chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: White blood cell count increased, Wound closure, Wound treatment
Clinical narrative: Patient is a 56 y.o. female who presented to the hospital with  abdominal pain and was found to have perforated acute diverticulitis with  associated pneumoperitoneum. She underwent exploratory laparotomy with  sigmoidectomy and end colostomy on 9/18/23. Patient has a known history of  solitary transplanted kidney and nephrology was consulted post  operatively, resumed her home immunosuppresion. On POD2, patient developed  acute encephalopathy, hypotension, tachycardia, she was ultimately and  transported to the ICU on 9/20/23. She was initiated on CRRT as she  quickly went into renal failure. While in the ICU, she was initiated on  stress dose steroids, patient remained olgiuric and required several  pressors to augment blood pressure.  She was also found to be COVID + and  started on remdesevir and covid dosing decadron, she remained in  isolation, patient was extubated on 9/24/23. Throughout her ICU stay, from  an abdominal standpoint, patient progressed well, she had daily dressing  changes to her midline until a wound vac was placed. Her JP drain remained  serous, and she had adequate stoma output. When she was off pressors, her  tube feeds were advanced to goal, which she tolerated well.  CT CAP 9/29  was done in the context of increased WBC without cause and found  significant hydronephrosis in her newer L sided kidney transplant. She was  taken to VIR and had a drain placed 9/30. By 10/1 she was advanced to  regular diet with renal restrictions. During this time, the pt was kept  for observation as she waited on placement to a rehab facility. On 10/9,  patient's stoma was noted to be dusky and with mucocutaneous separation.  She was taken back to the operating room on 10/10 for revision of her  ostomy. Her wound vac was removed at this time and replaced with wet to  dry dressing. She tolerated the operation well and the ostomy had good  output by POD2. At time of discharge the patient was tolerating a diet,  producing urine through her nephrostomy tube, and had good stoma output.  Her pain was well controlled with oral medications. She was discharged to in-patient rehab. She was instructed to follow up with  ACS clinic  in 2 weeks.    Discharge Diagnoses:   Perforated sigmoid diverticulitis s/p Hartmann's procedure (Sigmoid colectomy with end colostomy)
Age: 78.0
Sex: F
Vaccine: RSV
Symptoms: Herpes zoster
Clinical narrative: Shingles
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Asthma, COVID-19, Chest X-ray abnormal
Clinical narrative: Patient is a 82 y.o. female who presented as a direct admission from home on 10/12/2023 with COVID-19 and asthma/COPD exacerbation.            Assessment and Plan   Acute asthma exacerbation Acute hypoxic respiratory failure  -Pt has a history of asthma however she also has a history of exposure to secondhand smoke from her husband who is a longtime smoker. In addition, she and her husband both worked as floor refinishers and suspect some element of chronic exposure to noxious stimuli/COPD/bronchiolitis playing a role in her underlying lung disease. -At home she uses Breo with albuterol inhaler/nebulizer as needed. -Acute exacerbation likely secondary to COVID-19 however her daughter mentioned that she often has significant exertional dyspnea so have to wonder if she has some element of chronic hypoxia at baseline. -CT chest 10/13/2023 with chronic changes as noted below. -IV steroids, Zithromax, bronchodilators, incentive spirometry, and mucolytic started on admission. -Required up to 3 L O2 nasal cannula since admission and down to 1 L nasal cannula since 10/16/2023. -She desaturates into the 80s on room air and was set up for home O2.   COVID 19 - Presented with: cough, sob  - Symptom onset: 10/4/23  - Positive COVID-19: 10/12 at PC  - Vaccination status: vaccinated X 2,  did not get any boosters -Outpatient chest x-ray prior to admission showed viral pneumonia. - Oxygen status: 1L as of 10/17/2023. - Decadron: Yes. Expected end date 10/22/2023. - Remdesivir: Does not qualify due to > 7 days since symptom onset.  - DVT prophylaxis:Lovenox   Abnormal CT chest Elevated D-Dimer -Elevated D-Dimer in the setting of COVID-19. -CTPA and lower extremity venous Dopplers negative for PE/DVT respectively however CTPA 10/13/2023 showed extensive nodular tree-in-bud nodularity concerning for bronchiolitis and repeat CT chest in 3 months was recommended by radiology. -Treatment as noted above for asthma/COPD exacerbation. -Discharged to home on 7 days of p.o. doxycycline. Essential HTN -Stable on triamterene-hydrochlorothiazide   Hypothyroidism - continue levothyroxine    Chronic Joint Pain, Multiple Joints -Noted primarily in the hands, reportedly OA per history. -Patient has experienced marked improvement in chronic pain on steroids.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Dyspnoea
Clinical narrative: Patient is a 82 y.o. female who presented as a direct admission from home on 10/12/2023 with COVID-19 and asthma/COPD exacerbation.            Assessment and Plan   Acute asthma exacerbation Acute hypoxic respiratory failure  -Pt has a history of asthma however she also has a history of exposure to secondhand smoke from her husband who is a longtime smoker. In addition, she and her husband both worked as floor refinishers and suspect some element of chronic exposure to noxious stimuli/COPD/bronchiolitis playing a role in her underlying lung disease. -At home she uses Breo with albuterol inhaler/nebulizer as needed. -Acute exacerbation likely secondary to COVID-19 however her daughter mentioned that she often has significant exertional dyspnea so have to wonder if she has some element of chronic hypoxia at baseline. -CT chest 10/13/2023 with chronic changes as noted below. -IV steroids, Zithromax, bronchodilators, incentive spirometry, and mucolytic started on admission. -Required up to 3 L O2 nasal cannula since admission and down to 1 L nasal cannula since 10/16/2023. -She desaturates into the 80s on room air and was set up for home O2.   