chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Ejection fraction normal, Electrocardiogram normal, Fatigue, Haemoglobin decreased, Hypophagia
Clinical narrative: Patient is a 76 y.o. female patient of MD with history of CAD s/p CABG, HFpEF, MR s/p mitral clip, mechanical AVR, chronic hypoxic respiratory failure, uncontrolled type 2 diabetes mellitus, hypothyroidism, RLS, chronic pain, and depression/anxiety who presented to Hospital with fatigue and shortness of breath.   Acute on Chronic Hypoxic Respiratory Failure - Resolved COVID 19 Pneumonia Fatigue, decreased appetite, SOB. Initially saturating ok on chronic home 2L NC but worsened in ED and required 10L HFNC COVID positive, vaccinated x3 Tested positive 11/8, symptoms since 11/5  CXR non acute  Dexamethasone x10d Given AKI as below, remdesivir not ordered. May consider baricitinib if worsen.  CRP improving and weaned to RA Pulmonary followed   Generalized Weakness PT/OT rec 5-7d/week Patient not interested in SNF SW following, appreciate assistance    AKI - Resolved CKD Stage 3 Initial creatinine 1.96, baseline appears to be about 1.3 Admits to poor PO intake and continued Bumex daily Likely pre-renal in the setting of covid and above IVF given in ED, will hold on additional fluid given COVID  Initially held bumex, now resumed Continue to monitor with daily RFP's Cr stable at 1.2 Recommend repeat BMP in 1 week    NSTEMI, likely type 2 CAD s/p CABG Chronic HFpEF MR s/p Mitral Clip AVS s/p mechanical AVR Pulmonary Hypertension Tropinin elevated with flat trend  Patient denies chest pain EKG with paced rhythm, no clear ST changes Echo 11/2 with LVEF 56%, RVSP of 100, mild MVR, severe TVR Held bumex on admit due to AKI, now resumed Continue home aspirin and pravastatin Pharmacy consulted to dose coumadin, goal INR 2.5-3.5   Uncontrolled Type 2 Diabetes Mellitus Last A1C 8.0% on 10/10/23 Continue home long acting insulin, 20 units nightly Holding home sitagliptin while inpatient  Increased SSI; accuchecks Diabetic diet   Chronic Normocytic Anemia Leukopenia Hemoglobin 9.4 on admission, which appears to be about baseline WBC 4.44, likely due to COVID Continue home iron supplementation   Hypothyroidism Continue home levothyroxine   RLS Continue home requip   Chronic Pain Continue home Oxycodone    Depression/Anxiety Continue home zoloft PRN ativan Recommend close follow up with psychiatry for uncontrolled anxiety
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Mitral valve incompetence, Pacemaker generated rhythm, Respiratory failure, SARS-CoV-2 test positive, Tricuspid valve incompetence
Clinical narrative: Patient is a 76 y.o. female patient of MD with history of CAD s/p CABG, HFpEF, MR s/p mitral clip, mechanical AVR, chronic hypoxic respiratory failure, uncontrolled type 2 diabetes mellitus, hypothyroidism, RLS, chronic pain, and depression/anxiety who presented to Hospital with fatigue and shortness of breath.   Acute on Chronic Hypoxic Respiratory Failure - Resolved COVID 19 Pneumonia Fatigue, decreased appetite, SOB. Initially saturating ok on chronic home 2L NC but worsened in ED and required 10L HFNC COVID positive, vaccinated x3 Tested positive 11/8, symptoms since 11/5  CXR non acute  Dexamethasone x10d Given AKI as below, remdesivir not ordered. May consider baricitinib if worsen.  CRP improving and weaned to RA Pulmonary followed   Generalized Weakness PT/OT rec 5-7d/week Patient not interested in SNF SW following, appreciate assistance    AKI - Resolved CKD Stage 3 Initial creatinine 1.96, baseline appears to be about 1.3 Admits to poor PO intake and continued Bumex daily Likely pre-renal in the setting of covid and above IVF given in ED, will hold on additional fluid given COVID  Initially held bumex, now resumed Continue to monitor with daily RFP's Cr stable at 1.2 Recommend repeat BMP in 1 week    NSTEMI, likely type 2 CAD s/p CABG Chronic HFpEF MR s/p Mitral Clip AVS s/p mechanical