chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Electrocardiogram, Mass, SARS-CoV-2 test positive, Troponin
Clinical narrative: Narrative:  86-year-old male with a history of chronic systolic heart failure and chronic kidney disease stage III presented to emergency department with 2 weeks of worsening shortness of breath and anorexia. On evaluation he was found to have an elevated BNP, slight elevation in troponin to 0.07 without change in EKG from baseline, and a chest x-ray that was clear except for a spiculated mass that is being followed with CT on an outpatient basis. With these findings the patient was given a loading dose of aspirin and started on IV Lasix; cardiology was consulted. The patient was then found to be Covid positive and was admitted to a contact precaution room. The patient required no supplemental O2 and was saturating well on room air. It is speculated that the patient's milder than expected course of COVID-19 is secondary to being fully vaccinated. On hospital day 2, the patient was doing well without any acute events and no new or worsening symptoms. H
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough
Clinical narrative: Narrative:  73 year old male with a past medical history of nonischemic HFrEF, Hx of atrial fibrillation on apixaban, HLD, HTN, GERD, Hiatal Hernia, Type II Diabetes, and Pernicious anemia presented to the ED with three days of lightheadedness, weakness, and cough. Patient received both doses of Pfizer vaccine. Patient tested positive for COVID and was admitted for COVID Pneumonia. Chest X ray showed no infiltrate with lungs mildly hypoinflated. Patient did not require any supplimental oxygen. He was given PRN albuterol, loratidine, and prn guifenesin. This morning, patient denied any weakness or lightheadedness and states his cough has improved. Patient is stable and ready for discharge. Patient was told to isolate for 7-14 days and to return to the ED if he experiences increasing shortness of breath, worsening cough, weakness or lightheadedness.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Dizziness, Lung hypoinflation, SARS-CoV-2 test positive
Clinical narrative: Narrative:  73 year old male with a past medical history of nonischemic HFrEF, Hx of atrial fibrillation on apixaban, HLD, HTN, GERD, Hiatal Hernia, Type II Diabetes, and Pernicious anemia presented to the ED with three days of lightheadedness, weakness, and cough. Patient received both doses of Pfizer vaccine. Patient tested positive for COVID and was admitted for COVID Pneumonia. Chest X ray showed no infiltrate with lungs mildly hypoinflated. Patient did not require any supplimental oxygen. He was given PRN albuterol, loratidine, and prn guifenesin. This morning, patient denied any weakness or lightheadedness and states his cough has improved. Patient is stable and ready for discharge. Patient was told to isolate for 7-14 days and to return to the ED if he experiences increasing shortness of breath, worsening cough, weakness or lightheadedness.
Age: 46.0
Sex: M
Vaccine: COVID19
Symptoms: Angiogram pulmonary abnormal, Deep vein thrombosis, Pain in extremity, Pulmonary embolism
Clinical narrative: Narrative: 45 year old male with PMH of bilateral ankle surgeries for deep venous insufficiency, right arm superficial thrombophlebitis, MDD, GERD, and concussions presented to the ED for bilateral lower extremity pain. Patient received both doses of Pfizer. Findings were positive for bilateral DVTs in right calf and left groin. Patient was transfered back to Facility where he was started on therapeutic lovenox, IVF, and got a CTA. CTA was positive for multiple, small right sided PEs in segmental branches. Pt was observed in the hospital for one day.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Epistaxis, Lactic acidosis, Respiratory failure
Clinical narrative: Narrative: 77-year-old male with past medical history of hypertension, hyperlipidemia, coronary disease status post coronary artery bypass graft x3, non-insulin dependent type II diabetes mellitus, squamous cell carcinoma of the lung status post chemoradiation, and recently COVID-19. Patient was admitted from 8/16-8/29 at a local hospital for COVID-19 and discharged on 2L at rest and 4L with activity. He was admitted at the Facility on 09/08/2021 for severe sepsis and acute on chronic hypoxic respiratory failure secondary to COVID-19 pneumonia. Patient's lactic acidosis responded appropriately to IV fluids. He was treated empirically treated for hospital acquired pneumonia with cefepime, later transitioned to oral levofloxacin. Patient's oxygen requirements waxed and waned throughout admission, at one point he required 10L via high flow nasal cannula. Patient was started on 40mg prednisone, which helped his respiratory status and oxygen requirements. Patient with history of poorly controlled diabetes and blood sugars were further uncontrolled when starting steroids. Sliding scale was initiated, as well as 10U NPH when the patient took his prednisone. Of note, patient experienced epistaxis due to the nasal cannula, which improved and was resolved using nasal spray and mupirocin ointment. He was on 2.5L  via nasal cannula at discharge. 6 minute walk test revealed patient requires 2L with rest and 6L with activity. He was discharged home with prednisone taper and insulin. Diabetes education provided to patient and family. Follow-up with PCP regarding insulin requirements going forward. He was discharged home in fair condition.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Sepsis
Clinical narrative: Narrative: 77-year-old male with past medical history of hypertension, hyperlipidemia, coronary disease status post coronary artery bypass graft x3, non-insulin dependent type II diabetes mellitus, squamous cell carcinoma of the lung status post chemoradiation, and recently COVID-19. Patient was admitted from 8/16-8/29 at a local hospital for COVID-19 and discharged on 2L at rest and 4L with activity. He was admitted at the Facility on 09/08/2021 for severe sepsis and acute on chronic hypoxic respiratory failure secondary to COVID-19 pneumonia. Patient's lactic acidosis responded appropriately to IV fluids. He was treated empirically treated for hospital acquired pneumonia with cefepime, later transitioned to oral levofloxacin. Patient's oxygen requirements waxed and waned throughout admission, at one point he required 10L via high flow nasal cannula. Patient was started on 40mg prednisone, which helped his respiratory status and oxygen requirements. Patient with history of poorly controlled diabetes and blood sugars were further uncontrolled when starting steroids. Sliding scale was initiated, as well as 10U NPH when the patient took his prednisone. Of note, patient experienced epistaxis due to the nasal cannula, which improved and was resolved using nasal spray and mupirocin ointment. He was on 2.5L  via nasal cannula at discharge. 6 minute walk test revealed patient requires 2L with rest and 6L with activity. He was discharged home with prednisone taper and insulin. Diabetes education provided to patient and family. Follow-up with PCP regarding insulin requirements going forward. He was discharged home in fair condition.
