chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia, Infarction, Ischaemia, Laboratory test normal, Low density lipoprotein normal
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Lung disorder, Malaise, Myocardial ischaemia, Osteomyelitis, Pathology test
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Peripheral arterial occlusive disease, Peripheral artery stenosis, Peripheral revascularisation, Pleural effusion, Red blood cell sedimentation rate increased
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive, Troponin increased, White blood cell count decreased, Wound secretion
Clinical narrative: Patient is a 76 y.o. male patient of Physician No with history of ESRD on HD, T2DM, HTN, HFpEF, PAF who presented to ED for direct admission to Podiatry for scheduled surgery; however found to be hypoxemic and COVID + in ED. S/p LLE vascular intervention, and left foot partial amputation with podiatry. Osteomyelitis of left 4th metatarsal Patient/family report wound present for several months, but recent increase in fluid output from wound Directed to ED by Podiatry for admission NIVS with severe LLE PAD requiring revascularization prior to podiatry intervention, see below Wound cx polymicrobial, bcx NGTD WBC 4.0 CRP 61 ESR 27 SIRS negative Empiric vanc/zosyn from 2/22 > cx with normal flora, narrowed to unasyn 2/24, continue through time of source control Pre op stress test with infarct, mild peri infarct ischemia. OK for OR from cardiology Status post left foot partial amputation 2/28 Operative sample from the amputation margin pathology showed osteomyelitis Infectious disease following: Ancef with HD through 4/12   PAD Known LLE PAD and reportedly had a revascularization 1 month ago s/p RLE disarticulation LLE arterial duplex with 50-99% stenosis in the left distal SFA and proximal PT. Occlusion noted in the left mid and distal AT. S/p L AT PTA and L PT recanalization via L brachial artery cutdown 2/24 with vascular surgery ASA continues, plavix loaded, hep gtt per vascular until OR with podiatry then switched to eliquis; per discussion with Dr., plan to continue all 3 for the time being post op until vascular surgery follow up on 03/15 (Discussed with vascular team) Continue statin   Covid-19 Virus Infection Date of onset of symptoms: 2/21/2023           Symptoms present on admission: Dyspnea Date of covid positive test: 2/21/2023 Vaccination status: vaccinated x4, last given 10/2023 Imaging: CXR w/patchy bilateral airspace disease Oxygen requirements on admission: 2-3L NC Current oxygen requirements: RA Medical therapy: steroids, stopped after 2/23 given stable on RA Special isolation end date: 3/3/2023   Elevated Troponin Coronary artery calcification Abnormal echocardiogram Asymptomatic, suspect largely demand ischemia Initial troponin 112 > 105 Initial EKG w/o acute ischemic changes Resume home statin, ASA LDL 39, A1c 6.0 Monitor on tele Echo with focal WMA, stress as above Cardiology consulted, OK for OR   Essential HTN Chronic, w/soft BP PTA Home amlodipine held on admission Monitor and resume PRN   Chronic/stable conditions: AHRF/pleural effusion- s/p thora for 1.6L, transudative, stable on RA ESRD- on HD MWF, renal following T2DM, insulin dependent- on SSI only, continue PAF- on low dose eliquis at home, does not meet criteria for dose reduction but consider low dose with ongoing DAPT Obesity OSA/OHS- noncompliant with home CPAP, AutoPAP ordered but patient has been refusing
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: Abdominal pain, Acute respiratory failure, Anticoagulant therapy, Asthenia, Atelectasis
Clinical narrative: Perpetual Assessment: Patient is a 88 y.o. male h/o COPD (3L NC), CHF, CAD who presented from home on 3/8/2023 with sob, abd pain, diarrhea and weakness who was positive for COVID in the ED.         Assessment and Plan Cardiorespiratory Arrest - Developed this in ER, due to below - Code status confirmed to be DNR CCA, DNI with patient and family prior to arrest. Patient expired at 1545.   COPD Exacerbation Acute on Chronic respiratory failure Possible Sepsis/Pneumonia - Possible early pneumonia seen on CXR (atelectasis vs infiltrate) - Hypoxic 70's on presentation, placed on Non-rebreather with improvement - Given iv steroids, iv fluids with improvement in hemodynamics   Diarrhea Dehydration - Most likely ischemic colitis given hypotension on presentation to ER - CT A/P showed concern by "bowel obstruction" and general surgery team was consulted by ER MD   Medication Reconciliation: Reviewed   DVT Prophylaxis: Lovenox   Code Status: DNR CCA, DNI (confirmed with patient and family)   Expected date of discharge: patient deceased in ER
