chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 71.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Pt has a PMH of MI, CAD s/p CABG, and CKD stage 3. He presented to the ED with a complaint of weakness. Pt has developed shortness of breath and coughing. He was found to be COVID positive and admitted with COVID-19 pneumonia.
Age: 28.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Half dose given
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Diarrhoea, Fatigue, Gastric disorder, Malaise, Paranasal sinus discomfort
Clinical narrative: I was having diarrhea on December first. That led to a sneezing and a runny nose by the evening. The next day the stomach issues had resolved but the runny nose had gotten worse, and I was congested and having sinus issues. I then developed a fever and that lasted through the fifth. At this point I was having horrible congestion and was tired- I also started having a rash which is normal for me when I am sick, so I knew I was very sick. By the seventh I felt that I was having a ton of pressure in my sinus' and went to my doctor and was diagnosed with a bad a sinus infection. They gave me a ten-day course of Augmentin for that which helped with the left side maxillary pain that I was having, and things started to resolve the symptoms as well. I did take a test for COVID-19 which was negative as well.  At this point I am having a runny nose, but it is clear and no longer as bad as it was with the pressure and pain of the sinus infection.  I did have my flu shot a week prior on 09/19/2022 to getting my COVID-19 vaccine.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pyrexia, Rash, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative
Clinical narrative: I was having diarrhea on December first. That led to a sneezing and a runny nose by the evening. The next day the stomach issues had resolved but the runny nose had gotten worse, and I was congested and having sinus issues. I then developed a fever and that lasted through the fifth. At this point I was having horrible congestion and was tired- I also started having a rash which is normal for me when I am sick, so I knew I was very sick. By the seventh I felt that I was having a ton of pressure in my sinus' and went to my doctor and was diagnosed with a bad a sinus infection. They gave me a ten-day course of Augmentin for that which helped with the left side maxillary pain that I was having, and things started to resolve the symptoms as well. I did take a test for COVID-19 which was negative as well.  At this point I am having a runny nose, but it is clear and no longer as bad as it was with the pressure and pain of the sinus infection.  I did have my flu shot a week prior on 09/19/2022 to getting my COVID-19 vaccine.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Sinus disorder, Sinus pain, Sinusitis, Sneezing
Clinical narrative: I was having diarrhea on December first. That led to a sneezing and a runny nose by the evening. The next day the stomach issues had resolved but the runny nose had gotten worse, and I was congested and having sinus issues. I then developed a fever and that lasted through the fifth. At this point I was having horrible congestion and was tired- I also started having a rash which is normal for me when I am sick, so I knew I was very sick. By the seventh I felt that I was having a ton of pressure in my sinus' and went to my doctor and was diagnosed with a bad a sinus infection. They gave me a ten-day course of Augmentin for that which helped with the left side maxillary pain that I was having, and things started to resolve the symptoms as well. I did take a test for COVID-19 which was negative as well.  At this point I am having a runny nose, but it is clear and no longer as bad as it was with the pressure and pain of the sinus infection.  I did have my flu shot a week prior on 09/19/2022 to getting my COVID-19 vaccine.
Age: 51.0
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Half dose given
Age: 53.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Chills, Cough, Fatigue, Feeling abnormal
Clinical narrative: On 12/20/2022, I woke up feeling off. I thought maybe it was a seasonal bug, but then it got worse. I was feeling warm, lethargic, had a dry cough, felt fatigued, had a headache and chills. I tested myself twice for Covid-19 on 12/21/2022 and the test came back positive. I contacted my PCP. I had an appointment later that day and while there, I told them I tested positive twice and she prescribed me Paxlovid and a Z-Pack because I have a history of Pneumonia. After taking the Paxlovid, I feel that it really helped.
