chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Fall, Hyponatraemia, Pyrexia, SARS-CoV-2 test positive, Stool analysis normal
Clinical narrative: 83 y.o. male patient of MD with history of deafness, vision impairment, and HTN presented to Hospital with weakness, covid and hyponatremia    Weakness Fall Initial presenting symptom in the setting of hyponatremia and covid Fell after using toilet Will address other medical issues below PT/ OT Improving HHC on discharge   Covid-19 Virus Infection Date of onset of symptoms: Uncertain (suspected 1-2 weeks ago) Symptoms present on admission: weakness Date of covid positive test: 11/8 Vaccination status: vaccinated Imaging: CXR non-acute Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated   Moderate Hyponatremia In the setting of covid infection Na 127 in ED Continue MIVF - NS Improving   Fever In the setting of positive covid testing CXR negative stool studies, UA negative Suspected in relation to covid infection Diarrhea Per family history, but no bowel movements in ED Stool studies, KUB negative Improved   Visual Impairment Deafness   BPH HTN Continue home meds
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Urine analysis normal
Clinical narrative: 83 y.o. male patient of MD with history of deafness, vision impairment, and HTN presented to Hospital with weakness, covid and hyponatremia    Weakness Fall Initial presenting symptom in the setting of hyponatremia and covid Fell after using toilet Will address other medical issues below PT/ OT Improving HHC on discharge   Covid-19 Virus Infection Date of onset of symptoms: Uncertain (suspected 1-2 weeks ago) Symptoms present on admission: weakness Date of covid positive test: 11/8 Vaccination status: vaccinated Imaging: CXR non-acute Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated   Moderate Hyponatremia In the setting of covid infection Na 127 in ED Continue MIVF - NS Improving   Fever In the setting of positive covid testing CXR negative stool studies, UA negative Suspected in relation to covid infection Diarrhea Per family history, but no bowel movements in ED Stool studies, KUB negative Improved   Visual Impairment Deafness   BPH HTN Continue home meds
Age: 67.0
Sex: M
Vaccine: VARZOS
Symptoms: Product storage error
Clinical narrative: VACCINE FROZEN INSTEAD OF REFRIGERATED
Age: 61.0
Sex: M
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Vaccine was given outside of date of use. The vaccine had been out of the recommended storage temperature for 31 days.
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Spikevax vaccine was given out of date range. Vaccine was out of recommended temperature for 1 day.
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Aortic valve sclerosis, COVID-19, COVID-19 pneumonia
Clinical narrative: Patient is a 78 y.o. female patient of MD    Report on admission: 78-year-old female with history of HTN, HLD, CKD, aortic stenosis, sarcoidosis, pulmonary hypertension presents to ED with open sores on her left lower leg and "a cold".  Patient has chronic swelling with chronic venous stasis skin changes in both lower legs.  Over the last 2 weeks she has developed open wounds into areas in the left lower leg.  The areas have scabbed over.  There has been no purulent drainage.  She has not had a fever with this at any point.  Over the last week she has had a runny nose, sore throat, generalized headache, diffuse achiness, cough, shortness of breath.  Denies pleuritic or other chest pain.  No nausea, vomiting, diarrhea.  Went to urgent care about all of this this morning, was sent to ED for further evaluation            Hospital course as below.  Patient improved with medical treatment.  Patient declined rehab unit placement and will be discharging home with home health care services and family.  Patient discharged in stable condition.   1.  COVID pneumonia: -Pulmonology following -Symptoms 10/24, +10/28 -Out of window for remdesivir -10-day course Decadron -Completing empiric antibiotics for possible bacterial pneumonia as well   2.  Acute hypoxic respiratory failure: -In setting of above -10/30 intubated -11/3 extubated   3.  Acute on chronic HFpEF: -Receiving diuresis -10/29 Echo EF 63%, grade 3 diastolic dysfunction, moderate aortic valve sclerosis, moderate TVR, pulmonary hypertension   4.  AKI on CKD: -Nephrology following -Hold nephrotoxic agents -Renal ultrasound negative   5.  Seizure disorder, metabolic encephalopathy: -Neurology consulted -Continue home AED, keppra increased 6. Left leg cellulitis: -receiving abx -local wound care   7. BLE saphenous vein thrombosis: -complete 3 months OAC bc high risk for DVT or PE   8.  Other chronic medical conditions: Chronic back pain, history of CVA, hyperlipidemia, hypertension history, history of aortic stenosis, osteopenia history, sarcoidosis history
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardiac failure acute, Cellulitis, Chronic kidney disease, Condition aggravated, Cough
