chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, Fraction of inspired oxygen
Clinical narrative: Patient is a 64 y.o. female with a PMHx of NASH cirrhosis, asthma, recently diagnosed ampulla of vater adenocarcinoma, hx of renal cell carcinoma s/p partial right nephrectomy presented to DH with complaints of trouble breathing, ongoing for the past few weeks and had been progressive, with increased oxygen requirements. Patient hypoxemic on arrival, fond to have COVID pneumonia and bilateral pleural and transferred to ICU on BiPAP for closer monitoring of respiratory status. Thoracentesis was performed on 10/10 after increasing FiO2 requirements on bipap. Respiratory status continued to decline and patient was intubated and placed on mechanical ventilation 10/11. Increasing vasopressor requirements on 10/11 secondary to medical conditions and new aflutter with RVR, cardioverted to normal sinus rhythm. Pressors continued to increase later that evening and went back into a-fib with RVR, this time is was not amendable to cardioversion overnight. Patient continued to decline despite aggressive medical intervention. Patients husband was updated on her overall prognosis and after multiple conversations, patients husband made the decision to make her comfort care. Patient was compassionately extubated and passed at 2:26 pm, husband at bedside.    Discharge Diagnoses:   Acute hypoxic respiratory failure COVID + pneumonia Septic Shock Lactic Acidosis, worsening Low bicarb, worsening A-fib Elevated troponins NASH cirrhosis Recently diagnosed Ampulla of Vater adenocarcinoma Hx of Renal Cell Carcinoma
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: General physical health deterioration, Hypoxia, Intensive care, Lactic acidosis, Mechanical ventilation
Clinical narrative: Patient is a 64 y.o. female with a PMHx of NASH cirrhosis, asthma, recently diagnosed ampulla of vater adenocarcinoma, hx of renal cell carcinoma s/p partial right nephrectomy presented to DH with complaints of trouble breathing, ongoing for the past few weeks and had been progressive, with increased oxygen requirements. Patient hypoxemic on arrival, fond to have COVID pneumonia and bilateral pleural and transferred to ICU on BiPAP for closer monitoring of respiratory status. Thoracentesis was performed on 10/10 after increasing FiO2 requirements on bipap. Respiratory status continued to decline and patient was intubated and placed on mechanical ventilation 10/11. Increasing vasopressor requirements on 10/11 secondary to medical conditions and new aflutter with RVR, cardioverted to normal sinus rhythm. Pressors continued to increase later that evening and went back into a-fib with RVR, this time is was not amendable to cardioversion overnight. Patient continued to decline despite aggressive medical intervention. Patients husband was updated on her overall prognosis and after multiple conversations, patients husband made the decision to make her comfort care. Patient was compassionately extubated and passed at 2:26 pm, husband at bedside.    Discharge Diagnoses:   Acute hypoxic respiratory failure COVID + pneumonia Septic Shock Lactic Acidosis, worsening Low bicarb, worsening A-fib Elevated troponins NASH cirrhosis Recently diagnosed Ampulla of Vater adenocarcinoma Hx of Renal Cell Carcinoma
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Pleural effusion, Positive airway pressure therapy, Procedural failure, Respiratory distress, SARS-CoV-2 test positive
Clinical narrative: Patient is a 64 y.o. female with a PMHx of NASH cirrhosis, asthma, recently diagnosed ampulla of vater adenocarcinoma, hx of renal cell carcinoma s/p partial right nephrectomy presented to DH with complaints of trouble breathing, ongoing for the past few weeks and had been progressive, with increased oxygen requirements. Patient hypoxemic on arrival, fond to have COVID pneumonia and bilateral pleural and transferred to ICU on BiPAP for closer monitoring of respiratory status. Thoracentesis was performed on 10/10 after increasing FiO2 requirements on bipap. Respiratory status continued to decline and patient was intubated and placed on mechanical ventilation 10/11. Increasing vasopressor requirements on 10/11 secondary to medical conditions and new aflutter with RVR, cardioverted to normal sinus rhythm. Pressors continued to increase later that evening and went back into a-fib with RVR, this time is was not amendable to cardioversion overnight. Patient continued to decline despite aggressive medical intervention. Patients husband was updated on her overall prognosis and after multiple conversations, patients husband made the decision to make her comfort care. Patient was compassionately extubated and passed at 2:26 pm, husband at bedside.    Discharge Diagnoses:   Acute hypoxic respiratory failure COVID + pneumonia Septic Shock Lactic Acidosis, worsening Low bicarb, worsening A-fib Elevated troponins NASH cirrhosis Recently diagnosed Ampulla of Vater adenocarcinoma Hx of Renal Cell Carcinoma
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Septic shock, Sinus rhythm, Troponin increased
Clinical narrative: Patient is a 64 y.o. female with a PMHx of NASH cirrhosis, asthma, recently diagnosed ampulla of vater adenocarcinoma, hx of renal cell carcinoma s/p partial right nephrectomy presented to DH with complaints of trouble breathing, ongoing for the past few weeks and had been progressive, with increased oxygen requirements. Patient hypoxemic on arrival, fond to have COVID pneumonia and bilateral pleural and transferred to ICU on BiPAP for closer monitoring of respiratory status. Thoracentesis was performed on 10/10 after increasing FiO2 requirements on bipap. Respiratory status continued to decline and patient was intubated and placed on mechanical ventilation 10/11. Increasing vasopressor requirements on 10/11 secondary to medical conditions and new aflutter with RVR, cardioverted to normal sinus rhythm. Pressors continued to increase later that evening and went back into a-fib with RVR, this time is was not amendable to cardioversion overnight. Patient continued to decline despite aggressive medical intervention. Patients husband was updated on her overall prognosis and after multiple conversations, patients husband made the decision to make her comfort care. Patient was compassionately extubated and passed at 2:26 pm, husband at bedside.    Discharge Diagnoses:   Acute hypoxic respiratory failure COVID + pneumonia Septic Shock Lactic Acidosis, worsening Low bicarb, worsening A-fib Elevated troponins NASH cirrhosis Recently diagnosed Ampulla of Vater adenocarcinoma Hx of Renal Cell Carcinoma
Age: 61.0
Sex: F
Vaccine: COVID19-2
Symptoms: Rash morbilliform
Clinical narrative: Morbilliform rash developing 3-4 days after administration. Patient has received the Moderna vaccine x3 and the Pfizer vaccine x3 and developed the morbilliform rash 3-4 days after administration each time. The reaction has progressively worsened with each administration. No breathing issues, swelling, anaphylaxis.