Age: 53.0
Sex: F
Vaccine: COVID19-2
Symptoms: Feeling hot, Headache, Lethargy, SARS-CoV-2 test positive
Clinical narrative: On 12/20/2022, I woke up feeling off. I thought maybe it was a seasonal bug, but then it got worse. I was feeling warm, lethargic, had a dry cough, felt fatigued, had a headache and chills. I tested myself twice for Covid-19 on 12/21/2022 and the test came back positive. I contacted my PCP. I had an appointment later that day and while there, I told them I tested positive twice and she prescribed me Paxlovid and a Z-Pack because I have a history of Pneumonia. After taking the Paxlovid, I feel that it really helped.
Age: 72.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Fatigue, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: 11/10/22 presents to ED for "fatigue". "fever" PMHx of ", bilateral decreased auditory acuity, HTN/dyslipidemia, NIDDM, COPD/remote tobacco use, h/o treated Hepatitis C+, MGUS, chronic RLE DV"
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Inadvertent administration past the 30-day Use by Date of the Moderna vaccine. No Symptoms to report as no adverse event was reported.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Alpha 1 foetoprotein normal, Back pain, Blood parathyroid hormone normal, Blood smear test abnormal
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Blood thyroid stimulating hormone normal, Bone scan abnormal, C-reactive protein normal, COVID-19, Carbohydrate antigen 19-9
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Carcinoembryonic antigen normal, Full blood count abnormal, Human chorionic gonadotropin negative, Leukocytosis, Magnetic resonance cholangiopancreatography
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Magnetic resonance imaging spinal, Magnetic resonance imaging thoracic abnormal, Metabolic function test normal, Muscular weakness, Myelopathy
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Red blood cell sedimentation rate normal, SARS-CoV-2 test positive, Scan with contrast abnormal, Scrotal cyst, Sleep disorder
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: Tenderness, Thoracic vertebral fracture, Ultrasound scan abnormal, Vitamin D decreased, Vitamin D deficiency
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 19.0
Sex: M
Vaccine: COVID19
Symptoms: White blood cell count increased
Clinical narrative: COVID+ 12/23/22.  Vaccination status - pfizer x3 BRIEF OVERVIEW: Discharge Provider: PRIVATE MD Primary Care Provider at Discharge: PRIVATE MD Admission Date: 12/23/2022 Discharge Date: 12/24/2022   DISCHARGE DIAGNOSES 1. Vitamin D deficiency 2. Pathologic compression fracture of T6-8 3. COVID -19 4. Leukocytosis - resolved 5. AKI DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 21 y.o. male with no significant past medical history who presented to emergency department on 12/23 with sudden and significant back pain that woke him up at 3:00 a.m. notably, there was no inciting events.  He denied recent trauma of any kind as well as prior pain.  He does not play any sports.  He has not had any recent flu-like symptoms.  He denied bowel or bladder incontinence.In the ED his VSS, his CMP returned wnl no protein gap, crp normal, ESR 14, blood cultures drawn, CBC with WBC 19, he was given 1L NS, toradol for back pain. COVID returns positive.  He was asymptomatic.  He had tenderness to his thoracic spine and weakness of upper extremities. He underwent MRI whole spine, which showed subacute fractures of T6-T8 with <50 vertebral height loss T6, 50% or greater at T7 and T8. Degenerative changes of spine. Neurology and ortho spine consulted in ED and recommended inpatient admission for work up.    Further workup is as follows.  CT with contrast demonstrated prior mentioned subacute compression fractures of T6-8, as well as hypodensity of the pancreatic head.  MRI with MRCP to evaluate this was unremarkable.  A scrotal ultrasound demonstrated a small epidermal cyst with no concern for mass.  A full bone scan demonstrated only the above-mentioned fractures with no other suspicious for lytic lesions.  Initially his complete blood count demonstrated leukocytosis, however, this did resolve after admission.  Peripheral smear demonstrated reactive leukocytosis with a left shift.  Beta HCG, AFP, CEA CA19-9 were negative.  PTH and TSH were normal.  Vitamin-D was 9, representing severe deficiency.    He was started on 50,000 IU vitamin D weekly, and his painwas well controlled with acetaminophen and a lidocaine patch. NSAID's were avoided during hospitalization due to AKI after contrast. He was given a small bolus of fluids and recommended to follow up with PCP for further monitoring. Ortho Spine was consulted be noted that he did not need a brace, and gave him 10lb lifting restrictions until follow up in the clinic in 2 weeks. Hematology on consulted and recommenced outpatient follow up.    He was discharged on 12/24 with instructions to follow up with PCP, Heme/onc, and othro. He was educated on his activity restrictions and instructed to continue the vitamin D, and tylenol/lidocaine and ibuprofen for pain. He, and his parents, were in agreement with the plan and had no questions or concerns at the time of discharge.
