chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Blood gases normal, Blood lactic acid normal, Blood urea normal, COVID-19, Chest X-ray normal
Clinical narrative: 1/3/22 Patient present to ED via squad after falling at home. Pt reportedly had cold symptoms since 12/25/21. He developed progressive weakness leading to fall. In ED, was found to be positive for SARS CoV 2 and head CT showed acute sinusitis. He was admitted on Augmentin. He was discharged after 5 days. Acute metabolic encephalopathy Generalized weakness -Presented with worsening weakness, wife was unable to transfer patient into his wheelchair due to patient having no strength.  Also seemed very confused. -Per patient's wife, patient nonambulatory at baseline and wheelchair bound however usually able to transfer out of bed and into wheelchair with only 1 person assist.  Due to previous stroke has left-sided hemiparesis at baseline. -CT head on presentation negative for acute intracranial process.  Extensive disease noted in paranasal sinuses. -Mental status appears to fluctuate.  More somnolent yesterday, still drowsy today but awakens more easily. ABG yesterday unremarkable. -No new focal neuro deficits on exam -Repeat UA without evidence of UTI -Weakness and confusion likely secondary to acute viral illness and sinusitis.   -Evaluated by PT/OT, plan for discharge home with home health, hospital bed ordered.   COVID-19 infection - Presented with: Acute encephalopathy, cold-like symptoms - Symptom onset: 12/25/2021 - Positive COVID-19: 1/3/22  - Vaccination status: Vaccinated with J&J with last dose 3/2021 - CXR on admission showed No acute disease in the chest.  - Oxygen status: 95% on RA  - Decadron: Does not qualify due to SpO2>94% on RA. - Remdesivir: Does not qualify due to SpO2>94% on RA and >10 days since symptom onset. - DVT prophylaxis:Currently on full anticoagulation
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram head abnormal, Confusional state, Encephalopathy, Fall, Illness
Clinical narrative: 1/3/22 Patient present to ED via squad after falling at home. Pt reportedly had cold symptoms since 12/25/21. He developed progressive weakness leading to fall. In ED, was found to be positive for SARS CoV 2 and head CT showed acute sinusitis. He was admitted on Augmentin. He was discharged after 5 days. Acute metabolic encephalopathy Generalized weakness -Presented with worsening weakness, wife was unable to transfer patient into his wheelchair due to patient having no strength.  Also seemed very confused. -Per patient's wife, patient nonambulatory at baseline and wheelchair bound however usually able to transfer out of bed and into wheelchair with only 1 person assist.  Due to previous stroke has left-sided hemiparesis at baseline. -CT head on presentation negative for acute intracranial process.  Extensive disease noted in paranasal sinuses. -Mental status appears to fluctuate.  More somnolent yesterday, still drowsy today but awakens more easily. ABG yesterday unremarkable. -No new focal neuro deficits on exam -Repeat UA without evidence of UTI -Weakness and confusion likely secondary to acute viral illness and sinusitis.   -Evaluated by PT/OT, plan for discharge home with home health, hospital bed ordered.   COVID-19 infection - Presented with: Acute encephalopathy, cold-like symptoms - Symptom onset: 12/25/2021 - Positive COVID-19: 1/3/22  - Vaccination status: Vaccinated with J&J with last dose 3/2021 - CXR on admission showed No acute disease in the chest.  - Oxygen status: 95% on RA  - Decadron: Does not qualify due to SpO2>94% on RA. - Remdesivir: Does not qualify due to SpO2>94% on RA and >10 days since symptom onset. - DVT prophylaxis:Currently on full anticoagulation
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Influenza A virus test negative, Influenza B virus test, Liver function test normal, Mental status changes, Metabolic encephalopathy
Clinical narrative: 1/3/22 Patient present to ED via squad after falling at home. Pt reportedly had cold symptoms since 12/25/21. He developed progressive weakness leading to fall. In ED, was found to be positive for SARS CoV 2 and head CT showed acute sinusitis. He was admitted on Augmentin. He was discharged after 5 days. Acute metabolic encephalopathy Generalized weakness -Presented with worsening weakness, wife was unable to transfer patient into his wheelchair due to patient having no strength.  Also seemed very confused. -Per patient's wife, patient nonambulatory at baseline and wheelchair bound however usually able to transfer out of bed and into wheelchair with only 1 person assist.  Due to previous stroke has left-sided hemiparesis at baseline. -CT head on presentation negative for acute intracranial process.  Extensive disease noted in paranasal sinuses. -Mental status appears to fluctuate.  More somnolent yesterday, still drowsy today but awakens more easily. ABG yesterday unremarkable. -No new focal neuro deficits on exam -Repeat UA without evidence of UTI -Weakness and confusion likely secondary to acute viral illness and sinusitis.   -Evaluated by PT/OT, plan for discharge home with home health, hospital bed ordered.   COVID-19 infection - Presented with: Acute encephalopathy, cold-like symptoms - Symptom onset: 12/25/2021 - Positive COVID-19: 1/3/22  - Vaccination status: Vaccinated with J&J with last dose 3/2021 - CXR on admission showed No acute disease in the chest.  - Oxygen status: 95% on RA  - Decadron: Does not qualify due to SpO2>94% on RA. - Remdesivir: Does not qualify due to SpO2>94% on RA and >10 days since symptom onset. - DVT prophylaxis:Currently on full anticoagulation
