chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Lung disorder, Lung opacity, Pancytopenia, Platelet count decreased, Pneumonia viral
Clinical narrative: Patient is a 51 y.o. female with history of renal transplant (on immunosuppressants) and current COVID-19 infection who presented from home on 9/6/2022 with worsening dyspnea and cough, along with worsening renal function.  Nephrology and ID involved with care.  Fevers  COVID-19 pneumonia Patient overall feeling improved, symptoms are resolving.  Initially presented with worsening cough, dyspnea, fevers, diarrhea in the setting of COVID-19; tested positive 8/24 on home rapid test. Symptom onset ~8/19-8/20. CXR at COPC 9/2 suggestive of CHF, indeterminate pulmonary nodules within R lung; CXR in ED with diminished lung volumes and crowding of vasculature, faint opacity in R mid to lower lung zone; CT chest with patchy ground glass opacities likely consistent with COVID / viral pneumonitis  - pt fully vaccinated and boosted x 2; had Evushield in March 2022; could not get MAB and not a candidate for Paxlovid.  Monoclonal antibodies given during this hospitalization - TTE obtained, no evidence of overt volume overload -will continue isolation in the hospital and continue CDC guidelines in the outpatient setting.  We discussed ongoing isolation and mask wearing in the home setting given her recent fever. - ID consulted for guidance on further infectious work-up, appreciate recommendations   AKI on CKD 4 Hypovolemia, hyponatremia  History of kidney transplant History of metabolic acidosis With history of membranous nephropathy. S/p deceased donor transplant 6/1999 at OSU; functioned until 2011; then s/p cadaveric kidney transplant 3/30/2016 (second transplant); 11/30/20 transplant kidney biopsy with evidence of acute on chronic rejection with transplant glomerulopathy  - sCr 2.78 and Na 134 on admit 9/6; improved compared to COPC labs 9/2 which showed sCr 3.1, BUN 56 - baseline sCr ~2.1?2.3 - continue home immunosuppression regimen -Close to patient follow-up with her nephrologist in outpatient setting for recheck of renal function this upcoming week.   History of nonischemic CMP Elevated troponin No evidence of overt volume overload on exam.  Recovered EF; secondary to ESRD per OP notes.  Ongoing care in the outpatient setting   Hypertension  Home beta-blocker dose increased.   Pancytopenia History of anemia of CKD Hemoglobin 9.2, WBC 4.05, platelets 118 on admission 9/6. COPC labs 9/2 with Hgb 9.2, WBC 4.4, PLT 117. ESA per nephrology, started 4/2021, goal hemoglobin 10?11. Noted history of neutropenia due to higher dose Myfortic, resolved with reduction and use of steroids -Continue to follow counts in the outpatient setting  Hyperlipidemia Resume statin therapy on discharge
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary mass, Pyrexia, Renal impairment, Renal transplant, SARS-CoV-2 test positive
Clinical narrative: Patient is a 51 y.o. female with history of renal transplant (on immunosuppressants) and current COVID-19 infection who presented from home on 9/6/2022 with worsening dyspnea and cough, along with worsening renal function.  Nephrology and ID involved with care.  Fevers  COVID-19 pneumonia Patient overall feeling improved, symptoms are resolving.  Initially presented with worsening cough, dyspnea, fevers, diarrhea in the setting of COVID-19; tested positive 8/24 on home rapid test. Symptom onset ~8/19-8/20. CXR at COPC 9/2 suggestive of CHF, indeterminate pulmonary nodules within R lung; CXR in ED with diminished lung volumes and crowding of vasculature, faint opacity in R mid to lower lung zone; CT chest with patchy ground glass opacities likely consistent with COVID / viral pneumonitis  - pt fully vaccinated and boosted x 2; had Evushield in March 2022; could not get MAB and not a candidate for Paxlovid.  Monoclonal antibodies given during this hospitalization - TTE obtained, no evidence of overt volume overload -will continue isolation in the hospital and continue CDC guidelines in the outpatient setting.  We discussed ongoing isolation and mask wearing in the home setting given her recent fever. - ID consulted for guidance on further infectious work-up, appreciate recommendations   AKI on CKD 4 Hypovolemia, hyponatremia  History of kidney transplant History of metabolic acidosis With history of membranous nephropathy. S/p deceased donor transplant 6/1999 at OSU; functioned until 2011; then s/p cadaveric kidney transplant 3/30/2016 (second transplant); 11/30/20 transplant kidney biopsy with evidence of acute on chronic rejection with transplant glomerulopathy  - sCr 2.78 and Na 134 on admit 9/6; improved compared to COPC labs 9/2 which showed sCr 3.1, BUN 56 - baseline sCr ~2.1?2.3 - continue home immunosuppression regimen -Close to patient follow-up with her nephrologist in outpatient setting for recheck of renal function this upcoming week.   