chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 44.0
Sex: F
Vaccine: FLU4
Symptoms: Injection site muscle weakness, Injection site pain, Myalgia, Neck pain, Pain
Clinical narrative: Starting in the evening on the day she got her flu vaccination, she reported onset of injection site pain to left arm, with intermittent sharp pain radiating up left side of neck. As of 11/14/23, patient reports ongoing constant sharp left upper arm pain from elbow to superior trapezius area, associated with left upper arm weakness.  No longer shocking pain radiating up arm from elbow. Has tingling to left hand upon waking up if laying on that side. She can lift her arm above her head but she has to do this slowly due to the pain.  She has not tried picking up or grabbing anything with her left arm for fear of triggering increased pain. Patient has been taking tylenol and ibuprofen, applying heating pad and doing massage with no improvement. I prescribed her cyclobenzaprine 10 mg for the myalgias, and as of this morning (11/15/23), after 1 dose of this medication, not much improvement reported. I referred patient to physical therapy and physiatry, these referrals are pending. No recent head, neck or shoulder injuries.
Age: 44.0
Sex: F
Vaccine: FLU4
Symptoms: Paraesthesia
Clinical narrative: Starting in the evening on the day she got her flu vaccination, she reported onset of injection site pain to left arm, with intermittent sharp pain radiating up left side of neck. As of 11/14/23, patient reports ongoing constant sharp left upper arm pain from elbow to superior trapezius area, associated with left upper arm weakness.  No longer shocking pain radiating up arm from elbow. Has tingling to left hand upon waking up if laying on that side. She can lift her arm above her head but she has to do this slowly due to the pain.  She has not tried picking up or grabbing anything with her left arm for fear of triggering increased pain. Patient has been taking tylenol and ibuprofen, applying heating pad and doing massage with no improvement. I prescribed her cyclobenzaprine 10 mg for the myalgias, and as of this morning (11/15/23), after 1 dose of this medication, not much improvement reported. I referred patient to physical therapy and physiatry, these referrals are pending. No recent head, neck or shoulder injuries.
Age: 2.0
Sex: F
Vaccine: FLUA4
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: parents had declined the flu shot and it was administered into the patients Left Deltoid  Mom was  called and informed
Age: 0.83
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Infant irritability, Infantile diarrhoea, Pyrexia, Vomiting
Clinical narrative: pt received double the dose 0.5ml  parent took child to hospital due to having high fever 41 C, vomiting , diarrhea and real fussy.  at this time they are doing Tylenol and keeping a eye on her,
Age: 27.0
Sex: F
Vaccine: HEP
Symptoms: Cough, Pruritus, Throat irritation
Clinical narrative: Employee reported to have a cough, scratchy throat, itchy chest. Was given 4L 02 via nasal canula. EMS was contacted and transported to ER
Age: 0.17
Sex: M
Vaccine: HPV9
Symptoms: Product administered to patient of inappropriate age, Wrong product administered
Clinical narrative: The HPV vaccine was given inadvertently to a 2mo M instead of HiB
Age: 11.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Client is 11 years old and received Comirnaty  covid-19 vaccine which is licensed for 12 years and older.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Blood glucose decreased, Dizziness, Seizure
Clinical narrative: AFTER GIVING PATIENT VACCINE, SHE FELT LIGHTHEADED, AND STATED HER SUGAR WAS LOW. GAVE PATIENT A BOTTLE OF COKE, AND GLUCOSE TABLETS, PATIENT WANTED TO LAY DOWN AFTER ABOUT 10 MINUTES, THEN STARTING HAVING A SEIZURE. EMS ARRIVED AND SHE WAS AWAKE AND COHERENT AS THEY TOOK HER OUT
Age: 75.0
Sex: F
Vaccine: VARZOS
Symptoms: Abdominal discomfort, Abdominal pain upper, Asthenia, Chills, Decreased appetite
Clinical narrative: The day after the vaccine on 11-12-2023, I experienced the following: headache, shivering, upset stomach. nauseous, feeling tired and weak. On Monday 11-13, I had stomach pain and diarrhea, very dry throat, trouble swallowing and lack of appetite.   Today 11-15 I am still feeling tired and weak and have intermittent diarrhea.
Age: 75.0
Sex: F
Vaccine: VARZOS
Symptoms: Diarrhoea, Dry throat, Dysphagia, Fatigue, Headache
Clinical narrative: The day after the vaccine on 11-12-2023, I experienced the following: headache, shivering, upset stomach. nauseous, feeling tired and weak. On Monday 11-13, I had stomach pain and diarrhea, very dry throat, trouble swallowing and lack of appetite.   Today 11-15 I am still feeling tired and weak and have intermittent diarrhea.
Age: 75.0
Sex: F
Vaccine: VARZOS
Symptoms: Nausea
Clinical narrative: The day after the vaccine on 11-12-2023, I experienced the following: headache, shivering, upset stomach. nauseous, feeling tired and weak. On Monday 11-13, I had stomach pain and diarrhea, very dry throat, trouble swallowing and lack of appetite.   Today 11-15 I am still feeling tired and weak and have intermittent diarrhea.
