chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 40.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Epicondylitis
Clinical narrative: Right elbow pain similar to lateral epicondylitis.  First-aid-only treatment at this time; she will follow-up in four weeks or sooner if needed.
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, COVID-19, Chest X-ray abnormal, Dyspnoea, Lung disorder
Clinical narrative: Patient received Pfizer vaccine on 1/26/21 and 2/15/21. Received moderna booster on 1/19/22. Presented to ER on 1/26/22. Three days prior to admission, patient had worsening SOB with purulent sputum and general malaise. Found to be COVID19 positive on 1/22/22. Patient was admitted for COVID 19 pneumona. Her baseline oxygen requirement is room air, however she was placed on 6L of oxygen via nasal cannula upon admission and required high flow at some point. MRSA swab was obtained and resulted negative. She also had a UTI on admission and was treated with zosyn for the UTI and pneumonia. She received decadron and remdesevir as well. Her home medications were continued. Her course was complicated by her paroxysmal Atrial fibrillation with RVR; so she was placed on Amiodarone 200mg daily and lopressor 12.5mg twice daily for adequate rhythm and rate control. Her home propanolol was discontinued. She had increased production of sputum; and with her increased oxygen requirements, pulmonology was consulted. They recommended  Acetylcysteine 10% (MUCOMYST) be added to her regimen. Patient is take nebulized twice daily for the next 1-2 weeks. Ipatropium- Albuterol Duo-neb has been added to her regimen. Patient is to take nebulized twice daily for the next 1-2 weeks. Nebulized saline has been added to patients regimen. Patient take nebulized twice daily for the next 1-2 weeks. Guaifenesin has been added to her regimen. Patient is to take 5-10ML as needed for congestion. She also received some chest physiotherapy.   Patient became clear of COVID isolation. Repeat Chest X-Ray showed significant improvement in lung infiltrates. She had a bout of SVT for which she received a lopressor push IV X1. She began to improve clinically and was weaned down to room air oxygen. She returned back on 2/7/22
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Lung infiltration, Lung opacity, Malaise, Physiotherapy chest, Pleural effusion
Clinical narrative: Patient received Pfizer vaccine on 1/26/21 and 2/15/21. Received moderna booster on 1/19/22. Presented to ER on 1/26/22. Three days prior to admission, patient had worsening SOB with purulent sputum and general malaise. Found to be COVID19 positive on 1/22/22. Patient was admitted for COVID 19 pneumona. Her baseline oxygen requirement is room air, however she was placed on 6L of oxygen via nasal cannula upon admission and required high flow at some point. MRSA swab was obtained and resulted negative. She also had a UTI on admission and was treated with zosyn for the UTI and pneumonia. She received decadron and remdesevir as well. Her home medications were continued. Her course was complicated by her paroxysmal Atrial fibrillation with RVR; so she was placed on Amiodarone 200mg daily and lopressor 12.5mg twice daily for adequate rhythm and rate control. Her home propanolol was discontinued. She had increased production of sputum; and with her increased oxygen requirements, pulmonology was consulted. They recommended  Acetylcysteine 10% (MUCOMYST) be added to her regimen. Patient is take nebulized twice daily for the next 1-2 weeks. Ipatropium- Albuterol Duo-neb has been added to her regimen. Patient is to take nebulized twice daily for the next 1-2 weeks. Nebulized saline has been added to patients regimen. Patient take nebulized twice daily for the next 1-2 weeks. Guaifenesin has been added to her regimen. Patient is to take 5-10ML as needed for congestion. She also received some chest physiotherapy.   Patient became clear of COVID isolation. Repeat Chest X-Ray showed significant improvement in lung infiltrates. She had a bout of SVT for which she received a lopressor push IV X1. She began to improve clinically and was weaned down to room air oxygen. She returned back on 2/7/22
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Pneumonia, Respiratory tract congestion, SARS-CoV-2 test positive, Sputum increased, Sputum purulent
Clinical narrative: Patient received Pfizer vaccine on 1/26/21 and 2/15/21. Received moderna booster on 1/19/22. Presented to ER on 1/26/22. Three days prior to admission, patient had worsening SOB with purulent sputum and general malaise. Found to be COVID19 positive on 1/22/22. Patient was admitted for COVID 19 pneumona. Her baseline oxygen requirement is room air, however she was placed on 6L of oxygen via nasal cannula upon admission and required high flow at some point. MRSA swab was obtained and resulted negative. She also had a UTI on admission and was treated with zosyn for the UTI and pneumonia. She received decadron and remdesevir as well. Her home medications were continued. Her course was complicated by her paroxysmal Atrial fibrillation with RVR; so she was placed on Amiodarone 200mg daily and lopressor 12.5mg twice daily for adequate rhythm and rate control. Her home propanolol was discontinued. She had increased production of sputum; and with her increased oxygen requirements, pulmonology was consulted. They recommended  Acetylcysteine 10% (MUCOMYST) be added to her regimen. Patient is take nebulized twice daily for the next 1-2 weeks. Ipatropium- Albuterol Duo-neb has been added to her regimen. Patient is to take nebulized twice daily for the next 1-2 weeks. Nebulized saline has been added to patients regimen. Patient take nebulized twice daily for the next 1-2 weeks. Guaifenesin has been added to her regimen. Patient is to take 5-10ML as needed for congestion. She also received some chest physiotherapy.   Patient became clear of COVID isolation. Repeat Chest X-Ray showed significant improvement in lung infiltrates. She had a bout of SVT for which she received a lopressor push IV X1. She began to improve clinically and was weaned down to room air oxygen. She returned back on 2/7/22
