chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Osteoarthritis, Osteopenia, SARS-CoV-2 test positive, Spinal X-ray abnormal, Spondylolisthesis
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/19/2022 Discharge Date: 12/30/2022 COVID positive date: 12/19/2022  HOSPITAL COURSE: Patient is a 75-year-old female with a past medical history of a CVA with residual left-sided weakness, hypertension, hyperlipidemia who presented with weakness and falls.  Patient's family stated that she had been falling quite frequently and that her knees would give out.  She did have chronic left-sided weakness which was greater in the upper extremity and prior to this admission was able to ambulate.   In the Emergency Department, she was found to be positive for COVID-19.  She was afebrile and not hypoxic.  Labs were within normal limits. She had pelvic x-ray done 12/18 which showed degenerative changes without any acute pathology.  Lumbar spine x-ray done 12/19 that showed osteopenia, grade 1 anterolisthesis of L4, no compression fracture.  X-ray of the left tib-fib and left foot did not reveal any acute fracture.   CT cervical spine did not reveal any acute fracture or dislocation.  CT thoracic spine also did not reveal any acute pathology. Neurology was consulted and their recommendation was for MRI of the cervical, lumbar spine and brain.  MRI lumbar spine and cervical spine showed degenerative changes without any acute significant findings.  MRI of the brain was completed and did not reveal any acute intracranial abnormality and showed findings of chronic small-vessel ischemic disease, generalized pain atrophy, encephalomalacia and multiple foci of old appearing lacunar infarcts. Neurology did not recommend any further workup and signed off.  She was continued on Plavix and statin for her prior CVA.   Patient was not hypoxic and therefore was not placed on any treatments for COVID-19.  Her blood pressures were found to be elevated and she her doses of Cozaar and Coreg were increased to 12.5 mg and 50 mg, respectively.  She was seen by PT and OT and recommendation was for acute inpatient rehabilitation. However PM&R evaluated patient and felt she was a candidate for subacute rehab and not acute rehab.   She was ultimately discharged for rehab on 12/30/2022.  She should follow-up with her PCP in 1 week.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: X-ray limb normal, X-ray of pelvis and hip abnormal
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/19/2022 Discharge Date: 12/30/2022 COVID positive date: 12/19/2022  HOSPITAL COURSE: Patient is a 75-year-old female with a past medical history of a CVA with residual left-sided weakness, hypertension, hyperlipidemia who presented with weakness and falls.  Patient's family stated that she had been falling quite frequently and that her knees would give out.  She did have chronic left-sided weakness which was greater in the upper extremity and prior to this admission was able to ambulate.   In the Emergency Department, she was found to be positive for COVID-19.  She was afebrile and not hypoxic.  Labs were within normal limits. She had pelvic x-ray done 12/18 which showed degenerative changes without any acute pathology.  Lumbar spine x-ray done 12/19 that showed osteopenia, grade 1 anterolisthesis of L4, no compression fracture.  X-ray of the left tib-fib and left foot did not reveal any acute fracture.   CT cervical spine did not reveal any acute fracture or dislocation.  CT thoracic spine also did not reveal any acute pathology. Neurology was consulted and their recommendation was for MRI of the cervical, lumbar spine and brain.  MRI lumbar spine and cervical spine showed degenerative changes without any acute significant findings.  MRI of the brain was completed and did not reveal any acute intracranial abnormality and showed findings of chronic small-vessel ischemic disease, generalized pain atrophy, encephalomalacia and multiple foci of old appearing lacunar infarcts. Neurology did not recommend any further workup and signed off.  She was continued on Plavix and statin for her prior CVA.   Patient was not hypoxic and therefore was not placed on any treatments for COVID-19.  Her blood pressures were found to be elevated and she her doses of Cozaar and Coreg were increased to 12.5 mg and 50 mg, respectively.  She was seen by PT and OT and recommendation was for acute inpatient rehabilitation. However PM&R evaluated patient and felt she was a candidate for subacute rehab and not acute rehab.   She was ultimately discharged for rehab on 12/30/2022.  She should follow-up with her PCP in 1 week.
