chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 94.0
Sex: F
Vaccine: COVID19
Symptoms: Hip fracture, Hypophagia, Hyporesponsive to stimuli, Lethargy, Malnutrition
Clinical narrative: Patient is a 95 y.o. female patient of MD with history of HTN, HLD, Afib, UTI who presented to Hospital with lethargy, poor intake in the setting of recent COVID diagnosis. Family ultimately decided to change to DNRCC on 1/3 and pursue Hospice.    Goals of care Comfort care Discussion at bedside with 2 children on 1/3 They have noticed a severe decline in function, nutrition and quality of life since her hip fracture in 11/2022 Had been getting oxycodone at ECF prior to admission -- currently complaining of "pain all over" Family desired change to DNR-CC  Hospice has accepted and will provide services at LTC once able to return out of COVID isolation Discontinued most medications including remdesivir as pt wants to limit pills Added oxycodone and anxiolytics PRN (OK for no IV) Palliative care consulted for assistance with hospice diagnosis  Discharge to ECF with hospice    Covid-19 Virus Infection Date of onset of symptoms: circa 12/31 Symptoms present on admission: poor appetite, decreased LOC Date of covid positive test: 1/1 at SNF (unable to obtain test result electronically to scan into chart) -- > repeat COVID test positive (1/3)  Vaccination status: vaccinated Imaging: CXR "vascular congestion" Oxygen requirements on admission: RA Current oxygen requirements: 94% RA Medical therapy: Remdesevir started per ID -- > stopped 1/3 End isolation on 1/11   Fall, initial encounter Inpatient fall on 1/6 from bed with +head trauma Complaining of R shoulder pain and with small forehead hematoma Shoulder XR -- non-acute Will hold on CT head given DNRCC and not going to change management Fall precautions, pain control as above   Acute UTI Candiduria Significant pyuria noted with many bacteria and rare yeast Pt denies urinary sx but is confused and unreliable Ucx with >100 candida albicans Stopped ceftriaxone Discussed with pharmacy -- start fluconazole for now given this may be contributing to her discomfort   Dysphagia Severe protein calorie malnutrition with cachexia Appears cachectic with muscle wasting, underweight on admission Did not tolerate recent mirtazapine per son Noted dysphagia for last month or so per family and currently tolerating little to no PO intake Should qualify for Hospice on this alone Will give gentle D5 gtt for now Family opting for DNRCC so hold on SLP consult and provide MDD diet   Acute metabolic encephalopathy Decreased responsiveness, arouses but oriented x 0 Normally conversant per son but has been steadily declining since hip fracture with poor nutrition Due to COVID, UTI, dehydration Family states she was doing well after recent sx for hip fracture, but got worse after Remeron was started for appetite, which has happened to her before Remeron added to allergy list due to worsening confusion with medication
Age: 94.0
Sex: F
Vaccine: COVID19
Symptoms: Metabolic encephalopathy, Muscle atrophy, Nutritional condition abnormal, Pain, Pulmonary congestion
Clinical narrative: Patient is a 95 y.o. female patient of MD with history of HTN, HLD, Afib, UTI who presented to Hospital with lethargy, poor intake in the setting of recent COVID diagnosis. Family ultimately decided to change to DNRCC on 1/3 and pursue Hospice.    Goals of care Comfort care Discussion at bedside with 2 children on 1/3 They have noticed a severe decline in function, nutrition and quality of life since her hip fracture in 11/2022 Had been getting oxycodone at ECF prior to admission -- currently complaining of "pain all over" Family desired change to DNR-CC  Hospice has accepted and will provide services at LTC once able to return out of COVID isolation Discontinued most medications including remdesivir as pt wants to limit pills Added oxycodone and anxiolytics PRN (OK for no IV) Palliative care consulted for assistance with hospice diagnosis  Discharge to ECF with hospice    Covid-19 Virus Infection Date of onset of symptoms: circa 12/31 Symptoms present on admission: poor appetite, decreased LOC Date of covid positive test: 1/1 at SNF (unable to obtain test result electronically to scan into chart) -- > repeat COVID test positive (1/3)  Vaccination status: vaccinated Imaging: CXR "vascular congestion" Oxygen requirements on admission: RA Current oxygen requirements: 94% RA Medical therapy: Remdesevir started per ID -- > stopped 1/3 End isolation on 1/11   Fall, initial encounter Inpatient fall on 1/6 from bed with +head trauma Complaining of R shoulder pain and with small forehead hematoma Shoulder XR -- non-acute