chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 24.0
Sex: F
Vaccine: RAB
Symptoms: Seizure, Seizure like phenomena, Status epilepticus, Tremor
Clinical narrative: HPI: 24yo F with no known significant neurologic history with new onset seizures with initial status epilepticus. She had a potential rabies exposure on Wednesday 3 May and, having had prior rabies vaccinations x 2, underwent post exposure prophylaxis for rabies exposure with 2 dose series of rabies vaccine. Within 5 minutes of the second dose of the vaccine on day 3 after exposure she felt unwell, then became unconscious, and had seizure-like activity with rapid eye movements and rhythmic shaking of the left arm at about 1330. She remained unconscious with GCS 3 for the next 3 hours with frequent episodes every 2-20 minutes of recurrent seizure activity lasting 15 seconds to 3+ minutes. She was treated initially with midazolam in recurrent boluses of 2mg up to 12mg in total. She was loaded with levetiracetam 4500mg IV and given an additional 10mg IM diazepam. She underwent CT head with and w/o IV contrast which was negative. She had a total of over 23 seizure-like events over about 3 hours. Over the next week she had progressive improvement in mental status. She had no further large events after about 24hrs and had only 1 very brief event.
Age: 89.0
Sex: F
Vaccine: COVID19-2
Symptoms: Deep vein thrombosis
Clinical narrative: ACUTE DVT OF LEFT LEG, UNSPECIFIED VEIN ACUTE DVT OF BILAT LEGS, UNSPECIFIED VEINS ACUTE DVT, UNSPECIFIED VEIN ACUTE DVT OF LEFT FEMORAL VEIN
Age: 5.0
Sex: M
Vaccine: DTAPIPV, MMRV
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Pyrexia
Clinical narrative: Right arm became red, swollen, and warm to the touch, Fever on Saturday of 101.3
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Deep vein thrombosis, Pulmonary embolism
Clinical narrative: ACUTE DVT, UNSPECIFIED VEIN ACUTE DVT OF RIGHT POPLITEAL VEIN ACUTE PULMONARY EMBOLISM
Age: 16.0
Sex: F
Vaccine: MENB, MNQ
Symptoms: No adverse event, Product preparation error
Clinical narrative: Nurse did not mix the proper diluent with the powder. No treatment needed. Mother notified. No signs of any complications from client. Will plan on administrating MVC4 again at next months appointment.
Age: 36.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Hypoxia, Obstructive sleep apnoea syndrome
Clinical narrative: ADULT OBSTRUCTIVE SLEEP APNEA, MILD ACUTE HYPOXEMIC RESPIRATORY FAILURE HYPOXIA
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Aortic arteriosclerosis
Clinical narrative: I22.0 SUBSEQ ST ELEVATION MI, LEFT ANTERIOR DESCENDING CORONARY ARTERY, WITHIN 4 WKS OF PREVIOUS MI 3/27/2023 ATHEROSCLEROSIS OF AORTA
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Infection, Obstructive sleep apnoea syndrome
Clinical narrative: OBSTRUCTIVE SLEEP APNEA 1/17/2023  -  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Transient ischaemic attack
Clinical narrative: TRANSIENT CEREBRAL ISCHEMIA
Age: 19.0
Sex: M
Vaccine: MNQ, TDAP
Symptoms: Confusional arousal, Confusional state, Fall, Headache, Heart rate abnormal
Clinical narrative: A few minutes after the vaccines were administered and patient was waiting for paperwork he experience a syncopal event. He fell off exam table and briefly lost consciousness.  He maintained breath and 02 sats were 99%.  He was out for 30 seconds or less, when he aroused he was confused and did not know exactly what happened.  His b/p was low 100/40, pale and tachycardic. He was escorted to a chair given a juice and allowed to sit.  At this time he complained of headache and was confused about what had happened.  15 minutes with observation and ongoing assessment later- color returned, b/p  and heart rate normalized.   No medications were administered.  He left the clinic on his own.  Mother was informed of events.  She had states his father had similar adverse events.