Age: 64.0
Sex: F
Vaccine: COVID19-2
Symptoms: Condition aggravated, Pruritus, Psoriasis, Skin exfoliation
Clinical narrative: Itchy scaling, psoriasis flaring of which not noted until covid vaccinations. Lab tests done after previous
Age: 72.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Developed Covid in Dec after receiving  booster vaccine in Sept.  I have had all Covid vaccines offered
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: Inadvertent administration past the 30-day Use by Date of the Moderna vaccine. No Symptoms to report as no adverse event was reported.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Cough, Dizziness, Headache, Malaise
Clinical narrative: My arm was sore for a couple of days after receiving the vaccine. On 11/24/2022, I began not feeling well with a runny nose, sore throat and a headache. On 11/25/2022, I developed a cough and decided to take a COVID-19 home test and it was positive. I had a video appointment with a special nurse with my pharmacy on 11/26/2022 and I got a prescription for Paxlovid.  After taking Paxlovid for three days, I began feeling little lightheaded and my stomach felt queasy.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Nausea, Oropharyngeal pain, Pain in extremity, Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: My arm was sore for a couple of days after receiving the vaccine. On 11/24/2022, I began not feeling well with a runny nose, sore throat and a headache. On 11/25/2022, I developed a cough and decided to take a COVID-19 home test and it was positive. I had a video appointment with a special nurse with my pharmacy on 11/26/2022 and I got a prescription for Paxlovid.  After taking Paxlovid for three days, I began feeling little lightheaded and my stomach felt queasy.
Age: 8.0
Sex: F
Vaccine: COVID19-2
Symptoms: Arthralgia, Arthritis, Auscultation, Band neutrophil percentage increased, C-reactive protein increased
Clinical narrative: Briefly, 8-year-old female with history as above with headaches now here with 36 hours of painful urticaria and swelling of the knees and arms.  She did get the COVID booster 3 days ago prior to this starting.  No other new exposures.  She has significant pain in her joints and is having difficulty walking.  She has had no fevers.  No difficulty breathing.  No syncope.  She has taken antihistamines however with no significant improvement.            My examination revealed the patient to be active, alert, and in no distress.  Has diffuse urticaria throughout her body which blanches and has some dusky central component to it.  Possible dermatographia some.  No purpura or petechiae.  No vesicles.  The HEENT exam was clear, no conjunctival injection, no ulcerations, the neck was supple, the lungs clear to auscultation, no abnormal cardiac sounds, the abdomen was nontender throughout.  Does have significantly swollen hands and joints of the hand bilaterally as well as left greater than right knee swelling.  Does have some pain with attempted range of motion.  Able to walk but gingerly.            ED course: 8-year-old female with concerns for urticaria and arthralgia/arthritis.  No systemic signs of fever.  Concern for urticaria multiform a or serum sickness-like reaction.  Trigger could be COVID-vaccine.  Other concerns could be acute rheumatoid arthritis.  No other signs of sepsis or other concerns at this time.  We will plan on labs, symptomatic management with antihistamines and NSAIDs with close reassessment and if not improving may consider consultation with rheumatology or dermatology.           12/27/2022:  Labs with mild leukocytosis and elevated CRP, normal ESR. Patient developed low-grade fever in ED Rheumatology team consulted, recommended naproxen and PCP f/u. Patient tachycardic and hypotensive in setting of fever, given fluid bolus with improvement in HR but no change in BP. Question post-vaccine hyperinflammatory syndrome vs. serum sickness like reaction vs. urticaria multiforme.  On assumption of care the patient had tachycardia and hypotension with fever. The hypotension had improved modestly after 20ml/kg NS. Our differential was serum sickness or urticaria multiforme though a more rare vasculitis was possible, as was a COVID vaccine reaction eg myocarditis. Less likely but possible are sepsis (fever, tachycardia, hypotension) which is less likely because it would not explain the urticaria and the patient does not have specific sepsis risk factors; and anaphylaxis which is unlikely because there is no clear trigger and the cardiovascular involvement of anaphylaxis would be unlikely to appear 2 days into the illness.   To investigate these possibilities, we obtained a bedside cardiac US (with normal function/no effusion), additional labs which showed ketosis but no signs of myocarditis. Given ongoing persistent tachycardia we admitted the patient for observation and rheum consultation. The patient was stable at the time of transfer.