AVR Pulmonary Hypertension Tropinin elevated with flat trend  Patient denies chest pain EKG with paced rhythm, no clear ST changes Echo 11/2 with LVEF 56%, RVSP of 100, mild MVR, severe TVR Held bumex on admit due to AKI, now resumed Continue home aspirin and pravastatin Pharmacy consulted to dose coumadin, goal INR 2.5-3.5   Uncontrolled Type 2 Diabetes Mellitus Last A1C 8.0% on 10/10/23 Continue home long acting insulin, 20 units nightly Holding home sitagliptin while inpatient  Increased SSI; accuchecks Diabetic diet   Chronic Normocytic Anemia Leukopenia Hemoglobin 9.4 on admission, which appears to be about baseline WBC 4.44, likely due to COVID Continue home iron supplementation   Hypothyroidism Continue home levothyroxine   RLS Continue home requip   Chronic Pain Continue home Oxycodone    Depression/Anxiety Continue home zoloft PRN ativan Recommend close follow up with psychiatry for uncontrolled anxiety
Age: 75.0
Sex: F
Vaccine: COVID19-2
Symptoms: Troponin increased, White blood cell count decreased
Clinical narrative: Patient is a 76 y.o. female patient of MD with history of CAD s/p CABG, HFpEF, MR s/p mitral clip, mechanical AVR, chronic hypoxic respiratory failure, uncontrolled type 2 diabetes mellitus, hypothyroidism, RLS, chronic pain, and depression/anxiety who presented to Hospital with fatigue and shortness of breath.   Acute on Chronic Hypoxic Respiratory Failure - Resolved COVID 19 Pneumonia Fatigue, decreased appetite, SOB. Initially saturating ok on chronic home 2L NC but worsened in ED and required 10L HFNC COVID positive, vaccinated x3 Tested positive 11/8, symptoms since 11/5  CXR non acute  Dexamethasone x10d Given AKI as below, remdesivir not ordered. May consider baricitinib if worsen.  CRP improving and weaned to RA Pulmonary followed   Generalized Weakness PT/OT rec 5-7d/week Patient not interested in SNF SW following, appreciate assistance    AKI - Resolved CKD Stage 3 Initial creatinine 1.96, baseline appears to be about 1.3 Admits to poor PO intake and continued Bumex daily Likely pre-renal in the setting of covid and above IVF given in ED, will hold on additional fluid given COVID  Initially held bumex, now resumed Continue to monitor with daily RFP's Cr stable at 1.2 Recommend repeat BMP in 1 week    NSTEMI, likely type 2 CAD s/p CABG Chronic HFpEF MR s/p Mitral Clip AVS s/p mechanical AVR Pulmonary Hypertension Tropinin elevated with flat trend  Patient denies chest pain EKG with paced rhythm, no clear ST changes Echo 11/2 with LVEF 56%, RVSP of 100, mild MVR, severe TVR Held bumex on admit due to AKI, now resumed Continue home aspirin and pravastatin Pharmacy consulted to dose coumadin, goal INR 2.5-3.5   Uncontrolled Type 2 Diabetes Mellitus Last A1C 8.0% on 10/10/23 Continue home long acting insulin, 20 units nightly Holding home sitagliptin while inpatient  Increased SSI; accuchecks Diabetic diet   Chronic Normocytic Anemia Leukopenia Hemoglobin 9.4 on admission, which appears to be about baseline WBC 4.44, likely due to COVID Continue home iron supplementation   Hypothyroidism Continue home levothyroxine   RLS Continue home requip   Chronic Pain Continue home Oxycodone    Depression/Anxiety Continue home zoloft PRN ativan Recommend close follow up with psychiatry for uncontrolled anxiety
Age: 27.0
Sex: F
Vaccine: COVID19-2
Symptoms: Electrocardiogram T wave abnormal, Palpitations, Panic attack, Ventricular extrasystoles
Clinical narrative: T wave abnormalities in EKGs, palpitations, increased PVCs and panic attacks
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Abdominal pain lower, Acute respiratory failure, Atelectasis, Back pain
