chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 65.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Pain in jaw, SARS-CoV-2 test positive
Clinical narrative: I tested positive for COVID-19 4/07/23. I had a headache, cough, pain in my ear and jaw. I contacted my doctor and was prescribed Paxlovid, Benzonatate, and Mucinex DM. I woke up the next day and I felt very dizzy, and I contacted my doctor, and they told me to rest, and they didn't think it was Paxlovid.
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Brain natriuretic peptide increased, Bronchial secretion retention, COVID-19, COVID-19 pneumonia
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of multiple sclerosis with neurogenic bladder, who presented to the hospital from the resident facility with dyspnea on 2/26/2023/   Covid-19 Pneumonia  Acute hypoxemic Respiratory Failure, POA Possible superimposed bacterial pneumonia Mucous plugging Date of onset of symptoms: 2/25/23 Symptoms present on admission: Hypoxia Date of covid positive test: 2/26/2023 Vaccination status: vaccinated Imaging: CT PE study on admission with bilateral left greater than right groundglass opacities on my interpretation.  Repeat chest x-ray 3/2/2023 showing right hemithorax Oxygen requirements on admission: 2 L Current oxygen requirements: High flow, 90% FiO2 Medical therapy: Dexamethasone.  Status post remdesivir Consultants following: ID following Continue cefepime and vancomycin for possible superimposed bacterial pneumonia Management of secretions/mucous plugging with Mucomyst, vibratory pep, and chest physiotherapy Diuresis as able Limited echo reviewed with normal EF, dextrocardia, small to moderate inferolateral pericardial effusion, indeterminate diastolic function.   Goals of care discussions repeatedly addressed throughout hospitalization with patient and adult children (2 daughters and son).  Ultimately CODE STATUS transition to DNR CC on 3/4/2023.   Discussed with patient and daughters at bedside today, referred to hospice per patient and family wishes. Comfort medications ordered.   Hospice meeting at 1 PM today.   Hyponatremia, worsening Likely hypovolemic in the setting of decreased p.o. and diuresis Trend sodium Hold diuresis today Hold off on fluid resuscitation given her tenuous respiratory status   Possible underlying heart failure with preserved ejection fraction On oral Lasix at home and BNP elevated on admission Unclear if has underlying heart failure.  Chest x-ray not consistent with cardiogenic pulmonary edema and exam not consistent with decompensated heart failure.   Chest x-ray 3/4 reviewed with near complete opacification of right hemithorax with minimal improvement from few days ago.  Consistent with lung airspace disease possible pulm edema bilaterally. Diurese as able, on hold for now due to hyponatremia Echocardiogram with normal LV function
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Computerised tomogram thorax abnormal, Dextrocardia, Diuretic therapy, Dyspnoea
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of multiple sclerosis with neurogenic bladder, who presented to the hospital from the resident facility with dyspnea on 2/26/2023/   Covid-19 Pneumonia  Acute hypoxemic Respiratory Failure, POA Possible superimposed bacterial pneumonia Mucous plugging Date of onset of symptoms: 2/25/23 Symptoms present on admission: Hypoxia Date of covid positive test: 2/26/2023 Vaccination status: vaccinated Imaging: CT PE study on admission with bilateral left greater than right groundglass opacities on my interpretation.  Repeat chest x-ray 3/2/2023 showing right hemithorax Oxygen requirements on admission: 2 L Current oxygen requirements: High flow, 90% FiO2 Medical therapy: Dexamethasone.  Status post remdesivir Consultants following: ID following Continue cefepime and vancomycin for possible superimposed bacterial pneumonia Management of secretions/mucous plugging with Mucomyst, vibratory pep, and chest physiotherapy Diuresis as able Limited echo reviewed with normal EF, dextrocardia, small to moderate inferolateral pericardial effusion, indeterminate diastolic function.   Goals of care discussions repeatedly addressed throughout hospitalization with patient and adult children (2 daughters and son).  Ultimately CODE STATUS transition to DNR CC on 3/4/2023.   Discussed with patient and daughters at bedside today, referred to hospice per patient and family wishes. Comfort medications ordered.   Hospice meeting at 1 PM today.   Hyponatremia, worsening Likely hypovolemic in the setting of decreased p.o. and diuresis Trend sodium Hold diuresis today Hold off on fluid resuscitation given her tenuous respiratory status   Possible underlying heart failure with preserved ejection fraction On oral Lasix at home and BNP elevated on admission Unclear if has underlying heart failure.  Chest x-ray not consistent with cardiogenic pulmonary edema and exam not consistent with decompensated heart failure.   Chest x-ray 3/4 reviewed with near complete opacification of right hemithorax with minimal improvement from few days ago.  Consistent with lung airspace disease possible pulm edema bilaterally. Diurese as able, on hold for now due to hyponatremia Echocardiogram with normal LV function
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Echocardiogram abnormal, Ejection fraction normal, Hyponatraemia, Hypophagia, Hypovolaemia
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of multiple sclerosis with neurogenic bladder, who presented to the hospital from the resident facility with dyspnea on 2/26/2023/   Covid-19 Pneumonia  Acute hypoxemic Respiratory Failure, POA Possible superimposed bacterial pneumonia Mucous plugging Date of onset of symptoms: 2/25/23 Symptoms present on admission: Hypoxia Date of covid positive test: 2/26/2023 Vaccination status: vaccinated Imaging: CT PE study on admission with bilateral left greater than right groundglass opacities on my interpretation.  Repeat chest x-ray 3/2/2023 showing right hemithorax Oxygen requirements on admission: 2 L Current oxygen requirements: High flow, 90% FiO2 Medical therapy: Dexamethasone.  Status post remdesivir Consultants following: ID following Continue cefepime and vancomycin for possible superimposed bacterial pneumonia Management of secretions/mucous plugging with Mucomyst, vibratory pep, and chest physiotherapy Diuresis as able Limited echo reviewed with normal EF, dextrocardia, small to moderate inferolateral pericardial effusion, indeterminate diastolic function.   