chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Allergy test positive, Allergy to arthropod sting, Antinuclear antibody, C1 esterase inhibitor test, Complement factor C3
Clinical narrative: 11/29/2021 booster moderna  12/11/2021  face swelling and rash  in spots around neck, shoulders, face, lower back, abdominal area, arms, hands, feet. I went to emergency area of Hospital, they only told me to keep taking Benadryl which I already had started taking every 6 horas two tablets of 25 mg, I took one pill of prednisone 10mg I had that first day and the last one I had the next day. The rash kept  appearing, itching and randomly went away to appear  around different areas of my body throughout the day. On Monday dec 13, I only had swelling on the eyes and the rash and went to a primary care physician. He gave me Medrol dose pack, Benadryl 50mg to take four times a day and loratadine 10mg to take daily. Because he told me I had dermographs .The rash kept on going. I  contacted an allergist and immunology specialist and had an appointment for January 2022. She  made me take allergy tests for  mosquito, dermatophagoides, fire ant,crab and shrimp, measured IgE. I was only reactive for fire ant 0.9 kU/L. She told me to changed clothes detergents and bed sheets that was safe for allergic people and to take Xyzal tablets daily and to have C3 complement measure it was low, she repeated it but it was low then she made me have C3, C4, C1 INH esterase function, c1 inh esterase function, ch 50, Ana anti dsDNA. Those came back within normal range except for complement C3.  She wanted to hace C2 complement tested but the laboratories I have visited told me they discontinued it. The rash kept going but is is less than at first. It still keeps appearing on face, neck, chest, abdominal area, back, feets and legs spontaneously and goes away in some minutes, some times it does not each, and when it does itch I mostly try to ignore it so it can go away. Sometimes it is just difficult and when. I scratch it the rash of course stays longer to go away so I apply Benadryl cream or hydrocortisone topical cream or ointment whichever I have nearby. Sometimes it has the form of my  scratch marks ?dermographs? or skin writing as the doctor told me it means. The allergist is still trying to figure out what has caused it but both the primary care physician and the allergist think it can be related to the vaccine. I am waiting for the next appointment with the allergist that is on June 16 because she told me that depending on the results she may have to do some other tests and  if she needs C2 she might refer me to a specific laboratory though i do not know if it will be useful because one of the laboratories I visited told me it is a reference lab and they were the ones who told me they discontinued C2 complement tests on around may 2022.
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Complement factor C4, Double stranded DNA antibody, Eye swelling, Immune complex assay, Laboratory test
Clinical narrative: 11/29/2021 booster moderna  12/11/2021  face swelling and rash  in spots around neck, shoulders, face, lower back, abdominal area, arms, hands, feet. I went to emergency area of Hospital, they only told me to keep taking Benadryl which I already had started taking every 6 horas two tablets of 25 mg, I took one pill of prednisone 10mg I had that first day and the last one I had the next day. The rash kept  appearing, itching and randomly went away to appear  around different areas of my body throughout the day. On Monday dec 13, I only had swelling on the eyes and the rash and went to a primary care physician. He gave me Medrol dose pack, Benadryl 50mg to take four times a day and loratadine 10mg to take daily. Because he told me I had dermographs .The rash kept on going. I  contacted an allergist and immunology specialist and had an appointment for January 2022. She  made me take allergy tests for  mosquito, dermatophagoides, fire ant,crab and shrimp, measured IgE. I was only reactive for fire ant 0.9 kU/L. She told me to changed clothes detergents and bed sheets that was safe for allergic people and to take Xyzal tablets daily and to have C3 complement measure it was low, she repeated it but it was low then she made me have C3, C4, C1 INH esterase function, c1 inh esterase function, ch 50, Ana anti dsDNA. Those came back within normal range except for complement C3.  She wanted to hace C2 complement tested but the laboratories I have visited told me they discontinued it. The rash kept going but is is less than at first. It still keeps appearing on face, neck, chest, abdominal area, back, feets and legs spontaneously and goes away in some minutes, some times it does not each, and when it does itch I mostly try to ignore it so it can go away. Sometimes it is just difficult and when. I scratch it the rash of course stays longer to go away so I apply Benadryl cream or hydrocortisone topical cream or ointment whichever I have nearby. Sometimes it has the form of my  scratch marks ?dermographs? or skin writing as the doctor told me it means. The allergist is still trying to figure out what has caused it but both the primary care physician and the allergist think it can be related to the vaccine. I am waiting for the next appointment with the allergist that is on June 16 because she told me that depending on the results she may have to do some other tests and  if she needs C2 she might refer me to a specific laboratory though i do not know if it will be useful because one of the laboratories I visited told me it is a reference lab and they were the ones who told me they discontinued C2 complement tests on around may 2022.
