chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea exertional, Fibrin D dimer increased, Hypophagia, Hypoxia, Lactic acidosis
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/6/21 (lot NA) Pfizer Dose 2 3/6/21 (lot NA) COVID Positive 11/27/2021  12/5/21: 66-year-old man who was brought into the emergency department with worsening shortness of breath, hypoxia following COVID diagnosis 9 days ago.  He reports feeling unwell approximately 2 weeks ago with generalized myalgias, low-grade fevers, shortness of breath.  He subsequently had COVID-19 PCR testing 10 days ago which was positive.  He has had COVID vaccines x2, scheduled for booster dose prior to onset of illness.  His status post monoclonal antibody infusion as outpatient despite which he has had worsening symptoms.  He has noted desaturation particularly with activity with oxygen saturation down to 88-89% on room air.   he continues to have low-grade fevers, poor appetite with poor oral intake, shortness of breath aggravated by exertion.  Presented to the emergency department where he was hypoxic on room air to 88%, laboratories  Revealed lactic acidosis, elevated D-dimer.  He has a contrast dye allergy precluding stat CT pulmonary angiogram, ventilation perfusion scan pending.  He will be admitted to the hospitalist service for further treatment and evaluation.  12/7/21: 66-year-old man who presented worsening shortness of breath, cough and myalgias following COVID-19 infection diagnosis 9 days ago.  On evaluation in the emergency department he was found to be hypoxic down to 88% on room air.  Chest x-ray demonstrated bilateral infiltrates in keeping with viral pneumonitis, elevated D-dimer was noted however ventilation perfusion scan done on account of contrast dye allergy was low probability for pulmonary embolism.  He was admitted to the hospitalist service and started on IV remdesivir, Decadron, empiric antibiotic therapy with good effect.  Significant improvement in oxygen requirements were noted during hospital course.  Oxygen walk for home determination done prior to discharge revealed that he did not meet criteria for home oxygen.  Has been discharged in stable medical condition to continue outpatient follow-up.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Lung infiltration, Malaise, Myalgia, Oxygen saturation decreased, Pneumonia viral
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/6/21 (lot NA) Pfizer Dose 2 3/6/21 (lot NA) COVID Positive 11/27/2021  12/5/21: 66-year-old man who was brought into the emergency department with worsening shortness of breath, hypoxia following COVID diagnosis 9 days ago.  He reports feeling unwell approximately 2 weeks ago with generalized myalgias, low-grade fevers, shortness of breath.  He subsequently had COVID-19 PCR testing 10 days ago which was positive.  He has had COVID vaccines x2, scheduled for booster dose prior to onset of illness.  His status post monoclonal antibody infusion as outpatient despite which he has had worsening symptoms.  He has noted desaturation particularly with activity with oxygen saturation down to 88-89% on room air.   he continues to have low-grade fevers, poor appetite with poor oral intake, shortness of breath aggravated by exertion.  Presented to the emergency department where he was hypoxic on room air to 88%, laboratories  Revealed lactic acidosis, elevated D-dimer.  He has a contrast dye allergy precluding stat CT pulmonary angiogram, ventilation perfusion scan pending.  He will be admitted to the hospitalist service for further treatment and evaluation.  12/7/21: 66-year-old man who presented worsening shortness of breath, cough and myalgias following COVID-19 infection diagnosis 9 days ago.  On evaluation in the emergency department he was found to be hypoxic down to 88% on room air.  Chest x-ray demonstrated bilateral infiltrates in keeping with viral pneumonitis, elevated D-dimer was noted however ventilation perfusion scan done on account of contrast dye allergy was low probability for pulmonary embolism.  He was admitted to the hospitalist service and started on IV remdesivir, Decadron, empiric antibiotic therapy with good effect.  Significant improvement in oxygen requirements were noted during hospital course.  Oxygen walk for home determination done prior to discharge revealed that he did not meet criteria for home oxygen.  Has been discharged in stable medical condition to continue outpatient follow-up.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection, Ventilation/perfusion scan normal, Walking distance test normal
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/6/21 (lot NA) Pfizer Dose 2 3/6/21 (lot NA) COVID Positive 11/27/2021  12/5/21: 66-year-old man who was brought into the emergency department with worsening shortness of breath, hypoxia following COVID diagnosis 9 days ago.  He reports feeling unwell approximately 2 weeks ago with generalized myalgias, low-grade fevers, shortness of breath.  He subsequently had COVID-19 PCR testing 10 days ago which was positive.  He has had COVID vaccines x2, scheduled for booster dose prior to onset of illness.  His status post monoclonal antibody infusion as outpatient despite which he has had worsening symptoms.  He has noted desaturation particularly with activity with oxygen saturation down to 88-89% on room air.   he continues to have low-grade fevers, poor appetite with poor oral intake, shortness of breath aggravated by exertion.  Presented to the emergency department where he was hypoxic on room air to 88%, laboratories  Revealed lactic acidosis, elevated D-dimer.  He has a contrast dye allergy precluding stat CT pulmonary angiogram, ventilation perfusion scan pending.  He will be admitted to the hospitalist service for further treatment and evaluation.  12/7/21: 66-year-old man who presented worsening shortness of breath, cough and myalgias following COVID-19 infection diagnosis 9 days ago.  On evaluation in the emergency department he was found to be hypoxic down to 88% on room air.  Chest x-ray demonstrated bilateral infiltrates in keeping with viral pneumonitis, elevated D-dimer was noted however ventilation perfusion scan done on account of contrast dye allergy was low probability for pulmonary embolism.  He was admitted to the hospitalist service and started on IV remdesivir, Decadron, empiric antibiotic therapy with good effect.  Significant improvement in oxygen requirements were noted during hospital course.  Oxygen walk for home determination done prior to discharge revealed that he did not meet criteria for home oxygen.  Has been discharged in stable medical condition to continue outpatient follow-up.
