chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Malaise, NIH stroke scale, Oropharyngeal pain, Pneumonia aspiration, Procalcitonin
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Rhinorrhoea, SARS-CoV-2 test positive, Serum ferritin, Somnolence, Spinal nerve stimulator implantation
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Transient ischaemic attack
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Angiogram, Arteriosclerosis, Arteriosclerosis coronary artery, Asthenia, Atelectasis
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood glucose, Blood pressure measurement, C-reactive protein, COVID-19, Cardiomegaly
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Cerebellar infarction, Cerebral small vessel ischaemic disease, Cerebrovascular accident, Chest scan, Computerised tomogram head
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Computerised tomogram neck, Condition aggravated, Cough, Dysarthria, Echocardiogram
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Embolic stroke, Emphysema, Endotracheal intubation, Facial paralysis, Fibrin D dimer
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Glomerular filtration rate, Hemiplegia, Hypercoagulation, Hypoperfusion, Hypoventilation
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Intensive care, Ischaemic stroke, Lacunar infarction, Lymphocyte count, Malaise
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Movement disorder, Mucosal hypertrophy, NIH stroke scale, Neurological examination, Oropharyngeal pain
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Oxygen saturation, Pneumonia aspiration, Procalcitonin, Pyrexia, Rhinorrhoea
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Rib fracture, SARS-CoV-2 test, Scan with contrast, Serum ferritin, Sinus congestion
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Somnolence, Spinal nerve stimulator implantation, Spinal osteoarthritis, Transient ischaemic attack, Unresponsive to stimuli
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Vaccination failure, White matter lesion
Clinical narrative: Hospitalization (9.10.21);  COVID-19 positive (9.9.21);  fully vaccinated  Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ;  TIA HPI:  Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria.  Note from 9.16.21:  ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable  CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal.            -continue statin           -PT/OT/SLP consulted; recommend SAR and dysphagia diet           -normal BP goal           -discharge planned to subacute rehab   COVID-19 Assessment & Plan Improving.  Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07  -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Breast discomfort, Breast pain, Formication, Mammogram normal
Clinical narrative: 05/31/2021 My left breast became extremely sore, that lasted for 2-3 weeks. Then right breast felt strange but not hurting. Not all the time, but like something is crawly inside and half way down the right arm. This is still ongoing.
Age: 72.0
Sex: F
Vaccine: PPV
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Skin warm
Clinical narrative: patient claims that by next day arm was swollen sore red and now as of 3 days later is warm to touch and more swollen and getting worse as days pass from the vaccine. We have not seen the localized reaction it was reported over the phone. Patient advised to seek medical attention and has not to this point. she also received fluzone hd in same arm on the same day
Age: 1.08
Sex: M
Vaccine: MMR
Symptoms: Dyspnoea, Pain in extremity, Rash
Clinical narrative: Pt was given both vaccines in same location, then a few hours later had trouble breathing, rash from head to toe, soreness of thigh and "bumpy" thigh. Pt was brought to Hospital ER by parent and is doing well now.
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Tinnitus
Clinical narrative: Tinnitus.  Loud ringing in ears that has not gone away.
Age: 22.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Blood test, Chest pain, Dyspnoea, Echocardiogram
Clinical narrative: Sinus Tachycardia, Shortness of Breath, Anxiety, Chest Pain, Tremors, Numbness, Fever, General Pain
Age: 22.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram, Hypoaesthesia, Pain, Pyrexia, Sinus tachycardia
Clinical narrative: Sinus Tachycardia, Shortness of Breath, Anxiety, Chest Pain, Tremors, Numbness, Fever, General Pain
Age: 22.0
Sex: F
Vaccine: COVID19
Symptoms: Tremor, Urine analysis
Clinical narrative: Sinus Tachycardia, Shortness of Breath, Anxiety, Chest Pain, Tremors, Numbness, Fever, General Pain