chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Condition aggravated, Confusional state, Constipation, Culture urine positive
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 ASSESSMENT Principal Problem:   Weakness Active Problems:   Weakness generalized   Moderate malnutrition      Skin Condition Reddened (Non-Pressure Related);Rash Left;Lower Back (Active) First Observed/Origin Date/First Observed/Origin Time: 01/29/22 1838   Skin Condition Type: Reddened (Non-Pressure Related);Rash  Orientation: Left;Lower  Location: Back     Comments:    Patient is a 81 y.o. female with history of frequent UTIs, dementia, hypertension who presented to the emergency room with generalized weakness.  She was diagnosed with a UTI.  She also had 4 episodes of nonsustained V. tach and a cardiology consult was requested. A TTE was done without significant structural heart disease.  No further interventions per Cardiology.   PLAN     Generalized weakness Suspect d/t combination of COVID-19 infection and possible UTI.  -- PT/OT.  Needs 24/7 assistance - SW working toward TCU placement.   E.coli UTI with MDR, history ESBL, possible CRE On prophylactic Keflex for hx of frequent UTIs.  Per daughter, only 2-3 UTIs in the past couple years.   Suspect likely colonization. UA+ and UC with MDR E.coli (R to ertrapenem but S to meropenem).  -- Discussed and reviewed sensitivities with ID  -- Stopped ceftriaxone 2/1 -- Meropenem IV x3 days completed treating an uncomplicated cystitis per ID recs -- Prophylactic Keflex not necessary given established resistance, the fact she is very likely colonized.  -- ? if prophylactic therapy necessary given only a couple UTIs in the past couple years -- Consider referral to outpt ID and/or Urology on d/c to help determine future appropriateness of prophylactic therapy   COVID-19 infection Incidental finding. No hypoxia. Felt to be contributing to the weakness.  -- Monitor respiratory status -- Patient does not qualify for any COVID-19 directed therapies as she is on RA   Constipation -- Bowel regimen available - prune juice, Senna-S, dulcolax, Miralax -- Encourage oral intake and ambulation   Nonsustained ventricular tachycardia Asymptomatic with these episodes. Felt likely d/t Covid.  -- TTE without significant structural heart disease -- Appreciate input from cardiology, signed off -- High goals for e-lytes    Hyponatremia Suspect d/t poor oral intake which has improved. Hyponatremia resolved. -- Encourage oral intake -- Periodic BMP monitoring   Leukopenia Was previously normal in April. Suspect r/t Covid infection. -- Periodic CBC monitoring    Dementia Patient seemed mildly confused but cooperative -- Continue PTA Aricept   Hypertension Blood pressure intermittently mildly elevated -- Continue PTA Prinivil   Moderate malnutrition Per Dietitian eval.  Loss of Muscle Mass: Not Present. Loss of Subcutaneous Fat: Not Present. Fluid Accumulation: Mild +1. Energy Intake: Less than or equal to 50% of estimated energy requirement for 5 days or greater. Interpretation of Weight Loss: Not Reported (does not meet criteria). -- Supplements per Dietitian     Patient's daughter, POA - updated 2/6/22.     DVT Prophylaxis - Lovenox
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Cystitis, Echocardiogram, Echocardiogram normal, Effusion, Erythema
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 ASSESSMENT Principal Problem:   Weakness Active Problems:   Weakness generalized   Moderate malnutrition      Skin Condition Reddened (Non-Pressure Related);Rash Left;Lower Back (Active) First Observed/Origin Date/First Observed/Origin Time: 01/29/22 1838   Skin Condition Type: Reddened (Non-Pressure Related);Rash  Orientation: Left;Lower  Location: Back     Comments:    Patient is a 81 y.o. female with history of frequent UTIs, dementia, hypertension who presented to the emergency room with generalized weakness.  She was diagnosed with a UTI.  She also had 4 episodes of nonsustained V. tach and a cardiology consult was requested. A TTE was done without significant structural heart disease.  No further interventions per Cardiology.   PLAN     Generalized weakness Suspect d/t combination of COVID-19 infection and possible UTI.  -- PT/OT.  Needs 24/7 assistance - SW working toward TCU placement.   E.coli UTI with MDR, history ESBL, possible CRE On prophylactic Keflex for hx of frequent UTIs.  Per daughter, only 2-3 UTIs in the past couple years.   Suspect likely colonization. UA+ and UC with MDR E.coli (R to ertrapenem but S to meropenem).  -- Discussed and reviewed sensitivities with ID  -- Stopped ceftriaxone 2/1 -- Meropenem IV x3 days completed treating an uncomplicated cystitis per ID recs -- Prophylactic Keflex not necessary given established resistance, the fact she is very likely colonized.  -- ? if prophylactic therapy necessary given only a couple UTIs in the past couple years -- Consider referral to outpt ID and/or Urology on d/c to help determine future appropriateness of prophylactic therapy   COVID-19 infection Incidental finding. No hypoxia. Felt to be contributing to the weakness.  -- Monitor respiratory status -- Patient does not qualify for any COVID-19 directed therapies as she is on RA   Constipation -- Bowel regimen available - prune juice, Senna-S, dulcolax, Miralax -- Encourage oral intake and ambulation   Nonsustained ventricular tachycardia Asymptomatic with these episodes. Felt likely d/t Covid.  -- TTE without significant structural heart disease -- Appreciate input from cardiology, signed off -- High goals for e-lytes    Hyponatremia Suspect d/t poor oral intake which has improved. Hyponatremia resolved. -- Encourage oral intake -- Periodic BMP monitoring   Leukopenia Was previously normal in April. Suspect r/t Covid infection. -- Periodic CBC monitoring    Dementia Patient seemed mildly confused but cooperative -- Continue PTA Aricept   Hypertension Blood pressure intermittently mildly elevated -- Continue PTA Prinivil   Moderate malnutrition Per Dietitian eval.  Loss of Muscle Mass: Not Present. Loss of Subcutaneous Fat: Not Present. Fluid Accumulation: Mild +1. Energy Intake: Less than or equal to 50% of estimated energy requirement for 5 days or greater. Interpretation of Weight Loss: Not Reported (does not meet criteria). -- Supplements per Dietitian     Patient's daughter, POA - updated 2/6/22.     DVT Prophylaxis - Lovenox
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Escherichia infection, Escherichia test positive, Full blood count, Hyponatraemia, Hypophagia
Clinical narrative: PROVIDER PROGRESS NOTE 2/7/2022 ASSESSMENT Principal Problem:   Weakness Active Problems:   Weakness generalized   Moderate malnutrition      Skin Condition Reddened (Non-Pressure Related);Rash Left;Lower Back (Active) First Observed/Origin Date/First Observed/Origin Time: 01/29/22 1838   Skin Condition Type: Reddened (Non-Pressure Related);Rash  Orientation: Left;Lower  Location: Back     Comments:    Patient is a 81 y.o. female with history of frequent UTIs, dementia, hypertension who presented to the emergency room with generalized weakness.  She was diagnosed with a UTI.  She also had 4 episodes of nonsustained V. tach and a cardiology consult was requested. A TTE was done without significant structural heart disease.  No further interventions per Cardiology.   PLAN     Generalized weakness Suspect d/t combination of COVID-19 infection and possible UTI.  -- PT/OT.  Needs 24/7 assistance - SW working toward TCU placement.   E.coli UTI with MDR, history ESBL, possible CRE On prophylactic Keflex for hx of frequent UTIs.  Per daughter, only 2-3 UTIs in the past couple years.   Suspect likely colonization. UA+ and UC with MDR E.coli (R to ertrapenem but S to meropenem).  -- Discussed and reviewed sensitivities with ID  -- Stopped ceftriaxone 2/1 -- Meropenem IV x3 days completed treating an uncomplicated cystitis per ID recs -- Prophylactic Keflex not necessary given established resistance, the fact she is very likely colonized.  -- ? if prophylactic therapy necessary given only a couple UTIs in the past couple years -- Consider referral to outpt ID and/or Urology on d/c to help determine future appropriateness of prophylactic therapy   COVID-19 infection Incidental finding. No hypoxia. Felt to be contributing to the weakness.  -- Monitor respiratory status -- Patient does not qualify for any COVID-19 directed therapies as she is on RA   Constipation -- Bowel regimen available - prune juice, Senna-S, dulcolax, Miralax -- Encourage oral intake and ambulation   Nonsustained ventricular tachycardia Asymptomatic with these episodes. Felt likely d/t Covid.  -- TTE without significant structural heart disease -- Appreciate input from cardiology, signed off -- High goals for e-lytes    Hyponatremia Suspect d/t poor oral intake which has improved. Hyponatremia resolved. -- Encourage oral intake -- Periodic BMP monitoring   Leukopenia Was previously normal in April. Suspect r/t Covid infection. -- Periodic CBC monitoring    Dementia Patient seemed mildly confused but cooperative -- Continue PTA Aricept   Hypertension Blood pressure intermittently mildly elevated -- Continue PTA Prinivil   Moderate malnutrition Per Dietitian eval.  Loss of Muscle Mass: Not Present. Loss of Subcutaneous Fat: Not Present. Fluid Accumulation: Mild +1. Energy Intake: Less than or equal to 50% of estimated energy requirement for 5 days or greater. Interpretation of Weight Loss: Not Reported (does not meet criteria). -- Supplements per Dietitian     Patient's daughter, POA - updated 2/6/22.     DVT Prophylaxis - Lovenox
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: No adverse advent.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Patient too young for Moderna vaccine (17 y/o)