COVID 19 - Presented with: cough, sob  - Symptom onset: 10/4/23  - Positive COVID-19: 10/12 at PC  - Vaccination status: vaccinated X 2,  did not get any boosters -Outpatient chest x-ray prior to admission showed viral pneumonia. - Oxygen status: 1L as of 10/17/2023. - Decadron: Yes. Expected end date 10/22/2023. - Remdesivir: Does not qualify due to > 7 days since symptom onset.  - DVT prophylaxis:Lovenox   Abnormal CT chest Elevated D-Dimer -Elevated D-Dimer in the setting of COVID-19. -CTPA and lower extremity venous Dopplers negative for PE/DVT respectively however CTPA 10/13/2023 showed extensive nodular tree-in-bud nodularity concerning for bronchiolitis and repeat CT chest in 3 months was recommended by radiology. -Treatment as noted above for asthma/COPD exacerbation. -Discharged to home on 7 days of p.o. doxycycline. Essential HTN -Stable on triamterene-hydrochlorothiazide   Hypothyroidism - continue levothyroxine    Chronic Joint Pain, Multiple Joints -Noted primarily in the hands, reportedly OA per history. -Patient has experienced marked improvement in chronic pain on steroids.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea exertional, Fibrin D dimer increased, Oxygen saturation decreased, Pneumonia viral, Pulmonary mass
Clinical narrative: Patient is a 82 y.o. female who presented as a direct admission from home on 10/12/2023 with COVID-19 and asthma/COPD exacerbation.            Assessment and Plan   Acute asthma exacerbation Acute hypoxic respiratory failure  -Pt has a history of asthma however she also has a history of exposure to secondhand smoke from her husband who is a longtime smoker. In addition, she and her husband both worked as floor refinishers and suspect some element of chronic exposure to noxious stimuli/COPD/bronchiolitis playing a role in her underlying lung disease. -At home she uses Breo with albuterol inhaler/nebulizer as needed. -Acute exacerbation likely secondary to COVID-19 however her daughter mentioned that she often has significant exertional dyspnea so have to wonder if she has some element of chronic hypoxia at baseline. -CT chest 10/13/2023 with chronic changes as noted below. -IV steroids, Zithromax, bronchodilators, incentive spirometry, and mucolytic started on admission. -Required up to 3 L O2 nasal cannula since admission and down to 1 L nasal cannula since 10/16/2023. -She desaturates into the 80s on room air and was set up for home O2.   COVID 19 - Presented with: cough, sob  - Symptom onset: 10/4/23  - Positive COVID-19: 10/12 at PC  - Vaccination status: vaccinated X 2,  did not get any boosters -Outpatient chest x-ray prior to admission showed viral pneumonia. - Oxygen status: 1L as of 10/17/2023. - Decadron: Yes. Expected end date 10/22/2023. - Remdesivir: Does not qualify due to > 7 days since symptom onset.  - DVT prophylaxis:Lovenox   Abnormal CT chest Elevated D-Dimer -Elevated D-Dimer in the setting of COVID-19. -CTPA and lower extremity venous Dopplers negative for PE/DVT respectively however CTPA 10/13/2023 showed extensive nodular tree-in-bud nodularity concerning for bronchiolitis and repeat CT chest in 3 months was recommended by radiology. -Treatment as noted above for asthma/COPD exacerbation. -Discharged to home on 7 days of p.o. doxycycline. Essential HTN -Stable on triamterene-hydrochlorothiazide   Hypothyroidism - continue levothyroxine    Chronic Joint Pain, Multiple Joints -Noted primarily in the hands, reportedly OA per history. -Patient has experienced marked improvement in chronic pain on steroids.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Ultrasound Doppler normal
Clinical narrative: Patient is a 82 y.o. female who presented as a direct admission from home on 10/12/2023 with COVID-19 and asthma/COPD exacerbation.            Assessment and Plan   Acute asthma exacerbation Acute hypoxic respiratory failure  -Pt has a history of asthma however she also has a history of exposure to secondhand smoke from her husband who is a longtime smoker. In addition, she and her husband both worked as floor refinishers and suspect some element of chronic exposure to noxious stimuli/COPD/bronchiolitis playing a role in her underlying lung disease. -At home she uses Breo with albuterol inhaler/nebulizer as needed. -Acute exacerbation likely secondary to COVID-19 however her daughter mentioned that she often has significant exertional dyspnea so have to wonder if she has some element of chronic hypoxia at baseline. -CT chest 10/13/2023 with chronic changes as noted below. -IV steroids, Zithromax, bronchodilators, incentive spirometry, and mucolytic started on admission. -Required up to 3 L O2 nasal cannula since admission and down to 1 L nasal cannula since 10/16/2023. -She desaturates into the 80s on room air and was set up for home O2.   COVID 19 - Presented with: cough, sob  - Symptom onset: 10/4/23  - Positive COVID-19: 10/12 at PC  - Vaccination status: vaccinated X 2,  did not get any boosters -Outpatient chest x-ray prior to admission showed viral pneumonia. - Oxygen status: 1L as of 10/17/2023. - Decadron: Yes. Expected end date 10/22/2023. - Remdesivir: Does not qualify due to > 7 days since symptom onset.  - DVT prophylaxis:Lovenox   Abnormal CT chest Elevated D-Dimer -Elevated D-Dimer in the setting of COVID-19. -CTPA and lower extremity venous Dopplers negative for PE/DVT respectively however CTPA 10/13/2023 showed extensive nodular tree-in-bud nodularity concerning for bronchiolitis and repeat CT chest in 3 months was recommended by radiology. -Treatment as noted above for asthma/COPD exacerbation. -Discharged to home on 7 days of p.o. doxycycline. Essential HTN -Stable on triamterene-hydrochlorothiazide   Hypothyroidism - continue levothyroxine    Chronic Joint Pain, Multiple Joints -Noted primarily in the hands, reportedly OA per history. -Patient has experienced marked improvement in chronic pain on steroids.
