chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Chemotherapy, Chest X-ray, Computerised tomogram head abnormal, Cough
Clinical narrative: Patient is a 66-year-old male With history of colon cancer with metastasis to the liver and recent COVID diagnosis on August 31 presenting to the emergency department via EMS from home for increased shortness of breath and generalized weakness.  Patient was seen at facility on Sunday for cough with his COVID, he was given azithromycin to go home with.  Family states ever since then he has been declining at home.  He has been very weak and unable to get out of bed much.  He is normally alert and oriented x4 and active, however today family had a hard time even getting him off the couch and noticed he seemed to be breathing fast so they called 911.  Per EMS, patient was 90% on room air at his home, and he was tachypneic.  They gave a DuoNeb breathing treatment in route along with Solu-Medrol 125 mg IV.  Patient states he feels very fatigued and generally weak, he denies any chest pain, abdominal pain, nausea, vomiting or diarrhea.  His last chemotherapy dose was 2 weeks ago, he is scheduled to have another 1 tomorrow, however this will be canceled. Associated Symptoms: cough, fatigue, shortness of breath, weakness
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dehydration, Dyspnoea, Electrocardiogram, Endotracheal intubation, Fatigue
Clinical narrative: Patient is a 66-year-old male With history of colon cancer with metastasis to the liver and recent COVID diagnosis on August 31 presenting to the emergency department via EMS from home for increased shortness of breath and generalized weakness.  Patient was seen at facility on Sunday for cough with his COVID, he was given azithromycin to go home with.  Family states ever since then he has been declining at home.  He has been very weak and unable to get out of bed much.  He is normally alert and oriented x4 and active, however today family had a hard time even getting him off the couch and noticed he seemed to be breathing fast so they called 911.  Per EMS, patient was 90% on room air at his home, and he was tachypneic.  They gave a DuoNeb breathing treatment in route along with Solu-Medrol 125 mg IV.  Patient states he feels very fatigued and generally weak, he denies any chest pain, abdominal pain, nausea, vomiting or diarrhea.  His last chemotherapy dose was 2 weeks ago, he is scheduled to have another 1 tomorrow, however this will be canceled. Associated Symptoms: cough, fatigue, shortness of breath, weakness
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: General physical health deterioration, Heart rate increased, Hypotension, Hypoxia, Lacunar infarction
Clinical narrative: Patient is a 66-year-old male With history of colon cancer with metastasis to the liver and recent COVID diagnosis on August 31 presenting to the emergency department via EMS from home for increased shortness of breath and generalized weakness.  Patient was seen at facility on Sunday for cough with his COVID, he was given azithromycin to go home with.  Family states ever since then he has been declining at home.  He has been very weak and unable to get out of bed much.  He is normally alert and oriented x4 and active, however today family had a hard time even getting him off the couch and noticed he seemed to be breathing fast so they called 911.  Per EMS, patient was 90% on room air at his home, and he was tachypneic.  They gave a DuoNeb breathing treatment in route along with Solu-Medrol 125 mg IV.  Patient states he feels very fatigued and generally weak, he denies any chest pain, abdominal pain, nausea, vomiting or diarrhea.  His last chemotherapy dose was 2 weeks ago, he is scheduled to have another 1 tomorrow, however this will be canceled. Associated Symptoms: cough, fatigue, shortness of breath, weakness
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Mechanical ventilation, Mobility decreased, Muscle strain, Positive airway pressure therapy, Pyrexia
Clinical narrative: Patient is a 66-year-old male With history of colon cancer with metastasis to the liver and recent COVID diagnosis on August 31 presenting to the emergency department via EMS from home for increased shortness of breath and generalized weakness.  Patient was seen at facility on Sunday for cough with his COVID, he was given azithromycin to go home with.  Family states ever since then he has been declining at home.  He has been very weak and unable to get out of bed much.  He is normally alert and oriented x4 and active, however today family had a hard time even getting him off the couch and noticed he seemed to be breathing fast so they called 911.  Per EMS, patient was 90% on room air at his home, and he was tachypneic.  They gave a DuoNeb breathing treatment in route along with Solu-Medrol 125 mg IV.  Patient states he feels very fatigued and generally weak, he denies any chest pain, abdominal pain, nausea, vomiting or diarrhea.  His last chemotherapy dose was 2 weeks ago, he is scheduled to have another 1 tomorrow, however this will be canceled. Associated Symptoms: cough, fatigue, shortness of breath, weakness
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Respiratory distress, Respiratory rate increased, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
Clinical narrative: Patient is a 66-year-old male With history of colon cancer with metastasis to the liver and recent COVID diagnosis on August 31 presenting to the emergency department via EMS from home for increased shortness of breath and generalized weakness.  Patient was seen at facility on Sunday for cough with his COVID, he was given azithromycin to go home with.  Family states ever since then he has been declining at home.  He has been very weak and unable to get out of bed much.  He is normally alert and oriented x4 and active, however today family had a hard time even getting him off the couch and noticed he seemed to be breathing fast so they called 911.  Per EMS, patient was 90% on room air at his home, and he was tachypneic.  They gave a DuoNeb breathing treatment in route along with Solu-Medrol 125 mg IV.  Patient states he feels very fatigued and generally weak, he denies any chest pain, abdominal pain, nausea, vomiting or diarrhea.  His last chemotherapy dose was 2 weeks ago, he is scheduled to have another 1 tomorrow, however this will be canceled. Associated Symptoms: cough, fatigue, shortness of breath, weakness
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Troponin
Clinical narrative: Patient is a 66-year-old male With history of colon cancer with metastasis to the liver and recent COVID diagnosis on August 31 presenting to the emergency department via EMS from home for increased shortness of breath and generalized weakness.  Patient was seen at facility on Sunday for cough with his COVID, he was given azithromycin to go home with.  Family states ever since then he has been declining at home.  He has been very weak and unable to get out of bed much.  He is normally alert and oriented x4 and active, however today family had a hard time even getting him off the couch and noticed he seemed to be breathing fast so they called 911.  Per EMS, patient was 90% on room air at his home, and he was tachypneic.  They gave a DuoNeb breathing treatment in route along with Solu-Medrol 125 mg IV.  Patient states he feels very fatigued and generally weak, he denies any chest pain, abdominal pain, nausea, vomiting or diarrhea.  His last chemotherapy dose was 2 weeks ago, he is scheduled to have another 1 tomorrow, however this will be canceled. Associated Symptoms: cough, fatigue, shortness of breath, weakness
Age: 4.0
Sex: M
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Administered covid Pfizer for 6months-4 yrs to child without diluting vaccine. Parent was notified per Dr. and parent stated there were no adverse events .
