chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 64.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash
Clinical narrative: This spontaneous report was received from a 64 year old female patient reporting on herself.  The patient's medical history included nausea (also reported as no pertinent medical history). Historical drug included codeine. On 19-AUG-2013, the patient was vaccinated with dose of ZOSTAVAX 0.65 ml/single dose (lot # J001005, expiration date 24-APR-2014). No other co-suspect therapy was reported. There were no concomitant medication. About eight days after receiving ZOSTAVAX, approximately on 27-AUG-2013, the patient developed sensitivity and pain in her scalp and around her eye which she believed to be caused by shingles. She added that she also had some bumps on her eyelid that were painful. The patient also stated that codeine (unspecified manufacturer, strength and frequency) made her nauseated. No treatment was given for the events. No lab diagnostics studies were performed. The outcome of the events was reported as not recovered/not resolved. The outcome of nauseated was unknown. The patient did not seek medical attention. Additional information has been requested.
Age: 79.0
Sex: M
Vaccine: VARZOS
Symptoms: Cough, Dysphagia, Flushing, Hyperhidrosis, Sinus congestion
Clinical narrative: This spontaneous report as received from a pharmacist refers to a 79 year old male patient. On 01-SEP-2013 the patient was vaccinated with ZOATAVAX, injections, 0.65 ml, subcutaneously; lot number # J003796, expiration date 28-JUN-2014. On 01-SEP-2013 the patient had developed a flushed face and sinus congestion within two to three hours of receiving the dose of ZOSTAVAX. He had been coughing and had trouble swallowing, his tonsils were swollen and he was diaphoretic at times. The episodes of diaphoresis and difficulty swallowing lasted for 48 hours after receipt of the dose of ZOSTAVX. A significant amount of sputum which he produced caused him to use an entire box of facial tissue over the course of the 48 hours. The patient sought medical attention  wrote a letter to the pharmacist. No treatment was given for the adverse events. The outcome of flushed face, significance of the amount of sputum, tonsils were swollen; coughing and sinus congestion was unknown. The relatedness between vaccination with ZOSTAVAX and events was not reported. The pharmacist was requesting a lot check for ZOSTAVAX (lot # J003796, exp 28-JUN-2014) since two other patients had also reported adverse effects since receiving ZOSTAVAX of this lot number. Reports from the same source (# 1309USA002794; #139USA002846). Additional information has been requested.
Age: 79.0
Sex: M
Vaccine: VARZOS
Symptoms: Sputum increased, Tonsillar hypertrophy
Clinical narrative: This spontaneous report as received from a pharmacist refers to a 79 year old male patient. On 01-SEP-2013 the patient was vaccinated with ZOATAVAX, injections, 0.65 ml, subcutaneously; lot number # J003796, expiration date 28-JUN-2014. On 01-SEP-2013 the patient had developed a flushed face and sinus congestion within two to three hours of receiving the dose of ZOSTAVAX. He had been coughing and had trouble swallowing, his tonsils were swollen and he was diaphoretic at times. The episodes of diaphoresis and difficulty swallowing lasted for 48 hours after receipt of the dose of ZOSTAVX. A significant amount of sputum which he produced caused him to use an entire box of facial tissue over the course of the 48 hours. The patient sought medical attention  wrote a letter to the pharmacist. No treatment was given for the adverse events. The outcome of flushed face, significance of the amount of sputum, tonsils were swollen; coughing and sinus congestion was unknown. The relatedness between vaccination with ZOSTAVAX and events was not reported. The pharmacist was requesting a lot check for ZOSTAVAX (lot # J003796, exp 28-JUN-2014) since two other patients had also reported adverse effects since receiving ZOSTAVAX of this lot number. Reports from the same source (# 1309USA002794; #139USA002846). Additional information has been requested.
Age: 34.0
Sex: F
Vaccine: FLUX, PPV
Symptoms: Headache, Injection site erythema, Injection site pain, Pain, Pyrexia
Clinical narrative: Vomiting, rash, fever, headache, body aches, redness at site along w/ pain.
Age: 34.0
Sex: F
Vaccine: FLUX, PPV
Symptoms: Rash, Vomiting
Clinical narrative: Vomiting, rash, fever, headache, body aches, redness at site along w/ pain.