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Blood culture negative, Blood lactic acid, Blood pressure increased
Clinical narrative: Patient is a 38 y.o. male patient with no significant past medical history who presented with cough.   Acute Respiratory Failure w/Hypoxia Secondary to multifocal PNA Requiring 2-3L NC on admission, RA at baseline with no history of lung or cardiac disease Initial CXR w/multifocal PNA CTA neg PE, + multifocal PNA; appearance of resolving COVID pneumonia with bilateral lower lobe secondary bacterial pneumonia Aggressive pulmonary hygiene Wean O2 as able to maintain SpO2 >90 Stable on RA 10/18, no desat with walking   Sepsis Multifocal secondary bacterial PNA, suspected gram negative Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, leukocytosis, source Evidence of end organ damage: none Initial lactic acid: 1.8 Initial antibiotic regimen: Rocephin/Azithro Culture data: Blood cultures NGTD, Resp PCR negative Vasopressors/steroids: none Status post Gentle IVF hydration  Adjusted abx per CAP protocol to ceftin to finish 5d course   Covid-19 Virus Infection Date of onset of symptoms: initial circa 01/1, recurrence of symproms10/15 Symptoms present on admission: cough, fever, chills, SOB Date of covid positive test: >2wks PTA Vaccination status: vaccinated Imaging: CTA w/multifocal PNA Oxygen requirements on admission: 2-3L NC Medical therapy: decadron stopped due to O2 requirement resolved, out of remdesivir window   Elevated Troponin Asytmpomatic, likely secondary to demand ischemia Troponin 29 -> 27 EKG w/o acute ischemic changes No further workup   Hyperlipidemia LDL 154, HDL 11 Too young for 10 year ASCVD risk score Strong consideration for addition of statin if not improved with lifestyle modification, needs PCP follow up Discussed with patient   Elevated blood pressure readings BP maintaining around 160 systolic here No known hypertension, states to his knowledge he has normal BP Given acute illness, steroid use, hold off on starting hypertension meds on discharge per discussion with patient.  Discussed need for home BP monitoring and close PCP follow up and he should start on medication if hypertension persists
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Chills, Cough, Dyspnoea
Clinical narrative: Patient is a 38 y.o. male patient with no significant past medical history who presented with cough.   Acute Respiratory Failure w/Hypoxia Secondary to multifocal PNA Requiring 2-3L NC on admission, RA at baseline with no history of lung or cardiac disease Initial CXR w/multifocal PNA CTA neg PE, + multifocal PNA; appearance of resolving COVID pneumonia with bilateral lower lobe secondary bacterial pneumonia Aggressive pulmonary hygiene Wean O2 as able to maintain SpO2 >90 Stable on RA 10/18, no desat with walking   Sepsis Multifocal secondary bacterial PNA, suspected gram negative Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, leukocytosis, source Evidence of end organ damage: none Initial lactic acid: 1.8 Initial antibiotic regimen: Rocephin/Azithro Culture data: Blood cultures NGTD, Resp PCR negative Vasopressors/steroids: none Status post Gentle IVF hydration  Adjusted abx per CAP protocol to ceftin to finish 5d course   Covid-19 Virus Infection Date of onset of symptoms: initial circa 01/1, recurrence of symproms10/15 Symptoms present on admission: cough, fever, chills, SOB Date of covid positive test: >2wks PTA Vaccination status: vaccinated Imaging: CTA w/multifocal PNA Oxygen requirements on admission: 2-3L NC Medical therapy: decadron stopped due to O2 requirement resolved, out of remdesivir window   Elevated Troponin Asytmpomatic, likely secondary to demand ischemia Troponin 29 -> 27 EKG w/o acute ischemic changes No further workup   Hyperlipidemia LDL 154, HDL 11 Too young for 10 year ASCVD risk score Strong consideration for addition of statin if not improved with lifestyle modification, needs PCP follow up Discussed with patient   Elevated blood pressure readings BP maintaining around 160 systolic here No known hypertension, states to his knowledge he has normal BP Given acute illness, steroid use, hold off on starting hypertension meds on discharge per discussion with patient.  Discussed need for home BP monitoring and close PCP follow up and he should start on medication if hypertension persists
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: Electrocardiogram normal, High density lipoprotein decreased, Hyperlipidaemia, Hypoxia, Low density lipoprotein increased
Clinical narrative: Patient is a 38 y.o. male patient with no significant past medical history who presented with cough.   Acute Respiratory Failure w/Hypoxia Secondary to multifocal PNA Requiring 2-3L NC on admission, RA at baseline with no history of lung or cardiac disease Initial CXR w/multifocal PNA CTA neg PE, + multifocal PNA; appearance of resolving COVID pneumonia with bilateral lower lobe secondary bacterial pneumonia Aggressive pulmonary hygiene Wean O2 as able to maintain SpO2 >90 Stable on RA 10/18, no desat with walking   Sepsis Multifocal secondary bacterial PNA, suspected gram negative Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, leukocytosis, source Evidence of end organ damage: none Initial lactic acid: 1.8 Initial antibiotic regimen: Rocephin/Azithro Culture data: Blood cultures NGTD, Resp PCR negative Vasopressors/steroids: none Status post Gentle IVF hydration  Adjusted abx per CAP protocol to ceftin to finish 5d course   Covid-19 Virus Infection Date of onset of symptoms: initial circa 01/1, recurrence of symproms10/15 Symptoms present on admission: cough, fever, chills, SOB Date of covid positive test: >2wks PTA Vaccination status: vaccinated Imaging: CTA w/multifocal PNA Oxygen requirements on admission: 2-3L NC Medical therapy: decadron stopped due to O2 requirement resolved, out of remdesivir window   Elevated Troponin Asytmpomatic, likely secondary to demand ischemia Troponin 29 -> 27 EKG w/o acute ischemic changes No further workup   Hyperlipidemia LDL 154, HDL 11 Too young for 10 year ASCVD risk score Strong consideration for addition of statin if not improved with lifestyle modification, needs PCP follow up Discussed with patient   Elevated blood pressure readings BP maintaining around 160 systolic here No known hypertension, states to his knowledge he has normal BP Given acute illness, steroid use, hold off on starting hypertension meds on discharge per discussion with patient.  Discussed need for home BP monitoring and close PCP follow up and he should start on medication if hypertension persists
