chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 16.0
Sex: F
Vaccine: MENB
Symptoms: Extra dose administered
Clinical narrative: Extra Dose; This non-serious case was reported by a other health professional via call center representative and described the occurrence of extra dose administered in a 16-year-old female patient who received Men B NVS (Bexsero) (batch number TP294, expiry date 31-OCT-2024) for prophylaxis.   Concomitant products included MENINGOCOCCAL B VACCINE (BEXSERO) and MENINGOCOCCAL B VACCINE (BEXSERO).   On 01-MAY-2023, the patient received the 3rd dose of Bexsero. On 01-MAY-2023, an unknown time after receiving Bexsero, the patient experienced extra dose administered (Verbatim: Extra Dose). The outcome of the extra dose administered was unknown.   This report is made by GSK without prejudice and does not imply any admission or liability for the incident or its consequences.   Additional Information: GSK Receipt Date: 04-MAY-2023 Medical Assistant reported that she inadvertently administered a dose of Bexsero to a 16-year-old female patient that had already received two doses.  The patient was dosed on 01Feb2023 (lot number EN939, expiration date 31Oct2024), 29Mar2023 (lot number TP294, expiration date 31Oct2024). The patient received third dose.  The vaccine administration facility was the same as primary reporter. The reporter was consented to follow up. The patient received third dose of Bexsero, which led to Extra dose administered.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Pyrexia
Clinical narrative: fever; some chills; This spontaneous case was reported by a patient and describes the occurrence of PYREXIA (fever) and CHILLS (some chills) in a 76-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis.     Concurrent medical conditions included Diabetes.   On an unknown date, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Spikevax) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PYREXIA (fever) and CHILLS (some chills). At the time of the report, PYREXIA (fever) and CHILLS (some chills) had resolved.        For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications were reported.  No treatment medications were reported.    This case was linked to MOD-2023-723031 (Patient Link).
Sex: U
Vaccine: COVID19-2
Symptoms: No adverse event, Wrong product administered
Clinical narrative: No adverse event; Patient received 0.2mL dose of the presentation of the vial with the dark pink cap instead of the 0.25mL dose of the dark blue cap presentation.; This spontaneous case was reported by an other health care professional and describes the occurrence of WRONG PRODUCT ADMINISTERED (Patient received 0.2mL dose of the presentation of the vial with the dark pink cap instead of the 0.25mL dose of the dark blue cap presentation.) and NO ADVERSE EVENT (No adverse event) in a child patient of an unknown gender who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. 216K22A) for COVID-19 prophylaxis.     No Medical History information was reported.    In April 2023, the patient received second dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) .2 milliliter. In April 2023, the patient experienced WRONG PRODUCT ADMINISTERED (Patient received 0.2mL dose of the presentation of the vial with the dark pink cap instead of the 0.25mL dose of the dark blue cap presentation.). On an unknown date, the patient experienced NO ADVERSE EVENT (No adverse event). At the time of the report, WRONG PRODUCT ADMINISTERED (Patient received 0.2mL dose of the presentation of the vial with the dark pink cap instead of the 0.25mL dose of the dark blue cap presentation.) and NO ADVERSE EVENT (No adverse event) outcome was unknown.        For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Unknown), the reporter considered NO ADVERSE EVENT (No adverse event) to be not related. No further causality assessment was provided for WRONG PRODUCT ADMINISTERED (Patient received 0.2mL dose of the presentation of the vial with the dark pink cap instead of the 0.25mL dose of the dark blue cap presentation.).    No concomitant medications was reported. Suspect product dosage text was reported as unknown. It was reported that 4 patients received 0.2mL doses of the presentation of the vial with the dark pink cap instead of the 0.25mL dose of the dark blue cap presentation. Doses were administered on 21-APR-2023 and 28-APR-2023. Each was administered as a second dose in the series. Patients ranged from 10m-5y old.  No treatment drug details was reported. This case contains information of 1st out of 4 patients as described by the reporter.   This case was linked to US-MODERNATX, INC.-MOD-2023-723265, US-MODERNATX, INC.-MOD-2023-723266, US-MODERNATX, INC.-MOD-2023-723267 (E2B Linked Report).; Sender's Comments:  US-MODERNATX, INC.-MOD-2023-723266:Patient 3 US-MODERNATX, INC.-MOD-2023-723265:Patient 2 US-MODERNATX, INC.-MOD-2023-723267:Patient 4
Age: 56.0
Sex: M
Vaccine: COVID19
Symptoms: Anosmia, Anxiety, Brain fog, COVID-19, Fatigue
Clinical narrative: Was feeling in full health prior to this vaccine so went in with my wife/ partner to get our 4th boosters.  Within 2 hours of receiving the vaccine, my left arm was noticeably sore.  Woke up with fever about 2 a.m. the next morning. The fever persisted and was low grade, but was intermittent for several days. Did my best to stay hydrated.  Deep exhaustion and fatigue. Slept a lot. Up to 18 - 20 hours per day.  Loss of smell for 3 - 4 days + (couldn't smell bacon cooking or coffee brewing. No specific treatment applied.  Intermittent, brief sharp headaches.  Brain fog  Anxiety  Tested negative on April 29, 2023 at approximately 10 am  Ongoing symptoms in recovery - fatigue, brain fog, anxiety
Age: 56.0
Sex: M
Vaccine: COVID19
Symptoms: Headache, Hypersomnia, Pain in extremity, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: Was feeling in full health prior to this vaccine so went in with my wife/ partner to get our 4th boosters.  Within 2 hours of receiving the vaccine, my left arm was noticeably sore.  Woke up with fever about 2 a.m. the next morning. The fever persisted and was low grade, but was intermittent for several days. Did my best to stay hydrated.  Deep exhaustion and fatigue. Slept a lot. Up to 18 - 20 hours per day.  Loss of smell for 3 - 4 days + (couldn't smell bacon cooking or coffee brewing. No specific treatment applied.  Intermittent, brief sharp headaches.  Brain fog  Anxiety  Tested negative on April 29, 2023 at approximately 10 am  Ongoing symptoms in recovery - fatigue, brain fog, anxiety
Age: 50.0
Sex: F
Vaccine: VARZOS
Symptoms: Anaphylactic reaction, Asthenia, Dizziness, Dysphagia, Injection site pain
Clinical narrative: Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fever-Medium, Systemic: Weakness-Severe, Additional Details: Pt. said the shot was administered really high on her left arm and was very painful.  She said that a couple of hours after receiving the vaccine she was dizzy, weak, had a fever, and her left arm was very swollen.  She went to the ER where she said she experienced anaphylaxis (throat closing in) and was told a blood vessel might have been hit during administration causing the reaction.