History of nonischemic CMP Elevated troponin No evidence of overt volume overload on exam.  Recovered EF; secondary to ESRD per OP notes.  Ongoing care in the outpatient setting   Hypertension  Home beta-blocker dose increased.   Pancytopenia History of anemia of CKD Hemoglobin 9.2, WBC 4.05, platelets 118 on admission 9/6. COPC labs 9/2 with Hgb 9.2, WBC 4.4, PLT 117. ESA per nephrology, started 4/2021, goal hemoglobin 10?11. Noted history of neutropenia due to higher dose Myfortic, resolved with reduction and use of steroids -Continue to follow counts in the outpatient setting  Hyperlipidemia Resume statin therapy on discharge
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Troponin increased, White blood cell count decreased
Clinical narrative: Patient is a 51 y.o. female with history of renal transplant (on immunosuppressants) and current COVID-19 infection who presented from home on 9/6/2022 with worsening dyspnea and cough, along with worsening renal function.  Nephrology and ID involved with care.  Fevers  COVID-19 pneumonia Patient overall feeling improved, symptoms are resolving.  Initially presented with worsening cough, dyspnea, fevers, diarrhea in the setting of COVID-19; tested positive 8/24 on home rapid test. Symptom onset ~8/19-8/20. CXR at COPC 9/2 suggestive of CHF, indeterminate pulmonary nodules within R lung; CXR in ED with diminished lung volumes and crowding of vasculature, faint opacity in R mid to lower lung zone; CT chest with patchy ground glass opacities likely consistent with COVID / viral pneumonitis  - pt fully vaccinated and boosted x 2; had Evushield in March 2022; could not get MAB and not a candidate for Paxlovid.  Monoclonal antibodies given during this hospitalization - TTE obtained, no evidence of overt volume overload -will continue isolation in the hospital and continue CDC guidelines in the outpatient setting.  We discussed ongoing isolation and mask wearing in the home setting given her recent fever. - ID consulted for guidance on further infectious work-up, appreciate recommendations   AKI on CKD 4 Hypovolemia, hyponatremia  History of kidney transplant History of metabolic acidosis With history of membranous nephropathy. S/p deceased donor transplant 6/1999 at OSU; functioned until 2011; then s/p cadaveric kidney transplant 3/30/2016 (second transplant); 11/30/20 transplant kidney biopsy with evidence of acute on chronic rejection with transplant glomerulopathy  - sCr 2.78 and Na 134 on admit 9/6; improved compared to COPC labs 9/2 which showed sCr 3.1, BUN 56 - baseline sCr ~2.1?2.3 - continue home immunosuppression regimen -Close to patient follow-up with her nephrologist in outpatient setting for recheck of renal function this upcoming week.   History of nonischemic CMP Elevated troponin No evidence of overt volume overload on exam.  Recovered EF; secondary to ESRD per OP notes.  Ongoing care in the outpatient setting   Hypertension  Home beta-blocker dose increased.   Pancytopenia History of anemia of CKD Hemoglobin 9.2, WBC 4.05, platelets 118 on admission 9/6. COPC labs 9/2 with Hgb 9.2, WBC 4.4, PLT 117. ESA per nephrology, started 4/2021, goal hemoglobin 10?11. Noted history of neutropenia due to higher dose Myfortic, resolved with reduction and use of steroids -Continue to follow counts in the outpatient setting  Hyperlipidemia Resume statin therapy on discharge
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event, Underdose
Clinical narrative: Client received a lower dose of Covid 19 then recommended for her age. She had no adverse reactions.
Age: 68.0
Sex: F
Vaccine: FLUA4
Symptoms: Arthralgia, Pain
Clinical narrative: I had severe pain in right shoulder and couldn't move it anywhere that it didn't hurt. Today it's still sore but it's bearable.
Age: 90.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: hospitilization
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid vaccine was administered past beyond use date.
Age: 41.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal discomfort, Arthralgia, Chills, Fatigue, Myalgia
Clinical narrative: Chills, low grade fever, muscle and joints pain, tired, abdominal discomfort.
Age: 41.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia
Clinical narrative: Chills, low grade fever, muscle and joints pain, tired, abdominal discomfort.
