chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Procalcitonin, Pyrexia, Staphylococcus test negative, Swelling face
Clinical narrative: Patient ID:  MRN:   Name:   Age: 49 y.o.  Birthday:  Admit Date: 8/15/2022  3:08 PM  Discharge Date:  8/18/2022  Unit: 3A125/3A125A  Admitting Physician:   Discharge Physician: M.D.     Discharge Diagnosis:  Principal Problem:    Facial cellulitis  Active Problems:    Type 2 diabetes mellitus, with long-term current use of insulin    Morbid obesity    Acute parotitis    COVID-19 virus infection           HPI: "The patient is a 49 y.o. female morbidly obese, with type 2 diabetes mellitus, fibromyalgia. Patient reported that for the past 2 days she noted worsening swelling and erythema on the right lower face associated with fever. Her significant pain especially when opening the mouth. She was seen at ER and was diagnosed with facial cellulitis and was advised admission but she refuses. She was treated with Augmentin. Her condition worsened today does she came to our emergency room. She was seen by ENT and diagnosis was parotitis with facial cellulitis. She is edentulous with no gum swelling. She was started on IV antibiotics and steroid and will be admitted."     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Facial cellulitis  ?Right Facial cellulitis/parotitis. Failed outpatient treatment with oral antibiotic therapy. CT of the head and neck results reviewed. Continue IV Unasyn and Decadron per ENT recommendations and start Decadron Taper. Patient admits to history of MRSA infections in the past. Vancomycin added. MRSA swab is negative, transitioned IV vancomycin to by mouth doxycycline. Continue supportive/symptomatic treatment and pain control. Continue hydration with IV fluids. Continues with leukocytosis likely due to IV steroids. Continue to monitor with daily Lab. Pro-calcitonin trending down. Advanced to soft diet and tolerated well. Leukocytosis trended down with steroids taper. Cleared for discharge per ENT to follow up on patient. Transition antibiotics and steroids to oral.   ?Covid 19 virus infection. Remains asymptomatic from respiratory standpoint. Oxygen saturation within normal limits on room air. No IV Remdesivir . Continued to monitor. Ambulatory care manager referral on discharge.   ?Diabetes mellitus type 2. Continue with same home regimen/equivalent and adjust Levemir dose. Monitor blood sugar and cover with insulin sliding scale. Diabetic diet and A1c ordered.                  Physical Exam on the Date of Discharge:  Stable and improved.            Consults:    IP CONSULT TO SEPSIS NURSE NAVIGATOR  IP CONSULT TO OTOLARYNGOLOGY  IP CONSULT TO SOCIAL WORK     Significant Diagnostic Studies:     labs, microbiology, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram head, Computerised tomogram spine, Constipation, Gait disturbance, Lumbar puncture
Clinical narrative: On June 3, 2021 tingling began in right buttocks. Within two hours tingling increased and began spreading up to right hip area and down right leg to right foot. Began having issues walking with a normal gait and right foot started to drag. Symptoms increasingly progressed within 6 hours and had to use a wall to brace walking in building. Outside walking gait was abnormal and struggled to move right leg and right foot. Went to clinic and was sent to get x-rays. Within 12 hours of onset of symptoms, began using crutches to get around.  Called clinic on June 4, June 5, June 7, and June 8, 2021 and clinic received x-rays but had not viewed x-rays yet. Went to the emergency room with assistance from co-worker as symptoms were still present and not improving. Over that weekend loss of bladder control started, and had not had a bowel movement since June 5, 2021. Was admitted to the hospital, received CT Scan of Head, T-Spine, and L-Spine on June 8, 2021. MRI done on June 8, 2021. Lumbar puncture attempted bedside on June 9, 2021 with no success. Sent to get Lumbar puncture done on June 10, 2021. Was given medication on June 10, to assist with bowel movement; no bowel movement since June 5, 2021. Loss of bladder control continued. Was given Steroids to assist with improving ability to walk starting on June 10, 2021. Was discharged on June 13, 2021 with plan to have in-home physical therapy. Began outpatient physical therapy at the hospital by the end of June 2021. Continued monitoring with MRI scans and Neurology.