Age: 50.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site swelling, Peripheral swelling, Product administered at inappropriate site, Pyrexia, Throat tightness
Clinical narrative: Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fever-Medium, Systemic: Weakness-Severe, Additional Details: Pt. said the shot was administered really high on her left arm and was very painful.  She said that a couple of hours after receiving the vaccine she was dizzy, weak, had a fever, and her left arm was very swollen.  She went to the ER where she said she experienced anaphylaxis (throat closing in) and was told a blood vessel might have been hit during administration causing the reaction.
Age: 51.0
Sex: F
Vaccine: COVID19-2
Symptoms: Mobility decreased, Myalgia
Clinical narrative: Site: Pain at Injection Site-Medium, Additional Details: patient said muscle soreness and still unable to move arm fully up or backwards
Age: 78.0
Sex: F
Vaccine: VARZOS
Symptoms: Rash, Urticaria
Clinical narrative: Systemic: Allergic: Rash Generalized-Medium, Additional Details: Patient said whenever she goes to the hospital she gets hives. Counseled patient to take diphenhydramine and get allergy testing.
Age: 26.0
Sex: M
Vaccine: COVID19
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: OBSTRUCTIVE SLEEP APNEA.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Neuropathy peripheral, Symptom recurrence
Clinical narrative: PERIPHERAL NEUROPATHY 8/4/2022,  10/26/2022,  12/18/2022,  11/29/2022  -- RECURRENCE OF SAME SYMPTOMS
Age: 1.0
Sex: F
Vaccine: VARCEL
Symptoms: Blood immunoglobulin G, Blood immunoglobulin M, Pyrexia, Rash morbilliform, Rash vesicular
Clinical narrative: Fever to 104, 17/23-1/21/23.  Vomiting intermittently first week.  Morbiliform rash developed 1/14/23, persisted but evolved and became vesicular around 1/23/23.
Age: 1.0
Sex: F
Vaccine: VARCEL
Symptoms: Skin lesion, Varicella virus test positive, Vomiting
Clinical narrative: Fever to 104, 17/23-1/21/23.  Vomiting intermittently first week.  Morbiliform rash developed 1/14/23, persisted but evolved and became vesicular around 1/23/23.
Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Hypotension, Neuropathy peripheral, Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE NEUROPATHY HYPOTENSION 4/27/2022 -- RECURRENCE OF SAME SYMPTOMS
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE  ACUTE RESPIRATORY FAILURE
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension, Transient ischaemic attack
Clinical narrative: TRANSIENT CEREBRAL ISCHEMIA HYPOTENSION
Age: 5.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Pass the Beyond use date
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE ACUTE MI 8/13/2022 & 1/7/2023  --RECURRENCE OF SAME SYMPTOMS     --
Age: 53.0
Sex: F
Vaccine: COVID19-2
Symptoms: Anticoagulant therapy, Axillary mass, Computerised tomogram thorax abnormal, Hemiparesis, Injection site reaction
Clinical narrative: 10/15/22: Heaviness and weakness in right arm. Arm had purple hue. Soft lump in right armpit. Broken blood vessels inside of upper arm. Increased over 2 weeks. Saw PCP end of October. Send for ultrasound of arm. No sign of blood clot. 12/2/2022: Saw PCP again for same symptoms. Sent for chest MRI on 12/8/22-lungs filled with multiple pulmonary emboli. Started Eliquis same day. Saw pulmonologist on 12/16/2022. suggested possibility of link to 9/19/22 bivalent vaccine. Saw vascular surgeon. Continuing w/ Eliquis.
Age: 53.0
Sex: F
Vaccine: COVID19-2
Symptoms: Limb discomfort, Magnetic resonance imaging thoracic abnormal, Muscular weakness, Pulmonary embolism, Skin discolouration
Clinical narrative: 10/15/22: Heaviness and weakness in right arm. Arm had purple hue. Soft lump in right armpit. Broken blood vessels inside of upper arm. Increased over 2 weeks. Saw PCP end of October. Send for ultrasound of arm. No sign of blood clot. 12/2/2022: Saw PCP again for same symptoms. Sent for chest MRI on 12/8/22-lungs filled with multiple pulmonary emboli. Started Eliquis same day. Saw pulmonologist on 12/16/2022. suggested possibility of link to 9/19/22 bivalent vaccine. Saw vascular surgeon. Continuing w/ Eliquis.
