chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 46.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sputum culture positive, Stenotrophomonas test positive, Wheezing
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 3/23/2023 Discharge Date: 3/28/23  PRESENTING PROBLEM: Cystic fibrosis [E84.9] Status post lung transplantation [Z94.2] COVID [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82]   HOSPITAL COURSE:   47 yo s/p double bilateral lung transplant 1/11/1993, ESRD post renal transplant 1998, PTLD, right bronchial stenosis, bronchiectasis,  recurrent pneumonia (stenotrophomonas, pseudomonas, and MSSA) , recent rhino-enterovirus pneumonia Jan 2023, presented to ER with one week of worsening wheezing, fatigue, and night sweats. Did not have increased cough, sputum production, or hypoxemia. ER workup found RLL PNA and film array + COVID 19.  He was admitted for treatment.    Pt given a 5 day course of remdisivir. He was also treated for suspected secondary bacterial infection, initially with Doxycycline to cover his hx of MSSA then extended to minocycline that is sensitive to the stenotrophomonas he is colonized with (and grew on sputum). He developed worsening secretion retention once admitted therefore bronchoscopy was completed morning of discharge, moderate mucus plugging identified and BAL cultures pending . He overall was feeling well and discharged 3/28/23 with instructions to follow up with local pulmonary clinic and  transplant clinic.
Age: 12.0
Sex: F
Vaccine: TDAP
Symptoms: Dizziness, Loss of consciousness
Clinical narrative: Patient received vaccine in clinic. waited 10 min in exam room. After leaving exam room patient felt dizzy. While speaking to medical staff patient passed out, she was caught by mom and staff and laid to the ground. Doctor was called. taken back to room and examined by doctor. Patient was cleared to leave after feeling better. As per patient and parent, patient was fasting before appt.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension
Clinical narrative: HYPOTENSION
Age: 68.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Anticoagulant therapy, Blood creatinine normal, Blood electrolytes, Blood glucose decreased, Blood lactic acid
Clinical narrative: Discharge Physician: MD, MPH Primary Care Physician: MD  Date of Admission: 3/24/2023 Discharge Date: 3/26/2023 Room Number:  PRESENTING PROBLEM: GI bleed [K92.2] Gastrointestinal hemorrhage with melena [K92.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 68 y.o. female who presents today with GI bleeding.  She has a history of DM, fatty liver disease for which she previously saw Dr., HTN, PAD, COPD, Bipolar disorder, and adrenal mass s/p removal.     In the ER today she tested positive for COVID.  Hemoccult was positive.  BUN mildly elevated at 26 with creatinine of 0.82.  Initial glucose was 49.  WBC 6.76, hgb 12.0, platelets 275, lactic acid 0.9, UA negative for infection.  CXR showed cardiac enlargement with small right pleural effusion.  CT of the abdomen/pelvis showed possible very mild colitis and possible mild cystitis.  However, CTA abdomen and pelvis thought wall thickening was likely related to underdistention.  She was given dextrose for hypoglycemia.  She was given IV protonix, zofran, and IVF.  She was placed in observation for GI bleeding. GI consulted and  recommended PPI q12 and advancing diet as tolerated. Stool studies were negative. Outpatient EGD/colonoscopy was recommended due to COVID19 status. She received IV iron infusion and ASA/Plavix held, given no further bleeding. ASA/Plavix resumed without further bleeding noted.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. . Patient voiced understanding was agreeable with plan of care discharge
Age: 68.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Blood urea increased, COVID-19, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram abdomen abnormal
Clinical narrative: Discharge Physician: MD, MPH Primary Care Physician: MD  Date of Admission: 3/24/2023 Discharge Date: 3/26/2023 Room Number:  PRESENTING PROBLEM: GI bleed [K92.2] Gastrointestinal hemorrhage with melena [K92.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 68 y.o. female who presents today with GI bleeding.  She has a history of DM, fatty liver disease for which she previously saw Dr., HTN, PAD, COPD, Bipolar disorder, and adrenal mass s/p removal.     In the ER today she tested positive for COVID.  Hemoccult was positive.  BUN mildly elevated at 26 with creatinine of 0.82.  Initial glucose was 49.  WBC 6.76, hgb 12.0, platelets 275, lactic acid 0.9, UA negative for infection.  CXR showed cardiac enlargement with small right pleural effusion.  CT of the abdomen/pelvis showed possible very mild colitis and possible mild cystitis.  However, CTA abdomen and pelvis thought wall thickening was likely related to underdistention.  She was given dextrose for hypoglycemia.  She was given IV protonix, zofran, and IVF.  She was placed in observation for GI bleeding. GI consulted and  recommended PPI q12 and advancing diet as tolerated. Stool studies were negative. Outpatient EGD/colonoscopy was recommended due to COVID19 status. She received IV iron infusion and ASA/Plavix held, given no further bleeding. ASA/Plavix resumed without further bleeding noted.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. . Patient voiced understanding was agreeable with plan of care discharge
Age: 68.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Condition aggravated, Electrolyte substitution therapy, Gastrointestinal haemorrhage, Gastrointestinal wall thickening, Haemoglobin normal