Age: 53.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Paraesthesia, Pruritus
Clinical narrative: Had the feeling in both hands that pins were being poked in all areas and became very itchy.
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: On the clinic day, the vaccine was transported out from the pharmacy to the facility without a digital data logger. The packing used for transport was refrigerated packaging tote to maintain a temperature of 36 F - 46 F.  However, that is not approved by State for COVID-19 vaccine transportation. The total time (from when vaccine left the pharmacy to the clinic completion) was less than 6 hours. There were no adverse events.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Atrial tachycardia, Cardiac monitoring abnormal, Dizziness, Hypoacusis
Clinical narrative: I had increasing light-headiness that would come and go. I went to see my NP and she put a heart monitor on me for 2 weeks and it showed a lot of atrial tachycardia. She has now sent me to a Cardiologist who is trying to figure out what's going on. I've had increasing difficulty hearing from my left ear. I continue to have the light headed spells more and more often.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease
Clinical narrative: COVID Vaccine Breakthrough Case  Moderna Dose 1 2/18/21 (031L20A) Moderna Dose 2 3/18/21 (013A21A) COVID Positive 12/5/21  12/5/21: Patient is an 80-year-old male with history of chronic obstructive pulmonary disease, recovered COVID-19 pneumonia, history of CAD, hypertension and hyperlipidemia. Presented to the emergency department with worsening shortness of breath associated with dry cough and difficulty breathing over the last week, symptoms got much worse over the last 4 days.  Reported fever at home, no body aches, no runny nose or sore throat.  No chest pain or palpitations.  No changes in bowel movements or urinary habits.  Denied any lower extremity swelling rash or open wounds.  Denies smoking, no alcohol use, received COVID-19 vaccine/Moderna roughly 1 year ago, patient with sick because of COVID-19 more than 1 year ago.  He is full code.   In ED, he was hypoxic, was placed on oxygen by nasal cannula 2 L, D-dimer was mildly elevated and CT angiogram ruled out pulmonary embolism but showed ground-glass opacity suggestive of possible viral pneumonia.  Was given levofloxacin, was given steroids, hour long breathing treatment.  12/10/21: Patient was admitted on 12/05/2021 of a presenting to the emergency department with a chief complaint of shortness of breath.  Patient was diagnosed acute hypoxic respiratory failure secondary to COVID-19 pneumonia with possible superimposed bacterial pneumonia and COPD exacerbation.  Patient was treated with remdesivir, Decadron, five-day course of azithromycin and Rocephin, breathing treatments.  Patient was weaned off oxygen.  Home O2 walk was performed on day of discharge and patient passed, did not have need for home O2.  Patient will discharge home with COVID safe at home kit including pulse oximeter so he can monitor his oxygen saturation. Patient will restart his VNA services.  Patient will continue his home inhalers for COPD including p.r.n. albuterol.  Discharge instructions and return precautions reviewed with patient.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Cough, Dyspnoea, Fibrin D dimer increased, Lung opacity
Clinical narrative: COVID Vaccine Breakthrough Case  Moderna Dose 1 2/18/21 (031L20A) Moderna Dose 2 3/18/21 (013A21A) COVID Positive 12/5/21  12/5/21: Patient is an 80-year-old male with history of chronic obstructive pulmonary disease, recovered COVID-19 pneumonia, history of CAD, hypertension and hyperlipidemia. Presented to the emergency department with worsening shortness of breath associated with dry cough and difficulty breathing over the last week, symptoms got much worse over the last 4 days.  Reported fever at home, no body aches, no runny nose or sore throat.  No chest pain or palpitations.  No changes in bowel movements or urinary habits.  Denied any lower extremity swelling rash or open wounds.  Denies smoking, no alcohol use, received COVID-19 vaccine/Moderna roughly 1 year ago, patient with sick because of COVID-19 more than 1 year ago.  He is full code.   In ED, he was hypoxic, was placed on oxygen by nasal cannula 2 L, D-dimer was mildly elevated and CT angiogram ruled out pulmonary embolism but showed ground-glass opacity suggestive of possible viral pneumonia.  Was given levofloxacin, was given steroids, hour long breathing treatment.  12/10/21: Patient was admitted on 12/05/2021 of a presenting to the emergency department with a chief complaint of shortness of breath.  Patient was diagnosed acute hypoxic respiratory failure secondary to COVID-19 pneumonia with possible superimposed bacterial pneumonia and COPD exacerbation.  Patient was treated with remdesivir, Decadron, five-day course of azithromycin and Rocephin, breathing treatments.  Patient was weaned off oxygen.  Home O2 walk was performed on day of discharge and patient passed, did not have need for home O2.  