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Mechanical urticaria, Rash, Rash pruritic, Swelling face
Clinical narrative: 11/29/2021 booster moderna  12/11/2021  face swelling and rash  in spots around neck, shoulders, face, lower back, abdominal area, arms, hands, feet. I went to emergency area of Hospital, they only told me to keep taking Benadryl which I already had started taking every 6 horas two tablets of 25 mg, I took one pill of prednisone 10mg I had that first day and the last one I had the next day. The rash kept  appearing, itching and randomly went away to appear  around different areas of my body throughout the day. On Monday dec 13, I only had swelling on the eyes and the rash and went to a primary care physician. He gave me Medrol dose pack, Benadryl 50mg to take four times a day and loratadine 10mg to take daily. Because he told me I had dermographs .The rash kept on going. I  contacted an allergist and immunology specialist and had an appointment for January 2022. She  made me take allergy tests for  mosquito, dermatophagoides, fire ant,crab and shrimp, measured IgE. I was only reactive for fire ant 0.9 kU/L. She told me to changed clothes detergents and bed sheets that was safe for allergic people and to take Xyzal tablets daily and to have C3 complement measure it was low, she repeated it but it was low then she made me have C3, C4, C1 INH esterase function, c1 inh esterase function, ch 50, Ana anti dsDNA. Those came back within normal range except for complement C3.  She wanted to hace C2 complement tested but the laboratories I have visited told me they discontinued it. The rash kept going but is is less than at first. It still keeps appearing on face, neck, chest, abdominal area, back, feets and legs spontaneously and goes away in some minutes, some times it does not each, and when it does itch I mostly try to ignore it so it can go away. Sometimes it is just difficult and when. I scratch it the rash of course stays longer to go away so I apply Benadryl cream or hydrocortisone topical cream or ointment whichever I have nearby. Sometimes it has the form of my  scratch marks ?dermographs? or skin writing as the doctor told me it means. The allergist is still trying to figure out what has caused it but both the primary care physician and the allergist think it can be related to the vaccine. I am waiting for the next appointment with the allergist that is on June 16 because she told me that depending on the results she may have to do some other tests and  if she needs C2 she might refer me to a specific laboratory though i do not know if it will be useful because one of the laboratories I visited told me it is a reference lab and they were the ones who told me they discontinued C2 complement tests on around may 2022.
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain upper, Arthralgia, Chills, Dizziness, Feeling hot
Clinical narrative: Started with headache then general body aches which was mostly manageable, then chills and dizziness. I took 3 ibuprofen. I took a hot bath for.about 30 minutes and most of the issues subsided for about 2 hours then returned (all that I described above) but more intensely, the chills became shakes even with wearing a large hoodie and large sweatpants. Also joint paint started. Taking a 2nd bath now and somewhat subsiding again but still have aches including a stomach ache now, joint paint, and feel very hot.
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Headache, Pain, Tremor
Clinical narrative: Started with headache then general body aches which was mostly manageable, then chills and dizziness. I took 3 ibuprofen. I took a hot bath for.about 30 minutes and most of the issues subsided for about 2 hours then returned (all that I described above) but more intensely, the chills became shakes even with wearing a large hoodie and large sweatpants. Also joint paint started. Taking a 2nd bath now and somewhat subsiding again but still have aches including a stomach ache now, joint paint, and feel very hot.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Oedema peripheral, Peripheral swelling
Clinical narrative: Significant swelling and tenderness  of underarm and surrounding area of arm that received injection.