Age: 19.0
Sex: M
Vaccine: MNQ, TDAP
Symptoms: Hypotension, Loss of consciousness, Pallor, Syncope, Tachycardia
Clinical narrative: A few minutes after the vaccines were administered and patient was waiting for paperwork he experience a syncopal event. He fell off exam table and briefly lost consciousness.  He maintained breath and 02 sats were 99%.  He was out for 30 seconds or less, when he aroused he was confused and did not know exactly what happened.  His b/p was low 100/40, pale and tachycardic. He was escorted to a chair given a juice and allowed to sit.  At this time he complained of headache and was confused about what had happened.  15 minutes with observation and ongoing assessment later- color returned, b/p  and heart rate normalized.   No medications were administered.  He left the clinic on his own.  Mother was informed of events.  She had states his father had similar adverse events.
Age: 66.0
Sex: M
Vaccine: HEP
Symptoms: Wrong product administered
Clinical narrative: The employee came down to our office and said that he was here for Hep B. The person checking him in ordered a hep b vaccine. I didn't check the task for him and gave him the vaccine after I went over the information with him. I told him that he should come back in 2 months and that we would draw his Hep B titer to see if he had immunity. He told me that he wasn't going to be here in 2 months so I went into his tasks to push out the follow up date, and noted that he actually needed the Hep B titer not the Hep B booster.
Age: 81.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure
Clinical narrative: ACUTE HYPOXEMIC RESPIRATORY FAILURE
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Alanine aminotransferase, Back pain, Blood creatinine, Blood folate, Blood potassium
Clinical narrative: Back pain (9/1/2021) Rash - Week later Bruising in legs Numbness/tingling of toes Split toenail Concern if affected her cognition
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Blood sodium, Blood thyroid stimulating hormone, C-reactive protein, Contusion, Differential white blood cell count
Clinical narrative: Back pain (9/1/2021) Rash - Week later Bruising in legs Numbness/tingling of toes Split toenail Concern if affected her cognition
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Full blood count, Glycosylated haemoglobin, Hypoaesthesia, Lipids, Nail injury
Clinical narrative: Back pain (9/1/2021) Rash - Week later Bruising in legs Numbness/tingling of toes Split toenail Concern if affected her cognition
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Paraesthesia, Rash, Red blood cell sedimentation rate, Vitamin B12
Clinical narrative: Back pain (9/1/2021) Rash - Week later Bruising in legs Numbness/tingling of toes Split toenail Concern if affected her cognition
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: ADULT OBSTRUCTIVE SLEEP APNEA, MODERATE 4/3/2023 BMI 45-49.9 ADULT
Age: 59.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chronic respiratory failure, Respiratory failure
Clinical narrative: CHRONIC HYPOXEMIC RESPIRATORY FAILURE
Age: 77.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site erythema, Injection site warmth, Rash, Rash erythematous, Rash macular
Clinical narrative: Localized reaction on site of injection with warmth and redness.  Both feet and lower legs with erythematous macular rash with vesicles
Age: 77.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash vesicular
Clinical narrative: Localized reaction on site of injection with warmth and redness.  Both feet and lower legs with erythematous macular rash with vesicles
Age: 80.0
Sex: M
Vaccine: COVID19-2
Symptoms: Musculoskeletal stiffness, Myalgia, Pain in extremity
Clinical narrative: Severe pain in left upper arm; pain in upper right arm; stiffness/pain in upper leg muscles; stiffness across back muscle.
Age: 67.0
Sex: M
Vaccine: PNC20
Symptoms: Arthralgia, Neck pain, Pain in extremity, Peripheral swelling, Skin warm
Clinical narrative: Arm swelling and pain, travelling from elbow up to neck. Pt took 2 benadryl, tylenol, and iced, and it has come down some, but still very hot and swollen. Pt is reaching out to provider to see if steroids are needed.
Age: 1.0
Sex: M
Vaccine: MMR
Symptoms: Injection site rash, Pruritus, Rash
Clinical narrative: rash that started 9 days after vaccination in Right upper thigh with MMR vaccine. Started on right foot and has now spread to BUE, BLE, abdomen, back, and chest. Mother states he is itching but responding well benadryl. She denies and drainage or crusting or the rash. Mother states the rash and itching is getting better.