Will hold on CT head given DNRCC and not going to change management Fall precautions, pain control as above   Acute UTI Candiduria Significant pyuria noted with many bacteria and rare yeast Pt denies urinary sx but is confused and unreliable Ucx with >100 candida albicans Stopped ceftriaxone Discussed with pharmacy -- start fluconazole for now given this may be contributing to her discomfort   Dysphagia Severe protein calorie malnutrition with cachexia Appears cachectic with muscle wasting, underweight on admission Did not tolerate recent mirtazapine per son Noted dysphagia for last month or so per family and currently tolerating little to no PO intake Should qualify for Hospice on this alone Will give gentle D5 gtt for now Family opting for DNRCC so hold on SLP consult and provide MDD diet   Acute metabolic encephalopathy Decreased responsiveness, arouses but oriented x 0 Normally conversant per son but has been steadily declining since hip fracture with poor nutrition Due to COVID, UTI, dehydration Family states she was doing well after recent sx for hip fracture, but got worse after Remeron was started for appetite, which has happened to her before Remeron added to allergy list due to worsening confusion with medication
Age: 94.0
Sex: F
Vaccine: COVID19
Symptoms: Pyuria, Quality of life decreased, SARS-CoV-2 test positive, Underweight, Urinary tract candidiasis
Clinical narrative: Patient is a 95 y.o. female patient of MD with history of HTN, HLD, Afib, UTI who presented to Hospital with lethargy, poor intake in the setting of recent COVID diagnosis. Family ultimately decided to change to DNRCC on 1/3 and pursue Hospice.    Goals of care Comfort care Discussion at bedside with 2 children on 1/3 They have noticed a severe decline in function, nutrition and quality of life since her hip fracture in 11/2022 Had been getting oxycodone at ECF prior to admission -- currently complaining of "pain all over" Family desired change to DNR-CC  Hospice has accepted and will provide services at LTC once able to return out of COVID isolation Discontinued most medications including remdesivir as pt wants to limit pills Added oxycodone and anxiolytics PRN (OK for no IV) Palliative care consulted for assistance with hospice diagnosis  Discharge to ECF with hospice    Covid-19 Virus Infection Date of onset of symptoms: circa 12/31 Symptoms present on admission: poor appetite, decreased LOC Date of covid positive test: 1/1 at SNF (unable to obtain test result electronically to scan into chart) -- > repeat COVID test positive (1/3)  Vaccination status: vaccinated Imaging: CXR "vascular congestion" Oxygen requirements on admission: RA Current oxygen requirements: 94% RA Medical therapy: Remdesevir started per ID -- > stopped 1/3 End isolation on 1/11   Fall, initial encounter Inpatient fall on 1/6 from bed with +head trauma Complaining of R shoulder pain and with small forehead hematoma Shoulder XR -- non-acute Will hold on CT head given DNRCC and not going to change management Fall precautions, pain control as above   Acute UTI Candiduria Significant pyuria noted with many bacteria and rare yeast Pt denies urinary sx but is confused and unreliable Ucx with >100 candida albicans Stopped ceftriaxone Discussed with pharmacy -- start fluconazole for now given this may be contributing to her discomfort   Dysphagia Severe protein calorie malnutrition with cachexia Appears cachectic with muscle wasting, underweight on admission Did not tolerate recent mirtazapine per son Noted dysphagia for last month or so per family and currently tolerating little to no PO intake Should qualify for Hospice on this alone Will give gentle D5 gtt for now Family opting for DNRCC so hold on SLP consult and provide MDD diet   Acute metabolic encephalopathy Decreased responsiveness, arouses but oriented x 0 Normally conversant per son but has been steadily declining since hip fracture with poor nutrition Due to COVID, UTI, dehydration Family states she was doing well after recent sx for hip fracture, but got worse after Remeron was started for appetite, which has happened to her before Remeron added to allergy list due to worsening confusion with medication
Age: 94.0
Sex: F
Vaccine: COVID19
Symptoms: Urinary tract infection, X-ray limb normal