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging, Mobility decreased, Myelitis transverse, Paraesthesia, Urinary incontinence
Clinical narrative: On June 3, 2021 tingling began in right buttocks. Within two hours tingling increased and began spreading up to right hip area and down right leg to right foot. Began having issues walking with a normal gait and right foot started to drag. Symptoms increasingly progressed within 6 hours and had to use a wall to brace walking in building. Outside walking gait was abnormal and struggled to move right leg and right foot. Went to clinic and was sent to get x-rays. Within 12 hours of onset of symptoms, began using crutches to get around.  Called clinic on June 4, June 5, June 7, and June 8, 2021 and clinic received x-rays but had not viewed x-rays yet. Went to the emergency room with assistance from co-worker as symptoms were still present and not improving. Over that weekend loss of bladder control started, and had not had a bowel movement since June 5, 2021. Was admitted to the hospital, received CT Scan of Head, T-Spine, and L-Spine on June 8, 2021. MRI done on June 8, 2021. Lumbar puncture attempted bedside on June 9, 2021 with no success. Sent to get Lumbar puncture done on June 10, 2021. Was given medication on June 10, to assist with bowel movement; no bowel movement since June 5, 2021. Loss of bladder control continued. Was given Steroids to assist with improving ability to walk starting on June 10, 2021. Was discharged on June 13, 2021 with plan to have in-home physical therapy. Began outpatient physical therapy at the hospital by the end of June 2021. Continued monitoring with MRI scans and Neurology.
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Walking aid user, X-ray
Clinical narrative: On June 3, 2021 tingling began in right buttocks. Within two hours tingling increased and began spreading up to right hip area and down right leg to right foot. Began having issues walking with a normal gait and right foot started to drag. Symptoms increasingly progressed within 6 hours and had to use a wall to brace walking in building. Outside walking gait was abnormal and struggled to move right leg and right foot. Went to clinic and was sent to get x-rays. Within 12 hours of onset of symptoms, began using crutches to get around.  Called clinic on June 4, June 5, June 7, and June 8, 2021 and clinic received x-rays but had not viewed x-rays yet. Went to the emergency room with assistance from co-worker as symptoms were still present and not improving. Over that weekend loss of bladder control started, and had not had a bowel movement since June 5, 2021. Was admitted to the hospital, received CT Scan of Head, T-Spine, and L-Spine on June 8, 2021. MRI done on June 8, 2021. Lumbar puncture attempted bedside on June 9, 2021 with no success. Sent to get Lumbar puncture done on June 10, 2021. Was given medication on June 10, to assist with bowel movement; no bowel movement since June 5, 2021. Loss of bladder control continued. Was given Steroids to assist with improving ability to walk starting on June 10, 2021. Was discharged on June 13, 2021 with plan to have in-home physical therapy. Began outpatient physical therapy at the hospital by the end of June 2021. Continued monitoring with MRI scans and Neurology.
Age: 59.0
Sex: M
Vaccine: COVID19-2
Symptoms: Fluid retention
Clinical narrative: the same day I received my vaccination, and the following day, I road my bicycle long distance, each day a multi-hour workout. By mid-week my left knee felt like it was accumulating fluid (limited range of motion).  I assumed that I'd injured the knee. The next day I experience the same symptom with my right knee. A few days later my left knee is feeling better (greater range of movement), while my right knee continues to have a limited range of movment.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered
Clinical narrative: Admitted to hospital.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, Blood creatinine increased, COVID-19
Clinical narrative: Admit Date: 8/15/2022 10:52 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician: M.D.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Pneumonia due to COVID-19 virus    Stage 3b chronic kidney disease    Atrial fibrillation    Acquired hypothyroidism    HTN (hypertension)    Mixed hyperlipidemia    Diabetes mellitus type 2, diet-controlled           HPI: "Patiemt is a 82 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of sob, worsening over past week, dry cough. Worse with exertion. No other associated symptoms. In er, found to be hypoxic and require new O2. Discussed with er and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. cxr with bilateral pna. Covid +. Procal low. Hx of interstitial lung disease. No previous O2 use.   Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Continue Remdesivir D4/5 and IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient was weaned off to room air today. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up daily lab. Pulmonary following and advised receiving antibiotics due to low pro-calcitonin and negative cultures so far. Antibiotics discontinued accordingly. Pulmonary clear to discharge to follow up on outpatient basis.   ?Atrial fibrillation. Controlled. Continue appropriate home medications including oral anticoagulation. Monitor on telemetry.   ?CKD 3b. Hold Cozaar due to increased serum Cr. Decrease Lasix to 40 mg PO ONCE DAILY. Monitor renal function with daily lab. Resume low dose Cozaar on discharge.    ?Diabetes mellitus type 2. Continue with same home regimen/equivalent. Monitor blood sugar and cover with insulin sliding scale. Diabetic diet and A1c ordered.   ?Hypertension. Poor Control. Added Norvasc, adjusted dose up to 10 mg PO QD. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy. Lipid profile ordered.   ?Hypothyroidism. Continue Synthroid. TSH and free T4 ordered.            Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO PULMONOLOGY  IP CONSULT TO SOCIAL WORK     Significant Diagnostic Studies:     labs, microbiology, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Chronic kidney disease, Condition aggravated, Cough
Clinical narrative: Admit Date: 8/15/2022 10:52 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician: M.D.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Pneumonia due to COVID-19 virus    Stage 3b chronic kidney disease    Atrial fibrillation    Acquired hypothyroidism    HTN (hypertension)    Mixed hyperlipidemia    Diabetes mellitus type 2, diet-controlled           HPI: "Patiemt is a 82 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of sob, worsening over past week, dry cough. Worse with exertion. No other associated symptoms. In er, found to be hypoxic and require new O2. Discussed with er and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. cxr with bilateral pna. Covid +. Procal low. Hx of interstitial lung disease. No previous O2 use.   Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Continue Remdesivir D4/5 and IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient was weaned off to room air today. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up daily lab. Pulmonary following and advised receiving antibiotics due to low pro-calcitonin and negative cultures so far. Antibiotics discontinued accordingly. Pulmonary clear to discharge to follow up on outpatient basis.   ?Atrial fibrillation. Controlled. Continue appropriate home medications including oral anticoagulation. Monitor on telemetry.   ?CKD 3b. Hold Cozaar due to increased serum Cr. Decrease Lasix to 40 mg PO ONCE DAILY. Monitor renal function with daily lab. Resume low dose Cozaar on discharge.    ?Diabetes mellitus type 2. Continue with same home regimen/equivalent. Monitor blood sugar and cover with insulin sliding scale. Diabetic diet and A1c ordered.   ?Hypertension. Poor Control. Added Norvasc, adjusted dose up to 10 mg PO QD. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy. Lipid profile ordered.   ?Hypothyroidism. Continue Synthroid. TSH and free T4 ordered.            Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO PULMONOLOGY  IP CONSULT TO SOCIAL WORK     Significant Diagnostic Studies:     labs, microbiology, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Culture negative, Diabetic diet, Dyspnoea, Dyspnoea exertional, Hypertension
Clinical narrative: Admit Date: 8/15/2022 10:52 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician: M.D.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Pneumonia due to COVID-19 virus    Stage 3b chronic kidney disease    Atrial fibrillation    Acquired hypothyroidism    HTN (hypertension)    Mixed hyperlipidemia    Diabetes mellitus type 2, diet-controlled           HPI: "Patiemt is a 82 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of sob, worsening over past week, dry cough. Worse with exertion. No other associated symptoms. In er, found to be hypoxic and require new O2. Discussed with er and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. cxr with bilateral pna. Covid +. Procal low. Hx of interstitial lung disease. No previous O2 use.   Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Continue Remdesivir D4/5 and IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient was weaned off to room air today. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up daily lab. Pulmonary following and advised receiving antibiotics due to low pro-calcitonin and negative cultures so far. Antibiotics discontinued accordingly. Pulmonary clear to discharge to follow up on outpatient basis.   ?Atrial fibrillation. Controlled. Continue appropriate home medications including oral anticoagulation. Monitor on telemetry.   ?CKD 3b. Hold Cozaar due to increased serum Cr. Decrease Lasix to 40 mg PO ONCE DAILY. Monitor renal function with daily lab. Resume low dose Cozaar on discharge.    ?Diabetes mellitus type 2. Continue with same home regimen/equivalent. Monitor blood sugar and cover with insulin sliding scale. Diabetic diet and A1c ordered.   ?Hypertension. Poor Control. Added Norvasc, adjusted dose up to 10 mg PO QD. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy. Lipid profile ordered.   ?Hypothyroidism. Continue Synthroid. TSH and free T4 ordered.            Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO PULMONOLOGY  IP CONSULT TO SOCIAL WORK     Significant Diagnostic Studies:     labs, microbiology, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Hypothyroidism, Pneumonia, Procalcitonin decreased, SARS-CoV-2 test positive, Type 2 diabetes mellitus
