chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 66.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Skin ulcer, Vitamin D deficiency
Clinical narrative: 67 yo female with Hx of breast cancer, remote bilateral THA, DVT/PE on xarelto, OCD, DM2, morbid obesity presented following a fall causing femur fracture    Right periprosthetic proximal femur fracture with non union  - s/p revision right total hip arthroplasty, repair proximal femur nonunion with bone graft substitute 8/8 - post operative and pain management and peri operative antibiotics per orthopedics   Acute on chronic anemia - now stable - suspected mostly post operative blood loss. No active bleeding noted. - baseline Hb around 11, decreased to around 8 post operatively, now stable around 7.5   Hx of DVT/PE - per patient, approximately one year ago. Per her report, anticoagulation lifelong. On outpatient rivaroxiban - currently on prophylactic enoxaparin. Resume home rivaroxiban 10mg daily Would continue rivaroxiban indefinately given she was previously on this prior to admission   DM2 - hold home metformin, likely can resume at discharge - HbA1c 6.7% this admission - basal, SSI/IIT. Diabetic diet. Goal blood glucose 140-180. Will not need insulin at discharge, only metformin given above HbA1c    AKI - resolved - noted post operatively   Constipation - postoperative, narcotic associated, immobility  - cont bowel regimen, daily Miralax. May require enema or suppository   COVID 19 infection, asymptomatic - positive test 8/2/22 - evaluated by ID at WBH GP: no further treatment needed   HTN  - resume metoprolol   Right breast skin ulcer: 2/2 self inflicted injury/skin picking due to pt's OCD  - no signs of infection, dry dressing if needed   OCD Mood disorder - cont home buspirone, clonazepam, fluoxetine, risperidone    Hypovitaminosis D - vitamin D supplementation   Hx of breast cancer >20 years ago S/P mastectomy/chemo and radiation  Morbid obesity :  weight loss GERD : resume omeprazole      Stable for discharge to ECF from medical standpoint
Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Angiogram, Anticoagulant therapy, Atrial fibrillation, COVID-19, Computerised tomogram abdomen
Clinical narrative: 90y.o. male with PMH as below who presented on 8/4/22 with coffee ground emesis found to have gallstone illeus requiring ex lap on 8/5/22. His post-operative course has been complicated by afib with RVR, initiation of TPN, COVID+ on 8/17 with worsening respiratory distress requiring ICU admission. He underwent CT non-contrast abd/pelvis today after hgb this am returned at 6.7, down from 9.0. Imaging demonstrated new bilateral retroperitoneal hematomas, greater on the right. IR is consulted for possible embolization. 8/24: The patient has been hypotensive during the day with BP 80s/40s. He has received 1 uPRBCs. Current HR in the 60's on amiodarone drip. He is on HFNC. He is on a heparin gtt for treatment of his Afib. The patient reports right flank pain. He otherwise states that he is doing well. He denies fever, chills, chest pain, n/v/d, or headaches.   8/25:  Hgb downtrending during the day despite 3 uPRBCs. CTA abd/pelvis obtained demonstrating small contrast blush along the proximal right inferior epigastric artery. CTA demonstrating possible extrav near R inferior epigastric. IR angiogram with no evidence of bleeding, no intervention done .  Intubated and ventilated.
Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Computerised tomogram abdomen abnormal, Endotracheal intubation, Explorative laparotomy, Flank pain, Gallstone ileus
Clinical narrative: 90y.o. male with PMH as below who presented on 8/4/22 with coffee ground emesis found to have gallstone illeus requiring ex lap on 8/5/22. His post-operative course has been complicated by afib with RVR, initiation of TPN, COVID+ on 8/17 with worsening respiratory distress requiring ICU admission. He underwent CT non-contrast abd/pelvis today after hgb this am returned at 6.7, down from 9.0. Imaging demonstrated new bilateral retroperitoneal hematomas, greater on the right. IR is consulted for possible embolization. 8/24: The patient has been hypotensive during the day with BP 80s/40s. He has received 1 uPRBCs. Current HR in the 60's on amiodarone drip. He is on HFNC. He is on a heparin gtt for treatment of his Afib. The patient reports right flank pain. He otherwise states that he is doing well. He denies fever, chills, chest pain, n/v/d, or headaches.   8/25:  Hgb downtrending during the day despite 3 uPRBCs. CTA abd/pelvis obtained demonstrating small contrast blush along the proximal right inferior epigastric artery. CTA demonstrating possible extrav near R inferior epigastric. IR angiogram with no evidence of bleeding, no intervention done .  Intubated and ventilated.
Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Haematemesis, Haemoglobin decreased, Hypotension, Intensive care, Mechanical ventilation
Clinical narrative: 90y.o. male with PMH as below who presented on 8/4/22 with coffee ground emesis found to have gallstone illeus requiring ex lap on 8/5/22. His post-operative course has been complicated by afib with RVR, initiation of TPN, COVID+ on 8/17 with worsening respiratory distress requiring ICU admission. He underwent CT non-contrast abd/pelvis today after hgb this am returned at 6.7, down from 9.0. Imaging demonstrated new bilateral retroperitoneal hematomas, greater on the right. IR is consulted for possible embolization. 8/24: The patient has been hypotensive during the day with BP 80s/40s. He has received 1 uPRBCs. Current HR in the 60's on amiodarone drip. He is on HFNC. He is on a heparin gtt for treatment of his Afib. The patient reports right flank pain. He otherwise states that he is doing well. He denies fever, chills, chest pain, n/v/d, or headaches.   8/25:  Hgb downtrending during the day despite 3 uPRBCs. CTA abd/pelvis obtained demonstrating small contrast blush along the proximal right inferior epigastric artery. CTA demonstrating possible extrav near R inferior epigastric. IR angiogram with no evidence of bleeding, no intervention done .  Intubated and ventilated.
Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Parenteral nutrition, Post procedural complication, Red blood cell transfusion, Respiratory distress, Retroperitoneal haematoma
Clinical narrative: 90y.o. male with PMH as below who presented on 8/4/22 with coffee ground emesis found to have gallstone illeus requiring ex lap on 8/5/22. His post-operative course has been complicated by afib with RVR, initiation of TPN, COVID+ on 8/17 with worsening respiratory distress requiring ICU admission. He underwent CT non-contrast abd/pelvis today after hgb this am returned at 6.7, down from 9.0. Imaging demonstrated new bilateral retroperitoneal hematomas, greater on the right. IR is consulted for possible embolization. 8/24: The patient has been hypotensive during the day with BP 80s/40s. He has received 1 uPRBCs. Current HR in the 60's on amiodarone drip. He is on HFNC. He is on a heparin gtt for treatment of his Afib. The patient reports right flank pain. He otherwise states that he is doing well. He denies fever, chills, chest pain, n/v/d, or headaches.   8/25:  Hgb downtrending during the day despite 3 uPRBCs. CTA abd/pelvis obtained demonstrating small contrast blush along the proximal right inferior epigastric artery. CTA demonstrating possible extrav near R inferior epigastric. IR angiogram with no evidence of bleeding, no intervention done .  Intubated and ventilated.
Age: 89.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: 90y.o. male with PMH as below who presented on 8/4/22 with coffee ground emesis found to have gallstone illeus requiring ex lap on 8/5/22. His post-operative course has been complicated by afib with RVR, initiation of TPN, COVID+ on 8/17 with worsening respiratory distress requiring ICU admission. He underwent CT non-contrast abd/pelvis today after hgb this am returned at 6.7, down from 9.0. Imaging demonstrated new bilateral retroperitoneal hematomas, greater on the right. IR is consulted for possible embolization. 8/24: The patient has been hypotensive during the day with BP 80s/40s. He has received 1 uPRBCs. Current HR in the 60's on amiodarone drip. He is on HFNC. He is on a heparin gtt for treatment of his Afib. The patient reports right flank pain. He otherwise states that he is doing well. He denies fever, chills, chest pain, n/v/d, or headaches.   8/25:  Hgb downtrending during the day despite 3 uPRBCs. CTA abd/pelvis obtained demonstrating small contrast blush along the proximal right inferior epigastric artery. CTA demonstrating possible extrav near R inferior epigastric. IR angiogram with no evidence of bleeding, no intervention done .  Intubated and ventilated.
Age: 80.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Anxiety, COVID-19, Coronary arterial stent insertion, Coronary artery disease, Dizziness
Clinical narrative: Patient was initially admitted to the hospital due to a syncopal event he was diagnosis COVID-19 positive. Patient was trying to get out of the bed according to records and per his recount and had gone to the bathroom felt dizzy and passed out. Patient was evaluated in the EC seen by cardiology and also recommended 3 doses of remdesivir. Noted cardiology input regarding need for TEE with his recent coronary artery disease with PCI and stent in March 2022 and a TAVR in 2022 however patient was very anxious to be discharged so the nurse did help me get ahold of cardiology who did clear him for discharge. As clinically patient is better his symptoms have resolved he has not required any O2 he would be okay for discharge without the third dose of remdesivir. Patient does understand that the recommendations for CDCR for 3 days if he has any issues he would need to return to the hospital.
Age: 80.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Loss of consciousness, Percutaneous coronary intervention, SARS-CoV-2 test positive, Syncope, Transcatheter aortic valve implantation
Clinical narrative: Patient was initially admitted to the hospital due to a syncopal event he was diagnosis COVID-19 positive. Patient was trying to get out of the bed according to records and per his recount and had gone to the bathroom felt dizzy and passed out. Patient was evaluated in the EC seen by cardiology and also recommended 3 doses of remdesivir. Noted cardiology input regarding need for TEE with his recent coronary artery disease with PCI and stent in March 2022 and a TAVR in 2022 however patient was very anxious to be discharged so the nurse did help me get ahold of cardiology who did clear him for discharge. As clinically patient is better his symptoms have resolved he has not required any O2 he would be okay for discharge without the third dose of remdesivir. Patient does understand that the recommendations for CDCR for 3 days if he has any issues he would need to return to the hospital.
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Atrial fibrillation, COVID-19, Condition aggravated, Electrocardiogram abnormal, Heart rate increased
Clinical narrative: An 84-year-old male with a history of GI hemorrhage associated with a duodenal ulcer, hypertension, malignant lymphoma ?, atrial fibrillation. Patient was doing well and went for a routine follow-up visit with his pulmonologist for history of COPD.  On physical exam his heart rate was found to be elevated in the 140s which prompted an EKG revealing A. fib with RVR, patient was recommended to present to the ED. Patient denies any new symptoms, admits to recent worsening of his chronic cough (productive of yellow sputum which seems stable), but denies any fever/chills, palpitations, difficulty breathing, chest pain.