Age: 53.0
Sex: F
Vaccine: COVID19-2
Symptoms: Ultrasound Doppler abnormal, Vascular rupture
Clinical narrative: 10/15/22: Heaviness and weakness in right arm. Arm had purple hue. Soft lump in right armpit. Broken blood vessels inside of upper arm. Increased over 2 weeks. Saw PCP end of October. Send for ultrasound of arm. No sign of blood clot. 12/2/2022: Saw PCP again for same symptoms. Sent for chest MRI on 12/8/22-lungs filled with multiple pulmonary emboli. Started Eliquis same day. Saw pulmonologist on 12/16/2022. suggested possibility of link to 9/19/22 bivalent vaccine. Saw vascular surgeon. Continuing w/ Eliquis.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE  HYPOTENSION
Age: 62.0
Sex: F
Vaccine: COVID19-2
Symptoms: Aortic valve replacement, Cardiac murmur, Pain in extremity
Clinical narrative: I had a sore arm for a few days after receiving the vaccine. I was diagnosed with heart murmur, and I had an aortic valve replacement surgery on 02/01/2023. I am taking cardiac rehab since my surgery.
Age: 47.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension, Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE CHRONIC HYPOTENSION 8/2/2022 &  8/22/2022 -- RECURRENCE OF SAME SYMPTOMS
Age: 39.0
Sex: M
Vaccine: COVID19
Symptoms: Anti-GAD antibody negative, Anti-IA2 antibody negative, Anti-insulin antibody, Anti-zinc transporter 8 antibody, Blood glucose increased
Clinical narrative: New Type 1 Diabetes.
Age: 39.0
Sex: M
Vaccine: COVID19
Symptoms: Type 1 diabetes mellitus
Clinical narrative: New Type 1 Diabetes.
Age: 53.0
Sex: M
Vaccine: COVID19
Symptoms: Ischaemia, Ischaemic stroke
Clinical narrative: ACUTE STROKE DUE TO ISCHEMIA, UNSPECIFIED TYPE AND ARTERY
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Epilepsy, Symptom recurrence
Clinical narrative: EPILEPSY, UNSPECIFIED 10/2/2022 -- RECURRENCE OF SAME SYMPTOMS
Age: 13.0
Sex: M
Vaccine: HPV9, MENB, TDAP
Symptoms: Product administered to patient of inappropriate age, Wrong product administered
Clinical narrative: Pt was due for Menveo vaccine and received a Trumenba Men B vaccine in error.
Age: 28.0
Sex: M
Vaccine: COVID19
Symptoms: Discontinued product administered
Clinical narrative: THE SHOT WAS GIVEN ON 4/21/23, THE MONOVALENT WAS DISCONTINUED ON 4/18/23
Age: 5.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthma, Cough, SARS-CoV-2 test negative, Wheezing
Clinical narrative: By April 1st his coughing started to get worse but there was no fever. He saw a doctor because he was wheezing, and he was put on a antibiotic and steroid liquid and a nebulizer. We were instructed to continue treatment three times a day. His coughing improved but a few days later his coughing got worse again. The doctor gave him a steroid injection, a new antibiotic, and new nebulizer. At this point they called it asthmatic bronchitis. He still had no fever. Then from there he got better. We continued the nebulizer treatments and antibiotics. We finished out the prescribed treatments. We were cleared on April 7th. We finished the antibiotic April 14th, and he has been good ever since.
Age: 48.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiogenic shock, Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE  CARDIOGENIC SHOCK 5/16/2022 -- RECURRENCE OF SAME SYMPTOMS
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Chronic respiratory failure, Pulmonary embolism, Respiratory failure, Reversible ischaemic neurological deficit
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE REVERSIBLE ISCHEMIC NEUROLOGIC DEFICIT SYNDROME ACUTE PULMONARY EMBOLISM CHRONIC HYPOXEMIC RESPIRATORY FAILURE
Age: 57.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Discomfort, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: I consider my symptoms to be mild. A lot of congestion and general physical discomfort but no fever, just general discomfort and congestion.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 2 vaccines Pfizer 2/13/21 Lot# El9267;  Pfizer 3/6/21 Lot# EN6206
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal discomfort, COVID-19, Chills, Cough, Fatigue
Clinical narrative: I did not have an adverse reaction to the vaccine. I started feeling sick on 11/22/2022 with a sore throat, chills and body aches. I tested positive for COVID-19 on 11/23/2022. I went to an urgent care, and I was given a prescription for PAXLOVID but I did not get it filled. I took over the counter medication for my symptom. I had a fever, extreme fatigue, cough and headaches. As of today, I am still feeling fatigue. I have had stomach issues since having COVID-19.
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Headache, Malaise, No adverse event, Oropharyngeal pain, Pain
Clinical narrative: I did not have an adverse reaction to the vaccine. I started feeling sick on 11/22/2022 with a sore throat, chills and body aches. I tested positive for COVID-19 on 11/23/2022. I went to an urgent care, and I was given a prescription for PAXLOVID but I did not get it filled. I took over the counter medication for my symptom. I had a fever, extreme fatigue, cough and headaches. As of today, I am still feeling fatigue. I have had stomach issues since having COVID-19.
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, SARS-CoV-2 test positive
Clinical narrative: I did not have an adverse reaction to the vaccine. I started feeling sick on 11/22/2022 with a sore throat, chills and body aches. I tested positive for COVID-19 on 11/23/2022. I went to an urgent care, and I was given a prescription for PAXLOVID but I did not get it filled. I took over the counter medication for my symptom. I had a fever, extreme fatigue, cough and headaches. As of today, I am still feeling fatigue. I have had stomach issues since having COVID-19.