Age: 86.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: covid vaccine was administered past beyond use date
Age: 89.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, COVID-19, Condition aggravated, Hypertensive urgency, Troponin increased
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 9/7/2022 Discharge Date: Sep 11, 2022  PRESENTING PROBLEM: Weakness generalized [R53.1] Generalized weakness [R53.1]   HOSPITAL COURSE: 89 y.o. with a PMH of carotid occlusive disease, coronary artery disease, type 2 diabetes with diabetic peripheral neuropathy, essential hypertension, history of renal artery stenosis, history of retinal vein occlusion the right eye, dyslipidemia, prostate cancer and lupus.  He presents in the emergency department on 9/8 with progressive generalized weakness over the past several months, which became much worse over the 24-48 hours prior to presentation.  He was noted to have hypertensive urgency with elevated troponins.  Cardiology did evaluate him and did not think that this represented an acute coronary syndrome.  He was assessed by Physical and Occupational therapy and his weakness did improve.  His blood pressure remained quite elevated so his meds were titrated.  His systolic blood pressure ranged from 130 to 150s at discharge.   After discussion and in light of risk factors for progression to severe disease, paxlovid was prescribed for covid 19.
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid vaccine was administered beyond past use date
Age: 64.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Adrenocortical insufficiency acute, COVID-19, Chills, Condition aggravated, Cough
Clinical narrative: Admission Date: 9/7/2022 Discharge Date: 9/8/2022  PRESENTING PROBLEM: Addisonian crisis   HOSPITAL COURSE: 65 year old male with past medical history of Addision's disease, developed a cough, fever, chills and sore throat on 9/6. He reports he missed his mornings pills because his throat was too sore to swallow. Later that afternoon he went to the ED for malaise. Covid-19 positive. He was found to be hypotensive, received 3L IVF, hydrocortisone and started on Norepi. Norepi weaned off upon arrival in the ICU.
Age: 64.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Dysphagia, Hypotension, Intensive care, Malaise, Oropharyngeal pain
Clinical narrative: Admission Date: 9/7/2022 Discharge Date: 9/8/2022  PRESENTING PROBLEM: Addisonian crisis   HOSPITAL COURSE: 65 year old male with past medical history of Addision's disease, developed a cough, fever, chills and sore throat on 9/6. He reports he missed his mornings pills because his throat was too sore to swallow. Later that afternoon he went to the ED for malaise. Covid-19 positive. He was found to be hypotensive, received 3L IVF, hydrocortisone and started on Norepi. Norepi weaned off upon arrival in the ICU.
Age: 64.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Pyrexia, SARS-CoV-2 test positive
Clinical narrative: Admission Date: 9/7/2022 Discharge Date: 9/8/2022  PRESENTING PROBLEM: Addisonian crisis   HOSPITAL COURSE: 65 year old male with past medical history of Addision's disease, developed a cough, fever, chills and sore throat on 9/6. He reports he missed his mornings pills because his throat was too sore to swallow. Later that afternoon he went to the ED for malaise. Covid-19 positive. He was found to be hypotensive, received 3L IVF, hydrocortisone and started on Norepi. Norepi weaned off upon arrival in the ICU.
Age: 81.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid vaccine was given past beyond use date
Age: 17.0
Sex: F
Vaccine: UNK, UNK
Symptoms: Pain, Rash
Clinical narrative: Pain began hours after vaccination, rash developed 4 days later.