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Cardio-respiratory arrest, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Colitis ischaemic
Clinical narrative: Perpetual Assessment: Patient is a 88 y.o. male h/o COPD (3L NC), CHF, CAD who presented from home on 3/8/2023 with sob, abd pain, diarrhea and weakness who was positive for COVID in the ED.         Assessment and Plan Cardiorespiratory Arrest - Developed this in ER, due to below - Code status confirmed to be DNR CCA, DNI with patient and family prior to arrest. Patient expired at 1545.   COPD Exacerbation Acute on Chronic respiratory failure Possible Sepsis/Pneumonia - Possible early pneumonia seen on CXR (atelectasis vs infiltrate) - Hypoxic 70's on presentation, placed on Non-rebreather with improvement - Given iv steroids, iv fluids with improvement in hemodynamics   Diarrhea Dehydration - Most likely ischemic colitis given hypotension on presentation to ER - CT A/P showed concern by "bowel obstruction" and general surgery team was consulted by ER MD   Medication Reconciliation: Reviewed   DVT Prophylaxis: Lovenox   Code Status: DNR CCA, DNI (confirmed with patient and family)   Expected date of discharge: patient deceased in ER
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: Computerised tomogram abdomen abnormal, Condition aggravated, Death, Dehydration, Diarrhoea
Clinical narrative: Perpetual Assessment: Patient is a 88 y.o. male h/o COPD (3L NC), CHF, CAD who presented from home on 3/8/2023 with sob, abd pain, diarrhea and weakness who was positive for COVID in the ED.         Assessment and Plan Cardiorespiratory Arrest - Developed this in ER, due to below - Code status confirmed to be DNR CCA, DNI with patient and family prior to arrest. Patient expired at 1545.   COPD Exacerbation Acute on Chronic respiratory failure Possible Sepsis/Pneumonia - Possible early pneumonia seen on CXR (atelectasis vs infiltrate) - Hypoxic 70's on presentation, placed on Non-rebreather with improvement - Given iv steroids, iv fluids with improvement in hemodynamics   Diarrhea Dehydration - Most likely ischemic colitis given hypotension on presentation to ER - CT A/P showed concern by "bowel obstruction" and general surgery team was consulted by ER MD   Medication Reconciliation: Reviewed   DVT Prophylaxis: Lovenox   Code Status: DNR CCA, DNI (confirmed with patient and family)   Expected date of discharge: patient deceased in ER
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dyspnoea, Hypotension, Hypoxia, Lung infiltration, SARS-CoV-2 test positive
Clinical narrative: Perpetual Assessment: Patient is a 88 y.o. male h/o COPD (3L NC), CHF, CAD who presented from home on 3/8/2023 with sob, abd pain, diarrhea and weakness who was positive for COVID in the ED.         Assessment and Plan Cardiorespiratory Arrest - Developed this in ER, due to below - Code status confirmed to be DNR CCA, DNI with patient and family prior to arrest. Patient expired at 1545.   COPD Exacerbation Acute on Chronic respiratory failure Possible Sepsis/Pneumonia - Possible early pneumonia seen on CXR (atelectasis vs infiltrate) - Hypoxic 70's on presentation, placed on Non-rebreather with improvement - Given iv steroids, iv fluids with improvement in hemodynamics   Diarrhea Dehydration - Most likely ischemic colitis given hypotension on presentation to ER - CT A/P showed concern by "bowel obstruction" and general surgery team was consulted by ER MD   Medication Reconciliation: Reviewed   DVT Prophylaxis: Lovenox   Code Status: DNR CCA, DNI (confirmed with patient and family)   Expected date of discharge: patient deceased in ER
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Asthenia, Atrial fibrillation, Barium swallow, Blood creatinine increased
Clinical narrative: Patient is a 89 y.o. female patient of MD with history of atrial fibrillation, hiatal hernia, hyperlipidemia, hypothyroidism, hypertension, who presented to the emergency room with nausea, vomiting, with subsequent cough, phlegm production, found to have acute hypoxemic respiratory failure.   Acute hypoxemic respiratory failure Secondary to aspiration pneumonia and COVID infection. Improved, weaned off oxygen  COVID-19 virus infection with pneumonia Vaccinated x2. Symptoms: Shortness of breath, weakness. Continue dexamethasone Incentive spirometer Weaned off O2.   Aspiration pneumonia Dysphagia CT chest reviewed - groundglass patchy airspace disease in the lower lobes suggestive for aspiration/pneumonia Changed to oral antibiotics on discharge Evaluated by speech and status post barium swallow   Nausea vomiting?improved CT abdomen nonacute, diverticulosis Zofran as needed Status post IV fluid hydration   AKI Creatinine at the time presentation 1.68. Improved with IV fluid Continue monitor   Atrial fibrillation, continue metoprolol XL, continue Eliquis 2.5 mg twice daily   Hypothyroidism, levothyroxine