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Dehydration, Diarrhoea, Dyspnoea, Refusal of treatment by patient
Clinical narrative: Narrative:  65 year old male with a past medical history of HTN, COPD on room air, hx of PE on Xarelto, hx of subarachnoid hemorrhage, hypothyrodism, T2DM insulin depedent, HLD presented to the ED from his independent living facility due to worsening shortness of breath. Pt received both Pfizer vaccines in the community. The patient was admitted to the COVID unit on 4/23/21 on room air. Dex, remdesivir, and convalescent plasma was not started on admission or in the ED. 1L NS was given to the patient in the ED due to dehydration from diarrhea. The patient was observed overnight and did not require any oxygen supplementations except at night when he refused to use CPAP machine for OSA and was on room air otherwise. His diarrhea decreased, he was able to tolerate PO intake without concern. The patient was discharged to his independent living facility with isolation precautions for 10 days post discharge.
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Alanine aminotransferase increased, Aspartate aminotransferase increased, COVID-19
Clinical narrative: Narrative:  75yr old male direct admit from OSH due to acute hypoxic respiratory failure in setting of Covid pneumonia and ARDS. In the ED was saturating 76% on RA, RR 30s. 15L via non-breather was administered with improvement to 90% SpO2 but still appeared significantly dyspneic. Bipap 12/6 was tried with significant improvement (SpO2 90s, RR 20-22). Was transferred to ICU on Bipap on 9/10/2021 was placed on mechanical ventilation 4 days later (9/14) due to ongoing respiratory deterioration. Patient clinical condition continued to deteriorate with grave prognosis and family pursued de-escalation of care; passed on 9/26/2021. Pertinent PMH: DM2,HTN, obesity, tobacco use, and hypothyroid Pertinent labs (admission): COVID-19 positive (9/4/2021;outside) eGFR 67ml/min (9/10/21) AST/ALT: 74 (H) /45 (9/10/21) COVID Vaccination Status: Vaccinated March 2021 Pfizer x2 (outside) DDI: None COVID Therapeutics: received dexamethasone up to 20mg daily, completed 5 doses of remdesivir, and received INV-Baricitinib 4mg daily x 14 days.
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19 pneumonia, Death, Dyspnoea, General physical health deterioration, Glomerular filtration rate normal
Clinical narrative: Narrative:  75yr old male direct admit from OSH due to acute hypoxic respiratory failure in setting of Covid pneumonia and ARDS. In the ED was saturating 76% on RA, RR 30s. 15L via non-breather was administered with improvement to 90% SpO2 but still appeared significantly dyspneic. Bipap 12/6 was tried with significant improvement (SpO2 90s, RR 20-22). Was transferred to ICU on Bipap on 9/10/2021 was placed on mechanical ventilation 4 days later (9/14) due to ongoing respiratory deterioration. Patient clinical condition continued to deteriorate with grave prognosis and family pursued de-escalation of care; passed on 9/26/2021. Pertinent PMH: DM2,HTN, obesity, tobacco use, and hypothyroid Pertinent labs (admission): COVID-19 positive (9/4/2021;outside) eGFR 67ml/min (9/10/21) AST/ALT: 74 (H) /45 (9/10/21) COVID Vaccination Status: Vaccinated March 2021 Pfizer x2 (outside) DDI: None COVID Therapeutics: received dexamethasone up to 20mg daily, completed 5 doses of remdesivir, and received INV-Baricitinib 4mg daily x 14 days.
Age: 75.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Intensive care, Mechanical ventilation, Positive airway pressure therapy, Respiratory disorder, SARS-CoV-2 test positive
Clinical narrative: Narrative:  75yr old male direct admit from OSH due to acute hypoxic respiratory failure in setting of Covid pneumonia and ARDS. In the ED was saturating 76% on RA, RR 30s. 15L via non-breather was administered with improvement to 90% SpO2 but still appeared significantly dyspneic. Bipap 12/6 was tried with significant improvement (SpO2 90s, RR 20-22). Was transferred to ICU on Bipap on 9/10/2021 was placed on mechanical ventilation 4 days later (9/14) due to ongoing respiratory deterioration. Patient clinical condition continued to deteriorate with grave prognosis and family pursued de-escalation of care; passed on 9/26/2021. Pertinent PMH: DM2,HTN, obesity, tobacco use, and hypothyroid Pertinent labs (admission): COVID-19 positive (9/4/2021;outside) eGFR 67ml/min (9/10/21) AST/ALT: 74 (H) /45 (9/10/21) COVID Vaccination Status: Vaccinated March 2021 Pfizer x2 (outside) DDI: None COVID Therapeutics: received dexamethasone up to 20mg daily, completed 5 doses of remdesivir, and received INV-Baricitinib 4mg daily x 14 days.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Body temperature increased, COVID-19, COVID-19 pneumonia, Cardiopulmonary exercise test