Age: 56.0
Sex: M
Vaccine: FLUC4
Symptoms: Influenza, Lethargy, Oropharyngeal pain, Pain, Pyrexia
Clinical narrative: Pt describes having flu, aches (about 3 days), fever of 101.0 ( about 4 days) and sore throat continuing starting on 10/22 - patient is still feeling lethargic.
Age: 56.0
Sex: M
Vaccine: FLUC4
Symptoms: SARS-CoV-2 test negative, Streptococcus test negative
Clinical narrative: Pt describes having flu, aches (about 3 days), fever of 101.0 ( about 4 days) and sore throat continuing starting on 10/22 - patient is still feeling lethargic.
Age: 73.0
Sex: F
Vaccine: FLU4
Symptoms: Arthralgia, Injection site erythema, Injection site swelling, Injection site warmth, Pain
Clinical narrative: Significant swelling, redness at the injection site. Area was very hot to touch. Significant pain radiating from the shoulder to my wrist lasting three days. Pain level in the arm/wrist on the night of Nov 7th was 8/10.
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Breakthrough COVID-19
Clinical narrative: Covid 19 Breakthrough Infection
Age: 10.0
Sex: M
Vaccine: FLUC4
Symptoms: Agitation, Diet refusal, Dystonia, Neurological decompensation, Stereotypy
Clinical narrative: severe neurological decline, agitation, stopped eating/drinking, body twisting, repetitive movements,
Age: 13.0
Sex: F
Vaccine: MMR
Symptoms: Rash, Tenderness
Clinical narrative: rash on Hands, elbows and knees, that is Painful, Tender. Severity: Pain level (5)/10
Age: 32.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Blood pressure increased, Heart rate increased, Sensation of foreign body
Clinical narrative: Pt received both vaccines above and was told to wait 15 mins after the vaccination.  At around 12 mins after vaccination patient started to report a "lump" in her throat.  Pt was observed for several more mins and there was no improvement in symptoms.  Her HR and BP were elevated.  Pt stated that she got the same symptom with her previous reactions to Iodine and Tree Nuts.  Pt was given one dose of Epi Pen at 9:45am.  Pt reported that her symptoms were improving.  EMS arrived and transported patient to hospital.
Age: 91.0
Sex: M
Vaccine: COVID19
Symptoms: Chills, Gait disturbance, Hypersomnia
Clinical narrative: Chills for about an hour followed by uncontrolled shivering severe enough couldn't walk without hanging on to something.  Went to bed with extra clothing and slept 12 hours.  Never had this type of reaction to any previous vaccine.  Normal health next morning.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Asthenia, Balance disorder, Blood pressure increased, Headache
Clinical narrative: leg cramps started evening of around 10/22/23 and still occur periodically, insomnia started around 10/29/23 and improved around 11/12/23, anxiety started around 11/5/23 and resolved around 11/11/23, elevated blood pressure 11/8/23-11/9/23 seems resolved, extreme drowsiness 11/5/23-11/10/23, unsteadiness and weakness 10/22/23 improved by 11/12/23, intermittent headache 11/7/23 resolved 11/6/23.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Insomnia, Muscle spasms, Somnolence
Clinical narrative: leg cramps started evening of around 10/22/23 and still occur periodically, insomnia started around 10/29/23 and improved around 11/12/23, anxiety started around 11/5/23 and resolved around 11/11/23, elevated blood pressure 11/8/23-11/9/23 seems resolved, extreme drowsiness 11/5/23-11/10/23, unsteadiness and weakness 10/22/23 improved by 11/12/23, intermittent headache 11/7/23 resolved 11/6/23.
Age: 73.0
Sex: M
Vaccine: RSV
Symptoms: Chills, Pain in extremity, Pyrexia
Clinical narrative: Fever (100.8 F), severe chills,?Arm pain
Age: 82.0
Sex: M
Vaccine: RSV
Symptoms: Asthenia, Blood culture, Computerised tomogram head, Computerised tomogram thorax, Electrocardiogram
Clinical narrative: Profound weakness, fever, encephalopathy
Age: 82.0
Sex: M
Vaccine: RSV
Symptoms: Encephalopathy, Full blood count, Metabolic function test, Pyrexia
Clinical narrative: Profound weakness, fever, encephalopathy
Age: 86.0
Sex: F
Vaccine: RSV
Symptoms: Arthralgia, Asthenia, Fatigue, Feeling abnormal, Gait disturbance
Clinical narrative: She got her vaccine, she didn't have a reaction right off the bat.  The next day it started in the afternoon about 2:00 PM she started getting a runny nose.  She kept blowing her nose and thought she was coming down with a cold.  Then she figured it must be a reaction from the vaccine.  That's when she was sitting down watching TV, got up and had pains in her legs, ankles and calves very legs to the point that she could not walk.  She sat right back down again and started rubbing her legs, and decided to walk around.  She kept walking around and walking around her house and sat down afterwards and kept rubbing it, and after a few hours it got a little bit better.  The next day she did not feel good, felt weak, did not feel right.  Then she read the pamphlet that she got and it scared her.    She called her doctor and she informed her to call us and report it.  Her doctor did not give her anything or tell her anything she needed to do.    She had all the COVID shots and did well with those other than a runny nose and a sore throat.    She has been feeling weak, having bad headaches which she does not have.  She is very tired and not feeling like doing her grocery shopping like she normally does.  She is a very active person and makes a list every day to do things, and is not feeling her self yet to do those things.