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Dose administered beyond-use date
Age: 12.0
Sex: F
Vaccine: MMR
Symptoms: Expired product administered
Clinical narrative: Vaccine was expired on Aug 18,2022 and Vaccine was given 09/08/2022. Went to go document vaccine given in system and it wouldn't show lot number.  Recognized it was expired. Called and told patients mother to let her know what happened and that she needs to return for a revaccination.
Age: 5.0
Sex: M
Vaccine: MMR
Symptoms: Expired product administered
Clinical narrative: The student was administered a MMR vaccine (lot number T025927) on 8/9/22 with an expiration date of 7/30/22 at a back to school immunization clinic.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered
Clinical narrative: The Moderna was 1/2 the dose due ; no problems with patient
Age: 23.0
Sex: F
Vaccine: COVID19
Symptoms: Asymptomatic COVID-19, Delivery, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID Breakthrough. Patient was admitted to deliver her baby and tested positive. Asymptomatic.
Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Atelectasis, COVID-19, Chest X-ray abnormal, Condition aggravated, Exposure to SARS-CoV-2
Clinical narrative: Discharge Provider:  DO  Primary Care Physician at Discharge: MD Admission Date: 9/1/2022  Discharge Date: 09/02/2022  DETAILS OF HOSPITAL STAY: Seizure    HOSPITAL COURSE: Patient is a 16 y.o. female Patient has a history of global developmental delay, ADHD, Autism, Epilepsy, Anxiety, mild OSA (without CPAP), and intermittent explosive disorder had been transferred from ER for increased frequency of seizure and COVID-19 positive. Patient had 8 episodes of grand mal seizures in a day prior to arrival to our hospital. Had COVID-19 sick contacts at home for the past 2 weeks, tested positive for Covid-19 on 8/31/22 at the outside hospital.    Her labs were concerning for WBC of 15.9 and COVID 19, Respiratory panel otherwise negative. Outside hospital CXR on 8/31/22 with suboptimal inspiration, peripheral opacities in the left mid and lower lung may reflect combination of soft tissue chest wall opacity vs atelectasis.    Patient had no other episodes of seizures during her admission here. Per neurology, she was started on Valium bridge on 9/1/22, 2.5 mg TID for 3 days, then 2.5 mg BID for 3 days, then 2.5 mg qD for 3 days. She was started on Remdesivir on 9/1/22 but disconnected her own IV. She was started Paxlovid on 9/1/22, given that her admission was not for COVID but instead for her seizures. She had no hypoxia during her stay. Her guanfacine dose was halved while on Paxlovid for the next 4 days.     Otherwise patient had stable vital signs and did well during her admission
Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Generalised tonic-clonic seizure, Lung opacity, Respiratory viral panel, SARS-CoV-2 test positive, Seizure
Clinical narrative: Discharge Provider:  DO  Primary Care Physician at Discharge: MD Admission Date: 9/1/2022  Discharge Date: 09/02/2022  DETAILS OF HOSPITAL STAY: Seizure    HOSPITAL COURSE: Patient is a 16 y.o. female Patient has a history of global developmental delay, ADHD, Autism, Epilepsy, Anxiety, mild OSA (without CPAP), and intermittent explosive disorder had been transferred from ER for increased frequency of seizure and COVID-19 positive. Patient had 8 episodes of grand mal seizures in a day prior to arrival to our hospital. Had COVID-19 sick contacts at home for the past 2 weeks, tested positive for Covid-19 on 8/31/22 at the outside hospital.    Her labs were concerning for WBC of 15.9 and COVID 19, Respiratory panel otherwise negative. Outside hospital CXR on 8/31/22 with suboptimal inspiration, peripheral opacities in the left mid and lower lung may reflect combination of soft tissue chest wall opacity vs atelectasis.    Patient had no other episodes of seizures during her admission here. Per neurology, she was started on Valium bridge on 9/1/22, 2.5 mg TID for 3 days, then 2.5 mg BID for 3 days, then 2.5 mg qD for 3 days. She was started on Remdesivir on 9/1/22 but disconnected her own IV. She was started Paxlovid on 9/1/22, given that her admission was not for COVID but instead for her seizures. She had no hypoxia during her stay. Her guanfacine dose was halved while on Paxlovid for the next 4 days.     Otherwise patient had stable vital signs and did well during her admission
Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: White blood cell count increased
Clinical narrative: Discharge Provider:  DO  Primary Care Physician at Discharge: MD Admission Date: 9/1/2022  Discharge Date: 09/02/2022  DETAILS OF HOSPITAL STAY: Seizure    HOSPITAL COURSE: Patient is a 16 y.o. female Patient has a history of global developmental delay, ADHD, Autism, Epilepsy, Anxiety, mild OSA (without CPAP), and intermittent explosive disorder had been transferred from ER for increased frequency of seizure and COVID-19 positive. Patient had 8 episodes of grand mal seizures in a day prior to arrival to our hospital. Had COVID-19 sick contacts at home for the past 2 weeks, tested positive for Covid-19 on 8/31/22 at the outside hospital.    Her labs were concerning for WBC of 15.9 and COVID 19, Respiratory panel otherwise negative. Outside hospital CXR on 8/31/22 with suboptimal inspiration, peripheral opacities in the left mid and lower lung may reflect combination of soft tissue chest wall opacity vs atelectasis.    Patient had no other episodes of seizures during her admission here. Per neurology, she was started on Valium bridge on 9/1/22, 2.5 mg TID for 3 days, then 2.5 mg BID for 3 days, then 2.5 mg qD for 3 days. She was started on Remdesivir on 9/1/22 but disconnected her own IV. She was started Paxlovid on 9/1/22, given that her admission was not for COVID but instead for her seizures. She had no hypoxia during her stay. Her guanfacine dose was halved while on Paxlovid for the next 4 days.     Otherwise patient had stable vital signs and did well during her admission