Clinical narrative: Discharge Physician: MD, MPH Primary Care Physician: MD  Date of Admission: 3/24/2023 Discharge Date: 3/26/2023 Room Number:  PRESENTING PROBLEM: GI bleed [K92.2] Gastrointestinal hemorrhage with melena [K92.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 68 y.o. female who presents today with GI bleeding.  She has a history of DM, fatty liver disease for which she previously saw Dr., HTN, PAD, COPD, Bipolar disorder, and adrenal mass s/p removal.     In the ER today she tested positive for COVID.  Hemoccult was positive.  BUN mildly elevated at 26 with creatinine of 0.82.  Initial glucose was 49.  WBC 6.76, hgb 12.0, platelets 275, lactic acid 0.9, UA negative for infection.  CXR showed cardiac enlargement with small right pleural effusion.  CT of the abdomen/pelvis showed possible very mild colitis and possible mild cystitis.  However, CTA abdomen and pelvis thought wall thickening was likely related to underdistention.  She was given dextrose for hypoglycemia.  She was given IV protonix, zofran, and IVF.  She was placed in observation for GI bleeding. GI consulted and  recommended PPI q12 and advancing diet as tolerated. Stool studies were negative. Outpatient EGD/colonoscopy was recommended due to COVID19 status. She received IV iron infusion and ASA/Plavix held, given no further bleeding. ASA/Plavix resumed without further bleeding noted.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. . Patient voiced understanding was agreeable with plan of care discharge
Age: 68.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Hypoglycaemia, Melaena, Occult blood positive, Platelet count normal, Pleural effusion
Clinical narrative: Discharge Physician: MD, MPH Primary Care Physician: MD  Date of Admission: 3/24/2023 Discharge Date: 3/26/2023 Room Number:  PRESENTING PROBLEM: GI bleed [K92.2] Gastrointestinal hemorrhage with melena [K92.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 68 y.o. female who presents today with GI bleeding.  She has a history of DM, fatty liver disease for which she previously saw Dr., HTN, PAD, COPD, Bipolar disorder, and adrenal mass s/p removal.     In the ER today she tested positive for COVID.  Hemoccult was positive.  BUN mildly elevated at 26 with creatinine of 0.82.  Initial glucose was 49.  WBC 6.76, hgb 12.0, platelets 275, lactic acid 0.9, UA negative for infection.  CXR showed cardiac enlargement with small right pleural effusion.  CT of the abdomen/pelvis showed possible very mild colitis and possible mild cystitis.  However, CTA abdomen and pelvis thought wall thickening was likely related to underdistention.  She was given dextrose for hypoglycemia.  She was given IV protonix, zofran, and IVF.  She was placed in observation for GI bleeding. GI consulted and  recommended PPI q12 and advancing diet as tolerated. Stool studies were negative. Outpatient EGD/colonoscopy was recommended due to COVID19 status. She received IV iron infusion and ASA/Plavix held, given no further bleeding. ASA/Plavix resumed without further bleeding noted.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. . Patient voiced understanding was agreeable with plan of care discharge
Age: 68.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: SARS-CoV-2 test positive, Stool analysis normal, Urine analysis normal, White blood cell count normal
Clinical narrative: Discharge Physician: MD, MPH Primary Care Physician: MD  Date of Admission: 3/24/2023 Discharge Date: 3/26/2023 Room Number:  PRESENTING PROBLEM: GI bleed [K92.2] Gastrointestinal hemorrhage with melena [K92.1] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 68 y.o. female who presents today with GI bleeding.  She has a history of DM, fatty liver disease for which she previously saw Dr., HTN, PAD, COPD, Bipolar disorder, and adrenal mass s/p removal.     In the ER today she tested positive for COVID.  Hemoccult was positive.  BUN mildly elevated at 26 with creatinine of 0.82.  Initial glucose was 49.  WBC 6.76, hgb 12.0, platelets 275, lactic acid 0.9, UA negative for infection.  CXR showed cardiac enlargement with small right pleural effusion.  CT of the abdomen/pelvis showed possible very mild colitis and possible mild cystitis.  However, CTA abdomen and pelvis thought wall thickening was likely related to underdistention.  She was given dextrose for hypoglycemia.  She was given IV protonix, zofran, and IVF.  She was placed in observation for GI bleeding. GI consulted and  recommended PPI q12 and advancing diet as tolerated. Stool studies were negative. Outpatient EGD/colonoscopy was recommended due to COVID19 status. She received IV iron infusion and ASA/Plavix held, given no further bleeding. ASA/Plavix resumed without further bleeding noted.   Electrolytes were monitored and repleted PRN throughout the admission. Patient clinically improved and hemodynamically stable for discharge.  Discussed plan of care discharge with patient including outpatient follow-up PCP within 7 days. . Patient voiced understanding was agreeable with plan of care discharge
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Anaemia, Cardiac failure congestive, Chronic respiratory failure, Respiratory failure
Clinical narrative: J96.11 CHRONIC HYPOXEMIC RESPIRATORY FAILURE 8/7/2022 ANEMIA    CHF, STAGE D
Age: 53.0
Sex: F
Vaccine: COVID19
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE OBSTRUCTIVE SLEEP APNEA
Age: 70.0
Sex: F
Vaccine: COVID19-2, FLUX
Symptoms: Condition aggravated, Hypersensitivity, SARS-CoV-2 test negative, Thyroxine increased, Tri-iodothyronine decreased
Clinical narrative: I did not have an adverse reaction to the vaccine. In 03/2023, my thyroid levels are out of balance. The T4 went really high and T3 went down. In the last few days, my allergies have gotten worse. I went to my doctor and got a prednisone shot. I was also tested for COVID-19, and it was negative.
