chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 82.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Hypoxia, Malaise, Oedema, Pneumonia, Polyuria
Clinical narrative: Discharge Provider: DO Primary Care Physician at Discharge: MD   Admission Date: 11/18/2022 COVID positive Date 11/18/2022 Date of Death: 11/23/22 Time of Death: 11:21 AM PRESENTING PROBLEM: Acute respiratory failure with hypoxia  [J96.01] Multifocal pneumonia [J18.9] Acute on chronic congestive heart failure, unspecified heart failure type [I50.9]   HOSPITAL COURSE: Patient is an 82 y/o male with CAD, chronic systolic and diastolic CHF and stage IV CKD who presented with syncope.  It was unclear on presentation whether this was due to cardiac vs. neurologic cause. Work-up revealed bilateral CVAs as well as acute CHF with elevated troponin. He was noted to be COVID positive, but family reported that he had symptoms and positive test 2 weeks prior.  Neurology and cardiology were consulted, echo was ordered, lasix was started. Echo showed new EF reduction. Neurology started apixaban and stopped ASA as well as plavix. He was started on IV Lasix, and doses were increased due to poor response. With increasing dose of Lasix, he continued to have low urine output and developed acute kidney injury with hyperphosphatemia, increased edema and hypoxia.  By 11/22, he was essentially anuric. Nephro was consulted and felt dialysis could be considered should his renal function continue to worsen and volume status not improve with diuresis.  This was discussed with patient and family, and patient was clear that he did not wish to proceed with dialysis.  He underwent right heart cath on 11/22, which showed elevated PCWP and borderline low cardiac index, for which continued diuresis/fluid removal was recommended.  He had continued worsening of his respiratory status in the early morning of 11/23, requiring high flow nasal cannula.  After further discussions with family, decision was made to proceed with comfort care.  Hospice was consulted, and comfort measures were instituted with prn Ativan and Fentanyl drip.  He expired on 11/23/22 at 11:21 AM.
Age: 82.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Pulmonary arterial wedge pressure increased, Respiratory disorder, SARS-CoV-2 test positive, Syncope, Troponin increased
Clinical narrative: Discharge Provider: DO Primary Care Physician at Discharge: MD   Admission Date: 11/18/2022 COVID positive Date 11/18/2022 Date of Death: 11/23/22 Time of Death: 11:21 AM PRESENTING PROBLEM: Acute respiratory failure with hypoxia  [J96.01] Multifocal pneumonia [J18.9] Acute on chronic congestive heart failure, unspecified heart failure type [I50.9]   HOSPITAL COURSE: Patient is an 82 y/o male with CAD, chronic systolic and diastolic CHF and stage IV CKD who presented with syncope.  It was unclear on presentation whether this was due to cardiac vs. neurologic cause. Work-up revealed bilateral CVAs as well as acute CHF with elevated troponin. He was noted to be COVID positive, but family reported that he had symptoms and positive test 2 weeks prior.  Neurology and cardiology were consulted, echo was ordered, lasix was started. Echo showed new EF reduction. Neurology started apixaban and stopped ASA as well as plavix. He was started on IV Lasix, and doses were increased due to poor response. With increasing dose of Lasix, he continued to have low urine output and developed acute kidney injury with hyperphosphatemia, increased edema and hypoxia.  By 11/22, he was essentially anuric. Nephro was consulted and felt dialysis could be considered should his renal function continue to worsen and volume status not improve with diuresis.  This was discussed with patient and family, and patient was clear that he did not wish to proceed with dialysis.  He underwent right heart cath on 11/22, which showed elevated PCWP and borderline low cardiac index, for which continued diuresis/fluid removal was recommended.  He had continued worsening of his respiratory status in the early morning of 11/23, requiring high flow nasal cannula.  After further discussions with family, decision was made to proceed with comfort care.  Hospice was consulted, and comfort measures were instituted with prn Ativan and Fentanyl drip.  He expired on 11/23/22 at 11:21 AM.
Age: 82.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Urine output decreased
Clinical narrative: Discharge Provider: DO Primary Care Physician at Discharge: MD   Admission Date: 11/18/2022 COVID positive Date 11/18/2022 Date of Death: 11/23/22 Time of Death: 11:21 AM PRESENTING PROBLEM: Acute respiratory failure with hypoxia  [J96.01] Multifocal pneumonia [J18.9] Acute on chronic congestive heart failure, unspecified heart failure type [I50.9]   HOSPITAL COURSE: Patient is an 82 y/o male with CAD, chronic systolic and diastolic CHF and stage IV CKD who presented with syncope.  It was unclear on presentation whether this was due to cardiac vs. neurologic cause. Work-up revealed bilateral CVAs as well as acute CHF with elevated troponin. He was noted to be COVID positive, but family reported that he had symptoms and positive test 2 weeks prior.  Neurology and cardiology were consulted, echo was ordered, lasix was started. Echo showed new EF reduction. Neurology started apixaban and stopped ASA as well as plavix. He was started on IV Lasix, and doses were increased due to poor response. With increasing dose of Lasix, he continued to have low urine output and developed acute kidney injury with hyperphosphatemia, increased edema and hypoxia.  By 11/22, he was essentially anuric. Nephro was consulted and felt dialysis could be considered should his renal function continue to worsen and volume status not improve with diuresis.  This was discussed with patient and family, and patient was clear that he did not wish to proceed with dialysis.  He underwent right heart cath on 11/22, which showed elevated PCWP and borderline low cardiac index, for which continued diuresis/fluid removal was recommended.  He had continued worsening of his respiratory status in the early morning of 11/23, requiring high flow nasal cannula.  After further discussions with family, decision was made to proceed with comfort care.  Hospice was consulted, and comfort measures were instituted with prn Ativan and Fentanyl drip.  He expired on 11/23/22 at 11:21 AM.