Patient will discharge home with COVID safe at home kit including pulse oximeter so he can monitor his oxygen saturation. Patient will restart his VNA services.  Patient will continue his home inhalers for COPD including p.r.n. albuterol.  Discharge instructions and return precautions reviewed with patient.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Malaise, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID Vaccine Breakthrough Case  Moderna Dose 1 2/18/21 (031L20A) Moderna Dose 2 3/18/21 (013A21A) COVID Positive 12/5/21  12/5/21: Patient is an 80-year-old male with history of chronic obstructive pulmonary disease, recovered COVID-19 pneumonia, history of CAD, hypertension and hyperlipidemia. Presented to the emergency department with worsening shortness of breath associated with dry cough and difficulty breathing over the last week, symptoms got much worse over the last 4 days.  Reported fever at home, no body aches, no runny nose or sore throat.  No chest pain or palpitations.  No changes in bowel movements or urinary habits.  Denied any lower extremity swelling rash or open wounds.  Denies smoking, no alcohol use, received COVID-19 vaccine/Moderna roughly 1 year ago, patient with sick because of COVID-19 more than 1 year ago.  He is full code.   In ED, he was hypoxic, was placed on oxygen by nasal cannula 2 L, D-dimer was mildly elevated and CT angiogram ruled out pulmonary embolism but showed ground-glass opacity suggestive of possible viral pneumonia.  Was given levofloxacin, was given steroids, hour long breathing treatment.  12/10/21: Patient was admitted on 12/05/2021 of a presenting to the emergency department with a chief complaint of shortness of breath.  Patient was diagnosed acute hypoxic respiratory failure secondary to COVID-19 pneumonia with possible superimposed bacterial pneumonia and COPD exacerbation.  Patient was treated with remdesivir, Decadron, five-day course of azithromycin and Rocephin, breathing treatments.  Patient was weaned off oxygen.  Home O2 walk was performed on day of discharge and patient passed, did not have need for home O2.  Patient will discharge home with COVID safe at home kit including pulse oximeter so he can monitor his oxygen saturation. Patient will restart his VNA services.  Patient will continue his home inhalers for COPD including p.r.n. albuterol.  Discharge instructions and return precautions reviewed with patient.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: On the clinic day, the vaccine was transported out from the pharmacy to the facility without a digital data logger. The packing used for transport was refrigerated packaging tote to maintain a temperature of 36 F - 46 F.  However, that is not approved by State for COVID-19 vaccine transportation. The total time (from when vaccine left the pharmacy to the clinic completion) was less than 6 hours. There were no adverse events.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: I tested positive for COVID 40 days after my 2nd booster. My Dr. has given me a prescription for Paxlovid.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Clostridium test negative
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/27/21 (EN6198) Pfizer Dose 2 3/20/21 (ER2613) Pfizer Dose 3 11/5/21 (FF2593) COVID Positive 12/6/21  12/5/21: Patient is 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  Prior to incident patient has been in her usual state of health.  Denied any fever or chills prior to that, no sore throat or runny nose, no chest pain or palpitations, reported shortness of breath with cough and difficulty breathing 1 hour prior to presentation, no abdominal pain but reported nausea and vomiting with diarrhea also 1 hour prior to presentation, no lower extremity swelling, no joint pain or rash.  Did denies smoking, no alcohol use, no recreational drug use, she received Pfizer vaccine and booster, booster was given 1 month ago.  She is full code.   In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive.  D-dimer 0.75  12/9/21:  patient is a 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive. D-dimer 0.75   Patient admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  Patient is vaccinated against COVID-19.  Patient was requiring up to 6 L test anemia.  Patient on biotic moderate severe, Decadron and 1 dose of Actemra on 12/07/2021.  Patient had a persistent leukocytosis, peripheral smear did acute process.  C diff is negative.  Leukocytosis slightly improved.  Clinic today.  Patient has been improving significantly.  Patient will be discharged home on room air.  Patient did not qualify for home oxygen walk.  Patient will be discharged on antibiotic and Decadron.  Will order COVID-19 home program.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Cough, Diarrhoea, Dyspnoea, Fibrin D dimer, Hypoxia