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Condition aggravated
Clinical narrative: Patient is a 89 y.o. female patient of MD with history of atrial fibrillation, hiatal hernia, hyperlipidemia, hypothyroidism, hypertension, who presented to the emergency room with nausea, vomiting, with subsequent cough, phlegm production, found to have acute hypoxemic respiratory failure.   Acute hypoxemic respiratory failure Secondary to aspiration pneumonia and COVID infection. Improved, weaned off oxygen  COVID-19 virus infection with pneumonia Vaccinated x2. Symptoms: Shortness of breath, weakness. Continue dexamethasone Incentive spirometer Weaned off O2.   Aspiration pneumonia Dysphagia CT chest reviewed - groundglass patchy airspace disease in the lower lobes suggestive for aspiration/pneumonia Changed to oral antibiotics on discharge Evaluated by speech and status post barium swallow   Nausea vomiting?improved CT abdomen nonacute, diverticulosis Zofran as needed Status post IV fluid hydration   AKI Creatinine at the time presentation 1.68. Improved with IV fluid Continue monitor   Atrial fibrillation, continue metoprolol XL, continue Eliquis 2.5 mg twice daily   Hypothyroidism, levothyroxine
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Cough, Diverticulum, Dysphagia, Dyspnoea, Hypothyroidism
Clinical narrative: Patient is a 89 y.o. female patient of MD with history of atrial fibrillation, hiatal hernia, hyperlipidemia, hypothyroidism, hypertension, who presented to the emergency room with nausea, vomiting, with subsequent cough, phlegm production, found to have acute hypoxemic respiratory failure.   Acute hypoxemic respiratory failure Secondary to aspiration pneumonia and COVID infection. Improved, weaned off oxygen  COVID-19 virus infection with pneumonia Vaccinated x2. Symptoms: Shortness of breath, weakness. Continue dexamethasone Incentive spirometer Weaned off O2.   Aspiration pneumonia Dysphagia CT chest reviewed - groundglass patchy airspace disease in the lower lobes suggestive for aspiration/pneumonia Changed to oral antibiotics on discharge Evaluated by speech and status post barium swallow   Nausea vomiting?improved CT abdomen nonacute, diverticulosis Zofran as needed Status post IV fluid hydration   AKI Creatinine at the time presentation 1.68. Improved with IV fluid Continue monitor   Atrial fibrillation, continue metoprolol XL, continue Eliquis 2.5 mg twice daily   Hypothyroidism, levothyroxine
Age: 87.0
Sex: F
Vaccine: COVID19
Symptoms: Lung opacity, Nausea, Pneumonia aspiration, Productive cough, Vomiting
Clinical narrative: Patient is a 89 y.o. female patient of MD with history of atrial fibrillation, hiatal hernia, hyperlipidemia, hypothyroidism, hypertension, who presented to the emergency room with nausea, vomiting, with subsequent cough, phlegm production, found to have acute hypoxemic respiratory failure.   Acute hypoxemic respiratory failure Secondary to aspiration pneumonia and COVID infection. Improved, weaned off oxygen  COVID-19 virus infection with pneumonia Vaccinated x2. Symptoms: Shortness of breath, weakness. Continue dexamethasone Incentive spirometer Weaned off O2.   Aspiration pneumonia Dysphagia CT chest reviewed - groundglass patchy airspace disease in the lower lobes suggestive for aspiration/pneumonia Changed to oral antibiotics on discharge Evaluated by speech and status post barium swallow   Nausea vomiting?improved CT abdomen nonacute, diverticulosis Zofran as needed Status post IV fluid hydration   AKI Creatinine at the time presentation 1.68. Improved with IV fluid Continue monitor   Atrial fibrillation, continue metoprolol XL, continue Eliquis 2.5 mg twice daily   Hypothyroidism, levothyroxine
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Anticoagulation drug level above therapeutic, Atrial fibrillation, COVID-19