Clinical narrative: Patient is a 95 y.o. female patient of MD with history of HTN, HLD, Afib, UTI who presented to Hospital with lethargy, poor intake in the setting of recent COVID diagnosis. Family ultimately decided to change to DNRCC on 1/3 and pursue Hospice.    Goals of care Comfort care Discussion at bedside with 2 children on 1/3 They have noticed a severe decline in function, nutrition and quality of life since her hip fracture in 11/2022 Had been getting oxycodone at ECF prior to admission -- currently complaining of "pain all over" Family desired change to DNR-CC  Hospice has accepted and will provide services at LTC once able to return out of COVID isolation Discontinued most medications including remdesivir as pt wants to limit pills Added oxycodone and anxiolytics PRN (OK for no IV) Palliative care consulted for assistance with hospice diagnosis  Discharge to ECF with hospice    Covid-19 Virus Infection Date of onset of symptoms: circa 12/31 Symptoms present on admission: poor appetite, decreased LOC Date of covid positive test: 1/1 at SNF (unable to obtain test result electronically to scan into chart) -- > repeat COVID test positive (1/3)  Vaccination status: vaccinated Imaging: CXR "vascular congestion" Oxygen requirements on admission: RA Current oxygen requirements: 94% RA Medical therapy: Remdesevir started per ID -- > stopped 1/3 End isolation on 1/11   Fall, initial encounter Inpatient fall on 1/6 from bed with +head trauma Complaining of R shoulder pain and with small forehead hematoma Shoulder XR -- non-acute Will hold on CT head given DNRCC and not going to change management Fall precautions, pain control as above   Acute UTI Candiduria Significant pyuria noted with many bacteria and rare yeast Pt denies urinary sx but is confused and unreliable Ucx with >100 candida albicans Stopped ceftriaxone Discussed with pharmacy -- start fluconazole for now given this may be contributing to her discomfort   Dysphagia Severe protein calorie malnutrition with cachexia Appears cachectic with muscle wasting, underweight on admission Did not tolerate recent mirtazapine per son Noted dysphagia for last month or so per family and currently tolerating little to no PO intake Should qualify for Hospice on this alone Will give gentle D5 gtt for now Family opting for DNRCC so hold on SLP consult and provide MDD diet   Acute metabolic encephalopathy Decreased responsiveness, arouses but oriented x 0 Normally conversant per son but has been steadily declining since hip fracture with poor nutrition Due to COVID, UTI, dehydration Family states she was doing well after recent sx for hip fracture, but got worse after Remeron was started for appetite, which has happened to her before Remeron added to allergy list due to worsening confusion with medication
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Death
Clinical narrative: Patient expired 1/30/2023.
Age: 45.0
Sex: F
Vaccine: FLUA4
Symptoms: Product storage error
Clinical narrative: VACCINE STORAGE TEMP ISSUE, HEALTH DEPARTMENT ADVISED TO REPEAT.
Age: 12.0
Sex: F
Vaccine: DTAPHEPBIP
Symptoms: No adverse event, Wrong product administered
Clinical narrative: Patient >6 years received Dtap in form of Pediarix vaccine. No adverse outcomes known to patient
Age: 26.0
Sex: F
Vaccine: HEP
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus
Clinical narrative: Reports redness at injection site 5cm x 3cm with itchiness and mild pain. Noticed redness 1/30/23 in morning.
Age: 61.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood pressure increased, Blood test normal, Chills, Dizziness, Electrocardiogram normal
Clinical narrative: Sore upper arm developed late afternoon/evening on 1/13/13. I went to bed around 11 pm & woke up around 2:30 am super cold with teeth chattering. I could not get enough blankets on me to warm up. I fell back asleep. I woke up again around 4 am & when I got up I was dizzy, had headache & was nauseous. I went to the bathroom then to the kitchen to take a Tylenol. While at the sink taking Tylenol I developed very strong heart racing/pounding like my heart was coming out of my chest. I then felt like I was going to faint but made it to a couch and after laying down the heart racing & fainting feeling  went away. After about 10 minutes, I returned to bed. When I woke up the next morning around 8 am I was dizzy & light headed when I got out of bed. I felt better when I laid back down. The same thing happened when I got up again later in the morning. I decided to look at my iWatch to check out my sleep & heart &  then realized that every time I stood up after reclining my heart beat would increase 30-50 beats. This has continued since 1/14/23 although I have been able to manage it somewhat by drinking huge amounts of water with Liquid IV and a lot of salty food. Yesterday my heart rate increased to 165 & I've called my doctor. I visited him about a week after all this started and he said to contact him again if in two weeks my symptoms persisted. He was hopeful my apparent reaction to the vaccine would just go away.