Age: 60.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Hypertension, Myalgia
Clinical narrative: Discharge Provider Primary Care Provider Admission Date: 3/24/2023 Discharge Date: 03/25/2023 Admitting Diagnoses: Active Problems:   COVID  HOSPITAL COURSE: Patient is a 60 y.o. female with h/o metastatic ovarian adenocarcinoma, chemotherapy-associated neuropathy, HTN, hypothyroidism, anxiety/depression, narcolepsy, OSA and obesity, presented to the ER with c/o fever, sore throat, cough and myalgias. Symptoms present and progressive over the past 2-3 days, attributed to COVID due to recent sick contacts. In the ER, she was febrile, hypertensive, tachycardic, and mildly tachypnic, saturating in the mid-90's on room air alone.  Viral screen was COVID positive. Patient felt improved on supportive care and was walked by nursing without oxygen desaturation. Blood pressure also improved back to baseline and patient requested discharged on 3/25.    Close follow up advised as noted below including following up with primary care provider. Patient expressed understanding and agreement with this plan. Patient in agreement with and requested discharge on 03/25/2023
Age: 60.0
Sex: F
Vaccine: COVID19-2
Symptoms: Oropharyngeal pain, Pyrexia, Tachycardia, Tachypnoea, Viral test positive
Clinical narrative: Discharge Provider Primary Care Provider Admission Date: 3/24/2023 Discharge Date: 03/25/2023 Admitting Diagnoses: Active Problems:   COVID  HOSPITAL COURSE: Patient is a 60 y.o. female with h/o metastatic ovarian adenocarcinoma, chemotherapy-associated neuropathy, HTN, hypothyroidism, anxiety/depression, narcolepsy, OSA and obesity, presented to the ER with c/o fever, sore throat, cough and myalgias. Symptoms present and progressive over the past 2-3 days, attributed to COVID due to recent sick contacts. In the ER, she was febrile, hypertensive, tachycardic, and mildly tachypnic, saturating in the mid-90's on room air alone.  Viral screen was COVID positive. Patient felt improved on supportive care and was walked by nursing without oxygen desaturation. Blood pressure also improved back to baseline and patient requested discharged on 3/25.    Close follow up advised as noted below including following up with primary care provider. Patient expressed understanding and agreement with this plan. Patient in agreement with and requested discharge on 03/25/2023
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: OBSTRUCTIVE SLEEP APNEA
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Atrial fibrillation, Cellulitis, Deep vein thrombosis
Clinical narrative: Moderna vaccine was administered outside of office - reported by patient ? NO LOT NUMBER WERE SUPPLIED --------------------------------------------------------------------------------------------------------------- I82.403 ACUTE DVT OF BILAT LEGS, UNSPECIFIED VEINS 4/9/2021 ATRIAL FIBRILLATION, UNSPECIFIED I82.409 ACUTE DVT, UNSPECIFIED VEIN 3/17/2021 ATRIAL FIBRILLATION, UNSPECIFIED I82.403 ACUTE DVT OF BILAT LEGS, UNSPECIFIED VEINS 4/9/2021 RIGHT LEG CELLULITIS I82.409 ACUTE DVT, UNSPECIFIED VEIN 3/17/2021 RIGHT LEG CELLULITIS I82.403 ACUTE DVT OF BILAT LEGS, UNSPECIFIED VEINS 4/9/2021 ATRIAL FIBRILLATION, PAROXYSMAL W PROTHROMBOTIC STATE I82.409 ACUTE DVT, UNSPECIFIED VEIN 3/17/2021 ATRIAL FIBRILLATION, PAROXYSMAL W PROTHROMBOTIC STATE I82.403 ACUTE DVT OF BILAT LEGS, UNSPECIFIED VEINS 4/9/2021 ATRIAL FIBRILLATION, UNSPECIFIED I82.409 ACUTE DVT, UNSPECIFIED VEIN 3/17/2021 ATRIAL FIBRILLATION, UNSPECIFIED I82.403 ACUTE DVT OF BILAT LEGS, UNSPECIFIED VEINS 4/9/2021 ATRIAL FIBRILLATION, PAROXYSMAL W PROTHROMBOTIC STATE I82.409 ACUTE DVT, UNSPECIFIED VEIN 3/17/2021 ATRIAL FIBRILLATION, PAROXYSMAL W PROTHROMBOTIC STATE
Age: 62.0
Sex: F
Vaccine: COVID19-2
Symptoms: Chills, Cough, Fatigue, Infection, Influenza A virus test negative
Clinical narrative: I had a high fever, 101F-102F, chills, exhausted, very bad cough, I took a home COVID-19 test that came back negative, I made an appointment with my doctor. She tested me for COVID-19, Strep, Influenza A and B, all tests came back negative. She gave me a prescription for amoxicillin to help get the infection out of my body, I was also given a prescription for TESSALON PERLES to help with the cough. I still have a lingering cough but I am feeling much better.