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Mobility decreased, Nasopharyngitis, SARS-CoV-2 test positive, Somnolence, Thyroid function test normal
Clinical narrative: 1/3/22 Patient present to ED via squad after falling at home. Pt reportedly had cold symptoms since 12/25/21. He developed progressive weakness leading to fall. In ED, was found to be positive for SARS CoV 2 and head CT showed acute sinusitis. He was admitted on Augmentin. He was discharged after 5 days. Acute metabolic encephalopathy Generalized weakness -Presented with worsening weakness, wife was unable to transfer patient into his wheelchair due to patient having no strength.  Also seemed very confused. -Per patient's wife, patient nonambulatory at baseline and wheelchair bound however usually able to transfer out of bed and into wheelchair with only 1 person assist.  Due to previous stroke has left-sided hemiparesis at baseline. -CT head on presentation negative for acute intracranial process.  Extensive disease noted in paranasal sinuses. -Mental status appears to fluctuate.  More somnolent yesterday, still drowsy today but awakens more easily. ABG yesterday unremarkable. -No new focal neuro deficits on exam -Repeat UA without evidence of UTI -Weakness and confusion likely secondary to acute viral illness and sinusitis.   -Evaluated by PT/OT, plan for discharge home with home health, hospital bed ordered.   COVID-19 infection - Presented with: Acute encephalopathy, cold-like symptoms - Symptom onset: 12/25/2021 - Positive COVID-19: 1/3/22  - Vaccination status: Vaccinated with J&J with last dose 3/2021 - CXR on admission showed No acute disease in the chest.  - Oxygen status: 95% on RA  - Decadron: Does not qualify due to SpO2>94% on RA. - Remdesivir: Does not qualify due to SpO2>94% on RA and >10 days since symptom onset. - DVT prophylaxis:Currently on full anticoagulation
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Troponin normal, Urine analysis normal
Clinical narrative: 1/3/22 Patient present to ED via squad after falling at home. Pt reportedly had cold symptoms since 12/25/21. He developed progressive weakness leading to fall. In ED, was found to be positive for SARS CoV 2 and head CT showed acute sinusitis. He was admitted on Augmentin. He was discharged after 5 days. Acute metabolic encephalopathy Generalized weakness -Presented with worsening weakness, wife was unable to transfer patient into his wheelchair due to patient having no strength.  Also seemed very confused. -Per patient's wife, patient nonambulatory at baseline and wheelchair bound however usually able to transfer out of bed and into wheelchair with only 1 person assist.  Due to previous stroke has left-sided hemiparesis at baseline. -CT head on presentation negative for acute intracranial process.  Extensive disease noted in paranasal sinuses. -Mental status appears to fluctuate.  More somnolent yesterday, still drowsy today but awakens more easily. ABG yesterday unremarkable. -No new focal neuro deficits on exam -Repeat UA without evidence of UTI -Weakness and confusion likely secondary to acute viral illness and sinusitis.   -Evaluated by PT/OT, plan for discharge home with home health, hospital bed ordered.   COVID-19 infection - Presented with: Acute encephalopathy, cold-like symptoms - Symptom onset: 12/25/2021 - Positive COVID-19: 1/3/22  - Vaccination status: Vaccinated with J&J with last dose 3/2021 - CXR on admission showed No acute disease in the chest.  - Oxygen status: 95% on RA  - Decadron: Does not qualify due to SpO2>94% on RA. - Remdesivir: Does not qualify due to SpO2>94% on RA and >10 days since symptom onset. - DVT prophylaxis:Currently on full anticoagulation
Age: 50.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Incorrect route of product administration, Injection site pain, Pain in extremity, Shoulder injury related to vaccine administration
Clinical narrative: Noticed that the injection felt to be in the wrong place and hurt more than usual.  Have had pain in left arm, particularly elbow and shoulder, ever since.  Went to physician, who tried a round of prescription strength NSAID, but that did not help.  Physical Therapist diagnosed SIRVA.  Currently undergoing PT, but continue to have pain in left arm.
