chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood culture negative, COVID-19, Chest X-ray, Cough
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 2/21/2023 Discharge Date: Feb 25, 2023 PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 virus infection [U07.1]   HOSPITAL COURSE:   Patient is a 88 y.o. female with medical history significant for coronary artery disease, hypertension, dyslipidemia, CKD stage IIIA, prior stroke, dementia.  Presents ER for weakness over the past day.  History gathered from chart review, patient has dementia (A&Ox2-3 at baseline) .   Recent admission 1/4-1/6/2023 (notes reviewed) after presenting to ER for weakness and fatigue as well as cough, admitted for sepsis syndrome and lactic acidosis.  COVID-19, influenza, RSV negative.  Urinalysis showing significant pyuria and labs showing leukocytosis so patient started on IV Rocephin for possible urinary tract infection.  Also started on IV fluids.  Blood and urine cultures negative however patient's symptoms improved with fluids and antibiotics.  PT/OT evaluated patient who recommended discharge home with assistance.  Working with PT following discharge with improvement in strength, discharged from PT on 02/15 due to patient meeting goals and being independent with home exercise programs with daughter's supervision.   Back to ER evening of 2/21 reportedly due to increasing weakness over the previous 12 hours.  She had been ambulating independently with a walker, but this evening, was unable to even stand due to weakness.  Patient herself says she feels well, does report a cough for 2 weeks as well as weakness, otherwise denies concerns.  No headache, chest pain or pressure, shortness of breath, abdominal pain, vomiting, diarrhea or bowel changes.  Denies known sick contacts. Received last COVID-19 booster in 10/2021.   In ER, noted to be febrile with T-max 102.7° F, mildly tachycardic and tachypneic, vitals otherwise stable.  No hypoxia.  Labs unremarkable.  UA negative.  CXR.  Found to be COVID-19 positive.  Due to significant weakness and inability to safely return home, will place in observation for further management and safe dispo. Pt was observed for 24 hrs. Labs and VS wnl. PT/OT consulted for placement. Recs SAR.This was discussed with pts daughter. On day of discharge pt feels well. Denies any complaints. Stable for discharge.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Culture urine negative, Dysstasia, Fatigue, Influenza virus test negative, Laboratory test abnormal
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 2/21/2023 Discharge Date: Feb 25, 2023 PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 virus infection [U07.1]   HOSPITAL COURSE:   Patient is a 88 y.o. female with medical history significant for coronary artery disease, hypertension, dyslipidemia, CKD stage IIIA, prior stroke, dementia.  Presents ER for weakness over the past day.  History gathered from chart review, patient has dementia (A&Ox2-3 at baseline) .   Recent admission 1/4-1/6/2023 (notes reviewed) after presenting to ER for weakness and fatigue as well as cough, admitted for sepsis syndrome and lactic acidosis.  COVID-19, influenza, RSV negative.  Urinalysis showing significant pyuria and labs showing leukocytosis so patient started on IV Rocephin for possible urinary tract infection.  Also started on IV fluids.  Blood and urine cultures negative however patient's symptoms improved with fluids and antibiotics.  PT/OT evaluated patient who recommended discharge home with assistance.  Working with PT following discharge with improvement in strength, discharged from PT on 02/15 due to patient meeting goals and being independent with home exercise programs with daughter's supervision.   Back to ER evening of 2/21 reportedly due to increasing weakness over the previous 12 hours.  She had been ambulating independently with a walker, but this evening, was unable to even stand due to weakness.  Patient herself says she feels well, does report a cough for 2 weeks as well as weakness, otherwise denies concerns.  No headache, chest pain or pressure, shortness of breath, abdominal pain, vomiting, diarrhea or bowel changes.  Denies known sick contacts. Received last COVID-19 booster in 10/2021.   In ER, noted to be febrile with T-max 102.7° F, mildly tachycardic and tachypneic, vitals otherwise stable.  No hypoxia.  Labs unremarkable.  UA negative.  CXR.  Found to be COVID-19 positive.  Due to significant weakness and inability to safely return home, will place in observation for further management and safe dispo. Pt was observed for 24 hrs. Labs and VS wnl. PT/OT consulted for placement. Recs SAR.This was discussed with pts daughter. On day of discharge pt feels well. Denies any complaints. Stable for discharge.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Lactic acidosis, Leukocytosis, Pyrexia, Pyuria, Respiratory syncytial virus test negative
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 2/21/2023 Discharge Date: Feb 25, 2023 PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 virus infection [U07.1]   HOSPITAL COURSE:   Patient is a 88 y.o. female with medical history significant for coronary artery disease, hypertension, dyslipidemia, CKD stage IIIA, prior stroke, dementia.  Presents ER for weakness over the past day.  History gathered from chart review, patient has dementia (A&Ox2-3 at baseline) .   Recent admission 1/4-1/6/2023 (notes reviewed) after presenting to ER for weakness and fatigue as well as cough, admitted for sepsis syndrome and lactic acidosis.  COVID-19, influenza, RSV negative.  Urinalysis showing significant pyuria and labs showing leukocytosis so patient started on IV Rocephin for possible urinary tract infection.  Also started on IV fluids.  Blood and urine cultures negative however patient's symptoms improved with fluids and antibiotics.  PT/OT evaluated patient who recommended discharge home with assistance.  Working with PT following discharge with improvement in strength, discharged from PT on 02/15 due to patient meeting goals and being independent with home exercise programs with daughter's supervision.   Back to ER evening of 2/21 reportedly due to increasing weakness over the previous 12 hours.  