Clinical narrative: Narrative:  75 y/o male with PMH of T2DM, COPD, HTN, bilateral lower extremity DVT (in 01/2020), OSA (on CPAP), and gout presented the ED on 08/16/2021 for a 2 week history of worsening SOB, cough (with clear sputum), and weakness. In the ED, he met SIRS criteria with a temperature of 103.5 and a HR of 105. CXR demonstrated a left basilar airspace consolidation, so patient was given 1 L of NS and was ordered empiric vancomycin (not administered) and cefepime as part of the sepsis protocol. COVID test in the ED was positive (he is 2/2 for vaccinations), so pt was admitted for treatment/evaluation of presumptive COVID pneumonia with possible concurrent bacterial pneumonia (08/17/2021 procalcitonin 0.940). While admitted, patient always remained on room air. On 08/16/2021, he would transiently become hypoxic during conversation but this did not persist after treatment was initiated (i.e. after treatment initiation, SpO2 was usually steady in the low-to-mid 90s%). For COVID pneumonia, patient received remdesivir and dexamethasone from 08/16/2021 - 08/18/2021. For possible concurrent bacterial pneumonia, empiric antibiotics from the ED were switched to ceftriaxone and azithromycin; ceftriaxone was changed to cefdinir on 08/17/2021. On 08/18/2021, patient was determined to be stable for discharge with no outpatient steroids or supplemental oxygen after a 6-minute walk test. He will complete 5 total days of antibiotic therapy (cefdinir and azithromycin) on 08/20/2021.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Cough, Dyspnoea, Hypoxia, Lung consolidation
Clinical narrative: Narrative:  75 y/o male with PMH of T2DM, COPD, HTN, bilateral lower extremity DVT (in 01/2020), OSA (on CPAP), and gout presented the ED on 08/16/2021 for a 2 week history of worsening SOB, cough (with clear sputum), and weakness. In the ED, he met SIRS criteria with a temperature of 103.5 and a HR of 105. CXR demonstrated a left basilar airspace consolidation, so patient was given 1 L of NS and was ordered empiric vancomycin (not administered) and cefepime as part of the sepsis protocol. COVID test in the ED was positive (he is 2/2 for vaccinations), so pt was admitted for treatment/evaluation of presumptive COVID pneumonia with possible concurrent bacterial pneumonia (08/17/2021 procalcitonin 0.940). While admitted, patient always remained on room air. On 08/16/2021, he would transiently become hypoxic during conversation but this did not persist after treatment was initiated (i.e. after treatment initiation, SpO2 was usually steady in the low-to-mid 90s%). For COVID pneumonia, patient received remdesivir and dexamethasone from 08/16/2021 - 08/18/2021. For possible concurrent bacterial pneumonia, empiric antibiotics from the ED were switched to ceftriaxone and azithromycin; ceftriaxone was changed to cefdinir on 08/17/2021. On 08/18/2021, patient was determined to be stable for discharge with no outpatient steroids or supplemental oxygen after a 6-minute walk test. He will complete 5 total days of antibiotic therapy (cefdinir and azithromycin) on 08/20/2021.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Pneumonia bacterial, Procalcitonin, Productive cough, SARS-CoV-2 test positive, Systemic inflammatory response syndrome
Clinical narrative: Narrative:  75 y/o male with PMH of T2DM, COPD, HTN, bilateral lower extremity DVT (in 01/2020), OSA (on CPAP), and gout presented the ED on 08/16/2021 for a 2 week history of worsening SOB, cough (with clear sputum), and weakness. In the ED, he met SIRS criteria with a temperature of 103.5 and a HR of 105. CXR demonstrated a left basilar airspace consolidation, so patient was given 1 L of NS and was ordered empiric vancomycin (not administered) and cefepime as part of the sepsis protocol. COVID test in the ED was positive (he is 2/2 for vaccinations), so pt was admitted for treatment/evaluation of presumptive COVID pneumonia with possible concurrent bacterial pneumonia (08/17/2021 procalcitonin 0.940). While admitted, patient always remained on room air. On 08/16/2021, he would transiently become hypoxic during conversation but this did not persist after treatment was initiated (i.e. after treatment initiation, SpO2 was usually steady in the low-to-mid 90s%). For COVID pneumonia, patient received remdesivir and dexamethasone from 08/16/2021 - 08/18/2021. For possible concurrent bacterial pneumonia, empiric antibiotics from the ED were switched to ceftriaxone and azithromycin; ceftriaxone was changed to cefdinir on 08/17/2021. On 08/18/2021, patient was determined to be stable for discharge with no outpatient steroids or supplemental oxygen after a 6-minute walk test. He will complete 5 total days of antibiotic therapy (cefdinir and azithromycin) on 08/20/2021.
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Computerised tomogram head normal, Headache, SARS-CoV-2 test positive
Clinical narrative: Narrative:  90 YO male with PMH of pulmonary nodule, chronic diastolic HF, PVD, OA, vitamin D deficiency, nicotine dependence, BPH and HLP presented to the emergency department for "worst headache of my life." Was also found to have a new oxygen requirement and and to be Covid positive at that time. CT head did not show any acute pathology. Received remdesivir and dexamethasone during hospitalization. At times required up to 4 L of oxygen by nasal cannula. This was weaned over the course of hospitalization. On the day of discharge patient was not requiring any oxygen at rest however when completing the 6-minute walk test his saturatrf, recommendation was for discharge on home O2 for exertion. Patient declined.