Clinical narrative: Patient is a 85 y.o. male patient of, CNP with history of atrial fibrillation, hypertension, CAD status post CABG, GERD presented to Hospital with acute respiratory failure with hypoxia. Problem based management in the hospital is as follows:   Acute metabolic encephalopathy, resolved Acute delirium, improved In setting of hypoxia, UTI, advanced age Treatment of UTI and COVID as mentioned below Continue delirium precautions   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 2/19/23 Symptoms present on admission: Respiratory failure Date of covid positive test: 2/19/23 Vaccination status: Unknown Imaging: Chest x-ray?multifocal opacities throughout the right side, ill-defined prominent left perihilar interstitial lung markings Oxygen requirements on admission: Nonrebreather mask Patient currently on 4 L oxygen nasal cannula.  I spoke with the nurse to continue to wean oxygen with O2 saturation target around 92% given the COVID infection and also for comfort. Medical therapy: Decadron started 2/21, ordered a fast taper at discharge to be completed on 3/5 for Decadron. Remdesivir started 2/22, remdesivir therapy now completed. Consultants following: Infectious disease Anticipated special isolation end date: 3/3 completed cefepime course/23   Urinary tract infection?secondary to Pseudomonas Present on admission Currently on cefepime, will finish a 5 to 7-day course. ID following   Atrial fibrillation Supratherapeutic INR History of sick sinus syndrome-pacemaker in place Was on Coumadin, now discontinued since he is DNR CC INR 3.2 <7.6 <5.7<4.6<3.2<4.2<2.7 Given 1 dose of vitamin K 2.5 mg on 2/23 Will give another dose of vitamin K since hematuria has recurred Continue to monitor INR off Coumadin Echocardiogram July 2022-EF of 57%   Hematuria, resolved Secondary to coagulopathy from Coumadin and UTI Give vitamin K, hold Coumadin, continue antibiotics Since he has history of nephrolithiasis and stent placement, consulted urology, stent removed on 3/2   Hypothyroidism On Synthroid
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray abnormal, Delirium, Echocardiogram normal, Haematuria, Hypothyroidism
Clinical narrative: Patient is a 85 y.o. male patient of, CNP with history of atrial fibrillation, hypertension, CAD status post CABG, GERD presented to Hospital with acute respiratory failure with hypoxia. Problem based management in the hospital is as follows:   Acute metabolic encephalopathy, resolved Acute delirium, improved In setting of hypoxia, UTI, advanced age Treatment of UTI and COVID as mentioned below Continue delirium precautions   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 2/19/23 Symptoms present on admission: Respiratory failure Date of covid positive test: 2/19/23 Vaccination status: Unknown Imaging: Chest x-ray?multifocal opacities throughout the right side, ill-defined prominent left perihilar interstitial lung markings Oxygen requirements on admission: Nonrebreather mask Patient currently on 4 L oxygen nasal cannula.  I spoke with the nurse to continue to wean oxygen with O2 saturation target around 92% given the COVID infection and also for comfort. Medical therapy: Decadron started 2/21, ordered a fast taper at discharge to be completed on 3/5 for Decadron. Remdesivir started 2/22, remdesivir therapy now completed. Consultants following: Infectious disease Anticipated special isolation end date: 3/3 completed cefepime course/23   Urinary tract infection?secondary to Pseudomonas Present on admission Currently on cefepime, will finish a 5 to 7-day course. ID following   Atrial fibrillation Supratherapeutic INR History of sick sinus syndrome-pacemaker in place Was on Coumadin, now discontinued since he is DNR CC INR 3.2 <7.6 <5.7<4.6<3.2<4.2<2.7 Given 1 dose of vitamin K 2.5 mg on 2/23 Will give another dose of vitamin K since hematuria has recurred Continue to monitor INR off Coumadin Echocardiogram July 2022-EF of 57%   Hematuria, resolved Secondary to coagulopathy from Coumadin and UTI Give vitamin K, hold Coumadin, continue antibiotics Since he has history of nephrolithiasis and stent placement, consulted urology, stent removed on 3/2   Hypothyroidism On Synthroid
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, International normalised ratio increased, Interstitial lung disease, Lung opacity, Metabolic encephalopathy