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Event occurred after 3rd vaccine; breakthrough case.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic respiratory disease, Condition aggravated
Clinical narrative: Patient is fully vaccinated.  COVID + 1/23/2022 on admission to hospital. 94y.o. male with a PMHx of COPD, infiltrative lung disease, hypertension, diabetes and diverticulosis who presents with a complaint of Covid pneumonia. SOB; He was initially on nonrebreather and then required BiPAP. he remains tachypneic with respiratory rate anywhere between the 40s and 60s. He is in acute distress. CXR: Severe chronic lung disease with honeycombing suggestive of usual interstitial pneumonia/idiopathic pulmonary fibrosis. In addition, there are scattered bilateral infiltrates which should be correlated for a superimposed infectious etiology. Decadron, Remdesivir, Baricitinib,  Prophylactic lovenox ordered. Mild troponin elevation. Pancytopenia-WBC 1.7, hemoglobin 9.0, platelets 72Pt does not want intubation or CPR.  DNR comfort. Patient expired.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Death, Dyspnoea, Haemoglobin decreased, Idiopathic pulmonary fibrosis, Interstitial lung disease
Clinical narrative: Patient is fully vaccinated.  COVID + 1/23/2022 on admission to hospital. 94y.o. male with a PMHx of COPD, infiltrative lung disease, hypertension, diabetes and diverticulosis who presents with a complaint of Covid pneumonia. SOB; He was initially on nonrebreather and then required BiPAP. he remains tachypneic with respiratory rate anywhere between the 40s and 60s. He is in acute distress. CXR: Severe chronic lung disease with honeycombing suggestive of usual interstitial pneumonia/idiopathic pulmonary fibrosis. In addition, there are scattered bilateral infiltrates which should be correlated for a superimposed infectious etiology. Decadron, Remdesivir, Baricitinib,  Prophylactic lovenox ordered. Mild troponin elevation. Pancytopenia-WBC 1.7, hemoglobin 9.0, platelets 72Pt does not want intubation or CPR.  DNR comfort. Patient expired.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Lung infiltration, Pancytopenia, Platelet count decreased, Positive airway pressure therapy, Respiratory distress
Clinical narrative: Patient is fully vaccinated.  COVID + 1/23/2022 on admission to hospital. 94y.o. male with a PMHx of COPD, infiltrative lung disease, hypertension, diabetes and diverticulosis who presents with a complaint of Covid pneumonia. SOB; He was initially on nonrebreather and then required BiPAP. he remains tachypneic with respiratory rate anywhere between the 40s and 60s. He is in acute distress. CXR: Severe chronic lung disease with honeycombing suggestive of usual interstitial pneumonia/idiopathic pulmonary fibrosis. In addition, there are scattered bilateral infiltrates which should be correlated for a superimposed infectious etiology. Decadron, Remdesivir, Baricitinib,  Prophylactic lovenox ordered. Mild troponin elevation. Pancytopenia-WBC 1.7, hemoglobin 9.0, platelets 72Pt does not want intubation or CPR.  DNR comfort. Patient expired.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Superinfection, Tachypnoea, Troponin increased, White blood cell count decreased
Clinical narrative: Patient is fully vaccinated.  COVID + 1/23/2022 on admission to hospital. 94y.o. male with a PMHx of COPD, infiltrative lung disease, hypertension, diabetes and diverticulosis who presents with a complaint of Covid pneumonia. SOB; He was initially on nonrebreather and then required BiPAP. he remains tachypneic with respiratory rate anywhere between the 40s and 60s. He is in acute distress. CXR: Severe chronic lung disease with honeycombing suggestive of usual interstitial pneumonia/idiopathic pulmonary fibrosis. In addition, there are scattered bilateral infiltrates which should be correlated for a superimposed infectious etiology. Decadron, Remdesivir, Baricitinib,  Prophylactic lovenox ordered. Mild troponin elevation. Pancytopenia-WBC 1.7, hemoglobin 9.0, platelets 72Pt does not want intubation or CPR.  DNR comfort. Patient expired.
Age: 24.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Cold sweat, Dehydration, Headache, Influenza virus test
Clinical narrative: I had chills in the middle of the night. It was cold sweat. My body ache and I had a huge head. I went to the ER. They gave me Tylenol then an hour later they gave me Motrin. They put an IV of fluid because I was dehydrated and had fever of 102.  They let me go until fluid was done and fever went down after 4 hours.
Age: 24.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test, Urine analysis
Clinical narrative: I had chills in the middle of the night. It was cold sweat. My body ache and I had a huge head. I went to the ER. They gave me Tylenol then an hour later they gave me Motrin. They put an IV of fluid because I was dehydrated and had fever of 102.  They let me go until fluid was done and fever went down after 4 hours.
Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Full blood count, Leukopenia, White blood cell count decreased
Clinical narrative: Leukopenia. Received redraw 2 months after initial labs and still low. Another redraw 02/2022 and still low.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Plasma cell myeloma
Clinical narrative: pt wife reported 2 mos after booster vaccine for covid the patient had an uptick in his Multiple Myeloma
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: No adverse advent.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Patient too young to receive specific vaccine (Moderna)
Age: 34.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Bradycardia, C-reactive protein decreased, COVID-19, COVID-19 pneumonia
Clinical narrative: HOSPITAL COURSE: Briefly, this is a 35 y.o.,male, with a PMH of ESRD on HD, HTN, tobacco abuse , who was admitted on 1/27/2022, for nausea, vomiting, malaise found to have Acute Hypoxic respiratory failure, sepsis 2/2 COVID. For more detail, including PMH, PSH, PFH, Social Hx and further info please see admission H&P.    Hospital course dictated by problem: COVID-19 Pneumonia  Sepsis 2/2 COVID  Acute Hypoxic Respiratory Failure  Suspected OSA  Tachycardic, febrile, tachypenic on admission. Symptom onset 1/26, tested positive 1/27. Fully vaccinated/boosted. CRP 0.6, D Dimer 0.43. Treated with two doses of dexamethasone, stopped when hypoxia resolved. Oxygen requirement of 2L on admission resolved after dialysis, however had desaturations and episodic bradycardia while sleeping, given neck circumference and snoring strong suspicion for OSA.  - outpatient sleep study referral to be completed when convalescent from COVID  - tessalon prn    ESRD On HD TTS. Scheduled for dialysis 1/29 in COVID unit    HTN  Borderline CHF EF 40-45% 11/29/2020  - PTA amlodipine, coreg, Imdur, Bumex, losartan, ASA     Obesity cont Topiramate    Tobacco Use  Declined nicotine replacement, encouraged cessation    DM2  Diet controlled
Age: 34.0
Sex: M
Vaccine: COVID19
Symptoms: Dialysis, Fibrin D dimer, Hypoxia, Malaise, Nausea
Clinical narrative: HOSPITAL COURSE: Briefly, this is a 35 y.o.,male, with a PMH of ESRD on HD, HTN, tobacco abuse , who was admitted on 1/27/2022, for nausea, vomiting, malaise found to have Acute Hypoxic respiratory failure, sepsis 2/2 COVID. For more detail, including PMH, PSH, PFH, Social Hx and further info please see admission H&P.    Hospital course dictated by problem: COVID-19 Pneumonia  Sepsis 2/2 COVID  Acute Hypoxic Respiratory Failure  Suspected OSA  Tachycardic, febrile, tachypenic on admission. Symptom onset 1/26, tested positive 1/27. Fully vaccinated/boosted. CRP 0.6, D Dimer 0.43. Treated with two doses of dexamethasone, stopped when hypoxia resolved. Oxygen requirement of 2L on admission resolved after dialysis, however had desaturations and episodic bradycardia while sleeping, given neck circumference and snoring strong suspicion for OSA.  - outpatient sleep study referral to be completed when convalescent from COVID  - tessalon prn    ESRD On HD TTS. Scheduled for dialysis 1/29 in COVID unit    HTN  Borderline CHF EF 40-45% 11/29/2020  - PTA amlodipine, coreg, Imdur, Bumex, losartan, ASA     Obesity cont Topiramate    Tobacco Use  Declined nicotine replacement, encouraged cessation    DM2  Diet controlled
Age: 34.0
Sex: M
Vaccine: COVID19
Symptoms: Oxygen saturation decreased, SARS-CoV-2 test positive, Sepsis, Sleep apnoea syndrome, Snoring
Clinical narrative: HOSPITAL COURSE: Briefly, this is a 35 y.o.,male, with a PMH of ESRD on HD, HTN, tobacco abuse , who was admitted on 1/27/2022, for nausea, vomiting, malaise found to have Acute Hypoxic respiratory failure, sepsis 2/2 COVID. For more detail, including PMH, PSH, PFH, Social Hx and further info please see admission H&P.    Hospital course dictated by problem: COVID-19 Pneumonia  Sepsis 2/2 COVID  Acute Hypoxic Respiratory Failure  Suspected OSA  Tachycardic, febrile, tachypenic on admission. Symptom onset 1/26, tested positive 1/27. Fully vaccinated/boosted. CRP 0.6, D Dimer 0.43. Treated with two doses of dexamethasone, stopped when hypoxia resolved. Oxygen requirement of 2L on admission resolved after dialysis, however had desaturations and episodic bradycardia while sleeping, given neck circumference and snoring strong suspicion for OSA.  - outpatient sleep study referral to be completed when convalescent from COVID  - tessalon prn    ESRD On HD TTS. Scheduled for dialysis 1/29 in COVID unit    HTN  Borderline CHF EF 40-45% 11/29/2020  - PTA amlodipine, coreg, Imdur, Bumex, losartan, ASA     Obesity cont Topiramate    Tobacco Use  Declined nicotine replacement, encouraged cessation    DM2  Diet controlled
Age: 34.0
Sex: M
Vaccine: COVID19
Symptoms: Tachycardia, Tachypnoea, Vomiting