She had been ambulating independently with a walker, but this evening, was unable to even stand due to weakness.  Patient herself says she feels well, does report a cough for 2 weeks as well as weakness, otherwise denies concerns.  No headache, chest pain or pressure, shortness of breath, abdominal pain, vomiting, diarrhea or bowel changes.  Denies known sick contacts. Received last COVID-19 booster in 10/2021.   In ER, noted to be febrile with T-max 102.7° F, mildly tachycardic and tachypneic, vitals otherwise stable.  No hypoxia.  Labs unremarkable.  UA negative.  CXR.  Found to be COVID-19 positive.  Due to significant weakness and inability to safely return home, will place in observation for further management and safe dispo. Pt was observed for 24 hrs. Labs and VS wnl. PT/OT consulted for placement. Recs SAR.This was discussed with pts daughter. On day of discharge pt feels well. Denies any complaints. Stable for discharge.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis, Tachycardia, Tachypnoea, Urine analysis abnormal
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 2/21/2023 Discharge Date: Feb 25, 2023 PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 virus infection [U07.1]   HOSPITAL COURSE:   Patient is a 88 y.o. female with medical history significant for coronary artery disease, hypertension, dyslipidemia, CKD stage IIIA, prior stroke, dementia.  Presents ER for weakness over the past day.  History gathered from chart review, patient has dementia (A&Ox2-3 at baseline) .   Recent admission 1/4-1/6/2023 (notes reviewed) after presenting to ER for weakness and fatigue as well as cough, admitted for sepsis syndrome and lactic acidosis.  COVID-19, influenza, RSV negative.  Urinalysis showing significant pyuria and labs showing leukocytosis so patient started on IV Rocephin for possible urinary tract infection.  Also started on IV fluids.  Blood and urine cultures negative however patient's symptoms improved with fluids and antibiotics.  PT/OT evaluated patient who recommended discharge home with assistance.  Working with PT following discharge with improvement in strength, discharged from PT on 02/15 due to patient meeting goals and being independent with home exercise programs with daughter's supervision.   Back to ER evening of 2/21 reportedly due to increasing weakness over the previous 12 hours.  She had been ambulating independently with a walker, but this evening, was unable to even stand due to weakness.  Patient herself says she feels well, does report a cough for 2 weeks as well as weakness, otherwise denies concerns.  No headache, chest pain or pressure, shortness of breath, abdominal pain, vomiting, diarrhea or bowel changes.  Denies known sick contacts. Received last COVID-19 booster in 10/2021.   In ER, noted to be febrile with T-max 102.7° F, mildly tachycardic and tachypneic, vitals otherwise stable.  No hypoxia.  Labs unremarkable.  UA negative.  CXR.  Found to be COVID-19 positive.  Due to significant weakness and inability to safely return home, will place in observation for further management and safe dispo. Pt was observed for 24 hrs. Labs and VS wnl. PT/OT consulted for placement. Recs SAR.This was discussed with pts daughter. On day of discharge pt feels well. Denies any complaints. Stable for discharge.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Walking aid user
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 2/21/2023 Discharge Date: Feb 25, 2023 PRESENTING PROBLEM: Generalized weakness [R53.1] COVID-19 virus infection [U07.1]   HOSPITAL COURSE:   Patient is a 88 y.o. female with medical history significant for coronary artery disease, hypertension, dyslipidemia, CKD stage IIIA, prior stroke, dementia.  Presents ER for weakness over the past day.  History gathered from chart review, patient has dementia (A&Ox2-3 at baseline) .   Recent admission 1/4-1/6/2023 (notes reviewed) after presenting to ER for weakness and fatigue as well as cough, admitted for sepsis syndrome and lactic acidosis.  COVID-19, influenza, RSV negative.  Urinalysis showing significant pyuria and labs showing leukocytosis so patient started on IV Rocephin for possible urinary tract infection.  Also started on IV fluids.  Blood and urine cultures negative however patient's symptoms improved with fluids and antibiotics.  PT/OT evaluated patient who recommended discharge home with assistance.  Working with PT following discharge with improvement in strength, discharged from PT on 02/15 due to patient meeting goals and being independent with home exercise programs with daughter's supervision.   Back to ER evening of 2/21 reportedly due to increasing weakness over the previous 12 hours.  She had been ambulating independently with a walker, but this evening, was unable to even stand due to weakness.  Patient herself says she feels well, does report a cough for 2 weeks as well as weakness, otherwise denies concerns.  No headache, chest pain or pressure, shortness of breath, abdominal pain, vomiting, diarrhea or bowel changes.  Denies known sick contacts. Received last COVID-19 booster in 10/2021.   In ER, noted to be febrile with T-max 102.7° F, mildly tachycardic and tachypneic, vitals otherwise stable.  No hypoxia.  Labs unremarkable.  UA negative.  CXR.  Found to be COVID-19 positive.  Due to significant weakness and inability to safely return home, will place in observation for further management and safe dispo. Pt was observed for 24 hrs. Labs and VS wnl. PT/OT consulted for placement. Recs SAR.This was discussed with pts daughter. On day of discharge pt feels well. Denies any complaints. Stable for discharge.
Age: 9.0
Sex: F
Vaccine: UNK
Symptoms: Injection site discolouration, Injection site erythema, Injection site reaction, Skin exfoliation
Clinical narrative: Left deltoid erythema with hyperpigmented scaly area & was prescribed Cephalexin (250mg/5ML)
Age: 10.0
Sex: F
Vaccine: FLUN4, HPV9, MNQ, TDAP
Symptoms: Injection site induration, Injection site mass, Injection site pain
Clinical narrative: PATIENT DEVELOPED PAIN AND INDURATION AT INJECTION SITE THE DAY AFTER TDAP IMMUNIZATION WAS GIVEN. THIS MASS HAS REMAINED AT INJECTION SITE FOR 17 MONTHS AND IS STILL TENDER TO PALPATION.