Age: 86.0
Sex: F
Vaccine: RSV
Symptoms: Headache, Nasopharyngitis, Pain in extremity, Rhinorrhoea
Clinical narrative: She got her vaccine, she didn't have a reaction right off the bat.  The next day it started in the afternoon about 2:00 PM she started getting a runny nose.  She kept blowing her nose and thought she was coming down with a cold.  Then she figured it must be a reaction from the vaccine.  That's when she was sitting down watching TV, got up and had pains in her legs, ankles and calves very legs to the point that she could not walk.  She sat right back down again and started rubbing her legs, and decided to walk around.  She kept walking around and walking around her house and sat down afterwards and kept rubbing it, and after a few hours it got a little bit better.  The next day she did not feel good, felt weak, did not feel right.  Then she read the pamphlet that she got and it scared her.    She called her doctor and she informed her to call us and report it.  Her doctor did not give her anything or tell her anything she needed to do.    She had all the COVID shots and did well with those other than a runny nose and a sore throat.    She has been feeling weak, having bad headaches which she does not have.  She is very tired and not feeling like doing her grocery shopping like she normally does.  She is a very active person and makes a list every day to do things, and is not feeling her self yet to do those things.
Age: 1.25
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product preparation error
Clinical narrative: patient given undiluted vaccine
Age: 0.75
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product preparation error
Clinical narrative: patient given undiluted vaccine
Age: 3.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product preparation error
Clinical narrative: patient given undiluted vaccine
Age: 2.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain upper, Gastrointestinal disorder
Clinical narrative: Gastrointestinal issues. Stomach pain and pooping or trying to poop multiple times during the day.
Age: 0.67
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product preparation error
Clinical narrative: patient given undiluted vaccine
Age: 1.17
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product preparation error
Clinical narrative: patient given undiluted vaccine
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Underdose, Wrong product administered
Clinical narrative: Pt. was mistakenly given a PEDS dose of Moderna (0.25mL) instead of a 0.5mL adult dose.
Age: 83.0
Sex: F
Vaccine: COVID19
Symptoms: Pollakiuria
Clinical narrative: frequent urination
Age: 27.0
Sex: F
Vaccine: TDAP
Symptoms: Exposure during pregnancy, No adverse event, Wrong product administered
Clinical narrative: 27 year old G4P3003. Estimated gestational age is 13w6d and estimated date of delivery 5/8/24. Physician requested to flu vaccine and TDAP was provided to the patient instead. Patient did not have an adverse event to this vaccine.  Physician notified patient of error.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Pollakiuria
Clinical narrative: frequent urination
Age: 0.17
Sex: M
Vaccine: DTAPIPVHIB, HEP, MNQ, RV5
Symptoms: Wrong product administered
Clinical narrative: Wrong vaccine (Meningococcal cong) was given.
Age: 11.0
Sex: F
Vaccine: HEP
Symptoms: Wrong product administered
Clinical narrative: Given vaccine by accident. Patient sister here for vaccines at well given in error. No reported problems noted from parent yet.
Age: 18.0
Sex: F
Vaccine: MENB
Symptoms: Injection site erythema, Injection site pruritus, Swelling face
Clinical narrative: Itching and redness at site of injection c/o feeling like face was a little swollen. Denied SOB or Throat swelling/closing
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Ultrasound neck, Ultrasound scan abnormal, Urinary tract obstruction
Clinical narrative: Patient is a 71 y.o. male patient of with history of diabetes, hypertension, hyperlipidemia, asthma, neuropathy presented to Hospital with encephalopathy on 9/4/2023.  Hospitalization has been prolonged and complicated by COVID-19 pneumonia and subsequently aspiration pneumonia with MRSA.  Patient status post PEG tube this hospitalization.   The following describes as Hospital course in further detail by problem:     Hospital-acquired aspiration pneumonia Elevated risk for aspiration Failed swallow eval Initially finished cefepime per ID ID following - now back on vanco after sputum culture from 9/30 growing mrsa That is post 10-day course of vancomycin for MRSA pneumonia.  