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with 3 boosters
Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Fatigue, Thinking abnormal, Visual impairment
Clinical narrative: tired and weak for a long time and can't think good. I can't go out. I can't look at the cars when I go out. It messed up my brain. With my psych meds. They are crazy in the zoo and got me sick for a long time. I wish I never go the shot.
Sex: F
Vaccine: COVID19-2
Symptoms: Concussion, Dizziness, Dyspnoea, Fall, Head injury
Clinical narrative: Fainted approx. 20 hours after receiving dual vaccines of Bivalent booster and flu shot.  Prior to fainting felt dizzy, and lightheaded.  Fell straight back and hit head on the floor.  Remained "unconscious for about 5-7 seconds gasping for air.  Took about 1 hour for them to not feel dizzy/nauseous etc.
Sex: F
Vaccine: COVID19-2
Symptoms: Loss of consciousness, Nausea, Syncope
Clinical narrative: Fainted approx. 20 hours after receiving dual vaccines of Bivalent booster and flu shot.  Prior to fainting felt dizzy, and lightheaded.  Fell straight back and hit head on the floor.  Remained "unconscious for about 5-7 seconds gasping for air.  Took about 1 hour for them to not feel dizzy/nauseous etc.
Age: 83.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with 3 boosters
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac murmur, Tinnitus, Vaccine positive rechallenge
Clinical narrative: Ringing. Constant stream of a high pitched, constant noise. It's been almost 6 months and no reduction of noise. Had an audiology visit. No lose of hearing detected. I must mention that I've had the same reaction to my first vaccine. That noise didn't stop for 6 months. I must also mention that after my booster this last July, together with the noise I heard music. That persisted for 2 months. It was almost constant. I have also reported this to my primary doctor. A great murmur was also detected post vaccination. New.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with 2 boosters
Age: 58.0
Sex: F
Vaccine: COVID19, FLUC4
Symptoms: Cardiac arrest, Death
Clinical narrative: SUDDEN CARDIAC ARREST THEN DEATH
Age: 34.0
Sex: F
Vaccine: COVID19-2
Symptoms: Inappropriate schedule of product administration
Clinical narrative: The patient presented to the clinic for her scheduled apt, per the apt note, booster, Bivalent if available. After confirming the patient's Name and DOB, and verifying that the patient was here to receive the booster, the administration of the booster was completed.   When filling out the patient's card for COVID injections, a date read of 10/4/22. When asking the patient about getting the booster before, the patient states that she doesn't remember getting the booster that day. Per the patient's chart, it is dated that she received this injection on 10/04/22. The injection on 11/29/22 was also charted. The patient was notified of this and of the CDC's recommendation per Moderna to not get any more booster injections. The patient again stated that she doesn't remember getting the vaccine on 10.4.22 The patient then states that she appreciated being called.  The patient was advised to call the clinic with any concerns. At the time of the call, there were no concerns voiced.
Age: 44.0
Sex: F
Vaccine: FLUC4
Symptoms: Blood test, Chest X-ray, Dyspnoea, Eye swelling, Lung disorder
Clinical narrative: 30 minutes after shot I started to experience shortness of breathe, lungs closed up, hives, swollen eye (lots of tears) and non stop sneezing.
Age: 44.0
Sex: F
Vaccine: FLUC4
Symptoms: Sneezing, Tearfulness, Urticaria
Clinical narrative: 30 minutes after shot I started to experience shortness of breathe, lungs closed up, hives, swollen eye (lots of tears) and non stop sneezing.
Age: 8.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient received Pfizer TS 5-11 Monovalent   NDC 59267-1055-04 on 11/29/2022 instead of the Pfizer Bivalent Booster   ( 5-11) 59267-0565-02. Mom was made of the incident immediately and pediatrician office was contacted .
Age: 1.58
Sex: F
Vaccine: DTAPIPV
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: The patient had a provider order for Dtap and received  Kinrix
Age: 23.0
Sex: F
Vaccine: COVID19-2
Symptoms: Dizziness, Feeling hot, Headache, Pallor, Visual impairment
Clinical narrative: Vision impaired went black then fuzzy then black. Felt faint and dizzy. Got really hot, went pale.  Headache began.