Age: 9.0
Sex: F
Vaccine: HEP, VARCEL
Symptoms: Loss of consciousness, Nausea, Syncope, Vomiting
Clinical narrative: Patient had a syncopal event (passed out) on the way out of the clinic.  Was quickly revived and alert, but then was nauseated and threw up.
Age: 29.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Dose administered beyond-use date
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood potassium decreased, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 9/1/2022 Discharge Date: 9/5/2022  PRESENTING PROBLEM: COPD exacerbation [J44.1] Acute on chronic respiratory failure with hypoxia [J96.21] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a pleasant 73-year-old male admitted with cough shortness of breath and hypoxia does have chronic obstructive pulmonary disease uses 5 L of oxygen at night patient also with history of pneumonias in the past and squamous cell cancer of the lung.  Patient admitted for COVID-19 with hypoxia and exacerbation of his underlying lung disease.  The patient was admitted placed on steroids bronchodilators antibiotics and started on remdesivir.  Patient did receive 5 doses of remdesivir during the hospitalization patient's steroids were weaned off as these were likely exacerbating his delirium.  Clinical condition improved hypoxia resolved lungs improved.  Patient did have some delirium likely on underlying dementia on day of discharge patient is oriented to his name where he is at the year it is in the month.  Patient will need further workup of his memory issues outpatient.  Patient also was supplemented for a potassium of 3.3 and potassium was added to his medications will need a repeat BMP later in the week for re-evaluation this patient discharged in stable condition home with home health care evaluation.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Cough, Delirium, Dyspnoea, Hypoxia, Memory impairment
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 9/1/2022 Discharge Date: 9/5/2022  PRESENTING PROBLEM: COPD exacerbation [J44.1] Acute on chronic respiratory failure with hypoxia [J96.21] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a pleasant 73-year-old male admitted with cough shortness of breath and hypoxia does have chronic obstructive pulmonary disease uses 5 L of oxygen at night patient also with history of pneumonias in the past and squamous cell cancer of the lung.  Patient admitted for COVID-19 with hypoxia and exacerbation of his underlying lung disease.  The patient was admitted placed on steroids bronchodilators antibiotics and started on remdesivir.  Patient did receive 5 doses of remdesivir during the hospitalization patient's steroids were weaned off as these were likely exacerbating his delirium.  Clinical condition improved hypoxia resolved lungs improved.  Patient did have some delirium likely on underlying dementia on day of discharge patient is oriented to his name where he is at the year it is in the month.  Patient will need further workup of his memory issues outpatient.  Patient also was supplemented for a potassium of 3.3 and potassium was added to his medications will need a repeat BMP later in the week for re-evaluation this patient discharged in stable condition home with home health care evaluation.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Metabolic function test, Respiratory failure
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 9/1/2022 Discharge Date: 9/5/2022  PRESENTING PROBLEM: COPD exacerbation [J44.1] Acute on chronic respiratory failure with hypoxia [J96.21] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a pleasant 73-year-old male admitted with cough shortness of breath and hypoxia does have chronic obstructive pulmonary disease uses 5 L of oxygen at night patient also with history of pneumonias in the past and squamous cell cancer of the lung.  Patient admitted for COVID-19 with hypoxia and exacerbation of his underlying lung disease.  The patient was admitted placed on steroids bronchodilators antibiotics and started on remdesivir.  Patient did receive 5 doses of remdesivir during the hospitalization patient's steroids were weaned off as these were likely exacerbating his delirium.  Clinical condition improved hypoxia resolved lungs improved.  Patient did have some delirium likely on underlying dementia on day of discharge patient is oriented to his name where he is at the year it is in the month.  Patient will need further workup of his memory issues outpatient.  Patient also was supplemented for a potassium of 3.3 and potassium was added to his medications will need a repeat BMP later in the week for re-evaluation this patient discharged in stable condition home with home health care evaluation.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Dose administered beyond-use date.
