chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Asthenia, Atrial fibrillation, Atrial flutter, Blood culture negative
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Bradykinesia, COVID-19, Cardiac telemetry abnormal, Chest X-ray abnormal, Circadian rhythm sleep disorder
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Computerised tomogram head normal, Condition aggravated, Delirium, Dysphagia, Electrocardiogram abnormal
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Facial paralysis, Fall, Haemoglobin decreased, Hallucination, Lung infiltration
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Muscle rigidity, Parkinson's disease, Platelet count decreased, Pneumonia aspiration, Productive cough
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pyrexia, Respiratory disorder, SARS-CoV-2 test positive, Sinus rhythm, Transfusion
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 84.0
Sex: M
Vaccine: COVID19-2
Symptoms: Tremor
Clinical narrative: Patient is a 85 y.o. male with h/o- Parkinson disease, who presented from assisted living on 10/29/2023 with progressive generalized weakness and recurrent falls found to have COVID and aspiration pneumonia.         Assessment and Plan COVID Acute hypoxic respiratory failure Aspiration pneumonia-suspected -Noted to have low-grade fever and moist cough; no leukocytosis -Initial chest x-ray was negative, repeat chest x-ray confirms a right lung infiltrate -Noted to be COVID-positive on 10/30 -Currently requiring 1-2L nasal cannula -Completed course of IV Unasyn for aspiration pneumonia  -Continue supportive care for COVID with incentive spirometry, Acapella and Albuterol -Cont Decadron daily for 10 day course  -wean oxygen as able -blood cultures are negative   Acute delirium with intermittent hallucinations -Patient with intermittent episodes of mild delirium on exam in setting of COVID infection and IV steroids -Continue delirium precautions and reoriented as able -Continue melatonin nightly to assist with sleep-wake cycle -Added Depakote nightly.  Avoid any Haldol or benzos given his history of Parkinson's disease -improving   Atrial flutter/afib-transient -Noted on telemetry and EKG confirmed 11/1, back in sinus rhythm as of 11/2 -In setting of current COVID infection and respiratory illness -Asymptomatic -He is not an good candidate for anticoagulation secondary to his known myelofibrosis and chronic anemia requiring intermittent blood transfusions -continue aspirin daily and low-dose metoprolol for rate control   Recurrent falls Generalized weakness Parkinson disease, progressive -History of progressive Parkinson disease -With delayed responses, oral and hand tremors, bradykinesia, rigidity in upper extremities; mild right facial droop  -Follows with neurology/Dr. -did not respond well to multiple medications in the past -No longer on treatment -Noncontrast CT head nonacute -Neurology evaluated, no acute intervention at this time.  Continue management as above   Dysphagia -Likely secondary to Parkinson's now exacerbated by ongoing weakness due to COVID -passed MBS 10/31 and now on regular diet with slow sips/double swallow   Myelofibrosis Chronic anemia Thrombocytopenia POA due to myelofibrosis - follows with oncology, on Jakafi.  Hold Jakafi while hospitalized and resume outpatient -Receives intermittent blood transfusions, most recently on 10/27 -Hemoglobin currently at 9.0 platelets at 88K -Follow CBC and transfuse to keep hemoglobin greater than 8 per oncology recommendations CAD -aspirin, statin resumed   Essential hypertension -Blood pressure acceptable, noted to be on ACE inhibitor per PCP records but not noted on ALF list -Monitor without meds for now   Obstructive sleep apnea -Continue nocturnal CPAP   Chronic venous insufficiency -Leg elevation, compression stockings
Age: 35.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine Spikevax was given outside of the date of use.  The vaccine had been out of the recommended storage temperature for 31 days.
Age: 65.0
Sex: F
Vaccine: FLU4
Symptoms: Extra dose administered, No adverse event
Clinical narrative: Patient received a second high dose flu vaccine within a year. The first High dose was administered on 10/10/2023 and the second High dose was administered on 12/04/2023. Patient had no reaction, patient denies any symptoms at the visit.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Spikevax vaccine was given out of the date of use range. Vaccine had been out of the recommended temperature range for 31 days.
