chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Pulmonary congestion, Red blood cell sedimentation rate, SARS-CoV-2 test positive, Total lung capacity decreased, Tracheostomy
Clinical narrative: Patient is a 64 y.o. male patient of CNP with history of MRDD, CKD, seizure disorder, hypertension, tracheostomy/GJ tube placement, who resides at nursing facility, presented with cough, shortness of breath and increased tracheal secretions, found to have acute hypoxemic respiratory failure.   Patient unable to provide history due to MRDD, I met with one of her caregivers at bedside, noted 2 days of cough, increased secretions/suctioning requirements, and shortness of breath in addition to hypoxia.    Acute hypoxemic respiratory failure Concern for pneumonia, multidrug-resistant S/p tracheostomy but no oxygen at baseline History of prolonged hospitalization secondary to pneumonia Chest x-ray 1/4 reviewed low lung volumes.  Some atelectasis versus opacities within the lower lobe bilaterally.     Chest x-ray 1/11 personally reviewed?low lung volumes with some bronchovascular crowding.   Echocardiogram in August reviewed?normal EF normal diastolic function. Some pulmonary congestion due to IV fluids. Status post 10 days of IV Zosyn.   Tracheal cultures and antigen negative. Now down to room air just using T-piece oxygenation for humidification. Okay to discharge back to group home.   Covid-19 Virus Infection Pneumonia secondary to COVID Date of onset of symptoms: 1/3/23 Symptoms present on admission: Shortness of breath  Date of covid positive test: 1/4/2023 Vaccination status: vaccinated status post 3 doses of Pfizer Imaging: Chest x-ray, past reviewed, lower lobe airspace disease Oxygen requirements on admission: Trach mask, 10 L Current oxygen requirements: RA Medical therapy: steroids Consultants following: Infectious disease starting remdesivir  Anticipated special isolation end date: January 14 LDH ESR and CRP 23.5    S/p remdesivir and dexamethasone.   AKI resolved Resolved with IV fluids.   GJ feeding tube Status ISOSOURCE HN at 20ml/hr w/ 100ml free water flush q 4 hours; ADVCANCE 10ml/hr q 4 hours to GOAL: ISOSOURCE HN at 70ml/hr w/ 100ml free water flush q 4 hours(HOLD 1 hour before and after synthroid) Abdominal x-ray reviewed satisfactory position of jejunal feeding tube
Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough admission after one dose Janssen vaccine
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Alopecia, Biopsy skin, Blood iron, Thyroid function test, Vitamin D
Clinical narrative: Within 2 weeks of the 4th covid vaccine aggressive onset Alopecia  began. Within the course of 3 weeks 80% of all scalp  hair was lost and is continuing.
Sex: F
Vaccine: DTAPIPV, MMRV
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
Clinical narrative: Redness and swelling at area, left arm given subcutaneously. Area of left upper arm noted 24 hours after vaccination. Seen the next day in office; red area has expanded. Only mildly tender. No discharge. Antibiotic given for potential cellulitis development.