Clinical narrative: Perpetual Assessment: Patient is a 48 y.o. female who presented from home on 11/8/2023 with abdominal and back pain + fevers.  CT imaging and infectious work-up negative on admission.  COVID-19 positive after further investigation.  Symptoms improved with multimodal pain control strategy and steroids.  Discharged to home with improvement.          Assessment and Plan   COVID-19 Acute Hypoxic Respiratory Failure - resolved - Presented with: abdominal and back pain. - Symptom onset: 11/8/23 - Positive COVID-19: 11/9/23 at hospital - Vaccination status: Vaccinated - CTPE on admission showed no PE, subsegmental atelectasis. - Oxygen status: RA - 2LNC with sleep/activity.  RA at time of discharge. - Decadron: Yes. Expected end date 11/20.  Started for dual benefit with Back Pain as below.   Abdominal pain  Low back pain  - Suspected exacerbation of LBP in the setting of COVID inflammatory response. - pt with suprapubic pain, RLQ pain, right flank pain and lumbar back pain  - Occult Pyelonephritis, appendicitis considered on admission - though without evidence of. - CT abd/pelvis with and without contrast unremarkable, no radiographic evidence pyelonephritis, no renal stone, no ovarian cyst;  - UA unremarkable; labs unremarkable. UCx without growth. - CT spine with broad base disc protrusion L4-L5 though no spinal canal stenosis  - MR L spine with DDD at L4-S1, facet degeneration at L4-L5.  No central canal stenosis. - Appreciate General Surgery assessment, no plans for surgical intervention.  Zosyn stopped 11/10. - Continued multi-modal pain control on discharge.   Hypoglycemia  - in context of not eating for over 24 hours with above; possible infectious process above - no hx of diabetes, pt had been on adipex in past for weight loss though no longer taking  - glucose 28 on admission; received D5W.  Improved.  Stable on regular diet.   Asthma  - per hx; pt on steroid inhaler, breztri at home  - no exacerbation  - Non-formulary request to utilize home Breztri.
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Blood glucose decreased, COVID-19, Computerised tomogram abdomen normal, Computerised tomogram spine abnormal, Computerised tomogram thorax abnormal
Clinical narrative: Perpetual Assessment: Patient is a 48 y.o. female who presented from home on 11/8/2023 with abdominal and back pain + fevers.  CT imaging and infectious work-up negative on admission.  COVID-19 positive after further investigation.  Symptoms improved with multimodal pain control strategy and steroids.  Discharged to home with improvement.          Assessment and Plan   COVID-19 Acute Hypoxic Respiratory Failure - resolved - Presented with: abdominal and back pain. - Symptom onset: 11/8/23 - Positive COVID-19: 11/9/23 at hospital - Vaccination status: Vaccinated - CTPE on admission showed no PE, subsegmental atelectasis. - Oxygen status: RA - 2LNC with sleep/activity.  RA at time of discharge. - Decadron: Yes. Expected end date 11/20.  Started for dual benefit with Back Pain as below.   Abdominal pain  Low back pain  - Suspected exacerbation of LBP in the setting of COVID inflammatory response. - pt with suprapubic pain, RLQ pain, right flank pain and lumbar back pain  - Occult Pyelonephritis, appendicitis considered on admission - though without evidence of. - CT abd/pelvis with and without contrast unremarkable, no radiographic evidence pyelonephritis, no renal stone, no ovarian cyst;  - UA unremarkable; labs unremarkable. UCx without growth. - CT spine with broad base disc protrusion L4-L5 though no spinal canal stenosis  - MR L spine with DDD at L4-S1, facet degeneration at L4-L5.  No central canal stenosis. - Appreciate General Surgery assessment, no plans for surgical intervention.  Zosyn stopped 11/10. - Continued multi-modal pain control on discharge.   Hypoglycemia  - in context of not eating for over 24 hours with above; possible infectious process above - no hx of diabetes, pt had been on adipex in past for weight loss though no longer taking  - glucose 28 on admission; received D5W.  Improved.  Stable on regular diet.   Asthma  - per hx; pt on steroid inhaler, breztri at home  - no exacerbation  - Non-formulary request to utilize home Breztri.