Clinical narrative: Patient is a 85 y.o. male patient of, CNP with history of atrial fibrillation, hypertension, CAD status post CABG, GERD presented to Hospital with acute respiratory failure with hypoxia. Problem based management in the hospital is as follows:   Acute metabolic encephalopathy, resolved Acute delirium, improved In setting of hypoxia, UTI, advanced age Treatment of UTI and COVID as mentioned below Continue delirium precautions   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 2/19/23 Symptoms present on admission: Respiratory failure Date of covid positive test: 2/19/23 Vaccination status: Unknown Imaging: Chest x-ray?multifocal opacities throughout the right side, ill-defined prominent left perihilar interstitial lung markings Oxygen requirements on admission: Nonrebreather mask Patient currently on 4 L oxygen nasal cannula.  I spoke with the nurse to continue to wean oxygen with O2 saturation target around 92% given the COVID infection and also for comfort. Medical therapy: Decadron started 2/21, ordered a fast taper at discharge to be completed on 3/5 for Decadron. Remdesivir started 2/22, remdesivir therapy now completed. Consultants following: Infectious disease Anticipated special isolation end date: 3/3 completed cefepime course/23   Urinary tract infection?secondary to Pseudomonas Present on admission Currently on cefepime, will finish a 5 to 7-day course. ID following   Atrial fibrillation Supratherapeutic INR History of sick sinus syndrome-pacemaker in place Was on Coumadin, now discontinued since he is DNR CC INR 3.2 <7.6 <5.7<4.6<3.2<4.2<2.7 Given 1 dose of vitamin K 2.5 mg on 2/23 Will give another dose of vitamin K since hematuria has recurred Continue to monitor INR off Coumadin Echocardiogram July 2022-EF of 57%   Hematuria, resolved Secondary to coagulopathy from Coumadin and UTI Give vitamin K, hold Coumadin, continue antibiotics Since he has history of nephrolithiasis and stent placement, consulted urology, stent removed on 3/2   Hypothyroidism On Synthroid
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Nephrolithiasis, SARS-CoV-2 test positive, Stent placement, Stent removal, Urinary tract infection
Clinical narrative: Patient is a 85 y.o. male patient of, CNP with history of atrial fibrillation, hypertension, CAD status post CABG, GERD presented to Hospital with acute respiratory failure with hypoxia. Problem based management in the hospital is as follows:   Acute metabolic encephalopathy, resolved Acute delirium, improved In setting of hypoxia, UTI, advanced age Treatment of UTI and COVID as mentioned below Continue delirium precautions   Acute respiratory failure with hypoxia Covid-19 Virus Infection Date of onset of symptoms: 2/19/23 Symptoms present on admission: Respiratory failure Date of covid positive test: 2/19/23 Vaccination status: Unknown Imaging: Chest x-ray?multifocal opacities throughout the right side, ill-defined prominent left perihilar interstitial lung markings Oxygen requirements on admission: Nonrebreather mask Patient currently on 4 L oxygen nasal cannula.  I spoke with the nurse to continue to wean oxygen with O2 saturation target around 92% given the COVID infection and also for comfort. Medical therapy: Decadron started 2/21, ordered a fast taper at discharge to be completed on 3/5 for Decadron. Remdesivir started 2/22, remdesivir therapy now completed. Consultants following: Infectious disease Anticipated special isolation end date: 3/3 completed cefepime course/23   Urinary tract infection?secondary to Pseudomonas Present on admission Currently on cefepime, will finish a 5 to 7-day course. ID following   Atrial fibrillation Supratherapeutic INR History of sick sinus syndrome-pacemaker in place Was on Coumadin, now discontinued since he is DNR CC INR 3.2 <7.6 <5.7<4.6<3.2<4.2<2.7 Given 1 dose of vitamin K 2.5 mg on 2/23 Will give another dose of vitamin K since hematuria has recurred Continue to monitor INR off Coumadin Echocardiogram July 2022-EF of 57%   Hematuria, resolved Secondary to coagulopathy from Coumadin and UTI Give vitamin K, hold Coumadin, continue antibiotics Since he has history of nephrolithiasis and stent placement, consulted urology, stent removed on 3/2   Hypothyroidism On Synthroid
Age: 72.0
Sex: F
Vaccine: TDAP
Symptoms: Pain in extremity, Rash, Swelling
Clinical narrative: Pt said that she developed a rash on her arm, and was painful for a few days. swelling has since been reduced as well as the pain.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Chest discomfort, Chest pain, Computerised tomogram, Dyspnoea, Echocardiogram
Clinical narrative: Difficulty breathing leading to calling 911. 3 years post vaccine still trouble breathing at times, now new onset chest pain and pressure. Never had any of these symptoms until vaccine.
Age: 26.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram, Laboratory test, Magnetic resonance imaging, Positron emission tomogram, X-ray
Clinical narrative: Difficulty breathing leading to calling 911. 3 years post vaccine still trouble breathing at times, now new onset chest pain and pressure. Never had any of these symptoms until vaccine.