Age: 11.0
Sex: F
Vaccine: MNQ, MNQ
Symptoms: Single component of a two-component product administered
Clinical narrative: Only Vial 2 was given out of a 2 vial vaccine.
Age: 45.0
Sex: F
Vaccine: COVID19-2
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth, Loss of personal independence in daily activities
Clinical narrative: It started as a rash 6" x 3" with some swelling, it was very hot. By the next day it was 10" x 4" and hot and swelling more. By the 3rd day, the worst, it was from my elbow to my shoulder; more swollen, more hot and went 3'4s up my arm. I went to the Pharmacist and sought their opinion. It got worse for 3 days, with day 3 being the worst. Day 4 it was better. Today is day 7 and it's much much paler but still swollen and occasionally itchy but definitely improved.  I've had rashes with the other 3 COVID-19 vaccines but this was significantly different and worse because it kept me from doing my daily activities.
Age: 11.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product preparation issue
Clinical narrative: Vaccine administered without diluent. No known adverse event or outcome at this time.
Age: 80.0
Sex: F
Vaccine: PPV, VARZOS
Symptoms: Abdominal discomfort, Dizziness, Malaise, Pain
Clinical narrative: PATIENT FELT DIZZY  AND SICK TO HER STOMACH .  HER WHOLE BODY WAS HURTING . SHE WANTED ME TO CALL 911.
Age: 6.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Vaccine administered without diluent.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chest X-ray normal, Condition aggravated, Electrocardiogram normal, Hyperhidrosis, Hypotension
Clinical narrative: Patient returned 40 minutes after receiving the vaccine being driven by his daughter. Patient was diaphoretic, pale, and non-responsive. Sternal rub produced no reaction.  Instructed daughter to take patient to ER (which is right down the road).  Patient was hypotensive upon arrival to ER. Treated patient with bolus fluids, put in Trendelenburg, gave 0.3mg of epinephrine IM, 125 solu-medrol, 25 benadryl IV, and 40mg Pepcid IV. Patient was noted to improve after dosing with these medications. Patient was monitored for 3 hours in ER. Was sent home on Benadryl 25mg every 6 hours for the next 24-48 hours and a Medrol dosepak.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Laboratory test normal, Pallor, Unresponsive to stimuli
Clinical narrative: Patient returned 40 minutes after receiving the vaccine being driven by his daughter. Patient was diaphoretic, pale, and non-responsive. Sternal rub produced no reaction.  Instructed daughter to take patient to ER (which is right down the road).  Patient was hypotensive upon arrival to ER. Treated patient with bolus fluids, put in Trendelenburg, gave 0.3mg of epinephrine IM, 125 solu-medrol, 25 benadryl IV, and 40mg Pepcid IV. Patient was noted to improve after dosing with these medications. Patient was monitored for 3 hours in ER. Was sent home on Benadryl 25mg every 6 hours for the next 24-48 hours and a Medrol dosepak.
Age: 35.0
Sex: M
Vaccine: UNK
Symptoms: Fatigue, Headache
Clinical narrative: 2 days after receiving subcutaneous injection patient felt fatigued x 1 week, along with headache.
Age: 29.0
Sex: F
Vaccine: SMALLMNK
Symptoms: Adverse event, Incorrect dose administered, Injection site discharge
Clinical narrative: During the first attempt vaccine leaked from the injection site, and a complete dose was not administered. A second attempt was completed, and was successful. Physical adverse event occured.
Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Blood culture negative, COVID-19, Echocardiogram abnormal, Hypotension
Clinical narrative: Discharge Provider: MD Primary Care Provider: FNP Admission Date: 9/1/2022 Discharge Date: Sep 3, 2022  PRESENTING PROBLEM: Shock   HOSPITAL COURSE: Patient is a 36-year-old man with past medical history of bipolar disorder, untreated hepatitis-C, IV drug use, recent admission due to MSSA bacteremia complicated by epidural abscesses status post decompression and fusion with hardware and multilevel spinal osteomyelitis was concerns for septic pulmonary emboli treated with IV nafcillin for 4 weeks during that hospitalization followed by 2 doses of Bactrim and now currently undergoing dalbavancin  infusions as outpatient on a weekly basis for the last 2 weeks presented to facility leading to hospital from his outpatient infusion clinic due to abnormal labs concerning for acute kidney injury and worsening leukocytosis.  In the emergency department patient was tachycardic and hypotensive requiring 4 L of IV fluids and subsequently requiring pressor support.  He was later transferred to medical intensive care unit for further management.  Patient was found to be in septic shock related to hypovolemia and eventually Levophed was weaned off.  His echocardiogram showed preserved itchy ejection fraction and no vegetations.  Blood cultures remained negative and WBC started down trending after receiving IV fluids.  Infectious Disease was consulted who recommended discontinuing broad-spectrum antibiotics which include cefepime with recommendations to observe patient off antibiotics.  His acute kidney injury improved significantly.  Incidentally during this admission patient was also found to be COVID positive.  He was transferred out of the Medical intensive care unit once he no longer required pressor support.  Patient did really well hence was discharged in a stable condition with prescription for doxycycline 100 mg twice daily which he should be taking lifelong to prevent infections.
Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: Hypovolaemia, Infusion, Intensive care, Laboratory test abnormal, Leukocytosis
Clinical narrative: Discharge Provider: MD Primary Care Provider: FNP Admission Date: 9/1/2022 Discharge Date: Sep 3, 2022  PRESENTING PROBLEM: Shock   HOSPITAL COURSE: Patient is a 36-year-old man with past medical history of bipolar disorder, untreated hepatitis-C, IV drug use, recent admission due to MSSA bacteremia complicated by epidural abscesses status post decompression and fusion with hardware and multilevel spinal osteomyelitis was concerns for septic pulmonary emboli treated with IV nafcillin for 4 weeks during that hospitalization followed by 2 doses of Bactrim and now currently undergoing dalbavancin  infusions as outpatient on a weekly basis for the last 2 weeks presented to facility leading to hospital from his outpatient infusion clinic due to abnormal labs concerning for acute kidney injury and worsening leukocytosis.  In the emergency department patient was tachycardic and hypotensive requiring 4 L of IV fluids and subsequently requiring pressor support.  He was later transferred to medical intensive care unit for further management.  Patient was found to be in septic shock related to hypovolemia and eventually Levophed was weaned off.  His echocardiogram showed preserved itchy ejection fraction and no vegetations.  Blood cultures remained negative and WBC started down trending after receiving IV fluids.  Infectious Disease was consulted who recommended discontinuing broad-spectrum antibiotics which include cefepime with recommendations to observe patient off antibiotics.  His acute kidney injury improved significantly.  Incidentally during this admission patient was also found to be COVID positive.  He was transferred out of the Medical intensive care unit once he no longer required pressor support.  Patient did really well hence was discharged in a stable condition with prescription for doxycycline 100 mg twice daily which he should be taking lifelong to prevent infections.
Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Septic shock, Shock, Tachycardia, White blood cell count increased
Clinical narrative: Discharge Provider: MD Primary Care Provider: FNP Admission Date: 9/1/2022 Discharge Date: Sep 3, 2022  PRESENTING PROBLEM: Shock   HOSPITAL COURSE: Patient is a 36-year-old man with past medical history of bipolar disorder, untreated hepatitis-C, IV drug use, recent admission due to MSSA bacteremia complicated by epidural abscesses status post decompression and fusion with hardware and multilevel spinal osteomyelitis was concerns for septic pulmonary emboli treated with IV nafcillin for 4 weeks during that hospitalization followed by 2 doses of Bactrim and now currently undergoing dalbavancin  infusions as outpatient on a weekly basis for the last 2 weeks presented to facility leading to hospital from his outpatient infusion clinic due to abnormal labs concerning for acute kidney injury and worsening leukocytosis.  In the emergency department patient was tachycardic and hypotensive requiring 4 L of IV fluids and subsequently requiring pressor support.  He was later transferred to medical intensive care unit for further management.  Patient was found to be in septic shock related to hypovolemia and eventually Levophed was weaned off.  His echocardiogram showed preserved itchy ejection fraction and no vegetations.  Blood cultures remained negative and WBC started down trending after receiving IV fluids.  Infectious Disease was consulted who recommended discontinuing broad-spectrum antibiotics which include cefepime with recommendations to observe patient off antibiotics.  His acute kidney injury improved significantly.  Incidentally during this admission patient was also found to be COVID positive.  He was transferred out of the Medical intensive care unit once he no longer required pressor support.  Patient did really well hence was discharged in a stable condition with prescription for doxycycline 100 mg twice daily which he should be taking lifelong to prevent infections.
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID breakthrough. Patient presented to the ED on 8/30 for reason unrelated to COVID but was tested and resulted positive. Infectious disease consult considered him asymptomatic.
Age: 57.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Chills, Diarrhoea, Pyrexia
Clinical narrative: After vaccination, the same night patient developed chills and mild fever, and diarrhea.  The patient still has diarrhea after 6 days of vaccines. The patient is a physician and taking OTC medication for symptomatic relief. But, he is still complaints about low energy.