Clinical narrative: HOSPITAL COURSE: Briefly, this is a 35 y.o.,male, with a PMH of ESRD on HD, HTN, tobacco abuse , who was admitted on 1/27/2022, for nausea, vomiting, malaise found to have Acute Hypoxic respiratory failure, sepsis 2/2 COVID. For more detail, including PMH, PSH, PFH, Social Hx and further info please see admission H&P.    Hospital course dictated by problem: COVID-19 Pneumonia  Sepsis 2/2 COVID  Acute Hypoxic Respiratory Failure  Suspected OSA  Tachycardic, febrile, tachypenic on admission. Symptom onset 1/26, tested positive 1/27. Fully vaccinated/boosted. CRP 0.6, D Dimer 0.43. Treated with two doses of dexamethasone, stopped when hypoxia resolved. Oxygen requirement of 2L on admission resolved after dialysis, however had desaturations and episodic bradycardia while sleeping, given neck circumference and snoring strong suspicion for OSA.  - outpatient sleep study referral to be completed when convalescent from COVID  - tessalon prn    ESRD On HD TTS. Scheduled for dialysis 1/29 in COVID unit    HTN  Borderline CHF EF 40-45% 11/29/2020  - PTA amlodipine, coreg, Imdur, Bumex, losartan, ASA     Obesity cont Topiramate    Tobacco Use  Declined nicotine replacement, encouraged cessation    DM2  Diet controlled
Age: 56.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Arthralgia, Headache, Respiratory tract congestion
Clinical narrative: 2 days post  vaccination and every day since having headache, congestion, and soreness in joints
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Patient received Pfizer COVID-19 vaccine which was beyond the manufacturer recommended use time of 31 days at the refrigerated temperature. Organization has been in direct contact with the vaccine manufacturer regarding this issue. Pfizer has data to support the stability of the vaccine up to 45 days at refrigerated temperatures. The vaccine given was within this range which is supported by the above data. No known adverse outcomes. Patient received Pfizer COVID-19 vaccine which was beyond the manufacturer recommended use time of 31 days at the refrigerated temperature. Organization has been in direct contact with the vaccine manufacturer regarding this issue. Pfizer has data to support the stability of the vaccine up to 45 days at refrigerated temperatures. The vaccine given was within this range which is supported by the above data. No known adverse outcomes.
Age: 56.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Vaccine administered BUD
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, Atrioventricular block complete, COVID-19, COVID-19 pneumonia, Death
Clinical narrative: Moderna COVID Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/15/21 and 2/21/21. Covid + 1/5/22. Admitted 1/8/22 for acute hypoxemic respiratory failure 2/2 Covid PNA. Remdesivir given x1, discontinued 2/2 CHB with frequent pauses. Transferred to ICU for DTX infusion and s/p TVPW placement on 1/8/22. Intubated 1/25/22. Admission c/b DVTs, thrombocytopenia, CHB, and worsening hypoxic and hypercapnic respiratory failure. Treated with remdesivir, zosyn, solumedrol and vancomycin. Patient expired 2/02/22.
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Deep vein thrombosis, Endotracheal intubation, Inappropriate schedule of product administration, Intensive care, Respiratory failure
Clinical narrative: Moderna COVID Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/15/21 and 2/21/21. Covid + 1/5/22. Admitted 1/8/22 for acute hypoxemic respiratory failure 2/2 Covid PNA. Remdesivir given x1, discontinued 2/2 CHB with frequent pauses. Transferred to ICU for DTX infusion and s/p TVPW placement on 1/8/22. Intubated 1/25/22. Admission c/b DVTs, thrombocytopenia, CHB, and worsening hypoxic and hypercapnic respiratory failure. Treated with remdesivir, zosyn, solumedrol and vancomycin. Patient expired 2/02/22.
Age: 76.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Temporary transvenous pacing, Thrombocytopenia
Clinical narrative: Moderna COVID Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/15/21 and 2/21/21. Covid + 1/5/22. Admitted 1/8/22 for acute hypoxemic respiratory failure 2/2 Covid PNA. Remdesivir given x1, discontinued 2/2 CHB with frequent pauses. Transferred to ICU for DTX infusion and s/p TVPW placement on 1/8/22. Intubated 1/25/22. Admission c/b DVTs, thrombocytopenia, CHB, and worsening hypoxic and hypercapnic respiratory failure. Treated with remdesivir, zosyn, solumedrol and vancomycin. Patient expired 2/02/22.
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, Cardiac failure congestive
Clinical narrative: went into CHF exacerbation and atrial fibrillation, both new to patient; required hospitalization
Age: 57.0
Sex: F
Vaccine: VARZOS
Symptoms: Incorrect route of product administration
Clinical narrative: Shingrix vaccine was improperly administered via Subcutaneous route instead of IM.  Researched on CDC website that dose is still valid when given subcutaneously.
Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Rash, Swelling, Urticaria
Clinical narrative: 10 days after, broke out into hives with swelling, raised bumps, and rash all over my whole body.
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Abdominal pain, Colonoscopy, Computerised tomogram, Diarrhoea, Dizziness
Clinical narrative: Abdominal pain, diarrhea, dizziness, tinnitus, vertigo, vestibular migraine with vestibular therapy. Limited work schedule.  High level of HSV1- 42.40 HSV 1 IgG Type Spec taken 21 January 2022.  SARS-COV2-SEMI-QUANT TOTAL AB 191 U/ml taken 21 December 2022 SARS-CoV-2 Spike Ab Interp - Positive taken 21 Dec 2022
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Herpes simplex test, Impaired work ability, Laboratory test, Magnetic resonance imaging, SARS-CoV-2 antibody test positive
Clinical narrative: Abdominal pain, diarrhea, dizziness, tinnitus, vertigo, vestibular migraine with vestibular therapy. Limited work schedule.  High level of HSV1- 42.40 HSV 1 IgG Type Spec taken 21 January 2022.  SARS-COV2-SEMI-QUANT TOTAL AB 191 U/ml taken 21 December 2022 SARS-CoV-2 Spike Ab Interp - Positive taken 21 Dec 2022
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Tinnitus, Vertigo, Vestibular function test, Vestibular migraine
Clinical narrative: Abdominal pain, diarrhea, dizziness, tinnitus, vertigo, vestibular migraine with vestibular therapy. Limited work schedule.  High level of HSV1- 42.40 HSV 1 IgG Type Spec taken 21 January 2022.  SARS-COV2-SEMI-QUANT TOTAL AB 191 U/ml taken 21 December 2022 SARS-CoV-2 Spike Ab Interp - Positive taken 21 Dec 2022
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood immunoglobulin G, Chills, Dizziness, Feeling cold, Headache
Clinical narrative: Abdominal pain, diarrhea, dizziness, tinnitus, vertigo, vestibular migraine with vestibular therapy. Limited work schedule.  High level of HSV1- 42.40 HSV 1 IgG Type Spec taken 21 January 2022.  SARS-COV2-SEMI-QUANT TOTAL AB 191 U/ml taken 21 December 2022 SARS-CoV-2 Spike Ab Interp - Positive taken 21 Dec 2022
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Irritable bowel syndrome, Post-acute COVID-19 syndrome, SARS-CoV-2 test, Tinnitus, Tremor
Clinical narrative: Abdominal pain, diarrhea, dizziness, tinnitus, vertigo, vestibular migraine with vestibular therapy. Limited work schedule.  High level of HSV1- 42.40 HSV 1 IgG Type Spec taken 21 January 2022.  SARS-COV2-SEMI-QUANT TOTAL AB 191 U/ml taken 21 December 2022 SARS-CoV-2 Spike Ab Interp - Positive taken 21 Dec 2022
Age: 44.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Vestibular migraine
Clinical narrative: Abdominal pain, diarrhea, dizziness, tinnitus, vertigo, vestibular migraine with vestibular therapy. Limited work schedule.  High level of HSV1- 42.40 HSV 1 IgG Type Spec taken 21 January 2022.  SARS-COV2-SEMI-QUANT TOTAL AB 191 U/ml taken 21 December 2022 SARS-CoV-2 Spike Ab Interp - Positive taken 21 Dec 2022
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Diarrhoea
Clinical narrative: Diarrhea, episodic, 1-2 times a month since initial COVID-19 vaccine
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Fatigue, Feeling abnormal, Fibromyalgia, Headache
Clinical narrative: Headache, body aches (sore muscles, sensitive skin). It felt like it triggered a fibromyalgia outbreak which I haven't had in years. I've also been experiencing more fatigue and brain fog since then which is preventing me from looking for work.