Age: 82.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Productive cough, SARS-CoV-2 test positive, Sputum discoloured
Clinical narrative: An 84-year-old male with a history of GI hemorrhage associated with a duodenal ulcer, hypertension, malignant lymphoma ?, atrial fibrillation. Patient was doing well and went for a routine follow-up visit with his pulmonologist for history of COPD.  On physical exam his heart rate was found to be elevated in the 140s which prompted an EKG revealing A. fib with RVR, patient was recommended to present to the ED. Patient denies any new symptoms, admits to recent worsening of his chronic cough (productive of yellow sputum which seems stable), but denies any fever/chills, palpitations, difficulty breathing, chest pain.
Age: 56.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Cardiac arrest, Dyspnoea, Dyspnoea exertional, Goitre
Clinical narrative: 58-year-old man with past medical history of cardiac arrest in 2/2022, HFrEF, bilateral LE DVTs obesity, OSA, anoxic brain injury, HTN, thyroid mass, and diabetes who came to the emergency department on 5/4 due to shortness of breath and stridor.  Patient is accompanied by wife at bedside who helps with a history.  He has been having shortness of breath on minimal exertion, and abnormal stridor sound for the past few days before presentation.   Patient is status post tracheostomy in March 2022 that was eventually decannulated but he required repeat urgent tracheostomy in May 2022, and was eventually decannulated.  Patient was found to have asymmetric enlargement of the left lobule of the thyroid gland measuring up to 8 cm in size  compressing the left lateral subglottic trachea which was scheduled for thyroidectomy in the middle of August 2022.  But due to worsening of symptoms patient presented on 8/4.  He was found to be COVID-19 positive, he is vaccinated with 2 doses of Pfizer and received a booster dose too.  He was evaluated by endocrine surgery, ENT, and ICU during this admission.  He received 1 dose of Solu-Medrol and racemic epinephrine, did not have desaturations, evaluated by ID with recommendations for treatment with remdesivir, received 3 doses by 8/7. LFTs and heart rate were monitored were on remdesivir.    Discharged on room air with plan for follow-up with endocrine surgery for thyroidectomy with ENT recommendations for lower tracheal placement of the endotracheal tube and using extended length 6.5  Mm tube, Dr. performed balloon dilatation of the site if necessary following thyroid surgery.
Age: 56.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Intensive care, Liver function test, SARS-CoV-2 test positive, Stridor, Tracheal compression
Clinical narrative: 58-year-old man with past medical history of cardiac arrest in 2/2022, HFrEF, bilateral LE DVTs obesity, OSA, anoxic brain injury, HTN, thyroid mass, and diabetes who came to the emergency department on 5/4 due to shortness of breath and stridor.  Patient is accompanied by wife at bedside who helps with a history.  He has been having shortness of breath on minimal exertion, and abnormal stridor sound for the past few days before presentation.   Patient is status post tracheostomy in March 2022 that was eventually decannulated but he required repeat urgent tracheostomy in May 2022, and was eventually decannulated.  Patient was found to have asymmetric enlargement of the left lobule of the thyroid gland measuring up to 8 cm in size  compressing the left lateral subglottic trachea which was scheduled for thyroidectomy in the middle of August 2022.  But due to worsening of symptoms patient presented on 8/4.  He was found to be COVID-19 positive, he is vaccinated with 2 doses of Pfizer and received a booster dose too.  He was evaluated by endocrine surgery, ENT, and ICU during this admission.  He received 1 dose of Solu-Medrol and racemic epinephrine, did not have desaturations, evaluated by ID with recommendations for treatment with remdesivir, received 3 doses by 8/7. LFTs and heart rate were monitored were on remdesivir.    Discharged on room air with plan for follow-up with endocrine surgery for thyroidectomy with ENT recommendations for lower tracheal placement of the endotracheal tube and using extended length 6.5  Mm tube, Dr. performed balloon dilatation of the site if necessary following thyroid surgery.
Age: 56.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Tracheostomy, Tracheostomy tube removal
Clinical narrative: 58-year-old man with past medical history of cardiac arrest in 2/2022, HFrEF, bilateral LE DVTs obesity, OSA, anoxic brain injury, HTN, thyroid mass, and diabetes who came to the emergency department on 5/4 due to shortness of breath and stridor.  Patient is accompanied by wife at bedside who helps with a history.  He has been having shortness of breath on minimal exertion, and abnormal stridor sound for the past few days before presentation.   Patient is status post tracheostomy in March 2022 that was eventually decannulated but he required repeat urgent tracheostomy in May 2022, and was eventually decannulated.  Patient was found to have asymmetric enlargement of the left lobule of the thyroid gland measuring up to 8 cm in size  compressing the left lateral subglottic trachea which was scheduled for thyroidectomy in the middle of August 2022.  But due to worsening of symptoms patient presented on 8/4.  He was found to be COVID-19 positive, he is vaccinated with 2 doses of Pfizer and received a booster dose too.  He was evaluated by endocrine surgery, ENT, and ICU during this admission.  He received 1 dose of Solu-Medrol and racemic epinephrine, did not have desaturations, evaluated by ID with recommendations for treatment with remdesivir, received 3 doses by 8/7. LFTs and heart rate were monitored were on remdesivir.    Discharged on room air with plan for follow-up with endocrine surgery for thyroidectomy with ENT recommendations for lower tracheal placement of the endotracheal tube and using extended length 6.5  Mm tube, Dr. performed balloon dilatation of the site if necessary following thyroid surgery.