Age: 42.0
Sex: M
Vaccine: COVID19-2, FLUC4
Symptoms: Bronchoalveolar lavage abnormal, Bronchoscopy abnormal, COVID-19, Cough, Dyspnoea
Clinical narrative: Discharge Provider: MD Primary Care Provider: NP Admission Date: 2/21/2023 Discharge Date: Feb 26, 2023 PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia of both lower lobes due to infectious organism [J18.9] Pneumonia, unspecified organism [J18.9]   HOSPITAL COURSE: Patient is a 42-year-old man with past medical history significant for chronic obstructive pulmonary disease on chronic oxygen at 2 liters/minute, cavitary lung lesions, primary ciliary dyskinesia who presented with shortness of breath and hypoxia at home.  Found to be hypoxic on presentation to the hospital requiring increased O2 supplemental needs.  Admitted initially due to concern for chronic obstructive pulmonary disease exacerbation and concern for bilateral lower lobe pneumonia with possible bronchiectasis exacerbation. Started on IV Solu-Medrol, vancomycin, cefepime and azithromycin which was continued from home.  DuoNebs were also initiated.  Urinary pneumococcal and Legionella antigen were negative. Patient was seen by wanted to exclude fungal infection or mycobacterial infection.  They performed a bronchoscopic evaluation on 02/23 with BAL fluid sent for various cultures.  MRSA screen was negative vancomycin as well as azithromycin were discontinued.  Patient was continued on IV cefepime throughout hospitalization.  Initial COVID-19 PCR on admission was negative but subsequent respiratory film array was positive for COVID-19.  Patient was started on remdesivir as well as scaling back on IV Solu-Medrol 2 times a day.  Sputum cultures as well as BAL cultures were positive for Pseudomonas aeruginosa resistant to cefepime.  Of note pretty much since the beginning the admission, patient appeared to be close to his normal baseline from a respiratory standpoint.  He was back on 3 liters/minute on day 2 though he started to have cough at that time.  Given likely hypoxia due to COVID-19 given patient appeared improved while on in adequate treatment IV cefepime for resistant Pseudomonas.  Discussed with pulmonology who recommended stopping steroids, remdesivir given his current clinical status at discharge but continuing antibiotics to decrease Pseudomonas colonization.  Patient was discharged on 5 days of ciprofloxacin.  Patient was discharged home in medically stable condition.
Age: 42.0
Sex: M
Vaccine: COVID19-2, FLUC4
Symptoms: Hypoxia, Legionella test, Pneumonia, Pseudomonas test positive, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: MD Primary Care Provider: NP Admission Date: 2/21/2023 Discharge Date: Feb 26, 2023 PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia of both lower lobes due to infectious organism [J18.9] Pneumonia, unspecified organism [J18.9]   HOSPITAL COURSE: Patient is a 42-year-old man with past medical history significant for chronic obstructive pulmonary disease on chronic oxygen at 2 liters/minute, cavitary lung lesions, primary ciliary dyskinesia who presented with shortness of breath and hypoxia at home.  Found to be hypoxic on presentation to the hospital requiring increased O2 supplemental needs.  Admitted initially due to concern for chronic obstructive pulmonary disease exacerbation and concern for bilateral lower lobe pneumonia with possible bronchiectasis exacerbation. Started on IV Solu-Medrol, vancomycin, cefepime and azithromycin which was continued from home.  DuoNebs were also initiated.  Urinary pneumococcal and Legionella antigen were negative. Patient was seen by wanted to exclude fungal infection or mycobacterial infection.  They performed a bronchoscopic evaluation on 02/23 with BAL fluid sent for various cultures.  MRSA screen was negative vancomycin as well as azithromycin were discontinued.  Patient was continued on IV cefepime throughout hospitalization.  Initial COVID-19 PCR on admission was negative but subsequent respiratory film array was positive for COVID-19.  Patient was started on remdesivir as well as scaling back on IV Solu-Medrol 2 times a day.  Sputum cultures as well as BAL cultures were positive for Pseudomonas aeruginosa resistant to cefepime.  Of note pretty much since the beginning the admission, patient appeared to be close to his normal baseline from a respiratory standpoint.  He was back on 3 liters/minute on day 2 though he started to have cough at that time.  Given likely hypoxia due to COVID-19 given patient appeared improved while on in adequate treatment IV cefepime for resistant Pseudomonas.  Discussed with pulmonology who recommended stopping steroids, remdesivir given his current clinical status at discharge but continuing antibiotics to decrease Pseudomonas colonization.  Patient was discharged on 5 days of ciprofloxacin.  Patient was discharged home in medically stable condition.