Age: 65.0
Sex: M
Vaccine: COVID19-2, COVID19-2
Symptoms: Abdominal pain, Colectomy, Large intestine perforation, Pain
Clinical narrative: You had abdominal cramps which elevated to pain to ER- emergency surgery on your colon,perforated colon- removed part of colon
Age: 65.0
Sex: M
Vaccine: COVID19-2, COVID19-2
Symptoms: Abdominal pain, Colectomy, Computerised tomogram abdomen abnormal, Large intestine perforation
Clinical narrative: You had abdominal cramps which elevated to pain to ER- emergency surgery on your colon,perforated colon- removed part of colon
Age: 65.0
Sex: M
Vaccine: COVID19-2, COVID19-2
Symptoms: Abdominal pain, Colectomy, Large intestine perforation, Pain
Clinical narrative: I experienced abdominal pain late in the evening after receiving the injection.  The next day, around 1 PM, I went to the emergency room of the Hospital.  I was diagnosed with a perforated colon and received emergency colectomy surgery.
Age: 65.0
Sex: M
Vaccine: COVID19-2, COVID19-2
Symptoms: Abdominal pain, Colectomy, Computerised tomogram abdomen abnormal, Large intestine perforation
Clinical narrative: I experienced abdominal pain late in the evening after receiving the injection.  The next day, around 1 PM, I went to the emergency room of the Hospital.  I was diagnosed with a perforated colon and received emergency colectomy surgery.
Age: 64.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Cough, Fatigue, Pain, Respiratory tract congestion
Clinical narrative: I experienced vertigo on 10/27/2022. I went to my doctor and was given a prescription to help me with my symptoms. I tested positive for COVID -19 on 12/12/2022. I had severe head congestion, cough, body aches and fatigue. I contacted my doctor and was given the prescription PAXLOVID. I tested negative for COVID-19 on 12/19/2022. I rebound and tested positive for COVID-19 again on 12/21/2022.
Age: 64.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Vertigo
Clinical narrative: I experienced vertigo on 10/27/2022. I went to my doctor and was given a prescription to help me with my symptoms. I tested positive for COVID -19 on 12/12/2022. I had severe head congestion, cough, body aches and fatigue. I contacted my doctor and was given the prescription PAXLOVID. I tested negative for COVID-19 on 12/19/2022. I rebound and tested positive for COVID-19 again on 12/21/2022.
Age: 28.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID vaccine breakthrough case
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood culture negative, Blood thyroid stimulating hormone normal, COVID-19, Chest X-ray normal
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 12/18/2022 Discharge Date: Dec 31, 2022 COVID positive date: 12/18/2022 PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Pt. is an 84 year old male, past medical history of prior CVA with residual left sided weakness, expressive aphasia attributed to CVA and possible chronic progressive aphasia, dementia and BPH who presented to the ED for evaluation of multiple falls in the recent weeks and generalized weakness. He was admitted due to need for rehab placement. CT head/CT cervical through lumbar spine/bilateral tib-fib x-ray were grossly unremarkable. He was found to be COVID-19 positive and mildly symptomatic with low grade fever and cough. Chest xray was unremarkable and he was treated supportively. Other work-up for etiology of fall was unremarkable including basic labs, blood cultures, urine culture, orthostatic vitals and recent TSH. He had unwitnessed  while inpatient but CT head was negative and sustained no injuries. His mental status fluctuated but overall remained at baseline per family. DPOA was activated this admission via two physician signature.   PT/OT consulted and recommended SAR. Patient remained in hospital to complete COVID isolation which ended on 12/29. Discharged to SAR in stable condition on 12/31   Patient did have 3mm pulmonary nodule noted on routine imaging. Advised follow up with PCP for outpatient CT scan in 12 months for further eval
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Computerised tomogram head normal, Computerised tomogram spine, Cough, Culture urine negative, Fall