Age: 7.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Abdominal X-ray, Bacterial test positive, Blood creatinine decreased, Blood sodium decreased, COVID-19
Clinical narrative: Patient is an 8 year old male with PMH of VUR s/p bilateral ureteral implantation and Stage 1 CKD who presented to the EC with fevers and vomiting. In the EC he tested positive for COVID, which mom states that he tested positive 7/20 and has been overall asymptomatic. His UA came back positive for 1+ Leukocyte esterase, 1+ bacteria, and and 6-10 WBC. He had an elevated WBC to 18.5, was hyponatremic at 132 bil/L, and had elevated creatine to .62 from his baseline of .44. He was started on D5NS and Rocephin 1g qDay. He also had Tylenonal Q6 H PRN for pain control. His abdominal x-ray and KUB were WNL. Vital signs have been stable and he has remained afebrile. His fluids were stopped this morning as he was tolerating PO intake. Urology was consulted who felt that UTI was less likely diagnosis. They recommended stopping antibiotics prior to discharge and following the urine culture--planning to restart if urine culture turned positive after discharge.   His nephrologist, was also consulted and recommended a follow up renal funtion panel, a repeat urinalysis, and a urine protein/creatine. UA improved, without bacteria, and trace leukocyte esterase. RFP showed improving creatinine to 0.59 and sodium to 136. Patient was discharged in stable condition. Pediatric team will follow up urine culture results and treat if indicated. He will follow up with urology and nephrology outpatient in approximately 1 month. He will also follow up with PCP in 2-3 days.
Age: 7.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Culture urine, Hyponatraemia, Pyrexia, SARS-CoV-2 test positive, Urinary system x-ray normal
Clinical narrative: Patient is an 8 year old male with PMH of VUR s/p bilateral ureteral implantation and Stage 1 CKD who presented to the EC with fevers and vomiting. In the EC he tested positive for COVID, which mom states that he tested positive 7/20 and has been overall asymptomatic. His UA came back positive for 1+ Leukocyte esterase, 1+ bacteria, and and 6-10 WBC. He had an elevated WBC to 18.5, was hyponatremic at 132 bil/L, and had elevated creatine to .62 from his baseline of .44. He was started on D5NS and Rocephin 1g qDay. He also had Tylenonal Q6 H PRN for pain control. His abdominal x-ray and KUB were WNL. Vital signs have been stable and he has remained afebrile. His fluids were stopped this morning as he was tolerating PO intake. Urology was consulted who felt that UTI was less likely diagnosis. They recommended stopping antibiotics prior to discharge and following the urine culture--planning to restart if urine culture turned positive after discharge.   His nephrologist, was also consulted and recommended a follow up renal funtion panel, a repeat urinalysis, and a urine protein/creatine. UA improved, without bacteria, and trace leukocyte esterase. RFP showed improving creatinine to 0.59 and sodium to 136. Patient was discharged in stable condition. Pediatric team will follow up urine culture results and treat if indicated. He will follow up with urology and nephrology outpatient in approximately 1 month. He will also follow up with PCP in 2-3 days.
Age: 7.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Urine analysis, Urine leukocyte esterase positive, Vomiting, White blood cell count increased, White blood cells urine positive
Clinical narrative: Patient is an 8 year old male with PMH of VUR s/p bilateral ureteral implantation and Stage 1 CKD who presented to the EC with fevers and vomiting. In the EC he tested positive for COVID, which mom states that he tested positive 7/20 and has been overall asymptomatic. His UA came back positive for 1+ Leukocyte esterase, 1+ bacteria, and and 6-10 WBC. He had an elevated WBC to 18.5, was hyponatremic at 132 bil/L, and had elevated creatine to .62 from his baseline of .44. He was started on D5NS and Rocephin 1g qDay. He also had Tylenonal Q6 H PRN for pain control. His abdominal x-ray and KUB were WNL. Vital signs have been stable and he has remained afebrile. His fluids were stopped this morning as he was tolerating PO intake. Urology was consulted who felt that UTI was less likely diagnosis. They recommended stopping antibiotics prior to discharge and following the urine culture--planning to restart if urine culture turned positive after discharge.   His nephrologist, was also consulted and recommended a follow up renal funtion panel, a repeat urinalysis, and a urine protein/creatine. UA improved, without bacteria, and trace leukocyte esterase. RFP showed improving creatinine to 0.59 and sodium to 136. Patient was discharged in stable condition. Pediatric team will follow up urine culture results and treat if indicated. He will follow up with urology and nephrology outpatient in approximately 1 month. He will also follow up with PCP in 2-3 days.
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Acute kidney injury, Arthritis, Asthenia, Blood creatinine increased, Blood sodium decreased
Clinical narrative: Patient is an 84-year-old female with recent cellulitis, who presented from home with reports of low blood pressure and mental status changes. Initially, there was concern over persistent infection, but her urinalysis and other blood work were not consistent with persistent infection.  She remained afebrile and cultures were negative through her course.  We kept off antibiotics.  She did have followup with Dr.s team.  She did have acute kidney injury with creatinine up to 1.8, likely due to the hypotension.  Her ACE inhibitor was discontinued and we will keep her off this indefinitely now.  She received some hypotonic saline for hydration, actually had D5 half-normal.  Sodium fell down to 126.  Did resume her Lasix thereafter and sodium was trending up to 128.  This along with fluid restriction.  She had some persistent delirium at night, sometimes calling her family and being more confused, but was oriented during the day and not combative.  She has severe debility and degenerative arthritis, is able to stand, but her transfers are extremely slow and difficult.  She was felt to be a better candidate for extended care facility placement in the short-term.  Her creatinine was 0.9 at the time of discharge and sodium 128.  Hemoglobin was 11.2 and white count was 9.3.  Plan to discharge to nursing care facility hopefully later today.  Follow up in the office 1 week after discharge from there.