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/27/21 (EN6198) Pfizer Dose 2 3/20/21 (ER2613) Pfizer Dose 3 11/5/21 (FF2593) COVID Positive 12/6/21  12/5/21: Patient is 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  Prior to incident patient has been in her usual state of health.  Denied any fever or chills prior to that, no sore throat or runny nose, no chest pain or palpitations, reported shortness of breath with cough and difficulty breathing 1 hour prior to presentation, no abdominal pain but reported nausea and vomiting with diarrhea also 1 hour prior to presentation, no lower extremity swelling, no joint pain or rash.  Did denies smoking, no alcohol use, no recreational drug use, she received Pfizer vaccine and booster, booster was given 1 month ago.  She is full code.   In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive.  D-dimer 0.75  12/9/21:  patient is a 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive. D-dimer 0.75   Patient admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  Patient is vaccinated against COVID-19.  Patient was requiring up to 6 L test anemia.  Patient on biotic moderate severe, Decadron and 1 dose of Actemra on 12/07/2021.  Patient had a persistent leukocytosis, peripheral smear did acute process.  C diff is negative.  Leukocytosis slightly improved.  Clinic today.  Patient has been improving significantly.  Patient will be discharged home on room air.  Patient did not qualify for home oxygen walk.  Patient will be discharged on antibiotic and Decadron.  Will order COVID-19 home program.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Laboratory test, Leukocytosis, Lung opacity, Nausea, Pyrexia
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/27/21 (EN6198) Pfizer Dose 2 3/20/21 (ER2613) Pfizer Dose 3 11/5/21 (FF2593) COVID Positive 12/6/21  12/5/21: Patient is 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  Prior to incident patient has been in her usual state of health.  Denied any fever or chills prior to that, no sore throat or runny nose, no chest pain or palpitations, reported shortness of breath with cough and difficulty breathing 1 hour prior to presentation, no abdominal pain but reported nausea and vomiting with diarrhea also 1 hour prior to presentation, no lower extremity swelling, no joint pain or rash.  Did denies smoking, no alcohol use, no recreational drug use, she received Pfizer vaccine and booster, booster was given 1 month ago.  She is full code.   In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive.  D-dimer 0.75  12/9/21:  patient is a 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive. D-dimer 0.75   Patient admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  Patient is vaccinated against COVID-19.  Patient was requiring up to 6 L test anemia.  Patient on biotic moderate severe, Decadron and 1 dose of Actemra on 12/07/2021.  Patient had a persistent leukocytosis, peripheral smear did acute process.  C diff is negative.  Leukocytosis slightly improved.  Clinic today.  Patient has been improving significantly.  Patient will be discharged home on room air.  Patient did not qualify for home oxygen walk.  Patient will be discharged on antibiotic and Decadron.  Will order COVID-19 home program.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Smear test, Vaccine breakthrough infection, Vomiting
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 2/27/21 (EN6198) Pfizer Dose 2 3/20/21 (ER2613) Pfizer Dose 3 11/5/21 (FF2593) COVID Positive 12/6/21  12/5/21: Patient is 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  Prior to incident patient has been in her usual state of health.  Denied any fever or chills prior to that, no sore throat or runny nose, no chest pain or palpitations, reported shortness of breath with cough and difficulty breathing 1 hour prior to presentation, no abdominal pain but reported nausea and vomiting with diarrhea also 1 hour prior to presentation, no lower extremity swelling, no joint pain or rash.  Did denies smoking, no alcohol use, no recreational drug use, she received Pfizer vaccine and booster, booster was given 1 month ago.  She is full code.   In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive.  D-dimer 0.75  12/9/21:  patient is a 44-year-old female with no significant past medical history who presented to the emergency department for shortness of breath or difficulty breathing associated with nausea and vomiting and diarrhea of 1 hour duration.  In ED, fever of 102.5, hypoxia as low as 87% and was put on 5 L by nasal cannula.  CT angiogram ruled out pulmonary embolism and showed bilateral lung opacities.  COVID-19 antigen positive. D-dimer 0.75   Patient admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia.  Patient is vaccinated against COVID-19.  Patient was requiring up to 6 L test anemia.  Patient on biotic moderate severe, Decadron and 1 dose of Actemra on 12/07/2021.  Patient had a persistent leukocytosis, peripheral smear did acute process.  C diff is negative.  Leukocytosis slightly improved.  Clinic today.  Patient has been improving significantly.  Patient will be discharged home on room air.  Patient did not qualify for home oxygen walk.  Patient will be discharged on antibiotic and Decadron.  Will order COVID-19 home program.
Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Chest discomfort, Lymphadenopathy
Clinical narrative: PT REPORTED TIGHTNESS OF CHEST APPARENT LYMPH NODE SWELLING ON LEFT SIDE OF CHEST
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Blood creatinine increased, Brain natriuretic peptide increased
Clinical narrative: ED Visit Hospital 5/14/22 DIAGNOSIS at time of disposition: 1. COVID-19 virus infection  2. COVID-19 virus detected   MEDICAL DECISION MAKING: Patient is a 74-year-old male presents with a chief complaint of shortness of breath.  Upon initial evaluation he is hemodynamically stable.  He does not appear in any distress.  He is resting with eyes closed, arouses easily to voice.  Patient's complaint is rather vague today.  I have seen him multiple times in the past and he frequently has vague complaints of feeling unwell in cannot expound upon this further.  Therefore, his differential is broad and will initiate a broad workup for him with screening labs, scan of head given wife's report of decreased level consciousness.  COVID-19 test returns positive.  CT of the head and chest x-ray do not show any significant changes.  His lab work is overall similar to prior.  His BNP is elevated but mildly so, chest x-ray does not show significant fluid overload he has no lower extremity edema.  Here he maintains normal oxygen saturation, no respiratory distress or difficulty breathing.  He has no wheezing so do not believe he requires albuterol.  A reviewed his medication list he has multiple interactions with paxlovid.  Furthermore, he does not have a delineated onset time.  Wife actually says is been multiple days that he has been feeling tired in she cannot tell me that it has been definitely within 5 days.  Therefore, do not believe she currently meets emergency use authorization for this medication.  Re-evaluation he is resting, appears well.  Will have him follow up with primary care physician by phone.  Discharged in stable condition.  MD 5/16/2022 Physician Hospitalist  DIAGNOSIS at time of disposition: 1. COVID-19  2. Acute respiratory failure with hypoxia  3. Acute on chronic renal insufficiency     HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male with chronic systolic congestive Heart failure and chronic kidney disease who has had 3 hospitalizations prior to this in the past 2 months for congestive heart failure.  Once again presents with shortness of breath and weakness.  He was COVID tested in the emergency department and it is positive.  Also patient had an elevated D-dimer of 8000 in the emergency department.  His chest x-ray shows congestive heart failure changes and bilateral lower lobe infiltrates and his BNP is at least 60,000. Creatinine has been steadily increasing over the past 2 months and is now at 2.7. As far as I can tell he is not had outpatient Nephrology follow-up, but was seen by nephrology at Hospital in early April
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cardiac failure congestive, Chest X-ray normal, Chronic kidney disease, Chronic left ventricular failure
Clinical narrative: ED Visit Hospital 5/14/22 DIAGNOSIS at time of disposition: 1. COVID-19 virus infection  2. COVID-19 virus detected   MEDICAL DECISION MAKING: Patient is a 74-year-old male presents with a chief complaint of shortness of breath.  Upon initial evaluation he is hemodynamically stable.  He does not appear in any distress.  He is resting with eyes closed, arouses easily to voice.  Patient's complaint is rather vague today.  I have seen him multiple times in the past and he frequently has vague complaints of feeling unwell in cannot expound upon this further.  Therefore, his differential is broad and will initiate a broad workup for him with screening labs, scan of head given wife's report of decreased level consciousness.  COVID-19 test returns positive.  CT of the head and chest x-ray do not show any significant changes.  His lab work is overall similar to prior.  His BNP is elevated but mildly so, chest x-ray does not show significant fluid overload he has no lower extremity edema.  Here he maintains normal oxygen saturation, no respiratory distress or difficulty breathing.  He has no wheezing so do not believe he requires albuterol.  A reviewed his medication list he has multiple interactions with paxlovid.  Furthermore, he does not have a delineated onset time.  Wife actually says is been multiple days that he has been feeling tired in she cannot tell me that it has been definitely within 5 days.  Therefore, do not believe she currently meets emergency use authorization for this medication.  Re-evaluation he is resting, appears well.  Will have him follow up with primary care physician by phone.  Discharged in stable condition.  MD 5/16/2022 Physician Hospitalist  DIAGNOSIS at time of disposition: 1. COVID-19  2. Acute respiratory failure with hypoxia  3. Acute on chronic renal insufficiency     HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male with chronic systolic congestive Heart failure and chronic kidney disease who has had 3 hospitalizations prior to this in the past 2 months for congestive heart failure.  Once again presents with shortness of breath and weakness.  He was COVID tested in the emergency department and it is positive.  Also patient had an elevated D-dimer of 8000 in the emergency department.  His chest x-ray shows congestive heart failure changes and bilateral lower lobe infiltrates and his BNP is at least 60,000. Creatinine has been steadily increasing over the past 2 months and is now at 2.7. As far as I can tell he is not had outpatient Nephrology follow-up, but was seen by nephrology at Hospital in early April