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Asthenia, Benign prostatic hyperplasia, Bradycardia, COVID-19
Clinical narrative: Patient is a 84 y.o. male patient with history of HTN, BPH, CVA, hypercholesterolemia, hypothyroidism, osteopenia, rosacea , rhinophyma presented with weakness and confusion.   Bradycardia Dehydration Acute confusion following fall Generalized weakness Hx of CVA CT head - no acute intracranial process. Moderate old microvascular ischemic changes and age-related cerebral volume loss.  Old lacunar infarcts in basal ganglia bilaterally and left thalamus.  Small bilateral hemispheric subdural hygromas are unchanged. Continue amlodipine and spironolactone Decrease dose of Coreg to 12.5 mg twice daily.     COVID-19 Virus Infection Date of onset of symptoms: 8/26 Symptoms present on admission: Cough, congestion, poor energy, generalized weakness Date of covid positive test: 8/29 Vaccination status: vaccinated Imaging: CXR - no evidence of acute cardiopulmonary disease Oxygen requirements on admission: None Current oxygen requirements: Room air Medical therapy: Prednisone  Prior outpatient treatment: None Consultants following: None Anticipated special isolation end date: 9/7/2022    Normocytic anemia Hemoglobin 10.1, hemoglobin 5 months ago 13.7 No active bleeding  Acute kidney injury, likely prerenal Resolved with IV fluids  Hyperlipidemia Continue statin BPH Continue Proscar and tamsulosin.    Hypothyroidism Continue levothyroxine
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Cerebral atrophy, Chest X-ray normal, Computerised tomogram head abnormal, Condition aggravated, Confusional state
Clinical narrative: Patient is a 84 y.o. male patient with history of HTN, BPH, CVA, hypercholesterolemia, hypothyroidism, osteopenia, rosacea , rhinophyma presented with weakness and confusion.   Bradycardia Dehydration Acute confusion following fall Generalized weakness Hx of CVA CT head - no acute intracranial process. Moderate old microvascular ischemic changes and age-related cerebral volume loss.  Old lacunar infarcts in basal ganglia bilaterally and left thalamus.  Small bilateral hemispheric subdural hygromas are unchanged. Continue amlodipine and spironolactone Decrease dose of Coreg to 12.5 mg twice daily.     COVID-19 Virus Infection Date of onset of symptoms: 8/26 Symptoms present on admission: Cough, congestion, poor energy, generalized weakness Date of covid positive test: 8/29 Vaccination status: vaccinated Imaging: CXR - no evidence of acute cardiopulmonary disease Oxygen requirements on admission: None Current oxygen requirements: Room air Medical therapy: Prednisone  Prior outpatient treatment: None Consultants following: None Anticipated special isolation end date: 9/7/2022    Normocytic anemia Hemoglobin 10.1, hemoglobin 5 months ago 13.7 No active bleeding  Acute kidney injury, likely prerenal Resolved with IV fluids  Hyperlipidemia Continue statin BPH Continue Proscar and tamsulosin.    Hypothyroidism Continue levothyroxine
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Cough, Dehydration, Fall, Haemoglobin decreased, Hyperlipidaemia
Clinical narrative: Patient is a 84 y.o. male patient with history of HTN, BPH, CVA, hypercholesterolemia, hypothyroidism, osteopenia, rosacea , rhinophyma presented with weakness and confusion.   Bradycardia Dehydration Acute confusion following fall Generalized weakness Hx of CVA CT head - no acute intracranial process. Moderate old microvascular ischemic changes and age-related cerebral volume loss.  Old lacunar infarcts in basal ganglia bilaterally and left thalamus.  Small bilateral hemispheric subdural hygromas are unchanged. Continue amlodipine and spironolactone Decrease dose of Coreg to 12.5 mg twice daily.     COVID-19 Virus Infection Date of onset of symptoms: 8/26 Symptoms present on admission: Cough, congestion, poor energy, generalized weakness Date of covid positive test: 8/29 Vaccination status: vaccinated Imaging: CXR - no evidence of acute cardiopulmonary disease Oxygen requirements on admission: None Current oxygen requirements: Room air Medical therapy: Prednisone  Prior outpatient treatment: None Consultants following: None Anticipated special isolation end date: 9/7/2022    Normocytic anemia Hemoglobin 10.1, hemoglobin 5 months ago 13.7 No active bleeding  Acute kidney injury, likely prerenal Resolved with IV fluids  Hyperlipidemia Continue statin BPH Continue Proscar and tamsulosin.    Hypothyroidism Continue levothyroxine
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Hypothyroidism, Normocytic anaemia, Respiratory tract congestion, SARS-CoV-2 test positive, Subdural hygroma
Clinical narrative: Patient is a 84 y.o. male patient with history of HTN, BPH, CVA, hypercholesterolemia, hypothyroidism, osteopenia, rosacea , rhinophyma presented with weakness and confusion.   Bradycardia Dehydration Acute confusion following fall Generalized weakness Hx of CVA CT head - no acute intracranial process. Moderate old microvascular ischemic changes and age-related cerebral volume loss.  Old lacunar infarcts in basal ganglia bilaterally and left thalamus.  Small bilateral hemispheric subdural hygromas are unchanged. Continue amlodipine and spironolactone Decrease dose of Coreg to 12.5 mg twice daily.     COVID-19 Virus Infection Date of onset of symptoms: 8/26 Symptoms present on admission: Cough, congestion, poor energy, generalized weakness Date of covid positive test: 8/29 Vaccination status: vaccinated Imaging: CXR - no evidence of acute cardiopulmonary disease Oxygen requirements on admission: None Current oxygen requirements: Room air Medical therapy: Prednisone  Prior outpatient treatment: None Consultants following: None Anticipated special isolation end date: 9/7/2022    Normocytic anemia Hemoglobin 10.1, hemoglobin 5 months ago 13.7 No active bleeding  Acute kidney injury, likely prerenal Resolved with IV fluids  Hyperlipidemia Continue statin BPH Continue Proscar and tamsulosin.    Hypothyroidism Continue levothyroxine
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid vaccination was given past beyond use date
Age: 1.58
Sex: F
Vaccine: COVID19
Symptoms: Inappropriate schedule of product administration
Clinical narrative: Parent was given link to 9/15/22 clinic, as that was appropriate date for the third and final vaccine in the series. She erroneously registered for the clinic for 9/9/22, and the vaccine was therefore administered one week earlier than recommended.