Age: 51.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cytomegalovirus test positive, HIV infection
Clinical narrative: 09/23/22 presents as transfer for "acute respiratory hypoxia". ""COVID pneumonia, recently diagnosed with HIV and reportedly also positive for CMV and PCP pneumonia" PMHx of "IVDU (last used approximately 20 years ago) and a recent COVID pneumonia"
Age: 51.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Pneumocystis jirovecii pneumonia, Pneumocystis test positive, SARS-CoV-2 test positive
Clinical narrative: 09/23/22 presents as transfer for "acute respiratory hypoxia". ""COVID pneumonia, recently diagnosed with HIV and reportedly also positive for CMV and PCP pneumonia" PMHx of "IVDU (last used approximately 20 years ago) and a recent COVID pneumonia"
Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Moderna 3/19/21, 4/16/21, 10/26/21, 9/20/22. Positive on 11/29/22
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Blood test, Hypersomnia, Seizure
Clinical narrative: 10/18/2022, in the evening, I have been told I had a Metabolic Seizure, hours after dose 3 of my vaccine. I was taken to the hospital on 10/20/22, on my birthday. I woke up 3-4 days later. I was in the hospital ten days.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Moderna 9/16/21, 10/15/21. Positive on 11/29/22
Age: 46.0
Sex: M
Vaccine: COVID19
Symptoms: Depression, Fatigue, Feeling abnormal, Memory impairment
Clinical narrative: persistent brain fog, memory recall issues, fatigue, depression   since shortly after 2nd dose until now
Age: 19.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Maternal exposure before pregnancy, SARS-CoV-2 test positive
Clinical narrative: covid; fully vaccinated
Age: 86.0
Sex: F
Vaccine: PNC20
Symptoms: Headache, Injection site erythema, Injection site pain, Medical device site discomfort, Medical device site pain
Clinical narrative: Developed redness around injection site, left arm pain , pain discomfort around pacemaker radiating up to left side of neck starting on 11/8/22. Had a slight fever and headache the day after the vaccine that resolved with Tylenol. Was evaluated 11/15/22, rash had resolved but was still experiencing  tenderness noted in the left deltoid, trapezius, and sternocleidomastoid muscles. Was prescribed  Tylenol 1000 mg by mouth three times per day for 5 days.
Age: 86.0
Sex: F
Vaccine: PNC20
Symptoms: Musculoskeletal discomfort, Myalgia, Neck pain, Pain, Pain in extremity
Clinical narrative: Developed redness around injection site, left arm pain , pain discomfort around pacemaker radiating up to left side of neck starting on 11/8/22. Had a slight fever and headache the day after the vaccine that resolved with Tylenol. Was evaluated 11/15/22, rash had resolved but was still experiencing  tenderness noted in the left deltoid, trapezius, and sternocleidomastoid muscles. Was prescribed  Tylenol 1000 mg by mouth three times per day for 5 days.
Age: 86.0
Sex: F
Vaccine: PNC20
Symptoms: Pyrexia, Rash
Clinical narrative: Developed redness around injection site, left arm pain , pain discomfort around pacemaker radiating up to left side of neck starting on 11/8/22. Had a slight fever and headache the day after the vaccine that resolved with Tylenol. Was evaluated 11/15/22, rash had resolved but was still experiencing  tenderness noted in the left deltoid, trapezius, and sternocleidomastoid muscles. Was prescribed  Tylenol 1000 mg by mouth three times per day for 5 days.
Age: 12.0
Sex: F
Vaccine: MENB
Symptoms: Wrong product administered
Clinical narrative: Incorrect vaccine administered, patient should have received Meningococcal ACWY. Meningoococcal B Bexsero was administered instead.
Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Aspiration, COVID-19, Confusional state, Death, Hypoxia
Clinical narrative: PHIZER COVID VACCINE #3 GIVEN 9/27/2021, LOT #30135BA; Pt presented with hypoxia and confusion; tested positive for COVID on 5/27/22; NIPPV; ICU; given Decadron, Remdesivir, Baricitnib; O2 supplementation continued; transitioned to DNR; problems with aspiration; passed away in the hospital
Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Intensive care, Mechanical ventilation, SARS-CoV-2 test positive
Clinical narrative: PHIZER COVID VACCINE #3 GIVEN 9/27/2021, LOT #30135BA; Pt presented with hypoxia and confusion; tested positive for COVID on 5/27/22; NIPPV; ICU; given Decadron, Remdesivir, Baricitnib; O2 supplementation continued; transitioned to DNR; problems with aspiration; passed away in the hospital
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood iron abnormal, COVID-19, Cardiac failure, Cardiac failure congestive
Clinical narrative: COVID+ 11/16/22.  Vaccination Status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider:  MD Admission Date: 11/16/2022 Discharge Date: 11/28/2022 Presenting Problem: Chronic combined systolic and diastolic heart failure (HCC)   Active Hospital Problems   Diagnosis Date Noted POA o Dysphagia 11/28/2022 Unknown o Nausea 11/19/2022 Unknown o Goals of care, counseling/discussion 08/23/2022 Yes o Nonischemic cardiomyopathy, EF 43%  07/11/2022 Yes o Chronic bilateral low back pain 11/07/2019 Yes o CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (HCC) 12/19/2017 Yes o Acute on chronic combined systolic and diastolic congestive heart failure (HCC) HOSPITAL COURSE: Patient is a 87 y.o. female known to Dr. with past and current medical history of combined systolic and diastolic heart failure, persistent Afib on eliquis, CAD, NICM EF 40-45%, AS s/p TAVR 8/9/2022, CKD stage 4, hypertension, RA, gout, and COPD. She was recently admitted to the observation unit 11/8-11/11 with decompensated heart failure. She received a few doses of IV diuresis and was transferred. Since being admitted to rehab she has not made any significant improvements and continued to decline. She was seen 11/15 for H2O follow up and was felt to be in decompensated heart failure, encouraged to go to the ED but declined. That night she hit her head (unclear details or memory of the event), but awoke with significant periorbital bruising which prompted her care facility to send her to the ED.    