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: Myocardial ischaemia, Pneumonia, Pneumonia bacterial, Polymerase chain reaction negative, Pyrexia
Clinical narrative: Patient is a 38 y.o. male patient with no significant past medical history who presented with cough.   Acute Respiratory Failure w/Hypoxia Secondary to multifocal PNA Requiring 2-3L NC on admission, RA at baseline with no history of lung or cardiac disease Initial CXR w/multifocal PNA CTA neg PE, + multifocal PNA; appearance of resolving COVID pneumonia with bilateral lower lobe secondary bacterial pneumonia Aggressive pulmonary hygiene Wean O2 as able to maintain SpO2 >90 Stable on RA 10/18, no desat with walking   Sepsis Multifocal secondary bacterial PNA, suspected gram negative Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, leukocytosis, source Evidence of end organ damage: none Initial lactic acid: 1.8 Initial antibiotic regimen: Rocephin/Azithro Culture data: Blood cultures NGTD, Resp PCR negative Vasopressors/steroids: none Status post Gentle IVF hydration  Adjusted abx per CAP protocol to ceftin to finish 5d course   Covid-19 Virus Infection Date of onset of symptoms: initial circa 01/1, recurrence of symproms10/15 Symptoms present on admission: cough, fever, chills, SOB Date of covid positive test: >2wks PTA Vaccination status: vaccinated Imaging: CTA w/multifocal PNA Oxygen requirements on admission: 2-3L NC Medical therapy: decadron stopped due to O2 requirement resolved, out of remdesivir window   Elevated Troponin Asytmpomatic, likely secondary to demand ischemia Troponin 29 -> 27 EKG w/o acute ischemic changes No further workup   Hyperlipidemia LDL 154, HDL 11 Too young for 10 year ASCVD risk score Strong consideration for addition of statin if not improved with lifestyle modification, needs PCP follow up Discussed with patient   Elevated blood pressure readings BP maintaining around 160 systolic here No known hypertension, states to his knowledge he has normal BP Given acute illness, steroid use, hold off on starting hypertension meds on discharge per discussion with patient.  Discussed need for home BP monitoring and close PCP follow up and he should start on medication if hypertension persists
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis, Troponin increased
Clinical narrative: Patient is a 38 y.o. male patient with no significant past medical history who presented with cough.   Acute Respiratory Failure w/Hypoxia Secondary to multifocal PNA Requiring 2-3L NC on admission, RA at baseline with no history of lung or cardiac disease Initial CXR w/multifocal PNA CTA neg PE, + multifocal PNA; appearance of resolving COVID pneumonia with bilateral lower lobe secondary bacterial pneumonia Aggressive pulmonary hygiene Wean O2 as able to maintain SpO2 >90 Stable on RA 10/18, no desat with walking   Sepsis Multifocal secondary bacterial PNA, suspected gram negative Present on admission: yes Etiology: PNA Criteria: tachycardia, tachypnea, leukocytosis, source Evidence of end organ damage: none Initial lactic acid: 1.8 Initial antibiotic regimen: Rocephin/Azithro Culture data: Blood cultures NGTD, Resp PCR negative Vasopressors/steroids: none Status post Gentle IVF hydration  Adjusted abx per CAP protocol to ceftin to finish 5d course   Covid-19 Virus Infection Date of onset of symptoms: initial circa 01/1, recurrence of symproms10/15 Symptoms present on admission: cough, fever, chills, SOB Date of covid positive test: >2wks PTA Vaccination status: vaccinated Imaging: CTA w/multifocal PNA Oxygen requirements on admission: 2-3L NC Medical therapy: decadron stopped due to O2 requirement resolved, out of remdesivir window   Elevated Troponin Asytmpomatic, likely secondary to demand ischemia Troponin 29 -> 27 EKG w/o acute ischemic changes No further workup   Hyperlipidemia LDL 154, HDL 11 Too young for 10 year ASCVD risk score Strong consideration for addition of statin if not improved with lifestyle modification, needs PCP follow up Discussed with patient   Elevated blood pressure readings BP maintaining around 160 systolic here No known hypertension, states to his knowledge he has normal BP Given acute illness, steroid use, hold off on starting hypertension meds on discharge per discussion with patient.  Discussed need for home BP monitoring and close PCP follow up and he should start on medication if hypertension persists
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Blood culture, Blood lactic acid, COVID-19, Chest X-ray normal
