chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 74.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Laboratory test abnormal, Leukopenia, Lung hyperinflation, Mental status changes, Pyrexia
Clinical narrative: Admission Date: 5/8/2023 Discharge Date: May 11, 2023  PRESENTING PROBLEM: Shortness of breath  Hypoxia COVID-19  HOSPITAL COURSE:   75-year-old female with past medical history significant for rheumatoid arthritis (on Rituxan), type 2 diabetes, CKD stage IIIB, hypertension, lymphedema.  She presented to emergency department on 05/08 with several days of fatigue, poor appetite, altered mental status and dyspnea.  Patient also had a fever.  On arrival to hospital patient was found to be hypoxic to 86% requiring administration of nasal cannula.  Labs were notable for leukopenia, mild BUN elevation and creatinine elevation 1.78.  Viral panel was positive for COVID-19.  Chest x-ray was reviewed, showed hyperinflation but otherwise negative for an acute cardiopulmonary process.  Blood cultures were obtained.  She was given dose of Rocephin, DuoNeb and fluids and admitted to Medicine Service for further assessment and management.   For patient's acute hypoxic respiratory failure in setting of COVID-19 pneumonia, she was started on remdesivir and Decadron.  Rocephin was not continued as there was no evidence of community-acquired pneumonia clinically.  Patient's oxygen requirements improved and was able to wean off to room air after several days.  Patient's fatigue was also improving and her mental status returned to baseline.  Physical therapy recommended subacute rehab however patient refused this.  Elected to return home with home healthcare services.   Of note patient was also seen by infectious disease and wound care in the hospital for diabetic ulcer of toe of left foot.  Patient's ulcer was treated with Betadine and dressing changes.  Patient and family have been educated on management of diabetic ulcer of the toe at home.  She was treated with cefazolin for mild cellulitis to left lower extremity completing a 7 day course with Keflex at the time of discharge.   Patient's blood glucose was slightly elevated in the hospital stay, this is secondary to Decadron.  Insulin was slightly increased but will return to prior home dose of long-acting insulin.  Victoza will be resumed at that time as well.  Once Decadron course is completed expect that her blood glucose levels should normalize.   Patient is being discharged home in stable improved condition with home healthcare services.  She should follow up with primary care physician within 1-2 weeks to monitor blood sugar, blood was (BMP, complete blood count).
Age: 74.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Respiratory viral panel, SARS-CoV-2 test positive, Wound treatment
Clinical narrative: Admission Date: 5/8/2023 Discharge Date: May 11, 2023  PRESENTING PROBLEM: Shortness of breath  Hypoxia COVID-19  HOSPITAL COURSE:   75-year-old female with past medical history significant for rheumatoid arthritis (on Rituxan), type 2 diabetes, CKD stage IIIB, hypertension, lymphedema.  She presented to emergency department on 05/08 with several days of fatigue, poor appetite, altered mental status and dyspnea.  Patient also had a fever.  On arrival to hospital patient was found to be hypoxic to 86% requiring administration of nasal cannula.  Labs were notable for leukopenia, mild BUN elevation and creatinine elevation 1.78.  Viral panel was positive for COVID-19.  Chest x-ray was reviewed, showed hyperinflation but otherwise negative for an acute cardiopulmonary process.  Blood cultures were obtained.  She was given dose of Rocephin, DuoNeb and fluids and admitted to Medicine Service for further assessment and management.   For patient's acute hypoxic respiratory failure in setting of COVID-19 pneumonia, she was started on remdesivir and Decadron.  Rocephin was not continued as there was no evidence of community-acquired pneumonia clinically.  Patient's oxygen requirements improved and was able to wean off to room air after several days.  Patient's fatigue was also improving and her mental status returned to baseline.  Physical therapy recommended subacute rehab however patient refused this.  Elected to return home with home healthcare services.   Of note patient was also seen by infectious disease and wound care in the hospital for diabetic ulcer of toe of left foot.  Patient's ulcer was treated with Betadine and dressing changes.  Patient and family have been educated on management of diabetic ulcer of the toe at home.  She was treated with cefazolin for mild cellulitis to left lower extremity completing a 7 day course with Keflex at the time of discharge.   Patient's blood glucose was slightly elevated in the hospital stay, this is secondary to Decadron.  Insulin was slightly increased but will return to prior home dose of long-acting insulin.  Victoza will be resumed at that time as well.  Once Decadron course is completed expect that her blood glucose levels should normalize.   Patient is being discharged home in stable improved condition with home healthcare services.  She should follow up with primary care physician within 1-2 weeks to monitor blood sugar, blood was (BMP, complete blood count).
Age: 41.0
Sex: F
Vaccine: COVID19
Symptoms: Cervix cancer metastatic, Cervix carcinoma recurrent, Cervix carcinoma stage IV, Condition aggravated, Mass
Clinical narrative: Please note the dates of the vaccines above were as follows: #1 - 3/23/21 #2 - 4/14/21 #3 - 12/15/21  In January of 2023 we found a lump that was diagnosed in April 2021 as a recurrence of cervical cancer which has metastasized to stage IV. The original cervical cancer was stage I in 2015. A recurrence of stage I cervical cancer 7 years later is virtually unheard of. The only thing in my life that was different from the previous 7 years was getting vaccinated. I believe without a doubt that the vaccine caused my recurrence.
