chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Dyspnoea, Injection site erythema, Injection site warmth, Loss of consciousness
Clinical narrative: 5-6 hours after receiving Covid Moderna Spikevax vaccine on 10-2-23 at pharmacy, patient was home and began to feel shaky, dizzy, and started trembling while she was standing and making dinner. Patient then sat down and started seeing "tunnel vision" and "blacking out. Patient states she couldn't breath. Patient states she then 1 puff of her albuterol inhaler "and felt instant relief". Per patient, injection site was big, red, and "feverish". Today is 10-17-23, and it still feels "feverish".  This was a matter of minutes.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Nervousness, Tunnel vision
Clinical narrative: 5-6 hours after receiving Covid Moderna Spikevax vaccine on 10-2-23 at pharmacy, patient was home and began to feel shaky, dizzy, and started trembling while she was standing and making dinner. Patient then sat down and started seeing "tunnel vision" and "blacking out. Patient states she couldn't breath. Patient states she then 1 puff of her albuterol inhaler "and felt instant relief". Per patient, injection site was big, red, and "feverish". Today is 10-17-23, and it still feels "feverish".  This was a matter of minutes.
Age: 23.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Sex: F
Vaccine: COVID19
Symptoms: Aphonia, Balance disorder, Musculoskeletal disorder, Weight decreased, Wheelchair user
Clinical narrative: Patient reported: Received first Moderna vaccine on 2/23/21 lot 031L20A, Starting 2 weeks after receiving Moderna vaccine Lot 045A21A on 3/23/21, patient started loosing weight, lost total of 65 pounds, started loosing balance in March of 2022, started loosing use of legs June of 2022 and completely lost her singing voice August of 2022. Patient reports she received the Moderna vaccine at health department and doesn't remember exactly which facility. Did report to her physician and he suggested patient to call facility to report. Patient is now in wheelchair and has gained back up to 125pounds. Reports she is completely of descent and country has studies about adverse reactions following COVID-19 vaccines to those with descent. Family had to move her to state.
Age: 4.0
Sex: M
Vaccine: HEPA
Symptoms: Excessive eye blinking
Clinical narrative: Mom describes patient having eye blinking the day after receiving the Hep A vaccination. Symptoms are still present per mom, but are improving.
Age: 19.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 75.0
Sex: F
Vaccine: COVID19, RSV
Symptoms: Diarrhoea, Dizziness, Erythema, Induration, Pain in extremity
Clinical narrative: She got her vaccine, she felt dizzy, felt like she was going to pass out.  She has had diarrhea, vomiting.  She has a knot on her arm with a red area, and pain in the arm.  She has been taking Benadryl, and has put ice on the area.  This has helped some, but still has diarrhea.  She has not called her doctor regarding her symptoms.
Age: 75.0
Sex: F
Vaccine: COVID19, RSV
Symptoms: Vomiting
Clinical narrative: She got her vaccine, she felt dizzy, felt like she was going to pass out.  She has had diarrhea, vomiting.  She has a knot on her arm with a red area, and pain in the arm.  She has been taking Benadryl, and has put ice on the area.  This has helped some, but still has diarrhea.  She has not called her doctor regarding her symptoms.
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Chills, Myalgia, Pyrexia
Clinical narrative: slight fever, chills, muscle aches
Age: 57.0
Sex: M
Vaccine: FLUA4
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
Clinical narrative: Rn provided the FLUAD Quad dose for those >65. He should of had the FluLaval dose instead due to his age. He had a sore arm but no other concerns.
Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Underdose
Clinical narrative: Pfizer COVID dose for ages 6mo-5yr given by accident.
Age: 35.0
Sex: F
Vaccine: FLUA4
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Pt received high dose influenza vaccine. No noted adverse side effects.
Age: 5.0
Sex: M
Vaccine: FLU4
Symptoms: Injection site swelling
Clinical narrative: Localized arm swelling at the site, the morning after administration. no fever or other systemic symptoms. No pain at the ejection site.