Age: 64.0
Sex: F
Vaccine: FLU3
Symptoms: Dizziness, Palmar erythema
Clinical narrative: Dizzy, palms of hand turned red.
Sex: U
Vaccine: FLU3
Symptoms: Asthenia, Chills, Dizziness, Headache, Malaise
Clinical narrative: Got chills. Shaking. Fever. Felt weak. Sick all night. Got fever, need ice pack to cook down. Headaches. Almost called paramedics. I still have a headache and feel lightheaded today.
Sex: U
Vaccine: FLU3
Symptoms: Pyrexia, Tremor
Clinical narrative: Got chills. Shaking. Fever. Felt weak. Sick all night. Got fever, need ice pack to cook down. Headaches. Almost called paramedics. I still have a headache and feel lightheaded today.
Age: 57.0
Sex: F
Vaccine: TDAP
Symptoms: Abdominal pain, Pruritus generalised
Clinical narrative: Severe itching of the ears, head, neck, upper extremities, and abdominal pain.
Age: 57.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Joint stiffness
Clinical narrative: Stiffness of joints in hand. Mainly in right hand in middle and pointer finger. Hard to close hand.
Age: 58.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Influenza like illness, Injection site erythema, Injection site mass, Injection site swelling, Malaise
Clinical narrative: Pt got vaccines on 9-9. On 9-11 she called pharmacy stating started feeling sick (flu like) the evening of sots and progressively developed a fever that peaked at 103. Also patient had red lumpy swelling at pneumonia site.
Age: 58.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Pyrexia
Clinical narrative: Pt got vaccines on 9-9. On 9-11 she called pharmacy stating started feeling sick (flu like) the evening of sots and progressively developed a fever that peaked at 103. Also patient had red lumpy swelling at pneumonia site.
Age: 70.0
Sex: F
Vaccine: FLU3
Symptoms: Feeling hot, Tremor
Clinical narrative: Six hours after her shot patients started shaking and felt hot. Went to hospital ER. They gave her Tylenol. She waited 2 hours then went home.
Age: 79.0
Sex: F
Vaccine: VARZOS
Symptoms: Abdominal discomfort, Blister, Erythema, Herpes zoster, Post herpetic neuralgia
Clinical narrative: This spontaneous report was received from a 79 year old female consumer with no pertinent medical history and concomitant medications referring to herself. In June 2013, the patient was vaccinated with ZOSTAVAX, injection (route, dose, lot number and expiration date not provided). In approximately June 2013, reported as within 4 days of receiving ZOSTAVAX, the patient began itching and broke out in a rash all over her body; this rash was not diagnosed as shingles. The patient mentioned that separate from the rash she also developed a shingles outbreak on her left shoulder blade. She explained that although she was unable to see the shingles outbreak on her shoulder she was told that the area looked different from the rash that had spread around the rest of her body. The shingles area was comprised of red blisters and the rash areas were less defined. She talked to physician and had been treated with unspecified topical anti-itch medications to help her skin and a medication to help her sleep; sleep which had been affected due to the ever-present sensation to itch. The patient stated that the rash had improved some but overall the reaction had not responded to treatments. The patient also mentioned that she had also developed post herpetic neuralgia (PHN) with the shingles outbreak that was still present. The consumer also reported that DEMEROL made her sick to her stomach after operations (dates unspecified). There were no lab diagnostics studies performed. The outcome of shingles outbreak on her left shoulder blade, sleep had been affected due to sensation to itch, rash all over her body and itching was reported as recovering/resolving. The outcome of sick to her stomach and operations was unknown. Relatedness between vaccination with ZOSTAVAX and events was not reported. Upon internal review, operations were considered medically significant. Additional information is not expected.
