chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anaemia, Anaemia of chronic disease, Blood creatinine increased, Bronchiectasis
Clinical narrative: Patient is a 67 y.o. male patient of DO with history of pulmonary hypertension, COPD with chronic respiratory failure ( on home o2 at 2L), bronchiectasis, hypertension, IgA deficiency, chronic kidney disease presented with worsening shortness of breath admitted for further evaluation and treatment   Acute on chronic hypoxic respiratory failure Bronchiectasis COPD exacerbation - Continue IV decadron, supportive O2, bronchodilator - Appreciate pulmonary assistance - Discharged home on baseline O2 and 10 days of decadron 6mg daily   Positive COVID-19 - Up to date with vaccination including boosters x2 - Continue IV steroids, O2 support, deferring on IV remdesivir given length of illness   Acute on chronic anemia - Suspect due to underlying CKD - Transfuse 1 unit of PRBC for Hb 6.6 - Hb on discharge day was 7.7 - Repeat CBC in 1 week   Chronic kidney disease stage IV - Baseline creatinine is 2.4, presented with a creatinine of 2.6 - Continue bumex - Repeat labs in a week  - Follows up with nephrology as an outpatient (Dr.)   IgA deficiency - On weekly Hizentra   Hypertension Home regimen; Coreg 25 twice daily, Cardura 8 mg nightly    Histoplasmosis High titers noted with high fungitell Per ID planning for 12-week course of itraconazole Arranged 12/1/22 follow up with Dr. - may repeat CT at the end of 3 month course of itraconazole Discontinue cefepime after discussion with ID given sputum culture
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chronic kidney disease, Chronic obstructive pulmonary disease, Computerised tomogram, Condition aggravated
Clinical narrative: Patient is a 67 y.o. male patient of DO with history of pulmonary hypertension, COPD with chronic respiratory failure ( on home o2 at 2L), bronchiectasis, hypertension, IgA deficiency, chronic kidney disease presented with worsening shortness of breath admitted for further evaluation and treatment   Acute on chronic hypoxic respiratory failure Bronchiectasis COPD exacerbation - Continue IV decadron, supportive O2, bronchodilator - Appreciate pulmonary assistance - Discharged home on baseline O2 and 10 days of decadron 6mg daily   Positive COVID-19 - Up to date with vaccination including boosters x2 - Continue IV steroids, O2 support, deferring on IV remdesivir given length of illness   Acute on chronic anemia - Suspect due to underlying CKD - Transfuse 1 unit of PRBC for Hb 6.6 - Hb on discharge day was 7.7 - Repeat CBC in 1 week   Chronic kidney disease stage IV - Baseline creatinine is 2.4, presented with a creatinine of 2.6 - Continue bumex - Repeat labs in a week  - Follows up with nephrology as an outpatient (Dr.)   IgA deficiency - On weekly Hizentra   Hypertension Home regimen; Coreg 25 twice daily, Cardura 8 mg nightly    Histoplasmosis High titers noted with high fungitell Per ID planning for 12-week course of itraconazole Arranged 12/1/22 follow up with Dr. - may repeat CT at the end of 3 month course of itraconazole Discontinue cefepime after discussion with ID given sputum culture
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Full blood count, Fungal test positive, Haemoglobin decreased, Histoplasmosis
Clinical narrative: Patient is a 67 y.o. male patient of DO with history of pulmonary hypertension, COPD with chronic respiratory failure ( on home o2 at 2L), bronchiectasis, hypertension, IgA deficiency, chronic kidney disease presented with worsening shortness of breath admitted for further evaluation and treatment   Acute on chronic hypoxic respiratory failure Bronchiectasis COPD exacerbation - Continue IV decadron, supportive O2, bronchodilator - Appreciate pulmonary assistance - Discharged home on baseline O2 and 10 days of decadron 6mg daily   Positive COVID-19 - Up to date with vaccination including boosters x2 - Continue IV steroids, O2 support, deferring on IV remdesivir given length of illness   Acute on chronic anemia - Suspect due to underlying CKD - Transfuse 1 unit of PRBC for Hb 6.6 - Hb on discharge day was 7.7 - Repeat CBC in 1 week   Chronic kidney disease stage IV - Baseline creatinine is 2.4, presented with a creatinine of 2.6 - Continue bumex - Repeat labs in a week  - Follows up with nephrology as an outpatient (Dr.)   IgA deficiency - On weekly Hizentra   Hypertension Home regimen; Coreg 25 twice daily, Cardura 8 mg nightly    Histoplasmosis High titers noted with high fungitell Per ID planning for 12-week course of itraconazole Arranged 12/1/22 follow up with Dr. - may repeat CT at the end of 3 month course of itraconazole Discontinue cefepime after discussion with ID given sputum culture
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Hypertension, Laboratory test abnormal, Red blood cell transfusion, Respiratory failure, SARS-CoV-2 test positive