Clinical narrative: Patient is a 78 y.o. female patient of MD    Report on admission: 78-year-old female with history of HTN, HLD, CKD, aortic stenosis, sarcoidosis, pulmonary hypertension presents to ED with open sores on her left lower leg and "a cold".  Patient has chronic swelling with chronic venous stasis skin changes in both lower legs.  Over the last 2 weeks she has developed open wounds into areas in the left lower leg.  The areas have scabbed over.  There has been no purulent drainage.  She has not had a fever with this at any point.  Over the last week she has had a runny nose, sore throat, generalized headache, diffuse achiness, cough, shortness of breath.  Denies pleuritic or other chest pain.  No nausea, vomiting, diarrhea.  Went to urgent care about all of this this morning, was sent to ED for further evaluation            Hospital course as below.  Patient improved with medical treatment.  Patient declined rehab unit placement and will be discharging home with home health care services and family.  Patient discharged in stable condition.   1.  COVID pneumonia: -Pulmonology following -Symptoms 10/24, +10/28 -Out of window for remdesivir -10-day course Decadron -Completing empiric antibiotics for possible bacterial pneumonia as well   2.  Acute hypoxic respiratory failure: -In setting of above -10/30 intubated -11/3 extubated   3.  Acute on chronic HFpEF: -Receiving diuresis -10/29 Echo EF 63%, grade 3 diastolic dysfunction, moderate aortic valve sclerosis, moderate TVR, pulmonary hypertension   4.  AKI on CKD: -Nephrology following -Hold nephrotoxic agents -Renal ultrasound negative   5.  Seizure disorder, metabolic encephalopathy: -Neurology consulted -Continue home AED, keppra increased 6. Left leg cellulitis: -receiving abx -local wound care   7. BLE saphenous vein thrombosis: -complete 3 months OAC bc high risk for DVT or PE   8.  Other chronic medical conditions: Chronic back pain, history of CVA, hyperlipidemia, hypertension history, history of aortic stenosis, osteopenia history, sarcoidosis history
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Diastolic dysfunction, Diuretic therapy, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal
Clinical narrative: Patient is a 78 y.o. female patient of MD    Report on admission: 78-year-old female with history of HTN, HLD, CKD, aortic stenosis, sarcoidosis, pulmonary hypertension presents to ED with open sores on her left lower leg and "a cold".  Patient has chronic swelling with chronic venous stasis skin changes in both lower legs.  Over the last 2 weeks she has developed open wounds into areas in the left lower leg.  The areas have scabbed over.  There has been no purulent drainage.  She has not had a fever with this at any point.  Over the last week she has had a runny nose, sore throat, generalized headache, diffuse achiness, cough, shortness of breath.  Denies pleuritic or other chest pain.  No nausea, vomiting, diarrhea.  Went to urgent care about all of this this morning, was sent to ED for further evaluation            Hospital course as below.  Patient improved with medical treatment.  Patient declined rehab unit placement and will be discharging home with home health care services and family.  Patient discharged in stable condition.   1.  COVID pneumonia: -Pulmonology following -Symptoms 10/24, +10/28 -Out of window for remdesivir -10-day course Decadron -Completing empiric antibiotics for possible bacterial pneumonia as well   2.  Acute hypoxic respiratory failure: -In setting of above -10/30 intubated -11/3 extubated   3.  Acute on chronic HFpEF: -Receiving diuresis -10/29 Echo EF 63%, grade 3 diastolic dysfunction, moderate aortic valve sclerosis, moderate TVR, pulmonary hypertension   4.  AKI on CKD: -Nephrology following -Hold nephrotoxic agents -Renal ultrasound negative   5.  Seizure disorder, metabolic encephalopathy: -Neurology consulted -Continue home AED, keppra increased 6. Left leg cellulitis: -receiving abx -local wound care   7. BLE saphenous vein thrombosis: -complete 3 months OAC bc high risk for DVT or PE   8.  Other chronic medical conditions: Chronic back pain, history of CVA, hyperlipidemia, hypertension history, history of aortic stenosis, osteopenia history, sarcoidosis history
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Endotracheal intubation, Headache, Left ventricular failure, Limb injury, Nasopharyngitis
Clinical narrative: Patient is a 78 y.o. female patient of MD    Report on admission: 78-year-old female with history of HTN, HLD, CKD, aortic stenosis, sarcoidosis, pulmonary hypertension presents to ED with open sores on her left lower leg and "a cold".  Patient has chronic swelling with chronic venous stasis skin changes in both lower legs.  Over the last 2 weeks she has developed open wounds into areas in the left lower leg.  The areas have scabbed over.  There has been no purulent drainage.  She has not had a fever with this at any point.  Over the last week she has had a runny nose, sore throat, generalized headache, diffuse achiness, cough, shortness of breath.  Denies pleuritic or other chest pain.  No nausea, vomiting, diarrhea.  Went to urgent care about all of this this morning, was sent to ED for further evaluation            Hospital course as below.  Patient improved with medical treatment.  Patient declined rehab unit placement and will be discharging home with home health care services and family.  Patient discharged in stable condition.   1.  COVID pneumonia: -Pulmonology following -Symptoms 10/24, +10/28 -Out of window for remdesivir -10-day course Decadron -Completing empiric antibiotics for possible bacterial pneumonia as well   2.  Acute hypoxic respiratory failure: -In setting of above -10/30 intubated -11/3 extubated   3.  Acute on chronic HFpEF: -Receiving diuresis -10/29 Echo EF 63%, grade 3 diastolic dysfunction, moderate aortic valve sclerosis, moderate TVR, pulmonary hypertension   4.  AKI on CKD: -Nephrology following -Hold nephrotoxic agents -Renal ultrasound negative   5.  Seizure disorder, metabolic encephalopathy: -Neurology consulted -Continue home AED, keppra increased 6. Left leg cellulitis: -receiving abx -local wound care   7. BLE saphenous vein thrombosis: -complete 3 months OAC bc high risk for DVT or PE   8.  Other chronic medical conditions: Chronic back pain, history of CVA, hyperlipidemia, hypertension history, history of aortic stenosis, osteopenia history, sarcoidosis history