Clinical narrative: Admit Date: 8/15/2022 10:52 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician: M.D.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Pneumonia due to COVID-19 virus    Stage 3b chronic kidney disease    Atrial fibrillation    Acquired hypothyroidism    HTN (hypertension)    Mixed hyperlipidemia    Diabetes mellitus type 2, diet-controlled           HPI: "Patiemt is a 82 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of sob, worsening over past week, dry cough. Worse with exertion. No other associated symptoms. In er, found to be hypoxic and require new O2. Discussed with er and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. cxr with bilateral pna. Covid +. Procal low. Hx of interstitial lung disease. No previous O2 use.   Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Continue Remdesivir D4/5 and IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient was weaned off to room air today. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up daily lab. Pulmonary following and advised receiving antibiotics due to low pro-calcitonin and negative cultures so far. Antibiotics discontinued accordingly. Pulmonary clear to discharge to follow up on outpatient basis.   ?Atrial fibrillation. Controlled. Continue appropriate home medications including oral anticoagulation. Monitor on telemetry.   ?CKD 3b. Hold Cozaar due to increased serum Cr. Decrease Lasix to 40 mg PO ONCE DAILY. Monitor renal function with daily lab. Resume low dose Cozaar on discharge.    ?Diabetes mellitus type 2. Continue with same home regimen/equivalent. Monitor blood sugar and cover with insulin sliding scale. Diabetic diet and A1c ordered.   ?Hypertension. Poor Control. Added Norvasc, adjusted dose up to 10 mg PO QD. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy. Lipid profile ordered.   ?Hypothyroidism. Continue Synthroid. TSH and free T4 ordered.            Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO PULMONOLOGY  IP CONSULT TO SOCIAL WORK     Significant Diagnostic Studies:     labs, microbiology, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Type V hyperlipidaemia
Clinical narrative: Admit Date: 8/15/2022 10:52 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician: M.D.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Pneumonia due to COVID-19 virus    Stage 3b chronic kidney disease    Atrial fibrillation    Acquired hypothyroidism    HTN (hypertension)    Mixed hyperlipidemia    Diabetes mellitus type 2, diet-controlled           HPI: "Patiemt is a 82 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of sob, worsening over past week, dry cough. Worse with exertion. No other associated symptoms. In er, found to be hypoxic and require new O2. Discussed with er and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. cxr with bilateral pna. Covid +. Procal low. Hx of interstitial lung disease. No previous O2 use.   Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Continue Remdesivir D4/5 and IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient was weaned off to room air today. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up daily lab. Pulmonary following and advised receiving antibiotics due to low pro-calcitonin and negative cultures so far. Antibiotics discontinued accordingly. Pulmonary clear to discharge to follow up on outpatient basis.   ?Atrial fibrillation. Controlled. Continue appropriate home medications including oral anticoagulation. Monitor on telemetry.   ?CKD 3b. Hold Cozaar due to increased serum Cr. Decrease Lasix to 40 mg PO ONCE DAILY. Monitor renal function with daily lab. Resume low dose Cozaar on discharge.    ?Diabetes mellitus type 2. Continue with same home regimen/equivalent. Monitor blood sugar and cover with insulin sliding scale. Diabetic diet and A1c ordered.   ?Hypertension. Poor Control. Added Norvasc, adjusted dose up to 10 mg PO QD. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy. Lipid profile ordered.   ?Hypothyroidism. Continue Synthroid. TSH and free T4 ordered.            Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO PULMONOLOGY  IP CONSULT TO SOCIAL WORK     Significant Diagnostic Studies:     labs, microbiology, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills
Clinical narrative: Physician Discharge Summary     Patient ID:    Name:   Age: 79 y.o.  Birthday:  10/16/1942  Admit Date: 8/16/2022  9:00 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Acute on chronic diastolic (congestive) heart failure    Gastroesophageal reflux disease with esophagitis without hemorrhage    Stage 3b chronic kidney disease    Hyperlipidemia    Essential hypertension    Atrial fibrillation           HPI: "Patient is a 79 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of worsening sob, malaise, occurring over several days, associated chills / fevers / nausea / body aches, but also leg swelling. Sob worse with exertion. No cp. Discussed with ER physician and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. O2 of 50. Clinically signs of chf. Covid +. cxr with bilateral infiltrates. Will treat both   Acute on chronic diastolic hf  Covid-19  Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Completed Remdesivir D5/5 and continued IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient continues with hypoxia resolved and was weaned off oxygen to RA. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up outpatient.    ?Acute on chronic diastolic heart failure. Improved with IV diuresis. Continue the same and monitor I and O's and daily weights.   ?Stage IIIB chronic kidney disease. Remains at baseline. Monitor closely with daily lab.   ?Paroxysmal atrial fibrillation. Controlled. Continue home medications and monitor on telemetry. Continue oral anticoagulation. Coumadin per pharmacy dosing.   ?Hypertension. Controlled. Continue same treatment. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy.             Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO WOUND CARE     Significant Diagnostic Studies:     labs, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Dyspnoea exertional, Lung infiltration, Malaise, Nausea