Clinical narrative: Patient is a 67 y.o. male patient of DO with history of pulmonary hypertension, COPD with chronic respiratory failure ( on home o2 at 2L), bronchiectasis, hypertension, IgA deficiency, chronic kidney disease presented with worsening shortness of breath admitted for further evaluation and treatment   Acute on chronic hypoxic respiratory failure Bronchiectasis COPD exacerbation - Continue IV decadron, supportive O2, bronchodilator - Appreciate pulmonary assistance - Discharged home on baseline O2 and 10 days of decadron 6mg daily   Positive COVID-19 - Up to date with vaccination including boosters x2 - Continue IV steroids, O2 support, deferring on IV remdesivir given length of illness   Acute on chronic anemia - Suspect due to underlying CKD - Transfuse 1 unit of PRBC for Hb 6.6 - Hb on discharge day was 7.7 - Repeat CBC in 1 week   Chronic kidney disease stage IV - Baseline creatinine is 2.4, presented with a creatinine of 2.6 - Continue bumex - Repeat labs in a week  - Follows up with nephrology as an outpatient (Dr.)   IgA deficiency - On weekly Hizentra   Hypertension Home regimen; Coreg 25 twice daily, Cardura 8 mg nightly    Histoplasmosis High titers noted with high fungitell Per ID planning for 12-week course of itraconazole Arranged 12/1/22 follow up with Dr. - may repeat CT at the end of 3 month course of itraconazole Discontinue cefepime after discussion with ID given sputum culture
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Selective IgA immunodeficiency, Sputum culture
Clinical narrative: Patient is a 67 y.o. male patient of DO with history of pulmonary hypertension, COPD with chronic respiratory failure ( on home o2 at 2L), bronchiectasis, hypertension, IgA deficiency, chronic kidney disease presented with worsening shortness of breath admitted for further evaluation and treatment   Acute on chronic hypoxic respiratory failure Bronchiectasis COPD exacerbation - Continue IV decadron, supportive O2, bronchodilator - Appreciate pulmonary assistance - Discharged home on baseline O2 and 10 days of decadron 6mg daily   Positive COVID-19 - Up to date with vaccination including boosters x2 - Continue IV steroids, O2 support, deferring on IV remdesivir given length of illness   Acute on chronic anemia - Suspect due to underlying CKD - Transfuse 1 unit of PRBC for Hb 6.6 - Hb on discharge day was 7.7 - Repeat CBC in 1 week   Chronic kidney disease stage IV - Baseline creatinine is 2.4, presented with a creatinine of 2.6 - Continue bumex - Repeat labs in a week  - Follows up with nephrology as an outpatient (Dr.)   IgA deficiency - On weekly Hizentra   Hypertension Home regimen; Coreg 25 twice daily, Cardura 8 mg nightly    Histoplasmosis High titers noted with high fungitell Per ID planning for 12-week course of itraconazole Arranged 12/1/22 follow up with Dr. - may repeat CT at the end of 3 month course of itraconazole Discontinue cefepime after discussion with ID given sputum culture
Age: 79.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Chills, Cough, Exposure to SARS-CoV-2, Fatigue
Clinical narrative: I did not have a reaction to the vaccine, I caught COVID one month later at a small theater group event.  After exposure, it was about 3 or 4 days before symptoms presented in the form of chills, fatigue, cough and sore throat.  No fever and no other symptoms.  COVID test showed positive, and I went to Urgent Care for treatment.  They did a throat swab and confirmed I also had Strep throat.  They prescribed meds to relieve the persistent cough. This was on Saturday, November 5.
Age: 79.0
Sex: F
Vaccine: COVID19-2
Symptoms: Oropharyngeal pain, Pharyngitis streptococcal, SARS-CoV-2 test positive, Streptococcus test positive
Clinical narrative: I did not have a reaction to the vaccine, I caught COVID one month later at a small theater group event.  After exposure, it was about 3 or 4 days before symptoms presented in the form of chills, fatigue, cough and sore throat.  No fever and no other symptoms.  COVID test showed positive, and I went to Urgent Care for treatment.  They did a throat swab and confirmed I also had Strep throat.  They prescribed meds to relieve the persistent cough. This was on Saturday, November 5.
Age: 23.0
Sex: M
Vaccine: COVID19-2
Symptoms: Incorrect product formulation administered
Clinical narrative: Patient was given BiValent Booster as the First dose in series
Age: 81.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Vaccine was exposed to storage temperature outside the recommended ranges. Patient did not need any treatment and did not have any symptoms.
Age: 67.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Mental status changes, SARS-CoV-2 test positive
Clinical narrative: 09/14/22 presents to ED for "altered mental status". PMHx of "dyslipidemia, thyroid disease, anemia and chronic shoulder pain"
Age: 37.0
Sex: M
Vaccine: COVID19-2
Symptoms: No adverse event, Product preparation error
Clinical narrative: patient was administered 0.3ml of pfizer bivalent 5-11years with out diluted. no adverse reaction or side effects noted
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Bladder scan, Blood creatinine increased, Blood gases