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Staphylococcus test negative, Supraventricular tachycardia, Urinary tract infection
Clinical narrative: Patient received Pfizer vaccine on 1/26/21 and 2/15/21. Received moderna booster on 1/19/22. Presented to ER on 1/26/22. Three days prior to admission, patient had worsening SOB with purulent sputum and general malaise. Found to be COVID19 positive on 1/22/22. Patient was admitted for COVID 19 pneumona. Her baseline oxygen requirement is room air, however she was placed on 6L of oxygen via nasal cannula upon admission and required high flow at some point. MRSA swab was obtained and resulted negative. She also had a UTI on admission and was treated with zosyn for the UTI and pneumonia. She received decadron and remdesevir as well. Her home medications were continued. Her course was complicated by her paroxysmal Atrial fibrillation with RVR; so she was placed on Amiodarone 200mg daily and lopressor 12.5mg twice daily for adequate rhythm and rate control. Her home propanolol was discontinued. She had increased production of sputum; and with her increased oxygen requirements, pulmonology was consulted. They recommended  Acetylcysteine 10% (MUCOMYST) be added to her regimen. Patient is take nebulized twice daily for the next 1-2 weeks. Ipatropium- Albuterol Duo-neb has been added to her regimen. Patient is to take nebulized twice daily for the next 1-2 weeks. Nebulized saline has been added to patients regimen. Patient take nebulized twice daily for the next 1-2 weeks. Guaifenesin has been added to her regimen. Patient is to take 5-10ML as needed for congestion. She also received some chest physiotherapy.   Patient became clear of COVID isolation. Repeat Chest X-Ray showed significant improvement in lung infiltrates. She had a bout of SVT for which she received a lopressor push IV X1. She began to improve clinically and was weaned down to room air oxygen. She returned back on 2/7/22
Age: 11.0
Sex: F
Vaccine: COVID19
Symptoms: Chest discomfort, Pallor, Paraesthesia oral, Pruritus, Rash
Clinical narrative: ash, swelling, itching; Mother states onset of symptoms started when she got home after observation period was completed. Pt was in clinic over an hour as she also had her dental appt in clinic following 2nd dose pfizer administration. When pt got home, mother states she developed pallor, mild tongue swelling with rashey spots to edge of tongue and darker tongue, itchy throat and pt stated her tongue felt weird, but not that it was swelling, mild chest tightness, extensive rash to chest. Bendadryl 50mg given and that helped.
Age: 11.0
Sex: F
Vaccine: COVID19
Symptoms: Swelling, Swollen tongue, Throat irritation, Tongue discolouration, Tongue eruption
Clinical narrative: ash, swelling, itching; Mother states onset of symptoms started when she got home after observation period was completed. Pt was in clinic over an hour as she also had her dental appt in clinic following 2nd dose pfizer administration. When pt got home, mother states she developed pallor, mild tongue swelling with rashey spots to edge of tongue and darker tongue, itchy throat and pt stated her tongue felt weird, but not that it was swelling, mild chest tightness, extensive rash to chest. Bendadryl 50mg given and that helped.
Age: 13.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Cough, Respiratory symptom, Respiratory tract congestion, Rhinorrhoea
Clinical narrative: 1/16/22 13-year-old male with history of asthma presenting to the emergency department with upper respiratory symptoms for the past 3 days.  There has been cough, congestion and rhinorrhea.  There has been no wheezing or stridor noted at home.  There has been no labored breathing or increased work of breathing.  There has been no vomiting or diarrhea.  Appetite and activity levels have been normal.  Urine output has been normal.  No home treatment has been initiated.     ROS positive for cough, congestion and rhinorrhea, negative for vomiting or diarrhea, rash, labored breathing,  change in mental status, sore throat, eye or ear discharge; ROS o/w negative HEENT: TMs normal, oropharynx normal, mucus membranes moist. 1/16/22 Discharge: 13-year-old male presenting to the emergency department with chief complaint of upper respiratory symptoms for the last few days.  Exam reveals a healthy young man with occasional bronchospastic cough, rhinorrhea and congestion.  Dexamethasone x1 was given p.o. mother was advised to continue asthma regimen at home.  Benadryl to be taken at night.  Mother to allow rest and to push p.o. fluids.
Age: 13.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: 1/16/22 13-year-old male with history of asthma presenting to the emergency department with upper respiratory symptoms for the past 3 days.  There has been cough, congestion and rhinorrhea.  There has been no wheezing or stridor noted at home.  There has been no labored breathing or increased work of breathing.  There has been no vomiting or diarrhea.  Appetite and activity levels have been normal.  Urine output has been normal.  No home treatment has been initiated.     ROS positive for cough, congestion and rhinorrhea, negative for vomiting or diarrhea, rash, labored breathing,  change in mental status, sore throat, eye or ear discharge; ROS o/w negative HEENT: TMs normal, oropharynx normal, mucus membranes moist. 1/16/22 Discharge: 13-year-old male presenting to the emergency department with chief complaint of upper respiratory symptoms for the last few days.  Exam reveals a healthy young man with occasional bronchospastic cough, rhinorrhea and congestion.  Dexamethasone x1 was given p.o. mother was advised to continue asthma regimen at home.  Benadryl to be taken at night.  Mother to allow rest and to push p.o. fluids.