Age: 75.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Atrial fibrillation, Brain natriuretic peptide increased, COVID-19, Chest X-ray abnormal, Chronic obstructive pulmonary disease
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 5/7/2023 Discharge Date: May 11, 2023  PRESENTING PROBLEM: Shortness of breath [R06.02] COPD with acute exacerbation [J44.1] COPD exacerbation [J44.1]   HOSPITAL COURSE: Patient is a 76 y.o. female with past medical history significant for COPD, CAD - MI (2012), Afib, HTN, and HLD, who presented with increasing shortness of breath since 5/3 as well as productive cough with yellow sputum. She has noticed some wheezing. Pt Pt is on 3L O2 at baseline.  Pt is tachycardic with afib RVR in ED. Pt ststaes she was feeling her heart race a little earlier in the day but no longer symptomatic. Denies headaches, dizziness,  chest pain, N/V, abdominal pain, diarrhea, constipation and leg swelling.    In ED, CXR without evidence of pneumonia. There is patchy areas of mild interstitial prominence suggestive of inflammation. COVID-PCR is positive. BNP 4400, Troponins unremarkable. No leukocytosis. She was tachycardiac and was found in A-fib with RVR. The patient was given nebulizers as well as solu-medrol 125mg IV. Lopressor 5mg IV push given for rate control.    The patient was initially admitted for chronic obstructive pulmonary disease exacerbation as well as COVID infection.  She was initiated on remdesivir and switched to Decadron.  A 2D echo was obtained and showed normal ejection fraction but elevated RVSP of 53 mmHg.  The patient's shortness of breath did improve after few doses of IV Lasix.  Throughout her stay, the patient maintained oxygenation above 90% on 3 L of nasal cannula which is her baseline.  The patient was eventually discharged home in a stable condition on Decadron as well as Lasix.  She was instructed to follow up with Pulmonary Medicine for further treatment of her pulmonary hypertension.
Age: 75.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Condition aggravated, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Palpitations
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 5/7/2023 Discharge Date: May 11, 2023  PRESENTING PROBLEM: Shortness of breath [R06.02] COPD with acute exacerbation [J44.1] COPD exacerbation [J44.1]   HOSPITAL COURSE: Patient is a 76 y.o. female with past medical history significant for COPD, CAD - MI (2012), Afib, HTN, and HLD, who presented with increasing shortness of breath since 5/3 as well as productive cough with yellow sputum. She has noticed some wheezing. Pt Pt is on 3L O2 at baseline.  Pt is tachycardic with afib RVR in ED. Pt ststaes she was feeling her heart race a little earlier in the day but no longer symptomatic. Denies headaches, dizziness,  chest pain, N/V, abdominal pain, diarrhea, constipation and leg swelling.    In ED, CXR without evidence of pneumonia. There is patchy areas of mild interstitial prominence suggestive of inflammation. COVID-PCR is positive. BNP 4400, Troponins unremarkable. No leukocytosis. She was tachycardiac and was found in A-fib with RVR. The patient was given nebulizers as well as solu-medrol 125mg IV. Lopressor 5mg IV push given for rate control.    The patient was initially admitted for chronic obstructive pulmonary disease exacerbation as well as COVID infection.  She was initiated on remdesivir and switched to Decadron.  A 2D echo was obtained and showed normal ejection fraction but elevated RVSP of 53 mmHg.  The patient's shortness of breath did improve after few doses of IV Lasix.  Throughout her stay, the patient maintained oxygenation above 90% on 3 L of nasal cannula which is her baseline.  The patient was eventually discharged home in a stable condition on Decadron as well as Lasix.  She was instructed to follow up with Pulmonary Medicine for further treatment of her pulmonary hypertension.
Age: 75.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Pneumonitis, Productive cough, Pulmonary hypertension, Right ventricular systolic pressure increased, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 5/7/2023 Discharge Date: May 11, 2023  PRESENTING PROBLEM: Shortness of breath [R06.02] COPD with acute exacerbation [J44.1] COPD exacerbation [J44.1]   HOSPITAL COURSE: Patient is a 76 y.o. female with past medical history significant for COPD, CAD - MI (2012), Afib, HTN, and HLD, who presented with increasing shortness of breath since 5/3 as well as productive cough with yellow sputum. She has noticed some wheezing. Pt Pt is on 3L O2 at baseline.  Pt is tachycardic with afib RVR in ED. Pt ststaes she was feeling her heart race a little earlier in the day but no longer symptomatic. Denies headaches, dizziness,  chest pain, N/V, abdominal pain, diarrhea, constipation and leg swelling.    In ED, CXR without evidence of pneumonia. There is patchy areas of mild interstitial prominence suggestive of inflammation. COVID-PCR is positive. BNP 4400, Troponins unremarkable. No leukocytosis. She was tachycardiac and was found in A-fib with RVR. The patient was given nebulizers as well as solu-medrol 125mg IV. Lopressor 5mg IV push given for rate control.    The patient was initially admitted for chronic obstructive pulmonary disease exacerbation as well as COVID infection.  She was initiated on remdesivir and switched to Decadron.  A 2D echo was obtained and showed normal ejection fraction but elevated RVSP of 53 mmHg.  The patient's shortness of breath did improve after few doses of IV Lasix.  Throughout her stay, the patient maintained oxygenation above 90% on 3 L of nasal cannula which is her baseline.  The patient was eventually discharged home in a stable condition on Decadron as well as Lasix.  She was instructed to follow up with Pulmonary Medicine for further treatment of her pulmonary hypertension.