Clinical narrative: Patient is a pleasant 66 y.o. male patient of DO with a PMHx of CAD s/p PCI in 2015, cAF on Eliquis presenting with hemoptysis, SOB.   Acute hypoxic respiratory failure d/t, resolved  Post-viral bacterial pneumonia +COVID-19 infection Hemoptysis  1 week of cough, malaise, body aches. Brief period of improvement before recurrence of worsening sxs. Cough now productive w small volume hemoptysis (streaked sputum) Afebrile, HR 75, BP 102/57, RR 27, satting 91% on 2L CBC w mild leukocytosis (WBC 12.6). Trop 7, ProBNP 1.2K. VBG 7.41/39.3.  COVID+, influenza neg. Vaccinated x2, no boosters CXR (AP/LAT) with RML/RLL consolidation. No vascular congestion Currently on 2L supplemental O2, wean to goal SpO2 > 92% Abx coverage with Rocephin and Azithromycin, transition to Augmentin 10/22/22 Cont decadron but hold off on Remdesivir, course c/w post-viral PNA Strep pneu urine antigen + Procal 2.76, CRP 137,  Scheduled Mucinex. Robitussin-DM, Tylenol, nebs PRN Vibratory PEP and IS ordered, encourage use Continue Augmentin and decadron for 10 days total  Return precautions discussed    Acute kidney injury, resolved  Initial Cr 1.4 (baseline ~1.0)  Likely prerenal from above in the setting of ACEi Gentle resuscitation with NS gtt @ 100cc/hr for 1L total Hold home Lisinopril Bladder scan w PVR if e/o urinary retention Avoid nephrotoxic agents, renally adjust meds Daily RFPs, strict I&Os, daily weights to monitor   CAD s/p PCI in 2015 Chronic AF on Eliquis Continue home ASA, Lopressor, statin, Eliquis Discussed hold parameters for Lopressor and ACEi
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein increased, COVID-19, Chest X-ray abnormal, Dyspnoea, Full blood count abnormal
Clinical narrative: Patient is a pleasant 66 y.o. male patient of DO with a PMHx of CAD s/p PCI in 2015, cAF on Eliquis presenting with hemoptysis, SOB.   Acute hypoxic respiratory failure d/t, resolved  Post-viral bacterial pneumonia +COVID-19 infection Hemoptysis  1 week of cough, malaise, body aches. Brief period of improvement before recurrence of worsening sxs. Cough now productive w small volume hemoptysis (streaked sputum) Afebrile, HR 75, BP 102/57, RR 27, satting 91% on 2L CBC w mild leukocytosis (WBC 12.6). Trop 7, ProBNP 1.2K. VBG 7.41/39.3.  COVID+, influenza neg. Vaccinated x2, no boosters CXR (AP/LAT) with RML/RLL consolidation. No vascular congestion Currently on 2L supplemental O2, wean to goal SpO2 > 92% Abx coverage with Rocephin and Azithromycin, transition to Augmentin 10/22/22 Cont decadron but hold off on Remdesivir, course c/w post-viral PNA Strep pneu urine antigen + Procal 2.76, CRP 137,  Scheduled Mucinex. Robitussin-DM, Tylenol, nebs PRN Vibratory PEP and IS ordered, encourage use Continue Augmentin and decadron for 10 days total  Return precautions discussed    Acute kidney injury, resolved  Initial Cr 1.4 (baseline ~1.0)  Likely prerenal from above in the setting of ACEi Gentle resuscitation with NS gtt @ 100cc/hr for 1L total Hold home Lisinopril Bladder scan w PVR if e/o urinary retention Avoid nephrotoxic agents, renally adjust meds Daily RFPs, strict I&Os, daily weights to monitor   CAD s/p PCI in 2015 Chronic AF on Eliquis Continue home ASA, Lopressor, statin, Eliquis Discussed hold parameters for Lopressor and ACEi
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Haemoptysis, Influenza virus test negative, Leukocytosis, Lung consolidation, Malaise
Clinical narrative: Patient is a pleasant 66 y.o. male patient of DO with a PMHx of CAD s/p PCI in 2015, cAF on Eliquis presenting with hemoptysis, SOB.   Acute hypoxic respiratory failure d/t, resolved  Post-viral bacterial pneumonia +COVID-19 infection Hemoptysis  1 week of cough, malaise, body aches. Brief period of improvement before recurrence of worsening sxs. Cough now productive w small volume hemoptysis (streaked sputum) Afebrile, HR 75, BP 102/57, RR 27, satting 91% on 2L CBC w mild leukocytosis (WBC 12.6). Trop 7, ProBNP 1.2K. VBG 7.41/39.3.  COVID+, influenza neg. Vaccinated x2, no boosters CXR (AP/LAT) with RML/RLL consolidation. No vascular congestion Currently on 2L supplemental O2, wean to goal SpO2 > 92% Abx coverage with Rocephin and Azithromycin, transition to Augmentin 10/22/22 Cont decadron but hold off on Remdesivir, course c/w post-viral PNA Strep pneu urine antigen + Procal 2.76, CRP 137,  Scheduled Mucinex. Robitussin-DM, Tylenol, nebs PRN Vibratory PEP and IS ordered, encourage use Continue Augmentin and decadron for 10 days total  Return precautions discussed    Acute kidney injury, resolved  Initial Cr 1.4 (baseline ~1.0)  Likely prerenal from above in the setting of ACEi Gentle resuscitation with NS gtt @ 100cc/hr for 1L total Hold home Lisinopril Bladder scan w PVR if e/o urinary retention Avoid nephrotoxic agents, renally adjust meds Daily RFPs, strict I&Os, daily weights to monitor   CAD s/p PCI in 2015 Chronic AF on Eliquis Continue home ASA, Lopressor, statin, Eliquis Discussed hold parameters for Lopressor and ACEi
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Pain, Pneumonia bacterial, Pneumonia viral, Procalcitonin, Productive cough
Clinical narrative: Patient is a pleasant 66 y.o. male patient of DO with a PMHx of CAD s/p PCI in 2015, cAF on Eliquis presenting with hemoptysis, SOB.   Acute hypoxic respiratory failure d/t, resolved  Post-viral bacterial pneumonia +COVID-19 infection Hemoptysis  1 week of cough, malaise, body aches. Brief period of improvement before recurrence of worsening sxs. Cough now productive w small volume hemoptysis (streaked sputum) Afebrile, HR 75, BP 102/57, RR 27, satting 91% on 2L CBC w mild leukocytosis (WBC 12.6). Trop 7, ProBNP 1.2K. VBG 7.41/39.3.  COVID+, influenza neg. Vaccinated x2, no boosters CXR (AP/LAT) with RML/RLL consolidation. No vascular congestion Currently on 2L supplemental O2, wean to goal SpO2 > 92% Abx coverage with Rocephin and Azithromycin, transition to Augmentin 10/22/22 Cont decadron but hold off on Remdesivir, course c/w post-viral PNA Strep pneu urine antigen + Procal 2.76, CRP 137,  Scheduled Mucinex. Robitussin-DM, Tylenol, nebs PRN Vibratory PEP and IS ordered, encourage use Continue Augmentin and decadron for 10 days total  Return precautions discussed    Acute kidney injury, resolved  Initial Cr 1.4 (baseline ~1.0)  Likely prerenal from above in the setting of ACEi Gentle resuscitation with NS gtt @ 100cc/hr for 1L total Hold home Lisinopril Bladder scan w PVR if e/o urinary retention Avoid nephrotoxic agents, renally adjust meds Daily RFPs, strict I&Os, daily weights to monitor   CAD s/p PCI in 2015 Chronic AF on Eliquis Continue home ASA, Lopressor, statin, Eliquis Discussed hold parameters for Lopressor and ACEi