Clinical narrative: Patient is a 67 y.o. female patient of MD with history of A-fib, factor XI deficiency, cerebral palsy, CAD, COPD presented to Medical Center with cough, diarrhea and fevers.     Sepsis due to Covid -19 virus, sepsis now resolved  Tmax 101.7, tachycardic, tachypneic, WBC 4.14, LA 1.2 CXR with no acute process Possible source: UTI, more likely 2/2 COVID Blood cxs collected before abx, urine cxs collected after abx S/p CTX in ED, UA unremarkable, S/p 1 L bolus   Completed Keflex   Covid-19 Virus Infection Date of onset of symptoms: 10/12 Symptoms present on admission: yes Date of covid positive test: 10/14 Vaccination status: vaccinated Imaging: negative CXR Oxygen requirements on admission: was on 2L but for comfort, not hypoxic Current oxygen requirements: none Medical therapy: remdesivir Consultants following: ID Anticipated special isolation end date: 10/22   E. Coli UTI 10/10/2023 Ucx with pan-susceptible E.coli  Treated with keflex outpatient (last day 10/16) Symptoms have largely resolved, no dysuria, does report urinary frequency UA unremarkable on admission S/p one dose CTX in ED Completed Keflex    Chronic RLE DVT Noted since at least 2018 Continue home eliquis Left sided abdominal pain - resolved CT AP without left sided intraabdominal pathology Lipase wnl   Hepatomegaly Noted on CT LFTs wnl 10/10/2023 Hep panel negative Can check US Abdomen o/p   Sinus pauses Loop recorder placed 10/3, found to have sinus pauses, no evidence of A-fib Follows with cardiology outpatient   HTN Hypertensive to 150s on admission Continue home amlodipine, imdur   CAD NM Stress 4/2023 without inducible ischemia, normal LVSF EF 66% Continue home ASA, statin   COPD Not in exacerbation Continue home albuterol, flovent   Hx of cerebral palsy Lives alone in apartment   Dispo PT/OT recs c/w SNF;however, pt. Refusing adamantly Agrees to HHC
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram abdomen abnormal, Cough, Culture urine, Diarrhoea, Ejection fraction normal
Clinical narrative: Patient is a 67 y.o. female patient of MD with history of A-fib, factor XI deficiency, cerebral palsy, CAD, COPD presented to Medical Center with cough, diarrhea and fevers.     Sepsis due to Covid -19 virus, sepsis now resolved  Tmax 101.7, tachycardic, tachypneic, WBC 4.14, LA 1.2 CXR with no acute process Possible source: UTI, more likely 2/2 COVID Blood cxs collected before abx, urine cxs collected after abx S/p CTX in ED, UA unremarkable, S/p 1 L bolus   Completed Keflex   Covid-19 Virus Infection Date of onset of symptoms: 10/12 Symptoms present on admission: yes Date of covid positive test: 10/14 Vaccination status: vaccinated Imaging: negative CXR Oxygen requirements on admission: was on 2L but for comfort, not hypoxic Current oxygen requirements: none Medical therapy: remdesivir Consultants following: ID Anticipated special isolation end date: 10/22   E. Coli UTI 10/10/2023 Ucx with pan-susceptible E.coli  Treated with keflex outpatient (last day 10/16) Symptoms have largely resolved, no dysuria, does report urinary frequency UA unremarkable on admission S/p one dose CTX in ED Completed Keflex    Chronic RLE DVT Noted since at least 2018 Continue home eliquis Left sided abdominal pain - resolved CT AP without left sided intraabdominal pathology Lipase wnl   Hepatomegaly Noted on CT LFTs wnl 10/10/2023 Hep panel negative Can check US Abdomen o/p   Sinus pauses Loop recorder placed 10/3, found to have sinus pauses, no evidence of A-fib Follows with cardiology outpatient   HTN Hypertensive to 150s on admission Continue home amlodipine, imdur   CAD NM Stress 4/2023 without inducible ischemia, normal LVSF EF 66% Continue home ASA, statin   COPD Not in exacerbation Continue home albuterol, flovent   Hx of cerebral palsy Lives alone in apartment   Dispo PT/OT recs c/w SNF;however, pt. Refusing adamantly Agrees to HHC
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Escherichia infection, Hepatitis viral test negative, Hepatomegaly, Hypertension, Implantable cardiac monitor insertion
Clinical narrative: Patient is a 67 y.o. female patient of MD with history of A-fib, factor XI deficiency, cerebral palsy, CAD, COPD presented to Medical Center with cough, diarrhea and fevers.     Sepsis due to Covid -19 virus, sepsis now resolved  Tmax 101.7, tachycardic, tachypneic, WBC 4.14, LA 1.2 CXR with no acute process Possible source: UTI, more likely 2/2 COVID Blood cxs collected before abx, urine cxs collected after abx S/p CTX in ED, UA unremarkable, S/p 1 L bolus   Completed Keflex   Covid-19 Virus Infection Date of onset of symptoms: 10/12 Symptoms present on admission: yes Date of covid positive test: 10/14 Vaccination status: vaccinated Imaging: negative CXR Oxygen requirements on admission: was on 2L but for comfort, not hypoxic Current oxygen requirements: none Medical therapy: remdesivir Consultants following: ID Anticipated special isolation end date: 10/22   E. Coli UTI 10/10/2023 Ucx with pan-susceptible E.coli  Treated with keflex outpatient (last day 10/16) Symptoms have largely resolved, no dysuria, does report urinary frequency UA unremarkable on admission S/p one dose CTX in ED Completed Keflex    Chronic RLE DVT Noted since at least 2018 Continue home eliquis Left sided abdominal pain - resolved CT AP without left sided intraabdominal pathology Lipase wnl   Hepatomegaly Noted on CT LFTs wnl 10/10/2023 Hep panel negative Can check US Abdomen o/p   Sinus pauses Loop recorder placed 10/3, found to have sinus pauses, no evidence of A-fib Follows with cardiology outpatient   HTN Hypertensive to 150s on admission Continue home amlodipine, imdur   CAD NM Stress 4/2023 without inducible ischemia, normal LVSF EF 66% Continue home ASA, statin   COPD Not in exacerbation Continue home albuterol, flovent   Hx of cerebral palsy Lives alone in apartment   Dispo PT/OT recs c/w SNF;however, pt. Refusing adamantly Agrees to HHC
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Lipase normal, Liver function test normal, Pathology test, Pollakiuria, Pyrexia