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Ammonia normal, Bacterial test negative, Barbiturates positive, Blood culture negative, Blood folate normal
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood thyroid stimulating hormone normal, COVID-19, CSF glucose increased, CSF protein increased, CSF white blood cell count increased
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cerebral ischaemia, Chest X-ray abnormal, Chronic sinusitis, Computerised tomogram abdomen abnormal, Computerised tomogram abnormal
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Computerised tomogram head abnormal, Confusional state, Cough, Drug screen positive, Enteritis
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Gallbladder disorder, Infection, Liver function test normal, Lumbar puncture abnormal, Metabolic encephalopathy
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pneumonia, Polymerase chain reaction negative, Pulmonary congestion, Pulmonary oedema, Pyrexia
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Scan with contrast abnormal, Treatment noncompliance, Treponema test negative, Urine analysis normal
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Vitamin B12 normal
Clinical narrative: Patient with history of Urge incontinence, OSA, RLS, pseudogout, neuropathy, overactive bladder, arthritis, obesity, IBS, hypertension, hyperlipidemia, fibromyalgia, DM2, depression. Discharged from Medical Center after admission for fever and confusion thought to have enteritis presented to Hospital with Fever and confusion and found to be positive for COVID-19. .   Acute metabolic encephalopathy, resolved During her recent admission this was thought to be due to possible enteritis and had improved by discharge. Currently due to COVID-19. 1/22/2023 head CT with mild chronic ischemic changes and chronic sinusitis. B12, folate, ammonia, RPR, TSH, UA all unremarkable. Underwent lumbar puncture with negative PCR panel, aerobic culture no growth, protein 46, glucose 91, and white blood cell of 7. Prior UDS positive for barbiturate however she takes Fioricet at home. At baseline at discharge  this admission  Could consider neurocognitive evaluation outpatient to look for underlying dementia given her recurrent issues with confusion when she has infections.    Covid-19 Virus Infection Date of onset of symptoms: unclear  Symptoms present on admission: fever, confusion, cough  Date of covid positive test: 1/22/23 Vaccination status: vaccinated Imaging: CXR edema vs early pneumonia  Oxygen requirements on admission: room air  Current oxygen requirements: room air  Medical therapy: not a candidate given uncertain onset and on room air  Anticipated special isolation end date: 2/1/23   Fever Documented at 102.8 in the ED Chest x-ray with mild pulmonary vascular congestion. Abdominal CT with IV contrast with gallbladder largely distended but no visualized stones. 1/22/2023 blood culture no growth to date UA without signs of infection LFTs normal and no right upper quadrant tenderness Suspect this is due to COVID-19 and will monitor off antibiotics   History of enteritis Diagnosed during admission based on a CAT scan at that time with small intestinal air-fluid levels. Has completed antibiotics Hypertension, essential Continue home amlodipine and losartan   DM2 Holding home empagliflozin, liraglutide Continue home long-acting insulin 54 units each morning Take short acting insulin 18 units before dinner    OSA States she is not using CPAP currently
Age: 82.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after three vaccines Pfizer 1/5/21 Lot# El3249;  Pfizer 2/5/21 Lot# Em9810;  Pfizer 11/11/21 Lot# FF2590
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after one dose Janssen vaccine
Age: 44.0
Sex: M
Vaccine: COVID19-2
Symptoms: Unevaluable event
Clinical narrative: None stated.
Age: 55.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: VACCINE WAS STORED IN FREEZER NOT IN FRIDGE. NO TREATMENT.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 3 vaccines Moderna 3/6/21 Lot# 010A21A;  Mderna 4/3/21 Lot# 025B21A;  Moderna 11/17/21 Lot# 034F21A
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Impaired work ability, Loss of personal independence in daily activities, Sleep disorder, Tinnitus
Clinical narrative: Developed Tinnitus hours after 2nd vaccine in the Pfizer series.