Goals of care discussions repeatedly addressed throughout hospitalization with patient and adult children (2 daughters and son).  Ultimately CODE STATUS transition to DNR CC on 3/4/2023.   Discussed with patient and daughters at bedside today, referred to hospice per patient and family wishes. Comfort medications ordered.   Hospice meeting at 1 PM today.   Hyponatremia, worsening Likely hypovolemic in the setting of decreased p.o. and diuresis Trend sodium Hold diuresis today Hold off on fluid resuscitation given her tenuous respiratory status   Possible underlying heart failure with preserved ejection fraction On oral Lasix at home and BNP elevated on admission Unclear if has underlying heart failure.  Chest x-ray not consistent with cardiogenic pulmonary edema and exam not consistent with decompensated heart failure.   Chest x-ray 3/4 reviewed with near complete opacification of right hemithorax with minimal improvement from few days ago.  Consistent with lung airspace disease possible pulm edema bilaterally. Diurese as able, on hold for now due to hyponatremia Echocardiogram with normal LV function
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Lung disorder, Lung opacity, Malaise, Pericardial effusion
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of multiple sclerosis with neurogenic bladder, who presented to the hospital from the resident facility with dyspnea on 2/26/2023/   Covid-19 Pneumonia  Acute hypoxemic Respiratory Failure, POA Possible superimposed bacterial pneumonia Mucous plugging Date of onset of symptoms: 2/25/23 Symptoms present on admission: Hypoxia Date of covid positive test: 2/26/2023 Vaccination status: vaccinated Imaging: CT PE study on admission with bilateral left greater than right groundglass opacities on my interpretation.  Repeat chest x-ray 3/2/2023 showing right hemithorax Oxygen requirements on admission: 2 L Current oxygen requirements: High flow, 90% FiO2 Medical therapy: Dexamethasone.  Status post remdesivir Consultants following: ID following Continue cefepime and vancomycin for possible superimposed bacterial pneumonia Management of secretions/mucous plugging with Mucomyst, vibratory pep, and chest physiotherapy Diuresis as able Limited echo reviewed with normal EF, dextrocardia, small to moderate inferolateral pericardial effusion, indeterminate diastolic function.   Goals of care discussions repeatedly addressed throughout hospitalization with patient and adult children (2 daughters and son).  Ultimately CODE STATUS transition to DNR CC on 3/4/2023.   Discussed with patient and daughters at bedside today, referred to hospice per patient and family wishes. Comfort medications ordered.   Hospice meeting at 1 PM today.   Hyponatremia, worsening Likely hypovolemic in the setting of decreased p.o. and diuresis Trend sodium Hold diuresis today Hold off on fluid resuscitation given her tenuous respiratory status   Possible underlying heart failure with preserved ejection fraction On oral Lasix at home and BNP elevated on admission Unclear if has underlying heart failure.  Chest x-ray not consistent with cardiogenic pulmonary edema and exam not consistent with decompensated heart failure.   Chest x-ray 3/4 reviewed with near complete opacification of right hemithorax with minimal improvement from few days ago.  Consistent with lung airspace disease possible pulm edema bilaterally. Diurese as able, on hold for now due to hyponatremia Echocardiogram with normal LV function
Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory disorder, SARS-CoV-2 test positive
Clinical narrative: Patient is a 86 y.o. female patient of MD with history of multiple sclerosis with neurogenic bladder, who presented to the hospital from the resident facility with dyspnea on 2/26/2023/   Covid-19 Pneumonia  Acute hypoxemic Respiratory Failure, POA Possible superimposed bacterial pneumonia Mucous plugging Date of onset of symptoms: 2/25/23 Symptoms present on admission: Hypoxia Date of covid positive test: 2/26/2023 Vaccination status: vaccinated Imaging: CT PE study on admission with bilateral left greater than right groundglass opacities on my interpretation.  Repeat chest x-ray 3/2/2023 showing right hemithorax Oxygen requirements on admission: 2 L Current oxygen requirements: High flow, 90% FiO2 Medical therapy: Dexamethasone.  Status post remdesivir Consultants following: ID following Continue cefepime and vancomycin for possible superimposed bacterial pneumonia Management of secretions/mucous plugging with Mucomyst, vibratory pep, and chest physiotherapy Diuresis as able Limited echo reviewed with normal EF, dextrocardia, small to moderate inferolateral pericardial effusion, indeterminate diastolic function.   Goals of care discussions repeatedly addressed throughout hospitalization with patient and adult children (2 daughters and son).  Ultimately CODE STATUS transition to DNR CC on 3/4/2023.   Discussed with patient and daughters at bedside today, referred to hospice per patient and family wishes. Comfort medications ordered.   Hospice meeting at 1 PM today.   Hyponatremia, worsening Likely hypovolemic in the setting of decreased p.o. and diuresis Trend sodium Hold diuresis today Hold off on fluid resuscitation given her tenuous respiratory status   Possible underlying heart failure with preserved ejection fraction On oral Lasix at home and BNP elevated on admission Unclear if has underlying heart failure.  Chest x-ray not consistent with cardiogenic pulmonary edema and exam not consistent with decompensated heart failure.   Chest x-ray 3/4 reviewed with near complete opacification of right hemithorax with minimal improvement from few days ago.  Consistent with lung airspace disease possible pulm edema bilaterally. Diurese as able, on hold for now due to hyponatremia Echocardiogram with normal LV function
Age: 59.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Atrial fibrillation, Computerised tomogram heart abnormal, Echocardiogram abnormal, Malaise
Clinical narrative: Pt. called today (4/11/2023) stating that she received her first 2 COVID-19 Pfizer vaccines at Facility on 3/26/2021 and 4/17/2021 then about 2 months after her second dose she started not feeling  well and was subsequently diagnoses with AFib.  No allergies or cardiac history reported at the time of vaccination. States she didn't know what it was until she got a fitbit then went to the Dr.  Dr at Heart center.  She received an Echo and Cardiac CT and eventually diagnosed with Afib and put on Metoprolol.  Pt states "they said they are seeing a lot of AFib after COVID Pfizer vaccine."  Pt had a COVID Moderna vaccine on 12/18/2021.