Age: 5.0
Sex: M
Vaccine: DTAPIPV, MMRV
Symptoms: Immunisation reaction
Clinical narrative: Patient was administered vaccine with brother and mom present in the room by CMA. Vaccines was administered at 11:20 and patient and sibling was observed for 5 minutes following older siblings administration of Gardasil 9-writer confirmed with both moth and siblings that they were not feeling any dizziness or lightheadedness and patients were allowed to leave. At 11:35am writer heard mom exclaim from the waiting room, "oh my god, are you okay?" writer then got up on and saw patient beign cradeled in moms arms-ath which point PCP instructed mom to pick patient up and bring him to the room so that legs can be elevated and patient can be given ice pack. patient was place in the room with legs
Age: 76.0
Sex: F
Vaccine: COVID19-2, FLU4
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
Clinical narrative: 3/20/23 Pt reported to her day care program on 3/20 that her R delt has been swollen, red + itching  after receiving the vaccine on 3/17 Has H/O mastectomy + only uses R arm for shots
Age: 63.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Drug ineffective
Clinical narrative: COVID-19; COVID-19; This is a spontaneous report received from contactable consumer. The reporter is the patient.  A 64-year-old male patient received BNT162b2, BNT162b2 OMI BA.4-5 (BNT162B2, BNT162B2 OMI BA.4-5), on 18Oct2022 at 14:45 as dose 5 (booster), single (Lot number: GJ6742) at the age of 63 years, in left arm for COVID-19 immunisation; BNT162b2 (COMIRNATY), on 09Mar2021 at 09:45 as dose 1, single (Lot number: EL3248) and on 30Mar2021 at 09:45 as dose 2, single (Lot number: EN6199) for COVID-19 immunisation; COVID-19 vaccine (COVID-19 VACCINE), as dose 3 (booster), single (Batch/Lot number: unknown) and as dose 4 (booster), single (Batch/Lot number: unknown) for COVID-19 immunisation. The patient's relevant medical history included: "Hypertension" (unspecified if ongoing); "Allergies to penicillin" (unspecified if ongoing); "Allergies to some fruits" (unspecified if ongoing). Concomitant medication(s) included: LISINOPRIL taken for hypertension. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset Mar2023, outcome "unknown" and all described as "COVID-19". Therapeutic measures were taken as a result of drug ineffective, COVID-19 which included nirmatrelvir/ ritonavir (PAXLOVID; Lot Number: 660103) from 28Mar2023.; Sender's Comments: Linked Report(s) : US-PFIZER INC-202201256247 Same patient and product; different dose and event;US-PFIZER INC-2021284555 Same patient and product; different dose and event;US-PFIZER INC-2021368447 Same patient and product; different dose and event;
Age: 73.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Burning sensation, Bursa disorder, Exploratory operation, Immediate post-injection reaction, Joint range of motion decreased
Clinical narrative: Pain and burning upon injection. After self treatment with OTC meds patient saw orthopedic specialist and received codeine for pain. Since administration patient has experienced constant pain and partial paralysis of left shoulder, particularly on attempting to raise, bend back or rotate upper left arm. Patient has been advised that she has adhesive capsulitis, nerve impingement and a rotator cuff tear in left shoulder and arm.
Age: 73.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Magnetic resonance imaging, Nerve conduction studies, Pain, Rotator cuff syndrome, Swelling
Clinical narrative: Pain and burning upon injection. After self treatment with OTC meds patient saw orthopedic specialist and received codeine for pain. Since administration patient has experienced constant pain and partial paralysis of left shoulder, particularly on attempting to raise, bend back or rotate upper left arm. Patient has been advised that she has adhesive capsulitis, nerve impingement and a rotator cuff tear in left shoulder and arm.
Age: 73.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Tendonitis
Clinical narrative: Pain and burning upon injection. After self treatment with OTC meds patient saw orthopedic specialist and received codeine for pain. Since administration patient has experienced constant pain and partial paralysis of left shoulder, particularly on attempting to raise, bend back or rotate upper left arm. Patient has been advised that she has adhesive capsulitis, nerve impingement and a rotator cuff tear in left shoulder and arm.
Age: 73.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Burning sensation, Injected limb mobility decreased, Injection site pain, Monoplegia, Pain
Clinical narrative: Pain and burning upon injection. After self treatment with OTC meds patient saw orthopedic specialist and received codeine for pain. Since administration patient has experienced constant pain and partial paralysis of left shoulder, particularly on attempting to raise, bend back or rotate upper left arm. Patient has been advised that she has adhesive capsulitis, nerve impingement and a rotator cuff tear in left shoulder and arm.
Age: 73.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Periarthritis, Radiculopathy, Rotator cuff syndrome
Clinical narrative: Pain and burning upon injection. After self treatment with OTC meds patient saw orthopedic specialist and received codeine for pain. Since administration patient has experienced constant pain and partial paralysis of left shoulder, particularly on attempting to raise, bend back or rotate upper left arm. Patient has been advised that she has adhesive capsulitis, nerve impingement and a rotator cuff tear in left shoulder and arm.