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram pulmonary normal, COVID-19, Chest X-ray normal, Fall, Femur fracture
Clinical narrative: REceived moderna vaccine on 3/10/21, 4/7/21, and 1/27/22. Found to be COVID positive on 1/29/22. Presented to ER on 1/29/22. was admitted on 1/29/2022 presented with episode of fall without hitting her head/loss of consciousness.  Presented with right leg pain.  Imaging-right femur fracture. Orthopedic consulted.  S/p right femur retrograde nail on 01/29/22             Screening COVID test positive, was vaccinated.  Clinically asymptomatic. Elevated D-dimer-CT angio negative for PE, ultrasound leg negative for DVT. On room air, Waiting rehab placement when off covid isolation              PT evaluation done. Patient is medically stable to be discharge Rehab. Discharged on 2/8/22
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Fibrin D dimer increased, Pain in extremity, SARS-CoV-2 test positive, Ultrasound Doppler normal
Clinical narrative: REceived moderna vaccine on 3/10/21, 4/7/21, and 1/27/22. Found to be COVID positive on 1/29/22. Presented to ER on 1/29/22. was admitted on 1/29/2022 presented with episode of fall without hitting her head/loss of consciousness.  Presented with right leg pain.  Imaging-right femur fracture. Orthopedic consulted.  S/p right femur retrograde nail on 01/29/22             Screening COVID test positive, was vaccinated.  Clinically asymptomatic. Elevated D-dimer-CT angio negative for PE, ultrasound leg negative for DVT. On room air, Waiting rehab placement when off covid isolation              PT evaluation done. Patient is medically stable to be discharge Rehab. Discharged on 2/8/22
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram normal, Headache, SARS-CoV-2 test negative
Clinical narrative: After I had the vaccine, I woke up with a very bad headache. I waited for a few days, but the headache never went away at all. Tylenol and nothing worked. I made an appointment with my doctor to see if I can get a prescription for the pain. I went to walk in clinic they prescribed 50 mg of Imitrex (1/21) daily. No relief after I took the pills.  On 1/24 I went to the ER.  They gave me an infusion and that help with the headache. I left the hospital.  And I am planning to see my doctor, this time with a Neurologist. Appointment is March 17, 2022.
Age: 31.0
Sex: M
Vaccine: COVID19
Symptoms: Chest discomfort, Palpitations
Clinical narrative: Heart palpitations, tightness and pressure after exercise. Currently testing.
Age: 10.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient received undiluted pediatric vaccine 2/8/22.
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Atrial fibrillation, Barotrauma, Blood gases, Blood pH decreased
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 87 yo, covid positive start of January. Hospitalized 1/31 - intubated 2/6   1. Pulmonary:  1. Hypoxic resp failure due to covid. 1. Intubated 2/6 2. 20/450/80/12 + flolan + paralysis 1. Trying to limit MV given PTX/subQ emphysema. Dropped peep to 10 2. I'm fine with premissive hyeprcapnea and ph > 7.10.  1. venous 7.15 acceptable this am  2. Signs of barotrauma - subQ emphysema and L sided PTX. Latter not large enough for CT. Monitoring with daily cxr 2. Cardiac:  1. Septic shock - on repi and vaspressin. Added norepi to use as primary pressor 2. Afib - on amiodarone. Looks to have converted to sinus this am 3. Renal:  1. ARF - likely ischemic or prerenal ATB, on top of contrast nephropathy. Numers progressive today. Likely will need to start HD in next 24-48h. 4. ID:  1. Leukocytosis - likely stress infection post intubayion etc, but can't r/o 2ndry infection 1. On cefepime/vanco 2. Cx's pending, but ngtd 2. Covid  1. On steroids 2. Out of time window for Toci/Bari  5. GI: no issues 6. Nutrition: TF's on hold due to high residuals 7. Heme:  1. Leukocytosis as above 8. Neuro: no issues 9. Sedation/Analgesia: versed, dilaudid Restraints: Not indicated 10. Endocrine: accuchecks and ssi 11. Prophylaxis: h2b, lovenox 12. Lines/Site: PICC 13. Code Status: DNR/may intubate 14. Family Communication: with DIL yesterday, and son today. My message was despite full support, he has declined over the past 48h. If we were to continue full support, we need to decide about dialysis. My recommendation was that given his trajectory, The patient is unlikely to survive, and even if he did would be looking at prolonged recovery (trach, peg etc). My recommendation was given his age, we could feel comfortable about honoring his wishes and trying full support as we did, but I would transition to comfort cares
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Central venous catheterisation, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Culture
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 87 yo, covid positive start of January. Hospitalized 1/31 - intubated 2/6   1. Pulmonary:  1. Hypoxic resp failure due to covid. 1. Intubated 2/6 2. 20/450/80/12 + flolan + paralysis 1. Trying to limit MV given PTX/subQ emphysema. Dropped peep to 10 2. I'm fine with premissive hyeprcapnea and ph > 7.10.  1. venous 7.15 acceptable this am  2. Signs of barotrauma - subQ emphysema and L sided PTX. Latter not large enough for CT. Monitoring with daily cxr 2. Cardiac:  1. Septic shock - on repi and vaspressin. Added norepi to use as primary pressor 2. Afib - on amiodarone. Looks to have converted to sinus this am 3. Renal:  1. ARF - likely ischemic or prerenal ATB, on top of contrast nephropathy. Numers progressive today. Likely will need to start HD in next 24-48h. 4. ID:  1. Leukocytosis - likely stress infection post intubayion etc, but can't r/o 2ndry infection 1. On cefepime/vanco 2. Cx's pending, but ngtd 2. Covid  1. On steroids 2. Out of time window for Toci/Bari  5. GI: no issues 6. Nutrition: TF's on hold due to high residuals 7. Heme:  1. Leukocytosis as above 8. Neuro: no issues 9. Sedation/Analgesia: versed, dilaudid Restraints: Not indicated 10. Endocrine: accuchecks and ssi 11. Prophylaxis: h2b, lovenox 12. Lines/Site: PICC 13. Code Status: DNR/may intubate 14. Family Communication: with DIL yesterday, and son today. My message was despite full support, he has declined over the past 48h. If we were to continue full support, we need to decide about dialysis. My recommendation was that given his trajectory, The patient is unlikely to survive, and even if he did would be looking at prolonged recovery (trach, peg etc). My recommendation was given his age, we could feel comfortable about honoring his wishes and trying full support as we did, but I would transition to comfort cares