Age: 2.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Patient was administered expired vaccine; expiration date sticker 12/18/2023, given 12/19/2023
Age: 2.0
Sex: F
Vaccine: FLU4
Symptoms: Expired product administered
Clinical narrative: Patient was administered expired vaccine; expiration date sticker 12/18/2023, given 12/19/2023
Age: 74.0
Sex: F
Vaccine: FLUA4, RSV
Symptoms: No adverse event, Wrong product administered
Clinical narrative: Patient requested a RSV vaccine and received a Fluad vaccine instead. No adverse events were observed. The patient just received a different vaccine than requested.
Age: 0.33
Sex: M
Vaccine: DTAPHEPBIP, HIBV, PNC15, RV1
Symptoms: Rash, Vomiting
Clinical narrative: Pt had a developed rash and started vomiting and unable to keep breast milk or formula down
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray, Electrocardiogram, Hypoxia, Laboratory test, Lethargy
Clinical narrative: Hypoxia, Tachycardia, Extreme Lethargy, Went out by ambulance and stayed at the hospital for a day and needed supplmental oxygen and fluids for a diagnosis of sepsis with unknown cause. Given fluids and antibiotics. No obvious illness found at the hospital. Discharged back to the residence on 12-20-23.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Sepsis, Tachycardia, Urine analysis
Clinical narrative: Hypoxia, Tachycardia, Extreme Lethargy, Went out by ambulance and stayed at the hospital for a day and needed supplmental oxygen and fluids for a diagnosis of sepsis with unknown cause. Given fluids and antibiotics. No obvious illness found at the hospital. Discharged back to the residence on 12-20-23.
Age: 70.0
Sex: M
Vaccine: COVID19, VARZOS
Symptoms: Hypoaesthesia, Injected limb mobility decreased, Limb discomfort, Muscular weakness, Peripheral swelling
Clinical narrative: Spoke to patient, states he was working a little job of sweeping and cleaning stuff up. He came home from work and his left arm just would not work. States it was numb and swollen feeling, and unable to use his fingers to pick anything up. When he looked at his arm it was not swollen. Denies CP, SOB, or any pain in the arm. His Right arm was fine. He states on the 19th at his OV with provider, he got a covid vaccine in his left arm and shingles in his right. He was also started on 2 new medications Zyrtec 10 mg and protonix 40mg. TODAY his arm is just numb feeling, he is able to use it some but its not back to normal. Still states no pain, just feels numb and kind of heavy. Sending to provider for her Recommendations. after speaking with provider, she believes we should report the left arm numbness as an adverse reaction to the vaccines and she also recommends taking anti-inflammatory. Patient was very apprehensive about continuing his medication as provider does not believe that was the cause. Patient was going to take it and if it happens again he will not take the 2 new medications anymore. ******While looking in his Chart, he had the covid vaccine in his Right Arm and the shingles in the Left Arm per the charting documentation.
Age: 75.0
Sex: M
Vaccine: RSV
Symptoms: Injection site inflammation
Clinical narrative: Injection site reaction, inflammation
Age: 17.0
Sex: F
Vaccine: VARCEL
Symptoms: Extra dose administered
Clinical narrative: Pt given 3rd dose of varicella when only 2 is required for series completion
Age: 35.0
Sex: F
Vaccine: FLU4
Symptoms: Pain in extremity
Clinical narrative: Pain in arm started a few days after flu vaccine, has progressed down arm, all the way into her hand (still having pain as of 12/22/23).
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Rash pruritic
Clinical narrative: Rash with itching relieved with antihistamine and ibuprofen
Age: 78.0
Sex: F
Vaccine: FLU4
Symptoms: Cough, Fatigue, Productive cough, Pyrexia, SARS-CoV-2 test negative
Clinical narrative: Coughing very bad, sneezing, coughing up yellow gunk, low fever, very exhausted and tired.
Age: 78.0
Sex: F
Vaccine: FLU4
Symptoms: Sneezing, Sputum discoloured
Clinical narrative: Coughing very bad, sneezing, coughing up yellow gunk, low fever, very exhausted and tired.
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Exercise tolerance decreased, Loss of personal independence in daily activities, Pain in extremity
Clinical narrative: I quite do not know whether the Pfizer vaccine is Bio-N-Tech or Bivalent.  I took these two together: Vaccine information: Influenza 65Y+ Quadrivalent (FLUAD) Manufacturer Seqirus and Covid-19 12+ years 0.3ml Manufacturer Pfizer When I woke up in the morning, I had series extreme pain on left side heel, in the arch, the sides of the foot, toes.  This lasted for 7 days and even now there is tiny remnant remaining.  I walk 10K steps every day for may years.  So, this is not the case, where I was doing heavy workout the previous day, or playing tennis.  I slept normally the previous day and in the morning was excruciating pain.  I tried to use biofreeze and used massager but nothing helped.
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: no current adverse effects known, Patient was given the vaccine that was expired per the "beyond use date" from when it started being refrigerated rather than frozen.