Clinical narrative: Physician Discharge Summary     Patient ID:    Name:   Age: 79 y.o.  Birthday:  10/16/1942  Admit Date: 8/16/2022  9:00 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Acute on chronic diastolic (congestive) heart failure    Gastroesophageal reflux disease with esophagitis without hemorrhage    Stage 3b chronic kidney disease    Hyperlipidemia    Essential hypertension    Atrial fibrillation           HPI: "Patient is a 79 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of worsening sob, malaise, occurring over several days, associated chills / fevers / nausea / body aches, but also leg swelling. Sob worse with exertion. No cp. Discussed with ER physician and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. O2 of 50. Clinically signs of chf. Covid +. cxr with bilateral infiltrates. Will treat both   Acute on chronic diastolic hf  Covid-19  Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Completed Remdesivir D5/5 and continued IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient continues with hypoxia resolved and was weaned off oxygen to RA. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up outpatient.    ?Acute on chronic diastolic heart failure. Improved with IV diuresis. Continue the same and monitor I and O's and daily weights.   ?Stage IIIB chronic kidney disease. Remains at baseline. Monitor closely with daily lab.   ?Paroxysmal atrial fibrillation. Controlled. Continue home medications and monitor on telemetry. Continue oral anticoagulation. Coumadin per pharmacy dosing.   ?Hypertension. Controlled. Continue same treatment. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy.             Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO WOUND CARE     Significant Diagnostic Studies:     labs, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, Peripheral swelling, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: Physician Discharge Summary     Patient ID:    Name:   Age: 79 y.o.  Birthday:  10/16/1942  Admit Date: 8/16/2022  9:00 PM  Discharge Date:  8/19/2022    Admitting Physician:   Discharge Physician.     Discharge Diagnosis:  Principal Problem:    Acute respiratory failure with hypoxemia  Active Problems:    Acute on chronic diastolic (congestive) heart failure    Gastroesophageal reflux disease with esophagitis without hemorrhage    Stage 3b chronic kidney disease    Hyperlipidemia    Essential hypertension    Atrial fibrillation           HPI: "Patient is a 79 y.o. female with a history below admitted for Acute respiratory failure with hypoxemia. Pt came in with complaints of worsening sob, malaise, occurring over several days, associated chills / fevers / nausea / body aches, but also leg swelling. Sob worse with exertion. No cp. Discussed with ER physician and will admit".     Hospital Course:  The patient was admitted to the hospital and was evaluated and treated per below.         * Acute respiratory failure with hypoxemia  Description of the Problem/Progression: New. O2 of 50. Clinically signs of chf. Covid +. cxr with bilateral infiltrates. Will treat both   Acute on chronic diastolic hf  Covid-19  Plan:   ?Pneumonia due to Covid 19 virus with acute respiratory failure with hypoxia. Improving on current treatment. Completed Remdesivir D5/5 and continued IV Decadron. Nebs and inhalers as ordered. Continue to follow up daily inflammatory markers and d-dimer. Patient continues with hypoxia resolved and was weaned off oxygen to RA. Continue nebs and inhalers. Encourage incentive spirometry use and pronating. Continue supportive/symptomatic treatment and supplements as ordered per COVID protocol. Follow up outpatient.    ?Acute on chronic diastolic heart failure. Improved with IV diuresis. Continue the same and monitor I and O's and daily weights.   ?Stage IIIB chronic kidney disease. Remains at baseline. Monitor closely with daily lab.   ?Paroxysmal atrial fibrillation. Controlled. Continue home medications and monitor on telemetry. Continue oral anticoagulation. Coumadin per pharmacy dosing.   ?Hypertension. Controlled. Continue same treatment. Follow up daily labs.    ?Hyperlipidemia. Continue statin therapy.             Physical Exam on the Date of Discharge:  Stable and improved.         Consults:    IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO WOUND CARE     Significant Diagnostic Studies:     labs, radiology, and cardiac graphics: per chart.        Disposition:  home     Discharge Condition:  good
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Extra dose administered
Clinical narrative: Admitted to hospital.