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Culture urine negative, Flank pain, Hypoglycaemia, Hypophagia, Inflammation
Clinical narrative: Perpetual Assessment: Patient is a 48 y.o. female who presented from home on 11/8/2023 with abdominal and back pain + fevers.  CT imaging and infectious work-up negative on admission.  COVID-19 positive after further investigation.  Symptoms improved with multimodal pain control strategy and steroids.  Discharged to home with improvement.          Assessment and Plan   COVID-19 Acute Hypoxic Respiratory Failure - resolved - Presented with: abdominal and back pain. - Symptom onset: 11/8/23 - Positive COVID-19: 11/9/23 at hospital - Vaccination status: Vaccinated - CTPE on admission showed no PE, subsegmental atelectasis. - Oxygen status: RA - 2LNC with sleep/activity.  RA at time of discharge. - Decadron: Yes. Expected end date 11/20.  Started for dual benefit with Back Pain as below.   Abdominal pain  Low back pain  - Suspected exacerbation of LBP in the setting of COVID inflammatory response. - pt with suprapubic pain, RLQ pain, right flank pain and lumbar back pain  - Occult Pyelonephritis, appendicitis considered on admission - though without evidence of. - CT abd/pelvis with and without contrast unremarkable, no radiographic evidence pyelonephritis, no renal stone, no ovarian cyst;  - UA unremarkable; labs unremarkable. UCx without growth. - CT spine with broad base disc protrusion L4-L5 though no spinal canal stenosis  - MR L spine with DDD at L4-S1, facet degeneration at L4-L5.  No central canal stenosis. - Appreciate General Surgery assessment, no plans for surgical intervention.  Zosyn stopped 11/10. - Continued multi-modal pain control on discharge.   Hypoglycemia  - in context of not eating for over 24 hours with above; possible infectious process above - no hx of diabetes, pt had been on adipex in past for weight loss though no longer taking  - glucose 28 on admission; received D5W.  Improved.  Stable on regular diet.   Asthma  - per hx; pt on steroid inhaler, breztri at home  - no exacerbation  - Non-formulary request to utilize home Breztri.
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Intervertebral disc degeneration, Intervertebral disc protrusion, Laboratory test normal, Magnetic resonance imaging spinal abnormal, Pyrexia
Clinical narrative: Perpetual Assessment: Patient is a 48 y.o. female who presented from home on 11/8/2023 with abdominal and back pain + fevers.  CT imaging and infectious work-up negative on admission.  COVID-19 positive after further investigation.  Symptoms improved with multimodal pain control strategy and steroids.  Discharged to home with improvement.          Assessment and Plan   COVID-19 Acute Hypoxic Respiratory Failure - resolved - Presented with: abdominal and back pain. - Symptom onset: 11/8/23 - Positive COVID-19: 11/9/23 at hospital - Vaccination status: Vaccinated - CTPE on admission showed no PE, subsegmental atelectasis. - Oxygen status: RA - 2LNC with sleep/activity.  RA at time of discharge. - Decadron: Yes. Expected end date 11/20.  Started for dual benefit with Back Pain as below.   Abdominal pain  Low back pain  - Suspected exacerbation of LBP in the setting of COVID inflammatory response. - pt with suprapubic pain, RLQ pain, right flank pain and lumbar back pain  - Occult Pyelonephritis, appendicitis considered on admission - though without evidence of. - CT abd/pelvis with and without contrast unremarkable, no radiographic evidence pyelonephritis, no renal stone, no ovarian cyst;  - UA unremarkable; labs unremarkable. UCx without growth. - CT spine with broad base disc protrusion L4-L5 though no spinal canal stenosis  - MR L spine with DDD at L4-S1, facet degeneration at L4-L5.  No central canal stenosis. - Appreciate General Surgery assessment, no plans for surgical intervention.  Zosyn stopped 11/10. - Continued multi-modal pain control on discharge.   Hypoglycemia  - in context of not eating for over 24 hours with above; possible infectious process above - no hx of diabetes, pt had been on adipex in past for weight loss though no longer taking  - glucose 28 on admission; received D5W.  Improved.  Stable on regular diet.   Asthma  - per hx; pt on steroid inhaler, breztri at home  - no exacerbation  - Non-formulary request to utilize home Breztri.