Age: 28.0
Sex: F
Vaccine: TDAP
Symptoms: Rash, Rash pruritic
Clinical narrative: States that she developed an itchy rash down the left side of her neck and arm
Age: 7.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 RNA increased
Clinical narrative: HOSPITALIZATION RELATED TO COVID-19 FOLLOWING COMPLETION OF PRIMARY COVID VACCINE SERIES
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Ammonia normal, Aortic valve incompetence, Asthenia, Blood sodium decreased, COVID-19
Clinical narrative: Patient is a 85 y.o. female with a history of dementia, HFpEF, afib on Eliquis, IDDM2 who presented to hospital 9/21/2023 with cough and dyspnea x4 days found to be COVID positive. CXR showed right lung patchy opacities. Course complicated by poor intake and hypoglycemia requiring initiation of tube feeds but patient pulled out NGT. Family decided against tube feeds after Palliative team meeting.   1. COVID-19 Pneumonia: Presented as above. Symptom onset 9/18/23, positive test 9/21/23. Required no supplemental O2 on admit.  Admit CXR with right lung patchy opacities. S/p Azithro/Rocephin in ED. No indication for Decadron, Remdesivir on admit. Started paxlovid 9/23 but unable to crush so did not receive. Isolation discontinued 9/30/23. 2. Metabolic encephalopathy: Likely secondary to hypoglycemia on 9/25/23, with possible hospital delirium component with underlying dementia. Ammonia wnl, CTH 9/25/23 nonacute. Memory impairment is worsened per family, possible new baseline. Required restraints, discontinued 9/29/23. Mildly improved. 3. Hypoglycemia, poor intake: BG 44 9/25. Stopped insulin and given glucagon and D5 infusion 9/25-9/27. NGT placed and started tube feeds 9/26/23 with daughter's permission. Pt pulled out NGT, per son 9/29/23 no further tube feeds and no PEG tube. RD followed. Encouraged oral intake and assisted with feeds. 4. Hyponatremia : Na+ 125 on 10/3- from 130 on 10/2/23- suspect related to poor oral intake. Improved with normal saline 5. Generalized weakness: Suspect in the setting of viral infection. Supportive care. 6. Polycythemia: Admit Hgb 16.5. Possibly in the setting of dehydration. Monitored. 7. Thrombocytopenia: Admit Platelets 130, suspect due to acute illness. No signs of bleeding. Monitored CBC. 8. Chronic HFpEF: Per history, follows with Dr. TTE 3/1/22 with EF 65%, moderate to severe TR, mild AR, abnormal septal motion due to high right-sided pressure. Stopped home torsemide and aldactone given poor intake. 9. Persistent atrial fibrillation: per history, follows with Dr., s/p multiple cardioversions and PPM. Continued home BB, Eliquis. Monitored on tele.  10. HTN: Per history. Uncontrolled. Continued home BB, stopped diuretics. Monitored. 11. IDDM2: HgbA1c 6.3 9/2/22. Held home Januvia on admit, continued home basal insulin with added SSI while inpatient. Stopped insulin 9/25 and stopped home meds due to hypoglycemia.   12. Dementia: Per history with recent decline per notes 05/2023. Delirium precautions.  13. Code status: DNRCCA/DNI, discussed 9/29/23.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram head normal, Condition aggravated, Cough
Clinical narrative: Patient is a 85 y.o. female with a history of dementia, HFpEF, afib on Eliquis, IDDM2 who presented to hospital 9/21/2023 with cough and dyspnea x4 days found to be COVID positive. CXR showed right lung patchy opacities. Course complicated by poor intake and hypoglycemia requiring initiation of tube feeds but patient pulled out NGT. Family decided against tube feeds after Palliative team meeting.   1. COVID-19 Pneumonia: Presented as above. Symptom onset 9/18/23, positive test 9/21/23. Required no supplemental O2 on admit.  Admit CXR with right lung patchy opacities. S/p Azithro/Rocephin in ED. No indication for Decadron, Remdesivir on admit. Started paxlovid 9/23 but unable to crush so did not receive. Isolation discontinued 9/30/23. 2. Metabolic encephalopathy: Likely secondary to hypoglycemia on 9/25/23, with possible hospital delirium component with underlying dementia. Ammonia wnl, CTH 9/25/23 nonacute. Memory impairment is worsened per family, possible new baseline. Required restraints, discontinued 9/29/23. Mildly improved. 3. Hypoglycemia, poor intake: BG 44 9/25. Stopped insulin and given glucagon and D5 infusion 9/25-9/27. NGT placed and started tube feeds 9/26/23 with daughter's permission. Pt pulled out NGT, per son 9/29/23 no further tube feeds and no PEG tube. RD followed. Encouraged oral intake and assisted with feeds. 4. Hyponatremia : Na+ 125 on 10/3- from 130 on 10/2/23- suspect related to poor oral intake. Improved with normal saline 5. Generalized weakness: Suspect in the setting of viral infection. Supportive care. 6. Polycythemia: Admit Hgb 16.5. Possibly in the setting of dehydration. Monitored. 7. Thrombocytopenia: Admit Platelets 130, suspect due to acute illness. No signs of bleeding. Monitored CBC. 8. Chronic HFpEF: Per history, follows with Dr. TTE 3/1/22 with EF 65%, moderate to severe TR, mild AR, abnormal septal motion due to high right-sided pressure. Stopped home torsemide and aldactone given poor intake. 9. Persistent atrial fibrillation: per history, follows with Dr., s/p multiple cardioversions and PPM. Continued home BB, Eliquis. Monitored on tele.  10. HTN: Per history. Uncontrolled. Continued home BB, stopped diuretics. Monitored. 11. IDDM2: HgbA1c 6.3 9/2/22. Held home Januvia on admit, continued home basal insulin with added SSI while inpatient. Stopped insulin 9/25 and stopped home meds due to hypoglycemia.   12. Dementia: Per history with recent decline per notes 05/2023. Delirium precautions.  13. Code status: DNRCCA/DNI, discussed 9/29/23.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Dementia, Dyspnoea, Echocardiogram, Ejection fraction normal, Full blood count