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute left ventricular failure, Acute myocardial infarction, Anticoagulation drug level above therapeutic, Atrial fibrillation
Clinical narrative: Patient ID:  MRN:   Name:   Age: 77 y.o.  Birthday:    Admit Date: 8/16/2022  8:55 PM  Discharge Date: 8/24/2022     Unit:   Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    SOB (shortness of breath)  Active Problems:    Paroxysmal atrial fibrillation    Supratherapeutic INR    SVT (supraventricular tachycardia)    Elevated troponin    Acute combined systolic (congestive) and diastolic (congestive) heart failure    Positive cardiac stress test    AKI (acute kidney injury)    Gross hematuria    Hyperlipidemia    HTN (hypertension)    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin              Hospital Course: Patient is a 77 y.o. male admitted with sob / covid 19 / paroxysmal afib / acute on chronic systolic and diastolic hf / uti / trop elevation determined to be type 2 mi. Seen by cards. Also concern for svt nonsustained. lhc performed. Moderate cad, no intervention. Tee / tte performed, ef 30-35%. Cardioverted to nsr. Started on amio / cardiac meds. aki developed after diuresis. Improving back to baseline. Restarting small dose acei. Will delay aldactone, but chf meds need titrating up outpatient with close monitoring of renal function. Uti grew e faecalis, started on amoxicillin and will finish this op. Not treated for covid 19 as symptoms unrelated to this. Nephrology assisted with case given aki and need for contrast. Urology also assisted, give gross hematuria briefly. Foley left in place. Removal op with urology. Life vest prior to dc. Close f/u op     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 100/63, pulse 107, temperature 97.7 °F (36.5 °C), temperature source Oral, resp. rate 14, height 6' (182.9 cm), weight 80.2 kg (176 lb 11.2 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard            Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO CARDIOLOGY  IP CONSULT TO UROLOGY              Disposition:  home     Discharge Condition:  fair
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Bladder catheterisation, COVID-19, Cardiac assistance device user, Cardiac failure congestive, Cardiac stress test abnormal
Clinical narrative: Patient ID:  MRN:   Name:   Age: 77 y.o.  Birthday:    Admit Date: 8/16/2022  8:55 PM  Discharge Date: 8/24/2022     Unit:   Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    SOB (shortness of breath)  Active Problems:    Paroxysmal atrial fibrillation    Supratherapeutic INR    SVT (supraventricular tachycardia)    Elevated troponin    Acute combined systolic (congestive) and diastolic (congestive) heart failure    Positive cardiac stress test    AKI (acute kidney injury)    Gross hematuria    Hyperlipidemia    HTN (hypertension)    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin              Hospital Course: Patient is a 77 y.o. male admitted with sob / covid 19 / paroxysmal afib / acute on chronic systolic and diastolic hf / uti / trop elevation determined to be type 2 mi. Seen by cards. Also concern for svt nonsustained. lhc performed. Moderate cad, no intervention. Tee / tte performed, ef 30-35%. Cardioverted to nsr. Started on amio / cardiac meds. aki developed after diuresis. Improving back to baseline. Restarting small dose acei. Will delay aldactone, but chf meds need titrating up outpatient with close monitoring of renal function. Uti grew e faecalis, started on amoxicillin and will finish this op. Not treated for covid 19 as symptoms unrelated to this. Nephrology assisted with case given aki and need for contrast. Urology also assisted, give gross hematuria briefly. Foley left in place. Removal op with urology. Life vest prior to dc. Close f/u op     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 100/63, pulse 107, temperature 97.7 °F (36.5 °C), temperature source Oral, resp. rate 14, height 6' (182.9 cm), weight 80.2 kg (176 lb 11.2 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard            Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO CARDIOLOGY  IP CONSULT TO UROLOGY              Disposition:  home     Discharge Condition:  fair
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Cardioversion, Catheterisation cardiac abnormal, Coronary artery disease, Culture urine positive, Dyspnoea