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Blood bicarbonate normal, Blood fibrinogen normal, Blood gases abnormal, Blood pH increased, Blood phosphorus
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/25, Pfizer, dose #1 03/18, Pfizer, dose #2 08/03 pt cc: exposure: unknown 09/01 COVID swab, result: detected 09/01 pt admit to medicine dx: COVID-19 pneumonia LOS: 15 days 09/01 CXR impression: Radiographically worsened COVID pneumonitis is suspected as above. Bilateral pleural effusions, RIGHT larger than LEFT. 09/07 ABG i-pH 7.50, i-PCO2 35, i-PO2 53, i-HCO3 27.5 09/08 CXR impression: Stable Covid pneumonia. 09/12 PO4 RESULT: 2.3 09/13 ESR result: 14 09/13 procalcitonin <0.05 09/14 FIBRINOGEN result: 200 L 09/14 DDIMER result: 2.500 H 09/14 CXR impression: No significant interval change. 09/14 ESR result: 8 09/16 pt decease
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Fibrin D dimer
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/25, Pfizer, dose #1 03/18, Pfizer, dose #2 08/03 pt cc: exposure: unknown 09/01 COVID swab, result: detected 09/01 pt admit to medicine dx: COVID-19 pneumonia LOS: 15 days 09/01 CXR impression: Radiographically worsened COVID pneumonitis is suspected as above. Bilateral pleural effusions, RIGHT larger than LEFT. 09/07 ABG i-pH 7.50, i-PCO2 35, i-PO2 53, i-HCO3 27.5 09/08 CXR impression: Stable Covid pneumonia. 09/12 PO4 RESULT: 2.3 09/13 ESR result: 14 09/13 procalcitonin <0.05 09/14 FIBRINOGEN result: 200 L 09/14 DDIMER result: 2.500 H 09/14 CXR impression: No significant interval change. 09/14 ESR result: 8 09/16 pt decease
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: PCO2 increased, PO2 decreased, Pleural effusion, Procalcitonin, Red blood cell sedimentation rate normal
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/25, Pfizer, dose #1 03/18, Pfizer, dose #2 08/03 pt cc: exposure: unknown 09/01 COVID swab, result: detected 09/01 pt admit to medicine dx: COVID-19 pneumonia LOS: 15 days 09/01 CXR impression: Radiographically worsened COVID pneumonitis is suspected as above. Bilateral pleural effusions, RIGHT larger than LEFT. 09/07 ABG i-pH 7.50, i-PCO2 35, i-PO2 53, i-HCO3 27.5 09/08 CXR impression: Stable Covid pneumonia. 09/12 PO4 RESULT: 2.3 09/13 ESR result: 14 09/13 procalcitonin <0.05 09/14 FIBRINOGEN result: 200 L 09/14 DDIMER result: 2.500 H 09/14 CXR impression: No significant interval change. 09/14 ESR result: 8 09/16 pt decease
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Narrative: COVID infection following COVID vaccine series 02/25, Pfizer, dose #1 03/18, Pfizer, dose #2 08/03 pt cc: exposure: unknown 09/01 COVID swab, result: detected 09/01 pt admit to medicine dx: COVID-19 pneumonia LOS: 15 days 09/01 CXR impression: Radiographically worsened COVID pneumonitis is suspected as above. Bilateral pleural effusions, RIGHT larger than LEFT. 09/07 ABG i-pH 7.50, i-PCO2 35, i-PO2 53, i-HCO3 27.5 09/08 CXR impression: Stable Covid pneumonia. 09/12 PO4 RESULT: 2.3 09/13 ESR result: 14 09/13 procalcitonin <0.05 09/14 FIBRINOGEN result: 200 L 09/14 DDIMER result: 2.500 H 09/14 CXR impression: No significant interval change. 09/14 ESR result: 8 09/16 pt decease
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Blood lactate dehydrogenase increased, Costochondritis, Disorientation, Dyspnoea, Hypervolaemia
Clinical narrative: Narrative: Patient is a 72 y/o male with PMH significant for HTN, HLD, CKD, RA, hypothyroidism, and COVID infection in 11/2020 complicated by DVT requiring stenting. He received the third dose of Pfizer COVID-19 vaccine on 9/7/21 with no immediate issues reported. On 9/9, symptoms including SOB and disorientation were reported to his PCP. Additionally, labs showed elevated WBC and LDH, indicating a possible infectious or inflammatory process; the patient was advised to report to the ED for further workup, however he did not report. Heme/Onc was consulted for further evaluation of lab abnormalities. Patient saw non-agency PCP who diagnosed patient with costochondritis. Provider consulted ID pharmacy for review of adverse effect who advised that there has been no association between costochondritis and the COVID vaccine reported in literature, and that event could be reported to VAERS if desired. Due to continued SOB and lower chest wall pain, patient presented to urgent care who ruled out pneumonia. At follow-up visit with agency PCP on 9/28, patient was advised to report to ED due to ongoing SOB, DOE, and lower chest wall pain. Patient was found to have moderate to large pericardial effusion and pleural effusion; dyspnea was suspected to be secondary to fluid overload. He was admitted for further workup and evaluation of possible CHF exacerbation. Diagnosis from cardiology includes pericarditis and myocarditis.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Laboratory test abnormal, Musculoskeletal chest pain, Myocarditis, Pericardial effusion, Pericarditis
Clinical narrative: Narrative: Patient is a 72 y/o male with PMH significant for HTN, HLD, CKD, RA, hypothyroidism, and COVID infection in 11/2020 complicated by DVT requiring stenting. He received the third dose of Pfizer COVID-19 vaccine on 9/7/21 with no immediate issues reported. On 9/9, symptoms including SOB and disorientation were reported to his PCP. Additionally, labs showed elevated WBC and LDH, indicating a possible infectious or inflammatory process; the patient was advised to report to the ED for further workup, however he did not report. Heme/Onc was consulted for further evaluation of lab abnormalities. Patient saw non-agency PCP who diagnosed patient with costochondritis. Provider consulted ID pharmacy for review of adverse effect who advised that there has been no association between costochondritis and the COVID vaccine reported in literature, and that event could be reported to VAERS if desired. Due to continued SOB and lower chest wall pain, patient presented to urgent care who ruled out pneumonia. At follow-up visit with agency PCP on 9/28, patient was advised to report to ED due to ongoing SOB, DOE, and lower chest wall pain. Patient was found to have moderate to large pericardial effusion and pleural effusion; dyspnea was suspected to be secondary to fluid overload. He was admitted for further workup and evaluation of possible CHF exacerbation. Diagnosis from cardiology includes pericarditis and myocarditis.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Pleural effusion, White blood cell count increased