Clinical narrative: Patient is a 67 y.o. female patient of MD with history of A-fib, factor XI deficiency, cerebral palsy, CAD, COPD presented to Medical Center with cough, diarrhea and fevers.     Sepsis due to Covid -19 virus, sepsis now resolved  Tmax 101.7, tachycardic, tachypneic, WBC 4.14, LA 1.2 CXR with no acute process Possible source: UTI, more likely 2/2 COVID Blood cxs collected before abx, urine cxs collected after abx S/p CTX in ED, UA unremarkable, S/p 1 L bolus   Completed Keflex   Covid-19 Virus Infection Date of onset of symptoms: 10/12 Symptoms present on admission: yes Date of covid positive test: 10/14 Vaccination status: vaccinated Imaging: negative CXR Oxygen requirements on admission: was on 2L but for comfort, not hypoxic Current oxygen requirements: none Medical therapy: remdesivir Consultants following: ID Anticipated special isolation end date: 10/22   E. Coli UTI 10/10/2023 Ucx with pan-susceptible E.coli  Treated with keflex outpatient (last day 10/16) Symptoms have largely resolved, no dysuria, does report urinary frequency UA unremarkable on admission S/p one dose CTX in ED Completed Keflex    Chronic RLE DVT Noted since at least 2018 Continue home eliquis Left sided abdominal pain - resolved CT AP without left sided intraabdominal pathology Lipase wnl   Hepatomegaly Noted on CT LFTs wnl 10/10/2023 Hep panel negative Can check US Abdomen o/p   Sinus pauses Loop recorder placed 10/3, found to have sinus pauses, no evidence of A-fib Follows with cardiology outpatient   HTN Hypertensive to 150s on admission Continue home amlodipine, imdur   CAD NM Stress 4/2023 without inducible ischemia, normal LVSF EF 66% Continue home ASA, statin   COPD Not in exacerbation Continue home albuterol, flovent   Hx of cerebral palsy Lives alone in apartment   Dispo PT/OT recs c/w SNF;however, pt. Refusing adamantly Agrees to HHC
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis, Sinus arrest, Tachycardia, Tachypnoea
Clinical narrative: Patient is a 67 y.o. female patient of MD with history of A-fib, factor XI deficiency, cerebral palsy, CAD, COPD presented to Medical Center with cough, diarrhea and fevers.     Sepsis due to Covid -19 virus, sepsis now resolved  Tmax 101.7, tachycardic, tachypneic, WBC 4.14, LA 1.2 CXR with no acute process Possible source: UTI, more likely 2/2 COVID Blood cxs collected before abx, urine cxs collected after abx S/p CTX in ED, UA unremarkable, S/p 1 L bolus   Completed Keflex   Covid-19 Virus Infection Date of onset of symptoms: 10/12 Symptoms present on admission: yes Date of covid positive test: 10/14 Vaccination status: vaccinated Imaging: negative CXR Oxygen requirements on admission: was on 2L but for comfort, not hypoxic Current oxygen requirements: none Medical therapy: remdesivir Consultants following: ID Anticipated special isolation end date: 10/22   E. Coli UTI 10/10/2023 Ucx with pan-susceptible E.coli  Treated with keflex outpatient (last day 10/16) Symptoms have largely resolved, no dysuria, does report urinary frequency UA unremarkable on admission S/p one dose CTX in ED Completed Keflex    Chronic RLE DVT Noted since at least 2018 Continue home eliquis Left sided abdominal pain - resolved CT AP without left sided intraabdominal pathology Lipase wnl   Hepatomegaly Noted on CT LFTs wnl 10/10/2023 Hep panel negative Can check US Abdomen o/p   Sinus pauses Loop recorder placed 10/3, found to have sinus pauses, no evidence of A-fib Follows with cardiology outpatient   HTN Hypertensive to 150s on admission Continue home amlodipine, imdur   CAD NM Stress 4/2023 without inducible ischemia, normal LVSF EF 66% Continue home ASA, statin   COPD Not in exacerbation Continue home albuterol, flovent   Hx of cerebral palsy Lives alone in apartment   Dispo PT/OT recs c/w SNF;however, pt. Refusing adamantly Agrees to HHC
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Urinary tract infection, Urine analysis normal, White blood cell count decreased
Clinical narrative: Patient is a 67 y.o. female patient of MD with history of A-fib, factor XI deficiency, cerebral palsy, CAD, COPD presented to Medical Center with cough, diarrhea and fevers.     Sepsis due to Covid -19 virus, sepsis now resolved  Tmax 101.7, tachycardic, tachypneic, WBC 4.14, LA 1.2 CXR with no acute process Possible source: UTI, more likely 2/2 COVID Blood cxs collected before abx, urine cxs collected after abx S/p CTX in ED, UA unremarkable, S/p 1 L bolus   Completed Keflex   Covid-19 Virus Infection Date of onset of symptoms: 10/12 Symptoms present on admission: yes Date of covid positive test: 10/14 Vaccination status: vaccinated Imaging: negative CXR Oxygen requirements on admission: was on 2L but for comfort, not hypoxic Current oxygen requirements: none Medical therapy: remdesivir Consultants following: ID Anticipated special isolation end date: 10/22   E. Coli UTI 10/10/2023 Ucx with pan-susceptible E.coli  Treated with keflex outpatient (last day 10/16) Symptoms have largely resolved, no dysuria, does report urinary frequency UA unremarkable on admission S/p one dose CTX in ED Completed Keflex    Chronic RLE DVT Noted since at least 2018 Continue home eliquis Left sided abdominal pain - resolved CT AP without left sided intraabdominal pathology Lipase wnl   Hepatomegaly Noted on CT LFTs wnl 10/10/2023 Hep panel negative Can check US Abdomen o/p   Sinus pauses Loop recorder placed 10/3, found to have sinus pauses, no evidence of A-fib Follows with cardiology outpatient   HTN Hypertensive to 150s on admission Continue home amlodipine, imdur   CAD NM Stress 4/2023 without inducible ischemia, normal LVSF EF 66% Continue home ASA, statin   COPD Not in exacerbation Continue home albuterol, flovent   Hx of cerebral palsy Lives alone in apartment   Dispo PT/OT recs c/w SNF;however, pt. Refusing adamantly Agrees to HHC
Age: 1.33
Sex: M
Vaccine: DTAPIPV
Symptoms: Wrong product administered
Clinical narrative: MD ordered the patient to get the Dtap vaccines but a Dtap/IPV was mistakenly drawn and given to the patient. MD aware and the patient's family was notified.  Education was done with the staff member by the RN with teach back.