Age: 95.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
Clinical narrative: pt had a positive COVID test on 2/22/22; pt passed away at home on 2/27/22; no medical records
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cardiac failure congestive, Chest X-ray abnormal, Cough, Dyspnoea
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: MD  Admission Date: 8/31/2022 Discharge Date: 9/2/2022  HOSPITAL COURSE: The patient is a 70 y.o. female with past medical history significant for HFpEF, Afib (on eliquis), T2DM (requiring insulin), CKD IV, hypertension, and Von Willebrand disease, who presented to the ED with a chief complaint of cough and shortness of breath. Upon arrival to the ED patient was hypertensive of 179/64, remainder of vitals were stable. Saturations were 87% on room air with improvement to the mid 90s following 2 L nasal cannula. COVID-19 was noted to be positive. CXR revealed moderate pulmonary edema with CHF expected. While in the ED the patient did receive 1 L of normal saline as well as a 1-time dose of IV Lasix 40 mg. The patient was admitted to hospital medicine for further evaluation and management.    Patient quickly improved with wean from oxygen. She remained on decadron while admitted, due to hx of DM and improvement in respiratory status, decadron was not continued on discharge. Patient aware to monitor blood glucose and blood pressure closely at home. He was discharged home in stable condition.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Hypertension, Pulmonary oedema, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: DO Primary Care Provider at Discharge: MD  Admission Date: 8/31/2022 Discharge Date: 9/2/2022  HOSPITAL COURSE: The patient is a 70 y.o. female with past medical history significant for HFpEF, Afib (on eliquis), T2DM (requiring insulin), CKD IV, hypertension, and Von Willebrand disease, who presented to the ED with a chief complaint of cough and shortness of breath. Upon arrival to the ED patient was hypertensive of 179/64, remainder of vitals were stable. Saturations were 87% on room air with improvement to the mid 90s following 2 L nasal cannula. COVID-19 was noted to be positive. CXR revealed moderate pulmonary edema with CHF expected. While in the ED the patient did receive 1 L of normal saline as well as a 1-time dose of IV Lasix 40 mg. The patient was admitted to hospital medicine for further evaluation and management.    Patient quickly improved with wean from oxygen. She remained on decadron while admitted, due to hx of DM and improvement in respiratory status, decadron was not continued on discharge. Patient aware to monitor blood glucose and blood pressure closely at home. He was discharged home in stable condition.
Age: 5.0
Sex: F
Vaccine: MENB
Symptoms: Wrong product administered
Clinical narrative: Patient given MEN B provider ordered IPV patient is fine called manufacture vaccine is approved for ages 2years - 55 years old
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Dose administered beyond-use date.
Age: 30.0
Sex: M
Vaccine: SMALLMNK
Symptoms: No adverse event, Vaccination error
Clinical narrative: The first intradermal attempt did not result in a wheel. No physical adverse event occured. A second attmept was administered by an expert, and was successful
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Asthenia, COVID-19, Condition aggravated, Dehydration
Clinical narrative: Admission Date: 8/31/2022 Discharge Date: 9/5/2022  PRESENTING PROBLEM: Dehydration [E86.0] General weakness [R53.1] Muscular deconditioning [R29.898] AKI (acute kidney injury) (HCC) [N17.9] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: Patient is a very pleasant 93-year-old male presenting with generalized weakness uncontrolled pain related his sacral fraction and hypotension.  Patient was admitted patient's diuretics were held patient was hydrated patient empirically treated Decadron for his COVID-19.  Patient's renal insufficiency improved with hydration patient's blood pressure improved with treatment patient was empirically covered with doxycycline and Rocephin during hospitalization.  Patient's pain improved was able low work with PT and OT with recommendations for subacute rehab.  The patient stable normal renal function good saturation hypotension resolved.  Patient is back on his home medications with exception of Lasix which will be dosed daily for a greater than or equal to 2 lb weight gain along with his potassium chloride patient need labs within a week to re-evaluate his blood count and his kidney function electrolytes.  Patient in stable condition for discharge to subacute rehab
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Fractured sacrum, Hypotension, Muscle disorder, Pain, Polyuria
Clinical narrative: Admission Date: 8/31/2022 Discharge Date: 9/5/2022  PRESENTING PROBLEM: Dehydration [E86.0] General weakness [R53.1] Muscular deconditioning [R29.898] AKI (acute kidney injury) (HCC) [N17.9] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: Patient is a very pleasant 93-year-old male presenting with generalized weakness uncontrolled pain related his sacral fraction and hypotension.  Patient was admitted patient's diuretics were held patient was hydrated patient empirically treated Decadron for his COVID-19.  Patient's renal insufficiency improved with hydration patient's blood pressure improved with treatment patient was empirically covered with doxycycline and Rocephin during hospitalization.  Patient's pain improved was able low work with PT and OT with recommendations for subacute rehab.  The patient stable normal renal function good saturation hypotension resolved.  Patient is back on his home medications with exception of Lasix which will be dosed daily for a greater than or equal to 2 lb weight gain along with his potassium chloride patient need labs within a week to re-evaluate his blood count and his kidney function electrolytes.  Patient in stable condition for discharge to subacute rehab
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: Renal failure, Renal function test normal, Weight increased
Clinical narrative: Admission Date: 8/31/2022 Discharge Date: 9/5/2022  PRESENTING PROBLEM: Dehydration [E86.0] General weakness [R53.1] Muscular deconditioning [R29.898] AKI (acute kidney injury) (HCC) [N17.9] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: Patient is a very pleasant 93-year-old male presenting with generalized weakness uncontrolled pain related his sacral fraction and hypotension.  Patient was admitted patient's diuretics were held patient was hydrated patient empirically treated Decadron for his COVID-19.  Patient's renal insufficiency improved with hydration patient's blood pressure improved with treatment patient was empirically covered with doxycycline and Rocephin during hospitalization.  Patient's pain improved was able low work with PT and OT with recommendations for subacute rehab.  The patient stable normal renal function good saturation hypotension resolved.  Patient is back on his home medications with exception of Lasix which will be dosed daily for a greater than or equal to 2 lb weight gain along with his potassium chloride patient need labs within a week to re-evaluate his blood count and his kidney function electrolytes.  Patient in stable condition for discharge to subacute rehab
Age: 5.0
Sex: M
Vaccine: MMR
Symptoms: Expired product administered
Clinical narrative: The student was administered a MMR vaccine (lot number T025927) on 8/9/22 with an expiration date of 7/30/22 at a immunization clinic.   Notified parent and rescheduled a re-vaccination appointment for 9/15/22 Inventory to be returned to the health department at the end of each year. Summer clinics will be stocked with a fresh inventory during the summer for clinics.