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Oropharyngeal pain, Pain, Pulmonary hypertension, Rhinorrhoea, Scab
Clinical narrative: Patient is a 78 y.o. female patient of MD    Report on admission: 78-year-old female with history of HTN, HLD, CKD, aortic stenosis, sarcoidosis, pulmonary hypertension presents to ED with open sores on her left lower leg and "a cold".  Patient has chronic swelling with chronic venous stasis skin changes in both lower legs.  Over the last 2 weeks she has developed open wounds into areas in the left lower leg.  The areas have scabbed over.  There has been no purulent drainage.  She has not had a fever with this at any point.  Over the last week she has had a runny nose, sore throat, generalized headache, diffuse achiness, cough, shortness of breath.  Denies pleuritic or other chest pain.  No nausea, vomiting, diarrhea.  Went to urgent care about all of this this morning, was sent to ED for further evaluation            Hospital course as below.  Patient improved with medical treatment.  Patient declined rehab unit placement and will be discharging home with home health care services and family.  Patient discharged in stable condition.   1.  COVID pneumonia: -Pulmonology following -Symptoms 10/24, +10/28 -Out of window for remdesivir -10-day course Decadron -Completing empiric antibiotics for possible bacterial pneumonia as well   2.  Acute hypoxic respiratory failure: -In setting of above -10/30 intubated -11/3 extubated   3.  Acute on chronic HFpEF: -Receiving diuresis -10/29 Echo EF 63%, grade 3 diastolic dysfunction, moderate aortic valve sclerosis, moderate TVR, pulmonary hypertension   4.  AKI on CKD: -Nephrology following -Hold nephrotoxic agents -Renal ultrasound negative   5.  Seizure disorder, metabolic encephalopathy: -Neurology consulted -Continue home AED, keppra increased 6. Left leg cellulitis: -receiving abx -local wound care   7. BLE saphenous vein thrombosis: -complete 3 months OAC bc high risk for DVT or PE   8.  Other chronic medical conditions: Chronic back pain, history of CVA, hyperlipidemia, hypertension history, history of aortic stenosis, osteopenia history, sarcoidosis history
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Superficial vein thrombosis, Tricuspid valve incompetence, Ultrasound kidney normal, Wound, Wound treatment
Clinical narrative: Patient is a 78 y.o. female patient of MD    Report on admission: 78-year-old female with history of HTN, HLD, CKD, aortic stenosis, sarcoidosis, pulmonary hypertension presents to ED with open sores on her left lower leg and "a cold".  Patient has chronic swelling with chronic venous stasis skin changes in both lower legs.  Over the last 2 weeks she has developed open wounds into areas in the left lower leg.  The areas have scabbed over.  There has been no purulent drainage.  She has not had a fever with this at any point.  Over the last week she has had a runny nose, sore throat, generalized headache, diffuse achiness, cough, shortness of breath.  Denies pleuritic or other chest pain.  No nausea, vomiting, diarrhea.  Went to urgent care about all of this this morning, was sent to ED for further evaluation            Hospital course as below.  Patient improved with medical treatment.  Patient declined rehab unit placement and will be discharging home with home health care services and family.  Patient discharged in stable condition.   1.  COVID pneumonia: -Pulmonology following -Symptoms 10/24, +10/28 -Out of window for remdesivir -10-day course Decadron -Completing empiric antibiotics for possible bacterial pneumonia as well   2.  Acute hypoxic respiratory failure: -In setting of above -10/30 intubated -11/3 extubated   3.  Acute on chronic HFpEF: -Receiving diuresis -10/29 Echo EF 63%, grade 3 diastolic dysfunction, moderate aortic valve sclerosis, moderate TVR, pulmonary hypertension   4.  AKI on CKD: -Nephrology following -Hold nephrotoxic agents -Renal ultrasound negative   5.  Seizure disorder, metabolic encephalopathy: -Neurology consulted -Continue home AED, keppra increased 6. Left leg cellulitis: -receiving abx -local wound care   7. BLE saphenous vein thrombosis: -complete 3 months OAC bc high risk for DVT or PE   8.  Other chronic medical conditions: Chronic back pain, history of CVA, hyperlipidemia, hypertension history, history of aortic stenosis, osteopenia history, sarcoidosis history
Age: 78.0
Sex: M
Vaccine: RSV
Symptoms: Injected limb mobility decreased, Mobility decreased, Pain in extremity
Clinical narrative: Pt received vaccine from pharmacy intern.  Had arm pain afterwards.  Wasn't surprised as it was a known side effect. Several days go by and it gets progressively worse.  He had difficulty raising his arms, as he golfs three days per week.  Went to his doctor on 12/11 and received a Medrol Dosepak.  He seemed to improve, but his pain regressed several days after stopping the medication.  It didn't get as bad as the initial pain, but nonetheless, still remains problematic.  He has had another Medrol Dosepak prescribed 12/27/23.