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Blood test, COVID-19, Cellulitis, Confusional state, Culture negative
Clinical narrative: Patient is an 84-year-old female with recent cellulitis, who presented from home with reports of low blood pressure and mental status changes. Initially, there was concern over persistent infection, but her urinalysis and other blood work were not consistent with persistent infection.  She remained afebrile and cultures were negative through her course.  We kept off antibiotics.  She did have followup with Dr.s team.  She did have acute kidney injury with creatinine up to 1.8, likely due to the hypotension.  Her ACE inhibitor was discontinued and we will keep her off this indefinitely now.  She received some hypotonic saline for hydration, actually had D5 half-normal.  Sodium fell down to 126.  Did resume her Lasix thereafter and sodium was trending up to 128.  This along with fluid restriction.  She had some persistent delirium at night, sometimes calling her family and being more confused, but was oriented during the day and not combative.  She has severe debility and degenerative arthritis, is able to stand, but her transfers are extremely slow and difficult.  She was felt to be a better candidate for extended care facility placement in the short-term.  Her creatinine was 0.9 at the time of discharge and sodium 128.  Hemoglobin was 11.2 and white count was 9.3.  Plan to discharge to nursing care facility hopefully later today.  Follow up in the office 1 week after discharge from there.
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Delirium, Fluid intake restriction, Haemoglobin decreased, Hypotension, Mental status changes
Clinical narrative: Patient is an 84-year-old female with recent cellulitis, who presented from home with reports of low blood pressure and mental status changes. Initially, there was concern over persistent infection, but her urinalysis and other blood work were not consistent with persistent infection.  She remained afebrile and cultures were negative through her course.  We kept off antibiotics.  She did have followup with Dr.s team.  She did have acute kidney injury with creatinine up to 1.8, likely due to the hypotension.  Her ACE inhibitor was discontinued and we will keep her off this indefinitely now.  She received some hypotonic saline for hydration, actually had D5 half-normal.  Sodium fell down to 126.  Did resume her Lasix thereafter and sodium was trending up to 128.  This along with fluid restriction.  She had some persistent delirium at night, sometimes calling her family and being more confused, but was oriented during the day and not combative.  She has severe debility and degenerative arthritis, is able to stand, but her transfers are extremely slow and difficult.  She was felt to be a better candidate for extended care facility placement in the short-term.  Her creatinine was 0.9 at the time of discharge and sodium 128.  Hemoglobin was 11.2 and white count was 9.3.  Plan to discharge to nursing care facility hopefully later today.  Follow up in the office 1 week after discharge from there.
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Mobility decreased, SARS-CoV-2 test positive, Urine analysis, White blood cell count normal
Clinical narrative: Patient is an 84-year-old female with recent cellulitis, who presented from home with reports of low blood pressure and mental status changes. Initially, there was concern over persistent infection, but her urinalysis and other blood work were not consistent with persistent infection.  She remained afebrile and cultures were negative through her course.  We kept off antibiotics.  She did have followup with Dr.s team.  She did have acute kidney injury with creatinine up to 1.8, likely due to the hypotension.  Her ACE inhibitor was discontinued and we will keep her off this indefinitely now.  She received some hypotonic saline for hydration, actually had D5 half-normal.  Sodium fell down to 126.  Did resume her Lasix thereafter and sodium was trending up to 128.  This along with fluid restriction.  She had some persistent delirium at night, sometimes calling her family and being more confused, but was oriented during the day and not combative.  She has severe debility and degenerative arthritis, is able to stand, but her transfers are extremely slow and difficult.  She was felt to be a better candidate for extended care facility placement in the short-term.  Her creatinine was 0.9 at the time of discharge and sodium 128.  Hemoglobin was 11.2 and white count was 9.3.  Plan to discharge to nursing care facility hopefully later today.  Follow up in the office 1 week after discharge from there.
Age: 42.0
Sex: M
Vaccine: SMALLMNK
Symptoms: Blister, Erythema, Nodule
Clinical narrative: 8/30/2022 Redness, raised knot, followed by blister same day through day 2; took over the counter Benadryl. Resolved on day 3.
Age: 80.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Asthenia, COVID-19, Fatigue, Inflammatory marker increased, SARS-CoV-2 test positive
Clinical narrative: Patient is an 82 y/o male h/o prostate cancer, CAD s/p CABG 2003, DM, dementia who presents for positive COVID test and generalized weakness/fatigue. No SOB, chest pain, or other complaints at this time. He remained on room air throughout hospitalization. Inflammatory markers mildly elevated as expected. Evaluated by ID team and due to risk factors for severe disease (advanced age) he completed 3 days of remdesivir. He remained on room air with no SOB or cough. Arranged with his daughters and his 24/7 home care for discharge. DC in stable condition, pt is agreeable w plan.