Age: 42.0
Sex: M
Vaccine: COVID19-2, FLUC4
Symptoms: Sputum culture positive, Staphylococcus test negative, Urine analysis normal, Urine antigen test
Clinical narrative: Discharge Provider: MD Primary Care Provider: NP Admission Date: 2/21/2023 Discharge Date: Feb 26, 2023 PRESENTING PROBLEM: Hypoxia [R09.02] Pneumonia of both lower lobes due to infectious organism [J18.9] Pneumonia, unspecified organism [J18.9]   HOSPITAL COURSE: Patient is a 42-year-old man with past medical history significant for chronic obstructive pulmonary disease on chronic oxygen at 2 liters/minute, cavitary lung lesions, primary ciliary dyskinesia who presented with shortness of breath and hypoxia at home.  Found to be hypoxic on presentation to the hospital requiring increased O2 supplemental needs.  Admitted initially due to concern for chronic obstructive pulmonary disease exacerbation and concern for bilateral lower lobe pneumonia with possible bronchiectasis exacerbation. Started on IV Solu-Medrol, vancomycin, cefepime and azithromycin which was continued from home.  DuoNebs were also initiated.  Urinary pneumococcal and Legionella antigen were negative. Patient was seen by wanted to exclude fungal infection or mycobacterial infection.  They performed a bronchoscopic evaluation on 02/23 with BAL fluid sent for various cultures.  MRSA screen was negative vancomycin as well as azithromycin were discontinued.  Patient was continued on IV cefepime throughout hospitalization.  Initial COVID-19 PCR on admission was negative but subsequent respiratory film array was positive for COVID-19.  Patient was started on remdesivir as well as scaling back on IV Solu-Medrol 2 times a day.  Sputum cultures as well as BAL cultures were positive for Pseudomonas aeruginosa resistant to cefepime.  Of note pretty much since the beginning the admission, patient appeared to be close to his normal baseline from a respiratory standpoint.  He was back on 3 liters/minute on day 2 though he started to have cough at that time.  Given likely hypoxia due to COVID-19 given patient appeared improved while on in adequate treatment IV cefepime for resistant Pseudomonas.  Discussed with pulmonology who recommended stopping steroids, remdesivir given his current clinical status at discharge but continuing antibiotics to decrease Pseudomonas colonization.  Patient was discharged on 5 days of ciprofloxacin.  Patient was discharged home in medically stable condition.
Age: 12.0
Sex: M
Vaccine: MNQ
Symptoms: Blood thyroid stimulating hormone, Borrelia test, Dizziness, Dyspnoea, Feeling abnormal
Clinical narrative: shortness of breath, brain fog, dizziness
Age: 12.0
Sex: M
Vaccine: MNQ
Symptoms: Full blood count, Laboratory test, Metabolic function test, Streptococcus test
Clinical narrative: shortness of breath, brain fog, dizziness
Age: 77.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Acute kidney injury, Antineutrophil cytoplasmic antibody increased, Antineutrophil cytoplasmic antibody positive, Biopsy kidney abnormal, Bronchoalveolar lavage abnormal
Clinical narrative: Discharge Provider:  Primary Care Provider: DO Admission Date: 2/23/2023 Discharge Date: Mar 2, 2023  PRESENTING PROBLEM: Vasculitis (HCC) [I77.6] AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 77 y.o. who has a past medical history significant for mitral regurgitation, PSVT, HTN,  DOE, OSA, and positive ANCA/ RF. She had undergone work-up outpatient in the setting of blood tinged sputum for one week with productive cough for over a month and AKI with hematuria. She was transferred to the ED with concerns for vasculitis. Patient had positive p-ANCA, elevated MPO (8.0), mildly elevated PR3 (0.4) antibiody. Bronchoscopy performed with BAL on 2/24 with bloody secretions throughout. No ongoing hemorrhage was appreciated.  Culture notable for 50-100k normal upper respiratory flora.  Incidentally positive for COVID -19. Patient was treated with 5 day course of abx for CAP. Hypoxemia worsened and required BIPAP. Pulmonology consulted. Due to impending respiratory distress pulse dose steroids had to be started prior to a renal biopsy on 2/23 and 2/25 with marked improvement in her hypoxia and respiratory status, and patient was weaned to nasal cannula and eventually RA. IR performed renal biopsy on 2/27/23 with prelim pathology showing RBC bases, but no crescents- appears to be pauci immune vasculitis. Nephrology consulted and following for AKI and vasculitis. She was started on prednisone 60mg on 2/28, with plans to continue this for likely a few months. TB test obtained at time of discharge, with plans to follow-up in nephrology clinic in a week for TB test results and likely consideration of starting rituxan. Pulm following and to arrange outpatient follow-up and pentamidine treatments for PCP ppx. Pulm rehab evaluated patient and patient without any oxygen needs at rest or ambulation. Patient medically stable for discharge home on 3/2, with close nephrology follow-up and outpatient pulmonology follow-up.
Age: 77.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Bronchoscopy abnormal, COVID-19, Condition aggravated, Haematuria, Haemoptysis
Clinical narrative: Discharge Provider:  Primary Care Provider: DO Admission Date: 2/23/2023 Discharge Date: Mar 2, 2023  PRESENTING PROBLEM: Vasculitis (HCC) [I77.6] AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 77 y.o. who has a past medical history significant for mitral regurgitation, PSVT, HTN,  DOE, OSA, and positive ANCA/ RF. She had undergone work-up outpatient in the setting of blood tinged sputum for one week with productive cough for over a month and AKI with hematuria. She was transferred to the ED with concerns for vasculitis. Patient had positive p-ANCA, elevated MPO (8.0), mildly elevated PR3 (0.4) antibiody. Bronchoscopy performed with BAL on 2/24 with bloody secretions throughout. No ongoing hemorrhage was appreciated.  Culture notable for 50-100k normal upper respiratory flora.  Incidentally positive for COVID -19. Patient was treated with 5 day course of abx for CAP. Hypoxemia worsened and required BIPAP. Pulmonology consulted. Due to impending respiratory distress pulse dose steroids had to be started prior to a renal biopsy on 2/23 and 2/25 with marked improvement in her hypoxia and respiratory status, and patient was weaned to nasal cannula and eventually RA. IR performed renal biopsy on 2/27/23 with prelim pathology showing RBC bases, but no crescents- appears to be pauci immune vasculitis. Nephrology consulted and following for AKI and vasculitis. She was started on prednisone 60mg on 2/28, with plans to continue this for likely a few months. TB test obtained at time of discharge, with plans to follow-up in nephrology clinic in a week for TB test results and likely consideration of starting rituxan. Pulm following and to arrange outpatient follow-up and pentamidine treatments for PCP ppx. Pulm rehab evaluated patient and patient without any oxygen needs at rest or ambulation. Patient medically stable for discharge home on 3/2, with close nephrology follow-up and outpatient pulmonology follow-up.
