chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac failure congestive, Chronic kidney disease, Coronary artery disease, Essential hypertension, Hyponatraemia
Clinical narrative: Physician Discharge Summary: Patient: "PRIVATE", Age:82 y.o. DOB:3/8/1940. Admit Date: 7/6/2022- Discharge Date: 7/10/2022. Principal Diagnoses: Principal Problem: Pneumonia due to COVID-19 virus. Active Problems: PAF (paroxysmal atrial fibrillation); Essential hypertension; Type 2 diabetes mellitus, with long-term current use of insulin; Coronary artery disease involving native coronary artery of native heart without angina pectoris; Acute renal failure superimposed on stage 3b chronic kidney disease; Hyponatremia; Diastolic CHF, chronic; Metabolic encephalopathy; Morbid obesity; Elevated troponin. Discharge Diagnosis: Acute on chronic hypoxic respiratory failure, COVID 19, Hyponatremia. Elevated trop, Metabolic encephalopathy, Dm2, HTN. Hospital Course: The patient was admitted with the above. He was treated with 4 days of remdesivir and steroids. He also was placed on rocephin for possible bacterial super infection. He improved greatly and was on room air as I saw him on the day of discharge. It was not felt that a 5th day of remdesivir would improve him any more than he was so he was placed on one day of Omnicef. No steroids were given as he was not longer acutely hypoxic. His course was complicated by elevated troponin which cardiology felt was due to COVD and not ACS. He was asked to follow up outpatient. Consults to: cardiology. Significant Diagnostic Studies: none. Procedure(s): None. Disposition: home. Discharge Condition: fair.
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Left ventricular failure, Metabolic encephalopathy, Obesity, Respiratory failure, Troponin increased
Clinical narrative: Physician Discharge Summary: Patient: "PRIVATE", Age:82 y.o. DOB:3/8/1940. Admit Date: 7/6/2022- Discharge Date: 7/10/2022. Principal Diagnoses: Principal Problem: Pneumonia due to COVID-19 virus. Active Problems: PAF (paroxysmal atrial fibrillation); Essential hypertension; Type 2 diabetes mellitus, with long-term current use of insulin; Coronary artery disease involving native coronary artery of native heart without angina pectoris; Acute renal failure superimposed on stage 3b chronic kidney disease; Hyponatremia; Diastolic CHF, chronic; Metabolic encephalopathy; Morbid obesity; Elevated troponin. Discharge Diagnosis: Acute on chronic hypoxic respiratory failure, COVID 19, Hyponatremia. Elevated trop, Metabolic encephalopathy, Dm2, HTN. Hospital Course: The patient was admitted with the above. He was treated with 4 days of remdesivir and steroids. He also was placed on rocephin for possible bacterial super infection. He improved greatly and was on room air as I saw him on the day of discharge. It was not felt that a 5th day of remdesivir would improve him any more than he was so he was placed on one day of Omnicef. No steroids were given as he was not longer acutely hypoxic. His course was complicated by elevated troponin which cardiology felt was due to COVD and not ACS. He was asked to follow up outpatient. Consults to: cardiology. Significant Diagnostic Studies: none. Procedure(s): None. Disposition: home. Discharge Condition: fair.
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Type 1 diabetes mellitus, Type 2 diabetes mellitus
Clinical narrative: Physician Discharge Summary: Patient: "PRIVATE", Age:82 y.o. DOB:3/8/1940. Admit Date: 7/6/2022- Discharge Date: 7/10/2022. Principal Diagnoses: Principal Problem: Pneumonia due to COVID-19 virus. Active Problems: PAF (paroxysmal atrial fibrillation); Essential hypertension; Type 2 diabetes mellitus, with long-term current use of insulin; Coronary artery disease involving native coronary artery of native heart without angina pectoris; Acute renal failure superimposed on stage 3b chronic kidney disease; Hyponatremia; Diastolic CHF, chronic; Metabolic encephalopathy; Morbid obesity; Elevated troponin. Discharge Diagnosis: Acute on chronic hypoxic respiratory failure, COVID 19, Hyponatremia. Elevated trop, Metabolic encephalopathy, Dm2, HTN. Hospital Course: The patient was admitted with the above. He was treated with 4 days of remdesivir and steroids. He also was placed on rocephin for possible bacterial super infection. He improved greatly and was on room air as I saw him on the day of discharge. It was not felt that a 5th day of remdesivir would improve him any more than he was so he was placed on one day of Omnicef. No steroids were given as he was not longer acutely hypoxic. His course was complicated by elevated troponin which cardiology felt was due to COVD and not ACS. He was asked to follow up outpatient. Consults to: cardiology. Significant Diagnostic Studies: none. Procedure(s): None. Disposition: home. Discharge Condition: fair.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: patient under age
Age: 23.0
Sex: F
Vaccine: COVID19
Symptoms: Caesarean section, Delivery, Exposure during pregnancy, Substance abuse
Clinical narrative: C-Section Discharge Summary    Date of Admission: 7/6/2022 Date of Discharge: 7/9/2022   Diagnosis: 37 week; substance abuse; iugr; non-reassuring fhr;    Hospital Course   OB History Gravida Para Term Preterm AB Living 1 1 1     1 SAB IAB Ectopic Multiple Live Births          0 1      # Outcome Date GA Lbr Len/2nd Weight Sex Delivery Anes PTL Lv 1 Term           38w0d   2.665 kg (5 lb 14 oz) M CS-LTranv EPI   LIV     The patient underwent a Cesarean delivery during this hospitalization due to the above listed diagnoses.   She is now 2 days post operative.  She has not had complications since the delivery.  She has not been febrile.  She did not have a surgical sterilization at the time of her C-section.     At the time of discharge, the patient was afebrile and has been tolerating a regular diet.  She has been ambulating and voiding without difficulty.  Denies symptoms of orthostasis.    Plan   She has been given discharge instructions which include the following: No driving for 2 weeks, No straining or lifting >15-20 pounds, No sex, tampons, douche, or tub baths.  Follow up for an incision check in 2 weeks.  Call for any signs of fever, foul discharge, increased bleeding, wound redness or draining, or signs of postpartum depression.   Discharge Medications Toradol 10 mg po q 6 hr #20
Age: 17.0
Sex: U