Clinical narrative: Narrative: Patient is a 72 y/o male with PMH significant for HTN, HLD, CKD, RA, hypothyroidism, and COVID infection in 11/2020 complicated by DVT requiring stenting. He received the third dose of Pfizer COVID-19 vaccine on 9/7/21 with no immediate issues reported. On 9/9, symptoms including SOB and disorientation were reported to his PCP. Additionally, labs showed elevated WBC and LDH, indicating a possible infectious or inflammatory process; the patient was advised to report to the ED for further workup, however he did not report. Heme/Onc was consulted for further evaluation of lab abnormalities. Patient saw non-agency PCP who diagnosed patient with costochondritis. Provider consulted ID pharmacy for review of adverse effect who advised that there has been no association between costochondritis and the COVID vaccine reported in literature, and that event could be reported to VAERS if desired. Due to continued SOB and lower chest wall pain, patient presented to urgent care who ruled out pneumonia. At follow-up visit with agency PCP on 9/28, patient was advised to report to ED due to ongoing SOB, DOE, and lower chest wall pain. Patient was found to have moderate to large pericardial effusion and pleural effusion; dyspnea was suspected to be secondary to fluid overload. He was admitted for further workup and evaluation of possible CHF exacerbation. Diagnosis from cardiology includes pericarditis and myocarditis.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  74yo male with widespread diffuse large B-Cell lymphoma and is followed by heme/onc died at home with home hospice care. Pt had received pfizer covid vaccines on 2/2/21 &2/24/21. This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  70yo male pt died at home on 09/25/2021. See pt's problem list below. PROBLEM LAST MOD PROVIDER Obstructive sleep apnea of adult (SCT 03/27/2018 1101000119103) (ICD-10-CM G47.30) Atrial fibrillation (SCT 49436004) (ICD-10-CM 01/29/2018 I48.0) Cardiomyopathy (SCT 85898001) (ICD-10-CM I42.9) 11/28/2017 Osteoarthritis of knee (SCT 239873007) 07/14/2016 (ICD-10-CM M17.0) Benign hypertension (SCT 10725009) (ICD-10-CM 12/01/2015 I10.) Diabetes mellitus (SCT 73211009) (ICD-10-CM 12/01/2015 E11.9) Hyperlipidemia (SCT 55822004) (ICD-10-CM E78.5) 12/01/2015 Chronic obstructive lung disease (SCT 13645005) 12/01/2015 (ICD-10-CM J44.9) Knee pain (SCT 30989003) (ICD-10-CM M25.569) 12/01/2015 Gout (SCT 90560007) (ICD-10-CM M10.9) 12/01/2015 Gastroesophageal reflux disease (SCT 235595009) 12/01/2015 (ICD-10-CM K21.9) Hyperuricemia (SCT 35885006) (ICD-10-CM E79.0) 12/01/2015 (ICD-9-CM 272.2); Mixed Hyperlipidemia 12/05/2012 (ICD-9-CM 600.20); Benign Localized Hyperplasia 12/15/2010 of Prostate without Urinary obstruction (ICD-9-CM 6 (ICD-9-CM 477.9); Allergic Rhinitis 01/14/2010 (ICD-9-CM 274.9); Gout * (ICD-9-CM 274.9) 09/04/2009 (ICD-9-CM 144.9); Malignant neoplasm of floor of 05/06/2009 mouth (ICD-9-CM 144.9) (ICD-9-CM 272.0); Hypercholesterolemia, Pure 02/12/2008 (ICD-9-CM 496.); COPD * (ICD-9-CM 496.) 01/08/2007 (ICD-9-CM 303.90); Alcohol Dependence * 06/22/2011 (ICD-9-CM 303.90/303.91) In remission (ICD-9-CM 719.46); Knee: arthralgia * (ICD-9-CM 12/17/2004 719.46) (ICD-9-CM 278.00; Obesity * (ICD-9-CM 278.00) 10/22/2003 (ICD-9-CM 530.81); ESOPHAGEAL REFLUX 03/03/2003 (ICD-9-CM 786.09); Sleep Apnea (ICD-9-CM 786.09) 05/23/2001 Family History of Malignant Neoplasm of 02/07/2013 Gastrointestinal Tract (ICD-9-CM V16.0) 1. Colonoscopy 11/07 - no adenomatous polyps 2. Scope 1/13- tics, hemorr., no polyps Diabetes Mellitus Type II or unspecified 05/09/2000 (ICD-9-CM 250.00) Essential Hypertension (ICD-9-CM 401.9) 03/14/2000 Tobacco Use Disorder (ICD-9-CM 305.1) 04/06/2007 In remission This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative: 92yo male died at nursing home with family at bedside. Cause of death not in system. Pt received covid vaccines on 1/15/21 and 2/12/21. Likely death is not related to vaccinations given pt's advanced age and time btwn date of vaccinations & date of death.
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Death
Clinical narrative: Narrative:  89yo male died on 9/23/2021 while inpatient hospice after inpatient admission on 9/12/2021 for covid pneumonia complicated by COPD. Pt had received covid vaccinations on 1/28/21 & 2/25/21 which failed prevention of covid infection. Per Md death report: "Death was caused by: Acute hypoxic respiratory failure from COVID Pneumonia complicated by underlying COPD"
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, CHA2DS2-VASc-score, COVID-19 pneumonia, Echocardiogram, Pneumonia
Clinical narrative: Narrative:  Patient is an 82-year-old male with a past medical history significant for B- cell chronic lymphocytic leukemia; OSA on BiPAP; chronic autoimmune hemolytic anemia; history of chronic diastolic heart failure (EF 50 to 55%); history of bilateral PE on apixaban; history of interstitial lung disease secondary to IPF; hypothyroidism - who was admitted on August 24 for sepsis 2/2 acute Covid pneumonia versus CAP. Patient received Pfizer vaccine on 1/11/21 and 2/1/2021. Started on remdesivir, dexamethasone, ceftriaxone, doxycycline. Admission complicated by atrial fibrillation with rapid ventricular response. Cardiology consulted. Patient's Lopressor increased from 25 mg twice daily to 50 mg twice daily. Rates controlled on increased dose. Apixaban dose also increased from 2.5 mg to 5 mg twice daily. CHA2DS2-VASc of 3. Mild initial hypoxia that improved quickly and patient on room air for majority of admission. Ultimately completed 4 days of remdesivir, dexamethasone. Discharged to complete 1 final day of Levaquin to complete 5-day course for community-acquired pneumonia. Patient to follow-up with cardiology in 3 to 4 weeks for consideration of DCCV. Of note, thyroid function tests within normal limits and TTE without significant changes from baseline. Discussed self-isolation recommendations, especially in regard to non- vaccinated grandchild.