Age: 79.0
Sex: F
Vaccine: VARZOS
Symptoms: Pruritus generalised, Rash generalised, Sleep disorder, Surgery
Clinical narrative: This spontaneous report was received from a 79 year old female consumer with no pertinent medical history and concomitant medications referring to herself. In June 2013, the patient was vaccinated with ZOSTAVAX, injection (route, dose, lot number and expiration date not provided). In approximately June 2013, reported as within 4 days of receiving ZOSTAVAX, the patient began itching and broke out in a rash all over her body; this rash was not diagnosed as shingles. The patient mentioned that separate from the rash she also developed a shingles outbreak on her left shoulder blade. She explained that although she was unable to see the shingles outbreak on her shoulder she was told that the area looked different from the rash that had spread around the rest of her body. The shingles area was comprised of red blisters and the rash areas were less defined. She talked to physician and had been treated with unspecified topical anti-itch medications to help her skin and a medication to help her sleep; sleep which had been affected due to the ever-present sensation to itch. The patient stated that the rash had improved some but overall the reaction had not responded to treatments. The patient also mentioned that she had also developed post herpetic neuralgia (PHN) with the shingles outbreak that was still present. The consumer also reported that DEMEROL made her sick to her stomach after operations (dates unspecified). There were no lab diagnostics studies performed. The outcome of shingles outbreak on her left shoulder blade, sleep had been affected due to sensation to itch, rash all over her body and itching was reported as recovering/resolving. The outcome of sick to her stomach and operations was unknown. Relatedness between vaccination with ZOSTAVAX and events was not reported. Upon internal review, operations were considered medically significant. Additional information is not expected.
Age: 70.0
Sex: F
Vaccine: FLU3
Symptoms: Diarrhoea, Dizziness, Nausea, Sluggishness, Vomiting
Clinical narrative: Within 2-3 hours post vaccination severe nausea, vomiting, diarrhea, dizzy, lightheaded very extreme today rather sluggish.
Age: 5.0
Sex: M
Vaccine: PNC13
Symptoms: Erythema, Injection site urticaria, Local swelling, Urticaria
Clinical narrative: Child seen 8/29/13 by CNP for lingering hives on R upper arm. Reaction began 8/24/13 by mom's report as redness and swelling from shoulder to elbow. Now no swelling but scattered welts. No signs of infection.
Age: 17.0
Sex: F
Vaccine: HPV4
Symptoms: Diarrhoea, Dizziness, Nausea, Retching
Clinical narrative: Pt went school feeling under the weather (nauseated). At school around lunch time patient reports she got really hot and felt faint. She began dry-heaving. Father came to pick her up and she was having diarrhea. Took PHENERGAN and laid down. Slept most of that day. Felt better next day.
Age: 19.0
Sex: M
Vaccine: MMR
Symptoms: Pruritus, Rash generalised
Clinical narrative: Information has been received from a pharmacist via agency regarding a 19 year old male international student started the M-M-R II of an unknown dose, "given on the left" for his first shot on 26-JUL-2013 "to meet the requirements of the school". The patient's relevant medical history includes no drug allergies. The patient's relevant concomitant medications and relevant past drug history are unknown. 2 to 3 days after receiving the M-M-R II vaccination (appropriately 28-JUL-2013, the patient developed itching and a rash on an unknown locations on hs body "here and there", further explained as the rash fades away and then comes back to different places all over the body. On 11-SEP-2013, this patient came to this pharmacy to get his second shot and the pharmacist reported that this patient was an international student who showed her a "pretty unusual rash" on his left palm described as bigger than a quarter, about 2 quarters in size and not raised but darker than the skin color. She explained that the first vaccination was given at a different pharmacy. It was unknown if there was any relevant laboratory data. As of 11-SEP-2013, it was unknown if the consumer would continue to receive the M-M-R II vaccination, he currently had a rash on his left palm and it was unknown if he continued to have the itching and a rash that fades away and then comes back to different places all over the body. Additional information is not expected.
Age: 66.0
Sex: F
Vaccine: FLU3
Symptoms: Dehydration, Diarrhoea, Dizziness, Pain in extremity, Syncope
Clinical narrative: Approximately 7 hours after High Dose Flu shot pt felt dizzy and fainted. She had a strong pain in her arm and had diarrhea episode. Pain in arm went away and pt felt dehydrated.
Age: 44.0
Sex: M
Vaccine: FLU3
Symptoms: Cough, Fatigue, Malaise, Oedema peripheral, Pyrexia
Clinical narrative: 44 y/o male with onset of cough and runny nose within 24 hours of receiving injectable seasonal flu vaccine.  Patient febrile within 48 hours of vaccination.  3 days post vaccine, patient c/o malaise and fatigue.  On day 4, he reports developing erythematous, macular non-pruritic exanthem, on trunk, extremities and hands/feet to include palms/soles.  Hands and feet show mild edema without pitting.  Patient's overall condition has improved since day 3, but has not completely recovered.