Age: 62.0
Sex: F
Vaccine: COVID19-2
Symptoms: Influenza B virus test, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
Clinical narrative: I had a high fever, 101F-102F, chills, exhausted, very bad cough, I took a home COVID-19 test that came back negative, I made an appointment with my doctor. She tested me for COVID-19, Strep, Influenza A and B, all tests came back negative. She gave me a prescription for amoxicillin to help get the infection out of my body, I was also given a prescription for TESSALON PERLES to help with the cough. I still have a lingering cough but I am feeling much better.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, Hypoxia, Obstructive sleep apnoea syndrome
Clinical narrative: Moderna vaccine was administered outside of office - reported by patient ? NO LOT NUMBER WERE SUPPLIED -------------------------------------------------------------------------------------------------------------------------- G47.33 OBSTRUCTIVE SLEEP APNEA 9/9/2021 COVID-19 J96.00 ACUTE RESPIRATORY FAILURE 10/14/2021 COVID-19 R09.02 HYPOXIA 9/23/2021 COVID-19
Age: 68.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: COVID vaccine breakthrough case, Moderna 3/2/21 025A21A, 3/30/21 013B21A and 12/6/21 045F21A
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Ovarian cancer
Clinical narrative: Moderna vaccine was administered, reported by patient ? NO LOT NUMBER WERE SUPPLIED  ACUTE HYPOXEMIC RESPIRATORY FAILURE 6/5/2021 OVARIAN CANCER, UNSPECIFIED SIDE
Age: 11.0
Sex: M
Vaccine: COVID19-2
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
Clinical narrative: Pfizer orange cap 0.2ml given IM without dilution. No signs nor symptoms.
Age: 79.0
Sex: F
Vaccine: COVID19
Symptoms: Symptom recurrence
Clinical narrative: PATIENT RECEIVED VACCINE FROM OUTSIDE SOURCE 11/20/2022 -- RECURRENCE OF SAME SYMPTOMS
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, COVID-19, Cardiac failure, Chills, Condition aggravated
Clinical narrative: Discharge Provider: MD Primary Care Provider: NP Admission Date: 3/24/2023 Discharge Date: 3/29/2023 PRESENTING PROBLEM: Acute on chronic respiratory failure with hypoxia and hypercapnia  [J96.21, J96.22] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a pertinent past medical history of COPD on 4-6L NC baseline, constrictive CM (EF 57% 5/22), chronic diastolic HF s/p biventricular pacemaker placement, hx TR s/p mechanical tricuspid valve replacement in 2010 on coumadin, paroxysmal Afib, CKD3, morbid obesity, HTN and hypothyroidism who was admitted on 3/24 for AHHRF due to COVID-19 and an acute exacerbation of heart failure.   The patient began to feel more short of breath about 3 days prior to admission with increased cough, rhinorrhea, and chills.  She also had to increase her home oxygen from baseline of 4-6 L to 6 L or more.  On admission, she was hypoxic, and did require BiPAP.  Testing was positive for COVID-19 virus, which is likely the cause of her worsening of her baseline chronic respiratory failure.  Inpatient, she was also significantly diuresed with assistance of Cardiology.  Her home medications were changed as well, as she continued to diurese well below her dry weight.  Her previous dry weight was thought to be 131 kg, but upon discharge, she was 124 kg on 3/29/2023.  She was eventually able to be weaned back to her home baseline oxygen needs of 4 L nasal cannula.  On 03/29, patient's symptoms overall has significantly improved.  No significant shortness of breath or new/worsening chest pain.  Stable for discharge back to facility with outpatient therapy services .       Of note, did stop the patient's home Diamox, and given her chronic hypercarbia, this medication should not be considered for use in this patient in the future.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cough, Diuretic therapy, Dyspnoea, Hypercapnia, Hypoxia
Clinical narrative: Discharge Provider: MD Primary Care Provider: NP Admission Date: 3/24/2023 Discharge Date: 3/29/2023 PRESENTING PROBLEM: Acute on chronic respiratory failure with hypoxia and hypercapnia  [J96.21, J96.22] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a pertinent past medical history of COPD on 4-6L NC baseline, constrictive CM (EF 57% 5/22), chronic diastolic HF s/p biventricular pacemaker placement, hx TR s/p mechanical tricuspid valve replacement in 2010 on coumadin, paroxysmal Afib, CKD3, morbid obesity, HTN and hypothyroidism who was admitted on 3/24 for AHHRF due to COVID-19 and an acute exacerbation of heart failure.   The patient began to feel more short of breath about 3 days prior to admission with increased cough, rhinorrhea, and chills.  She also had to increase her home oxygen from baseline of 4-6 L to 6 L or more.  On admission, she was hypoxic, and did require BiPAP.  Testing was positive for COVID-19 virus, which is likely the cause of her worsening of her baseline chronic respiratory failure.  Inpatient, she was also significantly diuresed with assistance of Cardiology.  Her home medications were changed as well, as she continued to diurese well below her dry weight.  Her previous dry weight was thought to be 131 kg, but upon discharge, she was 124 kg on 3/29/2023.  She was eventually able to be weaned back to her home baseline oxygen needs of 4 L nasal cannula.  On 03/29, patient's symptoms overall has significantly improved.  No significant shortness of breath or new/worsening chest pain.  Stable for discharge back to facility with outpatient therapy services .       Of note, did stop the patient's home Diamox, and given her chronic hypercarbia, this medication should not be considered for use in this patient in the future.