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Respiratory failure, Symptom recurrence
Clinical narrative: ACUTE HYPOXEMIC RESPIRATORY FAILURE HYPERCAPNIC RESPIRATORY FAILURE, UNSPECIFIED ACUITY 2/1/2023  -- RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 12.0
Sex: M
Vaccine: DTAP
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: none
Age: 19.0
Sex: M
Vaccine: HEP
Symptoms: Device malfunction, Loss of personal independence in daily activities, Needle issue, Pain in extremity
Clinical narrative: THIS VACCINE HAD A STRANGE OCCURENCE WHEN I GAVE IT TO THIS PT-----UPON PUSHING THE NEEDLE INTO THE PTS ARM THE MEDICATION WOULDNT PUSH OUT OF THE BARRELL, I PUSHED FOR A LITTLE BIT AND THEN REALIZED THAT IT WASNT GOING TO WORK SO I PULLED THE NEEDLE BACK A LITTLE AND THEN A SUCTION SOUND OCCURED (THE SYRINGE WAS SUCTIONED TO PTS ARM) AFTER PULLING BACK THE MEDICATION DID GO IN BUT ONCE FINISHED AND I PULLED THE NEEDLE OUT OF HIS ARM IT WAS BENT!!?? HE WAS SUPER SWEET AND STATED THAT IT DIDNT HURT AND ALSO HE DIDNT BLEED---I BANDAGED HIS ARM AND TOLD HIM TO PLEASE LET ME KNOW IF HE HAS ANY ISSUES AND APOLOGIZED PROFUSELY!!------Patient called back today (7/10/23) stating that his arm is still sore and prevents him from doing his daily activities.  He has used Ibuprofen for pain and iced the area and is going to continue this care for a few more days before following up with his family practice provider.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Hypoxia
Clinical narrative: ACUTE HYPOXEMIC RESPIRATORY FAILURE HYPOXIA
Age: 1.08
Sex: M
Vaccine: HEP, HEPA, HIBV, MMR, PNC13, VARCEL
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Child received adult dosage of Hep A and B
Age: 9.0
Sex: M
Vaccine: COVID19-2
Symptoms: Breathing-related sleep disorder, Obstructive sleep apnoea syndrome
Clinical narrative: BREATHING RELATED SLEEP DISORDER OBSTRUCTIVE SLEEP APNEA
Age: 80.0
Sex: M
Vaccine: COVID19-2
Symptoms: Notalgia paraesthetica, Transient ischaemic attack
Clinical narrative: TRANSIENT CEREBRAL ISCHEMIA NOTALGIA PARESTHETICA
Age: 70.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 56.0
Sex: F
Vaccine: HEPAB
Symptoms: Blood glucose normal, Dizziness, Hyperhidrosis, Nausea, Pain in extremity
Clinical narrative: Patient had reaction to vaccine after administered. Pt described having pain and tingling down arm and became pale and diaphoretic. Patient stated feeling dizzy and nauseous. Patient was given water and granola bar and instructed to lay down on exam table. Vitals and blood sugar checked. Blood sugar was 120, BP 112/72, pulse 57, and O2 100. Provider recommended ER and patient declined. Patient remained in office until dizziness, nausea, and sweating stopped.
Age: 56.0
Sex: F
Vaccine: HEPAB
Symptoms: Pallor, Paraesthesia
Clinical narrative: Patient had reaction to vaccine after administered. Pt described having pain and tingling down arm and became pale and diaphoretic. Patient stated feeling dizzy and nauseous. Patient was given water and granola bar and instructed to lay down on exam table. Vitals and blood sugar checked. Blood sugar was 120, BP 112/72, pulse 57, and O2 100. Provider recommended ER and patient declined. Patient remained in office until dizziness, nausea, and sweating stopped.