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram head, Condition aggravated, Depressed level of consciousness, Dyspnoea, Fatigue
Clinical narrative: ED Visit Hospital 5/14/22 DIAGNOSIS at time of disposition: 1. COVID-19 virus infection  2. COVID-19 virus detected   MEDICAL DECISION MAKING: Patient is a 74-year-old male presents with a chief complaint of shortness of breath.  Upon initial evaluation he is hemodynamically stable.  He does not appear in any distress.  He is resting with eyes closed, arouses easily to voice.  Patient's complaint is rather vague today.  I have seen him multiple times in the past and he frequently has vague complaints of feeling unwell in cannot expound upon this further.  Therefore, his differential is broad and will initiate a broad workup for him with screening labs, scan of head given wife's report of decreased level consciousness.  COVID-19 test returns positive.  CT of the head and chest x-ray do not show any significant changes.  His lab work is overall similar to prior.  His BNP is elevated but mildly so, chest x-ray does not show significant fluid overload he has no lower extremity edema.  Here he maintains normal oxygen saturation, no respiratory distress or difficulty breathing.  He has no wheezing so do not believe he requires albuterol.  A reviewed his medication list he has multiple interactions with paxlovid.  Furthermore, he does not have a delineated onset time.  Wife actually says is been multiple days that he has been feeling tired in she cannot tell me that it has been definitely within 5 days.  Therefore, do not believe she currently meets emergency use authorization for this medication.  Re-evaluation he is resting, appears well.  Will have him follow up with primary care physician by phone.  Discharged in stable condition.  MD 5/16/2022 Physician Hospitalist  DIAGNOSIS at time of disposition: 1. COVID-19  2. Acute respiratory failure with hypoxia  3. Acute on chronic renal insufficiency     HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male with chronic systolic congestive Heart failure and chronic kidney disease who has had 3 hospitalizations prior to this in the past 2 months for congestive heart failure.  Once again presents with shortness of breath and weakness.  He was COVID tested in the emergency department and it is positive.  Also patient had an elevated D-dimer of 8000 in the emergency department.  His chest x-ray shows congestive heart failure changes and bilateral lower lobe infiltrates and his BNP is at least 60,000. Creatinine has been steadily increasing over the past 2 months and is now at 2.7. As far as I can tell he is not had outpatient Nephrology follow-up, but was seen by nephrology at Hospital in early April
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Fibrin D dimer increased, Hypervolaemia, Laboratory test, Lung infiltration, Malaise
Clinical narrative: ED Visit Hospital 5/14/22 DIAGNOSIS at time of disposition: 1. COVID-19 virus infection  2. COVID-19 virus detected   MEDICAL DECISION MAKING: Patient is a 74-year-old male presents with a chief complaint of shortness of breath.  Upon initial evaluation he is hemodynamically stable.  He does not appear in any distress.  He is resting with eyes closed, arouses easily to voice.  Patient's complaint is rather vague today.  I have seen him multiple times in the past and he frequently has vague complaints of feeling unwell in cannot expound upon this further.  Therefore, his differential is broad and will initiate a broad workup for him with screening labs, scan of head given wife's report of decreased level consciousness.  COVID-19 test returns positive.  CT of the head and chest x-ray do not show any significant changes.  His lab work is overall similar to prior.  His BNP is elevated but mildly so, chest x-ray does not show significant fluid overload he has no lower extremity edema.  Here he maintains normal oxygen saturation, no respiratory distress or difficulty breathing.  He has no wheezing so do not believe he requires albuterol.  A reviewed his medication list he has multiple interactions with paxlovid.  Furthermore, he does not have a delineated onset time.  Wife actually says is been multiple days that he has been feeling tired in she cannot tell me that it has been definitely within 5 days.  Therefore, do not believe she currently meets emergency use authorization for this medication.  Re-evaluation he is resting, appears well.  Will have him follow up with primary care physician by phone.  Discharged in stable condition.  MD 5/16/2022 Physician Hospitalist  DIAGNOSIS at time of disposition: 1. COVID-19  2. Acute respiratory failure with hypoxia  3. Acute on chronic renal insufficiency     HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male with chronic systolic congestive Heart failure and chronic kidney disease who has had 3 hospitalizations prior to this in the past 2 months for congestive heart failure.  Once again presents with shortness of breath and weakness.  He was COVID tested in the emergency department and it is positive.  Also patient had an elevated D-dimer of 8000 in the emergency department.  His chest x-ray shows congestive heart failure changes and bilateral lower lobe infiltrates and his BNP is at least 60,000. Creatinine has been steadily increasing over the past 2 months and is now at 2.7. As far as I can tell he is not had outpatient Nephrology follow-up, but was seen by nephrology at Hospital in early April