Sex: F
Vaccine: VARZOS
Symptoms: Chills, Fatigue, Pollakiuria, Thirst
Clinical narrative: Shivering; Fatigue; Frequent urination; thirst the night of June 1st; This case was reported by a consumer via call center representative and described the occurrence of shivering in a female patient who received Herpes zoster (Shingrix) for prophylaxis.   On 1st June 2022, the patient received the 1st dose of Shingrix. On 1st June 2022, less than a day after receiving Shingrix, the patient experienced shivering, fatigue, urinary frequency and thirst. On an unknown date, the outcome of the shivering and fatigue were recovered/resolved and the outcome of the urinary frequency and thirst were not recovered/not resolved.   It was unknown if the reporter considered the shivering, fatigue, urinary frequency and thirst to be related to Shingrix.     Additional Information: GSK receipt date: 02-June-2022 Reporter's comment: The patient-self reported this case. The patient received a dose of Shingrix and experienced shivering, fatigue, frequent urination and thirst in the night of the vaccination day. In June 2022, the shivering and fatigue was resolved. The patient reported that she continued to experience frequent urination and thirst. The reporter did not consent to follow-up.
Sex: U
Vaccine: COVID19
Symptoms: Accidental underdose
Clinical narrative: received a 0.25ml dose as a first dose by mistake; This spontaneous case was reported by a pharmacist and describes the occurrence of ACCIDENTAL UNDERDOSE (received a 0.25ml dose as a first dose by mistake) in a  patient of an unknown age and gender who received mRNA-1273 (Spikevax) (batch no. 049l21a) for COVID-19 vaccination.     No Medical History information was reported.    On 01-Jun-2022, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) .25 milliliter. On 01-Jun-2022, the patient experienced ACCIDENTAL UNDERDOSE (received a 0.25ml dose as a first dose by mistake). At the time of the report, ACCIDENTAL UNDERDOSE (received a 0.25ml dose as a first dose by mistake) outcome was unknown.        For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments.   Concomitant drugs were not reported. Treatment medications were not provided.  A patient instead of receiving a full dose of the Moderna COVID19 vaccine received a 0.25ml dose as a first dose.
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered, Product storage error
Clinical narrative: Vaccine was expired on 04-Apr-2022 then stored in refrigerator on same date of administration; Vaccine was expired on 04-Apr-2022 and administered on 16-Apr-2022; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Vaccine was expired on 04-Apr-2022 and administered on 16-Apr-2022) and PRODUCT STORAGE ERROR (Vaccine was expired on 04-Apr-2022 then stored in refrigerator on same date of administration) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 066H21A) for COVID-19 vaccination.     No Medical History information was reported.    On 16-Apr-2022, the patient received fourth dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Apr-2022, the patient experienced EXPIRED PRODUCT ADMINISTERED (Vaccine was expired on 04-Apr-2022 and administered on 16-Apr-2022). On an unknown date, the patient experienced PRODUCT STORAGE ERROR (Vaccine was expired on 04-Apr-2022 then stored in refrigerator on same date of administration). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Vaccine was expired on 04-Apr-2022 and administered on 16-Apr-2022) and PRODUCT STORAGE ERROR (Vaccine was expired on 04-Apr-2022 then stored in refrigerator on same date of administration) outcome was unknown. Not provided.      For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   The patient weight had been reported as 232. No concomitant medications were reported. The HCP (health care professional) stated that they had administered an expired doses of the Moderna COVID-19 Vaccine to 27 patients. The date of the vial that was initially stored in the refrigerator was the same day when the vials were thawed. The vial had not undergone any temperature excursions. The patient had no known reactions at office. No treatment information was provided.
Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Back pain, C-reactive protein increased, Loss of personal independence in daily activities, Myalgia
Clinical narrative: After the second vaccination the left arm started aching. It progressively got worse and started traveling up and around to his other shoulder and arm also into his lower back and back calf muscles. He has received multi x-rays  and tests for auto immune diseases. A rheumatologist has told him he has osteoarthritis. His CRP level is elavated to a level of 3.3 even with treatments of steroids the pain.  Meloxicam has been prescribed to help with the pain . Nothing has helped and pain is still getting progressively worse and now affecting his daily life including job/household duties. He can not put his own socks and shoes on in the morning because of the loss of flexibility in his muscles and believes it all started after the second dose of the vaccine.