Age: 54.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Cough, Ear discomfort, Lacrimation increased, Respiratory tract congestion, Rhinorrhoea
Clinical narrative: I had stuffy head, cough, runny nose, watery eyes, I made an appointment to see my doctor, who did an exam. Upon examining my ears, she said the pressure I was experiencing was from a sinus infection. She gave me a steroid shot before leaving the office, wrote me prescriptions for a Z-PAK, and MUCINEX-D.
Age: 54.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Sinusitis
Clinical narrative: I had stuffy head, cough, runny nose, watery eyes, I made an appointment to see my doctor, who did an exam. Upon examining my ears, she said the pressure I was experiencing was from a sinus infection. She gave me a steroid shot before leaving the office, wrote me prescriptions for a Z-PAK, and MUCINEX-D.
Age: 0.5
Sex: M
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Incorrect dose of 0.2mg  Pink cap/yellow label administered for dose 1.
Age: 84.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 3 vaccines Pfizer 6/28/21 Lot# EN6207;  Pfizer 7/23/21 Lot# Ew0173;  Pfizer 12/14/21 Lot# 33130BA
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Injection site pain, Pain
Clinical narrative: STABBING PAIN IN LEFT DELTOID MUSCLE AREA BEGAN AFTER 2ND MODERNA PRIMARY SERIES VACCINE AND HAS BEEN THERE EVER SINCE.  PATIENT DESCRIBES AS STABBING, CONSTANT ACHINESS THAT MAKES IT HARD TO RAISE HER ARM.  SHE HAS BEEN ADVISED TO SEEK MEDICAL TREATMENT FROM HER PRIMARY CARE PHYSICIAN AND IS PLANNING ON SCHEDULING THAT APPOINTMENT IN THE NEAR FUTURE.
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 4 vaccines Moderna 3/17/21 Lot# 007B21A;  Moderna 043B21A;  Moderna 1/2/22 Lot# 033H21A;  Moderna 11/23/22 Lot# 020H22A
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Pain in extremity
Clinical narrative: PATIENT DEVELOPED STABBING RIGHT ARM PAIN AFTER THE SECOND DOSE OF MODERNA PRIMARY SERIES VACCINE.  THE PAIN IS CONSTANT AND IS DESCRIBED AS STABBING, ACHINESS THAT LIMITS USE OF THE ARM.  IT HAS BEEN THERE SINCE THE 2ND VACCINE DATE AND HAS NOT WENT AWAY.  HAS NOT SEEN A MEDICAL PROFESSIONAL AS OF TODAY BUT IS MAKING AN APPOINTMENT WITH HIS PRIMARY CARE PHYSICIAN IN THE NEAR FUTURE.
Age: 9.0
Sex: F
Vaccine: COVID19-2
Symptoms: Incorrect dose administered
Clinical narrative: Pediatric patient given incorrect bivalent vaccine. Received vaccine for > 12 YO patients.
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 4 vaccines Pfizer 3/1/21 Lot# EN6199;  Pfizer 4/1/21 Lot# ER8730;  Pfizer 11/12/21 Lot# FF2593;  Pfizer 7/30/22 Lot# FP7150
Age: 39.0
Sex: M
Vaccine: COVID19
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE  OBSTRUCTIVE SLEEP APNEA
Age: 85.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 5 vaccines Moderna 4/20/21 NO LOT#;  5/4/21 Moderna no lot#;  Moderna 12/5/21 Lot# 029H21B; Moderna 5/17/22 Lot# 004M21A;  Moderna 12/1/22 Lot# 055F22B
Age: 0.83
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Incorrect dose administered after recent CDC changes discontinue monovalent.  Dose administered 0.2mg bivalent Pink/Yellow. Should have received 0.25ml/25ug  Dark Blue cap/gray border.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 3 vaccines PFizer 3/10/21 Lot# En6207;  Pfizer 3/31/21 Lot# ER8734;  Pfizer 9/23/21 Lot# FE3592;
Age: 0.58
Sex: F
Vaccine: COVID19-2
Symptoms: Incorrect dose administered
Clinical narrative: Incorrect dose administered for dose 2 following CDC guidelines discontinued monovalent.  Dose administered 0.2ml/10ug Pink cap/yellow label.
Age: 89.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 3 vaccines Moderna 1/28/21 Lot# 028L20A;  Moderna 2/25/21 Lot# 004M20A;  Moderna 10/5/22 Lot# 027E22
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Acute coronary syndrome, Acute myocardial infarction
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE ACUTE NON ST ELEVATION MI ACUTE CORONARY SYNDROME, UNSPECIFIED
Age: 0.83
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: Incorrect dose administered after CDC changes discontinue monvalent.  Patient received Moderna Bivalent Pink cap/yellow label. 0.2ml/10ug.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Anosmia, Asthenia, COVID-19, Exposure to SARS-CoV-2, Paranasal sinus hypersecretion
Clinical narrative: My husband had tested positive for COVID-19, I was his caregiver. I started having sinus issues, sinus drip, runny nose, a fever, I lost my sense of smell for three weeks. I suspected I was getting COVID-19; I took a home COVID-19 test that came back positive. The next day I went to Urgent Care to confirm that my home test was correct. The PCR Rapid COVID-19 test, it also came. The nurse practioner and I discussed my symptoms, that were, I really am not in the high-risk category aside from my age. We both agreed that it would not hurt for me to not take the antiviral medication. I am starting to feel more like me, my sense of smell is coming back, my energy is finally back. It did take m six or seven weeks to get my energy level back to where it was before I had COVID-19.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Sinus disorder
Clinical narrative: My husband had tested positive for COVID-19, I was his caregiver. I started having sinus issues, sinus drip, runny nose, a fever, I lost my sense of smell for three weeks. I suspected I was getting COVID-19; I took a home COVID-19 test that came back positive. The next day I went to Urgent Care to confirm that my home test was correct. The PCR Rapid COVID-19 test, it also came. The nurse practioner and I discussed my symptoms, that were, I really am not in the high-risk category aside from my age. We both agreed that it would not hurt for me to not take the antiviral medication. I am starting to feel more like me, my sense of smell is coming back, my energy is finally back. It did take m six or seven weeks to get my energy level back to where it was before I had COVID-19.