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Vaccine Spikevax was given outside of the date of use. The vaccine had been out of the recommended storage temperature for 31 days.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase increased, Basal ganglia infarction, Blood creatinine increased, Blood glucose, COVID-19
Clinical narrative: Patient is a 73 y.o. male with a history of NIDDM-2, HFrEF, CAD, VT  who presented to hospital 11/12/2023 with confusion and lethargy. Found COVID +.    1. COVID 19: Symptom onset 11/11/23 or early 11/12/23. Tested positive 11/12/23. CXR 11/12/23 with clear lungs b/l. Not requiring supplemental O2. No indications for steroids or remdesivir. eID consult placed paxlovid. Family and patient agreeable to Paxlovid, continue on discharge.  2. Acute Metabolic Encephalopathy: Suspect due to COVID 19. Neuro exam non-focal. CT head 11/12/23 non acute. Per discussion with family 11/14/2023, patient not far off from baseline. Improved.  3. IDDM2: Historically insulin dependent. A1c 8.2% 8/2023. Patient on 8u Lantus daily at home. Reduced dose + SSI still with tightly controlled BG inpatient. Changed to metformin on discharge. Recommend OP follow up with PCP for regimen titration.  4. Elevated Troponin: Troponin T 111, 95 on admit. Suspect demand ischemia with known CAD and COVID 19. Monitor.  5. Transaminitis: Mild ALT elevation. Suspect due to COVID 19. Resolved. 6. Multivessel CAD: S/p LHC 6/5/20 with DES x3. Patient no longer taking ASA. Resumed. Not on a statin. Recommend resumption outpatient if patient tolerates.  7. VT: VT storm arer NSTEMI and PCI 6/2020. No longer on amiodarone.  8. Chronic HFrEF: In setting of previous NSTEMI. TTE 6/5/20 with EF 25-30%, RWMA, moderate AR and moderate pulmonary HTN. No ECHO since. No longer on GDMT or lasix. Resume as indicated.  9. Prior CVA: CT head 11/2023 with old infarct of b/l basal ganglia and left parietal lobe. Added ASA as above.  10. CKD III: Creat baseline ~1.3-1.7. Creat 1.55 on admit.  11. Chronic Anemia: Hgb baseline ~ 11. Hgb 12.5 on admit.  12. Hypothyroidism: Continued home levothyroxine.  13. Underweight: Per BMI of 17.9. Monitor PO status. RD followed. Recommend OP follow up.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Cerebral infarction, Chest X-ray normal, Computerised tomogram head abnormal, Confusional state, Glycosylated haemoglobin increased
Clinical narrative: Patient is a 73 y.o. male with a history of NIDDM-2, HFrEF, CAD, VT  who presented to hospital 11/12/2023 with confusion and lethargy. Found COVID +.    1. COVID 19: Symptom onset 11/11/23 or early 11/12/23. Tested positive 11/12/23. CXR 11/12/23 with clear lungs b/l. Not requiring supplemental O2. No indications for steroids or remdesivir. eID consult placed paxlovid. Family and patient agreeable to Paxlovid, continue on discharge.  2. Acute Metabolic Encephalopathy: Suspect due to COVID 19. Neuro exam non-focal. CT head 11/12/23 non acute. Per discussion with family 11/14/2023, patient not far off from baseline. Improved.  3. IDDM2: Historically insulin dependent. A1c 8.2% 8/2023. Patient on 8u Lantus daily at home. Reduced dose + SSI still with tightly controlled BG inpatient. Changed to metformin on discharge. Recommend OP follow up with PCP for regimen titration.  4. Elevated Troponin: Troponin T 111, 95 on admit. Suspect demand ischemia with known CAD and COVID 19. Monitor.  5. Transaminitis: Mild ALT elevation. Suspect due to COVID 19. Resolved. 6. Multivessel CAD: S/p LHC 6/5/20 with DES x3. Patient no longer taking ASA. Resumed. Not on a statin. Recommend resumption outpatient if patient tolerates.  7. VT: VT storm arer NSTEMI and PCI 6/2020. No longer on amiodarone.  8. Chronic HFrEF: In setting of previous NSTEMI. TTE 6/5/20 with EF 25-30%, RWMA, moderate AR and moderate pulmonary HTN. No ECHO since. No longer on GDMT or lasix. Resume as indicated.  9. Prior CVA: CT head 11/2023 with old infarct of b/l basal ganglia and left parietal lobe. Added ASA as above.  10. CKD III: Creat baseline ~1.3-1.7. Creat 1.55 on admit.  11. Chronic Anemia: Hgb baseline ~ 11. Hgb 12.5 on admit.  12. Hypothyroidism: Continued home levothyroxine.  13. Underweight: Per BMI of 17.9. Monitor PO status. RD followed. Recommend OP follow up.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Haemoglobin decreased, Hypertransaminasaemia, Lethargy, Metabolic encephalopathy, Myocardial ischaemia
Clinical narrative: Patient is a 73 y.o. male with a history of NIDDM-2, HFrEF, CAD, VT  who presented to hospital 11/12/2023 with confusion and lethargy. Found COVID +.    1. COVID 19: Symptom onset 11/11/23 or early 11/12/23. Tested positive 11/12/23. CXR 11/12/23 with clear lungs b/l. Not requiring supplemental O2. No indications for steroids or remdesivir. eID consult placed paxlovid. Family and patient agreeable to Paxlovid, continue on discharge.  2. Acute Metabolic Encephalopathy: Suspect due to COVID 19. Neuro exam non-focal. CT head 11/12/23 non acute. Per discussion with family 11/14/2023, patient not far off from baseline. Improved.  3. IDDM2: Historically insulin dependent. A1c 8.2% 8/2023. Patient on 8u Lantus daily at home. Reduced dose + SSI still with tightly controlled BG inpatient. Changed to metformin on discharge. Recommend OP follow up with PCP for regimen titration.  4. Elevated Troponin: Troponin T 111, 95 on admit. Suspect demand ischemia with known CAD and COVID 19. Monitor.  5. Transaminitis: Mild ALT elevation. Suspect due to COVID 19. Resolved. 6. Multivessel CAD: S/p LHC 6/5/20 with DES x3. Patient no longer taking ASA. Resumed. Not on a statin. Recommend resumption outpatient if patient tolerates.  7. VT: VT storm arer NSTEMI and PCI 6/2020. No longer on amiodarone.  8. Chronic HFrEF: In setting of previous NSTEMI. TTE 6/5/20 with EF 25-30%, RWMA, moderate AR and moderate pulmonary HTN. No ECHO since. No longer on GDMT or lasix. Resume as indicated.  9. Prior CVA: CT head 11/2023 with old infarct of b/l basal ganglia and left parietal lobe. Added ASA as above.  10. CKD III: Creat baseline ~1.3-1.7. Creat 1.55 on admit.  11. Chronic Anemia: Hgb baseline ~ 11. Hgb 12.5 on admit.  12. Hypothyroidism: Continued home levothyroxine.  13. Underweight: Per BMI of 17.9. Monitor PO status. RD followed. Recommend OP follow up.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Neurological examination normal, SARS-CoV-2 test positive, Troponin T increased