Antibiotics completed at time of discharge Status post NGT feeds, now s/p PEG tube 10/2 Started on tube feeds, now at goal, tolerating well Continue aspiration precaution   Acute hypoxic respiratory failure Infectious disease following throughout admission and treated for both COVID-19 pneumonia with steroids and remdesivir and subsequently aspiration pneumonia as above. Oxygen patient stable at time of discharge on nasal cannula Discharge to skilled nursing facility PEG tube placed as above.  Remains n.p.o. at time of discharge.  Continue speech and language pathology services on discharge   Metabolic encephalopathy Delirium with agitation Continue Seroquel at night, increased dose to 50 mg 9/29 Neurology was consulted-EEG negative.  Rec to continue Wellbutrin, Zoloft, Seroquel, PT OT   Hypertension Better controlled Currently on Coreg, losartan, amlodipine   Recurrent major depression Seen by psychiatry  Currently on Wellbutrin, sertraline, Seroquel Acute kidney injury-improved  Hyperkalemia, improved obstructive uropathy, POA Nonobstructing right renal calculi Mild bilateral hydronephrosis Prostatomegaly Hematuria Initially, mostly due to obstructive uropathy CT C/A/P on admission showed moderate to severe bilateral hydronephrosis Urology  recommended continuing Foley on discharge Continue Flomax.  Had to be switched to doxazosin due to NG tube use. Nephrology signed off S/p ivf Discharge with foley and follow-up with urology   Acute hypoxic respiratory failure due to COVID 19 Covid-19 Virus Infection Date of onset of symptoms: Unknown yes Symptoms present on admission: yes Date of covid positive test: 9/4/2023 Vaccination status: pt says he Is vaccinated but isn't sure how many he got s/p dexamethasone for 10 days No remdesivir due to AKI. Status post IV Lasix.    New onset A-fib Rate controlled.  EKG reviewed from 2 days ago. Eliquis on hold for possible surgery next week.  Was changed to heparin dip Continue apixaban and Coreg on discharge   Hyperlipidemia Continue statin   Type 2 diabetes  currently controlled Continue aspirin statin Last A1c 7 in 8/28/2023 Continue to hold metformin. SSI   Hypothyroidism, primary Continue levothyroxine 25 TSH within normal limits 2.3 in 9//2023 Right middle lobe lung nodule 12 mm identical finding CT in 3 to 6 months as outpatient   Neck lipomas Ultrasound soft tissue of the neck showed lipomas
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Headache, Movement disorder, Myalgia, Pain
Clinical narrative: PATIENT STATED THAT AFTER RECEIVING HER COVID SHOT ON 11/7/2023,  THAT THE EVENING SHE BEING TO EXPERIENCE  SOME  MUSCLE ACHES , PAINS HEADACHE AND WEAKNESS.  SHE LATER WENT TO BED AND WOKE WITH WHAT SHE DESCRIBES AS FULL PARALYSIS AND UNABLE TO MOVE.  PATIENT NOTED THAT THE PARAYLSIS LASTED FOR ABOUT  24 HOURS  AND EVENTUALLY SUBSIDED.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Paralysis
Clinical narrative: PATIENT STATED THAT AFTER RECEIVING HER COVID SHOT ON 11/7/2023,  THAT THE EVENING SHE BEING TO EXPERIENCE  SOME  MUSCLE ACHES , PAINS HEADACHE AND WEAKNESS.  SHE LATER WENT TO BED AND WOKE WITH WHAT SHE DESCRIBES AS FULL PARALYSIS AND UNABLE TO MOVE.  PATIENT NOTED THAT THE PARAYLSIS LASTED FOR ABOUT  24 HOURS  AND EVENTUALLY SUBSIDED.
Age: 68.0
Sex: M
Vaccine: RSV
Symptoms: Cold sweat, Dizziness, Erythema, Heart rate increased, Hyperhidrosis
Clinical narrative: One to two minutes after receiving the vaccine, patient felt queasy and light-headed; his face was red in color.   He was then asked to sit down.  He then passed out and fainted; his back was supported and his feet were elevated.  Patient became sweaty, pale in color, had a few muscle tremors/twitching in the arms, rapid pulse and clammy.  After 15 minutes he became more responsive and color returned.  EMS monitored blood pressure and pulse - determined within normal range.  After 30 minutes patient was more like himself, alert, oriented, and able to stand/move around.
Age: 68.0
Sex: M
Vaccine: RSV
Symptoms: Loss of consciousness, Muscle twitching, Nausea, Pallor, Syncope
Clinical narrative: One to two minutes after receiving the vaccine, patient felt queasy and light-headed; his face was red in color.   He was then asked to sit down.  He then passed out and fainted; his back was supported and his feet were elevated.  Patient became sweaty, pale in color, had a few muscle tremors/twitching in the arms, rapid pulse and clammy.  After 15 minutes he became more responsive and color returned.  EMS monitored blood pressure and pulse - determined within normal range.  After 30 minutes patient was more like himself, alert, oriented, and able to stand/move around.