Age: 42.0
Sex: M
Vaccine: COVID19
Symptoms: Osteoarthritis, Pain in extremity, X-ray
Clinical narrative: After the second vaccination the left arm started aching. It progressively got worse and started traveling up and around to his other shoulder and arm also into his lower back and back calf muscles. He has received multi x-rays  and tests for auto immune diseases. A rheumatologist has told him he has osteoarthritis. His CRP level is elavated to a level of 3.3 even with treatments of steroids the pain.  Meloxicam has been prescribed to help with the pain . Nothing has helped and pain is still getting progressively worse and now affecting his daily life including job/household duties. He can not put his own socks and shoes on in the morning because of the loss of flexibility in his muscles and believes it all started after the second dose of the vaccine.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Atelectasis, Blood creatine phosphokinase increased, Blood gases
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest tube insertion
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Computerised tomogram thorax abnormal, Condition aggravated, Delirium tremens, Dyspnoea, Fall
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Hypertension, Hypertransaminasaemia, Intensive care, Lung infiltration, Lung opacity
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Musculoskeletal chest pain, Pneumothorax, Respiratory tract congestion, Rhabdomyolysis, Rib fracture
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis, Thoracic cavity drainage, Traumatic haemothorax, Tremor
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: White blood cell count increased
Clinical narrative: 1/30/2022- Presented to ER, report of a fall 2 days ago-right rib pain, congestion and SOB. T-pp, HR 111, RR-30 and 02 96% on RA. Covid+, WBC-22.7, CRP-2.8. ALT-114, AST-269 and CK-4,822. Transaminitis. CT Thorax- pneumothorax and Moderate compressive atelectasis right lower lobe and acute fractures right thirs-10th ribs. Chest tube placed, small amount of blood accompanied a rush of air. Admit fall with hemopneumothorax and sepsis secondary to Covid pneumonia. Started cefepime, vancomycin, solumedrol, heparin and remedesvir.  1/31/2022- Added Bicarb for traumatic Rhabdo and Valium d/t presenting with tremors and DT symptoms.  On 4L via NC sat 96%. Afebrile. BP-161/99.  2/3/2022- Chest xray-persistent bibasilar opacities similar to original study. AST-71, ALT-59  and CK-254 are trending down.  Reports dyspnea. BP-88/54. Levophed started. ABG-7.501/35.0/258/4.3  02 sat 92%.  NRBM placed, 15L. upgrade in care to ICU. Clonidine started for hypertension. Dislodged chest tube overnight, replaced drained 700cc of blood from thorax. Chest ct- Large hemothorax, compressed  right lung with collapsed right middle lobe. Small Right pneumothorax noted. O2 titrated down to 5L via NC. 2/4/2022- Levophed titrated off. BP 114/60 and o2 stable on 4L NC. Rhabdo resolved CK now 48.  Chest x ray-improved right hydropneumothorax and right pulmonary infiltrate.  2/7/2022-Increase of WBC-17.6. Afebrile. Cultures Pending.  Chest x ray- new small apical pneumothorax. Bibasilar pulmonary infiltrates. Chest tube drainage minimal.  96% o2 sat on RA. 2/8/2022- Chest tube removed. 2/10/22-BP-120/75. Afebrile. Maintaining 02 on RA. WBC trendig downward 15.0.  AST-46 and ALT-40.  Covid  improved. Continue IV Rocephin   ABG- 7.501/35.0/258/4.3 o2 sat 92. Chest x ray- No significant change. D/C to home.
Age: 46.0
Sex: F
Vaccine: COVID19
Symptoms: Adverse reaction
Clinical narrative: , Additional Details: Adverese events did not appear at time of injection. Patient reports they began hours after injection
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID vaccine breakthrough case.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Autoimmune disorder, Chest discomfort, Condition aggravated, Dyspnoea
Clinical narrative: , Additional Details: Pt to prescribed dose of valium for autoimmune flare and nitroglycerin due to chest tightness/shortness of breath
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: covid vaccine breakthrough
Age: 30.0
Sex: F
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: , Additional Details: instructed patient to continue taking ibuprofen and to follow up with primary care doctor
Age: 27.0
Sex: M
Vaccine: COVID19
Symptoms: Nervousness, Syncope
Clinical narrative: , Additional Details: patient fainted for 1 minute or so and then came back. He said he was ok but nervous. I ask if he wanted me to call ems he said no but we went ahead and called ems anyway. They checked him out he was ok and came inside store to thank and said he was ok now.