Age: 76.0
Sex: F
Vaccine: PNC20, RSV
Symptoms: Diarrhoea, Nausea, Rash, Vomiting
Clinical narrative: Shortly after vaccination, patient developed nausea, vomiting and diarrhea that have persisted for 5 days. She also has a bilateral rash on arms.  She has taken diphenhydramine 25mg periodically but reports that has not relieved the problem. I told her at this point, she should seek treatment at her primary doctor to evaluate need for a steroid, potentially.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness
Clinical narrative: Dizziness about 45 minutes after shot
Age: 63.0
Sex: M
Vaccine: FLUA4
Symptoms: Incorrect dose administered, No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Pt received high dose influenza vaccine. No noted adverse events.
Age: 29.0
Sex: F
Vaccine: FLU4
Symptoms: Pruritus, Rash
Clinical narrative: rash/itching on the arm of the injection
Age: 2.0
Sex: F
Vaccine: DTAP
Symptoms: Wrong patient received product, Wrong product administered
Clinical narrative: Medical assistant had asked parent to put sibling on the bed and the wrong patient was given the wrong set of vaccines.
Age: 22.0
Sex: F
Vaccine: FLU4
Symptoms: Chills, Endotracheal intubation, Gait inability, Hypoaesthesia, Intensive care
Clinical narrative: She started getting fever, sore throat, chills, swollen lymph nodes and went to the Doctor on 10/11/23.  They completed many labs on her and she tested negative for mono and strep throat. Labs were abnormal per her mothers report.  She went to the hospital on 10/14/23 at night with numbness and tingling which started in her toes, then her hands.  She quickly became worse, was unable to walk, move, and was intubated on Sunday night. She is currently in the ICU per her mother's report.
Age: 22.0
Sex: F
Vaccine: FLU4
Symptoms: Lymphadenopathy, Mobility decreased, Mononucleosis heterophile test negative, Oropharyngeal pain, Paraesthesia
Clinical narrative: She started getting fever, sore throat, chills, swollen lymph nodes and went to the Doctor on 10/11/23.  They completed many labs on her and she tested negative for mono and strep throat. Labs were abnormal per her mothers report.  She went to the hospital on 10/14/23 at night with numbness and tingling which started in her toes, then her hands.  She quickly became worse, was unable to walk, move, and was intubated on Sunday night. She is currently in the ICU per her mother's report.
Age: 22.0
Sex: F
Vaccine: FLU4
Symptoms: Pyrexia, Streptococcus test negative
Clinical narrative: She started getting fever, sore throat, chills, swollen lymph nodes and went to the Doctor on 10/11/23.  They completed many labs on her and she tested negative for mono and strep throat. Labs were abnormal per her mothers report.  She went to the hospital on 10/14/23 at night with numbness and tingling which started in her toes, then her hands.  She quickly became worse, was unable to walk, move, and was intubated on Sunday night. She is currently in the ICU per her mother's report.
Age: 9.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered
Clinical narrative: Patients Guardian was notified of incorrect dose and agreed to appointment to re-vaccinate  10/17/2023.
Age: 60.0
Sex: M
Vaccine: FLU4
Symptoms: Arthralgia, Neuropathy peripheral, Sleep disorder
Clinical narrative: Patient reports that approximately 1 week after receiving his flu vaccine he developed left middle finger DIP joint pain that spread to multiple joints (fingers,wrists, ankles, and knees)  severe PAIN 7/10 on pain scale that was worse at night and  tneuropathy in bilateral upper and lower extremities for at least 2 weeks that interupted his sleep. Reports still having pain however it has improved slightly currently pain 5/10.
Age: 31.0
Sex: M
Vaccine: MMR
Symptoms: Drooling, Injection site rash, Paraesthesia, Pyrexia, Swelling
Clinical narrative: Pt experienced drooling, fever, left hand tingling, neck swelling and rash at injection site
Age: 61.0
Sex: F
Vaccine: RSV
Symptoms: Pruritus, Rash
Clinical narrative: rash from head to toe/severe itching/  NO swollen throat or breathing problems
Age: 68.0
Sex: F
Vaccine: FLU4, VARZOS
Symptoms: Rash pruritic
Clinical narrative: The night of the vaccine administrations the patient stated she experienced an "itchy rash" on her arm that extended to her face, neck, and down her legs and back.