Age: 70.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Anticoagulant therapy, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Echocardiogram normal
Clinical narrative: I was travelling out of state. A few days before that, I noticed being short of breath and I had some coughing. After around 3 days of that getting worse, I wound up going to the emergency room. The doctor asked all the right questions, and the D-Dimer test came back with some concerns. They did a CT scan with contrast and came back with some indication of blood clots. The next day, the informed me that I did have blood clots that began in my legs and travelled to my lungs. I spent 3 days in the hospital on a Heparin I.V. I was release and was still on oxygen. I was informed that had I not come in, it could have been life threatening. They advised that we travel home very slowly. We only did 3 hours of driving a day and stopped frequently. I am now on Eliquis for the next 6 months.
Age: 70.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Fibrin D dimer increased, Pulmonary thrombosis, Scan with contrast abnormal, Thrombosis, Ultrasound Doppler abnormal
Clinical narrative: I was travelling out of state. A few days before that, I noticed being short of breath and I had some coughing. After around 3 days of that getting worse, I wound up going to the emergency room. The doctor asked all the right questions, and the D-Dimer test came back with some concerns. They did a CT scan with contrast and came back with some indication of blood clots. The next day, the informed me that I did have blood clots that began in my legs and travelled to my lungs. I spent 3 days in the hospital on a Heparin I.V. I was release and was still on oxygen. I was informed that had I not come in, it could have been life threatening. They advised that we travel home very slowly. We only did 3 hours of driving a day and stopped frequently. I am now on Eliquis for the next 6 months.
Age: 64.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Atrial flutter, COVID-19
Clinical narrative: Discharge Provider: Primary Care Physician at Discharge: Admission Date: 4/19/2023 PRESENTING PROBLEM: Acute respiratory failure with hypoxemia [J96.01] COVID-19 virus infection [U07.1] Acute on chronic respiratory failure with hypoxia [J96.21]   HOSPITAL COURSE: Patient is a 65 yr old M with PMHx of recently diagnosed metastatic right lung adenocarcinoma (3/2023), CAD s/p CABG in 2021 with post-operative atrial fibrillation (no longer on anticoagulation), HTN, 40 pack year smoking hx, chronic right shoulder pain 2/2 rotator cuff tear and cancer pain who presented to the ED in respiratory distress. At baseline, he is on 3L nasal cannula at home and dyspneic on exertion but noticed worsening shortness of breath and profound fatigue Visiting palliative care home nurse found the patient to be hypoxic to 70% on room air and hypotensive, thus EMS was called.   On admission he was placed on a non-rebreather mask then BIPAP.  He was found to be tachycardic in the 130s to 140s with EKG showing atrial flutter.  CT angiogram thorax with contrast was negative for PE but showed extensive mixed consolidation and ground-glass opacities of bilateral lungs as well as interval enlargement of the metastatic disease.    In the intensive care unit, he was found to have COVID 19 and treated with tocilizumab, remdemisvir, steroids, and broad-spectrum antibiotics.  His work of breathing improved and was subsequently moved off of BiPAP and transitioned to high-flow nasal cannula.    He remained on high-flow nasal cannula with slow titration.  Pulmonology consulted and he completed 10 days of remdesivir and 10 days of Decadron.  A tapering dose of prednisone was planned after.  He was started on IV Lasix to facility the negative fluid balance.  SLP consulted recommended general nectar thick liquids.  He was initially placed on Rocephin and azithromycin then cefepime.  With negative cultures, antibiotics were discontinued.   Regarding his atrial flutter and RVR he was placed on amiodarone metoprolol increased to 50 mg 2 times a day and Cardizem.  Heparin drip transition to oral Eliquis. Seen by pulmonology, concern for lymphangitic spread of lung cancer, recommended hospice.  Continued to require 100% FiO2 via high-flow nasal cannula, due to overall poor prognosis, patient and family agreed for hospice. Patient continued to decline and was made comfort care before passing on 5/10/23.  Date of Death: 5/10/23 Time of Death:  1:17 AM Preliminary Cause of Death: Hypoxia       Discharge Disposition: Deceased
Age: 64.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Condition aggravated, Culture negative, Death, Dyspnoea, Electrocardiogram abnormal