Clinical narrative: Patient is a 85 y.o. female with a history of dementia, HFpEF, afib on Eliquis, IDDM2 who presented to hospital 9/21/2023 with cough and dyspnea x4 days found to be COVID positive. CXR showed right lung patchy opacities. Course complicated by poor intake and hypoglycemia requiring initiation of tube feeds but patient pulled out NGT. Family decided against tube feeds after Palliative team meeting.   1. COVID-19 Pneumonia: Presented as above. Symptom onset 9/18/23, positive test 9/21/23. Required no supplemental O2 on admit.  Admit CXR with right lung patchy opacities. S/p Azithro/Rocephin in ED. No indication for Decadron, Remdesivir on admit. Started paxlovid 9/23 but unable to crush so did not receive. Isolation discontinued 9/30/23. 2. Metabolic encephalopathy: Likely secondary to hypoglycemia on 9/25/23, with possible hospital delirium component with underlying dementia. Ammonia wnl, CTH 9/25/23 nonacute. Memory impairment is worsened per family, possible new baseline. Required restraints, discontinued 9/29/23. Mildly improved. 3. Hypoglycemia, poor intake: BG 44 9/25. Stopped insulin and given glucagon and D5 infusion 9/25-9/27. NGT placed and started tube feeds 9/26/23 with daughter's permission. Pt pulled out NGT, per son 9/29/23 no further tube feeds and no PEG tube. RD followed. Encouraged oral intake and assisted with feeds. 4. Hyponatremia : Na+ 125 on 10/3- from 130 on 10/2/23- suspect related to poor oral intake. Improved with normal saline 5. Generalized weakness: Suspect in the setting of viral infection. Supportive care. 6. Polycythemia: Admit Hgb 16.5. Possibly in the setting of dehydration. Monitored. 7. Thrombocytopenia: Admit Platelets 130, suspect due to acute illness. No signs of bleeding. Monitored CBC. 8. Chronic HFpEF: Per history, follows with Dr. TTE 3/1/22 with EF 65%, moderate to severe TR, mild AR, abnormal septal motion due to high right-sided pressure. Stopped home torsemide and aldactone given poor intake. 9. Persistent atrial fibrillation: per history, follows with Dr., s/p multiple cardioversions and PPM. Continued home BB, Eliquis. Monitored on tele.  10. HTN: Per history. Uncontrolled. Continued home BB, stopped diuretics. Monitored. 11. IDDM2: HgbA1c 6.3 9/2/22. Held home Januvia on admit, continued home basal insulin with added SSI while inpatient. Stopped insulin 9/25 and stopped home meds due to hypoglycemia.   12. Dementia: Per history with recent decline per notes 05/2023. Delirium precautions.  13. Code status: DNRCCA/DNI, discussed 9/29/23.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Gastrointestinal tube insertion, Glycosylated haemoglobin, Haemoglobin, Hypoglycaemia, Hyponatraemia
Clinical narrative: Patient is a 85 y.o. female with a history of dementia, HFpEF, afib on Eliquis, IDDM2 who presented to hospital 9/21/2023 with cough and dyspnea x4 days found to be COVID positive. CXR showed right lung patchy opacities. Course complicated by poor intake and hypoglycemia requiring initiation of tube feeds but patient pulled out NGT. Family decided against tube feeds after Palliative team meeting.   1. COVID-19 Pneumonia: Presented as above. Symptom onset 9/18/23, positive test 9/21/23. Required no supplemental O2 on admit.  Admit CXR with right lung patchy opacities. S/p Azithro/Rocephin in ED. No indication for Decadron, Remdesivir on admit. Started paxlovid 9/23 but unable to crush so did not receive. Isolation discontinued 9/30/23. 2. Metabolic encephalopathy: Likely secondary to hypoglycemia on 9/25/23, with possible hospital delirium component with underlying dementia. Ammonia wnl, CTH 9/25/23 nonacute. Memory impairment is worsened per family, possible new baseline. Required restraints, discontinued 9/29/23. Mildly improved. 3. Hypoglycemia, poor intake: BG 44 9/25. Stopped insulin and given glucagon and D5 infusion 9/25-9/27. NGT placed and started tube feeds 9/26/23 with daughter's permission. Pt pulled out NGT, per son 9/29/23 no further tube feeds and no PEG tube. RD followed. Encouraged oral intake and assisted with feeds. 4. Hyponatremia : Na+ 125 on 10/3- from 130 on 10/2/23- suspect related to poor oral intake. Improved with normal saline 5. Generalized weakness: Suspect in the setting of viral infection. Supportive care. 6. Polycythemia: Admit Hgb 16.5. Possibly in the setting of dehydration. Monitored. 7. Thrombocytopenia: Admit Platelets 130, suspect due to acute illness. No signs of bleeding. Monitored CBC. 8. Chronic HFpEF: Per history, follows with Dr. TTE 3/1/22 with EF 65%, moderate to severe TR, mild AR, abnormal septal motion due to high right-sided pressure. Stopped home torsemide and aldactone given poor intake. 9. Persistent atrial fibrillation: per history, follows with Dr., s/p multiple cardioversions and PPM. Continued home BB, Eliquis. Monitored on tele.  10. HTN: Per history. Uncontrolled. Continued home BB, stopped diuretics. Monitored. 11. IDDM2: HgbA1c 6.3 9/2/22. Held home Januvia on admit, continued home basal insulin with added SSI while inpatient. Stopped insulin 9/25 and stopped home meds due to hypoglycemia.   12. Dementia: Per history with recent decline per notes 05/2023. Delirium precautions.  13. Code status: DNRCCA/DNI, discussed 9/29/23.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Hypophagia, Lung opacity, Memory impairment, Metabolic encephalopathy, Patient restraint