Age: 75.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Sputum discoloured, Tachycardia, Troponin normal, Wheezing
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 5/7/2023 Discharge Date: May 11, 2023  PRESENTING PROBLEM: Shortness of breath [R06.02] COPD with acute exacerbation [J44.1] COPD exacerbation [J44.1]   HOSPITAL COURSE: Patient is a 76 y.o. female with past medical history significant for COPD, CAD - MI (2012), Afib, HTN, and HLD, who presented with increasing shortness of breath since 5/3 as well as productive cough with yellow sputum. She has noticed some wheezing. Pt Pt is on 3L O2 at baseline.  Pt is tachycardic with afib RVR in ED. Pt ststaes she was feeling her heart race a little earlier in the day but no longer symptomatic. Denies headaches, dizziness,  chest pain, N/V, abdominal pain, diarrhea, constipation and leg swelling.    In ED, CXR without evidence of pneumonia. There is patchy areas of mild interstitial prominence suggestive of inflammation. COVID-PCR is positive. BNP 4400, Troponins unremarkable. No leukocytosis. She was tachycardiac and was found in A-fib with RVR. The patient was given nebulizers as well as solu-medrol 125mg IV. Lopressor 5mg IV push given for rate control.    The patient was initially admitted for chronic obstructive pulmonary disease exacerbation as well as COVID infection.  She was initiated on remdesivir and switched to Decadron.  A 2D echo was obtained and showed normal ejection fraction but elevated RVSP of 53 mmHg.  The patient's shortness of breath did improve after few doses of IV Lasix.  Throughout her stay, the patient maintained oxygenation above 90% on 3 L of nasal cannula which is her baseline.  The patient was eventually discharged home in a stable condition on Decadron as well as Lasix.  She was instructed to follow up with Pulmonary Medicine for further treatment of her pulmonary hypertension.
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, COVID-19, Confusional state, Failure to thrive, Malaise
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 5/4/2023 Discharge Date: 5/11/2023  Clinical Narrative: 77 y/o M admitted for Pneumonia, failure to thrive, and increased confusion.  He is debilitated with Parkinson's disease and has mild dementia and is cared for by his stepdaughter who noted increasing weakness.     Patient tested + for COVID on admission, but has been sick for a several days prior to admission.  The patient completed antibiotics prior to discharge.  His discharge was held due to policies in Nursing Homes accepting patient's with COVID positivity.  Facility was able to accept him on 5/11.  He was medically stable for discharge.     He will have SAR at  the facility with eventual LTC placement to be determined by family and ECF and primary care staff.     He has a vitamin B1 level to assess reversible causes of dementia.
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pneumonia, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 5/4/2023 Discharge Date: 5/11/2023  Clinical Narrative: 77 y/o M admitted for Pneumonia, failure to thrive, and increased confusion.  He is debilitated with Parkinson's disease and has mild dementia and is cared for by his stepdaughter who noted increasing weakness.     Patient tested + for COVID on admission, but has been sick for a several days prior to admission.  The patient completed antibiotics prior to discharge.  His discharge was held due to policies in Nursing Homes accepting patient's with COVID positivity.  Facility was able to accept him on 5/11.  He was medically stable for discharge.     He will have SAR at  the facility with eventual LTC placement to be determined by family and ECF and primary care staff.     He has a vitamin B1 level to assess reversible causes of dementia.
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Obstructive sleep apnoea syndrome
Clinical narrative: OBSTRUCTIVE SLEEP APNEA ACUTE NON ST ELEVATION MI
Age: 53.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE HYPOXIA 8/10/2022 -- RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Cough, Lacrimation increased, Nasal congestion, Oropharyngeal pain
Clinical narrative: I had a runny nose, cough, sore throat, cough, watery eyes. I took a home COVID-19 test that came back positive, called my doctor's office. I spoke to his nurse to describe my symptoms and let them know I had tested positive for COVID-19. She let the doctor know my symptoms and positive test results. My doctor called in a prescription of the Paxlovid that I was able to start in on Wednesday. By Friday I was able to participate in a work conference by Zoom. I still have a little bit of a cough and stuffy nose but for the most part I am recovered.
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: I had a runny nose, cough, sore throat, cough, watery eyes. I took a home COVID-19 test that came back positive, called my doctor's office. I spoke to his nurse to describe my symptoms and let them know I had tested positive for COVID-19. She let the doctor know my symptoms and positive test results. My doctor called in a prescription of the Paxlovid that I was able to start in on Wednesday. By Friday I was able to participate in a work conference by Zoom. I still have a little bit of a cough and stuffy nose but for the most part I am recovered.
Age: 90.0
Sex: F
Vaccine: COVID19
Symptoms: Transient ischaemic attack
Clinical narrative: TRANSIENT CEREBRAL ISCHEMIA
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Fatigue, Headache, Influenza virus test negative, Injection site erythema
Clinical narrative: I tested positive for COVID-19 on 4/22/2023. I had a sore throat, headache, fatigue, red throat on left side. No fever or chills. I did have a runny nose but no congestion. I also noticed a red lump on my arm where I received the injection at. It was sore and swollen. I started Paxlovid on 4/23/2023. by the next day, I didn't have a sore throat or headache anymore.