Clinical narrative: Discharge Provider: Primary Care Physician at Discharge: Admission Date: 4/19/2023 PRESENTING PROBLEM: Acute respiratory failure with hypoxemia [J96.01] COVID-19 virus infection [U07.1] Acute on chronic respiratory failure with hypoxia [J96.21]   HOSPITAL COURSE: Patient is a 65 yr old M with PMHx of recently diagnosed metastatic right lung adenocarcinoma (3/2023), CAD s/p CABG in 2021 with post-operative atrial fibrillation (no longer on anticoagulation), HTN, 40 pack year smoking hx, chronic right shoulder pain 2/2 rotator cuff tear and cancer pain who presented to the ED in respiratory distress. At baseline, he is on 3L nasal cannula at home and dyspneic on exertion but noticed worsening shortness of breath and profound fatigue Visiting palliative care home nurse found the patient to be hypoxic to 70% on room air and hypotensive, thus EMS was called.   On admission he was placed on a non-rebreather mask then BIPAP.  He was found to be tachycardic in the 130s to 140s with EKG showing atrial flutter.  CT angiogram thorax with contrast was negative for PE but showed extensive mixed consolidation and ground-glass opacities of bilateral lungs as well as interval enlargement of the metastatic disease.    In the intensive care unit, he was found to have COVID 19 and treated with tocilizumab, remdemisvir, steroids, and broad-spectrum antibiotics.  His work of breathing improved and was subsequently moved off of BiPAP and transitioned to high-flow nasal cannula.    He remained on high-flow nasal cannula with slow titration.  Pulmonology consulted and he completed 10 days of remdesivir and 10 days of Decadron.  A tapering dose of prednisone was planned after.  He was started on IV Lasix to facility the negative fluid balance.  SLP consulted recommended general nectar thick liquids.  He was initially placed on Rocephin and azithromycin then cefepime.  With negative cultures, antibiotics were discontinued.   Regarding his atrial flutter and RVR he was placed on amiodarone metoprolol increased to 50 mg 2 times a day and Cardizem.  Heparin drip transition to oral Eliquis. Seen by pulmonology, concern for lymphangitic spread of lung cancer, recommended hospice.  Continued to require 100% FiO2 via high-flow nasal cannula, due to overall poor prognosis, patient and family agreed for hospice. Patient continued to decline and was made comfort care before passing on 5/10/23.  Date of Death: 5/10/23 Time of Death:  1:17 AM Preliminary Cause of Death: Hypoxia       Discharge Disposition: Deceased
Age: 64.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Fatigue, General physical health deterioration, Hypotension, Hypoxia, Intensive care
Clinical narrative: Discharge Provider: Primary Care Physician at Discharge: Admission Date: 4/19/2023 PRESENTING PROBLEM: Acute respiratory failure with hypoxemia [J96.01] COVID-19 virus infection [U07.1] Acute on chronic respiratory failure with hypoxia [J96.21]   HOSPITAL COURSE: Patient is a 65 yr old M with PMHx of recently diagnosed metastatic right lung adenocarcinoma (3/2023), CAD s/p CABG in 2021 with post-operative atrial fibrillation (no longer on anticoagulation), HTN, 40 pack year smoking hx, chronic right shoulder pain 2/2 rotator cuff tear and cancer pain who presented to the ED in respiratory distress. At baseline, he is on 3L nasal cannula at home and dyspneic on exertion but noticed worsening shortness of breath and profound fatigue Visiting palliative care home nurse found the patient to be hypoxic to 70% on room air and hypotensive, thus EMS was called.   On admission he was placed on a non-rebreather mask then BIPAP.  He was found to be tachycardic in the 130s to 140s with EKG showing atrial flutter.  CT angiogram thorax with contrast was negative for PE but showed extensive mixed consolidation and ground-glass opacities of bilateral lungs as well as interval enlargement of the metastatic disease.    In the intensive care unit, he was found to have COVID 19 and treated with tocilizumab, remdemisvir, steroids, and broad-spectrum antibiotics.  His work of breathing improved and was subsequently moved off of BiPAP and transitioned to high-flow nasal cannula.    He remained on high-flow nasal cannula with slow titration.  Pulmonology consulted and he completed 10 days of remdesivir and 10 days of Decadron.  A tapering dose of prednisone was planned after.  He was started on IV Lasix to facility the negative fluid balance.  SLP consulted recommended general nectar thick liquids.  He was initially placed on Rocephin and azithromycin then cefepime.  With negative cultures, antibiotics were discontinued.   Regarding his atrial flutter and RVR he was placed on amiodarone metoprolol increased to 50 mg 2 times a day and Cardizem.  Heparin drip transition to oral Eliquis. Seen by pulmonology, concern for lymphangitic spread of lung cancer, recommended hospice.  Continued to require 100% FiO2 via high-flow nasal cannula, due to overall poor prognosis, patient and family agreed for hospice. Patient continued to decline and was made comfort care before passing on 5/10/23.  Date of Death: 5/10/23 Time of Death:  1:17 AM Preliminary Cause of Death: Hypoxia       Discharge Disposition: Deceased
Age: 64.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Lung adenocarcinoma, Lung consolidation, Lung neoplasm malignant, Lung opacity, Positive airway pressure therapy