Clinical narrative: Patient is a 73 y.o. male with a history of NIDDM-2, HFrEF, CAD, VT  who presented to hospital 11/12/2023 with confusion and lethargy. Found COVID +.    1. COVID 19: Symptom onset 11/11/23 or early 11/12/23. Tested positive 11/12/23. CXR 11/12/23 with clear lungs b/l. Not requiring supplemental O2. No indications for steroids or remdesivir. eID consult placed paxlovid. Family and patient agreeable to Paxlovid, continue on discharge.  2. Acute Metabolic Encephalopathy: Suspect due to COVID 19. Neuro exam non-focal. CT head 11/12/23 non acute. Per discussion with family 11/14/2023, patient not far off from baseline. Improved.  3. IDDM2: Historically insulin dependent. A1c 8.2% 8/2023. Patient on 8u Lantus daily at home. Reduced dose + SSI still with tightly controlled BG inpatient. Changed to metformin on discharge. Recommend OP follow up with PCP for regimen titration.  4. Elevated Troponin: Troponin T 111, 95 on admit. Suspect demand ischemia with known CAD and COVID 19. Monitor.  5. Transaminitis: Mild ALT elevation. Suspect due to COVID 19. Resolved. 6. Multivessel CAD: S/p LHC 6/5/20 with DES x3. Patient no longer taking ASA. Resumed. Not on a statin. Recommend resumption outpatient if patient tolerates.  7. VT: VT storm arer NSTEMI and PCI 6/2020. No longer on amiodarone.  8. Chronic HFrEF: In setting of previous NSTEMI. TTE 6/5/20 with EF 25-30%, RWMA, moderate AR and moderate pulmonary HTN. No ECHO since. No longer on GDMT or lasix. Resume as indicated.  9. Prior CVA: CT head 11/2023 with old infarct of b/l basal ganglia and left parietal lobe. Added ASA as above.  10. CKD III: Creat baseline ~1.3-1.7. Creat 1.55 on admit.  11. Chronic Anemia: Hgb baseline ~ 11. Hgb 12.5 on admit.  12. Hypothyroidism: Continued home levothyroxine.  13. Underweight: Per BMI of 17.9. Monitor PO status. RD followed. Recommend OP follow up.
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Spikevax vaccine was given out of the use of date. Vaccine was given 1 day outside of recommended usage.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Vaccine was given outside of date of use. The vaccine had been out of the recommended storage temperatur of 6 days.
Age: 78.0
Sex: F
Vaccine: RSV
Symptoms: Cellulitis, Injection site pain
Clinical narrative: Patient showed up at the pharmacy on 12/27/23 and stated that she experienced cellulitis post her arexvy vaccine. She told us that she had to go to the ER for her pain at injection site.
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Asthenia, Blood creatinine increased, Blood potassium increased, Blood sodium decreased
Clinical narrative: Patient is a 84 y.o. female patient of MD with history of CAD, atrial fibrillation, HFrEF with recovered EF, hyperlipidemia, OSA, DM 2, hyponatremia thought to be SIADH, pacer, CVA, and PMNR who presented to Hospital with 2 weeks of general weakness and fatigue with nonproductive cough and episode of emesis and diarrhea with blood pressure 91/52 on day of presentation found to have COVID-19.  Patient's diuretics were held, she was given IV fluids and clinically improved.  Sodium had improved to 135, Lasix and Aldactone held due to mild hyperkalemia and poor oral intake.  Patient recommended to hold this at discharge until follow-up with her PCP and heart failure team.  Patient voiced understanding.  Patient also advised to keep blood pressure log at home, as she is also on Entresto and may not tolerate if having lower blood pressures at home.  Patient medically stable at the time of discharge.   Covid-19 Virus Infection General Weakness Dehydration  Date of onset of symptoms: 10/26/23 Symptoms present on admission: fatigue, weakness, diarrhea Date of covid positive test: 11/9/23 Vaccination status: vaccinated Imaging: CXR no acute issues Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not indicated Anticipated special isolation end date: when confirmed she's afebrile and no hypoxia  PT, OT, UM consulted Now of iv fluids, and will monitor   Borderline blood pressure Repeat orthostat this am Hold HF meds except bblocker  Hope to dc home tomorrow if not hypotensive    HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium . HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium .   Chronic hyponatremia Past notes suggested SIADH Baseline Na runs ~ 130 and was 127 on admission Given her poor oral intake and clinical exam suspect she is partial dehdyarted and will see how she responds to IV fluids,    AKI on CKD Mild hyperkalemia Baseline Cr is 0.9 and was 1.3 on admission  UA with slight pyuria but no specific symptoms of infection Hold home Lasix and Aldactone, entresto 1L IV fluids ordered
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray normal, Chronic kidney disease, Cough, Dehydration