Age: 94.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal discomfort, Acute kidney injury, Acute myocardial infarction, Antiplatelet therapy, Bile duct stone
Clinical narrative: She is a 94 y.o. female patient of DO with history of GI bleed and diverticulosis who presented to the Hospital with complaint of diarrhea, LLQ discomfort and bright red blood in stool.  She had a recent NSTEMI a couple of weeks ago at which time DAPT was restarted.  She was found to have acute splenic flexure diverticulitis.  Acute diverticulitis History of diverticulosis. CT with acute splenic flexure diverticulitis. Blood Cx-no growth Continue Zosyn (day #3)- switch to oral antibiotics tomorrow- Cipro 500 mg oral daily and Flagyl 500 mg oral every 8 hours-for 7 days Pain management prn Monitor WBC  GI bleed Hematochezia Acute Anemia -blood loss Hgb 11.2> 10.1>10.3>9.0 Unremarkable EGD in 8/20/22, flex sig at that time showed sigmoid diverticulosis. Hold Plavix, continue aspirin. HOLD Plavix secondary to GI bleed- patient instructed to follow up with Cardiology to discuss re-starting this medication- patient wishes not to restart at this time due to bleeding Continue Protonix General surgery following- no indication for acute endoscopic intervention  Gastroenterology signed off- follow up with PCP Tolerating full liquid diet- advance as tolerated  Choledocholithiasis Noncontrast CT with choledocholithiasis within the distal common bile duct with common bile duct distention. Unremarkable hepatobiliary enzymes. GI evaluating, may not pursue ERCP as asymptomatic, and with advanced age. General surgery following-signed off no surgical intervention    Urinary bladder thickening Reviewed CT finding of urinary bladder thickening with surrounding fat stranding and intraluminal air. Patient reported bladder irrigation the day prior to presentation.   Monitor urine output and any urinary symptoms.   Leukocytosis WBC- 12.22>11.0>8.38 Afebrile Monitor CBC   Chronic combined systolic and diastolic CHF CAD Last 2D echo of 8/2022 with LVEF of 39%, grade 2 diastolic dysfunction. Recent NSTEMI 1/17/23 Continue medical management.-hold Plavix Daily weights Strict I & 0's   Essential hypertension Hyperlipidemia BP is controlled. Continue metoprolol, Zestril. Atorvastatin   AKI Creatinine of 1.49>1.31>1.45>1.51 Recent bladder irrigation. Avoid nephrotoxins. Monitor BMP Strict I & O's
Age: 94.0
Sex: F
Vaccine: COVID19-2
Symptoms: Biliary dilatation, Bladder hypertrophy, Bladder irrigation, Blood creatinine increased, Blood culture negative
Clinical narrative: She is a 94 y.o. female patient of DO with history of GI bleed and diverticulosis who presented to the Hospital with complaint of diarrhea, LLQ discomfort and bright red blood in stool.  She had a recent NSTEMI a couple of weeks ago at which time DAPT was restarted.  She was found to have acute splenic flexure diverticulitis.  Acute diverticulitis History of diverticulosis. CT with acute splenic flexure diverticulitis. Blood Cx-no growth Continue Zosyn (day #3)- switch to oral antibiotics tomorrow- Cipro 500 mg oral daily and Flagyl 500 mg oral every 8 hours-for 7 days Pain management prn Monitor WBC  GI bleed Hematochezia Acute Anemia -blood loss Hgb 11.2> 10.1>10.3>9.0 Unremarkable EGD in 8/20/22, flex sig at that time showed sigmoid diverticulosis. Hold Plavix, continue aspirin. HOLD Plavix secondary to GI bleed- patient instructed to follow up with Cardiology to discuss re-starting this medication- patient wishes not to restart at this time due to bleeding Continue Protonix General surgery following- no indication for acute endoscopic intervention  Gastroenterology signed off- follow up with PCP Tolerating full liquid diet- advance as tolerated  Choledocholithiasis Noncontrast CT with choledocholithiasis within the distal common bile duct with common bile duct distention. Unremarkable hepatobiliary enzymes. GI evaluating, may not pursue ERCP as asymptomatic, and with advanced age. General surgery following-signed off no surgical intervention    Urinary bladder thickening Reviewed CT finding of urinary bladder thickening with surrounding fat stranding and intraluminal air. Patient reported bladder irrigation the day prior to presentation.   Monitor urine output and any urinary symptoms.   Leukocytosis WBC- 12.22>11.0>8.38 Afebrile Monitor CBC   Chronic combined systolic and diastolic CHF CAD Last 2D echo of 8/2022 with LVEF of 39%, grade 2 diastolic dysfunction. Recent NSTEMI 1/17/23 Continue medical management.-hold Plavix Daily weights Strict I & 0's   Essential hypertension Hyperlipidemia BP is controlled. Continue metoprolol, Zestril. Atorvastatin   AKI Creatinine of 1.49>1.31>1.45>1.51 Recent bladder irrigation. Avoid nephrotoxins. Monitor BMP Strict I & O's