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: Severe Hives on arms and legs. Continuing to present.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Pfizer 3/1/21, 3/22/21, 12/14/21. Postitive on 6/2/22
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Moderna 3/1/21, 3/29/21, 10/25/21. Positive on 6/4/22
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: patient received an exp Modera vaccine
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Mobility decreased, Neck pain, Pain
Clinical narrative: The same night of vaccine Pt had severe neck pain. Could not move due to pain, went to Doctor and was advised to see Physical Therapy. Chronic pain. Had 3 months of neck pain before seeing a doctor.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received any exp dose of vaccine
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received an exp dose of moderna vaccine
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic spontaneous urticaria, Inflammation, Lethargy, Pruritus
Clinical narrative: Spontaneous urticaria started to present in scalp on 05/13/2022, itching all over subsequently, lethargic for 48 hours. Then saw a provider and received prednisone for 7 days 60mg orally daily. That held the itching down and then reoccurred after dosage. Cetrizine 10mg orally twice daily is now required to keep the inflammation down. Flares are upon waking and around 3pm if untreated.
Age: 23.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt recieved an exp dose of covid vaccine
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: Patient developed hives 5 days after receiving vaccination
Age: 6.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Patient was administered and undiluted dose of the Pfizer 5-11 COVID vaccine.
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received an exp dose of covid vaccine
Age: 10.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Patient was administered an undiluted dose of the COVID 5-11 Pfizer vaccine.
Age: 0.17
Sex: M
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV1
Symptoms: Crying, Mobility decreased, Pallor
Clinical narrative: Quickly after the vaccines were given (nurse giving shots was still in the room) pt had an episode of pallor. He cried right away and had no trouble taking the RV orally. He was alert, no distress or difficulty breathing, no hives or redness. He was moving extremities but not as vigorous or active as usual. I was called into the room and examined him within minutes after this happened. Exam was normal except he was pale, not cyanotic. No rash, no hives. No swelling of lips or any part of body- did not seem to be irritable or in pain. He was alert but not as vigorous. Good tone, not lethargic, but still. He took a bottle well at that point. Lungs, heart and abd exam all normal. PERLA, neuro exam as above. This lasted less than a total of 10 minutes and he slwoly regained his pink color. We waited for a total of 45 minutes in the office after this happened. Once mom got home he was continuing to look and behave normally  (although not quite normal color per mom until shortly after they got home)
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received an exp covid vaccine
Age: 8.0
Sex: F
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Patient was administered an undiluted dose of the Pfizer COVID 5-11yr vaccine.
Age: 46.0
Sex: F
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: Minimal sx.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received an exp covid vaccine
Age: 10.0
Sex: M
Vaccine: COVID19
Symptoms: Product preparation issue
Clinical narrative: Patient was administered an undiluted dose of the COVID 5-11 Pfizer vaccine.
Age: 53.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Death, Inappropriate schedule of product administration, SARS-CoV-2 test positive
Clinical narrative: death of a fully vaccinated COVID positive pt.
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received exp covid vaccine
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 80.0
Sex: F
Vaccine: VARZOS
Symptoms: Diarrhoea, Dizziness, Ear discomfort, Feeling abnormal, Flatulence
Clinical narrative: Patient woke up in the middle of the night after receiving the Shingrix shot feeling awful: body aches, nauseated, dizzy. Her arm hurts terribly. These symptoms continue through today which is day 4. She also developed a deep red rash at the injection site as well as excess gas and loose stools and her ears feel full. The red rash on her arm began to itch on day 4. She is not feeling better as of yet: the body aches, nausea, light headedness, arm pain, gas and loose stools, ears full...all continue. Reporting because mom asked me to. These side effects are only supposed to last 2-3 days.
Age: 80.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Nausea, Pain
Clinical narrative: Patient woke up in the middle of the night after receiving the Shingrix shot feeling awful: body aches, nauseated, dizzy. Her arm hurts terribly. These symptoms continue through today which is day 4. She also developed a deep red rash at the injection site as well as excess gas and loose stools and her ears feel full. The red rash on her arm began to itch on day 4. She is not feeling better as of yet: the body aches, nausea, light headedness, arm pain, gas and loose stools, ears full...all continue. Reporting because mom asked me to. These side effects are only supposed to last 2-3 days.