Age: 77.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Hypoxia, Mycobacterium tuberculosis complex test, Pathology test, Pneumonia, Positive airway pressure therapy
Clinical narrative: Discharge Provider:  Primary Care Provider: DO Admission Date: 2/23/2023 Discharge Date: Mar 2, 2023  PRESENTING PROBLEM: Vasculitis (HCC) [I77.6] AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 77 y.o. who has a past medical history significant for mitral regurgitation, PSVT, HTN,  DOE, OSA, and positive ANCA/ RF. She had undergone work-up outpatient in the setting of blood tinged sputum for one week with productive cough for over a month and AKI with hematuria. She was transferred to the ED with concerns for vasculitis. Patient had positive p-ANCA, elevated MPO (8.0), mildly elevated PR3 (0.4) antibiody. Bronchoscopy performed with BAL on 2/24 with bloody secretions throughout. No ongoing hemorrhage was appreciated.  Culture notable for 50-100k normal upper respiratory flora.  Incidentally positive for COVID -19. Patient was treated with 5 day course of abx for CAP. Hypoxemia worsened and required BIPAP. Pulmonology consulted. Due to impending respiratory distress pulse dose steroids had to be started prior to a renal biopsy on 2/23 and 2/25 with marked improvement in her hypoxia and respiratory status, and patient was weaned to nasal cannula and eventually RA. IR performed renal biopsy on 2/27/23 with prelim pathology showing RBC bases, but no crescents- appears to be pauci immune vasculitis. Nephrology consulted and following for AKI and vasculitis. She was started on prednisone 60mg on 2/28, with plans to continue this for likely a few months. TB test obtained at time of discharge, with plans to follow-up in nephrology clinic in a week for TB test results and likely consideration of starting rituxan. Pulm following and to arrange outpatient follow-up and pentamidine treatments for PCP ppx. Pulm rehab evaluated patient and patient without any oxygen needs at rest or ambulation. Patient medically stable for discharge home on 3/2, with close nephrology follow-up and outpatient pulmonology follow-up.
Age: 77.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Productive cough, SARS-CoV-2 test positive, Sputum culture positive, Vasculitis
Clinical narrative: Discharge Provider:  Primary Care Provider: DO Admission Date: 2/23/2023 Discharge Date: Mar 2, 2023  PRESENTING PROBLEM: Vasculitis (HCC) [I77.6] AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 77 y.o. who has a past medical history significant for mitral regurgitation, PSVT, HTN,  DOE, OSA, and positive ANCA/ RF. She had undergone work-up outpatient in the setting of blood tinged sputum for one week with productive cough for over a month and AKI with hematuria. She was transferred to the ED with concerns for vasculitis. Patient had positive p-ANCA, elevated MPO (8.0), mildly elevated PR3 (0.4) antibiody. Bronchoscopy performed with BAL on 2/24 with bloody secretions throughout. No ongoing hemorrhage was appreciated.  Culture notable for 50-100k normal upper respiratory flora.  Incidentally positive for COVID -19. Patient was treated with 5 day course of abx for CAP. Hypoxemia worsened and required BIPAP. Pulmonology consulted. Due to impending respiratory distress pulse dose steroids had to be started prior to a renal biopsy on 2/23 and 2/25 with marked improvement in her hypoxia and respiratory status, and patient was weaned to nasal cannula and eventually RA. IR performed renal biopsy on 2/27/23 with prelim pathology showing RBC bases, but no crescents- appears to be pauci immune vasculitis. Nephrology consulted and following for AKI and vasculitis. She was started on prednisone 60mg on 2/28, with plans to continue this for likely a few months. TB test obtained at time of discharge, with plans to follow-up in nephrology clinic in a week for TB test results and likely consideration of starting rituxan. Pulm following and to arrange outpatient follow-up and pentamidine treatments for PCP ppx. Pulm rehab evaluated patient and patient without any oxygen needs at rest or ambulation. Patient medically stable for discharge home on 3/2, with close nephrology follow-up and outpatient pulmonology follow-up.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: PATIENT WAS GIVENT THE MONOVALENT VACCINE INSTEAD OF THE BIVALENT VACCINE
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Abdominal pain, Abdominal pain lower, Alanine aminotransferase normal, Appendicitis, Appendix disorder
Clinical narrative: ED note by Dr. on 1/8/22: "Chief Complaint:  Abdominal Pain   HISTORY OF PRESENT ILLNESS   Patient, is a 13 y.o.male who presents to the Emergency Department with right lower quadrant abdominal pain onset yesterday morning. Patient notes that his pain initially was intermittent, but in the past few hours have become constant. Patient states that his pain is exacerbated after eating. The patient denies measured fevers, nausea, vomiting, diarrhea, shortness of breath, chest pain or extremity pain.    REVIEW OF SYSTEMS   The pertinent positive and negative symptoms are as per HPI. All other systems reviewed and are negative." "Encounter Diagnosis Name Primary? ? Acute appendicitis Yes   DISPOSITION/PLAN   Admitted     Condition at Disposition: Fair "  H&P note by Dr. on 1/9/22: "Patient Name:   Patient MRN:   Patient DOB:   Date of Service:1/9/2022   CC:  Chief Complaint Patient presents with ? Abdominal Pain     HPI: 13 yo male presented to the ER department last night with a 36 hour history of RLQ abdominal pain.  He states it was very mild on Friday night but became intolerable last evening.  Some nausea.  +Leukocytosis 15k.  CT shows acute appendicitis with fecaliths, pelvic fluid and retrocecal appendix.  He was started on IV antibiotics and admitted for appendectomy.  He is Positive for COVID 19.  Had both vaccinations this past summer.    History reviewed. No pertinent past medical history." "ASSESSMENT: 13 y.o. male with acute appendicitis, retrocecal appendix, Covid 19.   PLAN: 1. OR for laparoscopic appendectomy, possible open 2. Risk of infection/abscess, hernia, bleeding, iatrogenic intraabdominal injury"