Age: 61.0
Sex: F
Vaccine: COVID19-2
Symptoms: Feeling cold, Headache, Heart rate increased, Nausea, Palpitations
Clinical narrative: Sore upper arm developed late afternoon/evening on 1/13/13. I went to bed around 11 pm & woke up around 2:30 am super cold with teeth chattering. I could not get enough blankets on me to warm up. I fell back asleep. I woke up again around 4 am & when I got up I was dizzy, had headache & was nauseous. I went to the bathroom then to the kitchen to take a Tylenol. While at the sink taking Tylenol I developed very strong heart racing/pounding like my heart was coming out of my chest. I then felt like I was going to faint but made it to a couch and after laying down the heart racing & fainting feeling  went away. After about 10 minutes, I returned to bed. When I woke up the next morning around 8 am I was dizzy & light headed when I got out of bed. I felt better when I laid back down. The same thing happened when I got up again later in the morning. I decided to look at my iWatch to check out my sleep & heart &  then realized that every time I stood up after reclining my heart beat would increase 30-50 beats. This has continued since 1/14/23 although I have been able to manage it somewhat by drinking huge amounts of water with Liquid IV and a lot of salty food. Yesterday my heart rate increased to 165 & I've called my doctor. I visited him about a week after all this started and he said to contact him again if in two weeks my symptoms persisted. He was hopeful my apparent reaction to the vaccine would just go away.
Age: 61.0
Sex: F
Vaccine: COVID19-2
Symptoms: Tachycardia
Clinical narrative: Sore upper arm developed late afternoon/evening on 1/13/13. I went to bed around 11 pm & woke up around 2:30 am super cold with teeth chattering. I could not get enough blankets on me to warm up. I fell back asleep. I woke up again around 4 am & when I got up I was dizzy, had headache & was nauseous. I went to the bathroom then to the kitchen to take a Tylenol. While at the sink taking Tylenol I developed very strong heart racing/pounding like my heart was coming out of my chest. I then felt like I was going to faint but made it to a couch and after laying down the heart racing & fainting feeling  went away. After about 10 minutes, I returned to bed. When I woke up the next morning around 8 am I was dizzy & light headed when I got out of bed. I felt better when I laid back down. The same thing happened when I got up again later in the morning. I decided to look at my iWatch to check out my sleep & heart &  then realized that every time I stood up after reclining my heart beat would increase 30-50 beats. This has continued since 1/14/23 although I have been able to manage it somewhat by drinking huge amounts of water with Liquid IV and a lot of salty food. Yesterday my heart rate increased to 165 & I've called my doctor. I visited him about a week after all this started and he said to contact him again if in two weeks my symptoms persisted. He was hopeful my apparent reaction to the vaccine would just go away.
Age: 62.0
Sex: F
Vaccine: FLUA4
Symptoms: Product storage error
Clinical narrative: VACCINE STORAGE TEMP ISSUE, ADVISED TO REPEAT.
Age: 11.0
Sex: F
Vaccine: COVID19-2
Symptoms: Incorrect dose administered, No adverse event
Clinical narrative: NO ADVERSE EVENTS REPORTED. GAVE INCORRECT VACCINE FOR AGE (GAVE GRAY CAP FOR AGES 12+ INSTEAD OF ORANGE CAP FOR AGES 5-11).
