chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 94.0
Sex: M
Vaccine: COVID19
Symptoms: Lung consolidation, Metabolic encephalopathy, Nitrite urine present, Pain in extremity, SARS-CoV-2 test positive
Clinical narrative: Patient is a 95 y.o. female patient of DO with history of AAA, iliac aneurysm, OA, atrial fibrillation, hypothyroidism, HLD, and HTN who presented to a local Hospital with dyspnea, cough, and found to be in atrial fibrillation with RVR and have COVID.      Discharge Diagnoses:   Acute metabolic encephalopathy In setting of COVID, UTI, had intermittent episodes of delirium with hallucinations B12 <400, TSH normal, vit D mildly low CT head on admission without acute intracranial abnormalities B12 and vit D replacement initiated Seroquel scheduled nightly Mentation overall improved at time of discharge     Acute cystitis Urine showed positive nitrate and moderate WBC Prescribed Keflex as outpatient, but did not pick up prescription prior to being admitted Urine culture 2/14 with >100K Citrobacter freundii Bactrim 5-day course completed on 2/22   Acute respiratory failure with hypoxia, resolved Respiratory failure secondary to COVID  O2 sat 86% on room air on admission Mild leukocytosis on admission with mild lactic acidosis CXR with left basilar consolidation, possible small left pleural effusion Procalcitonin normal Urinary antigens negative Initially required NC O2, but now off oxygen       Covid-19 Virus Infection Date of onset of symptoms: 2/10/2023 Symptoms present on admission: Dyspnea, cough Date of covid positive test: 2/13/2023 Vaccination status: vaccinated, boosted Imaging: as above with basilar consolidation Oxygen requirements on admission: 2L NC O2 Current oxygen requirements: room air Medical therapy: received decadron, discontinued when no longer requiring supplemental O2 Consultants following: None Special isolation end date: 2/21/23 Inflammatory markers not elevated   Atrial fibrillation with RVR Has underlying atrial fibrillation, likely exacerbated by acute infection HR on admission in the 140s Echo (5/4/22): LVSF normal, EF 65%, no wall motion abnormality, no significant valvular disease Received IV metoprolol in ED, then started on diltiazem drip.  Drip discontinued when rate improved. Increased Toprol-XL to 200 mg, rate now better controlled Conintued xarelto   CKD3 Creatinine 0.86 at time of discharge   Hypothyroidism Continued outpatient Synthroid   Dizziness/vertigo Meclizine provided as needed   Bilateral feet pain Normal exam Ibuprofen given as needed Pain improved prior to discharge   Goals of care Previously living at home with son, but has become more difficult to manage due to dementia.  Family requesting discharge to SNF for rehab, but expressing some concerns regarding long-term management.  Discussed with daughter, who feels patient has been declining significantly.  Patient currently DNR CCA.  Palliative care consulted and assisted family with decision making.
Age: 94.0
Sex: M
Vaccine: COVID19
Symptoms: Urinary tract infection, Urine analysis abnormal, Urine antigen test, Vertigo, Vitamin B12 decreased
Clinical narrative: Patient is a 95 y.o. female patient of DO with history of AAA, iliac aneurysm, OA, atrial fibrillation, hypothyroidism, HLD, and HTN who presented to a local Hospital with dyspnea, cough, and found to be in atrial fibrillation with RVR and have COVID.      Discharge Diagnoses:   Acute metabolic encephalopathy In setting of COVID, UTI, had intermittent episodes of delirium with hallucinations B12 <400, TSH normal, vit D mildly low CT head on admission without acute intracranial abnormalities B12 and vit D replacement initiated Seroquel scheduled nightly Mentation overall improved at time of discharge     Acute cystitis Urine showed positive nitrate and moderate WBC Prescribed Keflex as outpatient, but did not pick up prescription prior to being admitted Urine culture 2/14 with >100K Citrobacter freundii Bactrim 5-day course completed on 2/22   Acute respiratory failure with hypoxia, resolved Respiratory failure secondary to COVID  O2 sat 86% on room air on admission Mild leukocytosis on admission with mild lactic acidosis CXR with left basilar consolidation, possible small left pleural effusion Procalcitonin normal Urinary antigens negative Initially required NC O2, but now off oxygen       Covid-19 Virus Infection Date of onset of symptoms: 2/10/2023 Symptoms present on admission: Dyspnea, cough Date of covid positive test: 2/13/2023 Vaccination status: vaccinated, boosted Imaging: as above with basilar consolidation Oxygen requirements on admission: 2L NC O2 Current oxygen requirements: room air Medical therapy: received decadron, discontinued when no longer requiring supplemental O2 Consultants following: None Special isolation end date: 2/21/23 Inflammatory markers not elevated   Atrial fibrillation with RVR Has underlying atrial fibrillation, likely exacerbated by acute infection HR on admission in the 140s Echo (5/4/22): LVSF normal, EF 65%, no wall motion abnormality, no significant valvular disease Received IV metoprolol in ED, then started on diltiazem drip.  Drip discontinued when rate improved. Increased Toprol-XL to 200 mg, rate now better controlled Conintued xarelto   CKD3 Creatinine 0.86 at time of discharge   Hypothyroidism Continued outpatient Synthroid   Dizziness/vertigo Meclizine provided as needed   Bilateral feet pain Normal exam Ibuprofen given as needed Pain improved prior to discharge   Goals of care Previously living at home with son, but has become more difficult to manage due to dementia.  Family requesting discharge to SNF for rehab, but expressing some concerns regarding long-term management.  Discussed with daughter, who feels patient has been declining significantly.  Patient currently DNR CCA.  Palliative care consulted and assisted family with decision making.
