history of HTN, DM2, CKDIV who was admitted to hospital from 11/8/22 to 11/13/22 for abdominal pain was diagnosed with H.pylori infection. Re-presented to hospital 11/14/2022 with increased upper abdominal pain and N/V. She was found to have acute cholecystitis, admitted to surgery. Consulted for pre-op evaluation and medical management. Underwent cholecystectomy 11/15/22. Course complicated by acute encephalopathy, likely secondary to delirium and uremia which resolved. Renal function worsened, so dialysis was initiated 11/22/22 with improvement in encephalopathy.  Patent then contracted COVID with hypoxia and required steroids and O2 then completed therapy and discharged to home.    1. COVID-19 infection: Unvaccinated.  Tested positive on 11/24/2022.  Minimal cough, with no phlegm.  Chest x-ray 11/26/2022 with patchy infiltrates at the periphery of the mid and lower lungs. Multifocal pneumonia versus developing pulmonary edema. Small bibasal pleural effusions.  Slightly hypoxic and given 5 days decadron with significant improvement. Stopped steroids early due to significant hyperglycemia with improvement in symptoms. Isolation complete on 12/5/22.   2. Uncontrolled DM2 with neuropathy and nephropathy: A1c 8.1, could use better control outpatient. With significant hyperglycemia >500 with decadron. 12/2/22 is last dose of steroids. Hyperglycemia resolved with stopping steroids.  3. Tooth pain: panorex 12/2/22 pending. Previously evaluted outpatient. Lasting last 6 months. Panorex negative for abscess. Will need outpatient follow up with dentistry 4. AKI on CKD stage IV: Likely ATN after decreased PO intake and vomiting and intra-op/post-op hypotension. Cr baseline 2.5 likely due to diabetic and hypertensive nephropathy. Cr 3.3 on admission, peaked around 6.5. IR HD cath placed 11/21/22, HD initiated 11/22/22, continued per nephrology.  Patient does have an outpatient dialysis chair arranged beginning 12/5/22.  5. Hospital acquired pneumonia: Patient febrile and hypoxic with new productive cough on 11/22/22. CXR with questionable LLL infiltrate. Unable to rule out aspiration given fluctuating mental status.  Blood culture no growth.  Urine antigens negative.  On Levaquin, ended 11/27/2022. 6. Cholelithiasis with acute cholecystitis: presented with RUQ abdominal pain and N/V. Admit US revealed distended GB with sludge/stones, CBD 4mm. S/p cholecystectomy 11/15/22. S/p IV abx. Follow up with surgery in 2-3 weeks. 7. Glaucoma: Patient reported pain and worsening of blurred vision 11/17/22. Ophthalmology evaluated, resumed glaucoma medications, follow up outpatient. 8. H. Pylori infection: Diagnosed 11/1/22. Triple therapy started 11/13/22, continued on admission, ended 11/27/22 9. Uncontrolled HTN: Continued Norvasc and BB. Monitor. Stable.