Head imaging negative for acute intracranial injury. She was initially admitted to ED observation with cardiology consult for concerns decompensated heart failure. Given concerns for volume overload with worsening renal function, Cardiology admitted patient for further optimization. Upon admission she was found to be COVID positive explaining much of her weakness and fatigue. She was diuresed with few doses of IV lasix, lasix then held over a weekend due to concern for AKI but CXR with worsening CHF and IV lasix resumed for few more days. She was diuresed to a weight of 80.3 kg and transitioned to an oral regimen of torsemide 40 mg BID. She did struggle with intermittent delirium in the hospital, repeat head CT unremarkable.    Noted to be anemia, iron studies consistent with iron deficiency anemia and received IV ferrlecit.    Palliative care was consulted for goals of care discussions. Code status updated to DNR. Will plan to follow outpatient. PT/OT/SLP consulted and all recommended she return \. Upon completion of COVID isolation she was transferred in stable condition, transport coordinated via care management.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiomyopathy, Chest X-ray abnormal, Chronic left ventricular failure, Computerised tomogram head normal, Condition aggravated
Clinical narrative: COVID+ 11/16/22.  Vaccination Status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider:  MD Admission Date: 11/16/2022 Discharge Date: 11/28/2022 Presenting Problem: Chronic combined systolic and diastolic heart failure (HCC)   Active Hospital Problems   Diagnosis Date Noted POA o Dysphagia 11/28/2022 Unknown o Nausea 11/19/2022 Unknown o Goals of care, counseling/discussion 08/23/2022 Yes o Nonischemic cardiomyopathy, EF 43%  07/11/2022 Yes o Chronic bilateral low back pain 11/07/2019 Yes o CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (HCC) 12/19/2017 Yes o Acute on chronic combined systolic and diastolic congestive heart failure (HCC) HOSPITAL COURSE: Patient is a 87 y.o. female known to Dr. with past and current medical history of combined systolic and diastolic heart failure, persistent Afib on eliquis, CAD, NICM EF 40-45%, AS s/p TAVR 8/9/2022, CKD stage 4, hypertension, RA, gout, and COPD. She was recently admitted to the observation unit 11/8-11/11 with decompensated heart failure. She received a few doses of IV diuresis and was transferred. Since being admitted to rehab she has not made any significant improvements and continued to decline. She was seen 11/15 for H2O follow up and was felt to be in decompensated heart failure, encouraged to go to the ED but declined. That night she hit her head (unclear details or memory of the event), but awoke with significant periorbital bruising which prompted her care facility to send her to the ED.    Head imaging negative for acute intracranial injury. She was initially admitted to ED observation with cardiology consult for concerns decompensated heart failure. Given concerns for volume overload with worsening renal function, Cardiology admitted patient for further optimization. Upon admission she was found to be COVID positive explaining much of her weakness and fatigue. She was diuresed with few doses of IV lasix, lasix then held over a weekend due to concern for AKI but CXR with worsening CHF and IV lasix resumed for few more days. She was diuresed to a weight of 80.3 kg and transitioned to an oral regimen of torsemide 40 mg BID. She did struggle with intermittent delirium in the hospital, repeat head CT unremarkable.    Noted to be anemia, iron studies consistent with iron deficiency anemia and received IV ferrlecit.    Palliative care was consulted for goals of care discussions. Code status updated to DNR. Will plan to follow outpatient. PT/OT/SLP consulted and all recommended she return \. Upon completion of COVID isolation she was transferred in stable condition, transport coordinated via care management.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Delirium, Diuretic therapy, Dysphagia, Ejection fraction decreased, Eye contusion
Clinical narrative: COVID+ 11/16/22.  Vaccination Status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider:  MD Admission Date: 11/16/2022 Discharge Date: 11/28/2022 Presenting Problem: Chronic combined systolic and diastolic heart failure (HCC)   Active Hospital Problems   Diagnosis Date Noted POA o Dysphagia 11/28/2022 Unknown o Nausea 11/19/2022 Unknown o Goals of care, counseling/discussion 08/23/2022 Yes o Nonischemic cardiomyopathy, EF 43%  07/11/2022 Yes o Chronic bilateral low back pain 11/07/2019 Yes o CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (HCC) 12/19/2017 Yes o Acute on chronic combined systolic and diastolic congestive heart failure (HCC) HOSPITAL COURSE: Patient is a 87 y.o. female known to Dr. with past and current medical history of combined systolic and diastolic heart failure, persistent Afib on eliquis, CAD, NICM EF 40-45%, AS s/p TAVR 8/9/2022, CKD stage 4, hypertension, RA, gout, and COPD. She was recently admitted to the observation unit 11/8-11/11 with decompensated heart failure. She received a few doses of IV diuresis and was transferred. Since being admitted to rehab she has not made any significant improvements and continued to decline. She was seen 11/15 for H2O follow up and was felt to be in decompensated heart failure, encouraged to go to the ED but declined. That night she hit her head (unclear details or memory of the event), but awoke with significant periorbital bruising which prompted her care facility to send her to the ED.    