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 12/18/2022 Discharge Date: Dec 31, 2022 COVID positive date: 12/18/2022 PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Pt. is an 84 year old male, past medical history of prior CVA with residual left sided weakness, expressive aphasia attributed to CVA and possible chronic progressive aphasia, dementia and BPH who presented to the ED for evaluation of multiple falls in the recent weeks and generalized weakness. He was admitted due to need for rehab placement. CT head/CT cervical through lumbar spine/bilateral tib-fib x-ray were grossly unremarkable. He was found to be COVID-19 positive and mildly symptomatic with low grade fever and cough. Chest xray was unremarkable and he was treated supportively. Other work-up for etiology of fall was unremarkable including basic labs, blood cultures, urine culture, orthostatic vitals and recent TSH. He had unwitnessed  while inpatient but CT head was negative and sustained no injuries. His mental status fluctuated but overall remained at baseline per family. DPOA was activated this admission via two physician signature.   PT/OT consulted and recommended SAR. Patient remained in hospital to complete COVID isolation which ended on 12/29. Discharged to SAR in stable condition on 12/31   Patient did have 3mm pulmonary nodule noted on routine imaging. Advised follow up with PCP for outpatient CT scan in 12 months for further eval
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Imaging procedure abnormal, Laboratory test normal, Malaise, Mental status changes, Pulmonary mass
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 12/18/2022 Discharge Date: Dec 31, 2022 COVID positive date: 12/18/2022 PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Pt. is an 84 year old male, past medical history of prior CVA with residual left sided weakness, expressive aphasia attributed to CVA and possible chronic progressive aphasia, dementia and BPH who presented to the ED for evaluation of multiple falls in the recent weeks and generalized weakness. He was admitted due to need for rehab placement. CT head/CT cervical through lumbar spine/bilateral tib-fib x-ray were grossly unremarkable. He was found to be COVID-19 positive and mildly symptomatic with low grade fever and cough. Chest xray was unremarkable and he was treated supportively. Other work-up for etiology of fall was unremarkable including basic labs, blood cultures, urine culture, orthostatic vitals and recent TSH. He had unwitnessed  while inpatient but CT head was negative and sustained no injuries. His mental status fluctuated but overall remained at baseline per family. DPOA was activated this admission via two physician signature.   PT/OT consulted and recommended SAR. Patient remained in hospital to complete COVID isolation which ended on 12/29. Discharged to SAR in stable condition on 12/31   Patient did have 3mm pulmonary nodule noted on routine imaging. Advised follow up with PCP for outpatient CT scan in 12 months for further eval
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pyrexia, SARS-CoV-2 test positive, X-ray limb normal
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 12/18/2022 Discharge Date: Dec 31, 2022 COVID positive date: 12/18/2022 PRESENTING PROBLEM: Weakness [R53.1]   HOSPITAL COURSE: Pt. is an 84 year old male, past medical history of prior CVA with residual left sided weakness, expressive aphasia attributed to CVA and possible chronic progressive aphasia, dementia and BPH who presented to the ED for evaluation of multiple falls in the recent weeks and generalized weakness. He was admitted due to need for rehab placement. CT head/CT cervical through lumbar spine/bilateral tib-fib x-ray were grossly unremarkable. He was found to be COVID-19 positive and mildly symptomatic with low grade fever and cough. Chest xray was unremarkable and he was treated supportively. Other work-up for etiology of fall was unremarkable including basic labs, blood cultures, urine culture, orthostatic vitals and recent TSH. He had unwitnessed  while inpatient but CT head was negative and sustained no injuries. His mental status fluctuated but overall remained at baseline per family. DPOA was activated this admission via two physician signature.   PT/OT consulted and recommended SAR. Patient remained in hospital to complete COVID isolation which ended on 12/29. Discharged to SAR in stable condition on 12/31   Patient did have 3mm pulmonary nodule noted on routine imaging. Advised follow up with PCP for outpatient CT scan in 12 months for further eval
Age: 69.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Fatigue, Nasopharyngitis
Clinical narrative: As I recall, I did not have symptoms when I tested positive. I was feeling fine. My wife had tested positive so I tested on Wednesday 12/23. She had plenty of symptoms when she tested positive, like a bad cold. When I tested positive I still felt fine but I moved to the other bedroom. It seemed like a bad cold, I had a high fever at one time, congestion, tiredness. The cough came later and I'm still dealing with that. on Friday we called the doctor and she prescribed Paxlovid. I took that for 5 days. Its hard to know whether that made any difference or not, I've never had COVID-19 before. After the Paxlovid ended this cough kicked in that would not go away. The doctor prescribed a cough medicine that has helped a lot, but I still have it, just not as severe.