Age: 94.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood loss anaemia, Computerised tomogram abdomen abnormal, Diarrhoea, Diverticulitis, Gastrointestinal haemorrhage
Clinical narrative: She is a 94 y.o. female patient of DO with history of GI bleed and diverticulosis who presented to the Hospital with complaint of diarrhea, LLQ discomfort and bright red blood in stool.  She had a recent NSTEMI a couple of weeks ago at which time DAPT was restarted.  She was found to have acute splenic flexure diverticulitis.  Acute diverticulitis History of diverticulosis. CT with acute splenic flexure diverticulitis. Blood Cx-no growth Continue Zosyn (day #3)- switch to oral antibiotics tomorrow- Cipro 500 mg oral daily and Flagyl 500 mg oral every 8 hours-for 7 days Pain management prn Monitor WBC  GI bleed Hematochezia Acute Anemia -blood loss Hgb 11.2> 10.1>10.3>9.0 Unremarkable EGD in 8/20/22, flex sig at that time showed sigmoid diverticulosis. Hold Plavix, continue aspirin. HOLD Plavix secondary to GI bleed- patient instructed to follow up with Cardiology to discuss re-starting this medication- patient wishes not to restart at this time due to bleeding Continue Protonix General surgery following- no indication for acute endoscopic intervention  Gastroenterology signed off- follow up with PCP Tolerating full liquid diet- advance as tolerated  Choledocholithiasis Noncontrast CT with choledocholithiasis within the distal common bile duct with common bile duct distention. Unremarkable hepatobiliary enzymes. GI evaluating, may not pursue ERCP as asymptomatic, and with advanced age. General surgery following-signed off no surgical intervention    Urinary bladder thickening Reviewed CT finding of urinary bladder thickening with surrounding fat stranding and intraluminal air. Patient reported bladder irrigation the day prior to presentation.   Monitor urine output and any urinary symptoms.   Leukocytosis WBC- 12.22>11.0>8.38 Afebrile Monitor CBC   Chronic combined systolic and diastolic CHF CAD Last 2D echo of 8/2022 with LVEF of 39%, grade 2 diastolic dysfunction. Recent NSTEMI 1/17/23 Continue medical management.-hold Plavix Daily weights Strict I & 0's   Essential hypertension Hyperlipidemia BP is controlled. Continue metoprolol, Zestril. Atorvastatin   AKI Creatinine of 1.49>1.31>1.45>1.51 Recent bladder irrigation. Avoid nephrotoxins. Monitor BMP Strict I & O's
Age: 94.0
Sex: F
Vaccine: COVID19-2
Symptoms: Haematochezia, Hepatic enzyme, Leukocytosis, White blood cell count increased
Clinical narrative: She is a 94 y.o. female patient of DO with history of GI bleed and diverticulosis who presented to the Hospital with complaint of diarrhea, LLQ discomfort and bright red blood in stool.  She had a recent NSTEMI a couple of weeks ago at which time DAPT was restarted.  She was found to have acute splenic flexure diverticulitis.  Acute diverticulitis History of diverticulosis. CT with acute splenic flexure diverticulitis. Blood Cx-no growth Continue Zosyn (day #3)- switch to oral antibiotics tomorrow- Cipro 500 mg oral daily and Flagyl 500 mg oral every 8 hours-for 7 days Pain management prn Monitor WBC  GI bleed Hematochezia Acute Anemia -blood loss Hgb 11.2> 10.1>10.3>9.0 Unremarkable EGD in 8/20/22, flex sig at that time showed sigmoid diverticulosis. Hold Plavix, continue aspirin. HOLD Plavix secondary to GI bleed- patient instructed to follow up with Cardiology to discuss re-starting this medication- patient wishes not to restart at this time due to bleeding Continue Protonix General surgery following- no indication for acute