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: patient under age
Age: 40.0
Sex: M
Vaccine: UNK
Symptoms: Urticaria
Clinical narrative: During the first intradermal administration of 0.1mL of the Jynneos vaccine a wheal was not achieved. A second administration of 0.1mL of Jynneos was administered intradermally and a wheal was achieved. The patient was monitored for 15 minutes and no adverse reaction was observed.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Anticoagulant therapy, COVID-19, Catheterisation cardiac, Chest pain
Clinical narrative: Physician discharge summary: Admit date: 7/12/2022. Discharge date: 7/16/2022. Hospital course: Patient came in with chest pain. EKG confirmed inferior lateral MI. Patient taken emergently to the cath lab for LHC with left groin access where she received PCI to RCA with plans for staged PCI to LAD as an outpatient. Will require aspirin and Brilinta at discharge. Also started on statin, BB, ACEI. Of note, patient was already positive for COVID-19 when she came in. Pulmonology consulted for management. During her stay, she developed ventricular tachycardia requiring amiodarone. She also developed superficial thrombosis to right forearm requiring Lovenox. Patient is going home on Eliquis for this. Nursing staff confirmed with pharmacy and insurance that Eliquis will be covered 100%. Patient is now stable and cleared for discharge by hospitalist, as well as, pulmonology. Patient consult with doctor in 2 weeks for follow-up on medications and plans for future PCI of LAD. Discharge condition: Good.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram abnormal, Hypertension, Percutaneous coronary intervention, SARS-CoV-2 test positive, Stent placement
Clinical narrative: Physician discharge summary: Admit date: 7/12/2022. Discharge date: 7/16/2022. Hospital course: Patient came in with chest pain. EKG confirmed inferior lateral MI. Patient taken emergently to the cath lab for LHC with left groin access where she received PCI to RCA with plans for staged PCI to LAD as an outpatient. Will require aspirin and Brilinta at discharge. Also started on statin, BB, ACEI. Of note, patient was already positive for COVID-19 when she came in. Pulmonology consulted for management. During her stay, she developed ventricular tachycardia requiring amiodarone. She also developed superficial thrombosis to right forearm requiring Lovenox. Patient is going home on Eliquis for this. Nursing staff confirmed with pharmacy and insurance that Eliquis will be covered 100%. Patient is now stable and cleared for discharge by hospitalist, as well as, pulmonology. Patient consult with doctor in 2 weeks for follow-up on medications and plans for future PCI of LAD. Discharge condition: Good.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Superficial vein thrombosis, Tobacco abuse, Ventricular tachycardia
Clinical narrative: Physician discharge summary: Admit date: 7/12/2022. Discharge date: 7/16/2022. Hospital course: Patient came in with chest pain. EKG confirmed inferior lateral MI. Patient taken emergently to the cath lab for LHC with left groin access where she received PCI to RCA with plans for staged PCI to LAD as an outpatient. Will require aspirin and Brilinta at discharge. Also started on statin, BB, ACEI. Of note, patient was already positive for COVID-19 when she came in. Pulmonology consulted for management. During her stay, she developed ventricular tachycardia requiring amiodarone. She also developed superficial thrombosis to right forearm requiring Lovenox. Patient is going home on Eliquis for this. Nursing staff confirmed with pharmacy and insurance that Eliquis will be covered 100%. Patient is now stable and cleared for discharge by hospitalist, as well as, pulmonology. Patient consult with doctor in 2 weeks for follow-up on medications and plans for future PCI of LAD. Discharge condition: Good.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Patient underage.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain, Alcohol abuse, Alcoholic pancreatitis, Blood bilirubin increased, COVID-19
Clinical narrative: Physician discharge summary: Admit date: 7/12/2022. Discharge date: 7/15/2022. Hospital course: The patient was admitted and treated with IVF. He slowly recovered. RUQ US and CT abdomen did not show obstruction. T. bili mildly elevated but improved with IVF. He was able to tolerate a regular diet at the time of discharge with no significant increase in abdominal pain. He was noted to have a fever while here. CXR was ok and urine was clean. The fever felt due to COVID-19. He also had intractable hiccups. He was placed on baclofen and these improved. It was felt pancreatitis was the underlying cause. He was asked to follow-up outpatient. Discharge condition: Fair.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray normal, Computerised tomogram abdomen normal, Hiccups, Pancreatitis acute, Pyrexia
Clinical narrative: Physician discharge summary: Admit date: 7/12/2022. Discharge date: 7/15/2022. Hospital course: The patient was admitted and treated with IVF. He slowly recovered. RUQ US and CT abdomen did not show obstruction. T. bili mildly elevated but improved with IVF. He was able to tolerate a regular diet at the time of discharge with no significant increase in abdominal pain. He was noted to have a fever while here. CXR was ok and urine was clean. The fever felt due to COVID-19. He also had intractable hiccups. He was placed on baclofen and these improved. It was felt pancreatitis was the underlying cause. He was asked to follow-up outpatient. Discharge condition: Fair.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Ultrasound abdomen normal, Urine analysis normal
Clinical narrative: Physician discharge summary: Admit date: 7/12/2022. Discharge date: 7/15/2022. Hospital course: The patient was admitted and treated with IVF. He slowly recovered. RUQ US and CT abdomen did not show obstruction. T. bili mildly elevated but improved with IVF. He was able to tolerate a regular diet at the time of discharge with no significant increase in abdominal pain. He was noted to have a fever while here. CXR was ok and urine was clean. The fever felt due to COVID-19. He also had intractable hiccups. He was placed on baclofen and these improved. It was felt pancreatitis was the underlying cause. He was asked to follow-up outpatient. Discharge condition: Fair.