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Blood creatinine increased, COVID-19
Clinical narrative: Patient is a 92 years Old male patient of, DO with history of COPD on chronic 3L NC O2 at home, CAD status post CABG, Alzheimer's dementia, and anxiety disorder, who presented to local General Hospital with weakness, and fall. Pt found to be COVID positive and noted worsen hypoxia.  Dementia and possible acute encephalopathy has complicated care as pt tends to remove O2 and requires higher amount to recover.    Goals of Care Called wife to discuss course and worsened hypoxia She states that she wants him to be comfortable and that we should do whatever we think is right Code status confirmed as DNRCC-A, DNI Discussed getting Palliative care involved, particularly if his hypoxia worsens, and she is in agreement Palliative care consulted, appreciate assistance Family met with palliative on 3/2 and decided on hospice care Patient code status changed to DNRCC   Acute on chronic hypoxic respiratory failure due to  COVID 19 infection Acute COPD exacerbation Patient presentation with generalized weakness and fall, on admit COVID-positive test. Patient is Vaccinated. Pt wears 2-3L O2 at home, Pt at night has been using BIPAP, but removes mask and becomes more hypoxic, so he requires more oxygen in the AM requirement continuing to vary between HFNC and BiPAP, a lot of times triggered by him not keeping oxygen on resulting in worsening hypoxia and longer time to improve Inflammatory markers, improving CT pulmonary arteries no evidence of pulmonary embolism, there is mild to moderate underlying emphysema Completed Decadron (2/20) and completed remdesivir (2/17) by pulmonary Pulmonary input appreciated, cont wean O2 as able Patient has f/u with Dr. on 4/4/2023 at 1 PM Remains intermittently between bipap and 15L oxymizer Appears to be on chronic steroids, which were not resumed after decadron was completed. Chronic steroid dose resumed No improvement in condition, plan to transition to inpatient hospice  Acute on chronic metabolic encephalopathy  in setting of COVID-19 Baseline Alzheimer's dementia Anxiety disorder Pt with delirium on admission, now just not oriented but calm and making jokes. .  Most probably multifactorial from infection and hypoxia and steroids. Continue home medication memantine, and donepezil. Started on Depakote 2/14/23 with good response . Continue home Lexapro.  AKI- resolved.  Most likely due to hydration, COVID infection.  On admission creatinine 1.31, now down to normal Avoid nephrotoxic medications, contrast, NSAIDs, renally dose medication.  Elevated troponin Probable new onset CHF. H/O CAD s/p CABG Severe pulmonary hypertension Elevated proBNP  4195. No chest pain, no new ischemic changes reported.   Likely due to COVID infection.   Echocardiogram EF 55%, hypokinesis of septum grade 2 DD, mod to severe TR, pulm HTN at 85mmHg On lasix 20mg PO
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac failure congestive, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Delirium
Clinical narrative: Patient is a 92 years Old male patient of, DO with history of COPD on chronic 3L NC O2 at home, CAD status post CABG, Alzheimer's dementia, and anxiety disorder, who presented to local General Hospital with weakness, and fall. Pt found to be COVID positive and noted worsen hypoxia.  Dementia and possible acute encephalopathy has complicated care as pt tends to remove O2 and requires higher amount to recover.    Goals of Care Called wife to discuss course and worsened hypoxia She states that she wants him to be comfortable and that we should do whatever we think is right Code status confirmed as DNRCC-A, DNI Discussed getting Palliative care involved, particularly if his hypoxia worsens, and she is in agreement Palliative care consulted, appreciate assistance Family met with palliative on 3/2 and decided on hospice care Patient code status changed to DNRCC   Acute on chronic hypoxic respiratory failure due to  COVID 19 infection Acute COPD exacerbation Patient presentation with generalized weakness and fall, on admit COVID-positive test. Patient is Vaccinated. Pt wears 2-3L O2 at home, Pt at night has been using BIPAP, but removes mask and becomes more hypoxic, so he requires more oxygen in the AM requirement continuing to vary between HFNC and BiPAP, a lot of times triggered by him not keeping oxygen on resulting in worsening hypoxia and longer time to improve Inflammatory markers, improving CT pulmonary arteries no evidence of pulmonary embolism, there is mild to moderate underlying emphysema Completed Decadron (2/20) and completed remdesivir (2/17) by pulmonary Pulmonary input appreciated, cont wean O2 as able Patient has f/u with Dr. on 4/4/2023 at 1 PM Remains intermittently between bipap and 15L oxymizer Appears to be on chronic steroids, which were not resumed after decadron was completed. Chronic steroid dose resumed No improvement in condition, plan to transition to inpatient hospice  Acute on chronic metabolic encephalopathy  in setting of COVID-19 Baseline Alzheimer's dementia Anxiety disorder Pt with delirium on admission, now just not oriented but calm and making jokes. .  Most probably multifactorial from infection and hypoxia and steroids. Continue home medication memantine, and donepezil. Started on Depakote 2/14/23 with good response . Continue home Lexapro.  AKI- resolved.  Most likely due to hydration, COVID infection.  On admission creatinine 1.31, now down to normal Avoid nephrotoxic medications, contrast, NSAIDs, renally dose medication.  Elevated troponin Probable new onset CHF. H/O CAD s/p CABG Severe pulmonary hypertension Elevated proBNP  4195. No chest pain, no new ischemic changes reported.   Likely due to COVID infection.   Echocardiogram EF 55%, hypokinesis of septum grade 2 DD, mod to severe TR, pulm HTN at 85mmHg On lasix 20mg PO