endoscopic intervention  Gastroenterology signed off- follow up with PCP Tolerating full liquid diet- advance as tolerated  Choledocholithiasis Noncontrast CT with choledocholithiasis within the distal common bile duct with common bile duct distention. Unremarkable hepatobiliary enzymes. GI evaluating, may not pursue ERCP as asymptomatic, and with advanced age. General surgery following-signed off no surgical intervention    Urinary bladder thickening Reviewed CT finding of urinary bladder thickening with surrounding fat stranding and intraluminal air. Patient reported bladder irrigation the day prior to presentation.   Monitor urine output and any urinary symptoms.   Leukocytosis WBC- 12.22>11.0>8.38 Afebrile Monitor CBC   Chronic combined systolic and diastolic CHF CAD Last 2D echo of 8/2022 with LVEF of 39%, grade 2 diastolic dysfunction. Recent NSTEMI 1/17/23 Continue medical management.-hold Plavix Daily weights Strict I & 0's   Essential hypertension Hyperlipidemia BP is controlled. Continue metoprolol, Zestril. Atorvastatin   AKI Creatinine of 1.49>1.31>1.45>1.51 Recent bladder irrigation. Avoid nephrotoxins. Monitor BMP Strict I & O's
Age: 38.0
Sex: M
Vaccine: COVID19
Symptoms: Tinnitus
Clinical narrative: Tinnitus has gotten worse and worse over the last two months. I read an article today saying the vaccine could cause it. 16,000 people have reported tinnitus after getting the vaccine.
Age: 43.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: VACCINE WAS STORED IN FREEZER AND NOT IN FRIDGE. NO TREATMENT.
Age: 64.0
Sex: M
Vaccine: COVID19-2
Symptoms: Electrocardiogram, Extrasystoles, Stress echocardiogram, Supraventricular extrasystoles
Clinical narrative: Skipped heart beats determined to be premature atrial contractions.
Age: 16.0
Sex: M
Vaccine: MENB
Symptoms: Fatigue, Pain in extremity, Tinnitus
Clinical narrative: Received a Meningococcal B and Meningococcal ACWY vaccines. Complained of extreme fatigue, arm soreness, and ringing in ears for approximately 36 hours.
Age: 55.0
Sex: F
Vaccine: PNC20
Symptoms: Arthralgia, Borrelia test, Hepatic enzyme increased, Inflammatory marker test, Joint stiffness
Clinical narrative: Joint pain and stiffness started on 2/03/23 in neck, shoulders, elbows, wrists, hands and knees. Progressed to include jaw and hips on 2/09/23 and pain and stiffness worsened.
Age: 55.0
Sex: F
Vaccine: PNC20
Symptoms: Musculoskeletal stiffness, Rheumatoid factor negative
Clinical narrative: Joint pain and stiffness started on 2/03/23 in neck, shoulders, elbows, wrists, hands and knees. Progressed to include jaw and hips on 2/09/23 and pain and stiffness worsened.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Angiogram normal, Angiogram pulmonary normal, Asthenia, COVID-19
Clinical narrative: Patient is a 76 y.o. female with PMH of HTN, DM 2, CAD as well as cognitive impairment who presents to ED with chest pain, nausea and vomiting.  She was found to have COVID-19 infection and initiated on Paxlovid by ID.  She was seen by cardiology and no chest pain was thought to be due to possibly myocarditis versus hypertensive emergency.  It resolved on its own.  Patient was recommended myocarditis precautions with no strenuous activity for 3 months.  Patient was resumed on her home antihypertensives which required titration for better BP control.  She symptomatically improved with resolution of nausea and emesis.  She was seen by PT and OT and thought to benefit from skilled nursing facility.  This was discussed with patient and her family all of whom are agreeable.  Patient will be discharged to SNF in stable condition today.   