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Asthenia, Body temperature increased, Chills, Nausea, Retching
Clinical narrative: Slight temp with chills, nausea and vomiting for two days, dry heaving for two days, I was only able to sip water or coke infrequently, no energy.  This is the third time I have been down.  The previous boosters gave me the same symptoms.
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Vaccine positive rechallenge, Vomiting
Clinical narrative: Slight temp with chills, nausea and vomiting for two days, dry heaving for two days, I was only able to sip water or coke infrequently, no energy.  This is the third time I have been down.  The previous boosters gave me the same symptoms.
Age: 1.25
Sex: M
Vaccine: DTAPIPVHIB
Symptoms: Expired product administered
Clinical narrative: On 10/16/2023 MA gave expired dose of Pentacel to patient on Left Thigh. I have contacted the manufacturer company to receive information and indications about vaccine. Dr. has contacted parent to notify about the incident. Mother of child stated patient is doing fine and will just keep a close eye on him and was very understanding. I have also contacted the compliance department of the company to notify them about incident that occured and incident is also recorded in patients chart.
Age: 8.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered
Clinical narrative: Patients Guardian was notified of incorrect dose and agreed to appointment to re-vaccinate 10/17/2023
Age: 36.0
Sex: F
Vaccine: RSV, RSV
Symptoms: Exposure during pregnancy, Product use issue
Clinical narrative: Pt came to clinic requesting a RSV vaccine.  Clinic only has Arexvy in stock.  LPN gave Arexvy.  Pt is pregnant and 36 years old.  Unsure how far along  Pt is with pregnancy.
Age: 36.0
Sex: F
Vaccine: RSV, RSV
Symptoms: Exposure during pregnancy, Product administered to patient of inappropriate age
Clinical narrative: Pt came to clinic requesting a RSV vaccine.  Clinic only has Arexvy in stock.  LPN gave Arexvy.  Pt is pregnant and 36 years old.  Unsure how far along  Pt is with pregnancy.
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood test, Computerised tomogram, Headache, Magnetic resonance imaging
Clinical narrative: started having massive debilitating headaches, stroke-like symptoms
Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Neurological symptom
Clinical narrative: started having massive debilitating headaches, stroke-like symptoms
Age: 81.0
Sex: F
Vaccine: RSV
Symptoms: Asthenia, Decreased appetite, Diarrhoea, Fatigue, Hyperhidrosis
Clinical narrative: She got her vaccine, and it really hurt bad.  By the next morning she was having diarrhea, and throwing up, bad fatigue, no energy whatsoever.  She felt like she could just sleep.  Loss of appetite as well.  She took nothing for her symptoms and just hoping that it would ware off with the vaccine.  She had the diarrhea and throwing up for 2 days.  She did call her doctor and she told her that this sometimes goes along with the vaccines.  She did not offer her anything to take for it and that it might take a week to go away.  She is still having fatigue, but she is eating yogurt but not having much of an appetite.  She is keeping hydrated with bottled water with electrolytes in it.    She also had 2 nights where she must have been running a fever as she woke up soaking wet with her pajamas plastered to her.
Age: 81.0
Sex: F
Vaccine: RSV
Symptoms: Injection site pain, Night sweats, Somnolence, Vomiting
Clinical narrative: She got her vaccine, and it really hurt bad.  By the next morning she was having diarrhea, and throwing up, bad fatigue, no energy whatsoever.  She felt like she could just sleep.  Loss of appetite as well.  She took nothing for her symptoms and just hoping that it would ware off with the vaccine.  She had the diarrhea and throwing up for 2 days.  She did call her doctor and she told her that this sometimes goes along with the vaccines.  She did not offer her anything to take for it and that it might take a week to go away.  She is still having fatigue, but she is eating yogurt but not having much of an appetite.  She is keeping hydrated with bottled water with electrolytes in it.    She also had 2 nights where she must have been running a fever as she woke up soaking wet with her pajamas plastered to her.