Age: 44.0
Sex: M
Vaccine: FLU3
Symptoms: Rash erythematous, Rash maculo-papular, Rhinorrhoea
Clinical narrative: 44 y/o male with onset of cough and runny nose within 24 hours of receiving injectable seasonal flu vaccine.  Patient febrile within 48 hours of vaccination.  3 days post vaccine, patient c/o malaise and fatigue.  On day 4, he reports developing erythematous, macular non-pruritic exanthem, on trunk, extremities and hands/feet to include palms/soles.  Hands and feet show mild edema without pitting.  Patient's overall condition has improved since day 3, but has not completely recovered.
Age: 77.0
Sex: M
Vaccine: FLU3, PPV
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pyrexia
Clinical narrative: Red swollen area around injection site and below injection site.  Area hot to the touch and mild fever.  Pain due to swelling that lasted three to four days.
Age: 23.0
Sex: F
Vaccine: FLU3
Symptoms: Activated partial thromboplastin time normal, Blood creatine phosphokinase normal, Blood magnesium normal, Electrocardiogram abnormal, Full blood count normal
Clinical narrative: Palpitations, racing heart rate, supraventricular tachycardia. Treated with adenosine IV, Benadryl, Pepcid, dexamethasone.
Age: 23.0
Sex: F
Vaccine: FLU3
Symptoms: International normalised ratio normal, Metabolic function test normal, Palpitations, Supraventricular tachycardia, Troponin
Clinical narrative: Palpitations, racing heart rate, supraventricular tachycardia. Treated with adenosine IV, Benadryl, Pepcid, dexamethasone.
Age: 23.0
Sex: F
Vaccine: FLU3
Symptoms: Troponin normal
Clinical narrative: Palpitations, racing heart rate, supraventricular tachycardia. Treated with adenosine IV, Benadryl, Pepcid, dexamethasone.
Age: 1.01
Sex: F
Vaccine: FLU3, HEPA, MMR, VARCEL
Symptoms: Laboratory test abnormal, Malaise, Polymerase chain reaction, Pyrexia, Rash generalised
Clinical narrative: Received Varicella vaccine 8/29/13, then on 9/4/13 developed fever/illness symptoms, then on 9/9/13 developed chicken pox. Had generalized rash which started in the thigh where administration occured and spread to adbomen, upper extremities, and face. PCR test from a vesicular swab specimen taken on 9/9/13 was positive.
Age: 1.01
Sex: F
Vaccine: FLU3, HEPA, MMR, VARCEL
Symptoms: Rash vesicular, Varicella post vaccine
Clinical narrative: Received Varicella vaccine 8/29/13, then on 9/4/13 developed fever/illness symptoms, then on 9/9/13 developed chicken pox. Had generalized rash which started in the thigh where administration occured and spread to adbomen, upper extremities, and face. PCR test from a vesicular swab specimen taken on 9/9/13 was positive.
Age: 52.0
Sex: F
Vaccine: FLU3
Symptoms: Cough, Headache, Pyrexia, Respiratory tract congestion
Clinical narrative: HEADACHE, FEVER (101.8 X 7DAYS), COUGH (2 MONTHS), CHEST CONGESTION (2 MONTHS).
Age: 1.27
Sex: M
Vaccine: DTAP, HIBV
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
Clinical narrative: Left deltoid: red, swollen and warm to touch.  Redness area is larger than a golf ball.  Painful.
Age: 54.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
Clinical narrative: Redness, heat, swelling, and pain, gradually spreading to about 6" diameter from injection site across elbow and arm lasting about 5 days.
Age: 73.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Blood electrolytes decreased, Chills, Cold sweat, Cystitis, Dizziness
Clinical narrative: Patient started experiencing chills at 10 pm.  Proceeded to go to work the next morning and complained of dizziness, cold sweats, and nausea.  Patient stated feeling better after vomiting 'green bile.'  Patient was taken to the emergency room and was given IV fluids.
Age: 73.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Nausea, Urine electrolytes decreased, Vomiting
Clinical narrative: Patient started experiencing chills at 10 pm.  Proceeded to go to work the next morning and complained of dizziness, cold sweats, and nausea.  Patient stated feeling better after vomiting 'green bile.'  Patient was taken to the emergency room and was given IV fluids.