Hospital course     Hypertensive emergency- resolved BP better controlled Home dose of Coreg and amlodipine continued Losartan added, titrate to 100 mg daily BP better controlled Some of the nocturnal blood pressure readings seems to be inaccurate   Acute Pleuritic chest pain-resolved Elevated troponin with NSTEMI 2 Myocarditis versus hypertensive emergency being the etiology Troponin 59, 63, 75, 105 CTA chest/abd/pelvis unrevealing Echo with preserved LVEF, grade 1 DD, trace pericardial effusion Cardiology input noted Outpatient stress test once COVID resolves Myocarditis precautions, no strenuous activity for 3 months Asymptomatic   Covid-19 infection Date of onset of symptoms: 1/21/23 Symptoms present on admission: nausea, vomiting Date of covid positive test: 1/21/23 Vaccination status: fully vaccinated per patient, no booster Imaging: 1/21/23 CT chest without infiltrates Oxygen requirements on admission: none Current oxygen requirements: None Medical therapy: Finished paxlovd  Consultants following: ID consulted Anticipated special isolation end date: 2/1/2023 Resume Lipitor from 2/1/2023   Nausea and emesis -Likely due to above -Improved -Better oral intake Generalized weakness Severe physical deconditioning Dizziness Acute dehydration  PT and OT and strongly referred to SNF -She seems to be needing a lot of assistance -Gentle IV hydration due to dizziness, may be dehydrated due to decreased oral intake in the last few days -Social work consulted to discuss SNF options -Patient is reluctant to go to SNF.  Need to review further discussion with family and explore home support -1/25-patient seems to be agreeable to go to SNF.  Spoke with CM.  Patient has been accepted to SNF and precertification obtained today.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Chest pain, Computerised tomogram abdomen, Computerised tomogram thorax normal, Condition aggravated, Dehydration
Clinical narrative: Patient is a 76 y.o. female with PMH of HTN, DM 2, CAD as well as cognitive impairment who presents to ED with chest pain, nausea and vomiting.  She was found to have COVID-19 infection and initiated on Paxlovid by ID.  She was seen by cardiology and no chest pain was thought to be due to possibly myocarditis versus hypertensive emergency.  It resolved on its own.  Patient was recommended myocarditis precautions with no strenuous activity for 3 months.  Patient was resumed on her home antihypertensives which required titration for better BP control.  She symptomatically improved with resolution of nausea and emesis.  She was seen by PT and OT and thought to benefit from skilled nursing facility.  This was discussed with patient and her family all of whom are agreeable.  Patient will be discharged to SNF in stable condition today.   Hospital course     Hypertensive emergency- resolved BP better controlled Home dose of Coreg and amlodipine continued Losartan added, titrate to 100 mg daily BP better controlled Some of the nocturnal blood pressure readings seems to be inaccurate   Acute Pleuritic chest pain-resolved Elevated troponin with NSTEMI 2 Myocarditis versus hypertensive emergency being the etiology Troponin 59, 63, 75, 105 CTA chest/abd/pelvis unrevealing Echo with preserved LVEF, grade 1 DD, trace pericardial effusion Cardiology input noted Outpatient stress test once COVID resolves Myocarditis precautions, no strenuous activity for 3 months Asymptomatic   Covid-19 infection Date of onset of symptoms: 1/21/23 Symptoms present on admission: nausea, vomiting Date of covid positive test: 1/21/23 Vaccination status: fully vaccinated per patient, no booster Imaging: 1/21/23 CT chest without infiltrates Oxygen requirements on admission: none Current oxygen requirements: None Medical therapy: Finished paxlovd  Consultants following: ID consulted Anticipated special isolation end date: 2/1/2023 Resume Lipitor from 2/1/2023   Nausea and emesis -Likely due to above -Improved -Better oral intake Generalized weakness Severe physical deconditioning Dizziness Acute dehydration  PT and OT and strongly referred to SNF -She seems to be needing a lot of assistance -Gentle IV hydration due to dizziness, may be dehydrated due to decreased oral intake in the last few days -Social work consulted to discuss SNF options -Patient is reluctant to go to SNF.  Need to review further discussion with family and explore home support -1/25-patient seems to be agreeable to go to SNF.  Spoke with CM.  Patient has been accepted to SNF and precertification obtained today.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Diastolic dysfunction, Dizziness, Echocardiogram abnormal, Ejection fraction, Hypertensive emergency