Age: 1.0
Sex: M
Vaccine: HEPA, HIBV, MMR, PNC13, VARCEL
Symptoms: Expired product administered
Clinical narrative: All vaccines were administered normally. Pt tolerated well. After administering vaccines, it was found that HIB was expired. Expiration date was 10/08/23 and vaccine was given 10/16/23. Pt did not show any concerning signs or symptoms of any type of adverse reactions to the vaccines. We reached out to the help desk (Health Authority) and they informed us that patient will want to repeat this dose. Patients mother was informed and agrees to get this dose repeated and pts next well child exam.
Age: 77.0
Sex: F
Vaccine: RSV
Symptoms: Atrial fibrillation, Electrocardiogram abnormal
Clinical narrative: I received the shot September 5th.  On  September 12th my Watch alerted me I had atrial fibrillation.  My watch continued to give me daily alerts. I was on a vacation and went to my doctor when I got home on September 13th.
Age: 75.0
Sex: M
Vaccine: PNC20
Symptoms: Rash
Clinical narrative: localized rash
Age: 71.0
Sex: F
Vaccine: COVID19-2
Symptoms: Extra dose administered
Clinical narrative: patient received the SPIKEVAX vaccine three weeks after getting another SPIKEVAX dose. The patient is currently fine but we told her to follow-up with any adverse events since she essentially received two doses of spivevax
Age: 20.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 36.0
Sex: F
Vaccine: COVID19, FLU4, PPV
Symptoms: Arthralgia, Fatigue, Headache, Pyrexia
Clinical narrative: Fever Severe fatigue Dizziness Joint pain Headache Joint pain
Age: 29.0
Sex: F
Vaccine: FLUC4
Symptoms: Chest pain, Electrocardiogram normal, Full blood count normal, Metabolic function test normal, Presyncope
Clinical narrative: Chest pain, vasovagal duration of 3 hours
Age: 29.0
Sex: F
Vaccine: FLUC4
Symptoms: Troponin normal
Clinical narrative: Chest pain, vasovagal duration of 3 hours
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Pruritus
Clinical narrative: patient is having an itching feeling across their face and upper body that has onset a few days after their vaccination. This happens mostly at night every other day and is relieved with Benadryl.
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood culture negative, Blood lactic acid, C-reactive protein increased, COVID-19
Clinical narrative: Patient with history of COVID vaccination admitted to hospital with COVID detected PCR test. Per provider discharge notes, "Patient is a 87 YO male with HTN, essential tremor, hypothyroidism, Afib with controlled ventricular rate,OSA on CPAP at home, HFpEF presents from ER for evaluation of SOB, increased WOB and dry cough for 2-3 days. Admitted for acute hypoxic respiratory failure secondary to COVID infection.    Hospital Course: SIRS 1/2 for tachypnea, did not meet criteria for sepsis. CXR: Normal pulmonary vascularity. No pulmonary consolidation, pneumothorax, or evident pleural effusion. Procal 0.03, afebrile, no leukocytosis, CRP 3.35, lactic acid 1.2, blood culture NGTD x 2 d. Antibiotics held, as no sign of bacterial co infection.    Patient was weaned off oxygen. Upon exam this morning, patient feeling overall better.  Patient was medically optimized. Vital signs were stable for discharge."
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray normal, Cough, Dyspnoea, SARS-CoV-2 test positive, Systemic inflammatory response syndrome
Clinical narrative: Patient with history of COVID vaccination admitted to hospital with COVID detected PCR test. Per provider discharge notes, "Patient is a 87 YO male with HTN, essential tremor, hypothyroidism, Afib with controlled ventricular rate,OSA on CPAP at home, HFpEF presents from ER for evaluation of SOB, increased WOB and dry cough for 2-3 days. Admitted for acute hypoxic respiratory failure secondary to COVID infection.    Hospital Course: SIRS 1/2 for tachypnea, did not meet criteria for sepsis. CXR: Normal pulmonary vascularity. No pulmonary consolidation, pneumothorax, or evident pleural effusion. Procal 0.03, afebrile, no leukocytosis, CRP 3.35, lactic acid 1.2, blood culture NGTD x 2 d. Antibiotics held, as no sign of bacterial co infection.    Patient was weaned off oxygen. Upon exam this morning, patient feeling overall better.  Patient was medically optimized. Vital signs were stable for discharge."