Age: 71.0
Sex: M
Vaccine: UNK
Symptoms: Immune system disorder, No adverse event
Clinical narrative: During the first intradermal administration of 0.1mL of the Jynneos vaccine a wheal was not achieved. A second administration of 0.1mL of Jynneos was administered intradermally and a wheal was achieved. The patient was monitored for 15 minutes and no adverse reaction was observed.
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Asthenia, COVID-19, Culture negative, Cystitis
Clinical narrative: Discharge Summary (Physician) ? ? Hospitalist Physician Discharge Summary       Age:83 y.o. Admit Date:  7/12/2022 Discharge Date:  7/14/2022      Principal Diagnoses:  Principal Problem:   AKI (acute kidney injury) Active Problems:   Acute cystitis without hematuria   Benign essential HTN   Hypokalemia   Hypomagnesemia   Orthostatic hypotension   Anorexia   COVID-19 virus infection   Generalized weakness     Discharge Diagnosis:  Acute renal failure, Hypotension, Anorexia, UTI, COVID 19, HTN, Debility.    Hospital Course:  The patient was admitted with the above. She was treated with IVF and her renal function improved. The UTI was treated with rocephin. Nothing grew on cultures. She was eating and drinking much better at the time of discharge. She declined SNF placement. She was placed on vantin to complete 3 days for the UTI. She was not hypoxic and did not require acute treatment for the COVID 19. She did have an elevated d.dimer but it was less than 10x normal. She was asked to follow up outpatient.    Consults to: None.    Significant Diagnostic Studies:  None.    Procedure(s): None.    Disposition:  home   Discharge Condition:  fair
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Decreased appetite, Essential hypertension, Fibrin D dimer increased, Hypokalaemia, Hypomagnesaemia
Clinical narrative: Discharge Summary (Physician) ? ? Hospitalist Physician Discharge Summary       Age:83 y.o. Admit Date:  7/12/2022 Discharge Date:  7/14/2022      Principal Diagnoses:  Principal Problem:   AKI (acute kidney injury) Active Problems:   Acute cystitis without hematuria   Benign essential HTN   Hypokalemia   Hypomagnesemia   Orthostatic hypotension   Anorexia   COVID-19 virus infection   Generalized weakness     Discharge Diagnosis:  Acute renal failure, Hypotension, Anorexia, UTI, COVID 19, HTN, Debility.    Hospital Course:  The patient was admitted with the above. She was treated with IVF and her renal function improved. The UTI was treated with rocephin. Nothing grew on cultures. She was eating and drinking much better at the time of discharge. She declined SNF placement. She was placed on vantin to complete 3 days for the UTI. She was not hypoxic and did not require acute treatment for the COVID 19. She did have an elevated d.dimer but it was less than 10x normal. She was asked to follow up outpatient.    Consults to: None.    Significant Diagnostic Studies:  None.    Procedure(s): None.    Disposition:  home   Discharge Condition:  fair
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Hypotension, Orthostatic hypotension, Urinary tract infection
Clinical narrative: Discharge Summary (Physician) ? ? Hospitalist Physician Discharge Summary       Age:83 y.o. Admit Date:  7/12/2022 Discharge Date:  7/14/2022      Principal Diagnoses:  Principal Problem:   AKI (acute kidney injury) Active Problems:   Acute cystitis without hematuria   Benign essential HTN   Hypokalemia   Hypomagnesemia   Orthostatic hypotension   Anorexia   COVID-19 virus infection   Generalized weakness     Discharge Diagnosis:  Acute renal failure, Hypotension, Anorexia, UTI, COVID 19, HTN, Debility.    Hospital Course:  The patient was admitted with the above. She was treated with IVF and her renal function improved. The UTI was treated with rocephin. Nothing grew on cultures. She was eating and drinking much better at the time of discharge. She declined SNF placement. She was placed on vantin to complete 3 days for the UTI. She was not hypoxic and did not require acute treatment for the COVID 19. She did have an elevated d.dimer but it was less than 10x normal. She was asked to follow up outpatient.    Consults to: None.    Significant Diagnostic Studies:  None.    Procedure(s): None.    Disposition:  home   Discharge Condition:  fair
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain, Abscess, Aspiration, COVID-19, Colostomy
Clinical narrative: Presented on 8/13 with worsening  severe abdominal pain, peritoneal signs, CT concerning for perforated bowel. Taken for exploratory lap which showed walled off abscess with perforated sigmoid colon and necrotic small bowel. Performed partial small bowel resection and end colostomy.  The next day the patient had an aspiration event leading to desaturations to the mid 70s. Proceeded with increasing oxygen requirements requiring intubation. Became increasingly hypotensive and started on levophed, vasopressin and epinephrine. COVID test returned +. Pulmonary consulted and started patient on dexamethsone, remdesivir and flolan.  Improved some with respiratory status but unable to be extubated with inability to follow commands. On 8/24 patient remained stable and scheduled for trach and PEG, however became increasingly tachycardic and hypotensive requiring increased pressors. CT of chest negative for PE but showed moderate pneumoperitoneum with pneumatosis and gas suggesting bowel perforation and ischemia/necrosis. Due to instability preventing further surgery family requested comfort care.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Endotracheal intubation, Explorative laparotomy, Flatulence