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: ED Visit Hospital 5/14/22 DIAGNOSIS at time of disposition: 1. COVID-19 virus infection  2. COVID-19 virus detected   MEDICAL DECISION MAKING: Patient is a 74-year-old male presents with a chief complaint of shortness of breath.  Upon initial evaluation he is hemodynamically stable.  He does not appear in any distress.  He is resting with eyes closed, arouses easily to voice.  Patient's complaint is rather vague today.  I have seen him multiple times in the past and he frequently has vague complaints of feeling unwell in cannot expound upon this further.  Therefore, his differential is broad and will initiate a broad workup for him with screening labs, scan of head given wife's report of decreased level consciousness.  COVID-19 test returns positive.  CT of the head and chest x-ray do not show any significant changes.  His lab work is overall similar to prior.  His BNP is elevated but mildly so, chest x-ray does not show significant fluid overload he has no lower extremity edema.  Here he maintains normal oxygen saturation, no respiratory distress or difficulty breathing.  He has no wheezing so do not believe he requires albuterol.  A reviewed his medication list he has multiple interactions with paxlovid.  Furthermore, he does not have a delineated onset time.  Wife actually says is been multiple days that he has been feeling tired in she cannot tell me that it has been definitely within 5 days.  Therefore, do not believe she currently meets emergency use authorization for this medication.  Re-evaluation he is resting, appears well.  Will have him follow up with primary care physician by phone.  Discharged in stable condition.  MD 5/16/2022 Physician Hospitalist  DIAGNOSIS at time of disposition: 1. COVID-19  2. Acute respiratory failure with hypoxia  3. Acute on chronic renal insufficiency     HISTORY OF PRESENT ILLNESS: Patient is a 74 y.o. male with chronic systolic congestive Heart failure and chronic kidney disease who has had 3 hospitalizations prior to this in the past 2 months for congestive heart failure.  Once again presents with shortness of breath and weakness.  He was COVID tested in the emergency department and it is positive.  Also patient had an elevated D-dimer of 8000 in the emergency department.  His chest x-ray shows congestive heart failure changes and bilateral lower lobe infiltrates and his BNP is at least 60,000. Creatinine has been steadily increasing over the past 2 months and is now at 2.7. As far as I can tell he is not had outpatient Nephrology follow-up, but was seen by nephrology at Hospital in early April
Age: 63.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Bacterial test positive, Bladder catheter replacement, Blood alkaline phosphatase increased, Blood lactic acid, Blood sodium decreased
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 1/25/21 (lot NA) Pfizer Dose 2 2/15/21 (lot NA) Pfizer Dose 3 11/2/21 (301308A) COVID Positive 12/8/21  12/8/21: Patient is a 63 year old female with PMH multiple sclerosis, anemia, chronic osteomyelitis of the pelvis, GERD, heart failure with preserved ejection fraction, neurogenic bladder with chronic suprapubic urinary catheter, chronic G-tube, ileostomy, legally blind who presented to the ED today due to altered mental status. She lives at facility and was noted to be confused with some low blood pressures and was sent to the ED.   Upon exam patient notes she is currently better than she was.  She notes her only pain is just below the waist. Denies any chest pain or shortness of breath.  Feels things are stuck in her esophagus.  She has a very dry mouth.  She otherwise denies headaches, nausea, abdominal pain, diarrhea, or constipation.   In the ED she was initially afebrile with a blood pressure 141/117 but then decreased to 91/55.  She was saturating 96% on room air with pulse 97. Labs are notable for sodium 132, ALP 135, lactic acid 2.2, WBC 35.13.  Urine with large leukocyte esterase, loaded bacteria, no RBCs.  Although patient asymptomatic, she did test COVID positive.  She received ceftriaxone and 2.5 L of fluid in the ED.   Surgical history:  Ileostomy, chronic G-tube, chronic suprapubic catheter  Social history:  Lives at facility  FH: Noncontributory  12/11/21: Patient is a 63 year old female with PMH multiple sclerosis, anemia, chronic osteomyelitis of the pelvis, GERD, heart failure with preserved ejection fraction, neurogenic bladder with chronic suprapubic urinary catheter, chronic G-tube, ileostomy, legally blind who had presented to the ER on 12/8/21 due to AMS and low BPs. Pt was found to have UTI with sepsis thought 2/2 indwelling suprapubic catheter. Urology was consulted and the catheter was changed out. Urine studies came back sensitive to ceftriaxone but resistant to Keflex. Given pt has allergies to Bactrim, pt will continue IM ceftriaxone 1gm for a total of 10 course given complicated UTI.  Oxybutynin was initiated by Urology which was continued on discharge.  Pt is doing well. No pain, no drainage around catheter site. Has been stable without fevers for the last few days. Will f/u with urology given renal stones in 2-3 weeks. F/U with PCP within 1-2 weeks after discharge. Holding Home Metoprolol on discharge with BP to be monitored outpatient and resumed if appropriate. Pt discharge back to facility in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Confusional state, Dry mouth, Hypotension, Laboratory test