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Scan with contrast normal, Spinal osteoarthritis, Suprapubic pain, Urine analysis normal
Clinical narrative: Perpetual Assessment: Patient is a 48 y.o. female who presented from home on 11/8/2023 with abdominal and back pain + fevers.  CT imaging and infectious work-up negative on admission.  COVID-19 positive after further investigation.  Symptoms improved with multimodal pain control strategy and steroids.  Discharged to home with improvement.          Assessment and Plan   COVID-19 Acute Hypoxic Respiratory Failure - resolved - Presented with: abdominal and back pain. - Symptom onset: 11/8/23 - Positive COVID-19: 11/9/23 at hospital - Vaccination status: Vaccinated - CTPE on admission showed no PE, subsegmental atelectasis. - Oxygen status: RA - 2LNC with sleep/activity.  RA at time of discharge. - Decadron: Yes. Expected end date 11/20.  Started for dual benefit with Back Pain as below.   Abdominal pain  Low back pain  - Suspected exacerbation of LBP in the setting of COVID inflammatory response. - pt with suprapubic pain, RLQ pain, right flank pain and lumbar back pain  - Occult Pyelonephritis, appendicitis considered on admission - though without evidence of. - CT abd/pelvis with and without contrast unremarkable, no radiographic evidence pyelonephritis, no renal stone, no ovarian cyst;  - UA unremarkable; labs unremarkable. UCx without growth. - CT spine with broad base disc protrusion L4-L5 though no spinal canal stenosis  - MR L spine with DDD at L4-S1, facet degeneration at L4-L5.  No central canal stenosis. - Appreciate General Surgery assessment, no plans for surgical intervention.  Zosyn stopped 11/10. - Continued multi-modal pain control on discharge.   Hypoglycemia  - in context of not eating for over 24 hours with above; possible infectious process above - no hx of diabetes, pt had been on adipex in past for weight loss though no longer taking  - glucose 28 on admission; received D5W.  Improved.  Stable on regular diet.   Asthma  - per hx; pt on steroid inhaler, breztri at home  - no exacerbation  - Non-formulary request to utilize home Breztri.
Age: 83.0
Sex: M
Vaccine: FLU4
Symptoms: Chills, Dizziness, Fall, Heart rate increased, Pallor
Clinical narrative: Spouse reports around 3:30 pm the patient walked outside to move his truck and he became light headed, pale lips and "slid down the side of his truck-she was unsure if he experienced syncope. He refused EMS /911. A neighbor that is an RN came over and assisted him to his feet and back in the house. The neighbor recommed that he go to the ER, but he refused. His B/P was 158/80 and his wife reported his heart rate was elevated. Spouse repreted he seemed "okay" in the evening, but experienced chills during the night.  He was up this morning (12/23/2023) for breakfast and seems "okay",  but went back to bed to rest. She has  called his primary care and is awaiting a return call.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Blood culture negative, Blood iron decreased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: Patient is a 75 y.o. female patient of MD with history of anxiety and hypertension.  She is admitted on 10/30/2023 with community-acquired pneumonia not improving with outpatient antibiotics.   COVID-19 PNA Community-acquired pneumonia: Presenting with a week history of productive cough, dyspnea on exertion, and reported fevers.  Chest x-ray with right middle lobe and left basilar infiltrate.  Not improving with 3 days of outpatient Levaquin Bcx NGTD, MRSA swab NEG, Procalcitonin negative, Strep and Legionella negative COVID POSITIVE 10/30 ID consulted, recommendations appreciated. Past window for  IV remdesivir and Paxlovid On day of discharge patient on room air with adequate saturation Received ceftriaxone and doxycycline while inpatient, discharged on 5 days of Augmentin and doxycycline Treated with IV dexamethasone while inpatient, per current recommendations stopped on discharge   Iron deficiency anemia Thrombocytopenia Without signs of bleeding on admission Iron studies consistent with iron deficiency Continue home p.o. iron Follow-up hemoglobin outpatient   Vitamin D deficiency, resolved Patient has hypervitaminosis D at this time with vitamin D level 148 Discontinue 50,000 IUs weekly Follow-up with primary care for continued management and appropriateness of lower dosage   Anxiety: Continue home Xanax   Hypertension: Continue home atenolol  Losartan and Lasix discontinued outpatient due to hypotension and symptoms   GERD PPI