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anaemia of chronic disease, Asthma, Blood creatinine increased, Blood glucose
Clinical narrative: Patient is a 67 y.o. male h/o asthma, type 2 diabetes mellitus with CKD, hypertension, and chronic anemia who was recently diagnosed with COVID-19.  He presented to ER on 1/3/2023 with cough, shortness of breath, and fever and pulse ox was 88% on room air, he had extensive wheezing, chest x-ray showed nothing acute, and perfusion scan was negative for PE.          Assessment and Plan   Acute hypoxemic respiratory failure Covid 19 infection Asthma Exacerbation -He has asthma exacerbation in the setting of underlying Covid-19 infection, OSA, and obesity.  -Tested positive for Covid-19 by home test on 12/31/22. Respiratory PCR panel on admission negative for everything except for COVID. -Initial O2 sat was 89% on room air and he required up to 5 L O2 nasal cannula. -CXR on admission showed no acute process and VQ scan without perfusion defect. -At home on Trelegy inhaler and pharmacy equivalent started here along with albuterol and Decadron. -With incentive spirometry and pulmonary toilet oxygen was weaned off by 1/6/2023 and O2 sats were in the 90s on room air. -Home bronchodilator regimen (Trelegy and albuterol nebulizer as needed) continued as before and he was discharged to home with plans to complete 10 days total of once daily Decadron.   Obstructive sleep apnea -Followed by Dr. of pulmonology as an outpatient. -Continue CPAP at bedtime.   Type 2 diabetes mellitus with peripheral neuropathy Chronic bilateral lower extremity edema Diabetic ulcer of right foot -Foot ulcer managed with 3X weekly dressing changes with silver alginate applied to wound bed, 4 x 4's, ABDs, Kerlix guaze and Ace  -Wound care nurse followed during this admission and he will need ongoing follow-up after discharge.   CKD 3B due to type 2 diabetes Solitary kidney with history of renal cell carcinoma -History of right nephrectomy in 2012 for renal cell carcinoma -Followed by Dr. of nephrology as an outpatient. -Baseline creatinine was running around 1.4 but then was up to 1.9 in June 2022. -Currently 1.7 and generally stable. -Continue ongoing outpatient follow-up after discharge.   Type 2 diabetes mellitus on insulin and with hyperglycemia -A1c used to be around 9 but was 7.6 in June 2022. -Home Farxiga, Trulicity, and U500 insulin pump continued as before. -Blood sugars were under good control during this admission.   Anemia of chronic disease -Per review of outpatient labs, baseline hemoglobin appears to run around 9-11 and is generally stable. -Continue ongoing outpatient monitoring after discharge. Chronic HFpEF -Last echo February 2022 showed LVEF 72% with mild concentric LVH. -No evidence for acute decompensation -Continue bumetanide and lisinopril.   Essential hypertension -Continue amlodipine, lisinopril, and bumetanide -Blood pressure stable.  GERD -Continue proton pump therapy   Morbid obesity (BMI 42) -He would benefit from lifestyle modification
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray normal, Condition aggravated, Cough, Diabetic foot
Clinical narrative: Patient is a 67 y.o. male h/o asthma, type 2 diabetes mellitus with CKD, hypertension, and chronic anemia who was recently diagnosed with COVID-19.  He presented to ER on 1/3/2023 with cough, shortness of breath, and fever and pulse ox was 88% on room air, he had extensive wheezing, chest x-ray showed nothing acute, and perfusion scan was negative for PE.          Assessment and Plan   Acute hypoxemic respiratory failure Covid 19 infection Asthma Exacerbation -He has asthma exacerbation in the setting of underlying Covid-19 infection, OSA, and obesity.  -Tested positive for Covid-19 by home test on 12/31/22. Respiratory PCR panel on admission negative for everything except for COVID. -Initial O2 sat was 89% on room air and he required up to 5 L O2 nasal cannula. -CXR on admission showed no acute process and VQ scan without perfusion defect. -At home on Trelegy inhaler and pharmacy equivalent started here along with albuterol and Decadron. -With incentive spirometry and pulmonary toilet oxygen was weaned off by 1/6/2023 and O2 sats were in the 90s on room air. -Home bronchodilator regimen (Trelegy and albuterol nebulizer as needed) continued as before and he was discharged to home with plans to complete 10 days total of once daily Decadron.   Obstructive sleep apnea -Followed by Dr. of pulmonology as an outpatient. -Continue CPAP at bedtime.   Type 2 diabetes mellitus with peripheral neuropathy Chronic bilateral lower extremity edema Diabetic ulcer of right foot -Foot ulcer managed with 3X weekly dressing changes with silver alginate applied to wound bed, 4 x 4's, ABDs, Kerlix guaze and Ace  -Wound care nurse followed during this admission and he will need ongoing follow-up after discharge.   