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Therapy change, Thyroid function test normal
Clinical narrative: Narrative:  Patient is an 82-year-old male with a past medical history significant for B- cell chronic lymphocytic leukemia; OSA on BiPAP; chronic autoimmune hemolytic anemia; history of chronic diastolic heart failure (EF 50 to 55%); history of bilateral PE on apixaban; history of interstitial lung disease secondary to IPF; hypothyroidism - who was admitted on August 24 for sepsis 2/2 acute Covid pneumonia versus CAP. Patient received Pfizer vaccine on 1/11/21 and 2/1/2021. Started on remdesivir, dexamethasone, ceftriaxone, doxycycline. Admission complicated by atrial fibrillation with rapid ventricular response. Cardiology consulted. Patient's Lopressor increased from 25 mg twice daily to 50 mg twice daily. Rates controlled on increased dose. Apixaban dose also increased from 2.5 mg to 5 mg twice daily. CHA2DS2-VASc of 3. Mild initial hypoxia that improved quickly and patient on room air for majority of admission. Ultimately completed 4 days of remdesivir, dexamethasone. Discharged to complete 1 final day of Levaquin to complete 5-day course for community-acquired pneumonia. Patient to follow-up with cardiology in 3 to 4 weeks for consideration of DCCV. Of note, thyroid function tests within normal limits and TTE without significant changes from baseline. Discussed self-isolation recommendations, especially in regard to non- vaccinated grandchild.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Balance disorder, Brain fog, COVID-19, Cough, Dyspnoea
Clinical narrative: Narrative:  67 yo male with PMH: HTN, OSA, social anxiety disorder, neuroleptic-induced parkinsonism, bipolar, obesity, and arthritis tested positive for covid19 on 9/2/2021. On 9/11/2021, he was admitted due to fogginess, increased falls. In addition, patient had cough and dyspnea on 8/29/2021 and tested positive for covid on 9/2/2021. Family felt that since 8/29/2021, he's had more fogginess and difficulty ambulating and has had 2 falls. During the hospital course, he did not require treatment for covid. It was found that his imbalance was due to polypharmacy (benzo and overuse of OTC robitussin).
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Fall, Gait disturbance, SARS-CoV-2 test positive
Clinical narrative: Narrative:  67 yo male with PMH: HTN, OSA, social anxiety disorder, neuroleptic-induced parkinsonism, bipolar, obesity, and arthritis tested positive for covid19 on 9/2/2021. On 9/11/2021, he was admitted due to fogginess, increased falls. In addition, patient had cough and dyspnea on 8/29/2021 and tested positive for covid on 9/2/2021. Family felt that since 8/29/2021, he's had more fogginess and difficulty ambulating and has had 2 falls. During the hospital course, he did not require treatment for covid. It was found that his imbalance was due to polypharmacy (benzo and overuse of OTC robitussin).
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Death, Dialysis
Clinical narrative: Narrative:  84yo male HBPC pt with Past Medical History: Loose stools (SCT 398032003) Malnutrition (SCT 2492009) Hyperlipidemia (SCT 55822004) Benign Prostatic Hypertrophy Without Outflow Obstruction (SCT 254902007) Constipation (SCT 14760008) Disorder of vitamin B12 (SCT 386067009) History of cervical spine surgery (SCT 4Hip fracture (SCT 263225007) Myoclonus (SCT 17450006) Hyperparathyroidism due to renal insufficiency (SCT 19034001) IH - Inguinal hernia (SCT 396232000) Metabolic bone disease (SCT 50279003) Vitamin D deficiency (SCT 34713006) Anxiety disorder (SCT 197480006) Osteoarthritis (SCT 396275006) Degeneration of intervertebral disc (SCT 77547008) Conduction disorder of the heart (SCT 44Chronic kidney disease stage 5 (SCT 433146000) Raised antinuclear antibody (SCT 4445510Angiokeratoma of skin (SCT 254788004) Chronic low back pain (SCT 278860009) Seborrheic dermatitis of scalp (SCT 156329007) Bradycardia (SCT 48867003) Peripheral vascular disease (SCT 400047006) Primary degenerative dementia of the AlzAnemia co-occurrent and due to chronic kidney disease (SCT 707323002) Hypertension (SCT 38341003) Active problem list reviewed Had requested hospice services on 9/9/21. Pt had recently started dialysis. On 9/14/2021 pt died at home. This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Ageusia, Anosmia, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated
Clinical narrative: Narrative:  76yr admitted with dyspnea in the setting of COVID + and likely COPD exacerbation. Patient was exposed to COVID one week prior to admission developed sx of SOB, cough, wheeze along with lost taste and smell. Tested positive 8/24 admitted 8/27. PMH: COPD (s/p R thoracotomy w/ lung resection), HTN, HLD, AAA, CKD, CVA (residual L hand weakness), mild cognitive impairment, and current tobacco use. Hospital course: Sats on RA did not drop below 92%, did not require oxygen or COVID medications. Was given albuterol MDI and prednisone 40mg for COPD exacerbation. Spent 1 day in ICU then discharged (8/27 to 8/28).