Clinical narrative: Patient ID:  MRN:   Name:   Age: 77 y.o.  Birthday:    Admit Date: 8/16/2022  8:55 PM  Discharge Date: 8/24/2022     Unit:   Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    SOB (shortness of breath)  Active Problems:    Paroxysmal atrial fibrillation    Supratherapeutic INR    SVT (supraventricular tachycardia)    Elevated troponin    Acute combined systolic (congestive) and diastolic (congestive) heart failure    Positive cardiac stress test    AKI (acute kidney injury)    Gross hematuria    Hyperlipidemia    HTN (hypertension)    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin              Hospital Course: Patient is a 77 y.o. male admitted with sob / covid 19 / paroxysmal afib / acute on chronic systolic and diastolic hf / uti / trop elevation determined to be type 2 mi. Seen by cards. Also concern for svt nonsustained. lhc performed. Moderate cad, no intervention. Tee / tte performed, ef 30-35%. Cardioverted to nsr. Started on amio / cardiac meds. aki developed after diuresis. Improving back to baseline. Restarting small dose acei. Will delay aldactone, but chf meds need titrating up outpatient with close monitoring of renal function. Uti grew e faecalis, started on amoxicillin and will finish this op. Not treated for covid 19 as symptoms unrelated to this. Nephrology assisted with case given aki and need for contrast. Urology also assisted, give gross hematuria briefly. Foley left in place. Removal op with urology. Life vest prior to dc. Close f/u op     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 100/63, pulse 107, temperature 97.7 °F (36.5 °C), temperature source Oral, resp. rate 14, height 6' (182.9 cm), weight 80.2 kg (176 lb 11.2 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard            Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO CARDIOLOGY  IP CONSULT TO UROLOGY              Disposition:  home     Discharge Condition:  fair
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram, Ejection fraction decreased, Enterococcus test positive, Haematuria, Hyperglycaemia
Clinical narrative: Patient ID:  MRN:   Name:   Age: 77 y.o.  Birthday:    Admit Date: 8/16/2022  8:55 PM  Discharge Date: 8/24/2022     Unit:   Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    SOB (shortness of breath)  Active Problems:    Paroxysmal atrial fibrillation    Supratherapeutic INR    SVT (supraventricular tachycardia)    Elevated troponin    Acute combined systolic (congestive) and diastolic (congestive) heart failure    Positive cardiac stress test    AKI (acute kidney injury)    Gross hematuria    Hyperlipidemia    HTN (hypertension)    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin              Hospital Course: Patient is a 77 y.o. male admitted with sob / covid 19 / paroxysmal afib / acute on chronic systolic and diastolic hf / uti / trop elevation determined to be type 2 mi. Seen by cards. Also concern for svt nonsustained. lhc performed. Moderate cad, no intervention. Tee / tte performed, ef 30-35%. Cardioverted to nsr. Started on amio / cardiac meds. aki developed after diuresis. Improving back to baseline. Restarting small dose acei. Will delay aldactone, but chf meds need titrating up outpatient with close monitoring of renal function. Uti grew e faecalis, started on amoxicillin and will finish this op. Not treated for covid 19 as symptoms unrelated to this. Nephrology assisted with case given aki and need for contrast. Urology also assisted, give gross hematuria briefly. Foley left in place. Removal op with urology. Life vest prior to dc. Close f/u op     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 100/63, pulse 107, temperature 97.7 °F (36.5 °C), temperature source Oral, resp. rate 14, height 6' (182.9 cm), weight 80.2 kg (176 lb 11.2 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard            Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO CARDIOLOGY  IP CONSULT TO UROLOGY              Disposition:  home     Discharge Condition:  fair
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperlipidaemia, Hypertension, Polyuria, Sinus rhythm, Supraventricular tachycardia
Clinical narrative: Patient ID:  MRN:   Name:   Age: 77 y.o.  Birthday:    Admit Date: 8/16/2022  8:55 PM  Discharge Date: 8/24/2022     Unit:   Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    SOB (shortness of breath)  Active Problems:    Paroxysmal atrial fibrillation    Supratherapeutic INR    SVT (supraventricular tachycardia)    Elevated troponin    Acute combined systolic (congestive) and diastolic (congestive) heart failure    Positive cardiac stress test    AKI (acute kidney injury)    Gross hematuria    Hyperlipidemia    HTN (hypertension)    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin              Hospital Course: Patient is a 77 y.o. male admitted with sob / covid 19 / paroxysmal afib / acute on chronic systolic and diastolic hf / uti / trop elevation determined to be type 2 mi. Seen by cards. Also concern for svt nonsustained. lhc performed. Moderate cad, no intervention. Tee / tte performed, ef 30-35%. Cardioverted to nsr. Started on amio / cardiac meds. aki developed after diuresis. Improving back to baseline. Restarting small dose acei. Will delay