Age: 94.0
Sex: M
Vaccine: COVID19
Symptoms: Vitamin D decreased, White blood cell count
Clinical narrative: Patient is a 95 y.o. female patient of DO with history of AAA, iliac aneurysm, OA, atrial fibrillation, hypothyroidism, HLD, and HTN who presented to a local Hospital with dyspnea, cough, and found to be in atrial fibrillation with RVR and have COVID.      Discharge Diagnoses:   Acute metabolic encephalopathy In setting of COVID, UTI, had intermittent episodes of delirium with hallucinations B12 <400, TSH normal, vit D mildly low CT head on admission without acute intracranial abnormalities B12 and vit D replacement initiated Seroquel scheduled nightly Mentation overall improved at time of discharge     Acute cystitis Urine showed positive nitrate and moderate WBC Prescribed Keflex as outpatient, but did not pick up prescription prior to being admitted Urine culture 2/14 with >100K Citrobacter freundii Bactrim 5-day course completed on 2/22   Acute respiratory failure with hypoxia, resolved Respiratory failure secondary to COVID  O2 sat 86% on room air on admission Mild leukocytosis on admission with mild lactic acidosis CXR with left basilar consolidation, possible small left pleural effusion Procalcitonin normal Urinary antigens negative Initially required NC O2, but now off oxygen       Covid-19 Virus Infection Date of onset of symptoms: 2/10/2023 Symptoms present on admission: Dyspnea, cough Date of covid positive test: 2/13/2023 Vaccination status: vaccinated, boosted Imaging: as above with basilar consolidation Oxygen requirements on admission: 2L NC O2 Current oxygen requirements: room air Medical therapy: received decadron, discontinued when no longer requiring supplemental O2 Consultants following: None Special isolation end date: 2/21/23 Inflammatory markers not elevated   Atrial fibrillation with RVR Has underlying atrial fibrillation, likely exacerbated by acute infection HR on admission in the 140s Echo (5/4/22): LVSF normal, EF 65%, no wall motion abnormality, no significant valvular disease Received IV metoprolol in ED, then started on diltiazem drip.  Drip discontinued when rate improved. Increased Toprol-XL to 200 mg, rate now better controlled Conintued xarelto   CKD3 Creatinine 0.86 at time of discharge   Hypothyroidism Continued outpatient Synthroid   Dizziness/vertigo Meclizine provided as needed   Bilateral feet pain Normal exam Ibuprofen given as needed Pain improved prior to discharge   Goals of care Previously living at home with son, but has become more difficult to manage due to dementia.  Family requesting discharge to SNF for rehab, but expressing some concerns regarding long-term management.  Discussed with daughter, who feels patient has been declining significantly.  Patient currently DNR CCA.  Palliative care consulted and assisted family with decision making.
Age: 61.0
Sex: F
Vaccine: TDAP
Symptoms: Discharge, Erythema, Haemorrhage, Induration, Laboratory test
Clinical narrative: After receiving the shot, my arm was red and swelling.  I developed a fever the next day.  A few days later my arm had lump.  A couple of months my arm formed 2 lumps.  The lumps got harder and opened up.  Discharge/blood came out.  They stayed open a bit.  Went to a dermatologist surgeon.  She removed them and sent to lab.  She stitched it up.  Went back 2 weeks later.  One healed, the other we still open.  She removed more, and sent samples to lab, and stitched it up.  The next week, the other hole opened up.  She removed more and stitched it up.  Went back 2 weeks later and stitches removed from both.  Waiting to see if it opens up again.  Will have to return to her for another visit.       11 years ago, I received this shot in my right arm.  Similar thing happened but didn't realize it was the shot.  Hole opened, discharged, and closed on and off for years.   Went to surgeon in 2020 and she removed it.       10 years before this in the same (right) arm, had similar issue but nobody identified it as a reaction to the shot.
Age: 61.0
Sex: F
Vaccine: TDAP
Symptoms: Limb mass, Mass excision, Peripheral swelling, Pyrexia, Suture insertion
Clinical narrative: After receiving the shot, my arm was red and swelling.  I developed a fever the next day.  A few days later my arm had lump.  A couple of months my arm formed 2 lumps.  The lumps got harder and opened up.  Discharge/blood came out.  They stayed open a bit.  Went to a dermatologist surgeon.  She removed them and sent to lab.  She stitched it up.  Went back 2 weeks later.  One healed, the other we still open.  She removed more, and sent samples to lab, and stitched it up.  The next week, the other hole opened up.  She removed more and stitched it up.  Went back 2 weeks later and stitches removed from both.  Waiting to see if it opens up again.  Will have to return to her for another visit.       11 years ago, I received this shot in my right arm.  Similar thing happened but didn't realize it was the shot.  Hole opened, discharged, and closed on and off for years.   Went to surgeon in 2020 and she removed it.       10 years before this in the same (right) arm, had similar issue but nobody identified it as a reaction to the shot.