Age: 12.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered
Clinical narrative: Patient given pediatric Pfizer dose instead of 12y old and up Pfizer dose.
Age: 27.0
Sex: F
Vaccine: COVID19
Symptoms: Heavy menstrual bleeding, Thrombosis
Clinical narrative: HEAVY PERIOD BLEEDING BLOOD COTS. SHE STILL HAS A BLOOD CLOT IN HER BREAST
Age: 4.0
Sex: M
Vaccine: UNK, UNK, UNK
Symptoms: Bronchitis, Chest pain, Conjunctivitis, Cough, Dyspnoea
Clinical narrative: Very high fever, rash, bronchitis, pharyngitis, rhinorrhea, headache, severe vomiting, coughing, wheezing, difficulty breathing, tachycardia, chest pain, conjunctivitis, congestion. He developed these symptoms within a 2 days of being vaccinated and various symptoms continued for 2 months.
Age: 4.0
Sex: M
Vaccine: UNK, UNK, UNK
Symptoms: Headache, Pharyngitis, Pyrexia, Rash, Respiratory tract congestion
Clinical narrative: Very high fever, rash, bronchitis, pharyngitis, rhinorrhea, headache, severe vomiting, coughing, wheezing, difficulty breathing, tachycardia, chest pain, conjunctivitis, congestion. He developed these symptoms within a 2 days of being vaccinated and various symptoms continued for 2 months.
Age: 4.0
Sex: M
Vaccine: UNK, UNK, UNK
Symptoms: Rhinorrhoea, Tachycardia, Vomiting, Wheezing
Clinical narrative: Very high fever, rash, bronchitis, pharyngitis, rhinorrhea, headache, severe vomiting, coughing, wheezing, difficulty breathing, tachycardia, chest pain, conjunctivitis, congestion. He developed these symptoms within a 2 days of being vaccinated and various symptoms continued for 2 months.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Head discomfort, Underdose
Clinical narrative: The patient received her Moderna booster dose (LOT#: 025L21B) on 02/13/22 at 1640. The pharmacist (RPh) alerted the RN that patient name was on Moderna booster participation form from Vial 2. The RPh stated she never pulled a full dose from Vial 2 and only boosters were pulled from Vial 2. The RN called the licensed vocational nurse (LVN) and she stated that she did remember having a patient who she thought received a full dose of Moderna but quickly realized she had given a Moderna booster. The RN called patient two times and left a voicemail to call back. Patient did not answer and has not called the RN back. The RN called the patient again the next morning and left a voicemail. Patient's son in law called back and gave the RN a new number to reach patient. The RN called new number and spoke to patient's daughter. The RN explained incident. Patient's daughter explained that they would be coming back to the vaccine site to receive Moderna dose (0.25 mL) in order to complete first dose of COVID-19 Moderna vaccine. Patient returned 2/14/22 at 1446 to receive Moderna (0.25 mL). A different RN assessed patient after completing 15 minute observation. Patient stated her head "felt big." Patient denied pressure, pain, and did not feel lightheaded. Patient left vaccine site unassisted and with a steady gait at 1503 with no adverse reactions.