Age: 80.0
Sex: F
Vaccine: VARZOS
Symptoms: Pain in extremity, Rash erythematous, Rash pruritic, Sleep disorder
Clinical narrative: Patient woke up in the middle of the night after receiving the Shingrix shot feeling awful: body aches, nauseated, dizzy. Her arm hurts terribly. These symptoms continue through today which is day 4. She also developed a deep red rash at the injection site as well as excess gas and loose stools and her ears feel full. The red rash on her arm began to itch on day 4. She is not feeling better as of yet: the body aches, nausea, light headedness, arm pain, gas and loose stools, ears full...all continue. Reporting because mom asked me to. These side effects are only supposed to last 2-3 days.
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test normal, Endometrial thickening, Heavy menstrual bleeding, Postmenopausal haemorrhage, Ultrasound uterus abnormal
Clinical narrative: Prior to receiving my first dose of Moderna I was considered post menopausal and had not had a period in months. But a few weeks after my first Covid vaccine, I began to notice some irregular spotting and bleeding. I didn't put anything together until recently that it may be associated with my Covid vaccine. But it seems that after each vaccine, I've now had my fourth, the bleeding gets heavier. I had an ultrasound done, where they found a greater than 7 millimeter thickening of the uterine lining and have a uterine biopsy planned for the near future.
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received an exp vaccine
Age: 93.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Asthenia, COVID-19, Pain
Clinical narrative: Patient presented to the ED with weakness and generalized pain.  Was subsequently found to have COVID.  Patient discharged on 5/24/22
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 71.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Cough, Dyspnoea, Exposure to SARS-CoV-2, Oropharyngeal pain
Clinical narrative: 72 year old gentleman who presented to the emergency room with shortness of breath, cough and fever which started 6/3/22 (1 day prior to admission); he also had a sore throat; his wife had similar symptoms and was admitted with covid earlier on 6/4/22; he denies chest pain; he went to urgent care where he tested positive for covid and ems was called he has had swelling of his legs; he is not on home oxygen  Patient admitted to hospital. Is currently receiving remdesivir 200 mg IV x1 dose followed 24 hours later by 100 mg IV q24h x4 days
Age: 71.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Peripheral swelling, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: 72 year old gentleman who presented to the emergency room with shortness of breath, cough and fever which started 6/3/22 (1 day prior to admission); he also had a sore throat; his wife had similar symptoms and was admitted with covid earlier on 6/4/22; he denies chest pain; he went to urgent care where he tested positive for covid and ems was called he has had swelling of his legs; he is not on home oxygen  Patient admitted to hospital. Is currently receiving remdesivir 200 mg IV x1 dose followed 24 hours later by 100 mg IV q24h x4 days
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Fall, Fatigue, Hypophagia
Clinical narrative: Progressive fatigue with fall, decreased oral intake, AKI  supportive treatment, fluids, not COVID directed.
Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Condition aggravated, Hyponatraemia, SARS-CoV-2 test positive
Clinical narrative: Hyponatremia causing admission, found to be COVID positive.
Age: 88.0
Sex: F
Vaccine: COVID19
Symptoms: Erythema, Injection site discolouration, Injection site swelling, Pain, Swelling
Clinical narrative: She got her vaccine, she got it in her left hip.  She got it in her hip as she has no lymph nodes due to breast cancer and was told that she cannot have any withdrawals or injection in her arm due to that.   She felt swelling and pain in the middle of the night.  When she was able to see it it was pinky red and swollen.  As the day went on it got a little bit larger.  Now if she puts her hand in that area it is the size of her hand, and now it looks like it is going to turn color.    Her other vaccines were given in the left hip as well.  She did have the same type of reaction with the other vaccines, and it takes about a week for the color to clear.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Vaccine breakthrough infection
Clinical narrative: Inpatient hospitalization/Breakthrough Covid
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram cerebral, Computerised tomogram neck, Immediate post-injection reaction, Impaired work ability, Lumbar puncture
Clinical narrative: Immediately following my second dose I had a migraine that lasted for weeks.  The migraines continued throughout all of last year and currently remain uncontrollable causing loss of work and loss of quality of life
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging head, Magnetic resonance imaging neck, Magnetic resonance imaging spinal, Migraine, Quality of life decreased
Clinical narrative: Immediately following my second dose I had a migraine that lasted for weeks.  The migraines continued throughout all of last year and currently remain uncontrollable causing loss of work and loss of quality of life
Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: none
Age: 28.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: pt received an exp covid vaccine
Age: 47.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Fatigue, Hyperhidrosis, Hypersomnia
Clinical narrative: Breakthrough case of Covid 05/21/2022 positive test date. Sx began 05/20/2022, I started to get really tired, it felt like I had a cold or allergies. I progressively got more and more tired, I slept for 12 hours and woke up on 05/21/2022 tired still. That afternoon after a nap I took a home test that was positive. That afternoon I spoke to the nurse from my insurance company and was prescribed PAXLOVID which I started on 05/22/2022. Sx were mainly tiredness, cough, possible fever in the nights but I was not able to document it. I never documented a fever, but I woke up sweating, but every time I took my temp it was fine. I still have a cough that is still hanging around, but it was a very mild case, it was not super bad.