Age: 65.0
Sex: F
Vaccine: COVID19-2
Symptoms: Polyuria, Positive airway pressure therapy, Respiratory failure, Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: Discharge Provider: MD Primary Care Provider: NP Admission Date: 3/24/2023 Discharge Date: 3/29/2023 PRESENTING PROBLEM: Acute on chronic respiratory failure with hypoxia and hypercapnia  [J96.21, J96.22] COVID-19 [U07.1]   HOSPITAL COURSE: Patient is a 65 y.o. female with a pertinent past medical history of COPD on 4-6L NC baseline, constrictive CM (EF 57% 5/22), chronic diastolic HF s/p biventricular pacemaker placement, hx TR s/p mechanical tricuspid valve replacement in 2010 on coumadin, paroxysmal Afib, CKD3, morbid obesity, HTN and hypothyroidism who was admitted on 3/24 for AHHRF due to COVID-19 and an acute exacerbation of heart failure.   The patient began to feel more short of breath about 3 days prior to admission with increased cough, rhinorrhea, and chills.  She also had to increase her home oxygen from baseline of 4-6 L to 6 L or more.  On admission, she was hypoxic, and did require BiPAP.  Testing was positive for COVID-19 virus, which is likely the cause of her worsening of her baseline chronic respiratory failure.  Inpatient, she was also significantly diuresed with assistance of Cardiology.  Her home medications were changed as well, as she continued to diurese well below her dry weight.  Her previous dry weight was thought to be 131 kg, but upon discharge, she was 124 kg on 3/29/2023.  She was eventually able to be weaned back to her home baseline oxygen needs of 4 L nasal cannula.  On 03/29, patient's symptoms overall has significantly improved.  No significant shortness of breath or new/worsening chest pain.  Stable for discharge back to facility with outpatient therapy services .       Of note, did stop the patient's home Diamox, and given her chronic hypercarbia, this medication should not be considered for use in this patient in the future.
Age: 85.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid abnormal, Blood bicarbonate increased, Blood urea increased, Bradycardia
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 3/25/2023 Discharge Date: 3/28/2023  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Altered mental status [R41.82] Encephalopathy [G93.40] Fluctuating mental status [R41.82] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is an 86 year old female patient with PMHx for dementia, depression, Afib s/p ablation, and chronic BLE Lymphedema, who presented 3/25/2023 from her ALF due to witnessed syncopal event with associated bradycardia by EMS. Patient was found to have Metabolic Encephalopathy likely 2/2 Orthostatic +/- Vasovagal Syncope. PT and OT were consulted during this admission.    In the ED patient's vitals were notable for heart rate in the 50s.  She was otherwise afebrile, normotensive. Stroke, syncope workup were initiated. CTH did not show any acute intracranial abnormality. CTA head and neck revealed stable carotid stenosis and no large vessel occlusion. CT imaging did demonstrated diffuse lymphadenopathy throughout neck and chest, appears chronic and increased compared to November 2022 images. Labs were largely unremarkable except for a very slightly high bicarbonate and BUN in the setting of recent poor oral intake.  EKG did not show any ischemic changes. UA showing 13 squamous cells, not clean catch. Urine drug screen was negative.    Further work up demonstrated positive orthostatic vitals, further chart review notable for patient taking moderate dose Lasix BID and Toprol in the setting of mild URI symptomatic COVID. Transient confusion and syncope w/ associated bradycardia aligns with vasovagal event. BP medications and therapies prone to orthostatic hypotension were held. Patient had rapid return to baseline (A&O x2). Dose adjustment for Lasix was done and Toprol was transitioned to Lopressor. Patient was recommended to stop Memantine if patient desires, due to rare ADR of hypotension.    Patient remained afebrile, hemodynamically stable on room air on discharge at 3/28/2023.
Age: 85.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: COVID-19, Carotid artery stenosis, Computerised tomogram head normal, Computerised tomogram neck, Computerised tomogram thorax abnormal
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 3/25/2023 Discharge Date: 3/28/2023  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Altered mental status [R41.82] Encephalopathy [G93.40] Fluctuating mental status [R41.82] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is an 86 year old female patient with PMHx for dementia, depression, Afib s/p ablation, and chronic BLE Lymphedema, who presented 3/25/2023 from her ALF due to witnessed syncopal event with associated bradycardia by EMS. Patient was found to have Metabolic Encephalopathy likely 2/2 Orthostatic +/- Vasovagal Syncope. PT and OT were consulted during this admission.    In the ED patient's vitals were notable for heart rate in the 50s.  She was otherwise afebrile, normotensive. Stroke, syncope workup were initiated. CTH did not show any acute intracranial abnormality. CTA head and neck revealed stable carotid stenosis and no large vessel occlusion. CT imaging did demonstrated diffuse lymphadenopathy throughout neck and chest, appears chronic and increased compared to November 2022 images. Labs were largely unremarkable except for a very slightly high bicarbonate and BUN in the setting of recent poor oral intake.  EKG did not show any ischemic changes. UA showing 13 squamous cells, not clean catch. Urine drug screen was negative.    Further work up demonstrated positive orthostatic vitals, further chart review notable for patient taking moderate dose Lasix BID and Toprol in the setting of mild URI symptomatic COVID. Transient confusion and syncope w/ associated bradycardia aligns with vasovagal event. BP medications and therapies prone to orthostatic hypotension were held. Patient had rapid return to baseline (A&O x2). Dose adjustment for Lasix was done and Toprol was transitioned to Lopressor. Patient was recommended to stop Memantine if patient desires, due to rare ADR of hypotension.    Patient remained afebrile, hemodynamically stable on room air on discharge at 3/28/2023.