Age: 33.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Blood test, Mobility decreased, Pain in extremity
Clinical narrative: Severe joint pain in ankles and feet that lasted about 2 months non stop (unable to walk a flight of stairs due to pain), also joint pain in shoulders and wrists that lasted about a month non stop (unable to hold my child, feed her, or change her), still get wrist pain every other month or so that lasts 24-48 hours.  Moved from joint to joint.  One day would be anterior right wrist, two days later it was anterior left wrist and right wrist was fine, month later and it was posterior left wrist.  Comes as fast as it goes without warning
Age: 16.0
Sex: M
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Patient came into my store for second covid vaccination his first shot was done at another pharmacy and the pharmacy had called first because they did not have the moderna and wanted to make sure we had it before sending patient to us.  When patient came her it was noted that he was only 16 years old.  We checked with our corporate immunization leader and it was determined that even though the patient should not have received the moderna vaccine we needed to complete the series with the same vaccine he received first.
Age: 3.0
Sex: M
Vaccine: COVID19
Symptoms: Inappropriate schedule of product administration
Clinical narrative: Pt given Moderna dose number 2 - one week to early. First dose was given on July 27th and second dose was given on August 17th (1 week to early). The second dose will not count toward the series and an additional dose will need to be given on or after September 14th to count as his second immunization to complete the series.
Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient received moderna booster 0.25 and was unaware that moderna will now be given for only 1st and 2nd dose.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Chills, Injection site pain, Myalgia, Pyrexia
Clinical narrative: fever, chills, muscle aches, injection site pain
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Asthenia, Blood creatinine increased, COVID-19, COVID-19 pneumonia
Clinical narrative: Admission Date: 8/30/2022 Discharge Date: 9/13/2022  Patient is a 91 y.o. male who presents today with medical history of emphysema, Parkinson disease, gout, hypertension, dementia brought to ER by her daughter due to chief complaints of weakness.  Patient lives with her wife, who has been hospitalized with COVID 19 infection.  The usually get help and support 2 caregivers who visit patient's home multiple times or daily basis.  Since his wife tested positive for COVID, caregivers have not been able to come to provide assistance.  Both patient and his wife have been dependent on caregiver and their daughters for iADLs.  Patient's daughter, at bedside provides history.  She states that for the last 2 days his father has been getting generalized weakness.  Last night he was getting confused.  She had great difficulty in helping him go to bed.  In this morning patient was too tired to get out of his bed.  At this point she decided to bring her further hospital. In ER, patient was tested positive for COVID-19 infection.  Chest x-ray without infiltrates.  Patient uses 2 L oxygen at home, his oxygenation requirement was unchanged from baseline.  Also found to have elevated creatinine 1.3 (4 months ago creatinine 1.1).  Due to lack of support at home, and acute kidney injury patient was admitted under hospitalist service.  He will likely require placement for short-term rehab upon discharge.   #Aspiration Pneumonia #Bacterial Pneumonia #COVID Pneumonia >finished abx course >clinically improved >excited to go home   #COVID 19 >dc home with hospice   #Goal of care <DNR/home with hospice
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray normal, Confusional state, Fatigue, Impaired self-care, Loss of personal independence in daily activities
Clinical narrative: Admission Date: 8/30/2022 Discharge Date: 9/13/2022  Patient is a 91 y.o. male who presents today with medical history of emphysema, Parkinson disease, gout, hypertension, dementia brought to ER by her daughter due to chief complaints of weakness.  Patient lives with her wife, who has been hospitalized with COVID 19 infection.  The usually get help and support 2 caregivers who visit patient's home multiple times or daily basis.  Since his wife tested positive for COVID, caregivers have not been able to come to provide assistance.  Both patient and his wife have been dependent on caregiver and their daughters for iADLs.  Patient's daughter, at bedside provides history.  She states that for the last 2 days his father has been getting generalized weakness.  Last night he was getting confused.  She had great difficulty in helping him go to bed.  In this morning patient was too tired to get out of his bed.  At this point she decided to bring her further hospital. In ER, patient was tested positive for COVID-19 infection.  Chest x-ray without infiltrates.  Patient uses 2 L oxygen at home, his oxygenation requirement was unchanged from baseline.  Also found to have elevated creatinine 1.3 (4 months ago creatinine 1.1).  Due to lack of support at home, and acute kidney injury patient was admitted under hospitalist service.  He will likely require placement for short-term rehab upon discharge.   #Aspiration Pneumonia #Bacterial Pneumonia #COVID Pneumonia >finished abx course >clinically improved >excited to go home   #COVID 19 >dc home with hospice   #Goal of care <DNR/home with hospice