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Myalgia, Pain, Sensitive skin
Clinical narrative: Headache, body aches (sore muscles, sensitive skin). It felt like it triggered a fibromyalgia outbreak which I haven't had in years. I've also been experiencing more fatigue and brain fog since then which is preventing me from looking for work.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Anion gap, Basophil count decreased, Blood calcium increased, Blood chloride decreased, Blood creatinine normal
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Blood glucose normal, Blood lactic acid, Blood potassium normal, Blood sodium decreased, Blood urea decreased
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Carbon dioxide normal, Chills, Condition aggravated, Differential white blood cell count, Electrocardiogram abnormal
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Eosinophil count decreased, Full blood count, Glomerular filtration rate, Haematocrit decreased, Haemoglobin decreased
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Heart rate increased, Hyperhidrosis, Injection site pain, Lymphocyte count decreased, Mean cell haemoglobin concentration normal
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Mean cell haemoglobin decreased, Mean cell volume decreased, Metabolic function test, Monocyte count normal, Neutrophil count decreased
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Pain, Pain in extremity, Platelet count normal, Pyrexia, Red blood cell count normal
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Red cell distribution width increased, Seizure, Sinus tachycardia, Sleep disorder, Swelling
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 48.0
Sex: F
Vaccine: TDAP
Symptoms: Tremor, Vomiting, White blood cell count decreased
Clinical narrative: Severe pain and swelling that continued to behind upper  and radiated down right arm. Had low grade fever shaking and chills .Vomited 2/06/2022 for close to two hours straight. Then early am 2/07/2022 had a seizure while in bed witnessed by my significant other. Pain was 7/10 in upper right arm. If I or anyone else accidently  touched the area 10/10 pain woke me from a dead sleep. Swelling got worse 2/07/2022 and went to urgent care where I was given two grams of Ceftriaxone through an IV. My heart rate did some spikes to 100-150 to 200 BPM at times while in urgent care. Sent home with oral Ceftriaxone 500mg four times a day for 10 days. Three hours after getting IV antibiotics I broke out into a complete body sweat as if getting out toxins in my body. I could then feel improvement happening at that time.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Back pain, Musculoskeletal chest pain, Pain
Clinical narrative: Extreme pain radiating from back across rib cage to front abdomen.  I went to the urgent care and they thought I might be coming down with shingles.  Prescribed a week of prednisone which helped.  After the course of prednisone, the pain returned.  Ended up getting 3 courses of prednisone and the pain was still there.  Never got shingles.  A different doctor order CT scans and took several weeks for insurance authorization.  Took ibuprofen for a week.  Pain eventually subsided before insurance authorizations for CT scans was received.  Haven't gone for the scans yet.  Pain is there but minimal.  I received my moderna shot 3 weeks post surgery for breast implant replacement.  My surgeon said I should report this to you,
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: No adverse advent.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Ear pruritus
Clinical narrative: Itchiness in both ears. Given diphenhydramine 50 mg here at the pharmacy.
Age: 28.0
Sex: M
Vaccine: COVID19
Symptoms: Inappropriate schedule of product administration, No adverse event
Clinical narrative: Patient requested Pfizer COVID vaccine on 1/19/22 at clinic.  He reported that he initially got his first dose about a year prior.  He was advised to contact the clinic where he got his first dose for their records.  He then came back to the clinic and stated that they did not have record of him receiving his COVID vaccine and isn't sure if he maybe received a flu vaccine instead. He then reported he needed 2 doses of the COVID vaccine to start work. His first dose was given on 1/19/22. His 2nd dose was given on 2/5/22. Patient received 2nd dose 4 days early. Patient was immediately notified he received his dose too early and was advised to closely monitor for symptoms. Dose is considered valid since within 4 days of first dose. Patient did not experience any adverse effects. Error was noted when RN went to hand the patient his vaccine card and thought the dates seemed off.
Age: 87.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Event occurred after full vaccination. Patient was diagnosed with COVID Inpatient
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Dizziness, Dyskinesia, Fatigue, Feeling cold
Clinical narrative: Approximately 24 hours after receiving the vaccine, I was walking in my home and my body suddenly went rigid and started to twitch, my head jerked to the side, my head felt as though it was spinning then went black, then my body suddenly relaxed and I my awareness returned, with my head still a little dizzy. About 30 minutes later I was suddenly very cold and started shivering. I laid under a sheet, 2 fuzzy blankets, and a bed spread in a short sleeve nightgown. I pulled my arms and legs into the nightgown and curled up to try to get warm, falling asleep after about an hour. During the night I began to sweat and continued to do so until morning, fitfully sleeping the rest of the night. The next day I was very tired and dozed off and on but I did not have any other symptoms.
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperhidrosis, Muscle rigidity, Muscle twitching, Neurological examination
Clinical narrative: Approximately 24 hours after receiving the vaccine, I was walking in my home and my body suddenly went rigid and started to twitch, my head jerked to the side, my head felt as though it was spinning then went black, then my body suddenly relaxed and I my awareness returned, with my head still a little dizzy. About 30 minutes later I was suddenly very cold and started shivering. I laid under a sheet, 2 fuzzy blankets, and a bed spread in a short sleeve nightgown. I pulled my arms and legs into the nightgown and curled up to try to get warm, falling asleep after about an hour. During the night I began to sweat and continued to do so until morning, fitfully sleeping the rest of the night. The next day I was very tired and dozed off and on but I did not have any other symptoms.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Event occurred after 2nd vaccine; breakthrough case.
Age: 5.0
Sex: F
Vaccine: COVID19
Symptoms: Vomiting
Clinical narrative: The patient, 5 minutes after administering the vaccine, told her mother hat he wanted to vomit. In the evaluation area she had two episodes of vomiting, Mom says that it happens frequently to her. She was evaluated and the Doctor was called, who gave instructions to observe for 30 minutes.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: No adverse advent.
Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Patient received Pfizer COVID-19 vaccine which was beyond the manufacturer recommended use time of 31 days at the refrigerated temperature. Organization has been in direct contact with the vaccine manufacturer regarding this issue. Pfizer has data to support the stability of the vaccine up to 45 days at refrigerated temperatures. The vaccine given was within this range which is supported by the above data. No known adverse outcomes.
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Anticoagulant therapy, Atrial fibrillation, COVID-19, Computerised tomogram thorax normal, Deep vein thrombosis
Clinical narrative: Patient is fully vaccinated and boosed on 10/27/2021.  COVID + 1/25/2022 on admission to hospital. This patient was admitted through the emergency room because of sudden onset of the atrial fibrillation with RVR. Recently diagnosed with DVT.  The patient has been started initially on IV drip of Cardizem and she switched short-acting Cardizem for 6 hours. The patient did remain in normal sinus rhythm.  Cardiology consultation was made.  The patient had 2D echo without any abnormality with ejection fraction over 50%. ON Eliquis. CT chest:  No evidence of acute pulmonary embolism. 2. No acute process. Discharged home.
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Echocardiogram normal, Ejection fraction normal, SARS-CoV-2 test positive
Clinical narrative: Patient is fully vaccinated and boosed on 10/27/2021.  COVID + 1/25/2022 on admission to hospital. This patient was admitted through the emergency room because of sudden onset of the atrial fibrillation with RVR. Recently diagnosed with DVT.  The patient has been started initially on IV drip of Cardizem and she switched short-acting Cardizem for 6 hours. The patient did remain in normal sinus rhythm.  Cardiology consultation was made.  The patient had 2D echo without any abnormality with ejection fraction over 50%. ON Eliquis. CT chest:  No evidence of acute pulmonary embolism. 2. No acute process. Discharged home.
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Anticoagulant therapy, Atrial fibrillation, COVID-19, Computerised tomogram thorax, Computerised tomogram thorax normal
Clinical narrative: Patient is fully vaccinated and boosed on 10/27/2021.  COVID + 1/25/2022 on admission to hospital. This patient was admitted through the emergency room because of sudden onset of the atrial fibrillation with RVR. Recently diagnosed with DVT.  The patient has been started initially on IV drip of Cardizem and she switched short-acting Cardizem for 6 hours. The patient did remain in normal sinus rhythm.  Cardiology consultation was made.  The patient had 2D echo without any abnormality with ejection fraction over 50%. ON Eliquis. CT chest:  No evidence of acute pulmonary embolism. 2. No acute process. Discharged home.
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Deep vein thrombosis, Echocardiogram, Echocardiogram normal, Ejection fraction, Ejection fraction normal
Clinical narrative: Patient is fully vaccinated and boosed on 10/27/2021.  COVID + 1/25/2022 on admission to hospital. This patient was admitted through the emergency room because of sudden onset of the atrial fibrillation with RVR. Recently diagnosed with DVT.  The patient has been started initially on IV drip of Cardizem and she switched short-acting Cardizem for 6 hours. The patient did remain in normal sinus rhythm.  Cardiology consultation was made.  The patient had 2D echo without any abnormality with ejection fraction over 50%. ON Eliquis. CT chest:  No evidence of acute pulmonary embolism. 2. No acute process. Discharged home.
Age: 62.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test, SARS-CoV-2 test positive
Clinical narrative: Patient is fully vaccinated and boosed on 10/27/2021.  COVID + 1/25/2022 on admission to hospital. This patient was admitted through the emergency room because of sudden onset of the atrial fibrillation with RVR. Recently diagnosed with DVT.  The patient has been started initially on IV drip of Cardizem and she switched short-acting Cardizem for 6 hours. The patient did remain in normal sinus rhythm.  Cardiology consultation was made.  The patient had 2D echo without any abnormality with ejection fraction over 50%. ON Eliquis. CT chest:  No evidence of acute pulmonary embolism. 2. No acute process. Discharged home.
Age: 41.0
Sex: M
Vaccine: COVID19
Symptoms: Bell's palsy
Clinical narrative: Diagnosis of Bell's palsy
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: No adverse advent.
Age: 51.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: COVID-19, Cough, Fatigue, Headache, Malaise
Clinical narrative: I started feeling ill on Monday, 1/31.  Mostly a little tired and sore throat.  It got worse on Tuesday and included a headache and congestion.  I took a COVID test on Wednesday and started coughing; I got a positive COVID result the next day.  I did not see a doctor, but I talked to a Telemed doctor who prescribed some cough medicine.  I felt better by Saturday.  I realize this might not be an adverse reaction to the COVID vaccine, but when I researched whether getting the COVID vax along with the flu could cause flu-like symptoms with a positive COVID test and it said there was no significant data to suggest any issues with taking both vaccines at same time.  So I felt it was important for me to report my case so that it can be considered among the rest of the data.