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Injection site mass, Injection site pain, Injection site swelling, Oropharyngeal pain, Pharyngeal erythema
Clinical narrative: I tested positive for COVID-19 on 4/22/2023. I had a sore throat, headache, fatigue, red throat on left side. No fever or chills. I did have a runny nose but no congestion. I also noticed a red lump on my arm where I received the injection at. It was sore and swollen. I started Paxlovid on 4/23/2023. by the next day, I didn't have a sore throat or headache anymore.
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Respiratory syncytial virus test negative, Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: I tested positive for COVID-19 on 4/22/2023. I had a sore throat, headache, fatigue, red throat on left side. No fever or chills. I did have a runny nose but no congestion. I also noticed a red lump on my arm where I received the injection at. It was sore and swollen. I started Paxlovid on 4/23/2023. by the next day, I didn't have a sore throat or headache anymore.
Age: 52.0
Sex: F
Vaccine: VARZOS
Symptoms: Chills, Fatigue, Headache, Muscular weakness, Myalgia
Clinical narrative: Severe chills,/shivering, severe headache and muscle/body aches., muscle weakness, extreme fatigue . Have been ongoing now for 30 hours.
Age: 52.0
Sex: F
Vaccine: VARZOS
Symptoms: Pain
Clinical narrative: Severe chills,/shivering, severe headache and muscle/body aches., muscle weakness, extreme fatigue . Have been ongoing now for 30 hours.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Pancytopenia
Clinical narrative: Hospitalization for COVID19 pneumonia/pancytopenia/acute hypoxemic respiratory failure on dates 5/1/2023-5/9/2023.  Treated with dexamethasone, Remdesivir, vitamin D 25 mcg PO daily, zinc 50 mg PO daily.
Age: 39.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood test, Borrelia test, CSF protein abnormal, Facial paralysis, Guillain-Barre syndrome
Clinical narrative: I had numbness in the hand's legs and face, and I also had facial paralysis I was Guillain barre.
Age: 39.0
Sex: F
Vaccine: COVID19-2
Symptoms: Hypoaesthesia, Lumbar puncture abnormal, Plasmapheresis
Clinical narrative: I had numbness in the hand's legs and face, and I also had facial paralysis I was Guillain barre.
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory distress syndrome, Arterial catheterisation, COVID-19, Central venous catheterisation, Computerised tomogram head normal
Clinical narrative: Discharge Date:04/26/23 from hospital. Transferred to hospital on 4/26/23 and is still inpatient at this time.  Admit Date:  4/3/2023  Attending Physician: Dr.  Consulting Physicians: Pulmonology, infectious disease, neurology, palliative medicine, endocrinology, general surgery Primary Care Physician: MD   Hospital Course:   The patient is a 69-year-old female with past medical history of asthma, T2DM, HLD, HTN, hypothyroidism, rheumatoid arthritis, cirrhosis. She initially presented to the ED 4/03/2023 with fever/chills, shortness of breath/cough and occasional hemoptysis.  These symptoms were present since she was diagnosed with COVID-19 on  3/13/23. She was treated outpatient with Paxlovid.  She was initially admitted to internal medicine on 4/3/2023 due to septic shock from bacterial pneumonia on top of COVID-19 infection.  Pulmonology was also consulted on 4/4/2023 for bronchoscopy.   Patient began a 7 day course of cefepime and despite further therapy had continued decompensation with ARDS. She was admitted to ICU 4/07 for intubation and then bronchoscopy.  Patient was eventually intubated and had a central venous catheter and arterial line placed 4/8 with initiation of vasopressor support.  She did eventually wean off all vasopressor medications.  A 7-day course of cefepime was completed and she was subsequently started on remdesivir for 10 days.  The patient's encephalopathy was worked up with CT head, MRI, EEG which did not demonstrate any etiology of the patient's encephalopathy.  Her encephalopathy eventually improved.  However, her respiratory status did not improve and she continues to have persistent vent requirements.  We conducted a repeat CT chest 4/19 which demonstrated worsened groundglass.  Due to the patient's persistent ventilatory requirements and no improvement on imaging, general surgery was consulted for trach/PEG, which was completed 4/21.   For the patient's type 2 diabetes with insulin pump at home, her insulin pump was not given due to acuity of illness.  Endocrinology was consulted and dosed the patient's Lantus appropriately along  with sliding scale.   The patient tolerated trach/PEG well and was able to tolerate trach mask.  She did require ventilator support overnight.  She became stable for discharge.