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Prohormone brain natriuretic peptide increased, Resuscitation, SARS-CoV-2 test positive, Streptococcus test positive, Troponin
Clinical narrative: Patient is a pleasant 66 y.o. male patient of DO with a PMHx of CAD s/p PCI in 2015, cAF on Eliquis presenting with hemoptysis, SOB.   Acute hypoxic respiratory failure d/t, resolved  Post-viral bacterial pneumonia +COVID-19 infection Hemoptysis  1 week of cough, malaise, body aches. Brief period of improvement before recurrence of worsening sxs. Cough now productive w small volume hemoptysis (streaked sputum) Afebrile, HR 75, BP 102/57, RR 27, satting 91% on 2L CBC w mild leukocytosis (WBC 12.6). Trop 7, ProBNP 1.2K. VBG 7.41/39.3.  COVID+, influenza neg. Vaccinated x2, no boosters CXR (AP/LAT) with RML/RLL consolidation. No vascular congestion Currently on 2L supplemental O2, wean to goal SpO2 > 92% Abx coverage with Rocephin and Azithromycin, transition to Augmentin 10/22/22 Cont decadron but hold off on Remdesivir, course c/w post-viral PNA Strep pneu urine antigen + Procal 2.76, CRP 137,  Scheduled Mucinex. Robitussin-DM, Tylenol, nebs PRN Vibratory PEP and IS ordered, encourage use Continue Augmentin and decadron for 10 days total  Return precautions discussed    Acute kidney injury, resolved  Initial Cr 1.4 (baseline ~1.0)  Likely prerenal from above in the setting of ACEi Gentle resuscitation with NS gtt @ 100cc/hr for 1L total Hold home Lisinopril Bladder scan w PVR if e/o urinary retention Avoid nephrotoxic agents, renally adjust meds Daily RFPs, strict I&Os, daily weights to monitor   CAD s/p PCI in 2015 Chronic AF on Eliquis Continue home ASA, Lopressor, statin, Eliquis Discussed hold parameters for Lopressor and ACEi
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Urinary retention, Urine antigen test, White blood cell count increased
Clinical narrative: Patient is a pleasant 66 y.o. male patient of DO with a PMHx of CAD s/p PCI in 2015, cAF on Eliquis presenting with hemoptysis, SOB.   Acute hypoxic respiratory failure d/t, resolved  Post-viral bacterial pneumonia +COVID-19 infection Hemoptysis  1 week of cough, malaise, body aches. Brief period of improvement before recurrence of worsening sxs. Cough now productive w small volume hemoptysis (streaked sputum) Afebrile, HR 75, BP 102/57, RR 27, satting 91% on 2L CBC w mild leukocytosis (WBC 12.6). Trop 7, ProBNP 1.2K. VBG 7.41/39.3.  COVID+, influenza neg. Vaccinated x2, no boosters CXR (AP/LAT) with RML/RLL consolidation. No vascular congestion Currently on 2L supplemental O2, wean to goal SpO2 > 92% Abx coverage with Rocephin and Azithromycin, transition to Augmentin 10/22/22 Cont decadron but hold off on Remdesivir, course c/w post-viral PNA Strep pneu urine antigen + Procal 2.76, CRP 137,  Scheduled Mucinex. Robitussin-DM, Tylenol, nebs PRN Vibratory PEP and IS ordered, encourage use Continue Augmentin and decadron for 10 days total  Return precautions discussed    Acute kidney injury, resolved  Initial Cr 1.4 (baseline ~1.0)  Likely prerenal from above in the setting of ACEi Gentle resuscitation with NS gtt @ 100cc/hr for 1L total Hold home Lisinopril Bladder scan w PVR if e/o urinary retention Avoid nephrotoxic agents, renally adjust meds Daily RFPs, strict I&Os, daily weights to monitor   CAD s/p PCI in 2015 Chronic AF on Eliquis Continue home ASA, Lopressor, statin, Eliquis Discussed hold parameters for Lopressor and ACEi
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Heart rate increased, SARS-CoV-2 test positive
Clinical narrative: 09/14/22 presents to ED for "rapid heart rate". PMHx of "cerebral palsy, quadriparesis, status post TBI now trach and PEG tube dependent"
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Urticaria
Clinical narrative: Day 8 (11/7/22) after injections, severe hives cover 50% of the body.  Mostly in the genital area and neck/scalp.  Tried OTC creams and antihistamines with no improvements. Prescribed oral and cream steroids on day 4 of hives (11/10/22)
Age: 28.0
Sex: F
Vaccine: FLU4
Symptoms: Injected limb mobility decreased, Injection site pain, Musculoskeletal stiffness, Pain
Clinical narrative: Employee/patient reports that the injection was given high in her upper arm,  superior to the usual deltoid placement, nearly at the acromion process.  She felt pain almost immediately following the injection. Throughout the evening, her arm became more stiff and she had difficulty moving it in any direction.  Range of motion improved some over the past couple of weeks, but she continues to have pain with certain movements of her left arm.  She denies any associated redness or swelling. She denies associated numbness or tingling. She denies any fever or chills.