Age: 64.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Asthenia, Atrial fibrillation
Clinical narrative: Patient is a 65 y.o. male presenting from home with c/o 65 y.o. male who presents with a chief complaint of SOB.  Patient is a 65-year-old male who presents with daughter for evaluation of fever, generalized weakness, shortness of breath.  Per daughter, patient had just arrived after a week long cruise.  Daughter states she picked him up from the airport and noticed that he appeared ill.  She states she drove patient directly to the hospital.  Patient reports shortness of breath, generalized weakness, with some mild chest discomfort.  Daughter states patient not normally on home O2.  Patient hypoxic on room air and required and received my immediate medical attention.   Hospital course as below.  Original plan was discharged to LTAC but oxygen requirements improved and patient was able to be discharged home with home health care services   1.  COVID pneumonia, ARDS: -+9/18 -Unclear symptom onset, isolation completed -Pulmonology following -Infectious disease saw pt -Decadron 10 day course completed 9/28 -Remdesivir completed 9/28 -DVT prophylaxis with lovenox -completed 10 day course of zosyn for possible bacterial coverage -pulm rehab at discharge: will be arranged by Dr.   2.  Acute hypoxic respiratory failure: -Secondary to above -Pulmonology following -home O2 concentrator arranged with SW   3.  AKI: resolved -Nephrology consulted  -monitor labs -Received fluids  -hold nephrotoxic agents -EP recommended stopping Tikosyn, cardio re-consulted once AKI resolved and decided not to restart tikosyn and re-eval with EP outpatient    4.  Elevated troponin -Cardiology consulted, likely type II/demand ischemia in the setting of acute illness -Plans for stress test outpatient when patient recovered -9/19 echo EF 60%   5.  A-fib: -Cardiology consulted -See recommendation above in regards to Tikosyn   6.  CLL, immunocompromise: -Follows with oncology -Oncology consulted, advised holding home oral chemo at this time until acute issues resolve   7.  Other chronic medical conditions: Chronic pain, anxiety, arthritis, hypertension, peripheral neuropathy, OSA unable to tolerate CPAP
Age: 64.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19 pneumonia, Chest discomfort, Dyspnoea, Echocardiogram normal, Ejection fraction normal
Clinical narrative: Patient is a 65 y.o. male presenting from home with c/o 65 y.o. male who presents with a chief complaint of SOB.  Patient is a 65-year-old male who presents with daughter for evaluation of fever, generalized weakness, shortness of breath.  Per daughter, patient had just arrived after a week long cruise.  Daughter states she picked him up from the airport and noticed that he appeared ill.  She states she drove patient directly to the hospital.  Patient reports shortness of breath, generalized weakness, with some mild chest discomfort.  Daughter states patient not normally on home O2.  Patient hypoxic on room air and required and received my immediate medical attention.   Hospital course as below.  Original plan was discharged to LTAC but oxygen requirements improved and patient was able to be discharged home with home health care services   1.  COVID pneumonia, ARDS: -+9/18 -Unclear symptom onset, isolation completed -Pulmonology following -Infectious disease saw pt -Decadron 10 day course completed 9/28 -Remdesivir completed 9/28 -DVT prophylaxis with lovenox -completed 10 day course of zosyn for possible bacterial coverage -pulm rehab at discharge: will be arranged by Dr.   2.  Acute hypoxic respiratory failure: -Secondary to above -Pulmonology following -home O2 concentrator arranged with SW   3.  AKI: resolved -Nephrology consulted  -monitor labs -Received fluids  -hold nephrotoxic agents -EP recommended stopping Tikosyn, cardio re-consulted once AKI resolved and decided not to restart tikosyn and re-eval with EP outpatient    4.  Elevated troponin -Cardiology consulted, likely type II/demand ischemia in the setting of acute illness -Plans for stress test outpatient when patient recovered -9/19 echo EF 60%   5.  A-fib: -Cardiology consulted -See recommendation above in regards to Tikosyn   6.  CLL, immunocompromise: -Follows with oncology -Oncology consulted, advised holding home oral chemo at this time until acute issues resolve   7.  Other chronic medical conditions: Chronic pain, anxiety, arthritis, hypertension, peripheral neuropathy, OSA unable to tolerate CPAP
Age: 64.0
Sex: M
Vaccine: COVID19-2
Symptoms: General physical condition abnormal, Hypoxia, Myocardial ischaemia, Pyrexia, Troponin increased
Clinical narrative: Patient is a 65 y.o. male presenting from home with c/o 65 y.o. male who presents with a chief complaint of SOB.  Patient is a 65-year-old male who presents with daughter for evaluation of fever, generalized weakness, shortness of breath.  Per daughter, patient had just arrived after a week long cruise.  Daughter states she picked him up from the airport and noticed that he appeared ill.  She states she drove patient directly to the hospital.  Patient reports shortness of breath, generalized weakness, with some mild chest discomfort.  Daughter states patient not normally on home O2.  Patient hypoxic on room air and required and received my immediate medical attention.   Hospital course as below.  Original plan was discharged to LTAC but oxygen requirements improved and patient was able to be discharged home with home health care services   1.  COVID pneumonia, ARDS: -+9/18 -Unclear symptom onset, isolation completed -Pulmonology following -Infectious disease saw pt -Decadron 10 day course completed 9/28 -Remdesivir completed 9/28 -DVT prophylaxis with lovenox -completed 10 day course of zosyn for possible bacterial coverage -pulm rehab at discharge: will be arranged by Dr.   2.  Acute hypoxic respiratory failure: -Secondary to above -Pulmonology following -home O2 concentrator arranged with SW   3.  AKI: resolved -Nephrology consulted  -monitor labs -Received fluids  -hold nephrotoxic agents -EP recommended stopping Tikosyn, cardio re-consulted once AKI resolved and decided not to restart tikosyn and re-eval with EP outpatient    4.  Elevated troponin -Cardiology consulted, likely type II/demand ischemia in the setting of acute illness -Plans for stress test outpatient when patient recovered -9/19 echo EF 60%   5.  A-fib: -Cardiology consulted -See recommendation above in regards to Tikosyn   6.  CLL, immunocompromise: -Follows with oncology -Oncology consulted, advised holding home oral chemo at this time until acute issues resolve   7.  Other chronic medical conditions: Chronic pain, anxiety, arthritis, hypertension, peripheral neuropathy, OSA unable to tolerate CPAP