Age: 69.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: As I recall, I did not have symptoms when I tested positive. I was feeling fine. My wife had tested positive so I tested on Wednesday 12/23. She had plenty of symptoms when she tested positive, like a bad cold. When I tested positive I still felt fine but I moved to the other bedroom. It seemed like a bad cold, I had a high fever at one time, congestion, tiredness. The cough came later and I'm still dealing with that. on Friday we called the doctor and she prescribed Paxlovid. I took that for 5 days. Its hard to know whether that made any difference or not, I've never had COVID-19 before. After the Paxlovid ended this cough kicked in that would not go away. The doctor prescribed a cough medicine that has helped a lot, but I still have it, just not as severe.
Age: 84.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute myocardial infarction, Ankle fracture, COVID-19 pneumonia
Clinical narrative: Pt was transferred from the ER with a history of diabetes mellitus post frequent falls. She had a left trimalleolar fracture, NSTEMI, and COVID pneumonia.
Age: 58.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID vaccine breakthrough case. Moderna 5/4/21 025B21A, 6/1/21 025B21A and boosted 12/22/21 030H21B
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID vaccine breakthrough case. Moderna 4/19/21 043B21A, 5/17/21 041C21A and boosted 11/16/21 067F21A.
Age: 32.0
Sex: M
Vaccine: COVID19-2
Symptoms: Incorrect product formulation administered
Clinical narrative: Bivalent vaccine given as second dose. 1st dose 12/6/2022, 2nd dose (Bivalent) 12/30/2022
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cough, Lymphadenopathy, Oropharyngeal pain, Respiratory tract congestion
Clinical narrative: I tested positive for COVID-19 on 11/11/22. I had a sore throat, swollen glands, congestion, cough, and runny nose. The cough lingered until sometime in December. I used over-the counter medication, Advil and Chloraseptic. I went to the doctor later because I couldn't stop coughing and was prescribed high dose Naproxen Sodium and Benzonatate. I am feeling much better now.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: I tested positive for COVID-19 on 11/11/22. I had a sore throat, swollen glands, congestion, cough, and runny nose. The cough lingered until sometime in December. I used over-the counter medication, Advil and Chloraseptic. I went to the doctor later because I couldn't stop coughing and was prescribed high dose Naproxen Sodium and Benzonatate. I am feeling much better now.
Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram cerebral abnormal, Blood test, Computerised tomogram head abnormal, Lumbar puncture, Magnetic resonance imaging head abnormal
Clinical narrative: Dermatographia developed about 1 week after booster shot across entire body. Treated with Zyrtec for 8 months. Around 4/1/2022 Optic Neuritis symptoms developed in left eye and then progressed to right eye 8/12/2022.  Multiple MRIs, an MRA, CT scan, a lumbar puncture, and many blood tests have not been able to identify another cause for the optic neuritis. Two rounds of high-dose IV steroids have also been unsuccessful at treating/improving the Optic Neuritis.
Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: Mechanical urticaria, Optic neuritis
Clinical narrative: Dermatographia developed about 1 week after booster shot across entire body. Treated with Zyrtec for 8 months. Around 4/1/2022 Optic Neuritis symptoms developed in left eye and then progressed to right eye 8/12/2022.  Multiple MRIs, an MRA, CT scan, a lumbar puncture, and many blood tests have not been able to identify another cause for the optic neuritis. Two rounds of high-dose IV steroids have also been unsuccessful at treating/improving the Optic Neuritis.