Age: 85.0
Sex: M
Vaccine: COVID19
Symptoms: Tachypnoea
Clinical narrative: Patient with history of COVID vaccination admitted to hospital with COVID detected PCR test. Per provider discharge notes, "Patient is a 87 YO male with HTN, essential tremor, hypothyroidism, Afib with controlled ventricular rate,OSA on CPAP at home, HFpEF presents from ER for evaluation of SOB, increased WOB and dry cough for 2-3 days. Admitted for acute hypoxic respiratory failure secondary to COVID infection.    Hospital Course: SIRS 1/2 for tachypnea, did not meet criteria for sepsis. CXR: Normal pulmonary vascularity. No pulmonary consolidation, pneumothorax, or evident pleural effusion. Procal 0.03, afebrile, no leukocytosis, CRP 3.35, lactic acid 1.2, blood culture NGTD x 2 d. Antibiotics held, as no sign of bacterial co infection.    Patient was weaned off oxygen. Upon exam this morning, patient feeling overall better.  Patient was medically optimized. Vital signs were stable for discharge."
Age: 85.0
Sex: F
Vaccine: FLU4
Symptoms: Vaccination site infection
Clinical narrative: Patient states she had an infection  at the vaccine site and took 7 days of smz/tmp antibiotics to resolve the infection
Age: 25.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Erythema
Clinical narrative: After patient received the Moderna (Spikevax) vaccine, about 1 minute later, patient turned red and couldn't breath. Inject  Epipen right away. Patient  fell a little better and gave second epipen  about 8 minutes later. Pt rested and checked blood pressure. Pt's blood pressure was 143/82 pulse 102.
Age: 67.0
Sex: F
Vaccine: FLU4, VARZOS
Symptoms: Rash, Rash erythematous, Rash pruritic
Clinical narrative: Itchy red rash with bumps on the left elbow, left side of abdomen and underwear line.
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Abdominal pain, Acute respiratory failure, COVID-19, Confusional state, Delirium
Clinical narrative: Patient with history of COVID vaccination admitted to hospital with COVID detected PCR. Per provider discharge note, "Patient is a 76 YO male with vascular dementia, chronic systolic CHF, PAF on xarelto, HTN, IDA, BPH presents with worsening confusion and delirium, admitted for Acute hypoxic respiratory failure secondary to covid infection.    Hospital Course: Patient initially required O2 supplementation via nasal cannula. He was placed on Remdesivir and steroids, with significant improvement in respiratory status. His mental status returned to baseline, patient was able to identify his location, why he was in the hospital and his name and DOB.   His admission was complicated by intractable nausea and abdominal pain. Per chart review, this is a chronic issue, and patient has had several studies in the past, which have only revealed a hiatal hernia. Symptoms improved over time, and on day of discharge, patient denies any pain. Stating he is "more than ready to go home""
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Mental status changes, Nausea, SARS-CoV-2 test positive
Clinical narrative: Patient with history of COVID vaccination admitted to hospital with COVID detected PCR. Per provider discharge note, "Patient is a 76 YO male with vascular dementia, chronic systolic CHF, PAF on xarelto, HTN, IDA, BPH presents with worsening confusion and delirium, admitted for Acute hypoxic respiratory failure secondary to covid infection.    Hospital Course: Patient initially required O2 supplementation via nasal cannula. He was placed on Remdesivir and steroids, with significant improvement in respiratory status. His mental status returned to baseline, patient was able to identify his location, why he was in the hospital and his name and DOB.   His admission was complicated by intractable nausea and abdominal pain. Per chart review, this is a chronic issue, and patient has had several studies in the past, which have only revealed a hiatal hernia. Symptoms improved over time, and on day of discharge, patient denies any pain. Stating he is "more than ready to go home""
Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS  STORED IN AN UNAPPROVED STORAGE UNIT