Clinical narrative: Patient is a 85 y.o. female with a history of dementia, HFpEF, afib on Eliquis, IDDM2 who presented to hospital 9/21/2023 with cough and dyspnea x4 days found to be COVID positive. CXR showed right lung patchy opacities. Course complicated by poor intake and hypoglycemia requiring initiation of tube feeds but patient pulled out NGT. Family decided against tube feeds after Palliative team meeting.   1. COVID-19 Pneumonia: Presented as above. Symptom onset 9/18/23, positive test 9/21/23. Required no supplemental O2 on admit.  Admit CXR with right lung patchy opacities. S/p Azithro/Rocephin in ED. No indication for Decadron, Remdesivir on admit. Started paxlovid 9/23 but unable to crush so did not receive. Isolation discontinued 9/30/23. 2. Metabolic encephalopathy: Likely secondary to hypoglycemia on 9/25/23, with possible hospital delirium component with underlying dementia. Ammonia wnl, CTH 9/25/23 nonacute. Memory impairment is worsened per family, possible new baseline. Required restraints, discontinued 9/29/23. Mildly improved. 3. Hypoglycemia, poor intake: BG 44 9/25. Stopped insulin and given glucagon and D5 infusion 9/25-9/27. NGT placed and started tube feeds 9/26/23 with daughter's permission. Pt pulled out NGT, per son 9/29/23 no further tube feeds and no PEG tube. RD followed. Encouraged oral intake and assisted with feeds. 4. Hyponatremia : Na+ 125 on 10/3- from 130 on 10/2/23- suspect related to poor oral intake. Improved with normal saline 5. Generalized weakness: Suspect in the setting of viral infection. Supportive care. 6. Polycythemia: Admit Hgb 16.5. Possibly in the setting of dehydration. Monitored. 7. Thrombocytopenia: Admit Platelets 130, suspect due to acute illness. No signs of bleeding. Monitored CBC. 8. Chronic HFpEF: Per history, follows with Dr. TTE 3/1/22 with EF 65%, moderate to severe TR, mild AR, abnormal septal motion due to high right-sided pressure. Stopped home torsemide and aldactone given poor intake. 9. Persistent atrial fibrillation: per history, follows with Dr., s/p multiple cardioversions and PPM. Continued home BB, Eliquis. Monitored on tele.  10. HTN: Per history. Uncontrolled. Continued home BB, stopped diuretics. Monitored. 11. IDDM2: HgbA1c 6.3 9/2/22. Held home Januvia on admit, continued home basal insulin with added SSI while inpatient. Stopped insulin 9/25 and stopped home meds due to hypoglycemia.   12. Dementia: Per history with recent decline per notes 05/2023. Delirium precautions.  13. Code status: DNRCCA/DNI, discussed 9/29/23.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Platelet count decreased, Polycythaemia, SARS-CoV-2 test positive, Thrombocytopenia, Tricuspid valve incompetence
Clinical narrative: Patient is a 85 y.o. female with a history of dementia, HFpEF, afib on Eliquis, IDDM2 who presented to hospital 9/21/2023 with cough and dyspnea x4 days found to be COVID positive. CXR showed right lung patchy opacities. Course complicated by poor intake and hypoglycemia requiring initiation of tube feeds but patient pulled out NGT. Family decided against tube feeds after Palliative team meeting.   1. COVID-19 Pneumonia: Presented as above. Symptom onset 9/18/23, positive test 9/21/23. Required no supplemental O2 on admit.  Admit CXR with right lung patchy opacities. S/p Azithro/Rocephin in ED. No indication for Decadron, Remdesivir on admit. Started paxlovid 9/23 but unable to crush so did not receive. Isolation discontinued 9/30/23. 2. Metabolic encephalopathy: Likely secondary to hypoglycemia on 9/25/23, with possible hospital delirium component with underlying dementia. Ammonia wnl, CTH 9/25/23 nonacute. Memory impairment is worsened per family, possible new baseline. Required restraints, discontinued 9/29/23. Mildly improved. 3. Hypoglycemia, poor intake: BG 44 9/25. Stopped insulin and given glucagon and D5 infusion 9/25-9/27. NGT placed and started tube feeds 9/26/23 with daughter's permission. Pt pulled out NGT, per son 9/29/23 no further tube feeds and no PEG tube. RD followed. Encouraged oral intake and assisted with feeds. 4. Hyponatremia : Na+ 125 on 10/3- from 130 on 10/2/23- suspect related to poor oral intake. Improved with normal saline 5. Generalized weakness: Suspect in the setting of viral infection. Supportive care. 6. Polycythemia: Admit Hgb 16.5. Possibly in the setting of dehydration. Monitored. 7. Thrombocytopenia: Admit Platelets 130, suspect due to acute illness. No signs of bleeding. Monitored CBC. 8. Chronic HFpEF: Per history, follows with Dr. TTE 3/1/22 with EF 65%, moderate to severe TR, mild AR, abnormal septal motion due to high right-sided pressure. Stopped home torsemide and aldactone given poor intake. 9. Persistent atrial fibrillation: per history, follows with Dr., s/p multiple cardioversions and PPM. Continued home BB, Eliquis. Monitored on tele.  10. HTN: Per history. Uncontrolled. Continued home BB, stopped diuretics. Monitored. 11. IDDM2: HgbA1c 6.3 9/2/22. Held home Januvia on admit, continued home basal insulin with added SSI while inpatient. Stopped insulin 9/25 and stopped home meds due to hypoglycemia.   12. Dementia: Per history with recent decline per notes 05/2023. Delirium precautions.  13. Code status: DNRCCA/DNI, discussed 9/29/23.