Age: 85.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Confusional state, Drug screen negative, Electrocardiogram normal, Encephalopathy, Hypophagia
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 3/25/2023 Discharge Date: 3/28/2023  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Altered mental status [R41.82] Encephalopathy [G93.40] Fluctuating mental status [R41.82] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is an 86 year old female patient with PMHx for dementia, depression, Afib s/p ablation, and chronic BLE Lymphedema, who presented 3/25/2023 from her ALF due to witnessed syncopal event with associated bradycardia by EMS. Patient was found to have Metabolic Encephalopathy likely 2/2 Orthostatic +/- Vasovagal Syncope. PT and OT were consulted during this admission.    In the ED patient's vitals were notable for heart rate in the 50s.  She was otherwise afebrile, normotensive. Stroke, syncope workup were initiated. CTH did not show any acute intracranial abnormality. CTA head and neck revealed stable carotid stenosis and no large vessel occlusion. CT imaging did demonstrated diffuse lymphadenopathy throughout neck and chest, appears chronic and increased compared to November 2022 images. Labs were largely unremarkable except for a very slightly high bicarbonate and BUN in the setting of recent poor oral intake.  EKG did not show any ischemic changes. UA showing 13 squamous cells, not clean catch. Urine drug screen was negative.    Further work up demonstrated positive orthostatic vitals, further chart review notable for patient taking moderate dose Lasix BID and Toprol in the setting of mild URI symptomatic COVID. Transient confusion and syncope w/ associated bradycardia aligns with vasovagal event. BP medications and therapies prone to orthostatic hypotension were held. Patient had rapid return to baseline (A&O x2). Dose adjustment for Lasix was done and Toprol was transitioned to Lopressor. Patient was recommended to stop Memantine if patient desires, due to rare ADR of hypotension.    Patient remained afebrile, hemodynamically stable on room air on discharge at 3/28/2023.
Age: 85.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Laboratory test abnormal, Lymphadenopathy, Mental status changes, Metabolic encephalopathy, Orthostatic hypotension
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 3/25/2023 Discharge Date: 3/28/2023  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Altered mental status [R41.82] Encephalopathy [G93.40] Fluctuating mental status [R41.82] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is an 86 year old female patient with PMHx for dementia, depression, Afib s/p ablation, and chronic BLE Lymphedema, who presented 3/25/2023 from her ALF due to witnessed syncopal event with associated bradycardia by EMS. Patient was found to have Metabolic Encephalopathy likely 2/2 Orthostatic +/- Vasovagal Syncope. PT and OT were consulted during this admission.    In the ED patient's vitals were notable for heart rate in the 50s.  She was otherwise afebrile, normotensive. Stroke, syncope workup were initiated. CTH did not show any acute intracranial abnormality. CTA head and neck revealed stable carotid stenosis and no large vessel occlusion. CT imaging did demonstrated diffuse lymphadenopathy throughout neck and chest, appears chronic and increased compared to November 2022 images. Labs were largely unremarkable except for a very slightly high bicarbonate and BUN in the setting of recent poor oral intake.  EKG did not show any ischemic changes. UA showing 13 squamous cells, not clean catch. Urine drug screen was negative.    Further work up demonstrated positive orthostatic vitals, further chart review notable for patient taking moderate dose Lasix BID and Toprol in the setting of mild URI symptomatic COVID. Transient confusion and syncope w/ associated bradycardia aligns with vasovagal event. BP medications and therapies prone to orthostatic hypotension were held. Patient had rapid return to baseline (A&O x2). Dose adjustment for Lasix was done and Toprol was transitioned to Lopressor. Patient was recommended to stop Memantine if patient desires, due to rare ADR of hypotension.    Patient remained afebrile, hemodynamically stable on room air on discharge at 3/28/2023.
Age: 85.0
Sex: F
Vaccine: COVID19-2, FLUA4
Symptoms: Presyncope, Syncope, Upper respiratory tract infection, Urinary squamous epithelial cells increased, Urine analysis abnormal
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 3/25/2023 Discharge Date: 3/28/2023  DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Altered mental status [R41.82] Encephalopathy [G93.40] Fluctuating mental status [R41.82] COVID-19 [U07.1]   HOSPITAL COURSE:   Patient is an 86 year old female patient with PMHx for dementia, depression, Afib s/p ablation, and chronic BLE Lymphedema, who presented 3/25/2023 from her ALF due to witnessed syncopal event with associated bradycardia by EMS. Patient was found to have Metabolic Encephalopathy likely 2/2 Orthostatic +/- Vasovagal Syncope. PT and OT were consulted during this admission.    In the ED patient's vitals were notable for heart rate in the 50s.  She was otherwise afebrile, normotensive. Stroke, syncope workup were initiated. CTH did not show any acute intracranial abnormality. CTA head and neck revealed stable carotid stenosis and no large vessel occlusion. CT imaging did demonstrated diffuse lymphadenopathy throughout neck and chest, appears chronic and increased compared to November 2022 images. Labs were largely unremarkable except for a very slightly high bicarbonate and BUN in the setting of recent poor oral intake.  EKG did not show any ischemic changes. UA showing 13 squamous cells, not clean catch. Urine drug screen was negative.    Further work up demonstrated positive orthostatic vitals, further chart review notable for patient taking moderate dose Lasix BID and Toprol in the setting of mild URI symptomatic COVID. Transient confusion and syncope w/ associated bradycardia aligns with vasovagal event. BP medications and therapies prone to orthostatic hypotension were held. Patient had rapid return to baseline (A&O x2). Dose adjustment for Lasix was done and Toprol was transitioned to Lopressor. Patient was recommended to stop Memantine if patient desires, due to rare ADR of hypotension.    Patient remained afebrile, hemodynamically stable on room air on discharge at 3/28/2023.