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Affective disorder, Angiogram cerebral normal, Anticoagulant therapy, Arteriogram carotid abnormal, Arteriosclerosis
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Atrial fibrillation, Bipolar disorder, Blood creatinine increased, Blood lactate dehydrogenase normal
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Bradycardia, COVID-19, Cardiac pacemaker replacement, Cardiac telemetry, Carotid artery stenosis
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram normal, Condition aggravated, Depression, Drug level increased, Drug level therapeutic
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Fall, Fatigue, Gait disturbance, General physical health deterioration, Haptoglobin normal
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Hypersomnia, Laboratory test normal, Malaise, Mania, Neurological examination normal
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Platelet count decreased, Positive airway pressure therapy, Respiratory tract congestion, SARS-CoV-2 test positive, Sinus node dysfunction
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Sinus rhythm, Spinal X-ray normal, Thrombocytopenia, Tremor, Troponin normal
Clinical narrative: Patient is a 76 y.o. male who presented from home on 9/14/2023 with unsteady gait, tremors and urinary symptoms. Tested positive for COVID-19.  Behavioral medicine consulted due to patient's history of bipolar disorder for titration of medications.  Patient was taken out of isolation for COVID.   Gait instability - Etiology unclear. Likely weakness and decompensation from COVID-19. Unlikely cardiac in nature due to normal troponin.  Unlikely stroke though unable to completely rule out as cannot have MRI - Patient uses cane and walker at baseline, since 2011 - Neuro exam unremarkable. Valproic acid level elevated but still within therapeutic range. - CT angio of the head and neck with no acute intracranial abnormality. Atherosclerosis present with moderate stenosis of the L vertebral artery, stenosis of the proximal cervical ICAs b/l. Orthostatics negative. -B12 normal -Unable to undergo MRI due to his cardiac device -Repeat CT negative; will monitor for any evidence of gait instability -He was clinically improving and ambulating better with therapy but then on 9/19 early morning had a fall - got up on own and tripped over bipap tubing - repeat ct stable -Imaging of lumbar spine 9/25 negative for any displacement of previous surgical hardware or acute fractures.   Depression Bipolar disorder - Recently hospitalization for manic episode and meds adjusted. Per wife, patient sleeps often and is fatigued due to depression.  -Also significantly improved on discharge. - Was started on Depakote for bipolar disorder 3 weeks ago. Continue inpatient; however dose reduced due to valproic acid level.  Significantly improved mood. -Dose of Depakote reduced from 2000mg to 1500mg and started on Wellbutrin 150 daily per behavioral medicine recs on discharge.   COVID-19 - Patient vaccinated with Moderna + booster. - Symptom onset day before admission. Patient satting well on room air. - ID consult for possible Paxlovid use; started on Paxlovid 9/15 and course completed  - Given one-time Lasix on 9/16/23; lung exam much improved now and off O2   Thrombocytopenia - Baseline PLT count ~200. 98 upon admission. Likely due to COVID-19 infection. - LDH is normal, haptoglobin is normal - improved to nl range now xysmal atrial fibrillation - On home Xarelto 20 mg.  Rate controlled in NSR - Changed to Eliquis while patient is on Paxlovid, now back on Xarelto.   SA node dysfunction w/ pacemaker - Pacemaker battery last replaced on 9/4. Base pace rate is 45 bpm. - Continue to monitor via telemetry.   Chronic kidney disease - Baseline Cr between ~1.5. Cr 1.60 upon admission.  - Continue to monitor.  - Was given one-time dose of Lasix on 9/16 given his congestion for dry lung strategy, tolerated this well   HTN -On home Norvasc 5 mg, Carvedilol 25 BID at home, Losartan 50 mg. -BP controlled without Coreg, patient was bradycardic to 50-55 HR without Coreg. -continue home meds and monitor. Stop Carvedilol due to bradycardia.