Sex: U
Vaccine: HPV2
Symptoms: Injection site discharge, No adverse event, Product preparation error, Wrong technique in product usage process
Clinical narrative: I injected a HPV bivalent vaccine....But I forgot to shake it before administration... Is this a problem? . After administration a liquid of vaccine came out of her arm...I am not sure whether she needs re dose of that vaccine....please acknowledge me with help
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Colonoscopy normal, Diarrhoea, Nausea, Stool analysis normal, Vomiting
Clinical narrative: Nausea, vomiting  and diarrhea. Chronic diarrhea with negative stool studies.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Acute left ventricular failure, Acute respiratory failure, Aortic dilatation, Atrial fibrillation, CHA2DS2-VASc-score
Clinical narrative: COVID-19 pneumonia Acute hypoxic respiratory failure secondary to COVID-pneumonia and acute congestive heart failure Presenting with bilateral opacities on chest x-ray, symptom onset 2 weeks prior to admission (9/27/22). No previous confirmed diagnosis and was vaccinated originally with Johnson & Johnson vaccine, no follow-up boosters. Infectious disease consulted currently on IV remdesivir, dexamethasone, Tocilizumab Tocilizumab started 10/16/2022 Initially requiring BiPAP then heated high flow oxygen then currently oxygen saturation maintained on 3 L of oxygen through nasal cannula.  Wean as tolerated.  Incentive spirometry.   Permanent atrial fibrillation Home medication include carvedilol 25 mg twice daily and digoxin 0.125 mg daily Currently rate controlled on digoxin 0.125 mg daily and low-dose carvedilol 6.25 mg twice daily CHA2DS2-VASc score 2  Coumadin pharmacy to dose, INR 2.4.   Acute congestive heart failure likely right-sided heart failure Acute diastolic congestive heart failure Cardiac diet Salt and fluid restriction Daily I's and O's and body weight IV then p.o. diuretics Heart failure education Echocardiogram 10/14/2022 showed EF 55% RV dilated with dilated aortic root 4.3 cm   Streptococcus salivarius bacteremia (1 out of 2 cultures) 10/12/2022 Repeat cultures negative Likely contaminant, status post discontinue ceftriaxone   Hypertension Home meds include lisinopril 2.5 mg daily and Coreg 25 mg twice daily initially on hold due to borderline hypotension.  Currently on lisinopril 2.5 mg daily and Coreg 6.25 mg twice daily.   Hyperlipidemia On statin therapy   History of coronary artery disease Nonobstructive coronary artery disease based on cardiac cath in 2011 Guideline directed medical therapy.   Morbid obesity Body mass index 48.9 Encourage weight loss and lifestyle modification Obstructive sleep apnea BIPAP nightly. Outpatient sleep study and follow-up with sleep medicine as an outpatient.   Chronic lymphedema and scaling lower extremity Topical Vaseline lower extremity. Patient denied any dressings.   Chronic thrombocytopenia Platelet count stable. ~80-100   We discharge patient home after improvement of general condition and shortness of breath.  Patient to follow-up with PCP in 1 week.  Follow-up with pulmonary/sleep medicine and ID as noted.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cardiac failure, Cardiac failure congestive, Chest X-ray abnormal, Culture positive
Clinical narrative: COVID-19 pneumonia Acute hypoxic respiratory failure secondary to COVID-pneumonia and acute congestive heart failure Presenting with bilateral opacities on chest x-ray, symptom onset 2 weeks prior to admission (9/27/22). No previous confirmed diagnosis and was vaccinated originally with Johnson & Johnson vaccine, no follow-up boosters. Infectious disease consulted currently on IV remdesivir, dexamethasone, Tocilizumab Tocilizumab started 10/16/2022 Initially requiring BiPAP then heated high flow oxygen then currently oxygen saturation maintained on 3 L of oxygen through nasal cannula.  Wean as tolerated.  Incentive spirometry.   Permanent atrial fibrillation Home medication include carvedilol 25 mg twice daily and digoxin 0.125 mg daily Currently rate controlled on digoxin 0.125 mg daily and low-dose carvedilol 6.25 mg twice daily CHA2DS2-VASc score 2  Coumadin pharmacy to dose, INR 2.4.   Acute congestive heart failure likely right-sided heart failure Acute diastolic congestive heart failure Cardiac diet Salt and fluid restriction Daily I's and O's and body weight IV then p.o. diuretics Heart failure education Echocardiogram 10/14/2022 showed EF 55% RV dilated with dilated aortic root 4.3 cm   Streptococcus salivarius bacteremia (1 out of 2 cultures) 10/12/2022 Repeat cultures negative Likely contaminant, status post discontinue ceftriaxone   Hypertension Home meds include lisinopril 2.5 mg daily and Coreg 25 mg twice daily initially on hold due to borderline hypotension.  Currently on lisinopril 2.5 mg daily and Coreg 6.25 mg twice daily.   Hyperlipidemia On statin therapy   History of coronary artery disease Nonobstructive coronary artery disease based on cardiac cath in 2011 Guideline directed medical therapy.   Morbid obesity Body mass index 48.9 Encourage weight loss and lifestyle modification Obstructive sleep apnea BIPAP nightly. Outpatient sleep study and follow-up with sleep medicine as an outpatient.   Chronic lymphedema and scaling lower extremity Topical Vaseline lower extremity. Patient denied any dressings.   Chronic thrombocytopenia Platelet count stable. ~80-100   We discharge patient home after improvement of general condition and shortness of breath.  Patient to follow-up with PCP in 1 week.  Follow-up with pulmonary/sleep medicine and ID as noted.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Diuretic therapy, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Fluid intake restriction
Clinical narrative: COVID-19 pneumonia Acute hypoxic respiratory failure secondary to COVID-pneumonia and acute congestive heart failure Presenting with bilateral opacities on chest x-ray, symptom onset 2 weeks prior to admission (9/27/22). No previous confirmed diagnosis and was vaccinated originally with Johnson & Johnson vaccine, no follow-up boosters. Infectious disease consulted currently on IV remdesivir, dexamethasone, Tocilizumab Tocilizumab started 10/16/2022 Initially requiring BiPAP then heated high flow oxygen then currently oxygen saturation maintained on 3 L of oxygen through nasal cannula.  Wean as tolerated.  Incentive spirometry.   Permanent atrial fibrillation Home medication include carvedilol 25 mg twice daily and digoxin 0.125 mg daily Currently rate controlled on digoxin 0.125 mg daily and low-dose carvedilol 6.25 mg twice daily CHA2DS2-VASc score 2  Coumadin pharmacy to dose, INR 2.4.   Acute congestive heart failure likely right-sided heart failure Acute diastolic congestive heart failure Cardiac diet Salt and fluid restriction Daily I's and O's and body weight IV then p.o. diuretics Heart failure education Echocardiogram 10/14/2022 showed EF 55% RV dilated with dilated aortic root 4.3 cm   Streptococcus salivarius bacteremia (1 out of 2 cultures) 10/12/2022 Repeat cultures negative Likely contaminant, status post discontinue ceftriaxone   Hypertension Home meds include lisinopril 2.5 mg daily and Coreg 25 mg twice daily initially on hold due to borderline hypotension.  Currently on lisinopril 2.5 mg daily and Coreg 6.25 mg twice daily.   Hyperlipidemia On statin therapy   History of coronary artery disease Nonobstructive coronary artery disease based on cardiac cath in 2011 Guideline directed medical therapy.   Morbid obesity Body mass index 48.9 Encourage weight loss and lifestyle modification Obstructive sleep apnea BIPAP nightly. Outpatient sleep study and follow-up with sleep medicine as an outpatient.   Chronic lymphedema and scaling lower extremity Topical Vaseline lower extremity. Patient denied any dressings.   Chronic thrombocytopenia Platelet count stable. ~80-100   We discharge patient home after improvement of general condition and shortness of breath.  Patient to follow-up with PCP in 1 week.  Follow-up with pulmonary/sleep medicine and ID as noted.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperlipidaemia, Hypertension, Incentive spirometry, International normalised ratio increased, Lung opacity