Age: 61.0
Sex: F
Vaccine: TDAP
Symptoms: Wound
Clinical narrative: After receiving the shot, my arm was red and swelling.  I developed a fever the next day.  A few days later my arm had lump.  A couple of months my arm formed 2 lumps.  The lumps got harder and opened up.  Discharge/blood came out.  They stayed open a bit.  Went to a dermatologist surgeon.  She removed them and sent to lab.  She stitched it up.  Went back 2 weeks later.  One healed, the other we still open.  She removed more, and sent samples to lab, and stitched it up.  The next week, the other hole opened up.  She removed more and stitched it up.  Went back 2 weeks later and stitches removed from both.  Waiting to see if it opens up again.  Will have to return to her for another visit.       11 years ago, I received this shot in my right arm.  Similar thing happened but didn't realize it was the shot.  Hole opened, discharged, and closed on and off for years.   Went to surgeon in 2020 and she removed it.       10 years before this in the same (right) arm, had similar issue but nobody identified it as a reaction to the shot.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Anion gap, Arthralgia, Blood creatine phosphokinase increased, Blood creatinine increased
Clinical narrative: Patient is a 68 y.o. female with a history of DM2, CAD, HTN, HFpEF, hyperlipidemia, CKD, chronic pain and OSA who presented to Hospital 2/17/2023 after mechanical fall out of bathtub and unable to get up for 3 days. Found to have DKA, leukocytosis of 20, lactic acidosis, covid positive, mildly elevated CPK at 1.2K. Trauma imaging negative. Hospital course complicated by progressive hypoxia.    1. COVID19 Pneumonia: DOP 2/17/23. Cough and congestion, sore throat. Mild o2 usage in ED. Will do remdesivir for now but cautious with renal function/GFR. Wean o2 as able. Isolation. Dexamethasone started 2/19/23 for worsening O2 sats. Procal 0.48 on 2/19/23. Ceftriaxone and azithro for possible CAP/superinfection x 5 days ending 2/22/23 2. Acute hypoxic respiratory failure: Due to above. High risk for progression as family requestng discharge home with O2 while patient recently titrated to 6lpm. Pulm hygiene ordered. Given COVID infection, patient may require chronic O2 on discharge pending recovery course. Improving and weaned to room air 2/21/23.   3. DKA: DM2 per history with likely DKA from acute stressors. Gap closed and ketones negative for 48 hours but limited by poor oral intake. Insulin transitioned to subcutaneous with steroids. Discharge on lantus 25 bid and lispro 16qac + ssi. May need titrated down with end of steroids and some instructions given. F/u with PCP.  4. Sepsis: Present on admission. COVID with suspected cellulitis and possible UTI will cover with rocephin. Blood cultures 2/17/23 NGTD x2. UCX no growth.    5. Fall with Elevated CPK: Mild with being down for 3 days. Improved with IVF.  CT Head, CTL, CTAP negative for acute fractures. Right shoulder pain, XR 2/18/23 showed no fracture but degenerative changes, recommended ortho follow up as patient established for knees. 6. DM2: On metformin at home. Held. Management as above  7. CAD:Hx, statin bb continued.  8. HTN: Home coreg 25 reduced and losartan held. Titrate PRN.  9. HFpEF: Hx echo 9/2021 with ef 59% mild AS. No longer on diuretics at home. IVF completed.  10. Hyperlipidemia: home statin 11. CKD: CKD 3 per notes and suspect baseline creat 1.3-1.5. At baseline on admission.  12. OSA: Does not use cpap at home.  13. Code status: DNR CCA DNI on discussed with with patient with son at bedside.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood culture negative, Blood ketone body, COVID-19, COVID-19 pneumonia, Cellulitis
Clinical narrative: Patient is a 68 y.o. female with a history of DM2, CAD, HTN, HFpEF, hyperlipidemia, CKD, chronic pain and OSA who presented to Hospital 2/17/2023 after mechanical fall out of bathtub and unable to get up for 3 days. Found to have DKA, leukocytosis of 20, lactic acidosis, covid positive, mildly elevated CPK at 1.2K. Trauma imaging negative. Hospital course complicated by progressive hypoxia.    1. COVID19 Pneumonia: DOP 2/17/23. Cough and congestion, sore throat. Mild o2 usage in ED. Will do remdesivir for now but cautious with renal function/GFR. Wean o2 as able. Isolation. Dexamethasone started 2/19/23 for worsening O2 sats. Procal 0.48 on 2/19/23. Ceftriaxone and azithro for possible CAP/superinfection x 5 days ending 2/22/23 2. Acute hypoxic respiratory failure: Due to above. High risk for progression as family requestng discharge home with O2 while patient recently titrated to 6lpm. Pulm hygiene ordered. Given COVID infection, patient may require chronic O2 on discharge pending recovery course. Improving and weaned to room air 2/21/23.   3. DKA: DM2 per history with likely DKA from acute stressors. Gap closed and ketones negative for 48 hours but limited by poor oral intake. Insulin transitioned to subcutaneous with steroids. Discharge on lantus 25 bid and lispro 16qac + ssi. May need titrated down with end of steroids and some instructions given. F/u with PCP.  4. Sepsis: Present on admission. COVID with suspected cellulitis and possible UTI will cover with rocephin. Blood cultures 2/17/23 NGTD x2. UCX no growth.    5. Fall with Elevated CPK: Mild with being down for 3 days. Improved with IVF.  CT Head, CTL, CTAP negative for acute fractures. Right shoulder pain, XR 2/18/23 showed no fracture but degenerative changes, recommended ortho follow up as patient established for knees. 6. DM2: On metformin at home. Held. Management as above  7. CAD:Hx, statin bb continued.  8. HTN: Home coreg 25 reduced and losartan held. Titrate PRN.  9. HFpEF: Hx echo 9/2021 with ef 59% mild AS. No longer on diuretics at home. IVF completed.  10. Hyperlipidemia: home statin 11. CKD: CKD 3 per notes and suspect baseline creat 1.3-1.5. At baseline on admission.  12. OSA: Does not use cpap at home.  13. Code status: DNR CCA DNI on discussed with with patient with son at bedside.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Computerised tomogram head normal, Cough, Culture urine negative, Diabetic ketoacidosis, Fall