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Aortic valve stenosis, Blood culture negative, Blood gases normal, Blood lactic acid increased
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Brain natriuretic peptide increased, COVID-19, Culture urine negative, Decreased activity, Decubitus ulcer
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Dementia, Echocardiogram abnormal, Ejection fraction normal, Glycosylated haemoglobin increased, Hyperglycaemia
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Hypophagia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Laboratory test abnormal
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Lactic acidosis, Lethargy, Leukocytosis, Limb injury, Liver function test normal
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Oedema, PO2 normal, Pneumonia, SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Staphylococcus test positive, Tachycardia, Tachypnoea, Urine analysis abnormal, Urine antigen test
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Wound
Clinical narrative: Patient is a 87 y.o. female patient of DO with history of DVT, chronic anticoagulation, obesity, breast cancer, bullous pemphigoid, gout, HTN, hyperlipidemia, wheelchair dependence and nonambulatory presented to with abnormal lab, wound to right leg and coccyx.   Severe Sepsis, POA Leukocytosis, improved Lactic Acidosis, resolved Suspect due to coccygeal pressure sore, POA Left sided Pneumonia, possibly due to COVID Tachycardic, tachypnea, leukocytosis present on arrival LA elevated 2.4>2.1>1.9 COVID positive Influenza A/B-negative Given 2.5L NS bolus, mIVF Blood Cult x2 (10/31)- NGTD UA concerning for UTI Urine culture- with <10,000 of normal urogenital microbiota Given Cefepime/Vancomycin in hospital, will discharge with Doxycycline and Keflex x7 days to complete course Urinary antigens-negative MRSA screen-positive Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots. CM following- Plan at discharge is to enroll in hospice at Paramount   COVID Acute hypoxic respiratory failure, resolved ABG-unremarkable, except pO2 of 89. Given dexamethasone IV in hospital, Ordered PO x 4 days at discharge to complete course Wean O2 as able Currently on room air   Goals of Care Spoke with the son who states he is the POA. States he has one other brother that is not involved. Son states the patient would not want compression, shock, or intubation.  States at baseline patient has not walked since last December. Patient to enroll in hospice when discharged to Paramount Code status changed to DNRCC-A, no intubation Anasarca Suspect poor dietary intake and minimal activity as edema mainly in the dependent areas  BNP elevated-3,325 on arrival ECHO (7/24/23)- EF 55% and mild aortic valve stenosis LFTs unremarkable Discontinued IVF Daily weight   Strict I's and O's   Coccygeal pressure sore, POA Wound consult-Recommend santyl and dakins moistened gauze to left buttock, change daily. Antifungal cream to right side/under breast, and heel float boots.   Dementia Possible acute metabolic encephalopathy Lethargy, resolved Was at baseline per ECF on arrival ABG as above Aspiration precautions SLP consulted-Recommend chopped meats, thin liquids with 1:1 assistance Patient with improved mentation  Pharmacy consulted-to change IV medications back to home/oral meds   Hyperglycemia Patient without history of diabetes, suspect reactive Hgb A1c-6.7% (11/01)   Hyperlipidemia Home Rx: ASA 81 mg daily, Atorvastatin 40 mg nightly-Continue   Hypertension Home Rx: Metoprolol tartrate 12.5 mg BID-Continue Elevated at times, Monitor   Asthma, without exacerbation Home Rx: Spiriva 18 mcg inhalation daily-Continue   Gout Home Rx: Colchicine 0.6 mg daily-Continue DVT Chronic anticoagulation Home Rx: Eliquis 5 mg BID-Continue   Obesity  BMI 32.92 Lifestyle changes as able
Age: 68.0
Sex: F
Vaccine: PPV
Symptoms: Arthralgia, Ear pain, Pain
Clinical narrative: On Dec 16,  3rd day after injection,  I woke up with extreme joint pain all over my body.  That lasted 8 hours. I also had severe shooting pain above my left ear which lasted intermittently for 2 days.  I was going to go to ER, but then pain went away and has not returned.  No other symptoms.
Age: 7.0
Sex: M
Vaccine: MMR
Symptoms: Pyrexia, Rash, Vomiting
Clinical narrative: Mom said that she believes her son developed a delayed reaction to MMR. She mentioned a mild rash with fever the day after vaccination but rash only got worse 6 days later. She has tried his eczema cream without relief and rash then spread to his wrists, lower back, buttocks, and thighs.  He had a fever first day after vaccine but none since.  She states he was sent home from school this morning for vomiting and has vomited 5 times on 12/20/2023  She denies diarrhea.
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood sodium decreased, COVID-19, Chest X-ray normal, Diarrhoea
Clinical narrative: 83 y.o. male patient of MD with history of deafness, vision impairment, and HTN presented to Hospital with weakness, covid and hyponatremia    Weakness Fall Initial presenting symptom in the setting of hyponatremia and covid Fell after using toilet Will address other medical issues below PT/ OT Improving HHC on discharge   Covid-19 Virus Infection Date of onset of symptoms: Uncertain (suspected 1-2 weeks ago) Symptoms present on admission: weakness Date of covid positive test: 11/8 Vaccination status: vaccinated Imaging: CXR non-acute Oxygen requirements on admission: none Current oxygen requirements: none Medical therapy: not indicated   Moderate Hyponatremia In the setting of covid infection Na 127 in ED Continue MIVF - NS Improving   Fever In the setting of positive covid testing CXR negative stool studies, UA negative Suspected in relation to covid infection Diarrhea Per family history, but no bowel movements in ED Stool studies, KUB negative Improved   Visual Impairment Deafness   BPH HTN Continue home meds