Age: 56.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Chills, Fatigue, Headache, Oropharyngeal discomfort
Clinical narrative: Began sniffles on 12/19 and mild fatigue. My daughter tested positive on 12/21 due to the holidays coming. Went to the pharmacy on 12/22 for a PCR test. PCR test returned positive for COVID-19 on 12/27. 12/21 at home test was negative and mild symptoms. 12/23 symptoms worsened. 12/24 developed fever of 99.4 and chills. Fatigue was the worst symptom. Began having razor blade feeling in my throat. Began taking benzocaine cough suppressant and was counting down until the time for the next dose. Also developed mouth sores. 12/25 tested positive on at home test and this was the worst day of symptoms with a fever of 101.9 on ibuprofen. Symptoms began slowly improving. 12/28 one fever and taking less ibuprofen. 12/29 one fever and major headache. 12/30-01/02 Symptoms still improving and the mouth sores were the worst. 01/03 Symptoms mostly resolved except for fatigue. I am a physician and I found the CDC website quite confusing and contradicting. Guidelines could be much clearer for the average person.
Age: 56.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Stomatitis
Clinical narrative: Began sniffles on 12/19 and mild fatigue. My daughter tested positive on 12/21 due to the holidays coming. Went to the pharmacy on 12/22 for a PCR test. PCR test returned positive for COVID-19 on 12/27. 12/21 at home test was negative and mild symptoms. 12/23 symptoms worsened. 12/24 developed fever of 99.4 and chills. Fatigue was the worst symptom. Began having razor blade feeling in my throat. Began taking benzocaine cough suppressant and was counting down until the time for the next dose. Also developed mouth sores. 12/25 tested positive on at home test and this was the worst day of symptoms with a fever of 101.9 on ibuprofen. Symptoms began slowly improving. 12/28 one fever and taking less ibuprofen. 12/29 one fever and major headache. 12/30-01/02 Symptoms still improving and the mouth sores were the worst. 01/03 Symptoms mostly resolved except for fatigue. I am a physician and I found the CDC website quite confusing and contradicting. Guidelines could be much clearer for the average person.
Age: 73.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Dyspnoea, Pneumonia, Respiratory symptom
Clinical narrative: Pt has had increased difficulty breathing for 3 days and is on home oxygen. She has COPD and has been giving herself 4 nebulizer treatments per day without improvement. She has had upper respiratory symptoms. She is found to have COVID-19 and pneumonia.
Age: 76.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: COVID-19, Chest discomfort, Cough, Dizziness, Dysphonia
Clinical narrative: Starting 12/29/2022, I woke up with a tight chest, raspy voice, deeper cough, sneezing fits and mild headache. My daughter tested herself that day and was positive. However, I tested negative. That evening, I started having a fever of 100.4. The next morning, I took a COVID-19 test (12/30/2022) and it was positive. At that point, I felt like I had the flu and my eyes had become sensitive to light. I went to urgent care per recommendation of the nurses line from my health plan. On 12/31/2022, I drove to the urgent care, where they tested me for flu, step and COVID-19. I tested positive for COVID-19 and was prescribed PAXLOVID. I started the medication that day. I still feel terrible to this day but I am not coughing as much. I still ache and my eyes are still sensitive to light. My headache is more intermittent and I feel more "dried" up. However, I'm still not feeling 100%. The medicine is causing some diarrhea and leaves a very poor taste in my mouth. Lately, I have been getting dizzy when I roll over in bed which is not normal. This is the most sick I have been in years.