Clinical narrative: Patient is a 68 y.o. female with a history of DM2, CAD, HTN, HFpEF, hyperlipidemia, CKD, chronic pain and OSA who presented to Hospital 2/17/2023 after mechanical fall out of bathtub and unable to get up for 3 days. Found to have DKA, leukocytosis of 20, lactic acidosis, covid positive, mildly elevated CPK at 1.2K. Trauma imaging negative. Hospital course complicated by progressive hypoxia.    1. COVID19 Pneumonia: DOP 2/17/23. Cough and congestion, sore throat. Mild o2 usage in ED. Will do remdesivir for now but cautious with renal function/GFR. Wean o2 as able. Isolation. Dexamethasone started 2/19/23 for worsening O2 sats. Procal 0.48 on 2/19/23. Ceftriaxone and azithro for possible CAP/superinfection x 5 days ending 2/22/23 2. Acute hypoxic respiratory failure: Due to above. High risk for progression as family requestng discharge home with O2 while patient recently titrated to 6lpm. Pulm hygiene ordered. Given COVID infection, patient may require chronic O2 on discharge pending recovery course. Improving and weaned to room air 2/21/23.   3. DKA: DM2 per history with likely DKA from acute stressors. Gap closed and ketones negative for 48 hours but limited by poor oral intake. Insulin transitioned to subcutaneous with steroids. Discharge on lantus 25 bid and lispro 16qac + ssi. May need titrated down with end of steroids and some instructions given. F/u with PCP.  4. Sepsis: Present on admission. COVID with suspected cellulitis and possible UTI will cover with rocephin. Blood cultures 2/17/23 NGTD x2. UCX no growth.    5. Fall with Elevated CPK: Mild with being down for 3 days. Improved with IVF.  CT Head, CTL, CTAP negative for acute fractures. Right shoulder pain, XR 2/18/23 showed no fracture but degenerative changes, recommended ortho follow up as patient established for knees. 6. DM2: On metformin at home. Held. Management as above  7. CAD:Hx, statin bb continued.  8. HTN: Home coreg 25 reduced and losartan held. Titrate PRN.  9. HFpEF: Hx echo 9/2021 with ef 59% mild AS. No longer on diuretics at home. IVF completed.  10. Hyperlipidemia: home statin 11. CKD: CKD 3 per notes and suspect baseline creat 1.3-1.5. At baseline on admission.  12. OSA: Does not use cpap at home.  13. Code status: DNR CCA DNI on discussed with with patient with son at bedside.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Hypophagia, Injury, Lactic acidosis, Leukocytosis, Mobility decreased
Clinical narrative: Patient is a 68 y.o. female with a history of DM2, CAD, HTN, HFpEF, hyperlipidemia, CKD, chronic pain and OSA who presented to Hospital 2/17/2023 after mechanical fall out of bathtub and unable to get up for 3 days. Found to have DKA, leukocytosis of 20, lactic acidosis, covid positive, mildly elevated CPK at 1.2K. Trauma imaging negative. Hospital course complicated by progressive hypoxia.    1. COVID19 Pneumonia: DOP 2/17/23. Cough and congestion, sore throat. Mild o2 usage in ED. Will do remdesivir for now but cautious with renal function/GFR. Wean o2 as able. Isolation. Dexamethasone started 2/19/23 for worsening O2 sats. Procal 0.48 on 2/19/23. Ceftriaxone and azithro for possible CAP/superinfection x 5 days ending 2/22/23 2. Acute hypoxic respiratory failure: Due to above. High risk for progression as family requestng discharge home with O2 while patient recently titrated to 6lpm. Pulm hygiene ordered. Given COVID infection, patient may require chronic O2 on discharge pending recovery course. Improving and weaned to room air 2/21/23.   3. DKA: DM2 per history with likely DKA from acute stressors. Gap closed and ketones negative for 48 hours but limited by poor oral intake. Insulin transitioned to subcutaneous with steroids. Discharge on lantus 25 bid and lispro 16qac + ssi. May need titrated down with end of steroids and some instructions given. F/u with PCP.  4. Sepsis: Present on admission. COVID with suspected cellulitis and possible UTI will cover with rocephin. Blood cultures 2/17/23 NGTD x2. UCX no growth.    5. Fall with Elevated CPK: Mild with being down for 3 days. Improved with IVF.  CT Head, CTL, CTAP negative for acute fractures. Right shoulder pain, XR 2/18/23 showed no fracture but degenerative changes, recommended ortho follow up as patient established for knees. 6. DM2: On metformin at home. Held. Management as above  7. CAD:Hx, statin bb continued.  8. HTN: Home coreg 25 reduced and losartan held. Titrate PRN.  9. HFpEF: Hx echo 9/2021 with ef 59% mild AS. No longer on diuretics at home. IVF completed.  10. Hyperlipidemia: home statin 11. CKD: CKD 3 per notes and suspect baseline creat 1.3-1.5. At baseline on admission.  12. OSA: Does not use cpap at home.  13. Code status: DNR CCA DNI on discussed with with patient with son at bedside.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Oropharyngeal pain, Osteoarthritis, Portogram, Procalcitonin increased, Respiratory tract congestion
Clinical narrative: Patient is a 68 y.o. female with a history of DM2, CAD, HTN, HFpEF, hyperlipidemia, CKD, chronic pain and OSA who presented to Hospital 2/17/2023 after mechanical fall out of bathtub and unable to get up for 3 days. Found to have DKA, leukocytosis of 20, lactic acidosis, covid positive, mildly elevated CPK at 1.2K. Trauma imaging negative. Hospital course complicated by progressive hypoxia.    1. COVID19 Pneumonia: DOP 2/17/23. Cough and congestion, sore throat. Mild o2 usage in ED. Will do remdesivir for now but cautious with renal function/GFR. Wean o2 as able. Isolation. Dexamethasone started 2/19/23 for worsening O2 sats. Procal 0.48 on 2/19/23. Ceftriaxone and azithro for possible CAP/superinfection x 5 days ending 2/22/23 2. Acute hypoxic respiratory failure: Due to above. High risk for progression as family requestng discharge home with O2 while patient recently titrated to 6lpm. Pulm hygiene ordered. Given COVID infection, patient may require chronic O2 on discharge pending recovery course. Improving and weaned to room air 2/21/23.   