Age: 74.0
Sex: F
Vaccine: PPV
Symptoms: Injection site erythema, Injection site warmth
Clinical narrative: Redness & warmth to injection site.
Age: 66.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Headache, Injection site reaction, Injection site swelling, Injection site warmth, Myalgia
Clinical narrative: Myalgia at site of injection, headaches, swelling and warmth in bicep/tricep in injecction arm. Symptoms occurred later in the evening w/ swelling worsening overnight.
Age: 65.0
Sex: M
Vaccine: FLUX
Symptoms: Arthralgia, Back pain, Dizziness, Fatigue, Feeling abnormal
Clinical narrative: Starting feeling lightheaded, a little nausea, pain and stiffness in shoulder and neck just below skull, and tired.  Doctor recommended taking some Benadryl, and I slept for about 13 hours.  Next day had aches in both legs and hips, continuation of foggy headed feeling and fatigue, as well as feeling of a lot of pressure in neck just below skull.  It is now 1:55 pm on 9/18/13, and I have pain in my back about the level of my shoulder blades, feeling of fatigue, and feeling like I am getting the flu.
Age: 65.0
Sex: M
Vaccine: FLUX
Symptoms: Musculoskeletal pain, Musculoskeletal stiffness, Nausea, Pain in extremity, Sensation of pressure
Clinical narrative: Starting feeling lightheaded, a little nausea, pain and stiffness in shoulder and neck just below skull, and tired.  Doctor recommended taking some Benadryl, and I slept for about 13 hours.  Next day had aches in both legs and hips, continuation of foggy headed feeling and fatigue, as well as feeling of a lot of pressure in neck just below skull.  It is now 1:55 pm on 9/18/13, and I have pain in my back about the level of my shoulder blades, feeling of fatigue, and feeling like I am getting the flu.
Age: 65.0
Sex: M
Vaccine: FLUX
Symptoms: Somnolence
Clinical narrative: Starting feeling lightheaded, a little nausea, pain and stiffness in shoulder and neck just below skull, and tired.  Doctor recommended taking some Benadryl, and I slept for about 13 hours.  Next day had aches in both legs and hips, continuation of foggy headed feeling and fatigue, as well as feeling of a lot of pressure in neck just below skull.  It is now 1:55 pm on 9/18/13, and I have pain in my back about the level of my shoulder blades, feeling of fatigue, and feeling like I am getting the flu.
Age: 64.0
Sex: F
Vaccine: VARZOS
Symptoms: Induration, Local reaction, Pain, Pruritus, Secretion discharge
Clinical narrative: Itch and pain; subsequently developed LARGE local reaction (we have photo) with induration and drainage.
Age: 64.0
Sex: F
Vaccine: VARZOS
Symptoms: Swelling
Clinical narrative: Itch and pain; subsequently developed LARGE local reaction (we have photo) with induration and drainage.
Age: 65.0
Sex: F
Vaccine: PPV
Symptoms: Injection site swelling, Pain, Pruritus, Skin swelling
Clinical narrative: Swelling and itching of the skin next to the injection site initially with pain in this area in the following hours and swelling extending from the left deltoid distally to the left elbow.
Age: 3.0
Sex: F
Vaccine: FLUX
Symptoms: Body temperature decreased, Decreased appetite, Lethargy, Somnolence
Clinical narrative: Lethargic for the remainder of the day.  Went to sleep 15 min after the injection and slept for the day.  Got a call from the school at 11:30 am saying that she had been sleep at school since I dropped her off.  They took the kids outside and she went to sleep on the ground.  At breakfast she did not eat, she went to sleep at the table.  When they returned from outside she went to sleep on the carpet.  I notified the doctor about 12:30.  Her body temp was low (96.4), she remained sleep I was instructed to give her lots of fluid and make sure that she will wake up easy.
Age: 74.0
Sex: F
Vaccine: FLU3
Symptoms: Chills, Fatigue, Tremor
Clinical narrative: CHILLS AND SHAKES FOR 1HR, AND FATIGUE FOR 24HRS.