Clinical narrative: Patient is a 76 y.o. female with PMH of HTN, DM 2, CAD as well as cognitive impairment who presents to ED with chest pain, nausea and vomiting.  She was found to have COVID-19 infection and initiated on Paxlovid by ID.  She was seen by cardiology and no chest pain was thought to be due to possibly myocarditis versus hypertensive emergency.  It resolved on its own.  Patient was recommended myocarditis precautions with no strenuous activity for 3 months.  Patient was resumed on her home antihypertensives which required titration for better BP control.  She symptomatically improved with resolution of nausea and emesis.  She was seen by PT and OT and thought to benefit from skilled nursing facility.  This was discussed with patient and her family all of whom are agreeable.  Patient will be discharged to SNF in stable condition today.   Hospital course     Hypertensive emergency- resolved BP better controlled Home dose of Coreg and amlodipine continued Losartan added, titrate to 100 mg daily BP better controlled Some of the nocturnal blood pressure readings seems to be inaccurate   Acute Pleuritic chest pain-resolved Elevated troponin with NSTEMI 2 Myocarditis versus hypertensive emergency being the etiology Troponin 59, 63, 75, 105 CTA chest/abd/pelvis unrevealing Echo with preserved LVEF, grade 1 DD, trace pericardial effusion Cardiology input noted Outpatient stress test once COVID resolves Myocarditis precautions, no strenuous activity for 3 months Asymptomatic   Covid-19 infection Date of onset of symptoms: 1/21/23 Symptoms present on admission: nausea, vomiting Date of covid positive test: 1/21/23 Vaccination status: fully vaccinated per patient, no booster Imaging: 1/21/23 CT chest without infiltrates Oxygen requirements on admission: none Current oxygen requirements: None Medical therapy: Finished paxlovd  Consultants following: ID consulted Anticipated special isolation end date: 2/1/2023 Resume Lipitor from 2/1/2023   Nausea and emesis -Likely due to above -Improved -Better oral intake Generalized weakness Severe physical deconditioning Dizziness Acute dehydration  PT and OT and strongly referred to SNF -She seems to be needing a lot of assistance -Gentle IV hydration due to dizziness, may be dehydrated due to decreased oral intake in the last few days -Social work consulted to discuss SNF options -Patient is reluctant to go to SNF.  Need to review further discussion with family and explore home support -1/25-patient seems to be agreeable to go to SNF.  Spoke with CM.  Patient has been accepted to SNF and precertification obtained today.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Hypophagia, Loss of personal independence in daily activities, Myocarditis, Nausea, Pericardial effusion
Clinical narrative: Patient is a 76 y.o. female with PMH of HTN, DM 2, CAD as well as cognitive impairment who presents to ED with chest pain, nausea and vomiting.  She was found to have COVID-19 infection and initiated on Paxlovid by ID.  She was seen by cardiology and no chest pain was thought to be due to possibly myocarditis versus hypertensive emergency.  It resolved on its own.  Patient was recommended myocarditis precautions with no strenuous activity for 3 months.  Patient was resumed on her home antihypertensives which required titration for better BP control.  She symptomatically improved with resolution of nausea and emesis.  She was seen by PT and OT and thought to benefit from skilled nursing facility.  This was discussed with patient and her family all of whom are agreeable.  Patient will be discharged to SNF in stable condition today.   