Age: 36.0
Sex: F
Vaccine: DF
Symptoms: Incorrect route of product administration, Product administration error
Clinical narrative: Administration error: Vaccinator: diluted 5-11 year Pfizer with 1.8mL of saline instead of 1.3mL and administered 0.3mL intramuscular deltoid.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Fatigue, Headache, Myalgia, Pyrexia
Clinical narrative: I had a fever temperature 101, muscle ache, fatigue and headache medium the effects lasted abut a day and a half. I took Tylenol and was fine after that. I also was dizzy that lasted for about 4 month that started about 3 days after the vaccination.
Age: 58.0
Sex: F
Vaccine: COVID19, FLUC4
Symptoms: Injection site mass, Injection site pain, Injection site pruritus
Clinical narrative: Patient developed right arm lump where she received the Flucelvax and COVID-19 vaccine. It has been painful and itching since day of administration (approximately 1 month at this point).
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Antibody test negative, Blood gases, COVID-19, Cardiomegaly, Chest X-ray abnormal
Clinical narrative: 53 yo F Renal transplant recipient October 2020 due to polycystic kidney disease. Received J and J vaccine then two subsequent Pfizer shots. States she had antibody levels checked and did not mount an antibody response. Has been "very careful" but her husband went back to work and contracted COVID. She began having symptoms she thinks on 1/10/22--with a mild cough and feeling poorly.  On 1/31/22 was the first time she noted low pulse oximetry reading and presented to our ED. She lives in city and sees Doctor post-transplant. She was admitted here 1/31/22-2/1/22 requiring 2 LI NC, her CXR was c/w viral pneumonia and she began decadron (has had #6 days including today).  The past 2 days she has felt increased dyspnea with her pulse ox dropping to 86% despite being on 2 L NC --she was unaware that she could increase the rate.  She has felt chills, +anorexia--eating and drinking little, has had decreased urine, and passing  about 5 loose brown stools daily x2 days.  She has had a nonproductive cough.  Her spouse drove her to the ED today.  She denies CP, palpitations, dizziness, edema, weight changes, HA, or abd pain.   In the ED, she is afebrile with HR 50-60s,  Bp initially soft but improvbed after IVFs in the ED.  ABGs on RA: 7.49 /34/47/26.1--she was placed on 4L NC but while seen (@1700) desaturated 82-84 % with speech and any movement with dyspnea.  now requiring 10 L NC to stay >90% sat (resp aware and adding humidifier.  CXR worsened compared to 1/31 w  coarse bilateral pulmonary infiltrates suggestive of COVID-19 more pronounced than prior exam.  Moderate cardiomegaly.   D-dimer increased 1300 compared to 990 on 02/01.  BNP is pending.  Hospital Medicine has  been asked to admit the pt to COVID stepdown.   INPATIENT AT THIS TIME
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Cough, Decreased appetite, Diarrhoea, Dyspnoea
Clinical narrative: 53 yo F Renal transplant recipient October 2020 due to polycystic kidney disease. Received J and J vaccine then two subsequent Pfizer shots. States she had antibody levels checked and did not mount an antibody response. Has been "very careful" but her husband went back to work and contracted COVID. She began having symptoms she thinks on 1/10/22--with a mild cough and feeling poorly.  On 1/31/22 was the first time she noted low pulse oximetry reading and presented to our ED. She lives in city and sees Doctor post-transplant. She was admitted here 1/31/22-2/1/22 requiring 2 LI NC, her CXR was c/w viral pneumonia and she began decadron (has had #6 days including today).  The past 2 days she has felt increased dyspnea with her pulse ox dropping to 86% despite being on 2 L NC --she was unaware that she could increase the rate.  She has felt chills, +anorexia--eating and drinking little, has had decreased urine, and passing  about 5 loose brown stools daily x2 days.  She has had a nonproductive cough.  Her spouse drove her to the ED today.  She denies CP, palpitations, dizziness, edema, weight changes, HA, or abd pain.   In the ED, she is afebrile with HR 50-60s,  Bp initially soft but improvbed after IVFs in the ED.  ABGs on RA: 7.49 /34/47/26.1--she was placed on 4L NC but while seen (@1700) desaturated 82-84 % with speech and any movement with dyspnea.  now requiring 10 L NC to stay >90% sat (resp aware and adding humidifier.  CXR worsened compared to 1/31 w  coarse bilateral pulmonary infiltrates suggestive of COVID-19 more pronounced than prior exam.  Moderate cardiomegaly.   D-dimer increased 1300 compared to 990 on 02/01.  BNP is pending.  Hospital Medicine has  been asked to admit the pt to COVID stepdown.   INPATIENT AT THIS TIME
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea exertional, Feeling abnormal, Fibrin D dimer increased, Fluid intake reduced, Hypophagia