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Endotracheal intubation, Feeding tube user, Gastric residual increased, Hypercapnia, Infection
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 87 yo, covid positive start of January. Hospitalized 1/31 - intubated 2/6   1. Pulmonary:  1. Hypoxic resp failure due to covid. 1. Intubated 2/6 2. 20/450/80/12 + flolan + paralysis 1. Trying to limit MV given PTX/subQ emphysema. Dropped peep to 10 2. I'm fine with premissive hyeprcapnea and ph > 7.10.  1. venous 7.15 acceptable this am  2. Signs of barotrauma - subQ emphysema and L sided PTX. Latter not large enough for CT. Monitoring with daily cxr 2. Cardiac:  1. Septic shock - on repi and vaspressin. Added norepi to use as primary pressor 2. Afib - on amiodarone. Looks to have converted to sinus this am 3. Renal:  1. ARF - likely ischemic or prerenal ATB, on top of contrast nephropathy. Numers progressive today. Likely will need to start HD in next 24-48h. 4. ID:  1. Leukocytosis - likely stress infection post intubayion etc, but can't r/o 2ndry infection 1. On cefepime/vanco 2. Cx's pending, but ngtd 2. Covid  1. On steroids 2. Out of time window for Toci/Bari  5. GI: no issues 6. Nutrition: TF's on hold due to high residuals 7. Heme:  1. Leukocytosis as above 8. Neuro: no issues 9. Sedation/Analgesia: versed, dilaudid Restraints: Not indicated 10. Endocrine: accuchecks and ssi 11. Prophylaxis: h2b, lovenox 12. Lines/Site: PICC 13. Code Status: DNR/may intubate 14. Family Communication: with DIL yesterday, and son today. My message was despite full support, he has declined over the past 48h. If we were to continue full support, we need to decide about dialysis. My recommendation was that given his trajectory, The patient is unlikely to survive, and even if he did would be looking at prolonged recovery (trach, peg etc). My recommendation was given his age, we could feel comfortable about honoring his wishes and trying full support as we did, but I would transition to comfort cares
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Leukocytosis, Nephropathy toxic, Paralysis, Pneumothorax, Positive end-expiratory pressure
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 87 yo, covid positive start of January. Hospitalized 1/31 - intubated 2/6   1. Pulmonary:  1. Hypoxic resp failure due to covid. 1. Intubated 2/6 2. 20/450/80/12 + flolan + paralysis 1. Trying to limit MV given PTX/subQ emphysema. Dropped peep to 10 2. I'm fine with premissive hyeprcapnea and ph > 7.10.  1. venous 7.15 acceptable this am  2. Signs of barotrauma - subQ emphysema and L sided PTX. Latter not large enough for CT. Monitoring with daily cxr 2. Cardiac:  1. Septic shock - on repi and vaspressin. Added norepi to use as primary pressor 2. Afib - on amiodarone. Looks to have converted to sinus this am 3. Renal:  1. ARF - likely ischemic or prerenal ATB, on top of contrast nephropathy. Numers progressive today. Likely will need to start HD in next 24-48h. 4. ID:  1. Leukocytosis - likely stress infection post intubayion etc, but can't r/o 2ndry infection 1. On cefepime/vanco 2. Cx's pending, but ngtd 2. Covid  1. On steroids 2. Out of time window for Toci/Bari  5. GI: no issues 6. Nutrition: TF's on hold due to high residuals 7. Heme:  1. Leukocytosis as above 8. Neuro: no issues 9. Sedation/Analgesia: versed, dilaudid Restraints: Not indicated 10. Endocrine: accuchecks and ssi 11. Prophylaxis: h2b, lovenox 12. Lines/Site: PICC 13. Code Status: DNR/may intubate 14. Family Communication: with DIL yesterday, and son today. My message was despite full support, he has declined over the past 48h. If we were to continue full support, we need to decide about dialysis. My recommendation was that given his trajectory, The patient is unlikely to survive, and even if he did would be looking at prolonged recovery (trach, peg etc). My recommendation was given his age, we could feel comfortable about honoring his wishes and trying full support as we did, but I would transition to comfort cares
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Post procedural infection, Prerenal failure, Respiratory failure, SARS-CoV-2 test positive, Septic shock
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 87 yo, covid positive start of January. Hospitalized 1/31 - intubated 2/6   1. Pulmonary:  1. Hypoxic resp failure due to covid. 1. Intubated 2/6 2. 20/450/80/12 + flolan + paralysis 1. Trying to limit MV given PTX/subQ emphysema. Dropped peep to 10 2. I'm fine with premissive hyeprcapnea and ph > 7.10.  1. venous 7.15 acceptable this am  2. Signs of barotrauma - subQ emphysema and L sided PTX. Latter not large enough for CT. Monitoring with daily cxr 2. Cardiac:  1. Septic shock - on repi and vaspressin. Added norepi to use as primary pressor 2. Afib - on amiodarone. Looks to have converted to sinus this am 3. Renal:  1. ARF - likely ischemic or prerenal ATB, on top of contrast nephropathy. Numers progressive today. Likely will need to start HD in next 24-48h. 4. ID:  1. Leukocytosis - likely stress infection post intubayion etc, but can't r/o 2ndry infection 1. On cefepime/vanco 2. Cx's pending, but ngtd 2. Covid  1. On steroids 2. Out of time window for Toci/Bari  5. GI: no issues 6. Nutrition: TF's on hold due to high residuals 7. Heme:  1. Leukocytosis as above 8. Neuro: no issues 9. Sedation/Analgesia: versed, dilaudid Restraints: Not indicated 10. Endocrine: accuchecks and ssi 11. Prophylaxis: h2b, lovenox 12. Lines/Site: PICC 13. Code Status: DNR/may intubate 14. Family Communication: with DIL yesterday, and son today. My message was despite full support, he has declined over the past 48h. If we were to continue full support, we need to decide about dialysis. My recommendation was that given his trajectory, The patient is unlikely to survive, and even if he did would be looking at prolonged recovery (trach, peg etc). My recommendation was given his age, we could feel comfortable about honoring his wishes and trying full support as we did, but I would transition to comfort cares