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cough, Dyspnoea, Exposure to SARS-CoV-2, Intensive care, SARS-CoV-2 test positive
Clinical narrative: Narrative:  76yr admitted with dyspnea in the setting of COVID + and likely COPD exacerbation. Patient was exposed to COVID one week prior to admission developed sx of SOB, cough, wheeze along with lost taste and smell. Tested positive 8/24 admitted 8/27. PMH: COPD (s/p R thoracotomy w/ lung resection), HTN, HLD, AAA, CKD, CVA (residual L hand weakness), mild cognitive impairment, and current tobacco use. Hospital course: Sats on RA did not drop below 92%, did not require oxygen or COVID medications. Was given albuterol MDI and prednisone 40mg for COPD exacerbation. Spent 1 day in ICU then discharged (8/27 to 8/28).
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Wheezing
Clinical narrative: Narrative:  76yr admitted with dyspnea in the setting of COVID + and likely COPD exacerbation. Patient was exposed to COVID one week prior to admission developed sx of SOB, cough, wheeze along with lost taste and smell. Tested positive 8/24 admitted 8/27. PMH: COPD (s/p R thoracotomy w/ lung resection), HTN, HLD, AAA, CKD, CVA (residual L hand weakness), mild cognitive impairment, and current tobacco use. Hospital course: Sats on RA did not drop below 92%, did not require oxygen or COVID medications. Was given albuterol MDI and prednisone 40mg for COPD exacerbation. Spent 1 day in ICU then discharged (8/27 to 8/28).
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Vaccine breakthrough infection
Clinical narrative: Narrative:  Breakthrough Delta Variant COVID infection requiring hospitalization
Age: 91.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  91 yo male died on 5/2021 at hospital. No information in records about pt's death. Pt had received covid vaccinations on 1/12/21 and 2/9/21. Likely death is not related to vaccines given pt's advanced age and length of time btwn date of death and vaccines.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Intensive care, Laboratory test normal, Lethargy, SARS-CoV-2 test positive
Clinical narrative: Narrative:  60yr patient direct admit from hospital to ICU for COVID-19+ and lethargic. PMH:HTN, DM-II on lispro BID, MDD, hx of LLE DVT Hemorrhagic CVA x2 with baseline R hemiparesis and expressive aphasia, chronic G-J Tube, and recent R subdural hematoma. Per hospital lethargy was at baseline and arrived on RA satting at 100%, Patient stay in the ICU was 1 day (8/22 to 8/23), no oxygen requirements (100% on RA), no lab abnormalities noted, and no COVID medications including steroids were administered. Received 2 doses of Moderna (12/30/2020 and 1/27/2021) locally.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Asthenia, Death, Intensive care, Interstitial lung disease
Clinical narrative: Narrative:  72 yo male with a h/o squamous cell carcinoma of the lung, stomach cancer s/p partial gastrectomy, ocular melanoma s/p resection, IgG monoclonal gammopathy, paroxysmal atrial fibrillation, and iron deficiency anemia who presented to the ED on 9/8/21 for progressive weakness and increased sputum production was admitted to internal medicine team, then transferred to MICU. Pt then was transferred MICU to inpatient hospice on 9/11/21 with Acute Hypoxic Respiratory Failure secondary to interstitial pneumonia, not caused by covid infection. Pt then died on 9/12/21 during inpt hospice care. Pt had received covid vaccines on 2/5/21 & 3/9/21. Death not related to covid vaccines.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Sputum increased
Clinical narrative: Narrative:  72 yo male with a h/o squamous cell carcinoma of the lung, stomach cancer s/p partial gastrectomy, ocular melanoma s/p resection, IgG monoclonal gammopathy, paroxysmal atrial fibrillation, and iron deficiency anemia who presented to the ED on 9/8/21 for progressive weakness and increased sputum production was admitted to internal medicine team, then transferred to MICU. Pt then was transferred MICU to inpatient hospice on 9/11/21 with Acute Hypoxic Respiratory Failure secondary to interstitial pneumonia, not caused by covid infection. Pt then died on 9/12/21 during inpt hospice care. Pt had received covid vaccines on 2/5/21 & 3/9/21. Death not related to covid vaccines.
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Narrative:  91 yo male with with age-related debility, COPD on O2, CAD died at home on 9/9/2021. Pt had received covid vaccines on 1/11/21 & 2/8/21. This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Death, General physical health deterioration, Respiratory distress, Respiratory failure
Clinical narrative: Narrative:  77yo M patient w/ALS and was declining. He was hospitalized x2 07/2021 for respiratory distress/failure and it was decided during hospitalization the pt/family wanted home hospice care. PMH includes ALS, respiratory failure, untreat OSA, COPD, HTN, dyspnea, spasms BLE, constipation, seasonal allergies, increased oral secretions. Pt admitted to home hospice on 8/17/2021. Pt died at home with home hospice on 9/11/21. Pt had received covid vaccines on 4/1/21 & 4/30/21. This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Death, Hepatocellular carcinoma, Philadelphia positive acute lymphocytic leukaemia, Philadelphia positive chronic myeloid leukaemia
Clinical narrative: Narrative:  79yo male oncology pt Diagnosised with: 1. met hepatocellular carcinoma (intrahepatic mets) PD-L1 negative, MSS 2. Ph+ CML/ALL On 9/3/2021 pt's wife had phoned oncology clinic to inform pt hospitalized at (outside agency hospital) and is now hospice. Pt died at this hospital on 9/11/2021. Pt had received covid vaccines on 1/15/21 & 2/12/21. This death is likely not related to the vaccinations due to comorbidities, age, and length of time from vaccine administration.