Age: 44.0
Sex: M
Vaccine: UNK, TDAP
Symptoms: Bacterial test negative, Choking, Dyspnoea, Retching, Uvulitis
Clinical narrative: 24+ hours later patient presented to ED for trouble swallowing, gagging, shortness of breath
Age: 44.0
Sex: M
Vaccine: UNK, TDAP
Symptoms: Viral test negative
Clinical narrative: 24+ hours later patient presented to ED for trouble swallowing, gagging, shortness of breath
Age: 44.0
Sex: M
Vaccine: UNK, TDAP
Symptoms: Differential white blood cell count, Dysphagia, Dyspnoea, Full blood count, Retching
Clinical narrative: 24+ hours later patient presented to ED for trouble swallowing, gagging, shortness of breath
Age: 44.0
Sex: M
Vaccine: UNK, TDAP
Symptoms: SARS-CoV-2 test negative
Clinical narrative: 24+ hours later patient presented to ED for trouble swallowing, gagging, shortness of breath
Age: 16.0
Sex: U
Vaccine: MMRV, MMRV
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: No additional AE; a 16 year old was inadvertently given PROQUAD; This spontaneous report has been received from a nurse referring to a 16-year-old patient of unknown gender. The patient's concomitant medications included sterile diluent. The information about the patient's concurrent conditions or medical history was not provided.  On 27-FEB-2023, the patient was inadvertently vaccinated with Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (rHA) (PROQUAD) at a dose of 0.5 ml, lot # W026327, expiry date 18-FEB-2024 (route of administration and anatomical location were not provided) for prophylaxis (product administered to patient of inappropriate age). No symptomatic side effects reported. No additional adverse event (AE) details (no adverse event).  This is one of two reports received from the same reporter.; Sender's Comments:  US-009507513-2303USA008990:
Sex: U
Vaccine: PNC20
Symptoms: Blister
Clinical narrative: A water blister besides the immunization point; This is a spontaneous report received from contactable reporter (Pharmacist) from a sales representative.  A patient (no qualifiers provided) received pneumococcal 20-val conj vac (dipht CRM197 protein) (PREVNAR 20), as dose number unknown, single (Batch/Lot number: unknown) for immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: VACCINATION SITE VESICLES (non-serious), 1 week after the suspect product administration, outcome "unknown", described as "A water blister besides the immunization point".   Additional information: Patients reported, after one week on immunization with Prevnar 20, a water blister besides the immunization point.  The information on the batch/lot number for pneumococcal 20-val conj vac (dipht CRM197 protein) has been requested and will be submitted if and when received.
Sex: U
Vaccine: RV5
Symptoms: No adverse event, Product storage error
Clinical narrative: No additional AE; ROTATEQ was administered after a temperature excursion; This spontaneous report was received from a nurse and refers to a patient of unknown age and gender. The patient's medical history, concurrent conditions and concomitant medications were not reported.  On 24-FEB-2023, the patient was vaccinated with rotavirus vaccine, live, oral, pentavalent (ROTATEQ) oral liquid, once, lot #W029695, expiration date: 29-JAN-2024, administered orally for prophylaxis (anatomical location was not provided), after the temperature excursion happened (Product storage error). Administrated rotavirus vaccine, live, oral, pentavalent (ROTATEQ) was stored at 18.0 Celsius degrees (C) for 3 hours and 50 minutes, no previous temperature excursion were reported.  There were no adverse events reported (no adverse event). This is one of several reports received from the same reporter.
Sex: U
Vaccine: MMRV
Symptoms: Expired product administered, No adverse event
Clinical narrative: No additional AEs; Caller reported expired dose of PROQUAD was administered.; This spontaneous report was received from a medical assistant referring to a patient of unknown age or gender. Information of concurrent conditions, pertinent medical history, concomitant medications and drug reactions/allergies was not reported.  On 03-MAR-2023, the patient was administered with expired dose of measles, mumps, rubella and varicella (oka-merck) virus vaccine live (albumin status recombinant Human albumin (rHA)) (PROQUAD) injection (0.5 milliliter (ml), lot# U026797, expiration date 26-FEB-2023, strength was unknown) intramuscularly (IM) at right thigh for prophylaxis (expired product administered). No other information provided. No additional adverse events (AEs) (no adverse event) or PQC reported .