Clinical narrative: Presented on 8/13 with worsening  severe abdominal pain, peritoneal signs, CT concerning for perforated bowel. Taken for exploratory lap which showed walled off abscess with perforated sigmoid colon and necrotic small bowel. Performed partial small bowel resection and end colostomy.  The next day the patient had an aspiration event leading to desaturations to the mid 70s. Proceeded with increasing oxygen requirements requiring intubation. Became increasingly hypotensive and started on levophed, vasopressin and epinephrine. COVID test returned +. Pulmonary consulted and started patient on dexamethsone, remdesivir and flolan.  Improved some with respiratory status but unable to be extubated with inability to follow commands. On 8/24 patient remained stable and scheduled for trach and PEG, however became increasingly tachycardic and hypotensive requiring increased pressors. CT of chest negative for PE but showed moderate pneumoperitoneum with pneumatosis and gas suggesting bowel perforation and ischemia/necrosis. Due to instability preventing further surgery family requested comfort care.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Gastrointestinal necrosis, Hypotension, Large intestine perforation, Oxygen saturation decreased, Peritoneal disorder
Clinical narrative: Presented on 8/13 with worsening  severe abdominal pain, peritoneal signs, CT concerning for perforated bowel. Taken for exploratory lap which showed walled off abscess with perforated sigmoid colon and necrotic small bowel. Performed partial small bowel resection and end colostomy.  The next day the patient had an aspiration event leading to desaturations to the mid 70s. Proceeded with increasing oxygen requirements requiring intubation. Became increasingly hypotensive and started on levophed, vasopressin and epinephrine. COVID test returned +. Pulmonary consulted and started patient on dexamethsone, remdesivir and flolan.  Improved some with respiratory status but unable to be extubated with inability to follow commands. On 8/24 patient remained stable and scheduled for trach and PEG, however became increasingly tachycardic and hypotensive requiring increased pressors. CT of chest negative for PE but showed moderate pneumoperitoneum with pneumatosis and gas suggesting bowel perforation and ischemia/necrosis. Due to instability preventing further surgery family requested comfort care.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Pneumatosis, Pneumoperitoneum, SARS-CoV-2 test positive, Small intestinal resection, Tachycardia
Clinical narrative: Presented on 8/13 with worsening  severe abdominal pain, peritoneal signs, CT concerning for perforated bowel. Taken for exploratory lap which showed walled off abscess with perforated sigmoid colon and necrotic small bowel. Performed partial small bowel resection and end colostomy.  The next day the patient had an aspiration event leading to desaturations to the mid 70s. Proceeded with increasing oxygen requirements requiring intubation. Became increasingly hypotensive and started on levophed, vasopressin and epinephrine. COVID test returned +. Pulmonary consulted and started patient on dexamethsone, remdesivir and flolan.  Improved some with respiratory status but unable to be extubated with inability to follow commands. On 8/24 patient remained stable and scheduled for trach and PEG, however became increasingly tachycardic and hypotensive requiring increased pressors. CT of chest negative for PE but showed moderate pneumoperitoneum with pneumatosis and gas suggesting bowel perforation and ischemia/necrosis. Due to instability preventing further surgery family requested comfort care.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Acute left ventricular failure, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac failure congestive
Clinical narrative: Physician Discharge Summary      Admit Date:  7/12/2022 Discharge Date:  7/15/2022      Principal Diagnoses:  Principal Problem:   Pneumonia due to COVID-19 virus Active Problems:   HTN (hypertension)   HLD (hyperlipidemia)   Acute diastolic CHF (congestive heart failure)   Chronic respiratory failure with hypoxia   Elevated troponin   COPD with acute exacerbation   GERD (gastroesophageal reflux disease)     Discharge Diagnosis:  Acute on chronic hypoxic respirtory failure, COVID 19, Acute diatolic CHF, elevated troponin. HTN.    Hospital Course:  The patient was admitted with the above. She was treated with remdesevir 3/3 days and steroids. Her oxygen requirement here was 21/2 liters and her home oxygen was 2 liters. She was initally treated with IV Cefepime and vanc but nothing grew on cultuers so she was placed on omnicef to complete 5 days. She had an elevated troponin on admission with no chest pain. She had a preserved EF on 2D echo. She had a low risk stress. She was asked to follow up outpatinet.    Consults to: Pulmonology, Cardiology.    Significant Diagnostic Studies: 2D echo, Stress test.    Procedure(s): none.    Disposition:  home   Discharge Condition:  fair
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac stress test, Chronic obstructive pulmonary disease, Echocardiogram, Ejection fraction, Gastrooesophageal reflux disease