Clinical narrative: 53 yo F Renal transplant recipient October 2020 due to polycystic kidney disease. Received J and J vaccine then two subsequent Pfizer shots. States she had antibody levels checked and did not mount an antibody response. Has been "very careful" but her husband went back to work and contracted COVID. She began having symptoms she thinks on 1/10/22--with a mild cough and feeling poorly.  On 1/31/22 was the first time she noted low pulse oximetry reading and presented to our ED. She lives in city and sees Doctor post-transplant. She was admitted here 1/31/22-2/1/22 requiring 2 LI NC, her CXR was c/w viral pneumonia and she began decadron (has had #6 days including today).  The past 2 days she has felt increased dyspnea with her pulse ox dropping to 86% despite being on 2 L NC --she was unaware that she could increase the rate.  She has felt chills, +anorexia--eating and drinking little, has had decreased urine, and passing  about 5 loose brown stools daily x2 days.  She has had a nonproductive cough.  Her spouse drove her to the ED today.  She denies CP, palpitations, dizziness, edema, weight changes, HA, or abd pain.   In the ED, she is afebrile with HR 50-60s,  Bp initially soft but improvbed after IVFs in the ED.  ABGs on RA: 7.49 /34/47/26.1--she was placed on 4L NC but while seen (@1700) desaturated 82-84 % with speech and any movement with dyspnea.  now requiring 10 L NC to stay >90% sat (resp aware and adding humidifier.  CXR worsened compared to 1/31 w  coarse bilateral pulmonary infiltrates suggestive of COVID-19 more pronounced than prior exam.  Moderate cardiomegaly.   D-dimer increased 1300 compared to 990 on 02/01.  BNP is pending.  Hospital Medicine has  been asked to admit the pt to COVID stepdown.   INPATIENT AT THIS TIME
Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Lung infiltration, Malaise, Oxygen saturation decreased, Pneumonia viral, Urine output decreased
Clinical narrative: 53 yo F Renal transplant recipient October 2020 due to polycystic kidney disease. Received J and J vaccine then two subsequent Pfizer shots. States she had antibody levels checked and did not mount an antibody response. Has been "very careful" but her husband went back to work and contracted COVID. She began having symptoms she thinks on 1/10/22--with a mild cough and feeling poorly.  On 1/31/22 was the first time she noted low pulse oximetry reading and presented to our ED. She lives in city and sees Doctor post-transplant. She was admitted here 1/31/22-2/1/22 requiring 2 LI NC, her CXR was c/w viral pneumonia and she began decadron (has had #6 days including today).  The past 2 days she has felt increased dyspnea with her pulse ox dropping to 86% despite being on 2 L NC --she was unaware that she could increase the rate.  She has felt chills, +anorexia--eating and drinking little, has had decreased urine, and passing  about 5 loose brown stools daily x2 days.  She has had a nonproductive cough.  Her spouse drove her to the ED today.  She denies CP, palpitations, dizziness, edema, weight changes, HA, or abd pain.   In the ED, she is afebrile with HR 50-60s,  Bp initially soft but improvbed after IVFs in the ED.  ABGs on RA: 7.49 /34/47/26.1--she was placed on 4L NC but while seen (@1700) desaturated 82-84 % with speech and any movement with dyspnea.  now requiring 10 L NC to stay >90% sat (resp aware and adding humidifier.  CXR worsened compared to 1/31 w  coarse bilateral pulmonary infiltrates suggestive of COVID-19 more pronounced than prior exam.  Moderate cardiomegaly.   D-dimer increased 1300 compared to 990 on 02/01.  BNP is pending.  Hospital Medicine has  been asked to admit the pt to COVID stepdown.   INPATIENT AT THIS TIME
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Acute kidney injury, Angiogram pulmonary abnormal, Arteriosclerosis, Bronchoscopic lung volume reduction, COVID-19
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Condition aggravated, Coronary artery disease, Cyanosis, Dyspnoea, Electrocardiogram normal
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Encephalopathy, Endotracheal intubation, Gastrooesophageal reflux disease, Hyperhidrosis, Lung opacity
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Nephrolithiasis, Oesophageal dilatation, Respiratory acidosis, Respiratory failure, Speech disorder
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Tracheomalacia
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Angiogram pulmonary abnormal, Aphasia, Arteriosclerosis, Breath sounds abnormal, Cyanosis
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Dyspnoea, Electrocardiogram normal, Endotracheal intubation, Gastrooesophageal reflux disease, Hyperhidrosis
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Intellectual disability, Lung disorder, Lung opacity, Nephrolithiasis, Oesophageal disorder
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE:Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAPDischarge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:   Dr. from-pulmonology at a Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY REPORT.