Head imaging negative for acute intracranial injury. She was initially admitted to ED observation with cardiology consult for concerns decompensated heart failure. Given concerns for volume overload with worsening renal function, Cardiology admitted patient for further optimization. Upon admission she was found to be COVID positive explaining much of her weakness and fatigue. She was diuresed with few doses of IV lasix, lasix then held over a weekend due to concern for AKI but CXR with worsening CHF and IV lasix resumed for few more days. She was diuresed to a weight of 80.3 kg and transitioned to an oral regimen of torsemide 40 mg BID. She did struggle with intermittent delirium in the hospital, repeat head CT unremarkable.    Noted to be anemia, iron studies consistent with iron deficiency anemia and received IV ferrlecit.    Palliative care was consulted for goals of care discussions. Code status updated to DNR. Will plan to follow outpatient. PT/OT/SLP consulted and all recommended she return \. Upon completion of COVID isolation she was transferred in stable condition, transport coordinated via care management.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, General physical health deterioration, Head injury, Iron deficiency anaemia, Nausea
Clinical narrative: COVID+ 11/16/22.  Vaccination Status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider:  MD Admission Date: 11/16/2022 Discharge Date: 11/28/2022 Presenting Problem: Chronic combined systolic and diastolic heart failure (HCC)   Active Hospital Problems   Diagnosis Date Noted POA o Dysphagia 11/28/2022 Unknown o Nausea 11/19/2022 Unknown o Goals of care, counseling/discussion 08/23/2022 Yes o Nonischemic cardiomyopathy, EF 43%  07/11/2022 Yes o Chronic bilateral low back pain 11/07/2019 Yes o CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (HCC) 12/19/2017 Yes o Acute on chronic combined systolic and diastolic congestive heart failure (HCC) HOSPITAL COURSE: Patient is a 87 y.o. female known to Dr. with past and current medical history of combined systolic and diastolic heart failure, persistent Afib on eliquis, CAD, NICM EF 40-45%, AS s/p TAVR 8/9/2022, CKD stage 4, hypertension, RA, gout, and COPD. She was recently admitted to the observation unit 11/8-11/11 with decompensated heart failure. She received a few doses of IV diuresis and was transferred. Since being admitted to rehab she has not made any significant improvements and continued to decline. She was seen 11/15 for H2O follow up and was felt to be in decompensated heart failure, encouraged to go to the ED but declined. That night she hit her head (unclear details or memory of the event), but awoke with significant periorbital bruising which prompted her care facility to send her to the ED.    Head imaging negative for acute intracranial injury. She was initially admitted to ED observation with cardiology consult for concerns decompensated heart failure. Given concerns for volume overload with worsening renal function, Cardiology admitted patient for further optimization. Upon admission she was found to be COVID positive explaining much of her weakness and fatigue. She was diuresed with few doses of IV lasix, lasix then held over a weekend due to concern for AKI but CXR with worsening CHF and IV lasix resumed for few more days. She was diuresed to a weight of 80.3 kg and transitioned to an oral regimen of torsemide 40 mg BID. She did struggle with intermittent delirium in the hospital, repeat head CT unremarkable.    Noted to be anemia, iron studies consistent with iron deficiency anemia and received IV ferrlecit.    Palliative care was consulted for goals of care discussions. Code status updated to DNR. Will plan to follow outpatient. PT/OT/SLP consulted and all recommended she return \. Upon completion of COVID isolation she was transferred in stable condition, transport coordinated via care management.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Renal impairment, SARS-CoV-2 test positive
Clinical narrative: COVID+ 11/16/22.  Vaccination Status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider:  MD Admission Date: 11/16/2022 Discharge Date: 11/28/2022 Presenting Problem: Chronic combined systolic and diastolic heart failure (HCC)   Active Hospital Problems   Diagnosis Date Noted POA o Dysphagia 11/28/2022 Unknown o Nausea 11/19/2022 Unknown o Goals of care, counseling/discussion 08/23/2022 Yes o Nonischemic cardiomyopathy, EF 43%  07/11/2022 Yes o Chronic bilateral low back pain 11/07/2019 Yes o CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min (HCC) 12/19/2017 Yes o Acute on chronic combined systolic and diastolic congestive heart failure (HCC) HOSPITAL COURSE: Patient is a 87 y.o. female known to Dr. with past and current medical history of combined systolic and diastolic heart failure, persistent Afib on eliquis, CAD, NICM EF 40-45%, AS s/p TAVR 8/9/2022, CKD stage 4, hypertension, RA, gout, and COPD. She was recently admitted to the observation unit 11/8-11/11 with decompensated heart failure. She received a few doses of IV diuresis and was transferred. Since being admitted to rehab she has not made any significant improvements and continued to decline. She was seen 11/15 for H2O follow up and was felt to be in decompensated heart failure, encouraged to go to the ED but declined. That night she hit her head (unclear details or memory of the event), but awoke with significant periorbital bruising which prompted her care facility to send her to the ED.    