Age: 8.0
Sex: F
Vaccine: COVID19-2
Symptoms: Echocardiogram normal, Gait disturbance, Hypotension, Joint swelling, Ketosis
Clinical narrative: Briefly, 8-year-old female with history as above with headaches now here with 36 hours of painful urticaria and swelling of the knees and arms.  She did get the COVID booster 3 days ago prior to this starting.  No other new exposures.  She has significant pain in her joints and is having difficulty walking.  She has had no fevers.  No difficulty breathing.  No syncope.  She has taken antihistamines however with no significant improvement.            My examination revealed the patient to be active, alert, and in no distress.  Has diffuse urticaria throughout her body which blanches and has some dusky central component to it.  Possible dermatographia some.  No purpura or petechiae.  No vesicles.  The HEENT exam was clear, no conjunctival injection, no ulcerations, the neck was supple, the lungs clear to auscultation, no abnormal cardiac sounds, the abdomen was nontender throughout.  Does have significantly swollen hands and joints of the hand bilaterally as well as left greater than right knee swelling.  Does have some pain with attempted range of motion.  Able to walk but gingerly.            ED course: 8-year-old female with concerns for urticaria and arthralgia/arthritis.  No systemic signs of fever.  Concern for urticaria multiform a or serum sickness-like reaction.  Trigger could be COVID-vaccine.  Other concerns could be acute rheumatoid arthritis.  No other signs of sepsis or other concerns at this time.  We will plan on labs, symptomatic management with antihistamines and NSAIDs with close reassessment and if not improving may consider consultation with rheumatology or dermatology.           12/27/2022:  Labs with mild leukocytosis and elevated CRP, normal ESR. Patient developed low-grade fever in ED Rheumatology team consulted, recommended naproxen and PCP f/u. Patient tachycardic and hypotensive in setting of fever, given fluid bolus with improvement in HR but no change in BP. Question post-vaccine hyperinflammatory syndrome vs. serum sickness like reaction vs. urticaria multiforme.  On assumption of care the patient had tachycardia and hypotension with fever. The hypotension had improved modestly after 20ml/kg NS. Our differential was serum sickness or urticaria multiforme though a more rare vasculitis was possible, as was a COVID vaccine reaction eg myocarditis. Less likely but possible are sepsis (fever, tachycardia, hypotension) which is less likely because it would not explain the urticaria and the patient does not have specific sepsis risk factors; and anaphylaxis which is unlikely because there is no clear trigger and the cardiovascular involvement of anaphylaxis would be unlikely to appear 2 days into the illness.   To investigate these possibilities, we obtained a bedside cardiac US (with normal function/no effusion), additional labs which showed ketosis but no signs of myocarditis. Given ongoing persistent tachycardia we admitted the patient for observation and rheum consultation. The patient was stable at the time of transfer.