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 48.0
Sex: F
Vaccine: COVID19
Symptoms: Obesity, Obstructive sleep apnoea syndrome
Clinical narrative: G47.33 OBSTRUCTIVE SLEEP APNEA 4/21/2023 SEVERE OBESITY
Age: 91.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chronic respiratory failure, Respiratory failure, Symptom recurrence
Clinical narrative: CHRONIC HYPOXEMIC RESPIRATORY FAILURE 1/29/2023 --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Asthma, Condition aggravated, Hypoxia
Clinical narrative: R09.02 HYPOXIA 4/13/2023 ASTHMA, UNSPECIFIED W ACUTE EXACERBATION
Age: 72.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Feeling abnormal, Pruritus, Rash
Clinical narrative: unbearable itching and a rash over my whole upper body, it has never completely gotten better. its in my head ,face, arms,back,chest. right now its worst than its ever been i have been to several Drs and no one know nothing about what is going on,But I am miserable, and I have never had anything like this until i took the shots. ms
Age: 90.0
Sex: M
Vaccine: COVID19-2
Symptoms: Transient ischaemic attack
Clinical narrative: TRANSIENT CEREBRAL ISCHEMIA
Age: 71.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 54.0
Sex: M
Vaccine: VARZOS
Symptoms: Circumstance or information capable of leading to medication error, Extra dose administered
Clinical narrative: Extra dose given due to incorrect forecasting
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Acute left ventricular failure, Acute myocardial infarction
Clinical narrative: I21.A1 TYPE 2 MI 4/18/2023 DIASTOLIC HEART FAILURE, ACUTE
Age: 76.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 0.5
Sex: M
Vaccine: DTAPHEPBIP, HIBV, PNC15, RV1
Symptoms: Inappropriate schedule of product administration, No adverse event
Clinical narrative: No adverse effects were noted.  Patient was given 1st dose of rotateq vaccine at age 6 months.  Rotateq is not indicated unless first dose is given prior to this.
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 61.0
Sex: M
Vaccine: UNK
Symptoms: Anxiety, General physical health deterioration, Injection site pain, Pain
Clinical narrative: Severe pain at injection site.  Severe! I am getting worse as time goes on.  I don?t know what to do. Doctors don?t know anything about it. This is causing me severe anxiety, and pain.
Age: 18.0
Sex: F
Vaccine: MNQ
Symptoms: Extra dose administered, No adverse event
Clinical narrative: A third dose of Menveo was given to patient 10 months after the second dose was administered. There were no symptoms or reactions after giving the vaccine.
Age: 43.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Biopsy lung abnormal, Biopsy lymph gland abnormal, Chest pain, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal
Clinical narrative: Patient began having symptoms on shortness of breath, chest pains and fatigue in the weeks following the vaccine. In June of 2022, finally went to a physician who ordered and MRI which incidentially noted 2 mass in rt Humerus bone, Ordered an ABD/PEL wow CT and found numerous lung nodules and enlarged calcified mediastinal lymph nodes. PET scan, PFT and tissue biopsy of lung nodules and mediastinal lymph nodes resulted in a diagnosis of possible pulmonary sarcoidosis. Patient is currently being treated with steriods.
Age: 43.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Fatigue, Laboratory test normal, Limb mass, Lung disorder
Clinical narrative: Patient began having symptoms on shortness of breath, chest pains and fatigue in the weeks following the vaccine. In June of 2022, finally went to a physician who ordered and MRI which incidentially noted 2 mass in rt Humerus bone, Ordered an ABD/PEL wow CT and found numerous lung nodules and enlarged calcified mediastinal lymph nodes. PET scan, PFT and tissue biopsy of lung nodules and mediastinal lymph nodes resulted in a diagnosis of possible pulmonary sarcoidosis. Patient is currently being treated with steriods.
Age: 43.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Lymph node calcification, Lymphadenopathy, Lymphadenopathy mediastinal, Magnetic resonance imaging abnormal, Positron emission tomogram abnormal
Clinical narrative: Patient began having symptoms on shortness of breath, chest pains and fatigue in the weeks following the vaccine. In June of 2022, finally went to a physician who ordered and MRI which incidentially noted 2 mass in rt Humerus bone, Ordered an ABD/PEL wow CT and found numerous lung nodules and enlarged calcified mediastinal lymph nodes. PET scan, PFT and tissue biopsy of lung nodules and mediastinal lymph nodes resulted in a diagnosis of possible pulmonary sarcoidosis. Patient is currently being treated with steriods.
Age: 43.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Pulmonary fibrosis, Pulmonary function test abnormal, Pulmonary mass
Clinical narrative: Patient began having symptoms on shortness of breath, chest pains and fatigue in the weeks following the vaccine. In June of 2022, finally went to a physician who ordered and MRI which incidentially noted 2 mass in rt Humerus bone, Ordered an ABD/PEL wow CT and found numerous lung nodules and enlarged calcified mediastinal lymph nodes. PET scan, PFT and tissue biopsy of lung nodules and mediastinal lymph nodes resulted in a diagnosis of possible pulmonary sarcoidosis. Patient is currently being treated with steriods.