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Disorientation, Echocardiogram abnormal, Ejection fraction normal, Emphysema, Encephalopathy
Clinical narrative: Patient is a 92 years Old male patient of, DO with history of COPD on chronic 3L NC O2 at home, CAD status post CABG, Alzheimer's dementia, and anxiety disorder, who presented to local General Hospital with weakness, and fall. Pt found to be COVID positive and noted worsen hypoxia.  Dementia and possible acute encephalopathy has complicated care as pt tends to remove O2 and requires higher amount to recover.    Goals of Care Called wife to discuss course and worsened hypoxia She states that she wants him to be comfortable and that we should do whatever we think is right Code status confirmed as DNRCC-A, DNI Discussed getting Palliative care involved, particularly if his hypoxia worsens, and she is in agreement Palliative care consulted, appreciate assistance Family met with palliative on 3/2 and decided on hospice care Patient code status changed to DNRCC   Acute on chronic hypoxic respiratory failure due to  COVID 19 infection Acute COPD exacerbation Patient presentation with generalized weakness and fall, on admit COVID-positive test. Patient is Vaccinated. Pt wears 2-3L O2 at home, Pt at night has been using BIPAP, but removes mask and becomes more hypoxic, so he requires more oxygen in the AM requirement continuing to vary between HFNC and BiPAP, a lot of times triggered by him not keeping oxygen on resulting in worsening hypoxia and longer time to improve Inflammatory markers, improving CT pulmonary arteries no evidence of pulmonary embolism, there is mild to moderate underlying emphysema Completed Decadron (2/20) and completed remdesivir (2/17) by pulmonary Pulmonary input appreciated, cont wean O2 as able Patient has f/u with Dr. on 4/4/2023 at 1 PM Remains intermittently between bipap and 15L oxymizer Appears to be on chronic steroids, which were not resumed after decadron was completed. Chronic steroid dose resumed No improvement in condition, plan to transition to inpatient hospice  Acute on chronic metabolic encephalopathy  in setting of COVID-19 Baseline Alzheimer's dementia Anxiety disorder Pt with delirium on admission, now just not oriented but calm and making jokes. .  Most probably multifactorial from infection and hypoxia and steroids. Continue home medication memantine, and donepezil. Started on Depakote 2/14/23 with good response . Continue home Lexapro.  AKI- resolved.  Most likely due to hydration, COVID infection.  On admission creatinine 1.31, now down to normal Avoid nephrotoxic medications, contrast, NSAIDs, renally dose medication.  Elevated troponin Probable new onset CHF. H/O CAD s/p CABG Severe pulmonary hypertension Elevated proBNP  4195. No chest pain, no new ischemic changes reported.   Likely due to COVID infection.   Echocardiogram EF 55%, hypokinesis of septum grade 2 DD, mod to severe TR, pulm HTN at 85mmHg On lasix 20mg PO
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Fall, Hypokinesia, Hypoxia, Inflammatory marker test, Intentional medical device removal by patient
Clinical narrative: Patient is a 92 years Old male patient of, DO with history of COPD on chronic 3L NC O2 at home, CAD status post CABG, Alzheimer's dementia, and anxiety disorder, who presented to local General Hospital with weakness, and fall. Pt found to be COVID positive and noted worsen hypoxia.  Dementia and possible acute encephalopathy has complicated care as pt tends to remove O2 and requires higher amount to recover.    Goals of Care Called wife to discuss course and worsened hypoxia She states that she wants him to be comfortable and that we should do whatever we think is right Code status confirmed as DNRCC-A, DNI Discussed getting Palliative care involved, particularly if his hypoxia worsens, and she is in agreement Palliative care consulted, appreciate assistance Family met with palliative on 3/2 and decided on hospice care Patient code status changed to DNRCC   Acute on chronic hypoxic respiratory failure due to  COVID 19 infection Acute COPD exacerbation Patient presentation with generalized weakness and fall, on admit COVID-positive test. Patient is Vaccinated. Pt wears 2-3L O2 at home, Pt at night has been using BIPAP, but removes mask and becomes more hypoxic, so he requires more oxygen in the AM requirement continuing to vary between HFNC and BiPAP, a lot of times triggered by him not keeping oxygen on resulting in worsening hypoxia and longer time to improve Inflammatory markers, improving CT pulmonary arteries no evidence of pulmonary embolism, there is mild to moderate underlying emphysema Completed Decadron (2/20) and completed remdesivir (2/17) by pulmonary Pulmonary input appreciated, cont wean O2 as able Patient has f/u with Dr. on 4/4/2023 at 1 PM Remains intermittently between bipap and 15L oxymizer Appears to be on chronic steroids, which were not resumed after decadron was completed. Chronic steroid dose resumed No improvement in condition, plan to transition to inpatient hospice  Acute on chronic metabolic encephalopathy  in setting of COVID-19 Baseline Alzheimer's dementia Anxiety disorder Pt with delirium on admission, now just not oriented but calm and making jokes. .  Most probably multifactorial from infection and hypoxia and steroids. Continue home medication memantine, and donepezil. Started on Depakote 2/14/23 with good response . Continue home Lexapro.  AKI- resolved.  Most likely due to hydration, COVID infection.  On admission creatinine 1.31, now down to normal Avoid nephrotoxic medications, contrast, NSAIDs, renally dose medication.  Elevated troponin Probable new onset CHF. H/O CAD s/p CABG Severe pulmonary hypertension Elevated proBNP  4195. No chest pain, no new ischemic changes reported.   Likely due to COVID infection.   Echocardiogram EF 55%, hypokinesis of septum grade 2 DD, mod to severe TR, pulm HTN at 85mmHg On lasix 20mg PO