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Aspartate aminotransferase normal, Blood albumin normal, Blood alkaline phosphatase increased, Blood calcium normal, Blood chloride normal
Clinical narrative: ED note by Dr. on 1/8/22: "Chief Complaint:  Abdominal Pain   HISTORY OF PRESENT ILLNESS   Patient, is a 13 y.o.male who presents to the Emergency Department with right lower quadrant abdominal pain onset yesterday morning. Patient notes that his pain initially was intermittent, but in the past few hours have become constant. Patient states that his pain is exacerbated after eating. The patient denies measured fevers, nausea, vomiting, diarrhea, shortness of breath, chest pain or extremity pain.    REVIEW OF SYSTEMS   The pertinent positive and negative symptoms are as per HPI. All other systems reviewed and are negative." "Encounter Diagnosis Name Primary? ? Acute appendicitis Yes   DISPOSITION/PLAN   Admitted     Condition at Disposition: Fair "  H&P note by Dr. on 1/9/22: "Patient Name:   Patient MRN:   Patient DOB:   Date of Service:1/9/2022   CC:  Chief Complaint Patient presents with ? Abdominal Pain     HPI: 13 yo male presented to the ER department last night with a 36 hour history of RLQ abdominal pain.  He states it was very mild on Friday night but became intolerable last evening.  Some nausea.  +Leukocytosis 15k.  CT shows acute appendicitis with fecaliths, pelvic fluid and retrocecal appendix.  He was started on IV antibiotics and admitted for appendectomy.  He is Positive for COVID 19.  Had both vaccinations this past summer.    History reviewed. No pertinent past medical history." "ASSESSMENT: 13 y.o. male with acute appendicitis, retrocecal appendix, Covid 19.   PLAN: 1. OR for laparoscopic appendectomy, possible open 2. Risk of infection/abscess, hernia, bleeding, iatrogenic intraabdominal injury"
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood creatinine normal, Blood potassium normal, Blood sodium normal, Blood urea normal, COVID-19
Clinical narrative: ED note by Dr. on 1/8/22: "Chief Complaint:  Abdominal Pain   HISTORY OF PRESENT ILLNESS   Patient, is a 13 y.o.male who presents to the Emergency Department with right lower quadrant abdominal pain onset yesterday morning. Patient notes that his pain initially was intermittent, but in the past few hours have become constant. Patient states that his pain is exacerbated after eating. The patient denies measured fevers, nausea, vomiting, diarrhea, shortness of breath, chest pain or extremity pain.    REVIEW OF SYSTEMS   The pertinent positive and negative symptoms are as per HPI. All other systems reviewed and are negative." "Encounter Diagnosis Name Primary? ? Acute appendicitis Yes   DISPOSITION/PLAN   Admitted     Condition at Disposition: Fair "  H&P note by Dr. on 1/9/22: "Patient Name:   Patient MRN:   Patient DOB:   Date of Service:1/9/2022   CC:  Chief Complaint Patient presents with ? Abdominal Pain     HPI: 13 yo male presented to the ER department last night with a 36 hour history of RLQ abdominal pain.  He states it was very mild on Friday night but became intolerable last evening.  Some nausea.  +Leukocytosis 15k.  CT shows acute appendicitis with fecaliths, pelvic fluid and retrocecal appendix.  He was started on IV antibiotics and admitted for appendectomy.  He is Positive for COVID 19.  Had both vaccinations this past summer.    History reviewed. No pertinent past medical history." "ASSESSMENT: 13 y.o. male with acute appendicitis, retrocecal appendix, Covid 19.   PLAN: 1. OR for laparoscopic appendectomy, possible open 2. Risk of infection/abscess, hernia, bleeding, iatrogenic intraabdominal injury"
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Carbon dioxide normal, Computerised tomogram abdomen abnormal, Faecalith, Full blood count, Glomerular filtration rate
Clinical narrative: ED note by Dr. on 1/8/22: "Chief Complaint:  Abdominal Pain   HISTORY OF PRESENT ILLNESS   Patient, is a 13 y.o.male who presents to the Emergency Department with right lower quadrant abdominal pain onset yesterday morning. Patient notes that his pain initially was intermittent, but in the past few hours have become constant. Patient states that his pain is exacerbated after eating. The patient denies measured fevers, nausea, vomiting, diarrhea, shortness of breath, chest pain or extremity pain.    REVIEW OF SYSTEMS   The pertinent positive and negative symptoms are as per HPI. All other systems reviewed and are negative." "Encounter Diagnosis Name Primary? ? Acute appendicitis Yes   DISPOSITION/PLAN   Admitted     Condition at Disposition: Fair "  H&P note by Dr. on 1/9/22: "Patient Name:   Patient MRN:   Patient DOB:   Date of Service:1/9/2022   CC:  Chief Complaint Patient presents with ? Abdominal Pain     HPI: 13 yo male presented to the ER department last night with a 36 hour history of RLQ abdominal pain.  He states it was very mild on Friday night but became intolerable last evening.  Some nausea.  +Leukocytosis 15k.  CT shows acute appendicitis with fecaliths, pelvic fluid and retrocecal appendix.  He was started on IV antibiotics and admitted for appendectomy.  He is Positive for COVID 19.  Had both vaccinations this past summer.    History reviewed. No pertinent past medical history." "ASSESSMENT: 13 y.o. male with acute appendicitis, retrocecal appendix, Covid 19.   PLAN: 1. OR for laparoscopic appendectomy, possible open 2. Risk of infection/abscess, hernia, bleeding, iatrogenic intraabdominal injury"