Age: 17.0
Sex: M
Vaccine: MENB
Symptoms: Expired product administered, No adverse event
Clinical narrative: Patient had NO adverse reaction.  Vaccine that was given was expired.  Lot # DW2999 exp 06/30/2023
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Hypotension, Symptom recurrence
Clinical narrative: HYPOTENSION 1/9/2023  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: administered after bud. no treatment or adverse effects
Age: 28.0
Sex: F
Vaccine: VARCEL
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
Clinical narrative: Employee reported redness and swelling at the injection site with minimal itching. This lasted about 2 days and went away completely. No issues since.
Age: 59.0
Sex: M
Vaccine: COVID19-2
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: ADULT OBSTRUCTIVE SLEEP APNEA, SEVERE
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram pulmonary normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: Hospital Course:  Patient is a 78 y.o. male patient of, CNP with history of essential hypertension diabetes mellitus dyslipidemia history of CVA A-fib status post watchman presented with cough and shortness of breath   Discharge Diagnoses: Covid-19 Virus PNA Acute Hypoxic Respiratory Failure POA Suspected gram positive PNA POA Date of onset of symptoms: 3/31/2023 Symptoms present on admission: Hypoxia and cough Date of covid positive test: 4/1/2023 Imaging: Chest x-ray bilateral lower infiltrates CTA Chest: No PE  Oxygen requirements on admission: Nasal cannula 5 L Current oxygen requirements: 1 L of O2 Medical therapy: remdesivir, steroids, rocephin and doxycycline Expected End of isolation: 4/11/23 Procal elevated, but trended down     Essential hypertension Continue lisinopril and metoprolol  Chronic A-fib status post watchman Currently sinus rhythm not on anticoagulation  Diabetes mellitus not on long-term insulin use Resume home meds   Dyslipidemia Statin  OSA Unable tolerate CPAP
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: Cough, Device intolerance, Dyspnoea, Hypoxia, Lung infiltration
Clinical narrative: Hospital Course:  Patient is a 78 y.o. male patient of, CNP with history of essential hypertension diabetes mellitus dyslipidemia history of CVA A-fib status post watchman presented with cough and shortness of breath   Discharge Diagnoses: Covid-19 Virus PNA Acute Hypoxic Respiratory Failure POA Suspected gram positive PNA POA Date of onset of symptoms: 3/31/2023 Symptoms present on admission: Hypoxia and cough Date of covid positive test: 4/1/2023 Imaging: Chest x-ray bilateral lower infiltrates CTA Chest: No PE  Oxygen requirements on admission: Nasal cannula 5 L Current oxygen requirements: 1 L of O2 Medical therapy: remdesivir, steroids, rocephin and doxycycline Expected End of isolation: 4/11/23 Procal elevated, but trended down     Essential hypertension Continue lisinopril and metoprolol  Chronic A-fib status post watchman Currently sinus rhythm not on anticoagulation  Diabetes mellitus not on long-term insulin use Resume home meds   Dyslipidemia Statin  OSA Unable tolerate CPAP
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pneumonia bacterial, Positive airway pressure therapy, Procalcitonin normal, SARS-CoV-2 test positive, Sinus rhythm
Clinical narrative: Hospital Course:  Patient is a 78 y.o. male patient of, CNP with history of essential hypertension diabetes mellitus dyslipidemia history of CVA A-fib status post watchman presented with cough and shortness of breath   Discharge Diagnoses: Covid-19 Virus PNA Acute Hypoxic Respiratory Failure POA Suspected gram positive PNA POA Date of onset of symptoms: 3/31/2023 Symptoms present on admission: Hypoxia and cough Date of covid positive test: 4/1/2023 Imaging: Chest x-ray bilateral lower infiltrates CTA Chest: No PE  Oxygen requirements on admission: Nasal cannula 5 L Current oxygen requirements: 1 L of O2 Medical therapy: remdesivir, steroids, rocephin and doxycycline Expected End of isolation: 4/11/23 Procal elevated, but trended down     Essential hypertension Continue lisinopril and metoprolol  Chronic A-fib status post watchman Currently sinus rhythm not on anticoagulation  Diabetes mellitus not on long-term insulin use Resume home meds   Dyslipidemia Statin  OSA Unable tolerate CPAP
Age: 70.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure
Clinical narrative: ACUTE RESPIRATORY FAILURE ACUTE HYPOXEMIC RESPIRATORY FAILURE
Age: 0.67
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Patient received the Moderna Pink cap when they should have received the Moderna blue cap.