3. DKA: DM2 per history with likely DKA from acute stressors. Gap closed and ketones negative for 48 hours but limited by poor oral intake. Insulin transitioned to subcutaneous with steroids. Discharge on lantus 25 bid and lispro 16qac + ssi. May need titrated down with end of steroids and some instructions given. F/u with PCP.  4. Sepsis: Present on admission. COVID with suspected cellulitis and possible UTI will cover with rocephin. Blood cultures 2/17/23 NGTD x2. UCX no growth.    5. Fall with Elevated CPK: Mild with being down for 3 days. Improved with IVF.  CT Head, CTL, CTAP negative for acute fractures. Right shoulder pain, XR 2/18/23 showed no fracture but degenerative changes, recommended ortho follow up as patient established for knees. 6. DM2: On metformin at home. Held. Management as above  7. CAD:Hx, statin bb continued.  8. HTN: Home coreg 25 reduced and losartan held. Titrate PRN.  9. HFpEF: Hx echo 9/2021 with ef 59% mild AS. No longer on diuretics at home. IVF completed.  10. Hyperlipidemia: home statin 11. CKD: CKD 3 per notes and suspect baseline creat 1.3-1.5. At baseline on admission.  12. OSA: Does not use cpap at home.  13. Code status: DNR CCA DNI on discussed with with patient with son at bedside.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Sepsis
Clinical narrative: Patient is a 68 y.o. female with a history of DM2, CAD, HTN, HFpEF, hyperlipidemia, CKD, chronic pain and OSA who presented to Hospital 2/17/2023 after mechanical fall out of bathtub and unable to get up for 3 days. Found to have DKA, leukocytosis of 20, lactic acidosis, covid positive, mildly elevated CPK at 1.2K. Trauma imaging negative. Hospital course complicated by progressive hypoxia.    1. COVID19 Pneumonia: DOP 2/17/23. Cough and congestion, sore throat. Mild o2 usage in ED. Will do remdesivir for now but cautious with renal function/GFR. Wean o2 as able. Isolation. Dexamethasone started 2/19/23 for worsening O2 sats. Procal 0.48 on 2/19/23. Ceftriaxone and azithro for possible CAP/superinfection x 5 days ending 2/22/23 2. Acute hypoxic respiratory failure: Due to above. High risk for progression as family requestng discharge home with O2 while patient recently titrated to 6lpm. Pulm hygiene ordered. Given COVID infection, patient may require chronic O2 on discharge pending recovery course. Improving and weaned to room air 2/21/23.   3. DKA: DM2 per history with likely DKA from acute stressors. Gap closed and ketones negative for 48 hours but limited by poor oral intake. Insulin transitioned to subcutaneous with steroids. Discharge on lantus 25 bid and lispro 16qac + ssi. May need titrated down with end of steroids and some instructions given. F/u with PCP.  4. Sepsis: Present on admission. COVID with suspected cellulitis and possible UTI will cover with rocephin. Blood cultures 2/17/23 NGTD x2. UCX no growth.    5. Fall with Elevated CPK: Mild with being down for 3 days. Improved with IVF.  CT Head, CTL, CTAP negative for acute fractures. Right shoulder pain, XR 2/18/23 showed no fracture but degenerative changes, recommended ortho follow up as patient established for knees. 6. DM2: On metformin at home. Held. Management as above  7. CAD:Hx, statin bb continued.  8. HTN: Home coreg 25 reduced and losartan held. Titrate PRN.  9. HFpEF: Hx echo 9/2021 with ef 59% mild AS. No longer on diuretics at home. IVF completed.  10. Hyperlipidemia: home statin 11. CKD: CKD 3 per notes and suspect baseline creat 1.3-1.5. At baseline on admission.  12. OSA: Does not use cpap at home.  13. Code status: DNR CCA DNI on discussed with with patient with son at bedside.
Age: 17.0
Sex: F
Vaccine: MENB, MNQ
Symptoms: Urticaria
Clinical narrative: Urticaria
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Blood creatinine increased, Blood potassium increased
Clinical narrative: Patient is a 76 y.o. male patient of DO with history of CAD, HTN, OSA not on CPAP, DVT, COVID (4/2022), gout, and stage IIIb CKD who presented to ER with weakness and shortness of breath in setting of known COVID dx.     Acute Respiratory Failure with Hypoxemia Covid-19 Virus Infection Sepsis R/o superimposed Bacterial Pneumonia Date of onset of symptoms: Middle of January Symptoms present on admission: Nonproductive cough, weakness, poor PO intake Date of covid positive test: 1/30 with home test Vaccination status: vaccinatedx2 Imaging: CT with mild peripheral bilateral GGO with emphysema Oxygen requirements on admission: 2 L O2 Current oxygen requirements: 2-3L Tmax 103 with WBC 6.26, currently afebrile Either protracted COVID course or new infection. Continue decadron Was previously on rocephin/azithro -- stopped on 2/13 due to negative w/u and procal No indication for  Paxlovid or Remdesivir based upon timeline   Hyperkalemia K 5.5 on 2/13 No obvious cause EKG reviewed by me does not show any peaked T waves K stayed around 5.2-5.3; he says he has been told he has hyperkalemia before   AKI on Stage IIIb CKD Cr baseline 1.4 - 1.5; follows with Dr. (Nephrology) Cr 2.32 s/p 30 cc/kg, Cr down to 1.45 by discharge Hold nephrotoxins and trend daily   HTN With softer BPs Holding Lisinopril and imdur Ok to resume Toprol xl given BP trending up  CAD S/p remote CABG, continue Aspirin and Lipitor Resume Toprol    Elevated Troponin TnT 31 -- > 31 in setting of COVID and AKI EKG NSR, normal axis, globally flat ST segments and QTc 436   Insomnia NARx reviewed, continue Ambien 5 mg nightly PRN
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Electrocardiogram normal
Clinical narrative: Patient is a 76 y.o. male patient of DO with history of CAD, HTN, OSA not on CPAP, DVT, COVID (4/2022), gout, and stage IIIb CKD who presented to ER with weakness and shortness of breath in setting of known COVID dx.     Acute Respiratory Failure with Hypoxemia Covid-19 Virus Infection Sepsis R/o superimposed Bacterial Pneumonia Date of onset of symptoms: Middle of January Symptoms present on admission: Nonproductive cough, weakness, poor PO intake Date of covid positive test: 1/30 with home test Vaccination status: vaccinatedx2 Imaging: CT with mild peripheral bilateral GGO with emphysema Oxygen requirements on admission: 2 L O2 Current oxygen requirements: 2-3L Tmax 103 with WBC 6.26, currently afebrile Either protracted COVID course or new infection. Continue decadron Was previously on rocephin/azithro -- stopped on 2/13 due to negative w/u and procal No indication for  Paxlovid or Remdesivir based upon timeline   Hyperkalemia K 5.5 on 2/13 No obvious cause EKG reviewed by me does not show any peaked T waves K stayed around 5.2-5.3; he says he has been told he has hyperkalemia before   AKI on Stage IIIb CKD Cr baseline 1.4 - 1.5; follows with Dr. (Nephrology) Cr 2.32 s/p 30 cc/kg, Cr down to 1.45 by discharge Hold nephrotoxins and trend daily   HTN With softer BPs Holding Lisinopril and imdur Ok to resume Toprol xl given BP trending up  CAD S/p remote CABG, continue Aspirin and Lipitor Resume Toprol    Elevated Troponin TnT 31 -- > 31 in setting of COVID and AKI EKG NSR, normal axis, globally flat ST segments and QTc 436   Insomnia NARx reviewed, continue Ambien 5 mg nightly PRN