Head imaging negative for acute intracranial injury. She was initially admitted to ED observation with cardiology consult for concerns decompensated heart failure. Given concerns for volume overload with worsening renal function, Cardiology admitted patient for further optimization. Upon admission she was found to be COVID positive explaining much of her weakness and fatigue. She was diuresed with few doses of IV lasix, lasix then held over a weekend due to concern for AKI but CXR with worsening CHF and IV lasix resumed for few more days. She was diuresed to a weight of 80.3 kg and transitioned to an oral regimen of torsemide 40 mg BID. She did struggle with intermittent delirium in the hospital, repeat head CT unremarkable.    Noted to be anemia, iron studies consistent with iron deficiency anemia and received IV ferrlecit.    Palliative care was consulted for goals of care discussions. Code status updated to DNR. Will plan to follow outpatient. PT/OT/SLP consulted and all recommended she return \. Upon completion of COVID isolation she was transferred in stable condition, transport coordinated via care management.
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal discomfort, COVID-19, CSF lymphocyte count abnormal, CSF protein increased, CSF test abnormal
Clinical narrative: Patient recounts that symptoms first began Nov 2nd when she had COVID and flu vaccines on the same day. The next day she was found to be positive for COVID after having a cough. She began taking Paxlovid on 11/5 and that same day she started having some symptoms of "wearing tight pants" from the level of her umbilicus down to her lower extremities. She was admitted 11/8-11/10 for these symptoms due to continued lower extremity numbness and weakness, and had extensive workup during that admission including MRI Brain, C/T/L spine which was unrevealing, as well as an LP which showed very minor protein elevation. Neurology was consulted for recommendations during this admission. Patient improved symptomatically without treatment and so was discharged home with plan for further outpatient neurology workup.    She represented on 11/13 due to continued symptoms and was again admitted for further workup and treatment 11/13-11/18. She received a repeat LP revealing for albuminocytologic dissociation with a protein of 57 and was treated for GBS. Neurology was consulted and recommended treatment with IVIG x5 days which the patient completed. The patient's symptoms improved during the hospitalization and she was evaluated by PT and discharged home with plan for further outpatient PT.    She attempted to take care of herself at home but recounts several falls over the weekend. She still has some weakness of her lower extremities and has to pull herself up off of the couch using her arms and lean on her walker to get around. She has never hit her head or lost consciousness from these falls and she has no prodromal symptoms when she has the falls. She has had several abrasions to her knees and various extremities from these falls but no swelling that she has noticed. She continues to endorse some numbness in her abdomen, lateral aspect of her LUE, and bilateral toes.    She denies recent infection, URI symptoms (cough, F/C, congestion, SOB). She denies N/V. She denies abdominal pain. She denies melena, BRBPR, hematemesis, hemoptysis. She endorses some decreased appetite. She endorses constipation. She denies any vaginal bleeding, states does not have periods after having IUD placed.
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: Computerised tomogram spine, Constipation, Cough, Decreased appetite, Fall
Clinical narrative: Patient recounts that symptoms first began Nov 2nd when she had COVID and flu vaccines on the same day. The next day she was found to be positive for COVID after having a cough. She began taking Paxlovid on 11/5 and that same day she started having some symptoms of "wearing tight pants" from the level of her umbilicus down to her lower extremities. She was admitted 11/8-11/10 for these symptoms due to continued lower extremity numbness and weakness, and had extensive workup during that admission including MRI Brain, C/T/L spine which was unrevealing, as well as an LP which showed very minor protein elevation. Neurology was consulted for recommendations during this admission. Patient improved symptomatically without treatment and so was discharged home with plan for further outpatient neurology workup.    She represented on 11/13 due to continued symptoms and was again admitted for further workup and treatment 11/13-11/18. She received a repeat LP revealing for albuminocytologic dissociation with a protein of 57 and was treated for GBS. Neurology was consulted and recommended treatment with IVIG x5 days which the patient completed. The patient's symptoms improved during the hospitalization and she was evaluated by PT and discharged home with plan for further outpatient PT.    She attempted to take care of herself at home but recounts several falls over the weekend. She still has some weakness of her lower extremities and has to pull herself up off of the couch using her arms and lean on her walker to get around. She has never hit her head or lost consciousness from these falls and she has no prodromal symptoms when she has the falls. She has had several abrasions to her knees and various extremities from these falls but no swelling that she has noticed. She continues to endorse some numbness in her abdomen, lateral aspect of her LUE, and bilateral toes.    She denies recent infection, URI symptoms (cough, F/C, congestion, SOB). She denies N/V. She denies abdominal pain. She denies melena, BRBPR, hematemesis, hemoptysis. She endorses some decreased appetite. She endorses constipation. She denies any vaginal bleeding, states does not have periods after having IUD placed.