Clinical narrative: COVID-19 pneumonia Acute hypoxic respiratory failure secondary to COVID-pneumonia and acute congestive heart failure Presenting with bilateral opacities on chest x-ray, symptom onset 2 weeks prior to admission (9/27/22). No previous confirmed diagnosis and was vaccinated originally with Johnson & Johnson vaccine, no follow-up boosters. Infectious disease consulted currently on IV remdesivir, dexamethasone, Tocilizumab Tocilizumab started 10/16/2022 Initially requiring BiPAP then heated high flow oxygen then currently oxygen saturation maintained on 3 L of oxygen through nasal cannula.  Wean as tolerated.  Incentive spirometry.   Permanent atrial fibrillation Home medication include carvedilol 25 mg twice daily and digoxin 0.125 mg daily Currently rate controlled on digoxin 0.125 mg daily and low-dose carvedilol 6.25 mg twice daily CHA2DS2-VASc score 2  Coumadin pharmacy to dose, INR 2.4.   Acute congestive heart failure likely right-sided heart failure Acute diastolic congestive heart failure Cardiac diet Salt and fluid restriction Daily I's and O's and body weight IV then p.o. diuretics Heart failure education Echocardiogram 10/14/2022 showed EF 55% RV dilated with dilated aortic root 4.3 cm   Streptococcus salivarius bacteremia (1 out of 2 cultures) 10/12/2022 Repeat cultures negative Likely contaminant, status post discontinue ceftriaxone   Hypertension Home meds include lisinopril 2.5 mg daily and Coreg 25 mg twice daily initially on hold due to borderline hypotension.  Currently on lisinopril 2.5 mg daily and Coreg 6.25 mg twice daily.   Hyperlipidemia On statin therapy   History of coronary artery disease Nonobstructive coronary artery disease based on cardiac cath in 2011 Guideline directed medical therapy.   Morbid obesity Body mass index 48.9 Encourage weight loss and lifestyle modification Obstructive sleep apnea BIPAP nightly. Outpatient sleep study and follow-up with sleep medicine as an outpatient.   Chronic lymphedema and scaling lower extremity Topical Vaseline lower extremity. Patient denied any dressings.   Chronic thrombocytopenia Platelet count stable. ~80-100   We discharge patient home after improvement of general condition and shortness of breath.  Patient to follow-up with PCP in 1 week.  Follow-up with pulmonary/sleep medicine and ID as noted.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Lymphoedema, Medical diet, Obesity, Obstructive sleep apnoea syndrome, Platelet count decreased
Clinical narrative: COVID-19 pneumonia Acute hypoxic respiratory failure secondary to COVID-pneumonia and acute congestive heart failure Presenting with bilateral opacities on chest x-ray, symptom onset 2 weeks prior to admission (9/27/22). No previous confirmed diagnosis and was vaccinated originally with Johnson & Johnson vaccine, no follow-up boosters. Infectious disease consulted currently on IV remdesivir, dexamethasone, Tocilizumab Tocilizumab started 10/16/2022 Initially requiring BiPAP then heated high flow oxygen then currently oxygen saturation maintained on 3 L of oxygen through nasal cannula.  Wean as tolerated.  Incentive spirometry.   Permanent atrial fibrillation Home medication include carvedilol 25 mg twice daily and digoxin 0.125 mg daily Currently rate controlled on digoxin 0.125 mg daily and low-dose carvedilol 6.25 mg twice daily CHA2DS2-VASc score 2  Coumadin pharmacy to dose, INR 2.4.   Acute congestive heart failure likely right-sided heart failure Acute diastolic congestive heart failure Cardiac diet Salt and fluid restriction Daily I's and O's and body weight IV then p.o. diuretics Heart failure education Echocardiogram 10/14/2022 showed EF 55% RV dilated with dilated aortic root 4.3 cm   Streptococcus salivarius bacteremia (1 out of 2 cultures) 10/12/2022 Repeat cultures negative Likely contaminant, status post discontinue ceftriaxone   Hypertension Home meds include lisinopril 2.5 mg daily and Coreg 25 mg twice daily initially on hold due to borderline hypotension.  Currently on lisinopril 2.5 mg daily and Coreg 6.25 mg twice daily.   Hyperlipidemia On statin therapy   History of coronary artery disease Nonobstructive coronary artery disease based on cardiac cath in 2011 Guideline directed medical therapy.   Morbid obesity Body mass index 48.9 Encourage weight loss and lifestyle modification Obstructive sleep apnea BIPAP nightly. Outpatient sleep study and follow-up with sleep medicine as an outpatient.   Chronic lymphedema and scaling lower extremity Topical Vaseline lower extremity. Patient denied any dressings.   Chronic thrombocytopenia Platelet count stable. ~80-100   We discharge patient home after improvement of general condition and shortness of breath.  Patient to follow-up with PCP in 1 week.  Follow-up with pulmonary/sleep medicine and ID as noted.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Positive airway pressure therapy, Right ventricular dilatation, Skin exfoliation, Streptococcal bacteraemia, Thrombocytopenia
Clinical narrative: COVID-19 pneumonia Acute hypoxic respiratory failure secondary to COVID-pneumonia and acute congestive heart failure Presenting with bilateral opacities on chest x-ray, symptom onset 2 weeks prior to admission (9/27/22). No previous confirmed diagnosis and was vaccinated originally with Johnson & Johnson vaccine, no follow-up boosters. Infectious disease consulted currently on IV remdesivir, dexamethasone, Tocilizumab Tocilizumab started 10/16/2022 Initially requiring BiPAP then heated high flow oxygen then currently oxygen saturation maintained on 3 L of oxygen through nasal cannula.  Wean as tolerated.  Incentive spirometry.   Permanent atrial fibrillation Home medication include carvedilol 25 mg twice daily and digoxin 0.125 mg daily Currently rate controlled on digoxin 0.125 mg daily and low-dose carvedilol 6.25 mg twice daily CHA2DS2-VASc score 2  Coumadin pharmacy to dose, INR 2.4.   Acute congestive heart failure likely right-sided heart failure Acute diastolic congestive heart failure Cardiac diet Salt and fluid restriction Daily I's and O's and body weight IV then p.o. diuretics Heart failure education Echocardiogram 10/14/2022 showed EF 55% RV dilated with dilated aortic root 4.3 cm   Streptococcus salivarius bacteremia (1 out of 2 cultures) 10/12/2022 Repeat cultures negative Likely contaminant, status post discontinue ceftriaxone   Hypertension Home meds include lisinopril 2.5 mg daily and Coreg 25 mg twice daily initially on hold due to borderline hypotension.  Currently on lisinopril 2.5 mg daily and Coreg 6.25 mg twice daily.   Hyperlipidemia On statin therapy   History of coronary artery disease Nonobstructive coronary artery disease based on cardiac cath in 2011 Guideline directed medical therapy.   Morbid obesity Body mass index 48.9 Encourage weight loss and lifestyle modification Obstructive sleep apnea BIPAP nightly. Outpatient sleep study and follow-up with sleep medicine as an outpatient.   Chronic lymphedema and scaling lower extremity Topical Vaseline lower extremity. Patient denied any dressings.   Chronic thrombocytopenia Platelet count stable. ~80-100   We discharge patient home after improvement of general condition and shortness of breath.  Patient to follow-up with PCP in 1 week.  Follow-up with pulmonary/sleep medicine and ID as noted.