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Computerised tomogram thorax abnormal, Cough, Dyspnoea, Electroencephalogram normal, Encephalopathy
Clinical narrative: Discharge Date:04/26/23 from hospital. Transferred to hospital on 4/26/23 and is still inpatient at this time.  Admit Date:  4/3/2023  Attending Physician: Dr.  Consulting Physicians: Pulmonology, infectious disease, neurology, palliative medicine, endocrinology, general surgery Primary Care Physician: MD   Hospital Course:   The patient is a 69-year-old female with past medical history of asthma, T2DM, HLD, HTN, hypothyroidism, rheumatoid arthritis, cirrhosis. She initially presented to the ED 4/03/2023 with fever/chills, shortness of breath/cough and occasional hemoptysis.  These symptoms were present since she was diagnosed with COVID-19 on  3/13/23. She was treated outpatient with Paxlovid.  She was initially admitted to internal medicine on 4/3/2023 due to septic shock from bacterial pneumonia on top of COVID-19 infection.  Pulmonology was also consulted on 4/4/2023 for bronchoscopy.   Patient began a 7 day course of cefepime and despite further therapy had continued decompensation with ARDS. She was admitted to ICU 4/07 for intubation and then bronchoscopy.  Patient was eventually intubated and had a central venous catheter and arterial line placed 4/8 with initiation of vasopressor support.  She did eventually wean off all vasopressor medications.  A 7-day course of cefepime was completed and she was subsequently started on remdesivir for 10 days.  The patient's encephalopathy was worked up with CT head, MRI, EEG which did not demonstrate any etiology of the patient's encephalopathy.  Her encephalopathy eventually improved.  However, her respiratory status did not improve and she continues to have persistent vent requirements.  We conducted a repeat CT chest 4/19 which demonstrated worsened groundglass.  Due to the patient's persistent ventilatory requirements and no improvement on imaging, general surgery was consulted for trach/PEG, which was completed 4/21.   For the patient's type 2 diabetes with insulin pump at home, her insulin pump was not given due to acuity of illness.  Endocrinology was consulted and dosed the patient's Lantus appropriately along  with sliding scale.   The patient tolerated trach/PEG well and was able to tolerate trach mask.  She did require ventilator support overnight.  She became stable for discharge.
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Endotracheal intubation, Gastrostomy, Haemoptysis, Intensive care, Lung opacity
Clinical narrative: Discharge Date:04/26/23 from hospital. Transferred to hospital on 4/26/23 and is still inpatient at this time.  Admit Date:  4/3/2023  Attending Physician: Dr.  Consulting Physicians: Pulmonology, infectious disease, neurology, palliative medicine, endocrinology, general surgery Primary Care Physician: MD   Hospital Course:   The patient is a 69-year-old female with past medical history of asthma, T2DM, HLD, HTN, hypothyroidism, rheumatoid arthritis, cirrhosis. She initially presented to the ED 4/03/2023 with fever/chills, shortness of breath/cough and occasional hemoptysis.  These symptoms were present since she was diagnosed with COVID-19 on  3/13/23. She was treated outpatient with Paxlovid.  She was initially admitted to internal medicine on 4/3/2023 due to septic shock from bacterial pneumonia on top of COVID-19 infection.  Pulmonology was also consulted on 4/4/2023 for bronchoscopy.   Patient began a 7 day course of cefepime and despite further therapy had continued decompensation with ARDS. She was admitted to ICU 4/07 for intubation and then bronchoscopy.  Patient was eventually intubated and had a central venous catheter and arterial line placed 4/8 with initiation of vasopressor support.  She did eventually wean off all vasopressor medications.  A 7-day course of cefepime was completed and she was subsequently started on remdesivir for 10 days.  The patient's encephalopathy was worked up with CT head, MRI, EEG which did not demonstrate any etiology of the patient's encephalopathy.  Her encephalopathy eventually improved.  However, her respiratory status did not improve and she continues to have persistent vent requirements.  We conducted a repeat CT chest 4/19 which demonstrated worsened groundglass.  Due to the patient's persistent ventilatory requirements and no improvement on imaging, general surgery was consulted for trach/PEG, which was completed 4/21.   For the patient's type 2 diabetes with insulin pump at home, her insulin pump was not given due to acuity of illness.  Endocrinology was consulted and dosed the patient's Lantus appropriately along  with sliding scale.   The patient tolerated trach/PEG well and was able to tolerate trach mask.  She did require ventilator support overnight.  She became stable for discharge.
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Magnetic resonance imaging normal, Mechanical ventilation, Pneumonia bacterial, Pyrexia, Septic shock
Clinical narrative: Discharge Date:04/26/23 from hospital. Transferred to hospital on 4/26/23 and is still inpatient at this time.  Admit Date:  4/3/2023  Attending Physician: Dr.  Consulting Physicians: Pulmonology, infectious disease, neurology, palliative medicine, endocrinology, general surgery Primary Care Physician: MD   Hospital Course:   The patient is a 69-year-old female with past medical history of asthma, T2DM, HLD, HTN, hypothyroidism, rheumatoid arthritis, cirrhosis. She initially presented to the ED 4/03/2023 with fever/chills, shortness of breath/cough and occasional hemoptysis.  These symptoms were present since she was diagnosed with COVID-19 on  3/13/23. She was treated outpatient with Paxlovid.  She was initially admitted to internal medicine on 4/3/2023 due to septic shock from bacterial pneumonia on top of COVID-19 infection.  Pulmonology was also consulted on 4/4/2023 for bronchoscopy.   Patient began a 7 day course of cefepime and despite further therapy had continued decompensation with ARDS. She was admitted to ICU 4/07 for intubation and then bronchoscopy.  Patient was eventually intubated and had a central venous catheter and arterial line placed 4/8 with initiation of vasopressor support.  She did eventually wean off all vasopressor medications.  A 7-day course of cefepime was completed and she was subsequently started on remdesivir for 10 days.  The patient's encephalopathy was worked up with CT head, MRI, EEG which did not demonstrate any etiology of the patient's encephalopathy.  Her encephalopathy eventually improved.  However, her respiratory status did not improve and she continues to have persistent vent requirements.  We conducted a repeat CT chest 4/19 which demonstrated worsened groundglass.  Due to the patient's persistent ventilatory requirements and no improvement on imaging, general surgery was consulted for trach/PEG, which was completed 4/21.   For the patient's type 2 diabetes with insulin pump at home, her insulin pump was not given due to acuity of illness.  Endocrinology was consulted and dosed the patient's Lantus appropriately along  with sliding scale.   The patient tolerated trach/PEG well and was able to tolerate trach mask.  She did require ventilator support overnight.  She became stable for discharge.