Age: 28.0
Sex: F
Vaccine: HEP
Symptoms: Expired product administered
Clinical narrative: Dose was expired
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Arthralgia, Atrial fibrillation, COVID-19, Dizziness, Electrocardiogram ST-T segment abnormal
Clinical narrative: 80 y/o female with a history of CAD by CTA 2015, hx of multiple PE's in 2015 on coumadin, PHT, HTN, HLD, GERD, CKD, and COPD who presented to the EC on 8/5 for knee pain after her legs gave out while bending down to pick up an object. Found to have a periprosthetic nondisplaced medial femoral condyle  Fracture. Also found to be positive for COVID on admission. During admission developed atrial fibrillation with RVR. On 8/13 she was RRT for tachycardia with palpitations and lightheadedness. ECG with recurrence of atrial fibrillation with diffuse ST-T abnormalities. She was started on IV amiodarone and her magnesium was supplemented with conversion back to NSR. She is stable for DC to SAR with outpatient follow-up.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Electrocardiogram abnormal, Femur fracture, Musculoskeletal disorder, Palpitations, Periprosthetic fracture
Clinical narrative: 80 y/o female with a history of CAD by CTA 2015, hx of multiple PE's in 2015 on coumadin, PHT, HTN, HLD, GERD, CKD, and COPD who presented to the EC on 8/5 for knee pain after her legs gave out while bending down to pick up an object. Found to have a periprosthetic nondisplaced medial femoral condyle  Fracture. Also found to be positive for COVID on admission. During admission developed atrial fibrillation with RVR. On 8/13 she was RRT for tachycardia with palpitations and lightheadedness. ECG with recurrence of atrial fibrillation with diffuse ST-T abnormalities. She was started on IV amiodarone and her magnesium was supplemented with conversion back to NSR. She is stable for DC to SAR with outpatient follow-up.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Sinus rhythm, Tachycardia
Clinical narrative: 80 y/o female with a history of CAD by CTA 2015, hx of multiple PE's in 2015 on coumadin, PHT, HTN, HLD, GERD, CKD, and COPD who presented to the EC on 8/5 for knee pain after her legs gave out while bending down to pick up an object. Found to have a periprosthetic nondisplaced medial femoral condyle  Fracture. Also found to be positive for COVID on admission. During admission developed atrial fibrillation with RVR. On 8/13 she was RRT for tachycardia with palpitations and lightheadedness. ECG with recurrence of atrial fibrillation with diffuse ST-T abnormalities. She was started on IV amiodarone and her magnesium was supplemented with conversion back to NSR. She is stable for DC to SAR with outpatient follow-up.
Age: 65.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Ankle fracture, COVID-19, Dizziness, Dysarthria, Dysphagia
Clinical narrative: 67-year-old male status post travel via plane.  Towards the end of the plane patient felt a little bit off.  Apparently had some dizziness and a headache with some dysphagia.  Patient had flown with his daughter to be with family.  Daughter was asymptomatic.  Original chart comments on lightheadedness and slight slurred speech.  Symptoms were rapid and he had not had much sleep he does have headaches and most recently had been on a course of steroids 3 tablets a day for the last 9 of 10 days.  Patient had been given that anti-inflammatory for his right ankle.  He states he does have a history of sinus congestion he does use nasal inhaler and trilogy.  Patient was transferred from 1 institution to another to evaluate for possible TIA . Patient is normally very active..  Previous hikes and biking.  Patient developed some right ankle swelling found to have microfractures patient has been evaluated for Charcot joint.  .  Patient is surprised that he actually is testing positive for COVID. History of COVID end of May.  By a home test patient had sinus congestion at that time relatively asymptomatic lasted 1 to 2 days.  Previous COVID in 2020 in November. Initial imaging was negative for stroke.  He was then transferred to hospital for further evaluation and management. He mentions that he had been diagnosed with COVID-19 about a month ago.   Patient was admitted for stroke work-up. Patient has declined the acute stroke clinic for now. Patient plans to create appointments with PCP and Neurologist.
Age: 65.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Feeling abnormal, Headache, Imaging procedure, Inflammation, Insomnia
Clinical narrative: 67-year-old male status post travel via plane.  Towards the end of the plane patient felt a little bit off.  Apparently had some dizziness and a headache with some dysphagia.  Patient had flown with his daughter to be with family.  Daughter was asymptomatic.  Original chart comments on lightheadedness and slight slurred speech.  Symptoms were rapid and he had not had much sleep he does have headaches and most recently had been on a course of steroids 3 tablets a day for the last 9 of 10 days.  Patient had been given that anti-inflammatory for his right ankle.  He states he does have a history of sinus congestion he does use nasal inhaler and trilogy.  Patient was transferred from 1 institution to another to evaluate for possible TIA . Patient is normally very active..  Previous hikes and biking.  Patient developed some right ankle swelling found to have microfractures patient has been evaluated for Charcot joint.  .  Patient is surprised that he actually is testing positive for COVID. History of COVID end of May.  By a home test patient had sinus congestion at that time relatively asymptomatic lasted 1 to 2 days.  Previous COVID in 2020 in November. Initial imaging was negative for stroke.  He was then transferred to hospital for further evaluation and management. He mentions that he had been diagnosed with COVID-19 about a month ago.   Patient was admitted for stroke work-up. Patient has declined the acute stroke clinic for now. Patient plans to create appointments with PCP and Neurologist.