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Positive airway pressure therapy, Prohormone brain natriuretic peptide increased, Pulmonary hypertension, Respiratory failure
Clinical narrative: Patient is a 92 years Old male patient of, DO with history of COPD on chronic 3L NC O2 at home, CAD status post CABG, Alzheimer's dementia, and anxiety disorder, who presented to local General Hospital with weakness, and fall. Pt found to be COVID positive and noted worsen hypoxia.  Dementia and possible acute encephalopathy has complicated care as pt tends to remove O2 and requires higher amount to recover.    Goals of Care Called wife to discuss course and worsened hypoxia She states that she wants him to be comfortable and that we should do whatever we think is right Code status confirmed as DNRCC-A, DNI Discussed getting Palliative care involved, particularly if his hypoxia worsens, and she is in agreement Palliative care consulted, appreciate assistance Family met with palliative on 3/2 and decided on hospice care Patient code status changed to DNRCC   Acute on chronic hypoxic respiratory failure due to  COVID 19 infection Acute COPD exacerbation Patient presentation with generalized weakness and fall, on admit COVID-positive test. Patient is Vaccinated. Pt wears 2-3L O2 at home, Pt at night has been using BIPAP, but removes mask and becomes more hypoxic, so he requires more oxygen in the AM requirement continuing to vary between HFNC and BiPAP, a lot of times triggered by him not keeping oxygen on resulting in worsening hypoxia and longer time to improve Inflammatory markers, improving CT pulmonary arteries no evidence of pulmonary embolism, there is mild to moderate underlying emphysema Completed Decadron (2/20) and completed remdesivir (2/17) by pulmonary Pulmonary input appreciated, cont wean O2 as able Patient has f/u with Dr. on 4/4/2023 at 1 PM Remains intermittently between bipap and 15L oxymizer Appears to be on chronic steroids, which were not resumed after decadron was completed. Chronic steroid dose resumed No improvement in condition, plan to transition to inpatient hospice  Acute on chronic metabolic encephalopathy  in setting of COVID-19 Baseline Alzheimer's dementia Anxiety disorder Pt with delirium on admission, now just not oriented but calm and making jokes. .  Most probably multifactorial from infection and hypoxia and steroids. Continue home medication memantine, and donepezil. Started on Depakote 2/14/23 with good response . Continue home Lexapro.  AKI- resolved.  Most likely due to hydration, COVID infection.  On admission creatinine 1.31, now down to normal Avoid nephrotoxic medications, contrast, NSAIDs, renally dose medication.  Elevated troponin Probable new onset CHF. H/O CAD s/p CABG Severe pulmonary hypertension Elevated proBNP  4195. No chest pain, no new ischemic changes reported.   Likely due to COVID infection.   Echocardiogram EF 55%, hypokinesis of septum grade 2 DD, mod to severe TR, pulm HTN at 85mmHg On lasix 20mg PO
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Tricuspid valve incompetence, Troponin increased
Clinical narrative: Patient is a 92 years Old male patient of, DO with history of COPD on chronic 3L NC O2 at home, CAD status post CABG, Alzheimer's dementia, and anxiety disorder, who presented to local General Hospital with weakness, and fall. Pt found to be COVID positive and noted worsen hypoxia.  Dementia and possible acute encephalopathy has complicated care as pt tends to remove O2 and requires higher amount to recover.    Goals of Care Called wife to discuss course and worsened hypoxia She states that she wants him to be comfortable and that we should do whatever we think is right Code status confirmed as DNRCC-A, DNI Discussed getting Palliative care involved, particularly if his hypoxia worsens, and she is in agreement Palliative care consulted, appreciate assistance Family met with palliative on 3/2 and decided on hospice care Patient code status changed to DNRCC   Acute on chronic hypoxic respiratory failure due to  COVID 19 infection Acute COPD exacerbation Patient presentation with generalized weakness and fall, on admit COVID-positive test. Patient is Vaccinated. Pt wears 2-3L O2 at home, Pt at night has been using BIPAP, but removes mask and becomes more hypoxic, so he requires more oxygen in the AM requirement continuing to vary between HFNC and BiPAP, a lot of times triggered by him not keeping oxygen on resulting in worsening hypoxia and longer time to improve Inflammatory markers, improving CT pulmonary arteries no evidence of pulmonary embolism, there is mild to moderate underlying emphysema Completed Decadron (2/20) and completed remdesivir (2/17) by pulmonary Pulmonary input appreciated, cont wean O2 as able Patient has f/u with Dr. on 4/4/2023 at 1 PM Remains intermittently between bipap and 15L oxymizer Appears to be on chronic steroids, which were not resumed after decadron was completed. Chronic steroid dose resumed No improvement in condition, plan to transition to inpatient hospice  Acute on chronic metabolic encephalopathy  in setting of COVID-19 Baseline Alzheimer's dementia Anxiety disorder Pt with delirium on admission, now just not oriented but calm and making jokes. .  Most probably multifactorial from infection and hypoxia and steroids. Continue home medication memantine, and donepezil. Started on Depakote 2/14/23 with good response . Continue home Lexapro.  AKI- resolved.  Most likely due to hydration, COVID infection.  On admission creatinine 1.31, now down to normal Avoid nephrotoxic medications, contrast, NSAIDs, renally dose medication.  Elevated troponin Probable new onset CHF. H/O CAD s/p CABG Severe pulmonary hypertension Elevated proBNP  4195. No chest pain, no new ischemic changes reported.   Likely due to COVID infection.   Echocardiogram EF 55%, hypokinesis of septum grade 2 DD, mod to severe TR, pulm HTN at 85mmHg On lasix 20mg PO