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Tracheostomy
Clinical narrative: Discharge Date:04/26/23 from hospital. Transferred to hospital on 4/26/23 and is still inpatient at this time.  Admit Date:  4/3/2023  Attending Physician: Dr.  Consulting Physicians: Pulmonology, infectious disease, neurology, palliative medicine, endocrinology, general surgery Primary Care Physician: MD   Hospital Course:   The patient is a 69-year-old female with past medical history of asthma, T2DM, HLD, HTN, hypothyroidism, rheumatoid arthritis, cirrhosis. She initially presented to the ED 4/03/2023 with fever/chills, shortness of breath/cough and occasional hemoptysis.  These symptoms were present since she was diagnosed with COVID-19 on  3/13/23. She was treated outpatient with Paxlovid.  She was initially admitted to internal medicine on 4/3/2023 due to septic shock from bacterial pneumonia on top of COVID-19 infection.  Pulmonology was also consulted on 4/4/2023 for bronchoscopy.   Patient began a 7 day course of cefepime and despite further therapy had continued decompensation with ARDS. She was admitted to ICU 4/07 for intubation and then bronchoscopy.  Patient was eventually intubated and had a central venous catheter and arterial line placed 4/8 with initiation of vasopressor support.  She did eventually wean off all vasopressor medications.  A 7-day course of cefepime was completed and she was subsequently started on remdesivir for 10 days.  The patient's encephalopathy was worked up with CT head, MRI, EEG which did not demonstrate any etiology of the patient's encephalopathy.  Her encephalopathy eventually improved.  However, her respiratory status did not improve and she continues to have persistent vent requirements.  We conducted a repeat CT chest 4/19 which demonstrated worsened groundglass.  Due to the patient's persistent ventilatory requirements and no improvement on imaging, general surgery was consulted for trach/PEG, which was completed 4/21.   For the patient's type 2 diabetes with insulin pump at home, her insulin pump was not given due to acuity of illness.  Endocrinology was consulted and dosed the patient's Lantus appropriately along  with sliding scale.   The patient tolerated trach/PEG well and was able to tolerate trach mask.  She did require ventilator support overnight.  She became stable for discharge.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Bell's palsy, Symptom recurrence
Clinical narrative: LEFT BELLS PALSY ACUTE RESPIRATORY FAILURE ACUTE HYPOXEMIC RESPIRATORY FAILURE 11/17/2022 &  12/3/2022  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Mental status changes, Pneumonia, Urinary tract infection
Clinical narrative: Hospitalization for altered mental status, UTI and right-sided pneumonia on dates 5/1/2023- 5/10/2023. Treated with dexamethasone,  Remdesivir, vitamin C 1,000 mg PO daily, vitamin D 25 mcg PO daily, zinc 50 mg PO daily.
Sex: U
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Choking, Cough, Dyspnoea
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATEDAND BOOSTED WITH PFIZER. PT FOUND TO BE DCOVID-19 POSTIVE,  AND HAS A HISTORY OF COVID +. PT admitted with shortness of breath, cough, aspiration pneumonia- choking episode prior to admission, and ESBL Klebsiella pneumoniae UTI. Prior to discharge pt was tested positive for COVID 19. Infectious disease did not medicate for COVID 19.
Sex: U
Vaccine: COVID19, COVID19, COVID19
Symptoms: Emphysema, Klebsiella infection, Klebsiella urinary tract infection, Pathogen resistance, Pneumonia aspiration
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATEDAND BOOSTED WITH PFIZER. PT FOUND TO BE DCOVID-19 POSTIVE,  AND HAS A HISTORY OF COVID +. PT admitted with shortness of breath, cough, aspiration pneumonia- choking episode prior to admission, and ESBL Klebsiella pneumoniae UTI. Prior to discharge pt was tested positive for COVID 19. Infectious disease did not medicate for COVID 19.