Age: 76.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Feeling abnormal, Headache, Influenza like illness, Influenza virus test, Pain
Clinical narrative: Starting 12/29/2022, I woke up with a tight chest, raspy voice, deeper cough, sneezing fits and mild headache. My daughter tested herself that day and was positive. However, I tested negative. That evening, I started having a fever of 100.4. The next morning, I took a COVID-19 test (12/30/2022) and it was positive. At that point, I felt like I had the flu and my eyes had become sensitive to light. I went to urgent care per recommendation of the nurses line from my health plan. On 12/31/2022, I drove to the urgent care, where they tested me for flu, step and COVID-19. I tested positive for COVID-19 and was prescribed PAXLOVID. I started the medication that day. I still feel terrible to this day but I am not coughing as much. I still ache and my eyes are still sensitive to light. My headache is more intermittent and I feel more "dried" up. However, I'm still not feeling 100%. The medicine is causing some diarrhea and leaves a very poor taste in my mouth. Lately, I have been getting dizzy when I roll over in bed which is not normal. This is the most sick I have been in years.
Age: 76.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Photophobia, Pyrexia, SARS-CoV-2 test positive, Sneezing, Streptococcus test
Clinical narrative: Starting 12/29/2022, I woke up with a tight chest, raspy voice, deeper cough, sneezing fits and mild headache. My daughter tested herself that day and was positive. However, I tested negative. That evening, I started having a fever of 100.4. The next morning, I took a COVID-19 test (12/30/2022) and it was positive. At that point, I felt like I had the flu and my eyes had become sensitive to light. I went to urgent care per recommendation of the nurses line from my health plan. On 12/31/2022, I drove to the urgent care, where they tested me for flu, step and COVID-19. I tested positive for COVID-19 and was prescribed PAXLOVID. I started the medication that day. I still feel terrible to this day but I am not coughing as much. I still ache and my eyes are still sensitive to light. My headache is more intermittent and I feel more "dried" up. However, I'm still not feeling 100%. The medicine is causing some diarrhea and leaves a very poor taste in my mouth. Lately, I have been getting dizzy when I roll over in bed which is not normal. This is the most sick I have been in years.
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Dyspnoea, Pneumonia, SARS-CoV-2 test positive
Clinical narrative: Pt has a PMH of COPD and is on 5 to 6 L of oxygen. She presented to the ED with worsening shortness of breath. She was found to be COVID positive and had pneumonia.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acidosis, Acute kidney injury, Agitation, Anaemia, Angiogram abnormal
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood creatinine, Blood glucose, Blood lactic acid increased, Blood pH decreased, Blood urea increased
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Catheter removal, Chest X-ray abnormal, Colitis, Colonoscopy
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Computerised tomogram abdomen, Computerised tomogram head normal, Computerised tomogram spine, Diarrhoea, Endotracheal intubation
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Extubation, Glycosylated haemoglobin normal, Haemodialysis, Haemofiltration, Haemoglobin decreased
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Hypophagia, Hypotension, Hypothermia, Influenza, Influenza A virus test positive
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Intensive care, Laboratory test abnormal, Leukocytosis, Lung infiltration, Mental status changes
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: NP  Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.  She reportedly had poor oral intake and diarrhea in the preceding days. In ED she was hypothermic and hypotensive with altered mental status. She became increasingly agitated, ultimately requiring intubation. Laboratory studies were significant for profound acidosis (PH 6.7), lactic acid (25), acute renal failure (BUN 56/creat 10.45), leukocytosis (34,000), and she was influenza A positive. CXR showed possible RLL infiltrate. CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable. CT head and c-spine without acute process/fracture. She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu. She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip. Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.  She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.  She was also started on Tamiflu.  She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.  Vascular catheter was placed and continuous renal replacement therapy was started 12/17.  Her acidosis cleared and vasopressors were slowly weaned down. She was able to be weaned off sedation by 12/21, and was extubated on 12/23. Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.   She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.  Vascular catheter was removed on 12/28.   Patient transferred to the hospitalist service 12/25/2022.  She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.  She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.5 g/dL thereafter.  Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.0%.   She was felt stable for discharge home on 12/31/22.  She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.  I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.  She will continue simvastatin and Ozempic.  She should follow-up her PCP in 1 week.  She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.