Clinical narrative: Patient is a 84 y.o. female patient of MD with history of CAD, atrial fibrillation, HFrEF with recovered EF, hyperlipidemia, OSA, DM 2, hyponatremia thought to be SIADH, pacer, CVA, and PMNR who presented to Hospital with 2 weeks of general weakness and fatigue with nonproductive cough and episode of emesis and diarrhea with blood pressure 91/52 on day of presentation found to have COVID-19.  Patient's diuretics were held, she was given IV fluids and clinically improved.  Sodium had improved to 135, Lasix and Aldactone held due to mild hyperkalemia and poor oral intake.  Patient recommended to hold this at discharge until follow-up with her PCP and heart failure team.  Patient voiced understanding.  Patient also advised to keep blood pressure log at home, as she is also on Entresto and may not tolerate if having lower blood pressures at home.  Patient medically stable at the time of discharge.   Covid-19 Virus Infection General Weakness Dehydration  Date of onset of symptoms: 10/26/23 Symptoms present on admission: fatigue, weakness, diarrhea Date of covid positive test: 11/9/23 Vaccination status: vaccinated Imaging: CXR no acute issues Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not indicated Anticipated special isolation end date: when confirmed she's afebrile and no hypoxia  PT, OT, UM consulted Now of iv fluids, and will monitor   Borderline blood pressure Repeat orthostat this am Hold HF meds except bblocker  Hope to dc home tomorrow if not hypotensive    HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium . HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium .   Chronic hyponatremia Past notes suggested SIADH Baseline Na runs ~ 130 and was 127 on admission Given her poor oral intake and clinical exam suspect she is partial dehdyarted and will see how she responds to IV fluids,    AKI on CKD Mild hyperkalemia Baseline Cr is 0.9 and was 1.3 on admission  UA with slight pyuria but no specific symptoms of infection Hold home Lasix and Aldactone, entresto 1L IV fluids ordered
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Diarrhoea, Fatigue, Hyperkalaemia, Hypophagia, Hypotension
Clinical narrative: Patient is a 84 y.o. female patient of MD with history of CAD, atrial fibrillation, HFrEF with recovered EF, hyperlipidemia, OSA, DM 2, hyponatremia thought to be SIADH, pacer, CVA, and PMNR who presented to Hospital with 2 weeks of general weakness and fatigue with nonproductive cough and episode of emesis and diarrhea with blood pressure 91/52 on day of presentation found to have COVID-19.  Patient's diuretics were held, she was given IV fluids and clinically improved.  Sodium had improved to 135, Lasix and Aldactone held due to mild hyperkalemia and poor oral intake.  Patient recommended to hold this at discharge until follow-up with her PCP and heart failure team.  Patient voiced understanding.  Patient also advised to keep blood pressure log at home, as she is also on Entresto and may not tolerate if having lower blood pressures at home.  Patient medically stable at the time of discharge.   Covid-19 Virus Infection General Weakness Dehydration  Date of onset of symptoms: 10/26/23 Symptoms present on admission: fatigue, weakness, diarrhea Date of covid positive test: 11/9/23 Vaccination status: vaccinated Imaging: CXR no acute issues Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not indicated Anticipated special isolation end date: when confirmed she's afebrile and no hypoxia  PT, OT, UM consulted Now of iv fluids, and will monitor   Borderline blood pressure Repeat orthostat this am Hold HF meds except bblocker  Hope to dc home tomorrow if not hypotensive    HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium . HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium .   Chronic hyponatremia Past notes suggested SIADH Baseline Na runs ~ 130 and was 127 on admission Given her poor oral intake and clinical exam suspect she is partial dehdyarted and will see how she responds to IV fluids,    AKI on CKD Mild hyperkalemia Baseline Cr is 0.9 and was 1.3 on admission  UA with slight pyuria but no specific symptoms of infection Hold home Lasix and Aldactone, entresto 1L IV fluids ordered
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Pyuria, SARS-CoV-2 test positive, Urine analysis abnormal, Vomiting
Clinical narrative: Patient is a 84 y.o. female patient of MD with history of CAD, atrial fibrillation, HFrEF with recovered EF, hyperlipidemia, OSA, DM 2, hyponatremia thought to be SIADH, pacer, CVA, and PMNR who presented to Hospital with 2 weeks of general weakness and fatigue with nonproductive cough and episode of emesis and diarrhea with blood pressure 91/52 on day of presentation found to have COVID-19.  Patient's diuretics were held, she was given IV fluids and clinically improved.  Sodium had improved to 135, Lasix and Aldactone held due to mild hyperkalemia and poor oral intake.  Patient recommended to hold this at discharge until follow-up with her PCP and heart failure team.  Patient voiced understanding.  Patient also advised to keep blood pressure log at home, as she is also on Entresto and may not tolerate if having lower blood pressures at home.  Patient medically stable at the time of discharge.   Covid-19 Virus Infection General Weakness Dehydration  Date of onset of symptoms: 10/26/23 Symptoms present on admission: fatigue, weakness, diarrhea Date of covid positive test: 11/9/23 Vaccination status: vaccinated Imaging: CXR no acute issues Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not indicated Anticipated special isolation end date: when confirmed she's afebrile and no hypoxia  PT, OT, UM consulted Now of iv fluids, and will monitor   Borderline blood pressure Repeat orthostat this am Hold HF meds except bblocker  Hope to dc home tomorrow if not hypotensive    HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium . HFrEF with recovered EF CAD Atrial fibrillation Status post pacer Follows with heart disease management EF previously 35% but recovered to 50 to 55% Home regimen includes Lasix 40 mg daily, Entresto, Pradaxa, Toprol, and spironolactone and will continue metoprolol and hold all due to lower blood pressure and increased potassium .   Chronic hyponatremia Past notes suggested SIADH Baseline Na runs ~ 130 and was 127 on admission Given her poor oral intake and clinical exam suspect she is partial dehdyarted and will see how she responds to IV fluids,    AKI on CKD Mild hyperkalemia Baseline Cr is 0.9 and was 1.3 on admission  UA with slight pyuria but no specific symptoms of infection Hold home Lasix and Aldactone, entresto 1L IV fluids ordered
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Back pain, COVID-19, Constipation, Cough, Culture urine positive