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Haematocrit normal, Haemoglobin normal, Inflammation, Leukocytosis, Metabolic function test
Clinical narrative: ED note by Dr. on 1/8/22: "Chief Complaint:  Abdominal Pain   HISTORY OF PRESENT ILLNESS   Patient, is a 13 y.o.male who presents to the Emergency Department with right lower quadrant abdominal pain onset yesterday morning. Patient notes that his pain initially was intermittent, but in the past few hours have become constant. Patient states that his pain is exacerbated after eating. The patient denies measured fevers, nausea, vomiting, diarrhea, shortness of breath, chest pain or extremity pain.    REVIEW OF SYSTEMS   The pertinent positive and negative symptoms are as per HPI. All other systems reviewed and are negative." "Encounter Diagnosis Name Primary? ? Acute appendicitis Yes   DISPOSITION/PLAN   Admitted     Condition at Disposition: Fair "  H&P note by Dr. on 1/9/22: "Patient Name:   Patient MRN:   Patient DOB:   Date of Service:1/9/2022   CC:  Chief Complaint Patient presents with ? Abdominal Pain     HPI: 13 yo male presented to the ER department last night with a 36 hour history of RLQ abdominal pain.  He states it was very mild on Friday night but became intolerable last evening.  Some nausea.  +Leukocytosis 15k.  CT shows acute appendicitis with fecaliths, pelvic fluid and retrocecal appendix.  He was started on IV antibiotics and admitted for appendectomy.  He is Positive for COVID 19.  Had both vaccinations this past summer.    History reviewed. No pertinent past medical history." "ASSESSMENT: 13 y.o. male with acute appendicitis, retrocecal appendix, Covid 19.   PLAN: 1. OR for laparoscopic appendectomy, possible open 2. Risk of infection/abscess, hernia, bleeding, iatrogenic intraabdominal injury"
Age: 12.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Nausea, Pelvic fluid collection, Platelet count normal, SARS-CoV-2 test positive, White blood cell count increased
Clinical narrative: ED note by Dr. on 1/8/22: "Chief Complaint:  Abdominal Pain   HISTORY OF PRESENT ILLNESS   Patient, is a 13 y.o.male who presents to the Emergency Department with right lower quadrant abdominal pain onset yesterday morning. Patient notes that his pain initially was intermittent, but in the past few hours have become constant. Patient states that his pain is exacerbated after eating. The patient denies measured fevers, nausea, vomiting, diarrhea, shortness of breath, chest pain or extremity pain.    REVIEW OF SYSTEMS   The pertinent positive and negative symptoms are as per HPI. All other systems reviewed and are negative." "Encounter Diagnosis Name Primary? ? Acute appendicitis Yes   DISPOSITION/PLAN   Admitted     Condition at Disposition: Fair "  H&P note by Dr. on 1/9/22: "Patient Name:   Patient MRN:   Patient DOB:   Date of Service:1/9/2022   CC:  Chief Complaint Patient presents with ? Abdominal Pain     HPI: 13 yo male presented to the ER department last night with a 36 hour history of RLQ abdominal pain.  He states it was very mild on Friday night but became intolerable last evening.  Some nausea.  +Leukocytosis 15k.  CT shows acute appendicitis with fecaliths, pelvic fluid and retrocecal appendix.  He was started on IV antibiotics and admitted for appendectomy.  He is Positive for COVID 19.  Had both vaccinations this past summer.    History reviewed. No pertinent past medical history." "ASSESSMENT: 13 y.o. male with acute appendicitis, retrocecal appendix, Covid 19.   PLAN: 1. OR for laparoscopic appendectomy, possible open 2. Risk of infection/abscess, hernia, bleeding, iatrogenic intraabdominal injury"
Age: 68.0
Sex: F
Vaccine: COVID19-2, COVID19-2, FLU4, VARZOS
Symptoms: Bacterial test positive, Body temperature increased, COVID-19, Chest X-ray normal, Cough
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/24/2023 Discharge Date: Feb 26, 2023  PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 [U07.1]   HOSPITAL COURSE: Pt is a 69 yr old F with PMHx of  chronic diastolic CHF (LVEF 62% on TTE in 2022), prior pulmonary embolism on Xarelto, pulmonary hypertension, status post left lower lobe lobectomy, OSA with obesity hypoventilation syndrome on nightly BiPAP, hypertension, restless leg syndrome, insomnia, morbid obesity presented to ED with shortness of breath that started on 2/23.    Her shortness of breath is associated with nasal congestion and dry cough. She was found to be COVID positive on a in home test. In ER, noted to be tachycardic, T-max 102.7° F. Briefly desaturated to 88% on room air.  EKG unremarkable.  Labs unremarkable.  Found to be COVID-19 positive.  UA with few bacteria, 19 WBC, small leukocytes.  CXR unremarkable.     Admitted for close monitoring, symptomatic control and Decadron. Her symptoms improved though she still continued to have non-productive cough. CBC and procalcitonin were stable.   I offered to monitor her 1 more tonight given her symptoms of cough, congestion but patient felt ready to discharge. I recommended she follow up with PCP within 1 week and monitor oxygen levels at home with pulse oximeter (pt has this at home).   She is discharged home in stable condition
Age: 68.0
Sex: F
Vaccine: COVID19-2, COVID19-2, FLU4, VARZOS
Symptoms: Dyspnoea, Electrocardiogram normal, Full blood count normal, Hypoxia, Laboratory test normal