Age: 86.0
Sex: F
Vaccine: COVID19, FLUA4
Symptoms: Asthenia, COVID-19, Chest discomfort, Cough, Dyspnoea
Clinical narrative: Discharge Provider:  MD Primary Care Provider: DO Admission Date: 9/6/2022 Discharge Date: Sep 7, 2022  PRESENTING PROBLEM: Weakness  COVID-19 virus infection  COVID-19    HOSPITAL COURSE: Patient is a 87 y.o. female with atrial fibrillation, coronary artery disease status post CABG, hypertension, iron deficiency anemia, diastolic CHF, pulmonary hypertension, type 2 diabetes, hyperlipidemia, history of GI bleeding, CKD 3 and asthma who presented with chest discomfort associated with shortness of breath and slight cough starting four days prior to arrival.     Significant workup in the ED included COVID 19 positive test. She was not requiring any supplemental oxygen in the ED. Family expressed concerns about increased care for her at this time so she was admitted for therapy evaluation and possible placement in deemed necessary. PT/OT recommended home with assist and patient was discharged home in stable condition under the care of her daughter.
Age: 86.0
Sex: F
Vaccine: COVID19, FLUA4
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Discharge Provider:  MD Primary Care Provider: DO Admission Date: 9/6/2022 Discharge Date: Sep 7, 2022  PRESENTING PROBLEM: Weakness  COVID-19 virus infection  COVID-19    HOSPITAL COURSE: Patient is a 87 y.o. female with atrial fibrillation, coronary artery disease status post CABG, hypertension, iron deficiency anemia, diastolic CHF, pulmonary hypertension, type 2 diabetes, hyperlipidemia, history of GI bleeding, CKD 3 and asthma who presented with chest discomfort associated with shortness of breath and slight cough starting four days prior to arrival.     Significant workup in the ED included COVID 19 positive test. She was not requiring any supplemental oxygen in the ED. Family expressed concerns about increased care for her at this time so she was admitted for therapy evaluation and possible placement in deemed necessary. PT/OT recommended home with assist and patient was discharged home in stable condition under the care of her daughter.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid vaccine was administered past beyond use date
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid Vaccine was given past beyond use date
Age: 56.0
Sex: M
Vaccine: SMALLMNK
Symptoms: Erythema, Inflammation, Injection site erythema, Skin exfoliation, Swelling
Clinical narrative: 3 days after vaccination client reports ongoing and increasing inflammatory response.  Size of swelling and redness reported to be silver dollar size.  This inflammatory response continues over the course of the following week.  Client states after about one week skin started to get bright red and the most superficial layer of skin began to slough off.  Client calls HD regarding his arm and HD invites client in to observe the reaction.  Client arrives to HD 9/15/22 and has a bright red spot at the site of vaccination, smaller than a dime, with less sever erythema surrounding.   No treatment sought by client.  HD will see client for his 2nd dose of Jynneos on Monday 9-26-22 and observe for any new changes.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Anticoagulant therapy, Atrial fibrillation, Blood alkaline phosphatase increased, Blood bicarbonate increased
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Blood creatinine increased, Blood iron normal, Blood smear test, Blood urea increased, COVID-19
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Chemotherapy, Chest X-ray normal, Computerised tomogram abdomen, Condition aggravated, General physical health deterioration
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Glomerular filtration rate normal, Haematemesis, Haemoglobin decreased, Haemorrhage, Hypovolaemia
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Inflammation, Malnutrition, Normochromic anaemia, Normocytic anaemia, Occult blood negative
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Oesophagogastroduodenoscopy normal, Physical deconditioning, Radiotherapy, Red blood cell transfusion, Reticulocyte count increased
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Serum ferritin increased, Uterine cancer