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Dyspnoea exertional, Hypervitaminosis D, Iron deficiency, Legionella test
Clinical narrative: Patient is a 75 y.o. female patient of MD with history of anxiety and hypertension.  She is admitted on 10/30/2023 with community-acquired pneumonia not improving with outpatient antibiotics.   COVID-19 PNA Community-acquired pneumonia: Presenting with a week history of productive cough, dyspnea on exertion, and reported fevers.  Chest x-ray with right middle lobe and left basilar infiltrate.  Not improving with 3 days of outpatient Levaquin Bcx NGTD, MRSA swab NEG, Procalcitonin negative, Strep and Legionella negative COVID POSITIVE 10/30 ID consulted, recommendations appreciated. Past window for  IV remdesivir and Paxlovid On day of discharge patient on room air with adequate saturation Received ceftriaxone and doxycycline while inpatient, discharged on 5 days of Augmentin and doxycycline Treated with IV dexamethasone while inpatient, per current recommendations stopped on discharge   Iron deficiency anemia Thrombocytopenia Without signs of bleeding on admission Iron studies consistent with iron deficiency Continue home p.o. iron Follow-up hemoglobin outpatient   Vitamin D deficiency, resolved Patient has hypervitaminosis D at this time with vitamin D level 148 Discontinue 50,000 IUs weekly Follow-up with primary care for continued management and appropriateness of lower dosage   Anxiety: Continue home Xanax   Hypertension: Continue home atenolol  Losartan and Lasix discontinued outpatient due to hypotension and symptoms   GERD PPI
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Lung infiltration, Pneumonia, Procalcitonin normal, Productive cough, Pyrexia
Clinical narrative: Patient is a 75 y.o. female patient of MD with history of anxiety and hypertension.  She is admitted on 10/30/2023 with community-acquired pneumonia not improving with outpatient antibiotics.   COVID-19 PNA Community-acquired pneumonia: Presenting with a week history of productive cough, dyspnea on exertion, and reported fevers.  Chest x-ray with right middle lobe and left basilar infiltrate.  Not improving with 3 days of outpatient Levaquin Bcx NGTD, MRSA swab NEG, Procalcitonin negative, Strep and Legionella negative COVID POSITIVE 10/30 ID consulted, recommendations appreciated. Past window for  IV remdesivir and Paxlovid On day of discharge patient on room air with adequate saturation Received ceftriaxone and doxycycline while inpatient, discharged on 5 days of Augmentin and doxycycline Treated with IV dexamethasone while inpatient, per current recommendations stopped on discharge   Iron deficiency anemia Thrombocytopenia Without signs of bleeding on admission Iron studies consistent with iron deficiency Continue home p.o. iron Follow-up hemoglobin outpatient   Vitamin D deficiency, resolved Patient has hypervitaminosis D at this time with vitamin D level 148 Discontinue 50,000 IUs weekly Follow-up with primary care for continued management and appropriateness of lower dosage   Anxiety: Continue home Xanax   Hypertension: Continue home atenolol  Losartan and Lasix discontinued outpatient due to hypotension and symptoms   GERD PPI
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Staphylococcus test negative, Streptococcus test negative, Vitamin D, Vitamin D deficiency
Clinical narrative: Patient is a 75 y.o. female patient of MD with history of anxiety and hypertension.  She is admitted on 10/30/2023 with community-acquired pneumonia not improving with outpatient antibiotics.   COVID-19 PNA Community-acquired pneumonia: Presenting with a week history of productive cough, dyspnea on exertion, and reported fevers.  Chest x-ray with right middle lobe and left basilar infiltrate.  Not improving with 3 days of outpatient Levaquin Bcx NGTD, MRSA swab NEG, Procalcitonin negative, Strep and Legionella negative COVID POSITIVE 10/30 ID consulted, recommendations appreciated. Past window for  IV remdesivir and Paxlovid On day of discharge patient on room air with adequate saturation Received ceftriaxone and doxycycline while inpatient, discharged on 5 days of Augmentin and doxycycline Treated with IV dexamethasone while inpatient, per current recommendations stopped on discharge   Iron deficiency anemia Thrombocytopenia Without signs of bleeding on admission Iron studies consistent with iron deficiency Continue home p.o. iron Follow-up hemoglobin outpatient   Vitamin D deficiency, resolved Patient has hypervitaminosis D at this time with vitamin D level 148 Discontinue 50,000 IUs weekly Follow-up with primary care for continued management and appropriateness of lower dosage   Anxiety: Continue home Xanax   Hypertension: Continue home atenolol  Losartan and Lasix discontinued outpatient due to hypotension and symptoms   GERD PPI