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Emphysema, Hyperkalaemia, Hypophagia, Hypotension, Lung opacity
Clinical narrative: Patient is a 76 y.o. male patient of DO with history of CAD, HTN, OSA not on CPAP, DVT, COVID (4/2022), gout, and stage IIIb CKD who presented to ER with weakness and shortness of breath in setting of known COVID dx.     Acute Respiratory Failure with Hypoxemia Covid-19 Virus Infection Sepsis R/o superimposed Bacterial Pneumonia Date of onset of symptoms: Middle of January Symptoms present on admission: Nonproductive cough, weakness, poor PO intake Date of covid positive test: 1/30 with home test Vaccination status: vaccinatedx2 Imaging: CT with mild peripheral bilateral GGO with emphysema Oxygen requirements on admission: 2 L O2 Current oxygen requirements: 2-3L Tmax 103 with WBC 6.26, currently afebrile Either protracted COVID course or new infection. Continue decadron Was previously on rocephin/azithro -- stopped on 2/13 due to negative w/u and procal No indication for  Paxlovid or Remdesivir based upon timeline   Hyperkalemia K 5.5 on 2/13 No obvious cause EKG reviewed by me does not show any peaked T waves K stayed around 5.2-5.3; he says he has been told he has hyperkalemia before   AKI on Stage IIIb CKD Cr baseline 1.4 - 1.5; follows with Dr. (Nephrology) Cr 2.32 s/p 30 cc/kg, Cr down to 1.45 by discharge Hold nephrotoxins and trend daily   HTN With softer BPs Holding Lisinopril and imdur Ok to resume Toprol xl given BP trending up  CAD S/p remote CABG, continue Aspirin and Lipitor Resume Toprol    Elevated Troponin TnT 31 -- > 31 in setting of COVID and AKI EKG NSR, normal axis, globally flat ST segments and QTc 436   Insomnia NARx reviewed, continue Ambien 5 mg nightly PRN
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: Procalcitonin normal, SARS-CoV-2 test positive, Sepsis, Troponin T increased, White blood cell count normal
Clinical narrative: Patient is a 76 y.o. male patient of DO with history of CAD, HTN, OSA not on CPAP, DVT, COVID (4/2022), gout, and stage IIIb CKD who presented to ER with weakness and shortness of breath in setting of known COVID dx.     Acute Respiratory Failure with Hypoxemia Covid-19 Virus Infection Sepsis R/o superimposed Bacterial Pneumonia Date of onset of symptoms: Middle of January Symptoms present on admission: Nonproductive cough, weakness, poor PO intake Date of covid positive test: 1/30 with home test Vaccination status: vaccinatedx2 Imaging: CT with mild peripheral bilateral GGO with emphysema Oxygen requirements on admission: 2 L O2 Current oxygen requirements: 2-3L Tmax 103 with WBC 6.26, currently afebrile Either protracted COVID course or new infection. Continue decadron Was previously on rocephin/azithro -- stopped on 2/13 due to negative w/u and procal No indication for  Paxlovid or Remdesivir based upon timeline   Hyperkalemia K 5.5 on 2/13 No obvious cause EKG reviewed by me does not show any peaked T waves K stayed around 5.2-5.3; he says he has been told he has hyperkalemia before   AKI on Stage IIIb CKD Cr baseline 1.4 - 1.5; follows with Dr. (Nephrology) Cr 2.32 s/p 30 cc/kg, Cr down to 1.45 by discharge Hold nephrotoxins and trend daily   HTN With softer BPs Holding Lisinopril and imdur Ok to resume Toprol xl given BP trending up  CAD S/p remote CABG, continue Aspirin and Lipitor Resume Toprol    Elevated Troponin TnT 31 -- > 31 in setting of COVID and AKI EKG NSR, normal axis, globally flat ST segments and QTc 436   Insomnia NARx reviewed, continue Ambien 5 mg nightly PRN
Age: 75.0
Sex: M
Vaccine: TDAP
Symptoms: Antibody test, Biopsy skin, Biopsy skin abnormal, Blister, Immunology test
Clinical narrative: 2/7/23 VACCINATION DAY  -  No injection site tenderness at all. Beginning ~ 24 hours after injection:  First noted 4 small (5-7 mm), separate, maculopapular lesions on R inner forearm because of their intense itch.  (Opposite arm from vaccination.) This spread over days to involve both arms, both thighs.  Many R arm lesions (the oldest) formed tense blisters resembling bullous pemphigoid. (BP) All cleared with oral prednisone, but began recurring when taper of the drug ended.  Now under treatment again. Skin biopsy histology was compatible with BP, but DIF study showed no findings compatable with BP.  Neither did repeat DIF after lesions began again. Serology studies for basement membrane autoimmune antibodies drawn, and are pending results.  I'm a retired physician, so thought I should contribute this report to VAERS.
Age: 75.0
Sex: M
Vaccine: TDAP
Symptoms: Pemphigoid, Pruritus, Rash maculo-papular, Serology test, Skin lesion
Clinical narrative: 2/7/23 VACCINATION DAY  -  No injection site tenderness at all. Beginning ~ 24 hours after injection:  First noted 4 small (5-7 mm), separate, maculopapular lesions on R inner forearm because of their intense itch.  (Opposite arm from vaccination.) This spread over days to involve both arms, both thighs.  Many R arm lesions (the oldest) formed tense blisters resembling bullous pemphigoid. (BP) All cleared with oral prednisone, but began recurring when taper of the drug ended.  Now under treatment again. Skin biopsy histology was compatible with BP, but DIF study showed no findings compatable with BP.  Neither did repeat DIF after lesions began again. Serology studies for basement membrane autoimmune antibodies drawn, and are pending results.  I'm a retired physician, so thought I should contribute this report to VAERS.