Clinical narrative: Discharge Provider: Primary Care Physician at Discharge: Admission Date: 4/19/2023 PRESENTING PROBLEM: Acute respiratory failure with hypoxemia [J96.01] COVID-19 virus infection [U07.1] Acute on chronic respiratory failure with hypoxia [J96.21]   HOSPITAL COURSE: Patient is a 65 yr old M with PMHx of recently diagnosed metastatic right lung adenocarcinoma (3/2023), CAD s/p CABG in 2021 with post-operative atrial fibrillation (no longer on anticoagulation), HTN, 40 pack year smoking hx, chronic right shoulder pain 2/2 rotator cuff tear and cancer pain who presented to the ED in respiratory distress. At baseline, he is on 3L nasal cannula at home and dyspneic on exertion but noticed worsening shortness of breath and profound fatigue Visiting palliative care home nurse found the patient to be hypoxic to 70% on room air and hypotensive, thus EMS was called.   On admission he was placed on a non-rebreather mask then BIPAP.  He was found to be tachycardic in the 130s to 140s with EKG showing atrial flutter.  CT angiogram thorax with contrast was negative for PE but showed extensive mixed consolidation and ground-glass opacities of bilateral lungs as well as interval enlargement of the metastatic disease.    In the intensive care unit, he was found to have COVID 19 and treated with tocilizumab, remdemisvir, steroids, and broad-spectrum antibiotics.  His work of breathing improved and was subsequently moved off of BiPAP and transitioned to high-flow nasal cannula.    He remained on high-flow nasal cannula with slow titration.  Pulmonology consulted and he completed 10 days of remdesivir and 10 days of Decadron.  A tapering dose of prednisone was planned after.  He was started on IV Lasix to facility the negative fluid balance.  SLP consulted recommended general nectar thick liquids.  He was initially placed on Rocephin and azithromycin then cefepime.  With negative cultures, antibiotics were discontinued.   Regarding his atrial flutter and RVR he was placed on amiodarone metoprolol increased to 50 mg 2 times a day and Cardizem.  Heparin drip transition to oral Eliquis. Seen by pulmonology, concern for lymphangitic spread of lung cancer, recommended hospice.  Continued to require 100% FiO2 via high-flow nasal cannula, due to overall poor prognosis, patient and family agreed for hospice. Patient continued to decline and was made comfort care before passing on 5/10/23.  Date of Death: 5/10/23 Time of Death:  1:17 AM Preliminary Cause of Death: Hypoxia       Discharge Disposition: Deceased
Age: 64.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Respiratory distress, Respiratory failure, Scan with contrast abnormal, Tachycardia
Clinical narrative: Discharge Provider: Primary Care Physician at Discharge: Admission Date: 4/19/2023 PRESENTING PROBLEM: Acute respiratory failure with hypoxemia [J96.01] COVID-19 virus infection [U07.1] Acute on chronic respiratory failure with hypoxia [J96.21]   HOSPITAL COURSE: Patient is a 65 yr old M with PMHx of recently diagnosed metastatic right lung adenocarcinoma (3/2023), CAD s/p CABG in 2021 with post-operative atrial fibrillation (no longer on anticoagulation), HTN, 40 pack year smoking hx, chronic right shoulder pain 2/2 rotator cuff tear and cancer pain who presented to the ED in respiratory distress. At baseline, he is on 3L nasal cannula at home and dyspneic on exertion but noticed worsening shortness of breath and profound fatigue Visiting palliative care home nurse found the patient to be hypoxic to 70% on room air and hypotensive, thus EMS was called.   On admission he was placed on a non-rebreather mask then BIPAP.  He was found to be tachycardic in the 130s to 140s with EKG showing atrial flutter.  CT angiogram thorax with contrast was negative for PE but showed extensive mixed consolidation and ground-glass opacities of bilateral lungs as well as interval enlargement of the metastatic disease.    In the intensive care unit, he was found to have COVID 19 and treated with tocilizumab, remdemisvir, steroids, and broad-spectrum antibiotics.  His work of breathing improved and was subsequently moved off of BiPAP and transitioned to high-flow nasal cannula.    He remained on high-flow nasal cannula with slow titration.  Pulmonology consulted and he completed 10 days of remdesivir and 10 days of Decadron.  A tapering dose of prednisone was planned after.  He was started on IV Lasix to facility the negative fluid balance.  SLP consulted recommended general nectar thick liquids.  He was initially placed on Rocephin and azithromycin then cefepime.  With negative cultures, antibiotics were discontinued.   Regarding his atrial flutter and RVR he was placed on amiodarone metoprolol increased to 50 mg 2 times a day and Cardizem.  Heparin drip transition to oral Eliquis. Seen by pulmonology, concern for lymphangitic spread of lung cancer, recommended hospice.  Continued to require 100% FiO2 via high-flow nasal cannula, due to overall poor prognosis, patient and family agreed for hospice. Patient continued to decline and was made comfort care before passing on 5/10/23.  Date of Death: 5/10/23 Time of Death:  1:17 AM Preliminary Cause of Death: Hypoxia       Discharge Disposition: Deceased
Age: 88.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient has a hx of cardiac pacemaker, mild cognitive impairment, aflutter on Eliquis, aortic valve disease s/p AVR, BPH/LUTS, urinary retention requiring foley catheter placement x approx. 1 year.. Patient was seen for routine home visit by Nurse Care Manager on May 8, 2023 at 1100. Patient was administered Moderna COVID-19 bivalent booster around approx. 1115, and was observed for remainder of Nursing visit until completed at 1200 w/o evidence of acute reaction/side effects, stable vital signs and examination. Patient had received COVID-19 Moderna vaccines in the community x 3 w/o documented or reported side effects. The Team was informed on May 10, 2023 that the patient was found deceased in his home on May 9, 2023 and was pronounced so by EMS at 1636. Due to timing of patient receiving vaccine and patient's time of death, it was discussed to enter a report for continuity of care.