Age: 47.0
Sex: M
Vaccine: COVID19
Symptoms: Nasopharyngitis, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case of Covid 05/21/2022 positive test date. Sx began 05/20/2022, I started to get really tired, it felt like I had a cold or allergies. I progressively got more and more tired, I slept for 12 hours and woke up on 05/21/2022 tired still. That afternoon after a nap I took a home test that was positive. That afternoon I spoke to the nurse from my insurance company and was prescribed PAXLOVID which I started on 05/22/2022. Sx were mainly tiredness, cough, possible fever in the nights but I was not able to document it. I never documented a fever, but I woke up sweating, but every time I took my temp it was fine. I still have a cough that is still hanging around, but it was a very mild case, it was not super bad.
Age: 29.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19
Clinical narrative: Patient developed COVID after being vaccinated prior.
Age: 34.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 24.0
Sex: M
Vaccine: COVID19
Symptoms: Axillary pain, Chest discomfort, Lymph node pain
Clinical narrative: 1-2 days later, he started having soreness around lymph node in the armpit of left arm. He also had discomfort in the left chest. No pulpitation noticed.  The symptoms lasted for 1 week. He did not need to seek any medical treatment.  He did not take any medications.
Age: 29.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Product storage error
Clinical narrative: No adverse reaction.  Vaccine temperature excursion.  Vaccine was kept at a frozen temperature, not refrigerated temperature upon receipt of shipment.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Patient has been vaccinated for COVID prior and had positive test on 6/4/22.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cough, Lung infiltration
Clinical narrative: Discharge Provider:  Primary Care Provider: MD Admission Date: 5/29/2022 Discharge Date: 6/3/22  PRESENTING PROBLEM: Cough Acute respiratory failure with hypoxia COVID-19   Brief history and medical decision making: s/p lung tranpslant, covid-19 pneumonia, admitted with hypoxemic respiratory failure with bilateral lung infiltrates possibly due to aspiration pneumonia vs. Post covid inflammatory pneumonia. Improving with steroids and antibiotics. Complete course as described below. Will have a telemedicine review to ensure symptoms are improving next week. Follow up in clinic in 2-3 weeks with CXR, PFT, oxygen titration study. Can likely increase MMF to previous goal dose next week if clinically stable and steroids are back to baseline. Needs work up pancreatic lesion and aspiration concerns.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Pancreatic disorder
Clinical narrative: Discharge Provider:  Primary Care Provider: MD Admission Date: 5/29/2022 Discharge Date: 6/3/22  PRESENTING PROBLEM: Cough Acute respiratory failure with hypoxia COVID-19   Brief history and medical decision making: s/p lung tranpslant, covid-19 pneumonia, admitted with hypoxemic respiratory failure with bilateral lung infiltrates possibly due to aspiration pneumonia vs. Post covid inflammatory pneumonia. Improving with steroids and antibiotics. Complete course as described below. Will have a telemedicine review to ensure symptoms are improving next week. Follow up in clinic in 2-3 weeks with CXR, PFT, oxygen titration study. Can likely increase MMF to previous goal dose next week if clinically stable and steroids are back to baseline. Needs work up pancreatic lesion and aspiration concerns.