Age: 13.0
Sex: F
Vaccine: HEP, TDAP, VARCEL
Symptoms: Dizziness, Hyperhidrosis, Irregular breathing, Loss of consciousness, Muscular weakness
Clinical narrative: Pale, sweaty, dizzy, weak legs. Brief LOC. 2 brief seizure-like episodes (60-90 seconds) with a lucid period in between. Irregular breathing after 2nd seizure. Normal pulse, adequate respirations throughout. BP 110s - 130s/70s-90s. O2 sats >98%. Awake and responsive with pale complexion, diaphoretic and slightly shaking hands at time of transfer to EMS.
Age: 13.0
Sex: F
Vaccine: HEP, TDAP, VARCEL
Symptoms: Pallor, Seizure like phenomena, Tremor
Clinical narrative: Pale, sweaty, dizzy, weak legs. Brief LOC. 2 brief seizure-like episodes (60-90 seconds) with a lucid period in between. Irregular breathing after 2nd seizure. Normal pulse, adequate respirations throughout. BP 110s - 130s/70s-90s. O2 sats >98%. Awake and responsive with pale complexion, diaphoretic and slightly shaking hands at time of transfer to EMS.
Age: 8.0
Sex: F
Vaccine: HEPA, HEPA
Symptoms: Expired product administered
Clinical narrative: Vaccine Expiration Date 11/07/2022. Hepatitis A vaccine given on 11/10/2022. RN spoke with Merck representative who said that there is evidence that within 3 days of expiration date, vaccine still has efficacy and patient is not required another dose of Hepatitis A.
Age: 8.0
Sex: F
Vaccine: HEPA, HEPA
Symptoms: Expired product administered, No adverse event
Clinical narrative: Vaccine Expiration Date 11/07/2022. Hepatitis A vaccine given on 11/10/2022. RN spoke with Merck representative who said that there is evidence that within 3 days of expiration date, vaccine still has efficacy and patient is not required another dose of Hepatitis A.
Age: 0.42
Sex: F
Vaccine: DTAPIPV
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: 5 month old patient was administer Kinrix, which is approved for ages 4-6 years. Patient/patient's parent has not reported any adverse reactions from the shot or other health concerns.
Age: 44.0
Sex: F
Vaccine: COVID19-2
Symptoms: No adverse event, Product preparation error
Clinical narrative: patient was administered 0.3ml of pfizer bivalent 5-11years with out diluted. no adverse reaction or side effects noted
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: Inappropriate schedule of product administration
Clinical narrative: Resident walked in requesting Moderna bivalent booster. Post vaccination, resident noted to have received a bivalent booster (Pfizer) on 10/24/22, as per the CDC POV card provided by the client. Education provided to the POC, Counselor, and client regarding increased risk of adverse effects of the vaccine, verbalized understanding. Client stayed for observation post vaccine administration, and left without any complications.