Sex: U
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: BREAKTHROUGH COVID: FULLY VACCINATEDAND BOOSTED WITH PFIZER. PT FOUND TO BE DCOVID-19 POSTIVE,  AND HAS A HISTORY OF COVID +. PT admitted with shortness of breath, cough, aspiration pneumonia- choking episode prior to admission, and ESBL Klebsiella pneumoniae UTI. Prior to discharge pt was tested positive for COVID 19. Infectious disease did not medicate for COVID 19.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Bladder catheterisation, COVID-19, Complication associated with device, Sepsis, Urinary tract infection
Clinical narrative: Hospitalization for Sepsis due to UTI from chronic indwelling Foley catheter and COVID-19 infection on dates 5/3/2023- 5/13/2023. Treated with dexamethasone, Remdesivir, vitamin C 1,000 mg PO daily, vitamin D 25 mcg PO daily, zinc 50 mg PO daily.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Acute hepatic failure, Acute kidney injury, Acute respiratory failure, Anaemia, Anticoagulant therapy
Clinical narrative: 4/22/2023 - 5/22/2023 (30 days)   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxemia (HCC)    HOSPITAL COURSE: Patient is an 80 y/o male with a PMHx of HTN, BPH (self-caths), dyslipidemia and LUE melanoma s/p resection, followed by Dr. of oncology, previously on Keytruda. He was recently hospitalized at BW from 4/10-4/17 for AKI and acute liver failure with liver bx secondary c/w DILI secondary to Keytruda. Patient was started on prednisone with subsequent improvement in LFTs and renal function, and was discharged home on a planned 7 day course of prednisone 70 mg daily. He presented back to the hospital on 4/22 with SOB, weakness and maroon stools. In the ED he was found to be hypotensive and was started on norepi after receiving 2 L IVF. Also placed on BiPAP for hypoxemia. Labs signficant for AKI, elevated LFTs, elevated troponins, lactic acidosis, leukocytosis and anemia with Hgb 5.9 (Hgb was 8.2 on 4/17). UA with pyuria and quad panel (+) for COVID. CTA of chest was negative for PE and showed moderate emphysematous changes, bilateral upper and lower airspace disease and small pleural effusions. He was admitted to the ICU.    He received 2 units PRBC and GI was consulted. They recommended EGD once respiratory status improved. He was able to wean off pressors and was transferred out of ICU 4/23. He was started on antibiotics to cover possible superimposed bacterial infection due to recent hospitalization.  Gastroenterology team deferred to oncology to manage steroids for DILI.  Oncology recommended tapering steroids to 40 mg daily at discharge and outpatient follow-up with oncology. Due to worsening respiratory status CT angiogram of the thorax and bilateral lower extremity venous duplexes were repeated which showed bilateral PEs and DVTs.  Patient was started on heparin drip.  While on heparin drip patient had drop in hemoglobin and received multiple units of blood transfusion.  Patient underwent EGD on 5/7/2023 which showed a duodenal 1 cm clean based ulcer without high risk stigmata (likely etiology for GI bleeding). He was continued on PPI BID with recommendations to continue for 8 weeks, then daily. He was restarted on heparin gtt and tolerated. He was transitioned to Eliquis. He briefly required high-flow nasal cannula which was slowly weaned off to nasal cannula with oxymizer. He remained stable on this for several days and oxygen was weaned further. He was seen by pulm rehab for home oxygen needs. Pulm rehab recommended 4 liters/minutes at rest and 6 liters/minute be O2 dependent   He was seen by PT/OT who recommended home with assist, home health and therapies.   Patient was discharged home in medically stable condition.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Arteriogram coronary abnormal, Asthenia, Biopsy liver, COVID-19, Deep vein thrombosis
Clinical narrative: 4/22/2023 - 5/22/2023 (30 days)   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxemia (HCC)    HOSPITAL COURSE: Patient is an 80 y/o male with a PMHx of HTN, BPH (self-caths), dyslipidemia and LUE melanoma s/p resection, followed by Dr. of oncology, previously on Keytruda. He was recently hospitalized at BW from 4/10-4/17 for AKI and acute liver failure with liver bx secondary c/w DILI secondary to Keytruda. Patient was started on prednisone with subsequent improvement in LFTs and renal function, and was discharged home on a planned 7 day course of prednisone 70 mg daily. He presented back to the hospital on 4/22 with SOB, weakness and maroon stools. In the ED he was found to be hypotensive and was started on norepi after receiving 2 L IVF. Also placed on BiPAP for hypoxemia. Labs signficant for AKI, elevated LFTs, elevated troponins, lactic acidosis, leukocytosis and anemia with Hgb 5.9 (Hgb was 8.2 on 4/17). UA with pyuria and quad panel (+) for COVID. CTA of chest was negative for PE and showed moderate emphysematous changes, bilateral upper and lower airspace disease and small pleural effusions. He was admitted to the ICU.    He received 2 units PRBC and GI was consulted. They recommended EGD once respiratory status improved. He was able to wean off pressors and was transferred out of ICU 4/23. He was started on antibiotics to cover possible superimposed bacterial infection due to recent hospitalization.  Gastroenterology team deferred to oncology to manage steroids for DILI.  Oncology recommended tapering steroids to 40 mg daily at discharge and outpatient follow-up with oncology. Due to worsening respiratory status CT angiogram of the thorax and bilateral lower extremity venous duplexes were repeated which showed bilateral PEs and DVTs.  Patient was started on heparin drip.  While on heparin drip patient had drop in hemoglobin and received multiple units of blood transfusion.  Patient underwent EGD on 5/7/2023 which showed a duodenal 1 cm clean based ulcer without high risk stigmata (likely etiology for GI bleeding). He was continued on PPI BID with recommendations to continue for 8 weeks, then daily. He was restarted on heparin gtt and tolerated. He was transitioned to Eliquis. He briefly required high-flow nasal cannula which was slowly weaned off to nasal cannula with oxymizer. He remained stable on this for several days and oxygen was weaned further. He was seen by pulm rehab for home oxygen needs. Pulm rehab recommended 4 liters/minutes at rest and 6 liters/minute be O2 dependent   He was seen by PT/OT who recommended home with assist, home health and therapies.   Patient was discharged home in medically stable condition.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Duodenal ulcer, Dyspnoea, Emphysema, Faeces discoloured, Haemoglobin decreased