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Acute sinusitis, Atelectasis, Blood bicarbonate decreased
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Blood chloride decreased, Blood creatinine, Blood culture positive, Blood lactic acid normal, Blood osmolarity increased
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Blood pH decreased, Blood sodium decreased, Blood urine present, Brain natriuretic peptide increased, COVID-19
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Carbon dioxide increased, Computerised tomogram thorax abnormal, Culture urine negative, Echocardiogram normal, Hypoacusis
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Hyponatraemia, Ketosis, Laboratory test, Lacunar infarction, Lung consolidation
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging head normal, Mastoid effusion, Mastoiditis, Mental status changes, Metabolic acidosis
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Neurological symptom, Otitis externa, Otitis media, Otorrhoea
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Pericardial effusion, Pneumonia, Procalcitonin, Septic shock, Sputum culture
Clinical narrative: The patient is a 55 y.o. female with a PMHx of CVA with residual left facial drop, anxiety, DDD, HLD, HTN and nicotine dependence presented on 4/6 with cc of AMS. Septic shock suspect secondary to PNA with COVID 19 infection. Also found to have AKI and mastoiditis.      Acute respiratory failure with hypoxia COVID 19 Infection Suspect secondary to PNA and COVID infection CT chest: Extensive multifocal pneumonia. Findings most pronounced in the right lung. Near complete lobar atelectasis/consolidation of the right middle lobe.  transitioned to 5L NC from HHF SpO2 goal 93% or higher Dexamethasone 10 mg for 5 days (stop date: 4/11) Albuterol nebs PRN Pulmonary hygiene ID following,  Started Remdesivir after improvement in creatinine last dose 4/11/23 End of isolation 4/16/2023 Patient eager for discharge.  Attempting to wean off O2. Dc 4/11 after last dose of Remdesevir   Septic shock POA Suspect PNA & Mastoiditis Procalcitonin - 20.10 UA benign but reveals ketones, blood, and hyaline casts MRSA probe, urine antigens, urine culture and sputum NGTD Blood culture coagulase negative staph 1/2 likely contaminant Off levo 4/7 Repeat blood cultures NGTD Cefepime and vancomycin ID following  - recommend 2 weeks clinda and levaquin   Acute Metabolic Encephalopathy, improving  H/o CVA with residual deficits Suspect AMS multifactorial from Presented on 3/12/23 with stroke like symptoms - MRI was negative CT Head Symmetrical lacunar infarcts involving the putamen bilaterally, seen previously. Can be seen in hypoxic injuries or from carbon monoxide, methanol or cyanide toxicity Supportive care  Continue PT, OT  Start ASA Continue Lipitor AKI, improving  NAGMA Initial bicarb 18; likely secondary to AKI Lactate unremarkable, BHB 2.2 potentially starvation ketosis vs AKI Initial VBG pH 7.26, CO2 37, bicarb 17, metabolic acidosis CT nonobstructive NAGMA likely secondary to decreased chloride  Was treated with bicarb drip now discontinued  Creatinine 8.29-- >6.25-- >5.61-- >4.06-- >1.53 -> 0.61 Nephrology followed   Hyponatremia, improving Initial sodium 122, 3 weeks ago sodium was 141, now 136 Serum osm 300, urine osm 293, urine sodium  Trend RFPs Nephrology followed   Right otitis externa Right otitis media Right mastoid effusion Acute sinusitis CT head: Bilateral maxillary sinus air-fluid levels.  There is also right otitis and mastoiditis. Right ear tender to palpation, no erythema no swelling of pinna nor mastoid. Purulent otorrhea from right auditory canal, unable to visualize TM due to otorrhea   Ofloxacin drops BID for 10 days (stop date: 4/16) On Cefepime & Vancomycin  - continue outpatient oral abx therapy as above Hard of hearing on right  ENT & ID following FU ENT after discharge   Elevated BNP Initial BNP 14,000, no comparison Small pericardial effusion seen on CT chest  Echocardiogram results normal EF