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Adenocarcinoma gastric, Blood alkaline phosphatase increased, Embolic stroke, Subdural haemorrhage
Clinical narrative: I63.9 ACUTE STROKE DUE TO EMBOLISM OF UNSPECIFIED ARTERY 2/11/2022 ACUTE NONTRAUMATIC SUBDURAL HEMORRHAGE I63.9 ACUTE STROKE DUE TO EMBOLISM OF UNSPECIFIED ARTERY 2/11/2022 ELEVATED ALKALINE PHOSPHATASE I63.9 ACUTE STROKE DUE TO EMBOLISM OF UNSPECIFIED ARTERY 2/11/2022 ADENOCARCINOMA, CARDIA OF STOMACH I63.9 ACUTE STROKE DUE TO EMBOLISM OF UNSPECIFIED ARTERY 2/11/2022 ELEVATED ALKALINE PHOSPHATASE I63.9 ACUTE STROKE DUE TO EMBOLISM OF UNSPECIFIED ARTERY 2/11/2022 ADENOCARCINOMA, CARDIA OF STOMACH
Age: 66.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: COVID-19, Chills, Cold sweat, Cough, Fatigue
Clinical narrative: 11/03/2022 I had fever, chills, headache, coughing, cold sweats, chest and nasal congestion and fatigue. Symptoms have been constant for 2 months. Dr. and I agreed that I would not take Paxlovid since I currently take intravenous vitamin supplements and I would have to stop. I have heard that Paxlovid may also cause a rebound case of COVID-19, so I treated my symptoms with Mucinex, Albuterol sulfate inhaler and OTC Tylenol.
Age: 66.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Headache, Malaise, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: 11/03/2022 I had fever, chills, headache, coughing, cold sweats, chest and nasal congestion and fatigue. Symptoms have been constant for 2 months. Dr. and I agreed that I would not take Paxlovid since I currently take intravenous vitamin supplements and I would have to stop. I have heard that Paxlovid may also cause a rebound case of COVID-19, so I treated my symptoms with Mucinex, Albuterol sulfate inhaler and OTC Tylenol.
Age: 1.25
Sex: M
Vaccine: HIBV
Symptoms: Expired product administered
Clinical narrative: Diluent for Hib vaccine was expired by 5 days. Sanofi said to repeat dose as soon as possible. Dose repeated with in date vaccine/diluent 2 days later. RN. No adverse reaction/outcome for patient.
Age: 45.0
Sex: F
Vaccine: COVID19-2
Symptoms: Asthenia, Fatigue, Pyrexia, Respiratory tract congestion, Tinnitus
Clinical narrative: I started having overall exhaustion March 8, 2023 followed by a low fever with some extra congestion. Over the next few days my symptoms progressed till I didn't have any energy at all. The severe congestion persisted for five days. The low fever lasted for ten days. Around March 20,2023, I started feeling better. On March 21, 2023, I started having a fluttering sound in my right ear. My doctor said I had a virus that attacked the nerve that attacked my ear drum. That lasted about three weeks. Accompanied with the fluttering, was a low fever that would happen only during the evenings. I still had extreme exhaustion that lasted till April 9, 2023. I took over the counter treatments such as Tylenol, Mucinex, and Ibuprofen.
Age: 45.0
Sex: F
Vaccine: COVID19-2
Symptoms: Viral infection
Clinical narrative: I started having overall exhaustion March 8, 2023 followed by a low fever with some extra congestion. Over the next few days my symptoms progressed till I didn't have any energy at all. The severe congestion persisted for five days. The low fever lasted for ten days. Around March 20,2023, I started feeling better. On March 21, 2023, I started having a fluttering sound in my right ear. My doctor said I had a virus that attacked the nerve that attacked my ear drum. That lasted about three weeks. Accompanied with the fluttering, was a low fever that would happen only during the evenings. I still had extreme exhaustion that lasted till April 9, 2023. I took over the counter treatments such as Tylenol, Mucinex, and Ibuprofen.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Discomfort, Joint swelling, Lymph node pain, Lymphadenopathy, Peripheral swelling
Clinical narrative: The first time I had the adverse event was after the second vaccine, I started swelling at the base of my neck in the V of the collar bone and under my arm, behind my knees, and at my ankles.  This lasted approximately one month but I did not see anybody for this.   After the 4th vaccine, the symptoms were more pronounced with a the swelling about the size of a half of a tennis ball at the V in my neck/collar bone, and swelling under my arm, at my knees, and ankles.  All of my lymph nodes were swollen.  It was very painful and uncomfortable.  This was only on the side of the body where I received the vaccine.  The doctor told me to take Ibuprofen and gave a prescription for 7 day regiment of Prednisone to help bring down the swelling.  This lasted approximately three months.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Swelling
Clinical narrative: The first time I had the adverse event was after the second vaccine, I started swelling at the base of my neck in the V of the collar bone and under my arm, behind my knees, and at my ankles.  This lasted approximately one month but I did not see anybody for this.   After the 4th vaccine, the symptoms were more pronounced with a the swelling about the size of a half of a tennis ball at the V in my neck/collar bone, and swelling under my arm, at my knees, and ankles.  All of my lymph nodes were swollen.  It was very painful and uncomfortable.  This was only on the side of the body where I received the vaccine.  The doctor told me to take Ibuprofen and gave a prescription for 7 day regiment of Prednisone to help bring down the swelling.  This lasted approximately three months.
Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Acute respiratory failure, Asthenia, Atrial fibrillation, Brain natriuretic peptide increased
Clinical narrative: Patient is a 53 y.o. male patient of Physician with history of morbid obesity, OSA/OHS, CHF, Afib presented to Hospital with chest pain, dyspnea, found to have Afib with RVR and Covid 19 .   Acute hypoxic respiratory failure  Peak 4 L 02, now on 2-3 Reports he has not been on chronic 02, but appears has been sent home on this in the past  Due to obesity, CHF , and covid  Discharged on 2L of oxygen, would attempt to cont to wean at convalarium    Covid 19  One day of nausea, chest pain  Positive test 2/28  Requiring 02, but likely multifactorial cause  Only received 1 moderna vaccine  Cant take paxlovid due to xarelto  CRP elevated  Given remdesivir during stay, stop on dc  Cont dexamethasone to complete course     Acute on chronic diastolic congestive heart failure, pulmonary HTN Body habitus makes exam difficult, but no sig pitting edema  BNP elevated, portable xray with some congestion  Echo 3/1 limited due to habitus, with diastolic dysfunction, EF 55 but with areas of hypokinesis, pHTN similar to prior 6/22  Taking lasix 80mg BID at home, given  IV lasix 40 BID, resume home dose    Afib with RVR  Rates initially 130's Improving, presume due to covid  Resume home cardizem 360mg daily, metoprolol 50 BID  Started on cardizem gtt on admission, now improving so stopped    NSTEMI Patient with atypical chest pain  Troponin peak  102 with positive delta  Ekg without ischemic changes  Cardiology consulted Given risk/benefit and difficult diagnosis given body habitus recommend continued medical therapy  Start asa, statin, cont BB    OSA CPAP/BiPAP with naps/sleeping    Obesity Severe debility Has bene at the Convalarium  for a year Has apparently not had medical follow up?  PT/OT/Social work assessed Prognosis poor if debility does not improve, would recommend therapy start or patient engage with palliative care
Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein increased, COVID-19, Cardiac failure acute, Cardiac failure congestive, Chest X-ray abnormal
Clinical narrative: Patient is a 53 y.o. male patient of Physician with history of morbid obesity, OSA/OHS, CHF, Afib presented to Hospital with chest pain, dyspnea, found to have Afib with RVR and Covid 19 .   Acute hypoxic respiratory failure  Peak 4 L 02, now on 2-3 Reports he has not been on chronic 02, but appears has been sent home on this in the past  Due to obesity, CHF , and covid  Discharged on 2L of oxygen, would attempt to cont to wean at convalarium    Covid 19  One day of nausea, chest pain  Positive test 2/28  Requiring 02, but likely multifactorial cause  Only received 1 moderna vaccine  Cant take paxlovid due to xarelto  CRP elevated  Given remdesivir during stay, stop on dc  Cont dexamethasone to complete course     Acute on chronic diastolic congestive heart failure, pulmonary HTN Body habitus makes exam difficult, but no sig pitting edema  BNP elevated, portable xray with some congestion  Echo 3/1 limited due to habitus, with diastolic dysfunction, EF 55 but with areas of hypokinesis, pHTN similar to prior 6/22  Taking lasix 80mg BID at home, given  IV lasix 40 BID, resume home dose    Afib with RVR  Rates initially 130's Improving, presume due to covid  Resume home cardizem 360mg daily, metoprolol 50 BID  Started on cardizem gtt on admission, now improving so stopped    NSTEMI Patient with atypical chest pain  Troponin peak  102 with positive delta  Ekg without ischemic changes  Cardiology consulted Given risk/benefit and difficult diagnosis given body habitus recommend continued medical therapy  Start asa, statin, cont BB    OSA CPAP/BiPAP with naps/sleeping    Obesity Severe debility Has bene at the Convalarium  for a year Has apparently not had medical follow up?  PT/OT/Social work assessed Prognosis poor if debility does not improve, would recommend therapy start or patient engage with palliative care
Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: Chest pain, Condition aggravated, Diastolic dysfunction, Dyspnoea, Echocardiogram abnormal
Clinical narrative: Patient is a 53 y.o. male patient of Physician with history of morbid obesity, OSA/OHS, CHF, Afib presented to Hospital with chest pain, dyspnea, found to have Afib with RVR and Covid 19 .   Acute hypoxic respiratory failure  Peak 4 L 02, now on 2-3 Reports he has not been on chronic 02, but appears has been sent home on this in the past  Due to obesity, CHF , and covid  Discharged on 2L of oxygen, would attempt to cont to wean at convalarium    Covid 19  One day of nausea, chest pain  Positive test 2/28  Requiring 02, but likely multifactorial cause  Only received 1 moderna vaccine  Cant take paxlovid due to xarelto  CRP elevated  Given remdesivir during stay, stop on dc  Cont dexamethasone to complete course     Acute on chronic diastolic congestive heart failure, pulmonary HTN Body habitus makes exam difficult, but no sig pitting edema  BNP elevated, portable xray with some congestion  Echo 3/1 limited due to habitus, with diastolic dysfunction, EF 55 but with areas of hypokinesis, pHTN similar to prior 6/22  Taking lasix 80mg BID at home, given  IV lasix 40 BID, resume home dose    Afib with RVR  Rates initially 130's Improving, presume due to covid  Resume home cardizem 360mg daily, metoprolol 50 BID  Started on cardizem gtt on admission, now improving so stopped    NSTEMI Patient with atypical chest pain  Troponin peak  102 with positive delta  Ekg without ischemic changes  Cardiology consulted Given risk/benefit and difficult diagnosis given body habitus recommend continued medical therapy  Start asa, statin, cont BB    OSA CPAP/BiPAP with naps/sleeping    Obesity Severe debility Has bene at the Convalarium  for a year Has apparently not had medical follow up?  PT/OT/Social work assessed Prognosis poor if debility does not improve, would recommend therapy start or patient engage with palliative care
Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: Ejection fraction normal, Electrocardiogram normal, Hypokinesia, Left ventricular failure, Nausea
Clinical narrative: Patient is a 53 y.o. male patient of Physician with history of morbid obesity, OSA/OHS, CHF, Afib presented to Hospital with chest pain, dyspnea, found to have Afib with RVR and Covid 19 .   Acute hypoxic respiratory failure  Peak 4 L 02, now on 2-3 Reports he has not been on chronic 02, but appears has been sent home on this in the past  Due to obesity, CHF , and covid  Discharged on 2L of oxygen, would attempt to cont to wean at convalarium    Covid 19  One day of nausea, chest pain  Positive test 2/28  Requiring 02, but likely multifactorial cause  Only received 1 moderna vaccine  Cant take paxlovid due to xarelto  CRP elevated  Given remdesivir during stay, stop on dc  Cont dexamethasone to complete course     Acute on chronic diastolic congestive heart failure, pulmonary HTN Body habitus makes exam difficult, but no sig pitting edema  BNP elevated, portable xray with some congestion  Echo 3/1 limited due to habitus, with diastolic dysfunction, EF 55 but with areas of hypokinesis, pHTN similar to prior 6/22  Taking lasix 80mg BID at home, given  IV lasix 40 BID, resume home dose    Afib with RVR  Rates initially 130's Improving, presume due to covid  Resume home cardizem 360mg daily, metoprolol 50 BID  Started on cardizem gtt on admission, now improving so stopped    NSTEMI Patient with atypical chest pain  Troponin peak  102 with positive delta  Ekg without ischemic changes  Cardiology consulted Given risk/benefit and difficult diagnosis given body habitus recommend continued medical therapy  Start asa, statin, cont BB    OSA CPAP/BiPAP with naps/sleeping    Obesity Severe debility Has bene at the Convalarium  for a year Has apparently not had medical follow up?  PT/OT/Social work assessed Prognosis poor if debility does not improve, would recommend therapy start or patient engage with palliative care
Age: 51.0
Sex: M
Vaccine: COVID19
Symptoms: Obesity, Pulmonary hypertension, Respiratory tract congestion, SARS-CoV-2 test positive, Troponin increased
Clinical narrative: Patient is a 53 y.o. male patient of Physician with history of morbid obesity, OSA/OHS, CHF, Afib presented to Hospital with chest pain, dyspnea, found to have Afib with RVR and Covid 19 .   Acute hypoxic respiratory failure  Peak 4 L 02, now on 2-3 Reports he has not been on chronic 02, but appears has been sent home on this in the past  Due to obesity, CHF , and covid  Discharged on 2L of oxygen, would attempt to cont to wean at convalarium    Covid 19  One day of nausea, chest pain  Positive test 2/28  Requiring 02, but likely multifactorial cause  Only received 1 moderna vaccine  Cant take paxlovid due to xarelto  CRP elevated  Given remdesivir during stay, stop on dc  Cont dexamethasone to complete course     Acute on chronic diastolic congestive heart failure, pulmonary HTN Body habitus makes exam difficult, but no sig pitting edema  BNP elevated, portable xray with some congestion  Echo 3/1 limited due to habitus, with diastolic dysfunction, EF 55 but with areas of hypokinesis, pHTN similar to prior 6/22  Taking lasix 80mg BID at home, given  IV lasix 40 BID, resume home dose    Afib with RVR  Rates initially 130's Improving, presume due to covid  Resume home cardizem 360mg daily, metoprolol 50 BID  Started on cardizem gtt on admission, now improving so stopped    NSTEMI Patient with atypical chest pain  Troponin peak  102 with positive delta  Ekg without ischemic changes  Cardiology consulted Given risk/benefit and difficult diagnosis given body habitus recommend continued medical therapy  Start asa, statin, cont BB    OSA CPAP/BiPAP with naps/sleeping    Obesity Severe debility Has bene at the Convalarium  for a year Has apparently not had medical follow up?  PT/OT/Social work assessed Prognosis poor if debility does not improve, would recommend therapy start or patient engage with palliative care
Age: 70.0
Sex: M
Vaccine: COVID19-2
Symptoms: Arthralgia, Blood test, Magnetic resonance imaging abnormal, Medical device implantation, Mobility decreased
Clinical narrative: I had my vaccination on 10/07/2022. On 10/12/2022 I started having muscle pains. These pains were manifesting on both shoulders and at the top of my legs and buttocks. It was difficult for me to move and I would have to gradually get my legs moving. I had a lot of pain in my shoulders. I could move my arms to the front of my body and near. I could not reach behind me or up above me. I contacted my physician in 10/2022. I stopped taking the alopurinol and testosterone. I was sent for blood panel. I was then referred to specialist for Neurology. I had an MRI of my right shoulder as it was the most painful. I was also referred to other specialty care and they put electrodes on my legs and put pins in my knees. I am still being followed up with specialty care. I was recommended by Neurology to have steroid injections. This made a substantial difference and the pain went away. I was then seen for my left shoulder. There was no tear but they treated with the same treatment. I was instructed to start Physical Therapy which I was doing daily. My legs improved dramatically with the physical therapy. I have had 2 months of pain free but the pain has started to come back the last 6 weeks and getting worse. I conversed with my doctor in 04/2023 and I have started back up with daily appointments the physical therapy.