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: Guillain-Barre syndrome, Hypoaesthesia, Immunoglobulin therapy, Impaired self-care, Limb discomfort
Clinical narrative: Patient recounts that symptoms first began Nov 2nd when she had COVID and flu vaccines on the same day. The next day she was found to be positive for COVID after having a cough. She began taking Paxlovid on 11/5 and that same day she started having some symptoms of "wearing tight pants" from the level of her umbilicus down to her lower extremities. She was admitted 11/8-11/10 for these symptoms due to continued lower extremity numbness and weakness, and had extensive workup during that admission including MRI Brain, C/T/L spine which was unrevealing, as well as an LP which showed very minor protein elevation. Neurology was consulted for recommendations during this admission. Patient improved symptomatically without treatment and so was discharged home with plan for further outpatient neurology workup.    She represented on 11/13 due to continued symptoms and was again admitted for further workup and treatment 11/13-11/18. She received a repeat LP revealing for albuminocytologic dissociation with a protein of 57 and was treated for GBS. Neurology was consulted and recommended treatment with IVIG x5 days which the patient completed. The patient's symptoms improved during the hospitalization and she was evaluated by PT and discharged home with plan for further outpatient PT.    She attempted to take care of herself at home but recounts several falls over the weekend. She still has some weakness of her lower extremities and has to pull herself up off of the couch using her arms and lean on her walker to get around. She has never hit her head or lost consciousness from these falls and she has no prodromal symptoms when she has the falls. She has had several abrasions to her knees and various extremities from these falls but no swelling that she has noticed. She continues to endorse some numbness in her abdomen, lateral aspect of her LUE, and bilateral toes.    She denies recent infection, URI symptoms (cough, F/C, congestion, SOB). She denies N/V. She denies abdominal pain. She denies melena, BRBPR, hematemesis, hemoptysis. She endorses some decreased appetite. She endorses constipation. She denies any vaginal bleeding, states does not have periods after having IUD placed.
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: Lumbar puncture abnormal, Magnetic resonance imaging head normal, Muscular weakness, Neurological symptom, SARS-CoV-2 test positive
Clinical narrative: Patient recounts that symptoms first began Nov 2nd when she had COVID and flu vaccines on the same day. The next day she was found to be positive for COVID after having a cough. She began taking Paxlovid on 11/5 and that same day she started having some symptoms of "wearing tight pants" from the level of her umbilicus down to her lower extremities. She was admitted 11/8-11/10 for these symptoms due to continued lower extremity numbness and weakness, and had extensive workup during that admission including MRI Brain, C/T/L spine which was unrevealing, as well as an LP which showed very minor protein elevation. Neurology was consulted for recommendations during this admission. Patient improved symptomatically without treatment and so was discharged home with plan for further outpatient neurology workup.    She represented on 11/13 due to continued symptoms and was again admitted for further workup and treatment 11/13-11/18. She received a repeat LP revealing for albuminocytologic dissociation with a protein of 57 and was treated for GBS. Neurology was consulted and recommended treatment with IVIG x5 days which the patient completed. The patient's symptoms improved during the hospitalization and she was evaluated by PT and discharged home with plan for further outpatient PT.    She attempted to take care of herself at home but recounts several falls over the weekend. She still has some weakness of her lower extremities and has to pull herself up off of the couch using her arms and lean on her walker to get around. She has never hit her head or lost consciousness from these falls and she has no prodromal symptoms when she has the falls. She has had several abrasions to her knees and various extremities from these falls but no swelling that she has noticed. She continues to endorse some numbness in her abdomen, lateral aspect of her LUE, and bilateral toes.    She denies recent infection, URI symptoms (cough, F/C, congestion, SOB). She denies N/V. She denies abdominal pain. She denies melena, BRBPR, hematemesis, hemoptysis. She endorses some decreased appetite. She endorses constipation. She denies any vaginal bleeding, states does not have periods after having IUD placed.