Clinical narrative: Physician Discharge Summary      Admit Date:  7/12/2022 Discharge Date:  7/15/2022      Principal Diagnoses:  Principal Problem:   Pneumonia due to COVID-19 virus Active Problems:   HTN (hypertension)   HLD (hyperlipidemia)   Acute diastolic CHF (congestive heart failure)   Chronic respiratory failure with hypoxia   Elevated troponin   COPD with acute exacerbation   GERD (gastroesophageal reflux disease)     Discharge Diagnosis:  Acute on chronic hypoxic respirtory failure, COVID 19, Acute diatolic CHF, elevated troponin. HTN.    Hospital Course:  The patient was admitted with the above. She was treated with remdesevir 3/3 days and steroids. Her oxygen requirement here was 21/2 liters and her home oxygen was 2 liters. She was initally treated with IV Cefepime and vanc but nothing grew on cultuers so she was placed on omnicef to complete 5 days. She had an elevated troponin on admission with no chest pain. She had a preserved EF on 2D echo. She had a low risk stress. She was asked to follow up outpatinet.    Consults to: Pulmonology, Cardiology.    Significant Diagnostic Studies: 2D echo, Stress test.    Procedure(s): none.    Disposition:  home   Discharge Condition:  fair
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperlipidaemia, Hypertension, Respiratory failure, Troponin increased
Clinical narrative: Physician Discharge Summary      Admit Date:  7/12/2022 Discharge Date:  7/15/2022      Principal Diagnoses:  Principal Problem:   Pneumonia due to COVID-19 virus Active Problems:   HTN (hypertension)   HLD (hyperlipidemia)   Acute diastolic CHF (congestive heart failure)   Chronic respiratory failure with hypoxia   Elevated troponin   COPD with acute exacerbation   GERD (gastroesophageal reflux disease)     Discharge Diagnosis:  Acute on chronic hypoxic respirtory failure, COVID 19, Acute diatolic CHF, elevated troponin. HTN.    Hospital Course:  The patient was admitted with the above. She was treated with remdesevir 3/3 days and steroids. Her oxygen requirement here was 21/2 liters and her home oxygen was 2 liters. She was initally treated with IV Cefepime and vanc but nothing grew on cultuers so she was placed on omnicef to complete 5 days. She had an elevated troponin on admission with no chest pain. She had a preserved EF on 2D echo. She had a low risk stress. She was asked to follow up outpatinet.    Consults to: Pulmonology, Cardiology.    Significant Diagnostic Studies: 2D echo, Stress test.    Procedure(s): none.    Disposition:  home   Discharge Condition:  fair
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest pain, Computerised tomogram head, Computerised tomogram spine, Essential hypertension
Clinical narrative: Physician Discharge Summary: Patient ID: "PRIVATE"- 66 y.o. female- DOB: 7/11/1956. Admit Date: 7/12/2022 -Discharge Date: 7/15/2022. Discharge Diagnosis: Principal Problem: Right sided numbness. Active Problems: Essential hypertension; Atypical chest pain; COVID-19. Hospital Course: 66 year old female was admitted for right side numbness with stroke alert. Symptoms resolved spontaneously. MRI showed no acute infarct. MRV brain showed no occlusion. Carotid duplex did not show stenosis. Bubble study was normal. She was discharged in stable condition on ASA and statin. Patient educated on appropriate level of care post-discharge. Follow up with Primary Care Doctor in 5-7 days. Physical Exam on the day of discharge: Last Recorded Vital Signs: Temp: 98.6 °F (37 °C) Heart Rate (Monitor): 72- Pulse: 64- BP: 135/72- Respirations: 14- SpO2: 99 %- O2 Flow Rate (l/min): 0 l/min. General Appearance: no distress; Eyes: PERRLA; ENT: moist mucus membranes, no adenopathy; Lungs: clear to auscultation bilaterally; Heart: regular rate and rhythm; Abdomen: soft, non-tender; Skin: No rashes or lesions; Extremities: full ROM; Neuro: alert, normal strength and tone. Consults: IP CONSULT TO NEUROLOGY; IP CONSULT TO NEUROLOGY; IP CONSULT TO STROKE NURSE NAVIGATOR. Significant Diagnostic Studies: MRI head, MRV brain, bubble study, carotid US, CT head, CT C spine. Operations: none; Disposition: Home; Discharge Condition: Fair.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoaesthesia, Laboratory test normal, Magnetic resonance imaging normal, Ultrasound Doppler normal, Venogram normal
Clinical narrative: Physician Discharge Summary: Patient ID: "PRIVATE"- 66 y.o. female- DOB: 7/11/1956. Admit Date: 7/12/2022 -Discharge Date: 7/15/2022. Discharge Diagnosis: Principal Problem: Right sided numbness. Active Problems: Essential hypertension; Atypical chest pain; COVID-19. Hospital Course: 66 year old female was admitted for right side numbness with stroke alert. Symptoms resolved spontaneously. MRI showed no acute infarct. MRV brain showed no occlusion. Carotid duplex did not show stenosis. Bubble study was normal. She was discharged in stable condition on ASA and statin. Patient educated on appropriate level of care post-discharge. Follow up with Primary Care Doctor in 5-7 days. Physical Exam on the day of discharge: Last Recorded Vital Signs: Temp: 98.6 °F (37 °C) Heart Rate (Monitor): 72- Pulse: 64- BP: 135/72- Respirations: 14- SpO2: 99 %- O2 Flow Rate (l/min): 0 l/min. General Appearance: no distress; Eyes: PERRLA; ENT: moist mucus membranes, no adenopathy; Lungs: clear to auscultation bilaterally; Heart: regular rate and rhythm; Abdomen: soft, non-tender; Skin: No rashes or lesions; Extremities: full ROM; Neuro: alert, normal strength and tone. Consults: IP CONSULT TO NEUROLOGY; IP CONSULT TO NEUROLOGY; IP CONSULT TO STROKE NURSE NAVIGATOR. Significant Diagnostic Studies: MRI head, MRV brain, bubble study, carotid US, CT head, CT C spine. Operations: none; Disposition: Home; Discharge Condition: Fair.
Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cardiac failure congestive, Death, Hypoxia, Intensive care
Clinical narrative: The patient presented to Healthcare Center on 02/02/2022 post hospitalization from 01/23/22-02/2/22 where the patient was admitted for hypoxia d/t Covid-19 PNA.  He required intensive care unit  for levophed, vapotherm and bipap and was treated with dexamethasone and tozolizumab.  CHF was treated with lasix.  The patient and wife stated the the patient would be a DNR.  The patient expired at the facility on 02/7/22.
Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: Positive airway pressure therapy
Clinical narrative: The patient presented to Healthcare Center on 02/02/2022 post hospitalization from 01/23/22-02/2/22 where the patient was admitted for hypoxia d/t Covid-19 PNA.  He required intensive care unit  for levophed, vapotherm and bipap and was treated with dexamethasone and tozolizumab.  CHF was treated with lasix.  The patient and wife stated the the patient would be a DNR.  The patient expired at the facility on 02/7/22.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Asthenia, Feeling abnormal, Impaired driving ability, Loss of personal independence in daily activities
Clinical narrative: The patient has extreme pain, weakness and pain up into his neck and shoulder on the side he received his vaccination.  States he feels weak and awful, unable to get up and do things for himself the morning after receiving the vaccine.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Neck pain, Pain
Clinical narrative: The patient has extreme pain, weakness and pain up into his neck and shoulder on the side he received his vaccination.  States he feels weak and awful, unable to get up and do things for himself the morning after receiving the vaccine.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal pain, Back pain, Chest X-ray abnormal, Constipation, Lung disorder
Clinical narrative: Hospital Medicine Admission History & Physical   Patient Date: 7/7/2022 Room: 31/31     Chief Complaint:  Idiopathic acute pancreatitis      History Of Present Illness: PT is a 62 y.o. male with a history below admitted for Idiopathic acute pancreatitis. Pt came in with complaints of abdominal pain, generalized, back pain. Started a week prior, attempted meds for constipation and did not improve. Pain 8/10. Constant. Nothing made better / worse. Sharp. Discussed with er and will admit. Labs concerning for pancreatitis.      Past Medical History:  Patient  has a past medical history of Back problem, Cigarette smoker, Colon polyp, Coronary artery disease, Deviated septum (1/2012), Diabetes mellitus, Disease of cardiovascular system, Diverticulitis, Heart attack (2005, 2010), Hyperlipidemia, Multiple sclerosis, Nasal turbinate hypertrophy (1/2012), and Sleep apnea.   Past Surgical History:  Patient's  has a past surgical history that includes Hx Other Surgical History; Hx Back Surgery; Hx Cardiac Catheterization; Hx Polypectomy; Hx Coronary Artery Bypass Graft (N/A, 11/13/2018); Hx Arterial Line Insertion (Right, 11/13/2018); Hx Swan-Ganz Insertion (Right, 11/13/2018); Hx Transesophageal Echocardiogram (N/A, 11/13/2018); Left heart cath (N/A, 10/31/2018); Drug-eluting stent placement (N/A, 10/31/2018); ACT (N/A, 10/31/2018); Hx Colonoscopy (N/A, 12/5/2015); Hx Septoplasty (N/A, 1/4/2012); Hx Turbinate, Submucosal Resection (Bilateral, 1/4/2012); Left heart cath (N/A, 10/27/2010); Drug-eluting stent placement (N/A, 10/27/2010); and Drug-eluting stent placement (N/A, 10/27/2010).   Family History:   Patient's family history includes Arthritis-Osteo in his mother; Cancer in his maternal grandfather and paternal grandfather; Colon Polyps in his mother; Diabetes in his mother and sister; Heart Disease in his father; Stroke in his mother.      Social History:  He  reports no history of alcohol use.  He  reports no history of drug use.  He  reports that he quit smoking about 15 years ago. His smoking use included cigarettes. He has a 30.00 pack-year smoking history. He has never used smokeless tobacco.  Social History   Social History Narrative ? Not on file  Patient left 0n 7/11/2022 Plan was to discharge patient today if VQ scan is negative. He had to wait for test all day, scheduled last due to positive covid test on admission (false positive). VQ scan done but px left without waiting for result. Repeat CXR also showed new patchy bilateral lower lung ill defined airspace disease - not discussed w/ px and addressed because px left as soon as he got back on the floor. Px left.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Pancreatitis acute, SARS-CoV-2 test positive, Ventilation/perfusion scan
Clinical narrative: Hospital Medicine Admission History & Physical   Patient Date: 7/7/2022 Room: 31/31     Chief Complaint:  Idiopathic acute pancreatitis      History Of Present Illness: PT is a 62 y.o. male with a history below admitted for Idiopathic acute pancreatitis. Pt came in with complaints of abdominal pain, generalized, back pain. Started a week prior, attempted meds for constipation and did not improve. Pain 8/10. Constant. Nothing made better / worse. Sharp. Discussed with er and will admit. Labs concerning for pancreatitis.      Past Medical History:  Patient  has a past medical history of Back problem, Cigarette smoker, Colon polyp, Coronary artery disease, Deviated septum (1/2012), Diabetes mellitus, Disease of cardiovascular system, Diverticulitis, Heart attack (2005, 2010), Hyperlipidemia, Multiple sclerosis, Nasal turbinate hypertrophy (1/2012), and Sleep apnea.   Past Surgical History:  Patient's  has a past surgical history that includes Hx Other Surgical History; Hx Back Surgery; Hx Cardiac Catheterization; Hx Polypectomy; Hx Coronary Artery Bypass Graft (N/A, 11/13/2018); Hx Arterial Line Insertion (Right, 11/13/2018); Hx Swan-Ganz Insertion (Right, 11/13/2018); Hx Transesophageal Echocardiogram (N/A, 11/13/2018); Left heart cath (N/A, 10/31/2018); Drug-eluting stent placement (N/A, 10/31/2018); ACT (N/A, 10/31/2018); Hx Colonoscopy (N/A, 12/5/2015); Hx Septoplasty (N/A, 1/4/2012); Hx Turbinate, Submucosal Resection (Bilateral, 1/4/2012); Left heart cath (N/A, 10/27/2010); Drug-eluting stent placement (N/A, 10/27/2010); and Drug-eluting stent placement (N/A, 10/27/2010).   Family History:   Patient's family history includes Arthritis-Osteo in his mother; Cancer in his maternal grandfather and paternal grandfather; Colon Polyps in his mother; Diabetes in his mother and sister; Heart Disease in his father; Stroke in his mother.      Social History:  He  reports no history of alcohol use.  He  reports no history of drug use.  He  reports that he quit smoking about 15 years ago. His smoking use included cigarettes. He has a 30.00 pack-year smoking history. He has never used smokeless tobacco.  Social History   Social History Narrative ? Not on file  Patient left 0n 7/11/2022 Plan was to discharge patient today if VQ scan is negative. He had to wait for test all day, scheduled last due to positive covid test on admission (false positive). VQ scan done but px left without waiting for result. Repeat CXR also showed new patchy bilateral lower lung ill defined airspace disease - not discussed w/ px and addressed because px left as soon as he got back on the floor. Px left.