Age: 68.0
Sex: M
Vaccine: RSV
Symptoms: Tremor
Clinical narrative: One to two minutes after receiving the vaccine, patient felt queasy and light-headed; his face was red in color.   He was then asked to sit down.  He then passed out and fainted; his back was supported and his feet were elevated.  Patient became sweaty, pale in color, had a few muscle tremors/twitching in the arms, rapid pulse and clammy.  After 15 minutes he became more responsive and color returned.  EMS monitored blood pressure and pulse - determined within normal range.  After 30 minutes patient was more like himself, alert, oriented, and able to stand/move around.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Agitation, Asthenia, Back pain, COVID-19, Decreased appetite
Clinical narrative: Patient is a 95 y.o. male PMHx AS s/p TAVR (1/3/2019) c/b CHB s/p PPM (1/9/2019), non obstructive CAD (LHC 1/2019), CKD3b (baseline cr ~ 1.5), HTN, HLD, HFpEF, prostate cancer s/p resection (1993), recent COVID infection (positive 9/27/23 s/p paxlovid) who presented from IL on 10/3/2023 with CC weakness, fatigue, myalgias. Hospital course complicated by issues with dizziness/labile blood pressures, as well as acute on chronic back pain from recent fall. Orthostasis improved with gentle IVF as well as holding BP medications. TTE 10/09/2023 showing TAVR with stable function compared to report from 10/31/2019. PT/OT recommending SNF on discharge. Patient stable for discharge on 10/09 in stable condition to SNF.   COVID-19, resolved Fatigue Poor Appetite, improved - Positive 9/27 s/p paxlovid; sxs onset 9/26 - here with fatigue, weakness, myalgias, and restlessness (severe/almost akethisia like) - Continue PT/OT; appreciate CM assistance with SNF at discharge   Dizziness Orthostatic hypotension - Orthostasis quite positive, noted history of HFpEF and AS s/p TAVR - Improved with gentle IVF - TTE 10/09: Unchanged/stable TAVR compared to TTE in October 2019. - Discontinue Bumex and Coreg on discharge. Continue amlodipine 5 mg daily. Follow up with Cardiology as outpatient to discuss further GDMT.   Acute on Chronic Back Pain - suspect OA and in light of fall above - TTP on left SI joint, no tenderness of lumbar SP; no observed erythema; gait with walker observed without foot drop; sacral XR as below - Continue lidocaine patch, tylenol, and gabapentin; encourage PT/OT   Mechanical Fall - trying to get off toilet 10/4, no LOC, did not strike head, no prodromal sxs - "toilet was too low;" neuro checks benign; no skin tears appreciated - sacral XR without fracture - PT/OT following AS s/p TAVR - continue ASA 81   HTN - Home regimen: coreg 6.25 BID, bumex 0.25 mg daily, amlodipine 5 mg daily. - Discontinue Coreg and Bumex.  Increase amlodipine back to 5 mg daily.  Advise accepting higher blood pressures to avoid orthostasis and falls.   Chronic HFpEF - Do not see recent exacerbation (likely was related to AS history) - Holding diuresis and Coreg as above.  Will discontinue on discharge. Follow up with PCP and Cardiology.   CKD3b - at baseline cr(1.6-1.8) - trend BMP daily; trend UOP   CHB - s/p ppm 2019 - Noted.   Gout - Continue allopurinol 150 mg daily (due to CKD).   Toxic metabolic encephalopathy, resolved - ED documentation showing that he is agitated and made a comment "I wish I had a gun"  - s/p haldol and seroquel 10/3; no access to firearms at independent living - no further SI/HI; mentation remains intact; AMA precautions removed. - Monitor.   Numbness, resolved - New 10/7/23, left face, suspect related to CKD and gabapentin - on left face, no dysarthria or dysmetria; no ringing in ears  Continue gabapentin 100 mg TID (reduced dose due to CKD).
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Dizziness, Echocardiogram, Echocardiogram normal, Fall, Fatigue
Clinical narrative: Patient is a 95 y.o. male PMHx AS s/p TAVR (1/3/2019) c/b CHB s/p PPM (1/9/2019), non obstructive CAD (LHC 1/2019), CKD3b (baseline cr ~ 1.5), HTN, HLD, HFpEF, prostate cancer s/p resection (1993), recent COVID infection (positive 9/27/23 s/p paxlovid) who presented from IL on 10/3/2023 with CC weakness, fatigue, myalgias. Hospital course complicated by issues with dizziness/labile blood pressures, as well as acute on chronic back pain from recent fall. Orthostasis improved with gentle IVF as well as holding BP medications. TTE 10/09/2023 showing TAVR with stable function compared to report from 10/31/2019. PT/OT recommending SNF on discharge. Patient stable for discharge on 10/09 in stable condition to SNF.   COVID-19, resolved Fatigue Poor Appetite, improved - Positive 9/27 s/p paxlovid; sxs onset 9/26 - here with fatigue, weakness, myalgias, and restlessness (severe/almost akethisia like) - Continue PT/OT; appreciate CM assistance with SNF at discharge   Dizziness Orthostatic hypotension - Orthostasis quite positive, noted history of HFpEF and AS s/p TAVR - Improved with gentle IVF - TTE 10/09: Unchanged/stable TAVR compared to TTE in October 2019. - Discontinue Bumex and Coreg on discharge. Continue amlodipine 5 mg daily. Follow up with Cardiology as outpatient to discuss further GDMT.   Acute on Chronic Back Pain - suspect OA and in light of fall above - TTP on left SI joint, no tenderness of lumbar SP; no observed erythema; gait with walker observed without foot drop; sacral XR as below - Continue lidocaine patch, tylenol, and gabapentin; encourage PT/OT   Mechanical Fall - trying to get off toilet 10/4, no LOC, did not strike head, no prodromal sxs - "toilet was too low;" neuro checks benign; no skin tears appreciated - sacral XR without fracture - PT/OT following AS s/p TAVR - continue ASA 81   HTN - Home regimen: coreg 6.25 BID, bumex 0.25 mg daily, amlodipine 5 mg daily. - Discontinue Coreg and Bumex.  Increase amlodipine back to 5 mg daily.  Advise accepting higher blood pressures to avoid orthostasis and falls.   Chronic HFpEF - Do not see recent exacerbation (likely was related to AS history) - Holding diuresis and Coreg as above.  Will discontinue on discharge. Follow up with PCP and Cardiology.   CKD3b - at baseline cr(1.6-1.8) - trend BMP daily; trend UOP   CHB - s/p ppm 2019 - Noted.   Gout - Continue allopurinol 150 mg daily (due to CKD).   Toxic metabolic encephalopathy, resolved - ED documentation showing that he is agitated and made a comment "I wish I had a gun"  - s/p haldol and seroquel 10/3; no access to firearms at independent living - no further SI/HI; mentation remains intact; AMA precautions removed. - Monitor.   Numbness, resolved - New 10/7/23, left face, suspect related to CKD and gabapentin - on left face, no dysarthria or dysmetria; no ringing in ears  Continue gabapentin 100 mg TID (reduced dose due to CKD).