Age: 47.0
Sex: F
Vaccine: COVID19-2
Symptoms: Skin abrasion, Walking aid user
Clinical narrative: Patient recounts that symptoms first began Nov 2nd when she had COVID and flu vaccines on the same day. The next day she was found to be positive for COVID after having a cough. She began taking Paxlovid on 11/5 and that same day she started having some symptoms of "wearing tight pants" from the level of her umbilicus down to her lower extremities. She was admitted 11/8-11/10 for these symptoms due to continued lower extremity numbness and weakness, and had extensive workup during that admission including MRI Brain, C/T/L spine which was unrevealing, as well as an LP which showed very minor protein elevation. Neurology was consulted for recommendations during this admission. Patient improved symptomatically without treatment and so was discharged home with plan for further outpatient neurology workup.    She represented on 11/13 due to continued symptoms and was again admitted for further workup and treatment 11/13-11/18. She received a repeat LP revealing for albuminocytologic dissociation with a protein of 57 and was treated for GBS. Neurology was consulted and recommended treatment with IVIG x5 days which the patient completed. The patient's symptoms improved during the hospitalization and she was evaluated by PT and discharged home with plan for further outpatient PT.    She attempted to take care of herself at home but recounts several falls over the weekend. She still has some weakness of her lower extremities and has to pull herself up off of the couch using her arms and lean on her walker to get around. She has never hit her head or lost consciousness from these falls and she has no prodromal symptoms when she has the falls. She has had several abrasions to her knees and various extremities from these falls but no swelling that she has noticed. She continues to endorse some numbness in her abdomen, lateral aspect of her LUE, and bilateral toes.    She denies recent infection, URI symptoms (cough, F/C, congestion, SOB). She denies N/V. She denies abdominal pain. She denies melena, BRBPR, hematemesis, hemoptysis. She endorses some decreased appetite. She endorses constipation. She denies any vaginal bleeding, states does not have periods after having IUD placed.
Age: 82.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: General symptom, Laboratory test
Clinical narrative: Patient symptoms started 11/29/22. Treatment includes Oxygen, labs, and admission.
Age: 57.0
Sex: M
Vaccine: COVID19
Symptoms: Iron deficiency anaemia, Serum ferritin decreased
Clinical narrative: Iron Deficient Anemia
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient was vaccinated Monovalent instead of Bivalent
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Blood sodium decreased, Blood test, Computerised tomogram, Hyponatraemia, Inappropriate antidiuretic hormone secretion
Clinical narrative: Syncope - lost consciousness for 10 minutes. Collapsed. Subarachnoid hemorrhage, vertigo, SIADH (Syndrome of inappropriate anti-diuretic hormone production), hyponatremia
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Loss of consciousness, Magnetic resonance imaging, Subarachnoid haemorrhage, Syncope, Vertigo
Clinical narrative: Syncope - lost consciousness for 10 minutes. Collapsed. Subarachnoid hemorrhage, vertigo, SIADH (Syndrome of inappropriate anti-diuretic hormone production), hyponatremia
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient was given monovalent instead of bivalent
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Ascites, Aspiration pleural cavity, Asthenia
Clinical narrative: COVID+ 11/24/22.  Vaccination status - pfizer x4 BRIEF OVERVIEW: Discharge Provider: MD Primary Care Physician at Discharge: MD Admission Date: 11/24/2022   Active Hospital Problems   Diagnosis Date Noted POA ? Chronic bilateral pleural effusions 11/25/2022 Yes ? Open wound of dorsum of foot 11/25/2022 Unknown ? Counseling regarding advance care planning and goals of care 11/25/2022 Unknown ? Septic shock 11/24/2022 Yes ? COVID-19 virus infection 11/24/2022 Yes ? Anasarca 11/24/2022 Yes ? Open wound of left foot 11/24/2022 Yes ? Acute respiratory failure with hypoxia and hypercapnia 11/24/2022 Yes ? Medication induced coagulopathy 11/24/2022 Yes ? AKI (acute kidney injury)    DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Septic shock    HOSPITAL COURSE: 78 y/o male with past medical history significant for HTN, Afib for which he is on Coumadin s/p pacemaker placement, PVD. He presented to ED 11/24 with one week history of weakness and recent falls. Family was unable to get him out of bed and called EMS. In the ED, patient denied any focal complaints but it was noted that 2 of his family members with whom he lives recently tested positive for COVID. Of note, patient has been recently treated with antibiotics for a foot infection.    Upon arrival to ED, patient was noted to be hypothermic/hypotensive/hypoxic. His oxygen requirements quickly escalated to requiring HFNC. Initial gas noted to be 7.27/66.5/145.2. Labs were notable for AKI with a Cr of 1.92 (baseline around 1-1.2), pro-bnp of 4663, initial troponin of 69, LA-2.7 which subsequently normalized to 1.9, normal PCT, and WBC-3.56. INR was elevated at >8 with stable Hg of 15 and no reported bleeding. COVID (+). UA unremarkable. EKG demonstrated ventricular paced rhythm with prolonged Qtc. CTH was negative for any acute abnormalities. CXR showed cardiomegaly with pulmonary vascular congestion as well as bilateral pleural effusions and patchy midlung opacities. Right basilar atelectasis or PNA was also reported. Patient was ultimately transitioned to Bipap with improvement in his respiratory status. Patient was given 250 ml of IVFs and then transitioned to NE gtt due to concerns of fluid overload. He additionally received Rocephin, Doxycycline, 10 mg of IV decadron, 40 mg IV lasix, and 2.5 mg PO of Vitamin K. He was then transferred to ICU for further care.   CT thorax 11/24 with bilateral pleural effusions, partially loculated. INR reversed and patient received left sided thoracentesis with right pleural drain. IR also performed diagnostic paracentesis for noted ascites on CT. Pleural fluid noted to be transudative, no signs of SBP in ascitic fluid. Renal function worsening with poor urine output. Following discussions with family patient transitioned to DNR/DNI. He was transitioned to comfort care 11/26 and pronounced deceased at 2110 11/26/23