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Pneumonia aspiration, Pneumonia bacterial, SARS-CoV-2 test positive
Clinical narrative: Admission Date: 8/30/2022 Discharge Date: 9/13/2022  Patient is a 91 y.o. male who presents today with medical history of emphysema, Parkinson disease, gout, hypertension, dementia brought to ER by her daughter due to chief complaints of weakness.  Patient lives with her wife, who has been hospitalized with COVID 19 infection.  The usually get help and support 2 caregivers who visit patient's home multiple times or daily basis.  Since his wife tested positive for COVID, caregivers have not been able to come to provide assistance.  Both patient and his wife have been dependent on caregiver and their daughters for iADLs.  Patient's daughter, at bedside provides history.  She states that for the last 2 days his father has been getting generalized weakness.  Last night he was getting confused.  She had great difficulty in helping him go to bed.  In this morning patient was too tired to get out of his bed.  At this point she decided to bring her further hospital. In ER, patient was tested positive for COVID-19 infection.  Chest x-ray without infiltrates.  Patient uses 2 L oxygen at home, his oxygenation requirement was unchanged from baseline.  Also found to have elevated creatinine 1.3 (4 months ago creatinine 1.1).  Due to lack of support at home, and acute kidney injury patient was admitted under hospitalist service.  He will likely require placement for short-term rehab upon discharge.   #Aspiration Pneumonia #Bacterial Pneumonia #COVID Pneumonia >finished abx course >clinically improved >excited to go home   #COVID 19 >dc home with hospice   #Goal of care <DNR/home with hospice
Age: 12.0
Sex: F
Vaccine: TDAP
Symptoms: Nausea
Clinical narrative: Nausea.  No vomiting.  Had pt lie down with elevated legs.  Pt felt better immediately, and was completely fine 15 minutes later.  observed total of 30 minutes after symptoms of nausea, with guardian and pt's school counselor also carefully monitoring pt.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID breakthrough. Presented to hospital on 8/30 for unrelated reason and tested positive for COVID on 8/30/22. Patient had fever of 100.8 on presentation to the hospital.
Age: 67.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Cellulitis, Inflammation, Pyrexia, Skin reaction, Skin warm
Clinical narrative: On 9-12-22, patient inquired at the pharmacy due to symptoms from her vaccinations on 9-9-22.  She reported having low grade fever that began on 9-10-22 and was off an on since.  Her arm was red, inflamed and around 2-3 inches circle.  It was warm to touch and remained the same size.  I instructed her to contact her prescriber.  It was determined it was cellulitis and she was prescribed an antibiotic 9-13-22.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Unevaluable event
Clinical narrative: Fully vaccinated and boosted once
Age: 90.0
Sex: F
Vaccine: COVID19
Symptoms: Bacterial test positive, Bladder irrigation, Blood creatinine normal, Blood electrolytes normal, Blood urea increased
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: MD  Admission Date: 8/29/2022 Discharge Date: 9/9/2022  PRESENTING PROBLEM: COVID-19   HOSPITAL COURSE:    90-year-old female with a history of paroxysmal atrial fibrillation on Coumadin, stage 2 chronic kidney disease, iron deficiency anemia, frequent falls of recent.  Patient states she has fallen multiple times in the last week, she attributes this to unsteady gait.  No loss of consciousness.  She presented to the emergency room today for evaluation after hitting her head.  On arrival she was mildly hypertensive, otherwise hemodynamically stable on room air oxygen.  Patient had a workup which included normal electrolytes with a BUN and creatinine of 24/1.1, white blood cell count normal at 7.85 hemoglobin 12.7.  Urinalysis showed greater than 180 white blood cells with positive leukocyte esterase and many bacteria.  She was also COVID-19 PCR positive.  Patient denies any respiratory complaints.  She denies any urinary complaints.  She states she has been eating and drinking okay, maybe not as much as usual.   Patient did have a CT cervical spine which demonstrated acute fractures of the inferior endplate of C6 and also nondisplaced fracture of C7.  The case was discussed with Trauma surgery/Orthopedic surgery and per ER they stated a Miami J collar is indicated, no recent to transfer downtown.   Patient patient also had a CT lumbar spine which showed no fracture but did demonstrate a new moderate right hydronephrosis and hydroureter, as well as a stable left hydronephrosis and hydroureter.   Patient currently has some mild discomfort in her neck at the fracture site per her report, she has however wearing a Miami J collar, and I did not removed for exam   When writer to cover case care management was looking for a rehab facility for patient and her husband was also admitted given that they are COVID positive.  During patient's admission she did well.  She did develop hematuria and required bladder irrigation which resolved.  Writer had several conversations with patient and her daughter regarding goals of care.  They did meet with palliative Care and will continue discussion as an outpatient.  We did discuss Coumadin and risk and benefits of stopping Coumadin and they were agreeable to stop Coumadin given patient's multiple falls resulting in significant injury as well as hematuria and anemia.  Patient was out of isolation and PT OT recommended home with home health.  On the day of discharge patient was stable and discharged in good condition.