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Ill-defined disorder, Lung disorder, SARS-CoV-2 test false positive
Clinical narrative: Plan was to discharge patient today if VQ scan is negative. He had to wait for test all day, scheduled last due to positive covid test on admission (false positive). VQ scan done but px left without waiting for result. Repeat CXR also showed new patchy bilateral lower lung ill defined airspace disease - not discussed w/ px and addressed because px left as soon as he got back on the floor. Px left AMA.
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Ventilation/perfusion scan normal
Clinical narrative: Plan was to discharge patient today if VQ scan is negative. He had to wait for test all day, scheduled last due to positive covid test on admission (false positive). VQ scan done but px left without waiting for result. Repeat CXR also showed new patchy bilateral lower lung ill defined airspace disease - not discussed w/ px and addressed because px left as soon as he got back on the floor. Px left AMA.
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac arrest, Confusional state, Death, Dysarthria, Dyspnoea
Clinical narrative: The patient presented to ED on 03/01/2022 for worsening hypoxia and fever.  He was treated and sent home on 03/04/2022 with supplemental oxygen.  A few hours later the patient's daughter noted his oxygen saturation in the 70s, he was confused and had slurred speech.  He returned to the hospital and suffered a cardiac arrest in the ED and was intubated.  The patient continued to decline with worsening neurological functions.  The patient was made comfort care on 03/14/2022.  The patient required high doses of fentanyl to treat dyspnea.  The patient was transferred on 03/15/2022 for end-of-life care. The patient expired on 03/17/2022.
Age: 81.0
Sex: M
Vaccine: COVID19
Symptoms: Endotracheal intubation, General physical health deterioration, Hypoxia, Nervous system disorder, Pyrexia
Clinical narrative: The patient presented to ED on 03/01/2022 for worsening hypoxia and fever.  He was treated and sent home on 03/04/2022 with supplemental oxygen.  A few hours later the patient's daughter noted his oxygen saturation in the 70s, he was confused and had slurred speech.  He returned to the hospital and suffered a cardiac arrest in the ED and was intubated.  The patient continued to decline with worsening neurological functions.  The patient was made comfort care on 03/14/2022.  The patient required high doses of fentanyl to treat dyspnea.  The patient was transferred on 03/15/2022 for end-of-life care. The patient expired on 03/17/2022.
Age: 28.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: vaccine was expired, no temperature excursions occurred and moderna determined the vial "maintained the activity necessary to protect against the SARS CoV-2 virus at the time of administration".  Patient reported no adverse reactions.
Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Injection site reaction, Injection site swelling, Musculoskeletal stiffness, Rash macular
Clinical narrative: large red blotch over injection site, swelling at vaccine site, joint pain and stiffness all lasting for >2 days post vaccination
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Ammonia normal, Asthenia, COVID-19, Computerised tomogram abdomen abnormal, Computerised tomogram head normal
Clinical narrative: Hospital Course:       Patient is a 82-year-old female with a previous history of severe dementia who was admitted via EMS, patient without ability to give significant history, per family she has stopped walking and had stopped eating or drinking and that they were concerned he could no longer take care of her at home.  In patient with history of underlying dementia, she was admitted to the hospitalist service.  His CT was negative for acute CVA, during this admission patient was diagnosed with metabolic encephalopathy superimposed on severe underlying dementia.  The patient was severe debility info to thrive, palliative Care was involved but family declined from hospice requested PEG tube.  Peg tube was placed, patient also tested positive for COVID, she tested positive on/7, respiratory symptoms resolve 7/14.  Patient was still positive may discharge.  On the day discharge, patient still with waxing waning encephalopathy, debility failure to thrive.  Patient is currently a full code, concerned that patient is having worsening clinical decompensation secondary to her severe dementia and is more appropriate for end of life care, however family has  Refused.  Patient had PEG tube placed 7/10, currently on tube feeds, discharged to skilled nursing facility.     Altered mental statu -Acute metabolic encephalopathy - progressive weakness/ debility + poor po intake x 3 days, after exposure to Covid; covid positive on admission. CT head no stroke/bleed.  UA unremarkable.  Ammonia wnl. prob 2 to acute Covid infection on top of underlying dementia. Improved some but far from baseline.   Debility, failure to thrive - palliative involved - family declined referral to hospice for end of life care, requested PEG. Perc GJ tube placed on 7/10 - TF via J tube, meds via G tube.    COVID-19 infection - +cough but not SOB. CXR u/r. Mucinex. No hypoxia, no indication for steroids or remdesivir at this time. Sxs noted 7/5. Tested positive 7/7. Resp sxs resolved 7/14. Repeat covid pcr 7/17 POSITIVE (prob Day 11-12   Dementia - chronic, prob Alzheimer's. Also HOH. Worsening even before acute illness. PT/OT if tolerated. Resume memantine/ donepezil (Home med   Ess HTN - unable to take meds. Home meds per G tube. BP now w/in acceptable limits.    Patient is a FULL CODE     Significant Diagnostic Studies:    Ct Abdomen and Pelvis: Nonobstructing renal stones.   Left renal cyst.   The stomach is not well distended.   Other findings as detailed above.         Procedure(s):  Placement of 18 Fr x 45 cm percutaneous gastrojejunostomy tube (Perc GJ) under fluoroscopic guidance. 7/9/2022