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoaesthesia, Labile blood pressure, Myalgia, Neurological examination normal, Orthostatic hypotension
Clinical narrative: Patient is a 95 y.o. male PMHx AS s/p TAVR (1/3/2019) c/b CHB s/p PPM (1/9/2019), non obstructive CAD (LHC 1/2019), CKD3b (baseline cr ~ 1.5), HTN, HLD, HFpEF, prostate cancer s/p resection (1993), recent COVID infection (positive 9/27/23 s/p paxlovid) who presented from IL on 10/3/2023 with CC weakness, fatigue, myalgias. Hospital course complicated by issues with dizziness/labile blood pressures, as well as acute on chronic back pain from recent fall. Orthostasis improved with gentle IVF as well as holding BP medications. TTE 10/09/2023 showing TAVR with stable function compared to report from 10/31/2019. PT/OT recommending SNF on discharge. Patient stable for discharge on 10/09 in stable condition to SNF.   COVID-19, resolved Fatigue Poor Appetite, improved - Positive 9/27 s/p paxlovid; sxs onset 9/26 - here with fatigue, weakness, myalgias, and restlessness (severe/almost akethisia like) - Continue PT/OT; appreciate CM assistance with SNF at discharge   Dizziness Orthostatic hypotension - Orthostasis quite positive, noted history of HFpEF and AS s/p TAVR - Improved with gentle IVF - TTE 10/09: Unchanged/stable TAVR compared to TTE in October 2019. - Discontinue Bumex and Coreg on discharge. Continue amlodipine 5 mg daily. Follow up with Cardiology as outpatient to discuss further GDMT.   Acute on Chronic Back Pain - suspect OA and in light of fall above - TTP on left SI joint, no tenderness of lumbar SP; no observed erythema; gait with walker observed without foot drop; sacral XR as below - Continue lidocaine patch, tylenol, and gabapentin; encourage PT/OT   Mechanical Fall - trying to get off toilet 10/4, no LOC, did not strike head, no prodromal sxs - "toilet was too low;" neuro checks benign; no skin tears appreciated - sacral XR without fracture - PT/OT following AS s/p TAVR - continue ASA 81   HTN - Home regimen: coreg 6.25 BID, bumex 0.25 mg daily, amlodipine 5 mg daily. - Discontinue Coreg and Bumex.  Increase amlodipine back to 5 mg daily.  Advise accepting higher blood pressures to avoid orthostasis and falls.   Chronic HFpEF - Do not see recent exacerbation (likely was related to AS history) - Holding diuresis and Coreg as above.  Will discontinue on discharge. Follow up with PCP and Cardiology.   CKD3b - at baseline cr(1.6-1.8) - trend BMP daily; trend UOP   CHB - s/p ppm 2019 - Noted.   Gout - Continue allopurinol 150 mg daily (due to CKD).   Toxic metabolic encephalopathy, resolved - ED documentation showing that he is agitated and made a comment "I wish I had a gun"  - s/p haldol and seroquel 10/3; no access to firearms at independent living - no further SI/HI; mentation remains intact; AMA precautions removed. - Monitor.   Numbness, resolved - New 10/7/23, left face, suspect related to CKD and gabapentin - on left face, no dysarthria or dysmetria; no ringing in ears  Continue gabapentin 100 mg TID (reduced dose due to CKD).