Age: 2.0
Sex: F
Vaccine: HEPA
Symptoms: Irritability, Pyrexia
Clinical narrative: fever and fussiness for about one day   She received Hep A earlier this week (5/1).  She was well appearing in clinic, suspect viral process, though given fever occurring recently after vaccines (tmax 103.3)
Age: 5.0
Sex: F
Vaccine: COVID19-2
Symptoms: Product storage error
Clinical narrative: Storage and Handling Incident
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Symptom recurrence
Clinical narrative: ACUTE NON ST ELEVATION MI 12/21/2021 &  12/23/2021  -- RECURRENCE OF SAME SYMPTOMS
Age: 54.0
Sex: F
Vaccine: COVID19-2
Symptoms: Abdominal distension, Anal dilatation, Asthenia, Blood sodium increased, COVID-19
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 3/24/2023 Discharge Date: Mar 30, 2023 PRESENTING PROBLEM: Dehydration [E86.0] Hypernatremia [E87.0] Acute cystitis without hematuria [N30.00] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: 54-year-old female past medical history of cerebral palsy, spastic quadriplegia, bipolar disorder, chronic constipation who lives in nursing facility and presented from nursing facility for weakness, fatigue, abnormal labs.  At baseline patient is nonverbal although reported that she can communicate with few words intermittently.  Mother is her guardian.  Patient and mother diagnosed 5 days prior to admission with COVID-19 after developing fevers, fatigue.  In the ER, pt noted to be tachycardic.  Lab significant for sodium 151. COVID-19 +.  KUB showing gas pattern but no obstruction.  UA suggestive of urinary tract infection.  Patient was started IV fluids and IV antibiotic for suspected urinary tract infection and admitted to Medicine.  She was felt to be more confused than baseline feeding diagnosis metabolic encephalopathy.   After admission, sodium did improve IV hydration.  She was on IV Cipro for antibiotic treatment for urinary tract infection.  Urine culture came back showing E coli pan susceptible.  Mental status did improve as well.  She was cleared to have diet by SLP on 03/26.  Pt was continued on bowel regimen as pt has history of constipation and pt with recurrent issues with fecal impaction.  Patient did have bowel distension despite bowel regimen and repeat CT/abdomen performed consistent with proctitis with rectum distended with stool.  GI consulted and recommended Gastrografin enema.  Post Gastrografin enema patient was having good bowel movements with improvement and abdominal distension.  Day discharge patient appeared comfortable.  GI recommends that patient continue with tap water enema scheduled 2 times a day in place of MiraLax.  It is likely that patient is having constipation from her rectum muscles not working well GI recommends that enemas scheduled her best treatment to prevent recurrent impaction.  If patient continues to come back to the hospital for repeat admissions for impaction may need to consider colostomy in the future with Colorectal consult and this was explained to mom.  She was also started on new medication of Linzess and given that this new medication was started does not need to continue with senna.  Sodium normalized by discharge.  To continue with 2 more doses of Cipro to complete 7 days total of urinary tract infection treatment.
Age: 54.0
Sex: F
Vaccine: COVID19-2
Symptoms: Computerised tomogram abdomen abnormal, Condition aggravated, Confusional state, Constipation, Culture urine positive
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 3/24/2023 Discharge Date: Mar 30, 2023 PRESENTING PROBLEM: Dehydration [E86.0] Hypernatremia [E87.0] Acute cystitis without hematuria [N30.00] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: 54-year-old female past medical history of cerebral palsy, spastic quadriplegia, bipolar disorder, chronic constipation who lives in nursing facility and presented from nursing facility for weakness, fatigue, abnormal labs.  At baseline patient is nonverbal although reported that she can communicate with few words intermittently.  Mother is her guardian.  Patient and mother diagnosed 5 days prior to admission with COVID-19 after developing fevers, fatigue.  In the ER, pt noted to be tachycardic.  Lab significant for sodium 151. COVID-19 +.  KUB showing gas pattern but no obstruction.  UA suggestive of urinary tract infection.  Patient was started IV fluids and IV antibiotic for suspected urinary tract infection and admitted to Medicine.  She was felt to be more confused than baseline feeding diagnosis metabolic encephalopathy.   After admission, sodium did improve IV hydration.  She was on IV Cipro for antibiotic treatment for urinary tract infection.  Urine culture came back showing E coli pan susceptible.  Mental status did improve as well.  She was cleared to have diet by SLP on 03/26.  Pt was continued on bowel regimen as pt has history of constipation and pt with recurrent issues with fecal impaction.  Patient did have bowel distension despite bowel regimen and repeat CT/abdomen performed consistent with proctitis with rectum distended with stool.  GI consulted and recommended Gastrografin enema.  Post Gastrografin enema patient was having good bowel movements with improvement and abdominal distension.  Day discharge patient appeared comfortable.  GI recommends that patient continue with tap water enema scheduled 2 times a day in place of MiraLax.  It is likely that patient is having constipation from her rectum muscles not working well GI recommends that enemas scheduled her best treatment to prevent recurrent impaction.  If patient continues to come back to the hospital for repeat admissions for impaction may need to consider colostomy in the future with Colorectal consult and this was explained to mom.  She was also started on new medication of Linzess and given that this new medication was started does not need to continue with senna.  Sodium normalized by discharge.  To continue with 2 more doses of Cipro to complete 7 days total of urinary tract infection treatment.