Hospital course     Hypertensive emergency- resolved BP better controlled Home dose of Coreg and amlodipine continued Losartan added, titrate to 100 mg daily BP better controlled Some of the nocturnal blood pressure readings seems to be inaccurate   Acute Pleuritic chest pain-resolved Elevated troponin with NSTEMI 2 Myocarditis versus hypertensive emergency being the etiology Troponin 59, 63, 75, 105 CTA chest/abd/pelvis unrevealing Echo with preserved LVEF, grade 1 DD, trace pericardial effusion Cardiology input noted Outpatient stress test once COVID resolves Myocarditis precautions, no strenuous activity for 3 months Asymptomatic   Covid-19 infection Date of onset of symptoms: 1/21/23 Symptoms present on admission: nausea, vomiting Date of covid positive test: 1/21/23 Vaccination status: fully vaccinated per patient, no booster Imaging: 1/21/23 CT chest without infiltrates Oxygen requirements on admission: none Current oxygen requirements: None Medical therapy: Finished paxlovd  Consultants following: ID consulted Anticipated special isolation end date: 2/1/2023 Resume Lipitor from 2/1/2023   Nausea and emesis -Likely due to above -Improved -Better oral intake Generalized weakness Severe physical deconditioning Dizziness Acute dehydration  PT and OT and strongly referred to SNF -She seems to be needing a lot of assistance -Gentle IV hydration due to dizziness, may be dehydrated due to decreased oral intake in the last few days -Social work consulted to discuss SNF options -Patient is reluctant to go to SNF.  Need to review further discussion with family and explore home support -1/25-patient seems to be agreeable to go to SNF.  Spoke with CM.  Patient has been accepted to SNF and precertification obtained today.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: Physical deconditioning, Pleuritic pain, SARS-CoV-2 test positive, Troponin increased, Vomiting
Clinical narrative: Patient is a 76 y.o. female with PMH of HTN, DM 2, CAD as well as cognitive impairment who presents to ED with chest pain, nausea and vomiting.  She was found to have COVID-19 infection and initiated on Paxlovid by ID.  She was seen by cardiology and no chest pain was thought to be due to possibly myocarditis versus hypertensive emergency.  It resolved on its own.  Patient was recommended myocarditis precautions with no strenuous activity for 3 months.  Patient was resumed on her home antihypertensives which required titration for better BP control.  She symptomatically improved with resolution of nausea and emesis.  She was seen by PT and OT and thought to benefit from skilled nursing facility.  This was discussed with patient and her family all of whom are agreeable.  Patient will be discharged to SNF in stable condition today.   Hospital course     Hypertensive emergency- resolved BP better controlled Home dose of Coreg and amlodipine continued Losartan added, titrate to 100 mg daily BP better controlled Some of the nocturnal blood pressure readings seems to be inaccurate   Acute Pleuritic chest pain-resolved Elevated troponin with NSTEMI 2 Myocarditis versus hypertensive emergency being the etiology Troponin 59, 63, 75, 105 CTA chest/abd/pelvis unrevealing Echo with preserved LVEF, grade 1 DD, trace pericardial effusion Cardiology input noted Outpatient stress test once COVID resolves Myocarditis precautions, no strenuous activity for 3 months Asymptomatic   Covid-19 infection Date of onset of symptoms: 1/21/23 Symptoms present on admission: nausea, vomiting Date of covid positive test: 1/21/23 Vaccination status: fully vaccinated per patient, no booster Imaging: 1/21/23 CT chest without infiltrates Oxygen requirements on admission: none Current oxygen requirements: None Medical therapy: Finished paxlovd  Consultants following: ID consulted Anticipated special isolation end date: 2/1/2023 Resume Lipitor from 2/1/2023   Nausea and emesis -Likely due to above -Improved -Better oral intake Generalized weakness Severe physical deconditioning Dizziness Acute dehydration  PT and OT and strongly referred to SNF -She seems to be needing a lot of assistance -Gentle IV hydration due to dizziness, may be dehydrated due to decreased oral intake in the last few days -Social work consulted to discuss SNF options -Patient is reluctant to go to SNF.  Need to review further discussion with family and explore home support -1/25-patient seems to be agreeable to go to SNF.  Spoke with CM.  Patient has been accepted to SNF and precertification obtained today.
Age: 24.0
Sex: M
Vaccine: HEP
Symptoms: Blood thyroid stimulating hormone, C-reactive protein, Full blood count, Metabolic function test, Pain
Clinical narrative: pruritic morbilliform rash began within 48 hours of receipt appeared on trunk and extremities feels achy has not self treated