Age: 8.0
Sex: F
Vaccine: COVID19-2
Symptoms: Laboratory test abnormal, Leukocytosis, Neutrophil count increased, Pain, Peripheral swelling
Clinical narrative: Briefly, 8-year-old female with history as above with headaches now here with 36 hours of painful urticaria and swelling of the knees and arms.  She did get the COVID booster 3 days ago prior to this starting.  No other new exposures.  She has significant pain in her joints and is having difficulty walking.  She has had no fevers.  No difficulty breathing.  No syncope.  She has taken antihistamines however with no significant improvement.            My examination revealed the patient to be active, alert, and in no distress.  Has diffuse urticaria throughout her body which blanches and has some dusky central component to it.  Possible dermatographia some.  No purpura or petechiae.  No vesicles.  The HEENT exam was clear, no conjunctival injection, no ulcerations, the neck was supple, the lungs clear to auscultation, no abnormal cardiac sounds, the abdomen was nontender throughout.  Does have significantly swollen hands and joints of the hand bilaterally as well as left greater than right knee swelling.  Does have some pain with attempted range of motion.  Able to walk but gingerly.            ED course: 8-year-old female with concerns for urticaria and arthralgia/arthritis.  No systemic signs of fever.  Concern for urticaria multiform a or serum sickness-like reaction.  Trigger could be COVID-vaccine.  Other concerns could be acute rheumatoid arthritis.  No other signs of sepsis or other concerns at this time.  We will plan on labs, symptomatic management with antihistamines and NSAIDs with close reassessment and if not improving may consider consultation with rheumatology or dermatology.           12/27/2022:  Labs with mild leukocytosis and elevated CRP, normal ESR. Patient developed low-grade fever in ED Rheumatology team consulted, recommended naproxen and PCP f/u. Patient tachycardic and hypotensive in setting of fever, given fluid bolus with improvement in HR but no change in BP. Question post-vaccine hyperinflammatory syndrome vs. serum sickness like reaction vs. urticaria multiforme.  On assumption of care the patient had tachycardia and hypotension with fever. The hypotension had improved modestly after 20ml/kg NS. Our differential was serum sickness or urticaria multiforme though a more rare vasculitis was possible, as was a COVID vaccine reaction eg myocarditis. Less likely but possible are sepsis (fever, tachycardia, hypotension) which is less likely because it would not explain the urticaria and the patient does not have specific sepsis risk factors; and anaphylaxis which is unlikely because there is no clear trigger and the cardiovascular involvement of anaphylaxis would be unlikely to appear 2 days into the illness.   To investigate these possibilities, we obtained a bedside cardiac US (with normal function/no effusion), additional labs which showed ketosis but no signs of myocarditis. Given ongoing persistent tachycardia we admitted the patient for observation and rheum consultation. The patient was stable at the time of transfer.
Age: 8.0
Sex: F
Vaccine: COVID19-2
Symptoms: Procalcitonin, Pyrexia, Red blood cell sedimentation rate normal, Tachycardia, Urticaria
Clinical narrative: Briefly, 8-year-old female with history as above with headaches now here with 36 hours of painful urticaria and swelling of the knees and arms.  She did get the COVID booster 3 days ago prior to this starting.  No other new exposures.  She has significant pain in her joints and is having difficulty walking.  She has had no fevers.  No difficulty breathing.  No syncope.  She has taken antihistamines however with no significant improvement.            My examination revealed the patient to be active, alert, and in no distress.  Has diffuse urticaria throughout her body which blanches and has some dusky central component to it.  Possible dermatographia some.  No purpura or petechiae.  No vesicles.  The HEENT exam was clear, no conjunctival injection, no ulcerations, the neck was supple, the lungs clear to auscultation, no abnormal cardiac sounds, the abdomen was nontender throughout.  Does have significantly swollen hands and joints of the hand bilaterally as well as left greater than right knee swelling.  Does have some pain with attempted range of motion.  Able to walk but gingerly.            ED course: 8-year-old female with concerns for urticaria and arthralgia/arthritis.  No systemic signs of fever.  Concern for urticaria multiform a or serum sickness-like reaction.  Trigger could be COVID-vaccine.  Other concerns could be acute rheumatoid arthritis.  