Clinical narrative: Patient is a 75 y.o. female who was referred to the Hospital ED by her neurosurgeon for urgent MR imaging after outpatient x-rays identified a comminuted 3-column injury extending into the L4 pedicles.  She is status post L4 laminectomy and facetectomy, L2-S1 posterior lateral arthrodesis with pedicle screw instrumentation performed 11/1/2023.  The surgery was delayed until 11/1/2023 by SARS-CoV-2/COVID-19 and an acute urinary tract infection.   By history, patient had presented with worsening back pain to the neurosurgery outpatient office from inpatient rehab after a fall.  That visit followed her 9/11/2023 thoracic spine surgery performed for thoracic myelopathy resulting from known thoracic stenosis, T8 compression fracture and proximal junctional kyphosis.   Going to SNF for continued therapy and rehab.        Assessment and Plan   Comminuted 3 column fracture of the L4 vertebra Sequela of low impact trauma and underlying osteoporosis status post surgical stabilization surgery performed this admission, 11/1/2023 -Postoperative care including pain medications and activity per neurosurgery   Atrial flutter Essential hypertension Established diagnoses; controlled with metoprolol succinate -Apixaban re-started 11/6/2023 following clearance from neurosurgery -No acute issues apparent this admission   Obsessive-compulsive disorder Insomnia Established diagnoses; no acute issues  -Continue fluoxetine and trazodone prn   COVID-19 infection Presented as cough and myalgias starting on 10/21/2023 with a confirmed diagnosis 10/23/2023 since removed from isolation 11/1/2023 -No overt sequelae apparent   History of an acute urinary tract infection Klebsiella pneumonia isolate was identified on the 10/23/2023 urine culture; she has completed 5 days of ceftriaxone therapy 10/27/2023 and no UTI symptoms at present Opioid induced constipation - Continue bowel regimen   Diabetes mellitus type 2, non-insulin-dependent Dyslipidemia By history controlled with a hemoglobin A1c of 5.7% noted in June 2023. -Continue atorvastatin with plans to resume Trulicty at discharge   Hypothyroidism Continue thyroid supplementation   B12 deficiency Historical diagnosis; chronic management includes IM cyanocobalamin every 21 days   Thrombocytosis - mild and suspect to be reactive - follow-up as outpatient
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Facetectomy, Fall, Kyphosis, Medical device implantation, Myalgia
Clinical narrative: Patient is a 75 y.o. female who was referred to the Hospital ED by her neurosurgeon for urgent MR imaging after outpatient x-rays identified a comminuted 3-column injury extending into the L4 pedicles.  She is status post L4 laminectomy and facetectomy, L2-S1 posterior lateral arthrodesis with pedicle screw instrumentation performed 11/1/2023.  The surgery was delayed until 11/1/2023 by SARS-CoV-2/COVID-19 and an acute urinary tract infection.   By history, patient had presented with worsening back pain to the neurosurgery outpatient office from inpatient rehab after a fall.  That visit followed her 9/11/2023 thoracic spine surgery performed for thoracic myelopathy resulting from known thoracic stenosis, T8 compression fracture and proximal junctional kyphosis.   Going to SNF for continued therapy and rehab.        Assessment and Plan   Comminuted 3 column fracture of the L4 vertebra Sequela of low impact trauma and underlying osteoporosis status post surgical stabilization surgery performed this admission, 11/1/2023 -Postoperative care including pain medications and activity per neurosurgery   Atrial flutter Essential hypertension Established diagnoses; controlled with metoprolol succinate -Apixaban re-started 11/6/2023 following clearance from neurosurgery -No acute issues apparent this admission   Obsessive-compulsive disorder Insomnia Established diagnoses; no acute issues  -Continue fluoxetine and trazodone prn   COVID-19 infection Presented as cough and myalgias starting on 10/21/2023 with a confirmed diagnosis 10/23/2023 since removed from isolation 11/1/2023 -No overt sequelae apparent   History of an acute urinary tract infection Klebsiella pneumonia isolate was identified on the 10/23/2023 urine culture; she has completed 5 days of ceftriaxone therapy 10/27/2023 and no UTI symptoms at present Opioid induced constipation - Continue bowel regimen   Diabetes mellitus type 2, non-insulin-dependent Dyslipidemia By history controlled with a hemoglobin A1c of 5.7% noted in June 2023. -Continue atorvastatin with plans to resume Trulicty at discharge   Hypothyroidism Continue thyroid supplementation   B12 deficiency Historical diagnosis; chronic management includes IM cyanocobalamin every 21 days   Thrombocytosis - mild and suspect to be reactive - follow-up as outpatient
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Myelopathy, Pneumonia klebsiella, Spinal X-ray abnormal, Spinal column injury, Spinal compression fracture
Clinical narrative: Patient is a 75 y.o. female who was referred to the Hospital ED by her neurosurgeon for urgent MR imaging after outpatient x-rays identified a comminuted 3-column injury extending into the L4 pedicles.  She is status post L4 laminectomy and facetectomy, L2-S1 posterior lateral arthrodesis with pedicle screw instrumentation performed 11/1/2023.  The surgery was delayed until 11/1/2023 by SARS-CoV-2/COVID-19 and an acute urinary tract infection.   By history, patient had presented with worsening back pain to the neurosurgery outpatient office from inpatient rehab after a fall.  That visit followed her 9/11/2023 thoracic spine surgery performed for thoracic myelopathy resulting from known thoracic stenosis, T8 compression fracture and proximal junctional kyphosis.   Going to SNF for continued therapy and rehab.        