aldactone, but chf meds need titrating up outpatient with close monitoring of renal function. Uti grew e faecalis, started on amoxicillin and will finish this op. Not treated for covid 19 as symptoms unrelated to this. Nephrology assisted with case given aki and need for contrast. Urology also assisted, give gross hematuria briefly. Foley left in place. Removal op with urology. Life vest prior to dc. Close f/u op     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 100/63, pulse 107, temperature 97.7 °F (36.5 °C), temperature source Oral, resp. rate 14, height 6' (182.9 cm), weight 80.2 kg (176 lb 11.2 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard            Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO CARDIOLOGY  IP CONSULT TO UROLOGY              Disposition:  home     Discharge Condition:  fair
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin increased, Type 2 diabetes mellitus, Urinary tract infection
Clinical narrative: Patient ID:  MRN:   Name:   Age: 77 y.o.  Birthday:    Admit Date: 8/16/2022  8:55 PM  Discharge Date: 8/24/2022     Unit:   Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    SOB (shortness of breath)  Active Problems:    Paroxysmal atrial fibrillation    Supratherapeutic INR    SVT (supraventricular tachycardia)    Elevated troponin    Acute combined systolic (congestive) and diastolic (congestive) heart failure    Positive cardiac stress test    AKI (acute kidney injury)    Gross hematuria    Hyperlipidemia    HTN (hypertension)    Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin              Hospital Course: Patient is a 77 y.o. male admitted with sob / covid 19 / paroxysmal afib / acute on chronic systolic and diastolic hf / uti / trop elevation determined to be type 2 mi. Seen by cards. Also concern for svt nonsustained. lhc performed. Moderate cad, no intervention. Tee / tte performed, ef 30-35%. Cardioverted to nsr. Started on amio / cardiac meds. aki developed after diuresis. Improving back to baseline. Restarting small dose acei. Will delay aldactone, but chf meds need titrating up outpatient with close monitoring of renal function. Uti grew e faecalis, started on amoxicillin and will finish this op. Not treated for covid 19 as symptoms unrelated to this. Nephrology assisted with case given aki and need for contrast. Urology also assisted, give gross hematuria briefly. Foley left in place. Removal op with urology. Life vest prior to dc. Close f/u op     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 100/63, pulse 107, temperature 97.7 °F (36.5 °C), temperature source Oral, resp. rate 14, height 6' (182.9 cm), weight 80.2 kg (176 lb 11.2 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard            Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO HEART FAILURE NURSE  IP CONSULT TO DIETARY  IP CONSULT TO CARDIAC REHAB  IP CONSULT TO SOCIAL WORK  IP CONSULT TO CARDIOLOGY  IP CONSULT TO UROLOGY              Disposition:  home     Discharge Condition:  fair
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered
Clinical narrative: Admitted to hospital.
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Atrial fibrillation, Bradycardia, COVID-19, Chronic kidney disease
Clinical narrative: Patient ID:  MRN:   Name:  Age: 89 y.o.  Birthday:   Admit Date: 8/17/2022 10:19 PM  Discharge Date: 8/23/2022  ?   Unit: 3A118/3A118A  Admitting Physician:    Discharge Physician: MD     Discharge Diagnosis:  Principal Problem:    Symptomatic bradycardia  Active Problems:    Diabetes mellitus    Persistent atrial fibrillation    Elevated d-dimer    Hypothyroid    Left ventricular systolic dysfunction    Essential hypertension  ckd3b           Hospital Course: Patient is a 89 y.o. male admitted with symptomatic bradycardia. Bb held. Cards assessed. ech owith ef of 40-45%, chronic systolic hf. Held lasix and given ivf for hypotension. PE, diagnosed on admission as well. Vq positive. Started on eliquis. Pulm rec 6 mo of oac. Chronic afib, but rate low. Covid 19 coincidentally diagnosed. Completed 5 days of remdesivir. Likely cause of PE, but no pneumonia or hypoxia. Dc with close f/u with cards / pcp     No new Assessment & Plan notes have been filed under this hospital service since the last note was generated.  Service: Hospitalist                 Physical Exam on the Date of Discharge:  Vitals: Blood pressure 120/73, pulse (!) 43, temperature 97.6 °F (36.4 °C), temperature source Oral, resp. rate 18, height 5' 6" (167.6 cm), weight 74.3 kg (163 lb 12.8 oz), SpO2 99 %.   General Appearance: alert, NAD  Lungs:  normal effort  Heart: S1 S2 heard        @HOSPDCED@     Consults:    IP CONSULT TO CARDIOLOGY  IP CONSULT TO SOCIAL WORK  IP CONSULT TO PULMONOLOGY  IP CONSULT TO CARDIAC ELECTROPHYSIOLOGY              Disposition:  home     Discharge Condition:  fair