Age: 87.0
Sex: M
Vaccine: COVID19
Symptoms: Sinus rhythm, Stress, Subcutaneous emphysema
Clinical narrative: PROVIDER PROGRESS NOTE 2/8/2022 87 yo, covid positive start of January. Hospitalized 1/31 - intubated 2/6   1. Pulmonary:  1. Hypoxic resp failure due to covid. 1. Intubated 2/6 2. 20/450/80/12 + flolan + paralysis 1. Trying to limit MV given PTX/subQ emphysema. Dropped peep to 10 2. I'm fine with premissive hyeprcapnea and ph > 7.10.  1. venous 7.15 acceptable this am  2. Signs of barotrauma - subQ emphysema and L sided PTX. Latter not large enough for CT. Monitoring with daily cxr 2. Cardiac:  1. Septic shock - on repi and vaspressin. Added norepi to use as primary pressor 2. Afib - on amiodarone. Looks to have converted to sinus this am 3. Renal:  1. ARF - likely ischemic or prerenal ATB, on top of contrast nephropathy. Numers progressive today. Likely will need to start HD in next 24-48h. 4. ID:  1. Leukocytosis - likely stress infection post intubayion etc, but can't r/o 2ndry infection 1. On cefepime/vanco 2. Cx's pending, but ngtd 2. Covid  1. On steroids 2. Out of time window for Toci/Bari  5. GI: no issues 6. Nutrition: TF's on hold due to high residuals 7. Heme:  1. Leukocytosis as above 8. Neuro: no issues 9. Sedation/Analgesia: versed, dilaudid Restraints: Not indicated 10. Endocrine: accuchecks and ssi 11. Prophylaxis: h2b, lovenox 12. Lines/Site: PICC 13. Code Status: DNR/may intubate 14. Family Communication: with DIL yesterday, and son today. My message was despite full support, he has declined over the past 48h. If we were to continue full support, we need to decide about dialysis. My recommendation was that given his trajectory, The patient is unlikely to survive, and even if he did would be looking at prolonged recovery (trach, peg etc). My recommendation was given his age, we could feel comfortable about honoring his wishes and trying full support as we did, but I would transition to comfort cares
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: Muscle tightness, Vomiting
Clinical narrative: Pt C/O face tightness and vomitted X2 after administration of the vaccine .  EMS on site interviened and vital signs as follows  B/P 108/70  P 150 O2 96% , repeated  5 min  P118 O2 100 %
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: On Tuesday, Feb. 8th 2022 at approximately 13:00. Patient and her mother Attended the local vaccination clinic. I was the Clinic Manager of this clinic. Pt and mother both received vaccination and while they were sitting in observation, Staff RN informed me that Pt. is 17 years old, but received a 1st dose of Moderna Vaccine. According to CDC Directives and Medical Teams policy, patients under 18 should only receive Pfizer brand COVID-19 Vaccination. I informed the patient and her mother of this mistake. The mother stated that they were also aware of the CDC directive, but wanted to receive Moderna due to advice from a Physician Friend. I informed them that we can not give pt. a second dose of Moderna until she was 18 years old, and they both understood. I informed them that I would follow up with them later via phone after, I receive counsel from Program Manager. Both patients finished their observation period and departed from the clinic site.
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Headache, Pain in extremity
Clinical narrative: That evening my arm was sore, I had a headache the next day, and it never went away. It was mild.  I did not miss work, I thought that it was a simple headache, I had it every day. I took Tylenol and ibuprofen.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Blood sodium normal, C-reactive protein, COVID-19
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 Patient is a 66 y.o. female with history of hypertension, rheumatoid arthritis, unspecified interstitial lung disease not on home oxygen, who presented to the emergency room with complaints of cough, shortness of breath, diarrhea, vaccinated for COVID-19, with known exposure to COVID-19 and tested positive for COVID-19 today.   Acute hypoxic respiratory failure due to COVID-19 viral pneumonia -Symptoms started approximately 5 weeks ago and have progressively worsened.  Patient is fully vaccinated and has had her booster injection on 12/26/2021.  She is immunocompromised as she is on Rituxan for rheumatoid arthritis and her last infusion was in December 2021 -Full barrier precautions -Procalcitonin is 0.09, bacterial infection less likely and hence no indication for antibiotics -Encourage proning and I-S use -As needed antitussives -Oxygen to keep saturation more than 90%, wean as tolerated -Patient uses DuoNebs 3 times daily and she would like to continue that -Follow inflammatory markers, CRP is improving.  Continue Decadron 6 mg IV daily. -Lovenox 1 mg/kg subcu every 12 hours for D-dimer > 1.0 and for right lower extremity calf vein DVT. -Oxygen needs remain the same.  Patient given 1 dose of IV Lasix daily for 2 days, 02/05/2022 and 02/06/2022 -Appreciate pulmonology input -Discussed with patient that her symptoms could take weeks to resolve.  I did tell her there was an option to go home with oxygen and cough medication.  She will think about it.   Mild transaminitis -Likely due to COVID-19 -Follow periodically, improving   Hyponatremia -Likely due to poor oral intake, dehydration -Avoid maintenance IV fluids with COVID-19 infection, bolus fluids if needed -Sodium level has normalized   Hypertension -Hold PTA Cozaar and Norvasc because of borderline blood pressure.  