Age: 57.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Acute kidney injury, Angiogram pulmonary abnormal, Arteriosclerosis, Bronchoscopic lung volume reduction, COVID-19
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albute albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE: Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Discharge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:  Pulmonology Primary care physician Community Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY VRAD REPORT.
Age: 57.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Condition aggravated, Coronary artery disease, Cyanosis, Dyspnoea, Electrocardiogram normal
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albute albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE: Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Discharge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:  Pulmonology Primary care physician Community Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY VRAD REPORT.
Age: 57.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Encephalopathy, Endotracheal intubation, Gastrooesophageal reflux disease, Hyperhidrosis, Lung opacity
Clinical narrative: Patient is a 57yF w/ PMHx of asthma, OSA with CPAP, CAD status post stent, and bipolar disorder presenting with acute onset SOB.  At time of my exam, patient intubated and sedated, unable to provide history.  History obtained per chart review and discussion with patient's daughter.  She reports that patient's husband called daughter whenever patient began to develop difficulty speaking due to SOB.  Daughter then instructed patient's husband to call EMS.  On 1st responder arrival patient was noted to be significantly dyspneic, lip cyanosis noted, responding in 1 to 2 word phrases only.  Reportedly AOx2 at that time.  Patient was also noted to be diaphoretic, without nausea.  EKG with NSR.  Patient was given albute albuterol and Atrovent via non-rebreather mask, and transported to ED. Daughter reports that patient is generally AOx4, but that she "has the mental status of a 12 year old, and won't get any older than that." Denies any diagnosis associated with this.  Patient has been vaccinated for COVID, no known positive contacts.   DISCHARGE: Admitting diagnoses:  History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis, acute encephalopathy, acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Discharge diagnoses: History of asthma, COVID-19 viral infection, hypercapnic respiratory failure, respiratory acidosis,  acute kidney injury, bipolar disorder, CAD, history of coronary artery stenting, hypertension, OSA on CPAP Consulting physician:  Pulmonology Primary care physician Community Clinic  Procedures and Diagnostics: CTA of the chest per PE protocol 02/04/2022:  IMPRESSION: NO EVIDENCE FOR PULMONARY EMBOLISM. ATHEROSCLEROSIS INCLUDING CORONARY ARTERY DISEASE. SMALL CALIBER TRACHEA AND MAINSTEM BRONCHI, SUGGESTIVE OF TRACHEOBRONCHOMALACIA.  CORRELATION FOR POTENTIALLY RELATED SYMPTOMS RECOMMENDED. MILD, CENTRAL GROUND-GLASS CHANGES IN EACH LUNG ARE NONSPECIFIC AND FAVORED TO BE SECONDARY TO LOW LUNG VOLUMES AT THE TIME OF THE EXAMINATION.  MILD BRONCHIOLITIS IS ALSO POSSIBLE. MILDLY DILATED UPPER THORACIC AND LOWER CERVICAL ESOPHAGUS WITH AN AIR-FLUID LEVEL, LIKELY GASTROESOPHAGEAL REFLUX. INCIDENTAL, NONOBSTRUCTING LEFT NEPHROLITHIASIS.  THE FINAL REPORT IS CONCORDANT WITH THE PRELIMINARY VRAD REPORT.