Age: 11.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 1.08
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Expired product administered
Clinical narrative: Patient was administered expired; vaccine expiration date sticker 12/18/2023, given 12/19/2023
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Bronchial secretion retention, C-reactive protein increased, COVID-19, Chest X-ray abnormal
Clinical narrative: Patient is a 64 y.o. male patient of, MD with history of esophageal  cancer s/p stent ( metastaic to liver, follows with dr),  COPD, HTN, HLD, PAD,  prostate cancer, DM2 and OSA ( on 2L o2 at home) , hx of Right ankle fracture ( s/p ORIF), and chronic pain ( on polypharmacy) with recurrent admissions for hypoxia and shortness of breath was brought to hospital rom home by family for another episode of shortness of breath and increased oxygen need. Of note, he was just admitted here from 9/20/23 to 9/29/23 for acute on chronic respiratory failure  when he was intubated and was treated for Pseudomonas pneumonia and mucus plug.     Acute on Chronic Hypoxemic Respiratory Failure Patient stated when he uses 2 L NC nightly And on and off 1 L during the day On admission was somnolent and hypoxic Somewhat improved with IV Narcan CT showed bibasilar infiltrates, concerning for aspiration Had a recent hospitalization for Pseudomonas PNA, completed 7-day course Was able to wean to 2 L NC ATC, based on predischarge O2 eval         COVID-19 infection Covid-19 Virus Infection Date of onset of symptoms: 10/1/2023 Symptoms present on admission: Dyspnea, hypoxia Date of covid positive test: 10/1/2023 Vaccination status: vaccinated Imaging: CT chest - right lung and LLL consolidation, CXR-interstitial edema vs pneumonia, stable right pleural effusion Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L Medical therapy: remdesivir and steroids Consultants following: Infectious disease Anticipated special isolation end date: 10/11/2023 CRP 109, D-dimer 2.79, ferritin 586   ID was consulted, DC to oral antibiotics Will complete 10 days of dexamethasone course   COPD with continued tobacco use No evidence of exacerbation  Continue nebulizer  Reinforced smoking cessation    DM2 Continue home medications   Metastatic Adenocarcinoma of Esophagus Follows with Hem/onc Dr.  He has hx of  esophageal stenting at facility, denies dysphagia symptoms S/p hx of cycle 6 of FOLFOX therapy completion Resume OP f/u with dr as needed     Prostate Cancer Follows with Urology On abiraterone and prednisone >change prednisone to stress doe, hold abiraterone while here Resume OP urology f/u Chronic pain Peripheral neuropathy Polypharmacy Continue home medications after discharge   HLD Continue statin   PAD Continue cilostazil, plavix and statin   OSA Uses nocturnal 2L NC,    Hx of R Ankle Fracture Follows with Dr.   Hx of bimalleolar fx in May 2023, s/p ORIF with delayed healing and wound dehiscence C/w local care      Physical deconditioning Insomnia Continue home medications after discharge   Severe malnutrition POA Consult dietitian
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Computerised tomogram thorax abnormal, Dyspnoea, Endotracheal intubation, Fibrin D dimer, Hypoxia
Clinical narrative: Patient is a 64 y.o. male patient of, MD with history of esophageal  cancer s/p stent ( metastaic to liver, follows with dr),  COPD, HTN, HLD, PAD,  prostate cancer, DM2 and OSA ( on 2L o2 at home) , hx of Right ankle fracture ( s/p ORIF), and chronic pain ( on polypharmacy) with recurrent admissions for hypoxia and shortness of breath was brought to hospital rom home by family for another episode of shortness of breath and increased oxygen need. Of note, he was just admitted here from 9/20/23 to 9/29/23 for acute on chronic respiratory failure  when he was intubated and was treated for Pseudomonas pneumonia and mucus plug.     Acute on Chronic Hypoxemic Respiratory Failure Patient stated when he uses 2 L NC nightly And on and off 1 L during the day On admission was somnolent and hypoxic Somewhat improved with IV Narcan CT showed bibasilar infiltrates, concerning for aspiration Had a recent hospitalization for Pseudomonas PNA, completed 7-day course Was able to wean to 2 L NC ATC, based on predischarge O2 eval         COVID-19 infection Covid-19 Virus Infection Date of onset of symptoms: 10/1/2023 Symptoms present on admission: Dyspnea, hypoxia Date of covid positive test: 10/1/2023 Vaccination status: vaccinated Imaging: CT chest - right lung and LLL consolidation, CXR-interstitial edema vs pneumonia, stable right pleural effusion Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L Medical therapy: remdesivir and steroids Consultants following: Infectious disease Anticipated special isolation end date: 10/11/2023 CRP 109, D-dimer 2.79, ferritin 586   ID was consulted, DC to oral antibiotics Will complete 10 days of dexamethasone course   COPD with continued tobacco use No evidence of exacerbation  Continue nebulizer  Reinforced smoking cessation    DM2 Continue home medications   Metastatic Adenocarcinoma of Esophagus Follows with Hem/onc Dr.  He has hx of  esophageal stenting at facility, denies dysphagia symptoms S/p hx of cycle 6 of FOLFOX therapy completion Resume OP f/u with dr as needed     Prostate Cancer Follows with Urology On abiraterone and prednisone >change prednisone to stress doe, hold abiraterone while here Resume OP urology f/u Chronic pain Peripheral neuropathy Polypharmacy Continue home medications after discharge   HLD Continue statin   PAD Continue cilostazil, plavix and statin   OSA Uses nocturnal 2L NC,    Hx of R Ankle Fracture Follows with Dr.   Hx of bimalleolar fx in May 2023, s/p ORIF with delayed healing and wound dehiscence C/w local care      Physical deconditioning Insomnia Continue home medications after discharge   Severe malnutrition POA Consult dietitian
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Impaired healing, Insomnia, Lung consolidation, Lung infiltration, Malaise