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal distension, Acute respiratory failure, Anticoagulant therapy, Brain natriuretic peptide increased, COVID-19
Clinical narrative: Narrative:  a 85 yo M with recently diagnosed SCC receiving VP-16 and carboplatin, admitted 09/10/2021 (TO PRESENT) with acute resp failure secondary to covid pneumonia. PATIENT remains on continuous bipap - sats 100%. Much more alert today, actually stated that he felt much better. Alert to person, place, year CV: RRR with systolic murmur Lungs: crackles throughout Abd: soft, mildly distended, nttp, pos BS Ext: 1+ BLE pitting edema A/P 1. Acute hypercarbic and hypoxic respiraty failure/COVID 19 pneumonia - secondary to covid-19, however, complicated by lung masses and L pleural effusion (malignant) - have requested trial of high flow - can d/c bipap - to allow patient to eat, sats remain 100% on bipap - continue remdesivir and IV solumedrol - not a candidate for IL or immunomodulators given SCC s/p chemo - overall prognosis still very poor - completed 5 days IV zosyn for possible superimposed bacterial pneumonia - heparin drip changed to treatment dose lovenox as patient with poor IV access and needs IV line for PPN, may need central line vs PICC if unable to wean from bipap and tolerate diet soon - monitor inflammatory markers - IV lasix changed to 80 mg bid for CHF (BNP 700s, monitor)- improved - will reduce to daily dosing given metabollic alkalosis 2. Small cell lung ca stage IIIa - followed by oncology, s/p chemo 09/08/2021 as above - very poor overall prognosis in setting underlying fibrosis/possible ILD and acute infection 3. FEN - D5 1/2 NS to be replaced by PPN today - hopeful that can start oral diet if able to change from bipap to high flow 4. Chronic medical conditions Hypertension - Continue metoprolol 6.25mg PO BID Diabetes Mellitus - aspart tid, adding lantus 10 units daily Diabetic neuropathy and nephropathy - Continue gabapentin. Hyperlipidemia - Continue Simvistatin RLS - ropinirole Overall prognosis very poor given chronic medical conditions, lung cancer, asbestosis
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cardiac failure congestive, Cardiac murmur, Chemotherapy, Fibrosis
Clinical narrative: Narrative:  a 85 yo M with recently diagnosed SCC receiving VP-16 and carboplatin, admitted 09/10/2021 (TO PRESENT) with acute resp failure secondary to covid pneumonia. PATIENT remains on continuous bipap - sats 100%. Much more alert today, actually stated that he felt much better. Alert to person, place, year CV: RRR with systolic murmur Lungs: crackles throughout Abd: soft, mildly distended, nttp, pos BS Ext: 1+ BLE pitting edema A/P 1. Acute hypercarbic and hypoxic respiraty failure/COVID 19 pneumonia - secondary to covid-19, however, complicated by lung masses and L pleural effusion (malignant) - have requested trial of high flow - can d/c bipap - to allow patient to eat, sats remain 100% on bipap - continue remdesivir and IV solumedrol - not a candidate for IL or immunomodulators given SCC s/p chemo - overall prognosis still very poor - completed 5 days IV zosyn for possible superimposed bacterial pneumonia - heparin drip changed to treatment dose lovenox as patient with poor IV access and needs IV line for PPN, may need central line vs PICC if unable to wean from bipap and tolerate diet soon - monitor inflammatory markers - IV lasix changed to 80 mg bid for CHF (BNP 700s, monitor)- improved - will reduce to daily dosing given metabollic alkalosis 2. Small cell lung ca stage IIIa - followed by oncology, s/p chemo 09/08/2021 as above - very poor overall prognosis in setting underlying fibrosis/possible ILD and acute infection 3. FEN - D5 1/2 NS to be replaced by PPN today - hopeful that can start oral diet if able to change from bipap to high flow 4. Chronic medical conditions Hypertension - Continue metoprolol 6.25mg PO BID Diabetes Mellitus - aspart tid, adding lantus 10 units daily Diabetic neuropathy and nephropathy - Continue gabapentin. Hyperlipidemia - Continue Simvistatin RLS - ropinirole Overall prognosis very poor given chronic medical conditions, lung cancer, asbestosis
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Infection, Metabolic alkalosis, Oedema peripheral, Pleural effusion, Positive airway pressure therapy
Clinical narrative: Narrative:  a 85 yo M with recently diagnosed SCC receiving VP-16 and carboplatin, admitted 09/10/2021 (TO PRESENT) with acute resp failure secondary to covid pneumonia. PATIENT remains on continuous bipap - sats 100%. Much more alert today, actually stated that he felt much better. Alert to person, place, year CV: RRR with systolic murmur Lungs: crackles throughout Abd: soft, mildly distended, nttp, pos BS Ext: 1+ BLE pitting edema A/P 1. Acute hypercarbic and hypoxic respiraty failure/COVID 19 pneumonia - secondary to covid-19, however, complicated by lung masses and L pleural effusion (malignant) - have requested trial of high flow - can d/c bipap - to allow patient to eat, sats remain 100% on bipap - continue remdesivir and IV solumedrol - not a candidate for IL or immunomodulators given SCC s/p chemo - overall prognosis still very poor - completed 5 days IV zosyn for possible superimposed bacterial pneumonia - heparin drip changed to treatment dose lovenox as patient with poor IV access and needs IV line for PPN, may need central line vs PICC if unable to wean from bipap and tolerate diet soon - monitor inflammatory markers - IV lasix changed to 80 mg bid for CHF (BNP 700s, monitor)- improved - will reduce to daily dosing given metabollic alkalosis 2. Small cell lung ca stage IIIa - followed by oncology, s/p chemo 09/08/2021 as above - very poor overall prognosis in setting underlying fibrosis/possible ILD and acute infection 3. FEN - D5 1/2 NS to be replaced by PPN today - hopeful that can start oral diet if able to change from bipap to high flow 4. Chronic medical conditions Hypertension - Continue metoprolol 6.25mg PO BID Diabetes Mellitus - aspart tid, adding lantus 10 units daily Diabetic neuropathy and nephropathy - Continue gabapentin. Hyperlipidemia - Continue Simvistatin RLS - ropinirole Overall prognosis very poor given chronic medical conditions, lung cancer, asbestosis