Clinical narrative: Discharge Provider: MD Primary Care Provider at Discharge: DO Admission Date: 9/2/2022 Discharge Date: 09/11/2022  HOSPITAL COURSE: Patient is a 75 y.o. female who presented from rehab, admitted with AKI. Outpatient provider noticed a slight increasing trend of her creatinine so sent her to the ED. Patient remains overall remains deconditioned due to previous prolonged hospital stay at Hospital from 08/2-8/18, where patient was treated for hypovolemia induced prerenal azotemia following radiation and chemo treatment for her uterine carcinoma.    ER Course: Vitals all stable, COVID-19 positive. Labs:Hgb 10.8. Bicarb 39, BUN 105, Creat 3.42, GFR 13, alk phos 170. Chest xray unremarkable.  Consults: nephrology recommended gentle fluid hydration.   AKI: creatinine upon discharge to hospital from hospital (8/2-8/18) was 2.9. Patient's AKI improved with fluid hydration, and holding her home torsemide. Cr 2.6 at discharge.    Anemia: Patient continued to have a normocytic normochromic anemia, HgB was 10 on admission.  Patient did not complain of bloody stool, no other active signs of bleeding.  Her anemia was also present at hospital stay and was believed to be secondary to chronic inflammation or low EPO from kidney injury. However starting on 09/04, patient's hemoglobin dropped to 9, followed by a 8.6 on 9/5, 7.6 on 9/6.  On 9/7 hemoglobin dropped to 6.9 and patient was given 1 unit RBCs.  Labs: Occult blood was negative.  Iron studies normal, ferritin and reticulocyte count were elevated.  Blood smear showed no evidence of hemolysis.   Imaging: CT abdomen/pelvis showed no definite evidence of intra-abdominal hemorrhage but GI bleed could not be fully evaluated due to lack of IV contrast.  Patient's hemoglobin continued to drop and she received 1 additional unit of RBCs on 09/08.  Patient had 1 episode of coffee-ground emesis morning of 9/8, IV Protonix 40 mg added daily. GI completed EGD on 9/9 with no evidence of acute bleeding.  Patient's hemoglobin continued to decrease with no clear source for her bleeding, and 1 unit RBCs given 9/10.  In total, she has received 3 units RBCs.  GI was consulted, and they were agreeable to transferring her to hospital for further workup of this bleeding and anemia.    Atrial fibrillation:  On admission patient was started on lower home dose of metoprolol due to initial hypotension.  Patient later developed AFib with RVR which was able to be rate controlled on her home Cardizem 120 mg daily and metoprolol 100 mg BID.  Her home Eliquis was held due to concern for bleeding.   Patient also continues to suffer from severe malnutrition persistent difficulty with intake, possible benefit from palliative paracentesis was mentioned at last hospital stay.    Due to patient's continued decline and unclear source of bleeding, patient was transferred to hospital for further evaluation and treatment. Patient transferred in stable condition.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid Vaccine was administered past beyond use date
Age: 4.0
Sex: F
Vaccine: COVID19
Symptoms: Inappropriate schedule of product administration
Clinical narrative: Parent was emailed link to register for the 9/15/22 clinic for children to receive their 3rd doses. Parent erroneously registered for the 9/9/22 clinic, which was one week too early for the last vaccine. This date discrepancy was not noted by clinic staff and vaccine was administered one week earlier than recommended.
Age: 46.0
Sex: F
Vaccine: COVID19-2
Symptoms: Wrong product administered
Clinical narrative: Patient wanted Moderna bivalent but received Pfizer bivalent
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Covid vaccine was administered past beyond use date
Age: 16.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Wrong product administered
Clinical narrative: Patient given Moderna Monovalent (o.5ml) versus Pfizer Bivalent (0.3ml) as a booster dose. Patient is 16 yo patient should have received Pfizer bivalent. Patient had no adverse reactions to medications. Patient was observed for 30minutes. Patient has n complaints. Aox4 response even and unlabored. skin warm and dry.  Parents and patient were both notified. Public health and Moderna were both contacted as well.
Sex: U
Vaccine: COVID19, COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: Reporting approximately 180 instances of monovalent boosters being given in the time frame between the deauthorization by the FDA and the arrival and implementation of the bivalent booster.  A few instances were due to patient request that they had to have another dose before the new boosters were available to be able to travel to another country and other issues. Most instances were staff not getting or under-standing the messaging to stop using the monovalent boosters even though the recommendation was turned off in our electronic health system.