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/24/2023 Discharge Date: Feb 26, 2023  PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 [U07.1]   HOSPITAL COURSE: Pt is a 69 yr old F with PMHx of  chronic diastolic CHF (LVEF 62% on TTE in 2022), prior pulmonary embolism on Xarelto, pulmonary hypertension, status post left lower lobe lobectomy, OSA with obesity hypoventilation syndrome on nightly BiPAP, hypertension, restless leg syndrome, insomnia, morbid obesity presented to ED with shortness of breath that started on 2/23.    Her shortness of breath is associated with nasal congestion and dry cough. She was found to be COVID positive on a in home test. In ER, noted to be tachycardic, T-max 102.7° F. Briefly desaturated to 88% on room air.  EKG unremarkable.  Labs unremarkable.  Found to be COVID-19 positive.  UA with few bacteria, 19 WBC, small leukocytes.  CXR unremarkable.     Admitted for close monitoring, symptomatic control and Decadron. Her symptoms improved though she still continued to have non-productive cough. CBC and procalcitonin were stable.   I offered to monitor her 1 more tonight given her symptoms of cough, congestion but patient felt ready to discharge. I recommended she follow up with PCP within 1 week and monitor oxygen levels at home with pulse oximeter (pt has this at home).   She is discharged home in stable condition
Age: 68.0
Sex: F
Vaccine: COVID19-2, COVID19-2, FLU4, VARZOS
Symptoms: Nasal congestion, Oxygen saturation decreased, Procalcitonin normal, SARS-CoV-2 test positive, Tachycardia
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/24/2023 Discharge Date: Feb 26, 2023  PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 [U07.1]   HOSPITAL COURSE: Pt is a 69 yr old F with PMHx of  chronic diastolic CHF (LVEF 62% on TTE in 2022), prior pulmonary embolism on Xarelto, pulmonary hypertension, status post left lower lobe lobectomy, OSA with obesity hypoventilation syndrome on nightly BiPAP, hypertension, restless leg syndrome, insomnia, morbid obesity presented to ED with shortness of breath that started on 2/23.    Her shortness of breath is associated with nasal congestion and dry cough. She was found to be COVID positive on a in home test. In ER, noted to be tachycardic, T-max 102.7° F. Briefly desaturated to 88% on room air.  EKG unremarkable.  Labs unremarkable.  Found to be COVID-19 positive.  UA with few bacteria, 19 WBC, small leukocytes.  CXR unremarkable.     Admitted for close monitoring, symptomatic control and Decadron. Her symptoms improved though she still continued to have non-productive cough. CBC and procalcitonin were stable.   I offered to monitor her 1 more tonight given her symptoms of cough, congestion but patient felt ready to discharge. I recommended she follow up with PCP within 1 week and monitor oxygen levels at home with pulse oximeter (pt has this at home).   She is discharged home in stable condition
Age: 68.0
Sex: F
Vaccine: COVID19-2, COVID19-2, FLU4, VARZOS
Symptoms: Urine analysis abnormal, Urine leukocyte esterase positive, White blood cells urine positive
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/24/2023 Discharge Date: Feb 26, 2023  PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 [U07.1]   HOSPITAL COURSE: Pt is a 69 yr old F with PMHx of  chronic diastolic CHF (LVEF 62% on TTE in 2022), prior pulmonary embolism on Xarelto, pulmonary hypertension, status post left lower lobe lobectomy, OSA with obesity hypoventilation syndrome on nightly BiPAP, hypertension, restless leg syndrome, insomnia, morbid obesity presented to ED with shortness of breath that started on 2/23.    Her shortness of breath is associated with nasal congestion and dry cough. She was found to be COVID positive on a in home test. In ER, noted to be tachycardic, T-max 102.7° F. Briefly desaturated to 88% on room air.  EKG unremarkable.  Labs unremarkable.  Found to be COVID-19 positive.  UA with few bacteria, 19 WBC, small leukocytes.  CXR unremarkable.     Admitted for close monitoring, symptomatic control and Decadron. Her symptoms improved though she still continued to have non-productive cough. CBC and procalcitonin were stable.   I offered to monitor her 1 more tonight given her symptoms of cough, congestion but patient felt ready to discharge. I recommended she follow up with PCP within 1 week and monitor oxygen levels at home with pulse oximeter (pt has this at home).   She is discharged home in stable condition
Age: 68.0
Sex: F
Vaccine: COVID19-2, COVID19-2, FLU4, VARZOS
Symptoms: Blood test abnormal, COVID-19, Chest X-ray normal, Exposure to SARS-CoV-2, Fatigue
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 2/24/2023 Discharge Date: Feb 26, 2023  PRESENTING PROBLEM: Hypoxia [R09.02] COVID-19 [U07.1]   HOSPITAL COURSE: Pt is a 69 yr old F with PMHx of  chronic diastolic CHF (LVEF 62% on TTE in 2022), prior pulmonary embolism on Xarelto, pulmonary hypertension, status post left lower lobe lobectomy, OSA with obesity hypoventilation syndrome on nightly BiPAP, hypertension, restless leg syndrome, insomnia, morbid obesity presented to ED with shortness of breath that started on 2/23.    Her shortness of breath is associated with nasal congestion and dry cough. She was found to be COVID positive on a in home test. In ER, noted to be tachycardic, T-max 102.7° F. Briefly desaturated to 88% on room air.  EKG unremarkable.  Labs unremarkable.  Found to be COVID-19 positive.  UA with few bacteria, 19 WBC, small leukocytes.  CXR unremarkable.     Admitted for close monitoring, symptomatic control and Decadron. Her symptoms improved though she still continued to have non-productive cough. CBC and procalcitonin were stable.   I offered to monitor her 1 more tonight given her symptoms of cough, congestion but patient felt ready to discharge. I recommended she follow up with PCP within 1 week and monitor oxygen levels at home with pulse oximeter (pt has this at home).   She is discharged home in stable condition