Continue PTA Toprol-XL   Right calf DVT -Likely provoked given her COVID-19 infection and her inactivity because of her illness -No contraindication to anticoagulation -Continue Lovenox 1 mg/kg subcu every 12 hours per thromboprophylaxis protocol. Would probably treat for 3 months for calf vein DVT as she does not have any contraindication to anticoagulation. -Cost of Xarelto is $94 and Eliquis is $47.   Rheumatoid arthritis -Stable -Patient received Rituxan infusion in December 2021   Interstitial lung disease -Patient has interstitial lung disease related to her rheumatoid arthritis -She was not oxygen dependent  prior to admission -She follows with an outpatient pulmonologist -Appreciate pulmonology's input.  At this point would recommend that she follow-up with her outpatient pulmonologist.   Constipation -She is on scheduled MiraLAX -Add scheduled senna -Add as needed milk of magnesia   DVT Prophylaxis: On Lovenox 1 mg/kg subcu every 12 hours for right calf vein DVT and D-dimer > 1.0  Universal COVID-19 Screening:   SARS-CoV-2 RNA by PCR Date Value Ref Range Status 02/01/2022 SARS-CoV-2 RNA Detected (A) SARS-CoV-2 RNA Not Detected Final
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Condition aggravated, Constipation, Cough, Deep vein thrombosis
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 Patient is a 66 y.o. female with history of hypertension, rheumatoid arthritis, unspecified interstitial lung disease not on home oxygen, who presented to the emergency room with complaints of cough, shortness of breath, diarrhea, vaccinated for COVID-19, with known exposure to COVID-19 and tested positive for COVID-19 today.   Acute hypoxic respiratory failure due to COVID-19 viral pneumonia -Symptoms started approximately 5 weeks ago and have progressively worsened.  Patient is fully vaccinated and has had her booster injection on 12/26/2021.  She is immunocompromised as she is on Rituxan for rheumatoid arthritis and her last infusion was in December 2021 -Full barrier precautions -Procalcitonin is 0.09, bacterial infection less likely and hence no indication for antibiotics -Encourage proning and I-S use -As needed antitussives -Oxygen to keep saturation more than 90%, wean as tolerated -Patient uses DuoNebs 3 times daily and she would like to continue that -Follow inflammatory markers, CRP is improving.  Continue Decadron 6 mg IV daily. -Lovenox 1 mg/kg subcu every 12 hours for D-dimer > 1.0 and for right lower extremity calf vein DVT. -Oxygen needs remain the same.  Patient given 1 dose of IV Lasix daily for 2 days, 02/05/2022 and 02/06/2022 -Appreciate pulmonology input -Discussed with patient that her symptoms could take weeks to resolve.  I did tell her there was an option to go home with oxygen and cough medication.  She will think about it.   Mild transaminitis -Likely due to COVID-19 -Follow periodically, improving   Hyponatremia -Likely due to poor oral intake, dehydration -Avoid maintenance IV fluids with COVID-19 infection, bolus fluids if needed -Sodium level has normalized   Hypertension -Hold PTA Cozaar and Norvasc because of borderline blood pressure.  Continue PTA Toprol-XL   Right calf DVT -Likely provoked given her COVID-19 infection and her inactivity because of her illness -No contraindication to anticoagulation -Continue Lovenox 1 mg/kg subcu every 12 hours per thromboprophylaxis protocol. Would probably treat for 3 months for calf vein DVT as she does not have any contraindication to anticoagulation. -Cost of Xarelto is $94 and Eliquis is $47.   Rheumatoid arthritis -Stable -Patient received Rituxan infusion in December 2021   Interstitial lung disease -Patient has interstitial lung disease related to her rheumatoid arthritis -She was not oxygen dependent  prior to admission -She follows with an outpatient pulmonologist -Appreciate pulmonology's input.  At this point would recommend that she follow-up with her outpatient pulmonologist.   Constipation -She is on scheduled MiraLAX -Add scheduled senna -Add as needed milk of magnesia   DVT Prophylaxis: On Lovenox 1 mg/kg subcu every 12 hours for right calf vein DVT and D-dimer > 1.0  Universal COVID-19 Screening:   SARS-CoV-2 RNA by PCR Date Value Ref Range Status 02/01/2022 SARS-CoV-2 RNA Detected (A) SARS-CoV-2 RNA Not Detected Final
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Dehydration, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fibrin D dimer
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 Patient is a 66 y.o. female with history of hypertension, rheumatoid arthritis, unspecified interstitial lung disease not on home oxygen, who presented to the emergency room with complaints of cough, shortness of breath, diarrhea, vaccinated for COVID-19, with known exposure to COVID-19 and tested positive for COVID-19 today.   Acute hypoxic respiratory failure due to COVID-19 viral pneumonia -Symptoms started approximately 5 weeks ago and have progressively worsened.  Patient is fully vaccinated and has had her booster injection on 12/26/2021.  She is immunocompromised as she is on Rituxan for rheumatoid arthritis and her last infusion was in December 2021 -Full barrier precautions -Procalcitonin is 0.09, bacterial infection less likely and hence no indication for antibiotics -Encourage proning and I-S use -As needed antitussives -Oxygen to keep saturation more than 90%, wean as tolerated -Patient uses DuoNebs 3 times daily and she would like to continue that -Follow inflammatory markers, CRP is improving.  Continue Decadron 6 mg IV daily. -Lovenox 1 mg/kg subcu every 12 hours for D-dimer > 1.0 and for right lower extremity calf vein DVT. -Oxygen needs remain the same.  Patient given 1 dose of IV Lasix daily for 2 days, 02/05/2022 and 02/06/2022 -Appreciate pulmonology input -Discussed with patient that her symptoms could take weeks to resolve.  I did tell her there was an option to go home with oxygen and cough medication.  She will think about it.   Mild transaminitis -Likely due to COVID-19 -Follow periodically, improving   Hyponatremia -Likely due to poor oral intake, dehydration -Avoid maintenance IV fluids with COVID-19 infection, bolus fluids if needed -Sodium level has normalized   Hypertension -Hold PTA Cozaar and Norvasc because of borderline blood pressure.  