Age: 0.58
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Hypersensitivity
Clinical narrative: Large local hypersensitivity reaction with onset on day 9. Resolved with Benadryl.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Arrhythmia, Atrial fibrillation, Atypical pneumonia, Blood lactic acid abnormal
Clinical narrative: Patient is a 69 y.o. female who presented to Hospital 2/18/2023 with shortness of breath     1.  Septic Shock - initial lactic acid was 4.2; has returned to normal - hypotension now resolved - known UTI- E.Coli - completed 5 days total of cefepime/ceftriaxone - 2/18: chest CT: Mild-to-moderate ground-glass opacities throughout the lungs, left greater than right consistent with atypical or viral pneumonia -(2/24) transferred out of ICU  - repeat labs OK; pulm signed off and patient transitioned to med/surg telemetry floor    2. Hypoxia    - was placed on bipap (2/20- improved and off bipap 2/21) Currently on room air - abnormal wide complex arrhythmia 2/19 and patient was cardioverted pacer interrogated revealing A.fib with RVR - on amiodarone and now transitioned to Xarelto - cardio followed -Continue Amioradone   3. COVID + (2/18)  - states got both vaccines and 2 boosters - initial CRP was 157 - on decadron and  also received remdesivir      4. UTI- e. coli - states had frequency at home - UA abnormal - urine cult sent - completed 5 days total of cefepime/ceftriaxone -Fluids (water) encouraged - urine amber in color still   5. Diab, type II - states sugar runs 130 at home - hosp gluc goal will be < 180. This is not being met; increased dose of NPH BID d/t stress hyperglycemia - A1C from Aug 2022 was 6.8   6. Elevated trop;      H/O TAVR 2019, perm pacer Dec 2022 - denies chest pain - follows with Dr.  - cardio recommends keeping magnesium >2; 2.1 today Hypothyroid due to thyroidectomy - Nov 2022 TSH 0.85 - states no recent change in thyroid dose - will cont with home dose here   8. OSA - has her own CPAP here   9. HTN, hyperlipidemia   10. Encephalopathy - resolved              - likely secondary to hypoxia/uti
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Blood magnesium normal, Blood thyroid stimulating hormone decreased, C-reactive protein increased, COVID-19, Cardiac assistance device user
Clinical narrative: Patient is a 69 y.o. female who presented to Hospital 2/18/2023 with shortness of breath     1.  Septic Shock - initial lactic acid was 4.2; has returned to normal - hypotension now resolved - known UTI- E.Coli - completed 5 days total of cefepime/ceftriaxone - 2/18: chest CT: Mild-to-moderate ground-glass opacities throughout the lungs, left greater than right consistent with atypical or viral pneumonia -(2/24) transferred out of ICU  - repeat labs OK; pulm signed off and patient transitioned to med/surg telemetry floor    2. Hypoxia    - was placed on bipap (2/20- improved and off bipap 2/21) Currently on room air - abnormal wide complex arrhythmia 2/19 and patient was cardioverted pacer interrogated revealing A.fib with RVR - on amiodarone and now transitioned to Xarelto - cardio followed -Continue Amioradone   3. COVID + (2/18)  - states got both vaccines and 2 boosters - initial CRP was 157 - on decadron and  also received remdesivir      4. UTI- e. coli - states had frequency at home - UA abnormal - urine cult sent - completed 5 days total of cefepime/ceftriaxone -Fluids (water) encouraged - urine amber in color still   5. Diab, type II - states sugar runs 130 at home - hosp gluc goal will be < 180. This is not being met; increased dose of NPH BID d/t stress hyperglycemia - A1C from Aug 2022 was 6.8   6. Elevated trop;      H/O TAVR 2019, perm pacer Dec 2022 - denies chest pain - follows with Dr.  - cardio recommends keeping magnesium >2; 2.1 today Hypothyroid due to thyroidectomy - Nov 2022 TSH 0.85 - states no recent change in thyroid dose - will cont with home dose here   8. OSA - has her own CPAP here   9. HTN, hyperlipidemia   10. Encephalopathy - resolved              - likely secondary to hypoxia/uti
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Cardioversion, Computerised tomogram thorax abnormal, Culture urine positive, Dyspnoea, Encephalopathy
Clinical narrative: Patient is a 69 y.o. female who presented to Hospital 2/18/2023 with shortness of breath     1.  Septic Shock - initial lactic acid was 4.2; has returned to normal - hypotension now resolved - known UTI- E.Coli - completed 5 days total of cefepime/ceftriaxone - 2/18: chest CT: Mild-to-moderate ground-glass opacities throughout the lungs, left greater than right consistent with atypical or viral pneumonia -(2/24) transferred out of ICU  - repeat labs OK; pulm signed off and patient transitioned to med/surg telemetry floor    2. Hypoxia    - was placed on bipap (2/20- improved and off bipap 2/21) Currently on room air - abnormal wide complex arrhythmia 2/19 and patient was cardioverted pacer interrogated revealing A.fib with RVR - on amiodarone and now transitioned to Xarelto - cardio followed -Continue Amioradone   3. COVID + (2/18)  - states got both vaccines and 2 boosters - initial CRP was 157 - on decadron and  also received remdesivir      4. UTI- e. coli - states had frequency at home - UA abnormal - urine cult sent - completed 5 days total of cefepime/ceftriaxone -Fluids (water) encouraged - urine amber in color still   5. Diab, type II - states sugar runs 130 at home - hosp gluc goal will be < 180. This is not being met; increased dose of NPH BID d/t stress hyperglycemia - A1C from Aug 2022 was 6.8   6. Elevated trop;      H/O TAVR 2019, perm pacer Dec 2022 - denies chest pain - follows with Dr.  - cardio recommends keeping magnesium >2; 2.1 today Hypothyroid due to thyroidectomy - Nov 2022 TSH 0.85 - states no recent change in thyroid dose - will cont with home dose here   8. OSA - has her own CPAP here   9. HTN, hyperlipidemia   10. Encephalopathy - resolved              - likely secondary to hypoxia/uti