Clinical narrative: Patient is a 64 y.o. male patient of, MD with history of esophageal  cancer s/p stent ( metastaic to liver, follows with dr),  COPD, HTN, HLD, PAD,  prostate cancer, DM2 and OSA ( on 2L o2 at home) , hx of Right ankle fracture ( s/p ORIF), and chronic pain ( on polypharmacy) with recurrent admissions for hypoxia and shortness of breath was brought to hospital rom home by family for another episode of shortness of breath and increased oxygen need. Of note, he was just admitted here from 9/20/23 to 9/29/23 for acute on chronic respiratory failure  when he was intubated and was treated for Pseudomonas pneumonia and mucus plug.     Acute on Chronic Hypoxemic Respiratory Failure Patient stated when he uses 2 L NC nightly And on and off 1 L during the day On admission was somnolent and hypoxic Somewhat improved with IV Narcan CT showed bibasilar infiltrates, concerning for aspiration Had a recent hospitalization for Pseudomonas PNA, completed 7-day course Was able to wean to 2 L NC ATC, based on predischarge O2 eval         COVID-19 infection Covid-19 Virus Infection Date of onset of symptoms: 10/1/2023 Symptoms present on admission: Dyspnea, hypoxia Date of covid positive test: 10/1/2023 Vaccination status: vaccinated Imaging: CT chest - right lung and LLL consolidation, CXR-interstitial edema vs pneumonia, stable right pleural effusion Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L Medical therapy: remdesivir and steroids Consultants following: Infectious disease Anticipated special isolation end date: 10/11/2023 CRP 109, D-dimer 2.79, ferritin 586   ID was consulted, DC to oral antibiotics Will complete 10 days of dexamethasone course   COPD with continued tobacco use No evidence of exacerbation  Continue nebulizer  Reinforced smoking cessation    DM2 Continue home medications   Metastatic Adenocarcinoma of Esophagus Follows with Hem/onc Dr.  He has hx of  esophageal stenting at facility, denies dysphagia symptoms S/p hx of cycle 6 of FOLFOX therapy completion Resume OP f/u with dr as needed     Prostate Cancer Follows with Urology On abiraterone and prednisone >change prednisone to stress doe, hold abiraterone while here Resume OP urology f/u Chronic pain Peripheral neuropathy Polypharmacy Continue home medications after discharge   HLD Continue statin   PAD Continue cilostazil, plavix and statin   OSA Uses nocturnal 2L NC,    Hx of R Ankle Fracture Follows with Dr.   Hx of bimalleolar fx in May 2023, s/p ORIF with delayed healing and wound dehiscence C/w local care      Physical deconditioning Insomnia Continue home medications after discharge   Severe malnutrition POA Consult dietitian
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Malnutrition, Physical deconditioning, Pleural effusion, Pneumonia pseudomonal, Pulmonary oedema
Clinical narrative: Patient is a 64 y.o. male patient of, MD with history of esophageal  cancer s/p stent ( metastaic to liver, follows with dr),  COPD, HTN, HLD, PAD,  prostate cancer, DM2 and OSA ( on 2L o2 at home) , hx of Right ankle fracture ( s/p ORIF), and chronic pain ( on polypharmacy) with recurrent admissions for hypoxia and shortness of breath was brought to hospital rom home by family for another episode of shortness of breath and increased oxygen need. Of note, he was just admitted here from 9/20/23 to 9/29/23 for acute on chronic respiratory failure  when he was intubated and was treated for Pseudomonas pneumonia and mucus plug.     Acute on Chronic Hypoxemic Respiratory Failure Patient stated when he uses 2 L NC nightly And on and off 1 L during the day On admission was somnolent and hypoxic Somewhat improved with IV Narcan CT showed bibasilar infiltrates, concerning for aspiration Had a recent hospitalization for Pseudomonas PNA, completed 7-day course Was able to wean to 2 L NC ATC, based on predischarge O2 eval         COVID-19 infection Covid-19 Virus Infection Date of onset of symptoms: 10/1/2023 Symptoms present on admission: Dyspnea, hypoxia Date of covid positive test: 10/1/2023 Vaccination status: vaccinated Imaging: CT chest - right lung and LLL consolidation, CXR-interstitial edema vs pneumonia, stable right pleural effusion Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L Medical therapy: remdesivir and steroids Consultants following: Infectious disease Anticipated special isolation end date: 10/11/2023 CRP 109, D-dimer 2.79, ferritin 586   ID was consulted, DC to oral antibiotics Will complete 10 days of dexamethasone course   COPD with continued tobacco use No evidence of exacerbation  Continue nebulizer  Reinforced smoking cessation    DM2 Continue home medications   Metastatic Adenocarcinoma of Esophagus Follows with Hem/onc Dr.  He has hx of  esophageal stenting at facility, denies dysphagia symptoms S/p hx of cycle 6 of FOLFOX therapy completion Resume OP f/u with dr as needed     Prostate Cancer Follows with Urology On abiraterone and prednisone >change prednisone to stress doe, hold abiraterone while here Resume OP urology f/u Chronic pain Peripheral neuropathy Polypharmacy Continue home medications after discharge   HLD Continue statin   PAD Continue cilostazil, plavix and statin   OSA Uses nocturnal 2L NC,    Hx of R Ankle Fracture Follows with Dr.   Hx of bimalleolar fx in May 2023, s/p ORIF with delayed healing and wound dehiscence C/w local care      Physical deconditioning Insomnia Continue home medications after discharge   Severe malnutrition POA Consult dietitian
Age: 63.0
Sex: M
Vaccine: COVID19-2
Symptoms: Respiratory failure, SARS-CoV-2 test positive, Serum ferritin increased, Somnolence, Wound dehiscence