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Osteoarthritis, Restlessness, SARS-CoV-2 test positive, Spinal X-ray normal, Toxic encephalopathy
Clinical narrative: Patient is a 95 y.o. male PMHx AS s/p TAVR (1/3/2019) c/b CHB s/p PPM (1/9/2019), non obstructive CAD (LHC 1/2019), CKD3b (baseline cr ~ 1.5), HTN, HLD, HFpEF, prostate cancer s/p resection (1993), recent COVID infection (positive 9/27/23 s/p paxlovid) who presented from IL on 10/3/2023 with CC weakness, fatigue, myalgias. Hospital course complicated by issues with dizziness/labile blood pressures, as well as acute on chronic back pain from recent fall. Orthostasis improved with gentle IVF as well as holding BP medications. TTE 10/09/2023 showing TAVR with stable function compared to report from 10/31/2019. PT/OT recommending SNF on discharge. Patient stable for discharge on 10/09 in stable condition to SNF.   COVID-19, resolved Fatigue Poor Appetite, improved - Positive 9/27 s/p paxlovid; sxs onset 9/26 - here with fatigue, weakness, myalgias, and restlessness (severe/almost akethisia like) - Continue PT/OT; appreciate CM assistance with SNF at discharge   Dizziness Orthostatic hypotension - Orthostasis quite positive, noted history of HFpEF and AS s/p TAVR - Improved with gentle IVF - TTE 10/09: Unchanged/stable TAVR compared to TTE in October 2019. - Discontinue Bumex and Coreg on discharge. Continue amlodipine 5 mg daily. Follow up with Cardiology as outpatient to discuss further GDMT.   Acute on Chronic Back Pain - suspect OA and in light of fall above - TTP on left SI joint, no tenderness of lumbar SP; no observed erythema; gait with walker observed without foot drop; sacral XR as below - Continue lidocaine patch, tylenol, and gabapentin; encourage PT/OT   Mechanical Fall - trying to get off toilet 10/4, no LOC, did not strike head, no prodromal sxs - "toilet was too low;" neuro checks benign; no skin tears appreciated - sacral XR without fracture - PT/OT following AS s/p TAVR - continue ASA 81   HTN - Home regimen: coreg 6.25 BID, bumex 0.25 mg daily, amlodipine 5 mg daily. - Discontinue Coreg and Bumex.  Increase amlodipine back to 5 mg daily.  Advise accepting higher blood pressures to avoid orthostasis and falls.   Chronic HFpEF - Do not see recent exacerbation (likely was related to AS history) - Holding diuresis and Coreg as above.  Will discontinue on discharge. Follow up with PCP and Cardiology.   CKD3b - at baseline cr(1.6-1.8) - trend BMP daily; trend UOP   CHB - s/p ppm 2019 - Noted.   Gout - Continue allopurinol 150 mg daily (due to CKD).   Toxic metabolic encephalopathy, resolved - ED documentation showing that he is agitated and made a comment "I wish I had a gun"  - s/p haldol and seroquel 10/3; no access to firearms at independent living - no further SI/HI; mentation remains intact; AMA precautions removed. - Monitor.   Numbness, resolved - New 10/7/23, left face, suspect related to CKD and gabapentin - on left face, no dysarthria or dysmetria; no ringing in ears  Continue gabapentin 100 mg TID (reduced dose due to CKD).
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Walking aid user
Clinical narrative: Patient is a 95 y.o. male PMHx AS s/p TAVR (1/3/2019) c/b CHB s/p PPM (1/9/2019), non obstructive CAD (LHC 1/2019), CKD3b (baseline cr ~ 1.5), HTN, HLD, HFpEF, prostate cancer s/p resection (1993), recent COVID infection (positive 9/27/23 s/p paxlovid) who presented from IL on 10/3/2023 with CC weakness, fatigue, myalgias. Hospital course complicated by issues with dizziness/labile blood pressures, as well as acute on chronic back pain from recent fall. Orthostasis improved with gentle IVF as well as holding BP medications. TTE 10/09/2023 showing TAVR with stable function compared to report from 10/31/2019. PT/OT recommending SNF on discharge. Patient stable for discharge on 10/09 in stable condition to SNF.   COVID-19, resolved Fatigue Poor Appetite, improved - Positive 9/27 s/p paxlovid; sxs onset 9/26 - here with fatigue, weakness, myalgias, and restlessness (severe/almost akethisia like) - Continue PT/OT; appreciate CM assistance with SNF at discharge   Dizziness Orthostatic hypotension - Orthostasis quite positive, noted history of HFpEF and AS s/p TAVR - Improved with gentle IVF - TTE 10/09: Unchanged/stable TAVR compared to TTE in October 2019. - Discontinue Bumex and Coreg on discharge. Continue amlodipine 5 mg daily. Follow up with Cardiology as outpatient to discuss further GDMT.   Acute on Chronic Back Pain - suspect OA and in light of fall above - TTP on left SI joint, no tenderness of lumbar SP; no observed erythema; gait with walker observed without foot drop; sacral XR as below - Continue lidocaine patch, tylenol, and gabapentin; encourage PT/OT   Mechanical Fall - trying to get off toilet 10/4, no LOC, did not strike head, no prodromal sxs - "toilet was too low;" neuro checks benign; no skin tears appreciated - sacral XR without fracture - PT/OT following AS s/p TAVR - continue ASA 81   HTN - Home regimen: coreg 6.25 BID, bumex 0.25 mg daily, amlodipine 5 mg daily. - Discontinue Coreg and Bumex.  Increase amlodipine back to 5 mg daily.  Advise accepting higher blood pressures to avoid orthostasis and falls.   Chronic HFpEF - Do not see recent exacerbation (likely was related to AS history) - Holding diuresis and Coreg as above.  Will discontinue on discharge. Follow up with PCP and Cardiology.   CKD3b - at baseline cr(1.6-1.8) - trend BMP daily; trend UOP   CHB - s/p ppm 2019 - Noted.   Gout - Continue allopurinol 150 mg daily (due to CKD).   Toxic metabolic encephalopathy, resolved - ED documentation showing that he is agitated and made a comment "I wish I had a gun"  - s/p haldol and seroquel 10/3; no access to firearms at independent living - no further SI/HI; mentation remains intact; AMA precautions removed. - Monitor.   Numbness, resolved - New 10/7/23, left face, suspect related to CKD and gabapentin - on left face, no dysarthria or dysmetria; no ringing in ears  Continue gabapentin 100 mg TID (reduced dose due to CKD).