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Cough, Decreased appetite, Dementia, Dyspnoea
Clinical narrative: Hospital Course:       Patient is a 82-year-old female with a previous history of severe dementia who was admitted via EMS, patient without ability to give significant history, per family she has stopped walking and had stopped eating or drinking and that they were concerned he could no longer take care of her at home.  In patient with history of underlying dementia, she was admitted to the hospitalist service.  His CT was negative for acute CVA, during this admission patient was diagnosed with metabolic encephalopathy superimposed on severe underlying dementia.  The patient was severe debility info to thrive, palliative Care was involved but family declined from hospice requested PEG tube.  Peg tube was placed, patient also tested positive for COVID, she tested positive on/7, respiratory symptoms resolve 7/14.  Patient was still positive may discharge.  On the day discharge, patient still with waxing waning encephalopathy, debility failure to thrive.  Patient is currently a full code, concerned that patient is having worsening clinical decompensation secondary to her severe dementia and is more appropriate for end of life care, however family has  Refused.  Patient had PEG tube placed 7/10, currently on tube feeds, discharged to skilled nursing facility.     Altered mental statu -Acute metabolic encephalopathy - progressive weakness/ debility + poor po intake x 3 days, after exposure to Covid; covid positive on admission. CT head no stroke/bleed.  UA unremarkable.  Ammonia wnl. prob 2 to acute Covid infection on top of underlying dementia. Improved some but far from baseline.   Debility, failure to thrive - palliative involved - family declined referral to hospice for end of life care, requested PEG. Perc GJ tube placed on 7/10 - TF via J tube, meds via G tube.    COVID-19 infection - +cough but not SOB. CXR u/r. Mucinex. No hypoxia, no indication for steroids or remdesivir at this time. Sxs noted 7/5. Tested positive 7/7. Resp sxs resolved 7/14. Repeat covid pcr 7/17 POSITIVE (prob Day 11-12   Dementia - chronic, prob Alzheimer's. Also HOH. Worsening even before acute illness. PT/OT if tolerated. Resume memantine/ donepezil (Home med   Ess HTN - unable to take meds. Home meds per G tube. BP now w/in acceptable limits.    Patient is a FULL CODE     Significant Diagnostic Studies:    Ct Abdomen and Pelvis: Nonobstructing renal stones.   Left renal cyst.   The stomach is not well distended.   Other findings as detailed above.         Procedure(s):  Placement of 18 Fr x 45 cm percutaneous gastrojejunostomy tube (Perc GJ) under fluoroscopic guidance. 7/9/2022
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Essential hypertension, Failure to thrive, Fluid intake reduced, Gait inability, Gastrostomy
Clinical narrative: Hospital Course:       Patient is a 82-year-old female with a previous history of severe dementia who was admitted via EMS, patient without ability to give significant history, per family she has stopped walking and had stopped eating or drinking and that they were concerned he could no longer take care of her at home.  In patient with history of underlying dementia, she was admitted to the hospitalist service.  His CT was negative for acute CVA, during this admission patient was diagnosed with metabolic encephalopathy superimposed on severe underlying dementia.  The patient was severe debility info to thrive, palliative Care was involved but family declined from hospice requested PEG tube.  Peg tube was placed, patient also tested positive for COVID, she tested positive on/7, respiratory symptoms resolve 7/14.  Patient was still positive may discharge.  On the day discharge, patient still with waxing waning encephalopathy, debility failure to thrive.  Patient is currently a full code, concerned that patient is having worsening clinical decompensation secondary to her severe dementia and is more appropriate for end of life care, however family has  Refused.  Patient had PEG tube placed 7/10, currently on tube feeds, discharged to skilled nursing facility.     Altered mental statu -Acute metabolic encephalopathy - progressive weakness/ debility + poor po intake x 3 days, after exposure to Covid; covid positive on admission. CT head no stroke/bleed.  UA unremarkable.  Ammonia wnl. prob 2 to acute Covid infection on top of underlying dementia. Improved some but far from baseline.   Debility, failure to thrive - palliative involved - family declined referral to hospice for end of life care, requested PEG. Perc GJ tube placed on 7/10 - TF via J tube, meds via G tube.    COVID-19 infection - +cough but not SOB. CXR u/r. Mucinex. No hypoxia, no indication for steroids or remdesivir at this time. Sxs noted 7/5. Tested positive 7/7. Resp sxs resolved 7/14. Repeat covid pcr 7/17 POSITIVE (prob Day 11-12   Dementia - chronic, prob Alzheimer's. Also HOH. Worsening even before acute illness. PT/OT if tolerated. Resume memantine/ donepezil (Home med   Ess HTN - unable to take meds. Home meds per G tube. BP now w/in acceptable limits.    Patient is a FULL CODE     Significant Diagnostic Studies:    Ct Abdomen and Pelvis: Nonobstructing renal stones.   Left renal cyst.   The stomach is not well distended.   Other findings as detailed above.         Procedure(s):  Placement of 18 Fr x 45 cm percutaneous gastrojejunostomy tube (Perc GJ) under fluoroscopic guidance. 7/9/2022