Age: 65.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Joint swelling, SARS-CoV-2 test positive
Clinical narrative: 67-year-old male status post travel via plane.  Towards the end of the plane patient felt a little bit off.  Apparently had some dizziness and a headache with some dysphagia.  Patient had flown with his daughter to be with family.  Daughter was asymptomatic.  Original chart comments on lightheadedness and slight slurred speech.  Symptoms were rapid and he had not had much sleep he does have headaches and most recently had been on a course of steroids 3 tablets a day for the last 9 of 10 days.  Patient had been given that anti-inflammatory for his right ankle.  He states he does have a history of sinus congestion he does use nasal inhaler and trilogy.  Patient was transferred from 1 institution to another to evaluate for possible TIA . Patient is normally very active..  Previous hikes and biking.  Patient developed some right ankle swelling found to have microfractures patient has been evaluated for Charcot joint.  .  Patient is surprised that he actually is testing positive for COVID. History of COVID end of May.  By a home test patient had sinus congestion at that time relatively asymptomatic lasted 1 to 2 days.  Previous COVID in 2020 in November. Initial imaging was negative for stroke.  He was then transferred to hospital for further evaluation and management. He mentions that he had been diagnosed with COVID-19 about a month ago.   Patient was admitted for stroke work-up. Patient has declined the acute stroke clinic for now. Patient plans to create appointments with PCP and Neurologist.
Age: 96.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Asymptomatic COVID-19, C-reactive protein increased, COVID-19, Computerised tomogram head normal, Fall
Clinical narrative: 97y.o. male with history of dementia, anemia, L1 compression fracture, urinary retention, and atrial fibrillation. He was brought in yesterday after he had fallen outside and hit his head on the concrete, unsure if any LOC. CT head was negative for any acute process. Labs including CBC, BMP, and troponin were all unremarkable. He was found to be positive for COVID but was saturating well on room air and otherwise asymptomatic. Inflammatory markers were checked, he did have elevated CRP and d-dimer. Patient deemed medically stable for discharge by physician. Hospital accepted patient.
Age: 96.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Fibrin D dimer increased, Full blood count normal, Head injury, Inflammatory marker increased, Metabolic function test normal
Clinical narrative: 97y.o. male with history of dementia, anemia, L1 compression fracture, urinary retention, and atrial fibrillation. He was brought in yesterday after he had fallen outside and hit his head on the concrete, unsure if any LOC. CT head was negative for any acute process. Labs including CBC, BMP, and troponin were all unremarkable. He was found to be positive for COVID but was saturating well on room air and otherwise asymptomatic. Inflammatory markers were checked, he did have elevated CRP and d-dimer. Patient deemed medically stable for discharge by physician. Hospital accepted patient.
Age: 96.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Troponin normal
Clinical narrative: 97y.o. male with history of dementia, anemia, L1 compression fracture, urinary retention, and atrial fibrillation. He was brought in yesterday after he had fallen outside and hit his head on the concrete, unsure if any LOC. CT head was negative for any acute process. Labs including CBC, BMP, and troponin were all unremarkable. He was found to be positive for COVID but was saturating well on room air and otherwise asymptomatic. Inflammatory markers were checked, he did have elevated CRP and d-dimer. Patient deemed medically stable for discharge by physician. Hospital accepted patient.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Abdominal lymphadenopathy, Alpha 1 foetoprotein normal, Ascites, Back pain, Biopsy
Clinical narrative: 70 yo M with PMH CAD, HTN, HLD who presents on 8/6 for n/v, decreased appetite x 1 week. He was evaluated by PCP who noted elevated LFT and was found to have liver lesions. Also with L lumbar back pain since June so he was taking 2 extra dose tylenol Q2-3H. On day PTA, took 6 tablets of tylenol at once. Pt was reading on tylenol OD so he came to EC for evaluation. Also notable for 20lb weight loss. On arrial to EC, CT a/p w lung nodules, severe liver cirrhosis and splenomegaly, ascites, R hepatic lobe and L hepatic lobe mass consistent with multifocal HCC, upper abdominal adenopathy indicating mets, lytic lesion L1. CBC, BMP unremarkable. HFT markedly elevated. Pt admitted for further w/u and oncology consult. Oncology, GI, hepatology consulted. AFP and CA-19-9 wnl. S/p CT guided bx of L1 on 8/12. FPRS consulted, started on methadone with improvement. Biopsy results pending at the time of dc. Pt instructed to f/u with oncology team for pathology results and further plan of care. Pt remained hemodynamically stable. He was discharged home in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Carbohydrate antigen 19-9, Computerised tomogram thorax abnormal, Decreased appetite, Full blood count normal
Clinical narrative: 70 yo M with PMH CAD, HTN, HLD who presents on 8/6 for n/v, decreased appetite x 1 week. He was evaluated by PCP who noted elevated LFT and was found to have liver lesions. Also with L lumbar back pain since June so he was taking 2 extra dose tylenol Q2-3H. On day PTA, took 6 tablets of tylenol at once. Pt was reading on tylenol OD so he came to EC for evaluation. Also notable for 20lb weight loss. On arrial to EC, CT a/p w lung nodules, severe liver cirrhosis and splenomegaly, ascites, R hepatic lobe and L hepatic lobe mass consistent with multifocal HCC, upper abdominal adenopathy indicating mets, lytic lesion L1. CBC, BMP unremarkable. HFT markedly elevated. Pt admitted for further w/u and oncology consult. Oncology, GI, hepatology consulted. AFP and CA-19-9 wnl. S/p CT guided bx of L1 on 8/12. FPRS consulted, started on methadone with improvement. Biopsy results pending at the time of dc. Pt instructed to f/u with oncology team for pathology results and further plan of care. Pt remained hemodynamically stable. He was discharged home in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Hepatic cirrhosis, Hepatic lesion, Hepatic mass, Hepatocellular carcinoma, Laboratory test abnormal