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulation drug level above therapeutic, Aortic aneurysm, Aortic dilatation, Arteriosclerosis
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Bradycardia, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Catheterisation cardiac abnormal, Cerebral atrophy, Cerebral small vessel ischaemic disease, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Conduction disorder, Coronary artery disease, Ejection fraction decreased, Electrocardiogram abnormal
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Fall, Glucose urine present, Hyperglycaemia, Hypotension, Hypoxia
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Lung opacity, Metastases to bone, Metastatic neoplasm, Myocardial ischaemia, Oxygen saturation decreased
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Pain, Pneumonia, SARS-CoV-2 test positive, Sinus rhythm, Troponin increased
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Urine ketone body present, Walking distance test abnormal, Wall motion score index abnormal, X-ray limb normal
Clinical narrative: 79 y.o. male patient of MD with history of DMII (HgbA1C 13.3), CAD, HFrEF w/EF 25%, Prostate Cancer w/ bone mets, Hx of LV thrombus, AAA, DDD. Presents with Fall, weakness. Found to have acute hypoxic respiratory failure secondary COVID pneumonia. Improving with remdesivir and dexamethasone. PT consulted to evaluate patient, benefit from outpatient PT.      Acute Hypoxic Respiratory Failure, improved COVID Pneumonia Symptoms started a few days ago, no home O2 requirements, AF Found COVID+ 10/31, hypoxic, started on 4L NC CT w/patchy airspace opacities, worst in lingula and LLL Completed remdesivir course 5d Discharged to complete last 5 of dexamethasone 10d course O2 walk test on RA decrease to 86%, discharged on 1L NC Wean supplemental O2 as able outpatient Encouraged continued IS at home   Fall Likely 2/2 weakness and hypoxia in setting of COVID infection CT T/L w/ multifocal PNA, multifocal osseous metastasis, similar to prior, severe atherosclerosis w/aneurysmal dilatation of abdominal aorta 3.1 cm CT scans without acute trauma CT head noted small vessel ischemic dx, cerebral atrophy XR Knee Right w/no osseous or soft tissue abnormality PT/OT consulted; PT AMPAC 18   Hyperglycemia, stable DMII with diabetic neuropathy Likely will worsen w/oral steroid treatment Has hx of diabetic wounds, home wound care UA w/ketones, elevated glucose BHB 1.3 > 0.4 S/p Non-DKA insulin gtt, transitioned to lantus 11/1 While admitted Lantus 40u qAM, lispro 14u TID + SSI Consult to diabetic educator Discharged with Rx for Trulicity in addition to home metformin Consider addition of SGLT2i as well HFrEF, not in acute exacerbation HLD Elevated Trops Hx of STEMI Elevated trops likely in setting of demand ischemia Follows with cards, CHF clinic Trop 61 (b/l 55), BNP 821 (b/l 1100s) EKG w/ sinus rhythm, intraventricular conduction delay Last echo 11/2021 EF 25%, Grade I diastolic dysfunction L Heart Cath w/ 70% lesion in circumflex, 90%lesion in RCA, LVEF 25% w/abnormal wall motion Continue lipitor, plavix, coumadin Held on discharge PO lasix, metoprolol, entresto given hypotension and bradycardia Consider restart metoprolol at lower dose at follow up   Prostate Cancer w/ bone metastasis Follows with Dr.  Last PSA 0.08 Imaging with diffuse sclerotic osseous metastatic disease that has been stable Treated with Lupron, Zytiga, has had good response Pain treated with oxy 7.5mg, diclofenac gel Discussed with Dr., held lupron and zytiga during admission   Hx of LV mural thrombus INR supratherapeutic initially Follows with coumadin clinic Continued coumadin while admitted
Age: 69.0
Sex: M
Vaccine: COVID19, PNC20
Symptoms: Vitreous floaters
Clinical narrative: THIS PATIENT PRESENTED TO THE PHARMACY A FEW DAYS AFTER RECEIVING THE VACCINE AND STATED THAT HE HAS HAD SOME VISUAL DISTURBANCES THAT BEGAN A FEW HOURS AFTER GETTING VACCINATED. HE STATES THERE ARE "FLOATERS" IN HIS VISUAL FIELD. THIS PT THEN CAME AGAIN A FEW DAYS AGO AND IT HAS NOT GONE AWAY. I TOLD HIM HE MAY WANT TO CALL HIS PCP OR EYE DOCTOR AND GET LOOKED AT
Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine Spikevax was given outside of the date of use. It had been out of the freezer 31 days.