Age: 60.0
Sex: M
Vaccine: FLU4
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: High dose FLU given to a 60 year old
Age: 2.0
Sex: M
Vaccine: DTAPHEPBIP
Symptoms: Extra dose administered, Screaming, Wrong patient received product, Wrong product administered
Clinical narrative: Patient came into receive a flu vaccine in a nurse visit.  The patient was with his sibling that was having a 6 month well child visit. The sibling was receiving all the 6 month well child shots that included rota, hib, Prevnar, Pediarix with the addition of a flu vaccine.  When this MA administered the flu vaccine to this patient this MA actually picked up the Pediarix and administered it to the wrong patient.  The parent was immediately notified of the mistake at 1108  This MA went and talked to the provider and informed her of the mistake and asked her if the extra dose of Pediarix which included Dtap, Hep B and Polio was okay. Provider said that it was fine.  This MA went ahead and gave the patient the correct Flu vaccine at 1113. This MA apologized and the mother didn't seem worried but felt a bit overwhelmed because the patient was screaming.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Abnormal dreams, Influenza, Insomnia
Clinical narrative: Unusual dreams, sleep loss, mild flu symptoms (had the flu in August 2023)
Age: 68.0
Sex: F
Vaccine: RSV
Symptoms: Diarrhoea, Headache
Clinical narrative: The  patients stated she had a headache and diarrhea lasting several days.
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Anal fistula, Antinuclear antibody, Biopsy kidney abnormal
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood creatinine increased, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Complement factor, Condition aggravated, Deep vein thrombosis, Diabetic nephropathy, Diuretic therapy
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP
Age: 62.0
Sex: M
Vaccine: COVID19-2
Symptoms: Electrocardiogram normal, End stage renal disease, Glycosylated haemoglobin increased, HIV test, Haemoglobin decreased
Clinical narrative: Patient is a 63 y.o. male patient of MD with history of CKD stage 3b, HTN, IDDM2 presented to Medical Center with abnormal renal labs. Hospital course complicated by COVID-19 pneumonia and worsening AKI on CKD.      AKI on CKD stage 4 with ATN Metabolic acidosis - resolved Anemia of CKD - stable Cr 3.85 on admission (baseline 2.5-2.6), now 4.67 Recently established care with Nephrology, Dr. 7/2023 renal USG w/o obstruction, indicative of medical renal disease IFE, hepatitis, HIV, ANA & complements -ve Nephrology consulted: s/p renal bx 09/21: DM nephropathy, HTN nephrosclerosis, ATN S/P IV lasix prn per Nephro recs - given 9/25, stopped further doses, ok for discharge, IPR denied Plan for to discharge home with HHS likely next am after Eliquis pre-auth complete     New onset RUE DVTs USG w/ complete occlusive acute DVT R radial v, partially occlusive acute DVT R ulnar v Was on heparin gtt, transitioned to DOAC 10/03, continue on discharge x3 mon ID preauthorization over the phone yesterday, Eliquis was approved Prescription was sent to his pharmacy, case management to verify coverage   HTN urgency : resolved BP 210s/90s on admission Currently well controlled with 5 mg Norvasc and 100 mg Toprol Continue the same, outpatient follow-up with PCP Adjust as needed Elevated troponin 2/2 demand ischemia in assoc w/ AKI on CKD Trop 88>97  EKG w/o acute coronary change Denies chest pain Continue statin, BB   Acute hypoxemic respiratory failure - Resolved COVID-19 Suspected CAP CXR B/L airspace opacities R>L edema vs infectious COVID +ve 9/8 BNP 10.6K in renal failure--diuresed w/ Bumex initially 2/2 fluid overload, COVID, and suspected CAP Pulm consulted, treated empirically with Levaquin PRN bronchodilators Initially hypoxic, req up to 4 L NC 09/19, dced IVFs, CXR w/ improvement, duoneb PRN, weaned to RA 09/20    COVID-19 COVID-19 +ve 9/8 Reports vaccination CXR R>L infiltrate 9/8 Finished course of Remdesivir/Decadron   T2DM on insulin 8/2023 A1c 7.4% Metformin held, renal decline likely precludes further use at DC Adjusted home insulin dose based on inpatient dosing Close follow-up with PCP, adjust as needed  Anemia of ESRD Baseline HGB ~9 Hgb 6.6 on 9/11 - transfused pRBC x 1 Venofer, Epo ordered per renal Hgb 9/30 stable  and stopped daily labs   Anal fistula F/w CRS, Dr Was scheduled for op intervention 9/7 Not cleared due to AKI Reschedule for later date as OP