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Escherichia infection, Escherichia test positive, Hyperglycaemia, Hypotension, Hypoxia
Clinical narrative: Patient is a 69 y.o. female who presented to Hospital 2/18/2023 with shortness of breath     1.  Septic Shock - initial lactic acid was 4.2; has returned to normal - hypotension now resolved - known UTI- E.Coli - completed 5 days total of cefepime/ceftriaxone - 2/18: chest CT: Mild-to-moderate ground-glass opacities throughout the lungs, left greater than right consistent with atypical or viral pneumonia -(2/24) transferred out of ICU  - repeat labs OK; pulm signed off and patient transitioned to med/surg telemetry floor    2. Hypoxia    - was placed on bipap (2/20- improved and off bipap 2/21) Currently on room air - abnormal wide complex arrhythmia 2/19 and patient was cardioverted pacer interrogated revealing A.fib with RVR - on amiodarone and now transitioned to Xarelto - cardio followed -Continue Amioradone   3. COVID + (2/18)  - states got both vaccines and 2 boosters - initial CRP was 157 - on decadron and  also received remdesivir      4. UTI- e. coli - states had frequency at home - UA abnormal - urine cult sent - completed 5 days total of cefepime/ceftriaxone -Fluids (water) encouraged - urine amber in color still   5. Diab, type II - states sugar runs 130 at home - hosp gluc goal will be < 180. This is not being met; increased dose of NPH BID d/t stress hyperglycemia - A1C from Aug 2022 was 6.8   6. Elevated trop;      H/O TAVR 2019, perm pacer Dec 2022 - denies chest pain - follows with Dr.  - cardio recommends keeping magnesium >2; 2.1 today Hypothyroid due to thyroidectomy - Nov 2022 TSH 0.85 - states no recent change in thyroid dose - will cont with home dose here   8. OSA - has her own CPAP here   9. HTN, hyperlipidemia   10. Encephalopathy - resolved              - likely secondary to hypoxia/uti
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Intensive care, Lung opacity, Pneumonia viral, Pollakiuria, Positive airway pressure therapy
Clinical narrative: Patient is a 69 y.o. female who presented to Hospital 2/18/2023 with shortness of breath     1.  Septic Shock - initial lactic acid was 4.2; has returned to normal - hypotension now resolved - known UTI- E.Coli - completed 5 days total of cefepime/ceftriaxone - 2/18: chest CT: Mild-to-moderate ground-glass opacities throughout the lungs, left greater than right consistent with atypical or viral pneumonia -(2/24) transferred out of ICU  - repeat labs OK; pulm signed off and patient transitioned to med/surg telemetry floor    2. Hypoxia    - was placed on bipap (2/20- improved and off bipap 2/21) Currently on room air - abnormal wide complex arrhythmia 2/19 and patient was cardioverted pacer interrogated revealing A.fib with RVR - on amiodarone and now transitioned to Xarelto - cardio followed -Continue Amioradone   3. COVID + (2/18)  - states got both vaccines and 2 boosters - initial CRP was 157 - on decadron and  also received remdesivir      4. UTI- e. coli - states had frequency at home - UA abnormal - urine cult sent - completed 5 days total of cefepime/ceftriaxone -Fluids (water) encouraged - urine amber in color still   5. Diab, type II - states sugar runs 130 at home - hosp gluc goal will be < 180. This is not being met; increased dose of NPH BID d/t stress hyperglycemia - A1C from Aug 2022 was 6.8   6. Elevated trop;      H/O TAVR 2019, perm pacer Dec 2022 - denies chest pain - follows with Dr.  - cardio recommends keeping magnesium >2; 2.1 today Hypothyroid due to thyroidectomy - Nov 2022 TSH 0.85 - states no recent change in thyroid dose - will cont with home dose here   8. OSA - has her own CPAP here   9. HTN, hyperlipidemia   10. Encephalopathy - resolved              - likely secondary to hypoxia/uti
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Septic shock, Troponin increased, Urinary tract infection, Urine analysis abnormal
Clinical narrative: Patient is a 69 y.o. female who presented to Hospital 2/18/2023 with shortness of breath     1.  Septic Shock - initial lactic acid was 4.2; has returned to normal - hypotension now resolved - known UTI- E.Coli - completed 5 days total of cefepime/ceftriaxone - 2/18: chest CT: Mild-to-moderate ground-glass opacities throughout the lungs, left greater than right consistent with atypical or viral pneumonia -(2/24) transferred out of ICU  - repeat labs OK; pulm signed off and patient transitioned to med/surg telemetry floor    2. Hypoxia    - was placed on bipap (2/20- improved and off bipap 2/21) Currently on room air - abnormal wide complex arrhythmia 2/19 and patient was cardioverted pacer interrogated revealing A.fib with RVR - on amiodarone and now transitioned to Xarelto - cardio followed -Continue Amioradone   3. COVID + (2/18)  - states got both vaccines and 2 boosters - initial CRP was 157 - on decadron and  also received remdesivir      4. UTI- e. coli - states had frequency at home - UA abnormal - urine cult sent - completed 5 days total of cefepime/ceftriaxone -Fluids (water) encouraged - urine amber in color still   5. Diab, type II - states sugar runs 130 at home - hosp gluc goal will be < 180. This is not being met; increased dose of NPH BID d/t stress hyperglycemia - A1C from Aug 2022 was 6.8   6. Elevated trop;      H/O TAVR 2019, perm pacer Dec 2022 - denies chest pain - follows with Dr.  - cardio recommends keeping magnesium >2; 2.1 today Hypothyroid due to thyroidectomy - Nov 2022 TSH 0.85 - states no recent change in thyroid dose - will cont with home dose here   8. OSA - has her own CPAP here   9. HTN, hyperlipidemia   10. Encephalopathy - resolved              - likely secondary to hypoxia/uti
Age: 69.0
Sex: F
Vaccine: VARZOS
Symptoms: Injection site induration, Injection site swelling, Pruritus
Clinical narrative: swelling and induration at the injection site with extreme itching that has been persistent for 1 week