Assessment and Plan   Comminuted 3 column fracture of the L4 vertebra Sequela of low impact trauma and underlying osteoporosis status post surgical stabilization surgery performed this admission, 11/1/2023 -Postoperative care including pain medications and activity per neurosurgery   Atrial flutter Essential hypertension Established diagnoses; controlled with metoprolol succinate -Apixaban re-started 11/6/2023 following clearance from neurosurgery -No acute issues apparent this admission   Obsessive-compulsive disorder Insomnia Established diagnoses; no acute issues  -Continue fluoxetine and trazodone prn   COVID-19 infection Presented as cough and myalgias starting on 10/21/2023 with a confirmed diagnosis 10/23/2023 since removed from isolation 11/1/2023 -No overt sequelae apparent   History of an acute urinary tract infection Klebsiella pneumonia isolate was identified on the 10/23/2023 urine culture; she has completed 5 days of ceftriaxone therapy 10/27/2023 and no UTI symptoms at present Opioid induced constipation - Continue bowel regimen   Diabetes mellitus type 2, non-insulin-dependent Dyslipidemia By history controlled with a hemoglobin A1c of 5.7% noted in June 2023. -Continue atorvastatin with plans to resume Trulicty at discharge   Hypothyroidism Continue thyroid supplementation   B12 deficiency Historical diagnosis; chronic management includes IM cyanocobalamin every 21 days   Thrombocytosis - mild and suspect to be reactive - follow-up as outpatient
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Spinal fusion surgery, Spinal laminectomy, Thoracic operation, Thoracic spinal stenosis, Urinary tract infection
Clinical narrative: Patient is a 75 y.o. female who was referred to the Hospital ED by her neurosurgeon for urgent MR imaging after outpatient x-rays identified a comminuted 3-column injury extending into the L4 pedicles.  She is status post L4 laminectomy and facetectomy, L2-S1 posterior lateral arthrodesis with pedicle screw instrumentation performed 11/1/2023.  The surgery was delayed until 11/1/2023 by SARS-CoV-2/COVID-19 and an acute urinary tract infection.   By history, patient had presented with worsening back pain to the neurosurgery outpatient office from inpatient rehab after a fall.  That visit followed her 9/11/2023 thoracic spine surgery performed for thoracic myelopathy resulting from known thoracic stenosis, T8 compression fracture and proximal junctional kyphosis.   Going to SNF for continued therapy and rehab.        Assessment and Plan   Comminuted 3 column fracture of the L4 vertebra Sequela of low impact trauma and underlying osteoporosis status post surgical stabilization surgery performed this admission, 11/1/2023 -Postoperative care including pain medications and activity per neurosurgery   Atrial flutter Essential hypertension Established diagnoses; controlled with metoprolol succinate -Apixaban re-started 11/6/2023 following clearance from neurosurgery -No acute issues apparent this admission   Obsessive-compulsive disorder Insomnia Established diagnoses; no acute issues  -Continue fluoxetine and trazodone prn   COVID-19 infection Presented as cough and myalgias starting on 10/21/2023 with a confirmed diagnosis 10/23/2023 since removed from isolation 11/1/2023 -No overt sequelae apparent   History of an acute urinary tract infection Klebsiella pneumonia isolate was identified on the 10/23/2023 urine culture; she has completed 5 days of ceftriaxone therapy 10/27/2023 and no UTI symptoms at present Opioid induced constipation - Continue bowel regimen   Diabetes mellitus type 2, non-insulin-dependent Dyslipidemia By history controlled with a hemoglobin A1c of 5.7% noted in June 2023. -Continue atorvastatin with plans to resume Trulicty at discharge   Hypothyroidism Continue thyroid supplementation   B12 deficiency Historical diagnosis; chronic management includes IM cyanocobalamin every 21 days   Thrombocytosis - mild and suspect to be reactive - follow-up as outpatient
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Metastases to lymph nodes, Squamous cell carcinoma of the tongue
Clinical narrative: Pt now has SCC of tongue.  Very rare for a 47 yr old to have this,  mets to lymph nodes
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Angina pectoris, Chest pain
Clinical narrative: Sharp pains around the heart and upper left chest area. I started to feel them every other week to weekly.
Age: 16.0
Sex: M
Vaccine: COVID19
Symptoms: Immediate post-injection reaction, Tinnitus
Clinical narrative: Patient developed a whooshing/ringing sound in ears almost immediately after receiving the vaccine, it got better upon sitting, but worse when standing. Patient stayed for about 15 minutes after vaccine and got Meclizine in case it did not get better. Told to call if any questions or if it got worse.  It was better when patient left, but not completely gone.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Balance disorder, Cerebrovascular accident, Cognitive disorder, Dysarthria, Gait disturbance
Clinical narrative: Series of at least 5 minor strokes and one major stroke, over a two month period.  Significant damage to Brocas' area.  Blood thinning medications, wafirin for 6 months, aspirin thereafter.  No issues after two months.  2 & 1/2 years later, has very limited ability to speak,  comprehension is moderately diminished, mild muscle weakness and instability on right side of body.  moderately diminished ability to walk.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Magnetic resonance imaging head abnormal, Muscular weakness, Necrosis
Clinical narrative: Series of at least 5 minor strokes and one major stroke, over a two month period.  Significant damage to Brocas' area.  Blood thinning medications, wafirin for 6 months, aspirin thereafter.  No issues after two months.  2 & 1/2 years later, has very limited ability to speak,  comprehension is moderately diminished, mild muscle weakness and instability on right side of body.  moderately diminished ability to walk.
Age: 14.0
Sex: F
Vaccine: COVID19-2
Symptoms: Headache, Hypnagogic hallucination, Insomnia, Pyrexia, Tachycardia
Clinical narrative: In addition to a very bad headache and a fever which resolved within 2 days, patient had difficulty sleeping for more than 3 weeks due to severe hypnogogic hallucinations that repeatedly awakened her from sleep throughout the night. She has also experienced tachycardia up to 135 bpm while lying in bed.