Age: 70.0
Sex: F
Vaccine: FLU3
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Somnolence
Clinical narrative: PATIENT GOT A PINKISH ITCHY RASH AROUND VACCINATED ARM APPROX 4 INCHES AROUND JUST ABOVE ELBOW ABOUT 8 INCHES BELOW VACCINATION SITE--PATIENT CLAIMS EGG ALLERGY AS CHILD BUT NOW SHE EATS EGGS SO MD OK'ED FLU SHOT.
Age: 67.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Cough, Eye swelling, Lip swelling
Clinical narrative: Coughing 10:00PM, 09/18/2013 6:00 AM swollen eyes and lips. No treatment, symptoms subsided by 5:30 PM 09/18/2013.
Age: 66.0
Sex: F
Vaccine: FLU3, PPV
Symptoms: Myalgia, Skin warm, Urticaria
Clinical narrative: Achy muscles; hives; hot skin.
Age: 70.0
Sex: F
Vaccine: FLU3
Symptoms: Erythema, Local swelling, Pruritus, Skin warm
Clinical narrative: Patient says her arm is swollen, red, itchy and warm.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Adenovirus infection, Alpha 1 foetoprotein normal, Amino acid level, Ammonia decreased, Anaemia
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Anti-NMDA antibody negative, Antibody test, Antibody test negative, Antinuclear antibody negative, Aspergillus test
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Asthenia, B-lymphocyte count, B-lymphocyte count decreased, Bacterial infection, Biopsy skin abnormal
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Blood creatine phosphokinase decreased, Blood culture negative, Blood fibrinogen increased, Blood fibrinogen normal, Blood homocysteine normal
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Blood immunoglobulin A normal, Blood immunoglobulin E, Blood immunoglobulin G normal, Blood immunoglobulin M increased, Blood lactate dehydrogenase increased
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Blood lactic acid decreased, Blood lactic acid normal, Blood pyruvic acid, Blood pyruvic acid increased, Blood triglycerides increased
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Blood urea, Bordetella test negative, Bronchial secretion retention, CD4 lymphocytes decreased, CD4/CD8 ratio
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: CD8 lymphocytes decreased, CSF culture negative, CSF oligoclonal band absent, CSF test abnormal, CSF test normal
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Carnitine decreased, Cell marker, Cerebral atrophy, Ceruloplasmin, Chlamydia test negative
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Clostridium test, Clostridium test negative, Complement factor, Corynebacterium test, Culture negative
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Culture urine negative, Culture wound negative, Culture wound positive, Cytomegalovirus test, Cytomegalovirus test negative
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Diarrhoea, Encephalopathy, Endotracheal intubation, Enterovirus test negative, Enzyme level test
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.
Age: 1.08
Sex: F
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL, MMR, VARCEL
Symptoms: Epstein-Barr virus test negative, Free fatty acids, Fungal test, Fungal test negative, General physical health deterioration
Clinical narrative: Patient presented to urgent care on 8/1/13 with 2 day history of diarrhea, possible fever, decreased energy, and jaundice.  She also developed a disseminated flesh colored papular rash which would rapidly scab over. She was found to be profoundly anemic to 5.4 and was admitted to hospital. She required nearly daily transfusions due to new onset warm Ab hemolytic anemia which only improved slightly with a burst of high dose steroids as well as two treatments with IVIG.  She also developed three other rashes during this hospital course.  She had a massive diagnostic workup at Hospital, and had a skin biopsy of a lesion that appeared to be consistent with a herpes virus infection but was negative for HSV1 or HSV2.  She was treated with IV acyclovir at meningitic dosing for 14 days. She also developed worsening encephalopathy with decreased ability to clear her own secretions.  It was determined that she was deteriorating clinically and required further diagnostic workup at a tertiary care center.  She was transferred to another hospital on 9/4/13. She was admitted to the PICU due to worsening neurologic status and has required prolonged intubation due to concern for neuromuscular weakness. LP on admission and subsequent skin lesion sample was positive for VZV DNA by PCR, and MRI brain and neck has shown diffuse cerebral atrophy and hyperintensity of basal ganglia, medulla, and cervical spine.  She was treated with a burst of high dose steroids and 3 back-to-back doses of IVIG with improvement in her transfusion requirements. She was also treated with acyclovir and subsequently foscarnet with improvement in symptoms.  Of note, she has had multiple infections during her hospital courses including rhinovirus, adenovirus, Pseudomonas, Ambiotrophia, and Klebsiella.