No other signs of sepsis or other concerns at this time.  We will plan on labs, symptomatic management with antihistamines and NSAIDs with close reassessment and if not improving may consider consultation with rheumatology or dermatology.           12/27/2022:  Labs with mild leukocytosis and elevated CRP, normal ESR. Patient developed low-grade fever in ED Rheumatology team consulted, recommended naproxen and PCP f/u. Patient tachycardic and hypotensive in setting of fever, given fluid bolus with improvement in HR but no change in BP. Question post-vaccine hyperinflammatory syndrome vs. serum sickness like reaction vs. urticaria multiforme.  On assumption of care the patient had tachycardia and hypotension with fever. The hypotension had improved modestly after 20ml/kg NS. Our differential was serum sickness or urticaria multiforme though a more rare vasculitis was possible, as was a COVID vaccine reaction eg myocarditis. Less likely but possible are sepsis (fever, tachycardia, hypotension) which is less likely because it would not explain the urticaria and the patient does not have specific sepsis risk factors; and anaphylaxis which is unlikely because there is no clear trigger and the cardiovascular involvement of anaphylaxis would be unlikely to appear 2 days into the illness.   To investigate these possibilities, we obtained a bedside cardiac US (with normal function/no effusion), additional labs which showed ketosis but no signs of myocarditis. Given ongoing persistent tachycardia we admitted the patient for observation and rheum consultation. The patient was stable at the time of transfer.
Age: 8.0
Sex: F
Vaccine: COVID19-2
Symptoms: White blood cell count increased
Clinical narrative: Briefly, 8-year-old female with history as above with headaches now here with 36 hours of painful urticaria and swelling of the knees and arms.  She did get the COVID booster 3 days ago prior to this starting.  No other new exposures.  She has significant pain in her joints and is having difficulty walking.  She has had no fevers.  No difficulty breathing.  No syncope.  She has taken antihistamines however with no significant improvement.            My examination revealed the patient to be active, alert, and in no distress.  Has diffuse urticaria throughout her body which blanches and has some dusky central component to it.  Possible dermatographia some.  No purpura or petechiae.  No vesicles.  The HEENT exam was clear, no conjunctival injection, no ulcerations, the neck was supple, the lungs clear to auscultation, no abnormal cardiac sounds, the abdomen was nontender throughout.  Does have significantly swollen hands and joints of the hand bilaterally as well as left greater than right knee swelling.  Does have some pain with attempted range of motion.  Able to walk but gingerly.            ED course: 8-year-old female with concerns for urticaria and arthralgia/arthritis.  No systemic signs of fever.  Concern for urticaria multiform a or serum sickness-like reaction.  Trigger could be COVID-vaccine.  Other concerns could be acute rheumatoid arthritis.  No other signs of sepsis or other concerns at this time.  We will plan on labs, symptomatic management with antihistamines and NSAIDs with close reassessment and if not improving may consider consultation with rheumatology or dermatology.           12/27/2022:  Labs with mild leukocytosis and elevated CRP, normal ESR. Patient developed low-grade fever in ED Rheumatology team consulted, recommended naproxen and PCP f/u. Patient tachycardic and hypotensive in setting of fever, given fluid bolus with improvement in HR but no change in BP. Question post-vaccine hyperinflammatory syndrome vs. serum sickness like reaction vs. urticaria multiforme.  On assumption of care the patient had tachycardia and hypotension with fever. The hypotension had improved modestly after 20ml/kg NS. Our differential was serum sickness or urticaria multiforme though a more rare vasculitis was possible, as was a COVID vaccine reaction eg myocarditis. Less likely but possible are sepsis (fever, tachycardia, hypotension) which is less likely because it would not explain the urticaria and the patient does not have specific sepsis risk factors; and anaphylaxis which is unlikely because there is no clear trigger and the cardiovascular involvement of anaphylaxis would be unlikely to appear 2 days into the illness.   To investigate these possibilities, we obtained a bedside cardiac US (with normal function/no effusion), additional labs which showed ketosis but no signs of myocarditis. Given ongoing persistent tachycardia we admitted the patient for observation and rheum consultation. The patient was stable at the time of transfer.