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 1/25/21 (lot NA) Pfizer Dose 2 2/15/21 (lot NA) Pfizer Dose 3 11/2/21 (301308A) COVID Positive 12/8/21  12/8/21: Patient is a 63 year old female with PMH multiple sclerosis, anemia, chronic osteomyelitis of the pelvis, GERD, heart failure with preserved ejection fraction, neurogenic bladder with chronic suprapubic urinary catheter, chronic G-tube, ileostomy, legally blind who presented to the ED today due to altered mental status. She lives at facility and was noted to be confused with some low blood pressures and was sent to the ED.   Upon exam patient notes she is currently better than she was.  She notes her only pain is just below the waist. Denies any chest pain or shortness of breath.  Feels things are stuck in her esophagus.  She has a very dry mouth.  She otherwise denies headaches, nausea, abdominal pain, diarrhea, or constipation.   In the ED she was initially afebrile with a blood pressure 141/117 but then decreased to 91/55.  She was saturating 96% on room air with pulse 97. Labs are notable for sodium 132, ALP 135, lactic acid 2.2, WBC 35.13.  Urine with large leukocyte esterase, loaded bacteria, no RBCs.  Although patient asymptomatic, she did test COVID positive.  She received ceftriaxone and 2.5 L of fluid in the ED.   Surgical history:  Ileostomy, chronic G-tube, chronic suprapubic catheter  Social history:  Lives at facility  FH: Noncontributory  12/11/21: Patient is a 63 year old female with PMH multiple sclerosis, anemia, chronic osteomyelitis of the pelvis, GERD, heart failure with preserved ejection fraction, neurogenic bladder with chronic suprapubic urinary catheter, chronic G-tube, ileostomy, legally blind who had presented to the ER on 12/8/21 due to AMS and low BPs. Pt was found to have UTI with sepsis thought 2/2 indwelling suprapubic catheter. Urology was consulted and the catheter was changed out. Urine studies came back sensitive to ceftriaxone but resistant to Keflex. Given pt has allergies to Bactrim, pt will continue IM ceftriaxone 1gm for a total of 10 course given complicated UTI.  Oxybutynin was initiated by Urology which was continued on discharge.  Pt is doing well. No pain, no drainage around catheter site. Has been stable without fevers for the last few days. Will f/u with urology given renal stones in 2-3 weeks. F/U with PCP within 1-2 weeks after discharge. Holding Home Metoprolol on discharge with BP to be monitored outpatient and resumed if appropriate. Pt discharge back to facility in stable condition.
Age: 63.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Mental status changes, Nephrolithiasis, Pain, Red blood cells urine negative, SARS-CoV-2 test positive
Clinical narrative: COVID Vaccine Breakthrough CAse  Pfizer Dose 1 1/25/21 (lot NA) Pfizer Dose 2 2/15/21 (lot NA) Pfizer Dose 3 11/2/21 (301308A) COVID Positive 12/8/21  12/8/21: Patient is a 63 year old female with PMH multiple sclerosis, anemia, chronic osteomyelitis of the pelvis, GERD, heart failure with preserved ejection fraction, neurogenic bladder with chronic suprapubic urinary catheter, chronic G-tube, ileostomy, legally blind who presented to the ED today due to altered mental status. She lives at facility and was noted to be confused with some low blood pressures and was sent to the ED.   Upon exam patient notes she is currently better than she was.  She notes her only pain is just below the waist. Denies any chest pain or shortness of breath.  Feels things are stuck in her esophagus.  She has a very dry mouth.  She otherwise denies headaches, nausea, abdominal pain, diarrhea, or constipation.   In the ED she was initially afebrile with a blood pressure 141/117 but then decreased to 91/55.  She was saturating 96% on room air with pulse 97. Labs are notable for sodium 132, ALP 135, lactic acid 2.2, WBC 35.13.  Urine with large leukocyte esterase, loaded bacteria, no RBCs.  Although patient asymptomatic, she did test COVID positive.  She received ceftriaxone and 2.5 L of fluid in the ED.   Surgical history:  Ileostomy, chronic G-tube, chronic suprapubic catheter  Social history:  Lives at facility  FH: Noncontributory  12/11/21: Patient is a 63 year old female with PMH multiple sclerosis, anemia, chronic osteomyelitis of the pelvis, GERD, heart failure with preserved ejection fraction, neurogenic bladder with chronic suprapubic urinary catheter, chronic G-tube, ileostomy, legally blind who had presented to the ER on 12/8/21 due to AMS and low BPs. Pt was found to have UTI with sepsis thought 2/2 indwelling suprapubic catheter. Urology was consulted and the catheter was changed out. Urine studies came back sensitive to ceftriaxone but resistant to Keflex. Given pt has allergies to Bactrim, pt will continue IM ceftriaxone 1gm for a total of 10 course given complicated UTI.  Oxybutynin was initiated by Urology which was continued on discharge.  Pt is doing well. No pain, no drainage around catheter site. Has been stable without fevers for the last few days. Will f/u with urology given renal stones in 2-3 weeks. F/U with PCP within 1-2 weeks after discharge. Holding Home Metoprolol on discharge with BP to be monitored outpatient and resumed if appropriate. Pt discharge back to facility in stable condition.