Age: 1.0
Sex: M
Vaccine: MMR, PNC15, VARCEL
Symptoms: Product storage error
Clinical narrative: no additional AE; the patient was given vaccines after temperature excursion; This spontaneous report was received from a nurse and refers to a 12-month-old male. No information regarding the patient's medical history, concurrent conditions, previous drug reactions or allergies and concomitant medications was provided.  On 10-MAR-2023, the patient was vaccinated with an improper storage doses of varicella virus vaccine live (oka/merck) (VARIVAX) subcutaneous injection, unk, lot #w021740, expiration date: 10-JUL-2024, administered subcutaneously for prophylaxis on right vasteous lateralis (dose and strength was not provided); pneumococcal 15v conj vaccine (crm197) (VAXNEUVANCE) lot #W027250, expiration date: 09-JUL-2024, administered intramuscularly for prophylaxis (strength and dose was not provided) left intramuscular; and  measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live recombinant human albumin (M-M-R II) subcutaneous injection, lot #W001519, expiration date: 13-JAN-2024, administered subcutaneously for prophylaxis on left vasteous lateralis  (strength and dose was not provided). Lot numbers and expiration dates were verified to be valid numbers and established the same expiration dates. (Product storage error). No additional adverse event. ; Sender's Comments:  US-009507513-2303USA006990:MSD US-009507513-2303USA007002:MSD US-009507513-2303USA006967:MSD
Sex: U
Vaccine: VARCEL
Symptoms: Expired product administered, No adverse event
Clinical narrative: no adverse event; one dose of VARIVAX was administered following a temperature excursion; VARIVAX W025277 expiration date reported as 8/10/2024, but validated internally as 28-SEP-2022; This spontaneous report was received from an administrator referring to a patient of unknown age and gender. The patient's relevant medical history, drug reactions/allergies and concomitant medication were not reported.  On 23-MAR-2023, the patient was vaccinated with an improperly stored dose of varicella virus vaccine live (oka/merck)(VARIVAX) lot number: W025277 (expiration date: 10-AUG-2024, but internally validated as 28-SEP-2022 (expired product administered)) for prophylaxis (strength, route, dose or units were not provided).   The storage characteristics were the following: Temperature: 25.9F Time frame: 2 hours 0 minutes Previous temperature excursion? NO   No adverse effects were reported.
Sex: U
Vaccine: VARCEL
Symptoms: No adverse event, Product storage error
Clinical narrative: No additional clarifying statements or AE details were provided; The HCP reports that a patient was administered a dose of VARIVAX that was involved in a temperature excursion.; This spontaneous report was received from medical assistant and refers to a patient of unknown age and gender. The patient's concurrent conditions, pertinent medical history, drug reactions or allergies, and concomitant therapies were not reported.  On 17-FEB-2023, the patient was administered dose of varicella virus vaccine live (oka/merck) (VARIVAX) lot #W021740, expiration date: 10-JUL-2024, for prophylaxis (route of administration and anatomical location were not provided), that was involved in a temperature excursion, at a temperature of 14.7F for a time frame of 1 hour and 3 minutes. There were no previous temperature excursion. No additional clarifying statements or adverse event (AE) details were provided.  This is one of several reports received from the same reporter.; Sender's Comments:  US-009507513-2303USA008836: US-009507513-2303USA009070: US-009507513-2303USA008740: US-009507513-2303USA008981:
Sex: U
Vaccine: PPV
Symptoms: Expired product administered, No adverse event
Clinical narrative: No additional AE reported; Product expired 1/8/2023 and was administered to 2 patients today 3/28/2023. Product had not experienced any temperature excursions through the date of administration; This spontaneous report has been received from a pharmacist, concerning a patient of unknown age and gender. The patient's medical history, concurrent conditions, concomitant medications, previous drug reactions, and allergies were not provided.  On 28-MAR-2023, the patient was vaccinated with an expired dose of pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) injection as prophylaxis (lot number U018309 has been verified to be valid; expiration date reported an established as 08-JAN-2023) (expired product administered) (strength, dose, route of administration, and anatomical location were not provided). No additional adverse events were reported.   This is one of two reports received from the same reporter. ; Sender's Comments:  US-009507513-2303USA010031:
Sex: F
Vaccine: VARCEL
Symptoms: Accidental exposure to product, Needle issue, Occupational exposure to product
Clinical narrative: Nurse calling to report that a drop of VARIVAX went into her eye after administration to a patient; the hub of the needle popped against the patient.; Nurse calling to report that a drop of VARIVAX went into her eye after administration to a patient; This spontaneous report as received from a nurse and refers to a 49-year-old female patient. No information on medical history, current condition or concomitant medications was provided.      On 29-MAR-2023 after administration of varicella virus vaccine live (oka/merck) (VARIVAX) lot # U030161 and expiration date 28-SEP-2023 for prophylaxis (exact dose and route of administration were not provided). The vaccine was administered by the nurse and a drop of varicella virus vaccine live (oka/merck)(VARIVAX) went into her eye as the hub of the needle popped against the patient (occupational exposure to product, needle issue and accidental exposure to product).
Sex: U
Vaccine: PPV
Symptoms: Expired product administered
Clinical narrative: No AE ocurred; An expired dose was administered to a patient; This spontaneous report was received from a consumer referring to a patient of unknown age and gender. The patient's medical history and concurrent conditions were not provided. Concomitant therapies were not reported.  On 29-MAR-2023, the patient was vaccinated with an expired dose of pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) injection, at a dose of 0.5 milliliters (lot #U018309 with an expiration date on 08-JAN-2023), administered for prophylaxis (strength, and route of administration were not provided) (expired product administered).  No adverse event occurred.