Continue PTA Toprol-XL   Right calf DVT -Likely provoked given her COVID-19 infection and her inactivity because of her illness -No contraindication to anticoagulation -Continue Lovenox 1 mg/kg subcu every 12 hours per thromboprophylaxis protocol. Would probably treat for 3 months for calf vein DVT as she does not have any contraindication to anticoagulation. -Cost of Xarelto is $94 and Eliquis is $47.   Rheumatoid arthritis -Stable -Patient received Rituxan infusion in December 2021   Interstitial lung disease -Patient has interstitial lung disease related to her rheumatoid arthritis -She was not oxygen dependent  prior to admission -She follows with an outpatient pulmonologist -Appreciate pulmonology's input.  At this point would recommend that she follow-up with her outpatient pulmonologist.   Constipation -She is on scheduled MiraLAX -Add scheduled senna -Add as needed milk of magnesia   DVT Prophylaxis: On Lovenox 1 mg/kg subcu every 12 hours for right calf vein DVT and D-dimer > 1.0  Universal COVID-19 Screening:   SARS-CoV-2 RNA by PCR Date Value Ref Range Status 02/01/2022 SARS-CoV-2 RNA Detected (A) SARS-CoV-2 RNA Not Detected Final
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Hypertension, Hyponatraemia, Hypophagia, Inflammatory marker test, Interstitial lung disease
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 Patient is a 66 y.o. female with history of hypertension, rheumatoid arthritis, unspecified interstitial lung disease not on home oxygen, who presented to the emergency room with complaints of cough, shortness of breath, diarrhea, vaccinated for COVID-19, with known exposure to COVID-19 and tested positive for COVID-19 today.   Acute hypoxic respiratory failure due to COVID-19 viral pneumonia -Symptoms started approximately 5 weeks ago and have progressively worsened.  Patient is fully vaccinated and has had her booster injection on 12/26/2021.  She is immunocompromised as she is on Rituxan for rheumatoid arthritis and her last infusion was in December 2021 -Full barrier precautions -Procalcitonin is 0.09, bacterial infection less likely and hence no indication for antibiotics -Encourage proning and I-S use -As needed antitussives -Oxygen to keep saturation more than 90%, wean as tolerated -Patient uses DuoNebs 3 times daily and she would like to continue that -Follow inflammatory markers, CRP is improving.  Continue Decadron 6 mg IV daily. -Lovenox 1 mg/kg subcu every 12 hours for D-dimer > 1.0 and for right lower extremity calf vein DVT. -Oxygen needs remain the same.  Patient given 1 dose of IV Lasix daily for 2 days, 02/05/2022 and 02/06/2022 -Appreciate pulmonology input -Discussed with patient that her symptoms could take weeks to resolve.  I did tell her there was an option to go home with oxygen and cough medication.  She will think about it.   Mild transaminitis -Likely due to COVID-19 -Follow periodically, improving   Hyponatremia -Likely due to poor oral intake, dehydration -Avoid maintenance IV fluids with COVID-19 infection, bolus fluids if needed -Sodium level has normalized   Hypertension -Hold PTA Cozaar and Norvasc because of borderline blood pressure.  Continue PTA Toprol-XL   Right calf DVT -Likely provoked given her COVID-19 infection and her inactivity because of her illness -No contraindication to anticoagulation -Continue Lovenox 1 mg/kg subcu every 12 hours per thromboprophylaxis protocol. Would probably treat for 3 months for calf vein DVT as she does not have any contraindication to anticoagulation. -Cost of Xarelto is $94 and Eliquis is $47.   Rheumatoid arthritis -Stable -Patient received Rituxan infusion in December 2021   Interstitial lung disease -Patient has interstitial lung disease related to her rheumatoid arthritis -She was not oxygen dependent  prior to admission -She follows with an outpatient pulmonologist -Appreciate pulmonology's input.  At this point would recommend that she follow-up with her outpatient pulmonologist.   Constipation -She is on scheduled MiraLAX -Add scheduled senna -Add as needed milk of magnesia   DVT Prophylaxis: On Lovenox 1 mg/kg subcu every 12 hours for right calf vein DVT and D-dimer > 1.0  Universal COVID-19 Screening:   SARS-CoV-2 RNA by PCR Date Value Ref Range Status 02/01/2022 SARS-CoV-2 RNA Detected (A) SARS-CoV-2 RNA Not Detected Final
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Procalcitonin increased, Rheumatoid arthritis, SARS-CoV-2 RNA, SARS-CoV-2 test positive, Transaminases increased
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 Patient is a 66 y.o. female with history of hypertension, rheumatoid arthritis, unspecified interstitial lung disease not on home oxygen, who presented to the emergency room with complaints of cough, shortness of breath, diarrhea, vaccinated for COVID-19, with known exposure to COVID-19 and tested positive for COVID-19 today.   Acute hypoxic respiratory failure due to COVID-19 viral pneumonia -Symptoms started approximately 5 weeks ago and have progressively worsened.  Patient is fully vaccinated and has had her booster injection on 12/26/2021.  She is immunocompromised as she is on Rituxan for rheumatoid arthritis and her last infusion was in December 2021 -Full barrier precautions -Procalcitonin is 0.09, bacterial infection less likely and hence no indication for antibiotics -Encourage proning and I-S use -As needed antitussives -Oxygen to keep saturation more than 90%, wean as tolerated -Patient uses DuoNebs 3 times daily and she would like to continue that -Follow inflammatory markers, CRP is improving.  Continue Decadron 6 mg IV daily. -Lovenox 1 mg/kg subcu every 12 hours for D-dimer > 1.0 and for right lower extremity calf vein DVT. -Oxygen needs remain the same.  Patient given 1 dose of IV Lasix daily for 2 days, 02/05/2022 and 02/06/2022 -Appreciate pulmonology input -Discussed with patient that her symptoms could take weeks to resolve.  I did tell her there was an option to go home with oxygen and cough medication.  She will think about it.   