Age: 54.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cystitis, Dehydration, Enema administration, Escherichia test positive, Fatigue
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 3/24/2023 Discharge Date: Mar 30, 2023 PRESENTING PROBLEM: Dehydration [E86.0] Hypernatremia [E87.0] Acute cystitis without hematuria [N30.00] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: 54-year-old female past medical history of cerebral palsy, spastic quadriplegia, bipolar disorder, chronic constipation who lives in nursing facility and presented from nursing facility for weakness, fatigue, abnormal labs.  At baseline patient is nonverbal although reported that she can communicate with few words intermittently.  Mother is her guardian.  Patient and mother diagnosed 5 days prior to admission with COVID-19 after developing fevers, fatigue.  In the ER, pt noted to be tachycardic.  Lab significant for sodium 151. COVID-19 +.  KUB showing gas pattern but no obstruction.  UA suggestive of urinary tract infection.  Patient was started IV fluids and IV antibiotic for suspected urinary tract infection and admitted to Medicine.  She was felt to be more confused than baseline feeding diagnosis metabolic encephalopathy.   After admission, sodium did improve IV hydration.  She was on IV Cipro for antibiotic treatment for urinary tract infection.  Urine culture came back showing E coli pan susceptible.  Mental status did improve as well.  She was cleared to have diet by SLP on 03/26.  Pt was continued on bowel regimen as pt has history of constipation and pt with recurrent issues with fecal impaction.  Patient did have bowel distension despite bowel regimen and repeat CT/abdomen performed consistent with proctitis with rectum distended with stool.  GI consulted and recommended Gastrografin enema.  Post Gastrografin enema patient was having good bowel movements with improvement and abdominal distension.  Day discharge patient appeared comfortable.  GI recommends that patient continue with tap water enema scheduled 2 times a day in place of MiraLax.  It is likely that patient is having constipation from her rectum muscles not working well GI recommends that enemas scheduled her best treatment to prevent recurrent impaction.  If patient continues to come back to the hospital for repeat admissions for impaction may need to consider colostomy in the future with Colorectal consult and this was explained to mom.  She was also started on new medication of Linzess and given that this new medication was started does not need to continue with senna.  Sodium normalized by discharge.  To continue with 2 more doses of Cipro to complete 7 days total of urinary tract infection treatment.
Age: 54.0
Sex: F
Vaccine: COVID19-2
Symptoms: Flatulence, Hypernatraemia, Intestinal dilatation, Laboratory test abnormal, Mental status changes
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 3/24/2023 Discharge Date: Mar 30, 2023 PRESENTING PROBLEM: Dehydration [E86.0] Hypernatremia [E87.0] Acute cystitis without hematuria [N30.00] COVID-19 virus infection [U07.1]   HOSPITAL COURSE: 54-year-old female past medical history of cerebral palsy, spastic quadriplegia, bipolar disorder, chronic constipation who lives in nursing facility and presented from nursing facility for weakness, fatigue, abnormal labs.  At baseline patient is nonverbal although reported that she can communicate with few words intermittently.  Mother is her guardian.  Patient and mother diagnosed 5 days prior to admission with COVID-19 after developing fevers, fatigue.  In the ER, pt noted to be tachycardic.  Lab significant for sodium 151. COVID-19 +.  KUB showing gas pattern but no obstruction.  UA suggestive of urinary tract infection.  Patient was started IV fluids and IV antibiotic for suspected urinary tract infection and admitted to Medicine.  She was felt to be more confused than baseline feeding diagnosis metabolic encephalopathy.   After admission, sodium did improve IV hydration.  She was on IV Cipro for antibiotic treatment for urinary tract infection.  Urine culture came back showing E coli pan susceptible.  Mental status did improve as well.  She was cleared to have diet by SLP on 03/26.  Pt was continued on bowel regimen as pt has history of constipation and pt with recurrent issues with fecal impaction.  Patient did have bowel distension despite bowel regimen and repeat CT/abdomen performed consistent with proctitis with rectum distended with stool.  GI consulted and recommended Gastrografin enema.  Post Gastrografin enema patient was having good bowel movements with improvement and abdominal distension.  Day discharge patient appeared comfortable.  GI recommends that patient continue with tap water enema scheduled 2 times a day in place of MiraLax.  It is likely that patient is having constipation from her rectum muscles not working well GI recommends that enemas scheduled her best treatment to prevent recurrent impaction.  If patient continues to come back to the hospital for repeat admissions for impaction may need to consider colostomy in the future with Colorectal consult and this was explained to mom.  She was also started on new medication of Linzess and given that this new medication was started does not need to continue with senna.  Sodium normalized by discharge.  To continue with 2 more doses of Cipro to complete 7 days total of urinary tract infection treatment.