Clinical narrative: 70 yo M with PMH CAD, HTN, HLD who presents on 8/6 for n/v, decreased appetite x 1 week. He was evaluated by PCP who noted elevated LFT and was found to have liver lesions. Also with L lumbar back pain since June so he was taking 2 extra dose tylenol Q2-3H. On day PTA, took 6 tablets of tylenol at once. Pt was reading on tylenol OD so he came to EC for evaluation. Also notable for 20lb weight loss. On arrial to EC, CT a/p w lung nodules, severe liver cirrhosis and splenomegaly, ascites, R hepatic lobe and L hepatic lobe mass consistent with multifocal HCC, upper abdominal adenopathy indicating mets, lytic lesion L1. CBC, BMP unremarkable. HFT markedly elevated. Pt admitted for further w/u and oncology consult. Oncology, GI, hepatology consulted. AFP and CA-19-9 wnl. S/p CT guided bx of L1 on 8/12. FPRS consulted, started on methadone with improvement. Biopsy results pending at the time of dc. Pt instructed to f/u with oncology team for pathology results and further plan of care. Pt remained hemodynamically stable. He was discharged home in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Liver function test increased, Metabolic function test normal, Nausea, Pulmonary mass, SARS-CoV-2 test positive
Clinical narrative: 70 yo M with PMH CAD, HTN, HLD who presents on 8/6 for n/v, decreased appetite x 1 week. He was evaluated by PCP who noted elevated LFT and was found to have liver lesions. Also with L lumbar back pain since June so he was taking 2 extra dose tylenol Q2-3H. On day PTA, took 6 tablets of tylenol at once. Pt was reading on tylenol OD so he came to EC for evaluation. Also notable for 20lb weight loss. On arrial to EC, CT a/p w lung nodules, severe liver cirrhosis and splenomegaly, ascites, R hepatic lobe and L hepatic lobe mass consistent with multifocal HCC, upper abdominal adenopathy indicating mets, lytic lesion L1. CBC, BMP unremarkable. HFT markedly elevated. Pt admitted for further w/u and oncology consult. Oncology, GI, hepatology consulted. AFP and CA-19-9 wnl. S/p CT guided bx of L1 on 8/12. FPRS consulted, started on methadone with improvement. Biopsy results pending at the time of dc. Pt instructed to f/u with oncology team for pathology results and further plan of care. Pt remained hemodynamically stable. He was discharged home in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19, COVID19
Symptoms: Splenomegaly, Vomiting, Weight decreased
Clinical narrative: 70 yo M with PMH CAD, HTN, HLD who presents on 8/6 for n/v, decreased appetite x 1 week. He was evaluated by PCP who noted elevated LFT and was found to have liver lesions. Also with L lumbar back pain since June so he was taking 2 extra dose tylenol Q2-3H. On day PTA, took 6 tablets of tylenol at once. Pt was reading on tylenol OD so he came to EC for evaluation. Also notable for 20lb weight loss. On arrial to EC, CT a/p w lung nodules, severe liver cirrhosis and splenomegaly, ascites, R hepatic lobe and L hepatic lobe mass consistent with multifocal HCC, upper abdominal adenopathy indicating mets, lytic lesion L1. CBC, BMP unremarkable. HFT markedly elevated. Pt admitted for further w/u and oncology consult. Oncology, GI, hepatology consulted. AFP and CA-19-9 wnl. S/p CT guided bx of L1 on 8/12. FPRS consulted, started on methadone with improvement. Biopsy results pending at the time of dc. Pt instructed to f/u with oncology team for pathology results and further plan of care. Pt remained hemodynamically stable. He was discharged home in stable condition.
Age: 73.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Bacteraemia, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Culture urine positive
Clinical narrative: 74y.o. female with PMHx of kidney stones who presented with shortness of breath. She stated that she is being worked up for possible lung cancer and had a biopsy done of a mediastinal mass at the end of June that was concerning for lung cancer. She states that she has been experiencing some exertional dyspnea. She had imaging done on 7/20 which revealed a moderate pericardial effusion and pt was sent in for eval. In EC, ECG shows sinus tachycardia. Imaging revealed a large pericardial effusion with possible early signs of tamponade. Pt was admitted to ICU for further management. Pt is s/p pericardiocentesis with drain. Repeat Echo demonstrated minimal pericardial effusion. Drain was removed. Developed fever and Urine culture with GNB and was treated with IV ceftriaxone and transitioned to Augmentin until 8/7. Pt started on radiation therapy for her lung cancer. Pt on radiation therapy until August 11th. Pt originally to stay IP until radiation completed but transportation was able to be arranged and patient wishes to go home. Pt to follow up with hematology and pulmonology as OP. Cleared for discharge home on 8/5. She returned on 8/6/2022 for shortness of breath that started earlier that day.  In EC, Bedside echocardiogram showed small pericardial effusion w/ no signs of tamponade.  Labs indicated a positive COVID-19 swab and CXR concerning for L sided pleural effusion. She was admitted for further workup. CT of chest showing significant enlargement of patient's anterior mediastinal mass with severe compression narrowing of the main pulmonary artery. There is also relative compression of the left atrium due to the increased size of the mass. There is increased pericardial effusion and there is new moderate left pleural effusion. She had episodes of NSVT improving, continue lopressor BID. repeat ECHO with EF 50%, small pericardial effusion. She  compelted remdesevir and sats stable on RA. hematology following  And completed 10 radiation treatments. Pt is stable for d/c home with close Op follow up