Age: 63.0
Sex: M
Vaccine: COVID19-2, FLU4, HEP, TDAP
Symptoms: Acute kidney injury, Anaemia, Bronchoscopy abnormal, COVID-19, Colitis
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 5/2/2023 Discharge Date: 5/9/23   PRESENTING PROBLEM: AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 64  Yo male 3 months  s/p bilateral lung transplasnt for COPD presented with complaints of worsening diarrhea. He was sent initially to OSH  ER and found to have profound neutropenia, anemia, AKI with metabolic acidosis and hyperkalemia. CT thorax with new tree-in-bud opacities in RLL. Found to be Covid +. He was transferred to hospital for further management. A bronchoscopy was completed upon admission given CT changes which was positive for staph aureus. Patient was treated with 10d of abx, initially ancef then cefuroxime on dc. Additional his film array was positive for COVID. Given ongoing diarrhea symptoms which was thought to be related to COVID, treatment with remdesivir was completed.  Regarding his severe AKI, this was felt to be likely from a combination of dehydration from diarrhea as well as severely high tacrolimus level also likely from diarrhea symptoms. Tacrolimus was held. AKI resolved completely after initiation of IVF and holding offending agents. Eventually tacrolimus was resumed without issue once kidney injury had resolved  In addition to the AKI patient was severely neutropenic and anemic. He was given 1u RBC and hematology was consulted. After testing it was determined the cause was likely bone marrow suppression from toxic levels of his valcyte and tacrolimus. Patient was given 3 doses of neupogen inpatient and neutropenia recovered. Valcyte was eventually resumed 5/8 after CMV level was checked which was 0. For his anemia, EPO was given 5/7 and hemoglobin remained stable after 1u RBC. Stool occult blood was found to be positive but given stable hemologobin and known colitis on CT which can cause positive occult blood, further GI workup was not completed but this will be followed closely as an outpatient.  Patient was discharged home in stable condition with plans to get outpatient labs 5/11 and be seen in clinic next week.
Age: 63.0
Sex: M
Vaccine: COVID19-2, FLU4, HEP, TDAP
Symptoms: Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Cytomegalovirus test, Dehydration, Diarrhoea
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 5/2/2023 Discharge Date: 5/9/23   PRESENTING PROBLEM: AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 64  Yo male 3 months  s/p bilateral lung transplasnt for COPD presented with complaints of worsening diarrhea. He was sent initially to OSH  ER and found to have profound neutropenia, anemia, AKI with metabolic acidosis and hyperkalemia. CT thorax with new tree-in-bud opacities in RLL. Found to be Covid +. He was transferred to hospital for further management. A bronchoscopy was completed upon admission given CT changes which was positive for staph aureus. Patient was treated with 10d of abx, initially ancef then cefuroxime on dc. Additional his film array was positive for COVID. Given ongoing diarrhea symptoms which was thought to be related to COVID, treatment with remdesivir was completed.  Regarding his severe AKI, this was felt to be likely from a combination of dehydration from diarrhea as well as severely high tacrolimus level also likely from diarrhea symptoms. Tacrolimus was held. AKI resolved completely after initiation of IVF and holding offending agents. Eventually tacrolimus was resumed without issue once kidney injury had resolved  In addition to the AKI patient was severely neutropenic and anemic. He was given 1u RBC and hematology was consulted. After testing it was determined the cause was likely bone marrow suppression from toxic levels of his valcyte and tacrolimus. Patient was given 3 doses of neupogen inpatient and neutropenia recovered. Valcyte was eventually resumed 5/8 after CMV level was checked which was 0. For his anemia, EPO was given 5/7 and hemoglobin remained stable after 1u RBC. Stool occult blood was found to be positive but given stable hemologobin and known colitis on CT which can cause positive occult blood, further GI workup was not completed but this will be followed closely as an outpatient.  Patient was discharged home in stable condition with plans to get outpatient labs 5/11 and be seen in clinic next week.
Age: 63.0
Sex: M
Vaccine: COVID19-2, FLU4, HEP, TDAP
Symptoms: Haemoglobin normal, Hyperkalaemia, Lung opacity, Metabolic acidosis, Myelosuppression
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 5/2/2023 Discharge Date: 5/9/23   PRESENTING PROBLEM: AKI (acute kidney injury) (HCC) [N17.9]   HOSPITAL COURSE: 64  Yo male 3 months  s/p bilateral lung transplasnt for COPD presented with complaints of worsening diarrhea. He was sent initially to OSH  ER and found to have profound neutropenia, anemia, AKI with metabolic acidosis and hyperkalemia. CT thorax with new tree-in-bud opacities in RLL. Found to be Covid +. He was transferred to hospital for further management. A bronchoscopy was completed upon admission given CT changes which was positive for staph aureus. Patient was treated with 10d of abx, initially ancef then cefuroxime on dc. Additional his film array was positive for COVID. Given ongoing diarrhea symptoms which was thought to be related to COVID, treatment with remdesivir was completed.  Regarding his severe AKI, this was felt to be likely from a combination of dehydration from diarrhea as well as severely high tacrolimus level also likely from diarrhea symptoms. Tacrolimus was held. AKI resolved completely after initiation of IVF and holding offending agents. Eventually tacrolimus was resumed without issue once kidney injury had resolved  In addition to the AKI patient was severely neutropenic and anemic. He was given 1u RBC and hematology was consulted. After testing it was determined the cause was likely bone marrow suppression from toxic levels of his valcyte and tacrolimus. Patient was given 3 doses of neupogen inpatient and neutropenia recovered. Valcyte was eventually resumed 5/8 after CMV level was checked which was 0. For his anemia, EPO was given 5/7 and hemoglobin remained stable after 1u RBC. Stool occult blood was found to be positive but given stable hemologobin and known colitis on CT which can cause positive occult blood, further GI workup was not completed but this will be followed closely as an outpatient.  Patient was discharged home in stable condition with plans to get outpatient labs 5/11 and be seen in clinic next week.