Clinical narrative: 4/22/2023 - 5/22/2023 (30 days)   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxemia (HCC)    HOSPITAL COURSE: Patient is an 80 y/o male with a PMHx of HTN, BPH (self-caths), dyslipidemia and LUE melanoma s/p resection, followed by Dr. of oncology, previously on Keytruda. He was recently hospitalized at BW from 4/10-4/17 for AKI and acute liver failure with liver bx secondary c/w DILI secondary to Keytruda. Patient was started on prednisone with subsequent improvement in LFTs and renal function, and was discharged home on a planned 7 day course of prednisone 70 mg daily. He presented back to the hospital on 4/22 with SOB, weakness and maroon stools. In the ED he was found to be hypotensive and was started on norepi after receiving 2 L IVF. Also placed on BiPAP for hypoxemia. Labs signficant for AKI, elevated LFTs, elevated troponins, lactic acidosis, leukocytosis and anemia with Hgb 5.9 (Hgb was 8.2 on 4/17). UA with pyuria and quad panel (+) for COVID. CTA of chest was negative for PE and showed moderate emphysematous changes, bilateral upper and lower airspace disease and small pleural effusions. He was admitted to the ICU.    He received 2 units PRBC and GI was consulted. They recommended EGD once respiratory status improved. He was able to wean off pressors and was transferred out of ICU 4/23. He was started on antibiotics to cover possible superimposed bacterial infection due to recent hospitalization.  Gastroenterology team deferred to oncology to manage steroids for DILI.  Oncology recommended tapering steroids to 40 mg daily at discharge and outpatient follow-up with oncology. Due to worsening respiratory status CT angiogram of the thorax and bilateral lower extremity venous duplexes were repeated which showed bilateral PEs and DVTs.  Patient was started on heparin drip.  While on heparin drip patient had drop in hemoglobin and received multiple units of blood transfusion.  Patient underwent EGD on 5/7/2023 which showed a duodenal 1 cm clean based ulcer without high risk stigmata (likely etiology for GI bleeding). He was continued on PPI BID with recommendations to continue for 8 weeks, then daily. He was restarted on heparin gtt and tolerated. He was transitioned to Eliquis. He briefly required high-flow nasal cannula which was slowly weaned off to nasal cannula with oxymizer. He remained stable on this for several days and oxygen was weaned further. He was seen by pulm rehab for home oxygen needs. Pulm rehab recommended 4 liters/minutes at rest and 6 liters/minute be O2 dependent   He was seen by PT/OT who recommended home with assist, home health and therapies.   Patient was discharged home in medically stable condition.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension, Hypoxia, Intensive care, Laboratory test abnormal, Lactic acidosis
Clinical narrative: 4/22/2023 - 5/22/2023 (30 days)   DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxemia (HCC)    HOSPITAL COURSE: Patient is an 80 y/o male with a PMHx of HTN, BPH (self-caths), dyslipidemia and LUE melanoma s/p resection, followed by Dr. of oncology, previously on Keytruda. He was recently hospitalized at BW from 4/10-4/17 for AKI and acute liver failure with liver bx secondary c/w DILI secondary to Keytruda. Patient was started on prednisone with subsequent improvement in LFTs and renal function, and was discharged home on a planned 7 day course of prednisone 70 mg daily. He presented back to the hospital on 4/22 with SOB, weakness and maroon stools. In the ED he was found to be hypotensive and was started on norepi after receiving 2 L IVF. Also placed on BiPAP for hypoxemia. Labs signficant for AKI, elevated LFTs, elevated troponins, lactic acidosis, leukocytosis and anemia with Hgb 5.9 (Hgb was 8.2 on 4/17). UA with pyuria and quad panel (+) for COVID. CTA of chest was negative for PE and showed moderate emphysematous changes, bilateral upper and lower airspace disease and small pleural effusions. He was admitted to the ICU.    He received 2 units PRBC and GI was consulted. They recommended EGD once respiratory status improved. He was able to wean off pressors and was transferred out of ICU 4/23. He was started on antibiotics to cover possible superimposed bacterial infection due to recent hospitalization.  Gastroenterology team deferred to oncology to manage steroids for DILI.  Oncology recommended tapering steroids to 40 mg daily at discharge and outpatient follow-up with oncology. Due to worsening respiratory status CT angiogram of the thorax and bilateral lower extremity venous duplexes were repeated which showed bilateral PEs and DVTs.  Patient was started on heparin drip.  While on heparin drip patient had drop in hemoglobin and received multiple units of blood transfusion.  Patient underwent EGD on 5/7/2023 which showed a duodenal 1 cm clean based ulcer without high risk stigmata (likely etiology for GI bleeding). He was continued on PPI BID with recommendations to continue for 8 weeks, then daily. He was restarted on heparin gtt and tolerated. He was transitioned to Eliquis. He briefly required high-flow nasal cannula which was slowly weaned off to nasal cannula with oxymizer. He remained stable on this for several days and oxygen was weaned further. He was seen by pulm rehab for home oxygen needs. Pulm rehab recommended 4 liters/minutes at rest and 6 liters/minute be O2 dependent   He was seen by PT/OT who recommended home with assist, home health and therapies.   Patient was discharged home in medically stable condition.