Mild transaminitis -Likely due to COVID-19 -Follow periodically, improving   Hyponatremia -Likely due to poor oral intake, dehydration -Avoid maintenance IV fluids with COVID-19 infection, bolus fluids if needed -Sodium level has normalized   Hypertension -Hold PTA Cozaar and Norvasc because of borderline blood pressure.  Continue PTA Toprol-XL   Right calf DVT -Likely provoked given her COVID-19 infection and her inactivity because of her illness -No contraindication to anticoagulation -Continue Lovenox 1 mg/kg subcu every 12 hours per thromboprophylaxis protocol. Would probably treat for 3 months for calf vein DVT as she does not have any contraindication to anticoagulation. -Cost of Xarelto is $94 and Eliquis is $47.   Rheumatoid arthritis -Stable -Patient received Rituxan infusion in December 2021   Interstitial lung disease -Patient has interstitial lung disease related to her rheumatoid arthritis -She was not oxygen dependent  prior to admission -She follows with an outpatient pulmonologist -Appreciate pulmonology's input.  At this point would recommend that she follow-up with her outpatient pulmonologist.   Constipation -She is on scheduled MiraLAX -Add scheduled senna -Add as needed milk of magnesia   DVT Prophylaxis: On Lovenox 1 mg/kg subcu every 12 hours for right calf vein DVT and D-dimer > 1.0  Universal COVID-19 Screening:   SARS-CoV-2 RNA by PCR Date Value Ref Range Status 02/01/2022 SARS-CoV-2 RNA Detected (A) SARS-CoV-2 RNA Not Detected Final
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Diplopia, Full blood count, Headache, Immediate post-injection reaction, Magnetic resonance imaging
Clinical narrative: Immediately subsequent to the shot, I had bad headache in the back of my head that didn't last more than 2 days. On August 24, I woke up with double vision. Neurologist diagnosed me with multiple sclerosis.
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic function test, Multiple sclerosis, Myasthenia gravis, Neurological examination abnormal
Clinical narrative: Immediately subsequent to the shot, I had bad headache in the back of my head that didn't last more than 2 days. On August 24, I woke up with double vision. Neurologist diagnosed me with multiple sclerosis.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Tested positive for COVID-19, mild achy, mild fever, mild sore throat, some fatigue all x3 days.
Age: 7.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered, Pain in extremity, Product preparation issue
Clinical narrative: The patient received 0.2ml of undiluted pediatric covid vaccine on 2/7/22 at 2:45pm. The mistake was found at 9pm that evening. The patient's mother was contacted 2/8/22 at 11am. She said her son had a sore arm but no other side effects from the vaccination. I explained the mistake and that the patient received a higher dose than was recommended. The patient's pediatrician was called at 3pm and everything explained to him. He said he spoke to the mother earlier, would document the event but was not too worried moving forward.
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Pediatric Pfizer dose: Product was not diluted before administration. No symptoms reported as of the time of this report.
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Fatigue, Heart rate increased, Pyrexia
Clinical narrative: After the vaccination about 7pm I noticed my HR elevating. In addition to that, I was having typical vaccine symptoms. Fatigue, fever. etc. heart elevated to 100 BPM and remained at the level consistently for 48-72 hours. All of the side effects resolved without treatment. Sent an message to doctor for concern, nurse called back and indicated symptoms were not a concern - no in-person visit.
Age: 6.0
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Extra dose administered
Clinical narrative: Patient was in clinic for immunizations.  He was brought in by Aunt who is his legal guardian.  Immunizations had been entered into the system by clerk.  Nurse reviewed the list of vaccines and vaccine forcaster.  The previous dose of MMR had not been entered into the system.  Nurse gave MMR and Varicella vaccines and the DTAP/IPV (Kinrix)  vaccine.  When the nurse entered the information in EHR and printed the Vaccine Certificate the expiration date was for 3/8/2022.  On further review of the child's records, nurse found the documentation of the MMRV that had been given on 2-21-2020.  Patient had received an extra dose today of MMR and Varicella that was not needed.  Patient did not have any adverse reaction at the time of vaccine in clinic.  Incident was reported to RN Supervisor.  Incident reports completed and submitted.
Age: 9.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product preparation issue, Wrong dose
Clinical narrative: Pfizer pediatric vial was not diluted prior to administration. Patient received wrong dose. Mom states there are no side effects as of 5pm 02/08/22.
Age: 12.0
Sex: M
Vaccine: COVID19
Symptoms: Lymphadenopathy
Clinical narrative: IPSILATERAL AXILLARY SWELLING
Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Contraception, Endometrial ablation, Ultrasound scan vagina, Vaginal haemorrhage
Clinical narrative: On 11/08/2021--I started having heavy vaginal bleeding. It stopped on 01/07/2022, and it started right back the very next day, 01/08/2022 The doctor put me on a birth control pill, Sprintec, and utilized it like a dose pack, I started at 5 days, and 4 days, and decreased, etc. That did not help. She also put me on iron pills 324 mg, twice a day. Then she put me on Provera, 10 mg once a day, I took that for 2 weeks and that did not help. Then she put me on Provera 10mg, until I had the surgery.  The heavy bleeding stopped on 01/21/2022, when I had surgery at outpatient surgery. I had a uterine ablation. I would say unknown at this point in time. I have a follow up appointment tomorrow, 02/09/2022.
Age: 0.33
Sex: M
Vaccine: DTAPIPVHIB
Symptoms: Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
Clinical narrative: Extensive leg swelling reported by mom at next visit. Described the (L) thigh as red, swollen in comparison to other leg, hard, and warm to the touch. Symptoms started within hours after the vaccine and lasted for approx 3 days.