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute myocardial infarction, Blood chloride increased, Blood creatinine increased, Blood lactic acid
Clinical narrative: Patient is a 90 y.o. female patient of MD with history of coronary artery disease status post CABG in 1996, type 2 diabetes, essential hypertension, hyperlipidemia, PAD status post left femoral-tibial bypass 5/2019 and recent hospitalization with discharge on 11/29/2022 following intubation secondary to acute metabolic encephalopathy of unclear etiology.  She was initially thought to have had a stroke, but MRI was negative.  She was diagnosed with VZV infection/Ramsay Hunt syndrome and treated with a course of steroids and antivirals.  She was discharged for rehab.  Reportedly she was diagnosed with COVID-pneumonia during that time.  She then had a steady decline over the next week with difficulty with p.o. intake.  She was found unresponsive the morning of 12/3 and was brought into the emergency department. On arrival to the emergency department blood pressure 50s systolic but following IV fluid bolus is 85/33 with subsequent reading of 74/34.  Respiratory rate is 27. Temperature is 99.1. She was 96% on room air. WBC 20,000. Creatinine 5.51. Sodium 151.  Chloride 119. Potassium 3.0. Troponin 111.  proBNP 2,068.  Lactic acid 2.5. Family requested no further radiologic or invasive testing. Condition was discussed by ED attending with the family who opted to proceed with DNR CC and be admitted for inpatient hospice. She had a slow decline over the course of her hospitalization and passed the away the morning of 12/7/22 with a time of death 0750.      Discharge diagnosis ? Viral sepsis due to COVID-19 pneumonia, POA COVID-19 pneumonia Acute metabolic encephalopathy Severe dehydration Hypernatremia/hyperchloremia NSTEMI Leukocytosis AKI on CKD  VZV infection/Ramsay Hunt syndrome Chronic left heel wound, unstageable Dysphagia Chronic HFpEF Essential hypertension Coronary artery disease Type 2 diabetes Peripheral arterial disease
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Blood potassium decreased, Blood sodium increased, COVID-19 pneumonia, Cardiac failure, Cardiac failure chronic
Clinical narrative: Patient is a 90 y.o. female patient of MD with history of coronary artery disease status post CABG in 1996, type 2 diabetes, essential hypertension, hyperlipidemia, PAD status post left femoral-tibial bypass 5/2019 and recent hospitalization with discharge on 11/29/2022 following intubation secondary to acute metabolic encephalopathy of unclear etiology.  She was initially thought to have had a stroke, but MRI was negative.  She was diagnosed with VZV infection/Ramsay Hunt syndrome and treated with a course of steroids and antivirals.  She was discharged for rehab.  Reportedly she was diagnosed with COVID-pneumonia during that time.  She then had a steady decline over the next week with difficulty with p.o. intake.  She was found unresponsive the morning of 12/3 and was brought into the emergency department. On arrival to the emergency department blood pressure 50s systolic but following IV fluid bolus is 85/33 with subsequent reading of 74/34.  Respiratory rate is 27. Temperature is 99.1. She was 96% on room air. WBC 20,000. Creatinine 5.51. Sodium 151.  Chloride 119. Potassium 3.0. Troponin 111.  proBNP 2,068.  Lactic acid 2.5. Family requested no further radiologic or invasive testing. Condition was discussed by ED attending with the family who opted to proceed with DNR CC and be admitted for inpatient hospice. She had a slow decline over the course of her hospitalization and passed the away the morning of 12/7/22 with a time of death 0750.      Discharge diagnosis ? Viral sepsis due to COVID-19 pneumonia, POA COVID-19 pneumonia Acute metabolic encephalopathy Severe dehydration Hypernatremia/hyperchloremia NSTEMI Leukocytosis AKI on CKD  VZV infection/Ramsay Hunt syndrome Chronic left heel wound, unstageable Dysphagia Chronic HFpEF Essential hypertension Coronary artery disease Type 2 diabetes Peripheral arterial disease