Age: 72.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Bundle branch block right, COVID-19, Chest X-ray abnormal, Chronic obstructive pulmonary disease
Clinical narrative: Patient is a 73 y.o. male patient of DO with history of COPD, atrial fibrillation, who presented to Hospital with shortness of breath.   COPD exacerbation: - resolving Acute on chronic hypoxemic respiratory failure: baseline of 2 liters CXR consistent with COPD DuoNebs scheduled Albuterol PRN Patient is back to his baseline of 2 liters, will discharge with close otupatient follow up   Rhinovirus COVID 19 Pulmonary following - added remdesvir and dexaethadone.  Patient is back to his baseline of 2 liters, will discharge with close otupatient follow up   Elevated troponin: down tredning Due to COPD exacerbation EKG sinus rhythm with occasional PVCs and PACs with RBBB and marked ST abnormality; possible inferior subendocardial injury   Atrial fibrillation: CAD: HTN: HLD: Eliquis and sotalol, losartan, Toprol, statin Plavix
Age: 72.0
Sex: M
Vaccine: COVID19-2
Symptoms: Condition aggravated, Dyspnoea, Electrocardiogram ST segment abnormal, Respiratory failure, Rhinovirus infection
Clinical narrative: Patient is a 73 y.o. male patient of DO with history of COPD, atrial fibrillation, who presented to Hospital with shortness of breath.   COPD exacerbation: - resolving Acute on chronic hypoxemic respiratory failure: baseline of 2 liters CXR consistent with COPD DuoNebs scheduled Albuterol PRN Patient is back to his baseline of 2 liters, will discharge with close otupatient follow up   Rhinovirus COVID 19 Pulmonary following - added remdesvir and dexaethadone.  Patient is back to his baseline of 2 liters, will discharge with close otupatient follow up   Elevated troponin: down tredning Due to COPD exacerbation EKG sinus rhythm with occasional PVCs and PACs with RBBB and marked ST abnormality; possible inferior subendocardial injury   Atrial fibrillation: CAD: HTN: HLD: Eliquis and sotalol, losartan, Toprol, statin Plavix
Age: 72.0
Sex: M
Vaccine: COVID19-2
Symptoms: Sinus rhythm, Supraventricular extrasystoles, Troponin increased, Ventricular extrasystoles
Clinical narrative: Patient is a 73 y.o. male patient of DO with history of COPD, atrial fibrillation, who presented to Hospital with shortness of breath.   COPD exacerbation: - resolving Acute on chronic hypoxemic respiratory failure: baseline of 2 liters CXR consistent with COPD DuoNebs scheduled Albuterol PRN Patient is back to his baseline of 2 liters, will discharge with close otupatient follow up   Rhinovirus COVID 19 Pulmonary following - added remdesvir and dexaethadone.  Patient is back to his baseline of 2 liters, will discharge with close otupatient follow up   Elevated troponin: down tredning Due to COPD exacerbation EKG sinus rhythm with occasional PVCs and PACs with RBBB and marked ST abnormality; possible inferior subendocardial injury   Atrial fibrillation: CAD: HTN: HLD: Eliquis and sotalol, losartan, Toprol, statin Plavix
Age: 39.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Cardiac ablation, Cardiac stress test normal, Cardioversion, Chest pain
Clinical narrative: Patient is a 40 y.o. F with hx of anxiety/depression and ADHD. Recent admit (10/11-10/13/23) for new onset A fib with RVR. EP followed and pt was placed on Eliquis, Flecainide and Cardizem. Pt re-presented on 10/23/23 with CC of palpitations and episodes of A fib (noted on smart watch) with associated chest pain and SOB. Noted to be in A fib with RVR in ED but converted back to NSR and fluid bolus. Per ED, pt uncomfortable about returning home. As such admit to OBS for EP evaluation. S/p ablation 10/23/23. Hospital course complicated by dyspnea with unclear etiology, possibly related to OSA/OHS deconditioning in the setting COVID. Repeat ECHO unchanged, only trivial pericardial effusion, likley reactive to ablation. EP followed. Pulmonology followed, trial prednisone and breathing inhalers for possible asthma exacerbation. Stress test unremarkable. Sniff test negative. CTPA 10/23/23 unremarkable but suboptimal, Q scan with low probability of PE. RT performed NIF which was normal with VC 1950 ml. Pt notes continued shortness of breath on exertion, typically after 5 min. CM to order nurses aid, family called previous day to ensure coverage.    1. A fib: Noted last admit. TSH normal. CHADS2-VASC 1. TTE on 10/13/2023 normal LVEF, no WMA. EP followed and pt initiated Eliquis, Flecainide, and Cardizem. Now presented as above. S/p ablation 10/23/23. Continued home meds. In sinus during admission. EP followed 2. Dyspnea: ongoing with questionable worsening after ablation. Patient notes conversational and exertional dyspnea. No hypoxia. No wheezing; did not improve with prednisone/breathing tx. ECHO 10/13/23 as above. BNP 10/24/23 normal. Unclear etiology, possibly related to OSA/OHS deconditioning in the setting COVID. Repeat ECHO unchanged, only trivial pericardial effusion, likley reactive to ablation. EP followed. Pulmonology followed, trial prednisone and breathing inhalers for possible asthma exacerbation. Stress test unremarkable. Sniff test negative. CTPA 10/23/23 unremarkable but suboptimal, Q scan with low probability of PE. RT performed NIF which was normal with VC 1950 ml. Pt notes continued shortness of breath on exertion, typically after 5 min. CM to order nurses aid, family called previous day to ensure coverage.  3. COVID +:  Not a candidate for paxlovid due to drug interaction. ID followed, remdesivir completed.  4. ADHD/Anxiety/Depression: Continued home Wellbutrin. Vyvanse discontinued on last admit.  5. Mild intermittent Asthma exacerbation: Xopenex scheduled as home med. Ipatroprium neb ordered. Prednisone thru 10/30/23. Ordered xopenex inhaler and neb, ipatropium neb for discharge.  6. Suspected OSA: Suspected on last admit. Often feel tired, fatigued, or sleepy during the daytime? + 1, Observed you stop breathing during sleep? + 1, BMI > 35 +1, Neck circumference > 40 cm + 1, and Patient's score is > 3 implying high risk for OSA. Referral was made for sleep study on last admit.  7. Morbid Obesity:  BMI 46. Recommend lifestyle modification and weight loss.