Age: 44.0
Sex: F
Vaccine: FLU4, PPV
Symptoms: Dyspnoea, Fall, Head titubation, Hot flush, Immunisation reaction
Clinical narrative: patient female age 44 requested to have Fluzone and Pneumococcal (pneumovax23)  and Boostrix administered.  Consent form reviewed - patient noted latex allergy.  Fluzone administered 1st in left deltoid. I chatted with patient for a couple of minutes before moving on to administer the Pneumococcal vaccine.   She rotated her chair to prepare for the last IMZ at which time she thought she was having a hot flash.  Her head tilted to the right and fell forward.  I supported her head and directed pharmacy technician to call emergency services  (time: 10:48a) and a code white.  I directed pharmacy technician to had me the adult Epi pen.  Patient  said again she was having a hot flash, I advised that I believed she was having a reaction to the 2nd IMZ and wanted to administer epi. Patient was experiencing difficulty breathing her mother appeared (she was shopping). I stated that her daughter was having a reaction and I advised that I needed to administer EPI.  Mother and daughter agreed.  EPI was administered.  with in 3 to 4 minutes she was breathing without laboring.  I provided the first responders with the information regarding IMZ and EPI administered.  her vital signs were checked  - EMTs recommended that she be evaluated at the hospital - Both mother and daughter asked my opinion.  I stated that it would be prudent to go and be checked. The mother returned to the pharmacy (4:34p) to pick up medrol dose pack for her daughter.  She informed us that Her daughter received 2 bags of NS, medrol pak and was released home.  She thanked the team and myself for reacting professionally and with great care for her daughter
Age: 15.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Administered Monovalent Pfizer Covid vaccine instead of Bivalent Date looked to be expired. Upon calling Pfizer to report and collect information,, discovered, it does not expire until 11/30/22
Age: 42.0
Sex: F
Vaccine: FLU4
Symptoms: Hypoaesthesia, Paraesthesia
Clinical narrative: "I receive my flu vaccine on 11/09/2022 at 1:20pm in my left arm. Today 11/10/2022, I noticed this morning a little numbness and tingling in left arm and hand. Didn't think too much of until this afternoon. I'm really feeling the numbness and tingling progress more since this morning".  Ice Tylenol
Age: 66.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Hip arthroplasty, SARS-CoV-2 test positive
Clinical narrative: 09/15/22 presents to Orthopedic Surgery for "right total hip arthroplasty". PMHx of "A. fib, Addison's disease, COPD, GERD, depression, HTN, osteoporosis, chronic back pain"
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Appetite disorder, Constipation, Cough, Dizziness, Nausea
Clinical narrative: appetite change, cough, constipation, nausea, light-headedness
Age: 51.0
Sex: U
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
Clinical narrative: 09/15/22 presents to ED for "SOB". PMHx of "CHF (LVEF 10% with ICD), HTN, sarcoidosis"
Age: 96.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Cough, Dyspnoea, Pyrexia
Clinical narrative: chills, fever, cough, SOB
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Anticoagulant therapy, Anxiety, Atrial fibrillation, Blood creatinine normal
Clinical narrative: The patient is a 76 y.o. female with history of HTN, SSS s/p pacemaker in 2012, PAF, and anxiety presented to the Hospital with chest pain with productive cough.   Acute hypoxic respiratory failure d/t Covid-19 infection   Gastroenteritis  Bronchitis  Received full immunization and 2 boosters, most recently on 10/17  RA on arrival, currently requiring 2L NC Afebrile, no leukocytosis On Decadron 6mg for 10 days CRP  TRENDING DOWN PRN mucinex and cough suppressants Encourage IS use Contact precautions On tele/pulse ox with goal SpO2 > 88-90% warfarin for DVT ppx PT/OT/SW consulted Weaned off from NC 02 as able, continue decadron for a total of 10 days, antitussive, PCP follow up. Monitor Pulse ox at home. IS  and Acapella   Atypical Chest Pain, unknown etiology Paroxysmal Atrial Fibrillation Elevated troponin  QT prolongation  Intermittent, episodic shooting chest pains similar to her previous symptomology of Afib Afebrile, no leukocytosis O2 saturation >94% on room air, no orthopnea  CBC unremarkable, Hgb stable at 13  Chem 7 shows mild hyponatremia (132) and hypokalemia (2.6) Last 2D echo July 2022 shows LVEF 55% +/- 5 with mild left ventricular concentric hypertrophy  Troponin elevated to 277, chronically elevated in the past, down trending w/o complaint of CP  CXR shows stable cardiomegaly, non-acute EKG shows atrial fibrillation with PVCs, rate of 90 Continuous cardiac monitoring Anticoagulation with warfarin to be continued on admission Cardiac diet  Repeat EKG   Essential HTN  Elevated BP to 160 SBP, ~80-90 DBP on admission Continue home metoprolol   Anxiety Continue home sertraline  Obesity  Body mass index is 35.09 kg/m². Discussed dietary and lifestyle modifications Consider nutrition consult    Severe hypokalemia, resolved  Mild hyponatremia, resolved  Potassium of 2.6 on admission, pt reported several episodes of diarrhea the past few days Sodium 132, continue to monitor with repeat labs and hydration  Cr stable at 0.63, eGFR 92  Received Covid-19 booster on Monday 10/17 Mag 1.5  EKG shows atrial fibrillation with PVCs, rate of 90 Replete potassium and monitor with repeat labs
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood magnesium normal, Blood potassium decreased, Blood pressure increased, Blood sodium decreased, Bronchitis
Clinical narrative: The patient is a 76 y.o. female with history of HTN, SSS s/p pacemaker in 2012, PAF, and anxiety presented to the Hospital with chest pain with productive cough.   Acute hypoxic respiratory failure d/t Covid-19 infection   Gastroenteritis  Bronchitis  Received full immunization and 2 boosters, most recently on 10/17  RA on arrival, currently requiring 2L NC Afebrile, no leukocytosis On Decadron 6mg for 10 days CRP  TRENDING DOWN PRN mucinex and cough suppressants Encourage IS use Contact precautions On tele/pulse ox with goal SpO2 > 88-90% warfarin for DVT ppx PT/OT/SW consulted Weaned off from NC 02 as able, continue decadron for a total of 10 days, antitussive, PCP follow up. Monitor Pulse ox at home. IS  and Acapella   Atypical Chest Pain, unknown etiology Paroxysmal Atrial Fibrillation Elevated troponin  QT prolongation  Intermittent, episodic shooting chest pains similar to her previous symptomology of Afib Afebrile, no leukocytosis O2 saturation >94% on room air, no orthopnea  CBC unremarkable, Hgb stable at 13  Chem 7 shows mild hyponatremia (132) and hypokalemia (2.6) Last 2D echo July 2022 shows LVEF 55% +/- 5 with mild left ventricular concentric hypertrophy  Troponin elevated to 277, chronically elevated in the past, down trending w/o complaint of CP  CXR shows stable cardiomegaly, non-acute EKG shows atrial fibrillation with PVCs, rate of 90 Continuous cardiac monitoring Anticoagulation with warfarin to be continued on admission Cardiac diet  Repeat EKG   Essential HTN  Elevated BP to 160 SBP, ~80-90 DBP on admission Continue home metoprolol   Anxiety Continue home sertraline  Obesity  Body mass index is 35.09 kg/m². Discussed dietary and lifestyle modifications Consider nutrition consult    Severe hypokalemia, resolved  Mild hyponatremia, resolved  Potassium of 2.6 on admission, pt reported several episodes of diarrhea the past few days Sodium 132, continue to monitor with repeat labs and hydration  Cr stable at 0.63, eGFR 92  Received Covid-19 booster on Monday 10/17 Mag 1.5  EKG shows atrial fibrillation with PVCs, rate of 90 Replete potassium and monitor with repeat labs