Clinical narrative: Patient is a 64 y.o. male patient of, MD with history of esophageal  cancer s/p stent ( metastaic to liver, follows with dr),  COPD, HTN, HLD, PAD,  prostate cancer, DM2 and OSA ( on 2L o2 at home) , hx of Right ankle fracture ( s/p ORIF), and chronic pain ( on polypharmacy) with recurrent admissions for hypoxia and shortness of breath was brought to hospital rom home by family for another episode of shortness of breath and increased oxygen need. Of note, he was just admitted here from 9/20/23 to 9/29/23 for acute on chronic respiratory failure  when he was intubated and was treated for Pseudomonas pneumonia and mucus plug.     Acute on Chronic Hypoxemic Respiratory Failure Patient stated when he uses 2 L NC nightly And on and off 1 L during the day On admission was somnolent and hypoxic Somewhat improved with IV Narcan CT showed bibasilar infiltrates, concerning for aspiration Had a recent hospitalization for Pseudomonas PNA, completed 7-day course Was able to wean to 2 L NC ATC, based on predischarge O2 eval         COVID-19 infection Covid-19 Virus Infection Date of onset of symptoms: 10/1/2023 Symptoms present on admission: Dyspnea, hypoxia Date of covid positive test: 10/1/2023 Vaccination status: vaccinated Imaging: CT chest - right lung and LLL consolidation, CXR-interstitial edema vs pneumonia, stable right pleural effusion Oxygen requirements on admission: 4 L Current oxygen requirements: 4 L Medical therapy: remdesivir and steroids Consultants following: Infectious disease Anticipated special isolation end date: 10/11/2023 CRP 109, D-dimer 2.79, ferritin 586   ID was consulted, DC to oral antibiotics Will complete 10 days of dexamethasone course   COPD with continued tobacco use No evidence of exacerbation  Continue nebulizer  Reinforced smoking cessation    DM2 Continue home medications   Metastatic Adenocarcinoma of Esophagus Follows with Hem/onc Dr.  He has hx of  esophageal stenting at facility, denies dysphagia symptoms S/p hx of cycle 6 of FOLFOX therapy completion Resume OP f/u with dr as needed     Prostate Cancer Follows with Urology On abiraterone and prednisone >change prednisone to stress doe, hold abiraterone while here Resume OP urology f/u Chronic pain Peripheral neuropathy Polypharmacy Continue home medications after discharge   HLD Continue statin   PAD Continue cilostazil, plavix and statin   OSA Uses nocturnal 2L NC,    Hx of R Ankle Fracture Follows with Dr.   Hx of bimalleolar fx in May 2023, s/p ORIF with delayed healing and wound dehiscence C/w local care      Physical deconditioning Insomnia Continue home medications after discharge   Severe malnutrition POA Consult dietitian
Age: 8.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse effects known, but patient was administered the vaccination past the "beyond use date" that goes into effect when changed from being stored frozen to refrigerated.
Age: 100.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid abnormal, Cerebrovascular accident, Middle cerebral artery stroke, Perfusion brain scan abnormal
Clinical narrative: Right MCA, CVA Not a candidate for TNK or thrombectomy
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood culture negative, Blood gases normal, Blood potassium decreased, Blood pressure increased
Clinical narrative: Patient is a 53 y.o. male patient of DO with history of HTN, HLD, CAD s/p PCI, OA, fibromyalgia presented to Hospital with chest pain, SOB. Problem based management in the hospital is as follows:   Acute Hypoxic Respiratory Failure, resoled COVID-19 virus pneumonia Acute onset chest pain/shortness of breath early a.m. 9/30.  O2 sats initially 89% on room air with swift recovery with 4 to 6 L nasal cannula. VBG wnl. CXR with interstitial opacities, edema versus infiltrates.  CT PE with no PE, pulmonary edema with bilateral pleural effusions. COVID (+). Suspect AHRF multifactorial due to COVID, slight volume overload.  Continued scheduled breathing treatments, prn albuterol S/p 60mg solumedrol in ED, de-escalated Decadron, discharged on taper Received remdesivir x2 days Continue supplemental O2 to maintain sats >90%, now back on room air Blood and sputum cultures NTD Procal negative ID were following   Chest Pain, resolved CAD s/p PCI Chronic Angina Elevated Troponin  Elevated BNP Known coronary disease and chronic angina with previous left heart cath 7/12/2022 with DES x3 across chronically occluded circumflex artery/obtuse marginal branch.  Distally noted to have moderate right coronary disease, and patent stent previously placed in LAD, 30% proximal left main lesion.  Has since had an echo 3/23 which was normal. Repeat stress test 3/23 due to ongoing chest pain, that despite being abnormal showed no ischemia.  Last follow-up with Dr. 6/7/2023 with recommendation to continue current regimen, continue DAPT for now.  In ED, BNP 117, initial trop 85-- >202. ECG with ST depressions I, II, aVl, normal T  waves.  Imaging with noted pulmonary edema. States current symptoms feel more severe than chronic angina, does not have radiation similar to last time when he had an MI.  Given up-trending trop/non-specific ECG abnormalities, initiated on heparin drip, discontinued heparin drip at discharge Gentle IV lasix 20mg x1 Monitored on Tele Continued plavix, ranolazine, imdur HTN tx as below Cardiology consulted, appreciate recs, do not feel respiratory failure secondary to heart failure, no further inpatient work-up recommended.   Hypokalemia, resolved K 3.3 on admission, s/p 40mEq KCl  HTN BP on arrival 209/133-- >170/84. Suspect elevated trop as above related to acute illness and not indicative of hypertensive emergency from elevated BP.  Continued home meds   HLD Continued statin   T2DM Diabetic Neuropathy Gastroparesis Last A1c 1/20/23 was 8.2. Current home meds include: glipizide 10mgTID, 70/30 30u BID.  Lantus 20 units + SSI while admitted,  Discharged back on home meds   Fibromyalgia Continued prn tramadol   Depression Continued sertraline   RLS Continued requip   BPH Continued flomax   OSA Does not tolerate CPAP. Currently being evaluated for Inspire   After 2 days of hospital stay, patient was doing well so he was discharged in stable condition. Advised to f/u with PCP and cardiology. All questions and concerns were addressed before discharge.