CKD 3B due to type 2 diabetes Solitary kidney with history of renal cell carcinoma -History of right nephrectomy in 2012 for renal cell carcinoma -Followed by Dr. of nephrology as an outpatient. -Baseline creatinine was running around 1.4 but then was up to 1.9 in June 2022. -Currently 1.7 and generally stable. -Continue ongoing outpatient follow-up after discharge.   Type 2 diabetes mellitus on insulin and with hyperglycemia -A1c used to be around 9 but was 7.6 in June 2022. -Home Farxiga, Trulicity, and U500 insulin pump continued as before. -Blood sugars were under good control during this admission.   Anemia of chronic disease -Per review of outpatient labs, baseline hemoglobin appears to run around 9-11 and is generally stable. -Continue ongoing outpatient monitoring after discharge. Chronic HFpEF -Last echo February 2022 showed LVEF 72% with mild concentric LVH. -No evidence for acute decompensation -Continue bumetanide and lisinopril.   Essential hypertension -Continue amlodipine, lisinopril, and bumetanide -Blood pressure stable.  GERD -Continue proton pump therapy   Morbid obesity (BMI 42) -He would benefit from lifestyle modification
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Echocardiogram abnormal, Ejection fraction, Glycosylated haemoglobin increased, Haemoglobin decreased
Clinical narrative: Patient is a 67 y.o. male h/o asthma, type 2 diabetes mellitus with CKD, hypertension, and chronic anemia who was recently diagnosed with COVID-19.  He presented to ER on 1/3/2023 with cough, shortness of breath, and fever and pulse ox was 88% on room air, he had extensive wheezing, chest x-ray showed nothing acute, and perfusion scan was negative for PE.          Assessment and Plan   Acute hypoxemic respiratory failure Covid 19 infection Asthma Exacerbation -He has asthma exacerbation in the setting of underlying Covid-19 infection, OSA, and obesity.  -Tested positive for Covid-19 by home test on 12/31/22. Respiratory PCR panel on admission negative for everything except for COVID. -Initial O2 sat was 89% on room air and he required up to 5 L O2 nasal cannula. -CXR on admission showed no acute process and VQ scan without perfusion defect. -At home on Trelegy inhaler and pharmacy equivalent started here along with albuterol and Decadron. -With incentive spirometry and pulmonary toilet oxygen was weaned off by 1/6/2023 and O2 sats were in the 90s on room air. -Home bronchodilator regimen (Trelegy and albuterol nebulizer as needed) continued as before and he was discharged to home with plans to complete 10 days total of once daily Decadron.   Obstructive sleep apnea -Followed by Dr. of pulmonology as an outpatient. -Continue CPAP at bedtime.   Type 2 diabetes mellitus with peripheral neuropathy Chronic bilateral lower extremity edema Diabetic ulcer of right foot -Foot ulcer managed with 3X weekly dressing changes with silver alginate applied to wound bed, 4 x 4's, ABDs, Kerlix guaze and Ace  -Wound care nurse followed during this admission and he will need ongoing follow-up after discharge.   CKD 3B due to type 2 diabetes Solitary kidney with history of renal cell carcinoma -History of right nephrectomy in 2012 for renal cell carcinoma -Followed by Dr. of nephrology as an outpatient. -Baseline creatinine was running around 1.4 but then was up to 1.9 in June 2022. -Currently 1.7 and generally stable. -Continue ongoing outpatient follow-up after discharge.   Type 2 diabetes mellitus on insulin and with hyperglycemia -A1c used to be around 9 but was 7.6 in June 2022. -Home Farxiga, Trulicity, and U500 insulin pump continued as before. -Blood sugars were under good control during this admission.   Anemia of chronic disease -Per review of outpatient labs, baseline hemoglobin appears to run around 9-11 and is generally stable. -Continue ongoing outpatient monitoring after discharge. Chronic HFpEF -Last echo February 2022 showed LVEF 72% with mild concentric LVH. -No evidence for acute decompensation -Continue bumetanide and lisinopril.   Essential hypertension -Continue amlodipine, lisinopril, and bumetanide -Blood pressure stable.  GERD -Continue proton pump therapy   Morbid obesity (BMI 42) -He would benefit from lifestyle modification
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Hyperglycaemia, Left ventricular hypertrophy, Obesity, Obstructive sleep apnoea syndrome, Oedema peripheral
Clinical narrative: Patient is a 67 y.o. male h/o asthma, type 2 diabetes mellitus with CKD, hypertension, and chronic anemia who was recently diagnosed with COVID-19.  He presented to ER on 1/3/2023 with cough, shortness of breath, and fever and pulse ox was 88% on room air, he had extensive wheezing, chest x-ray showed nothing acute, and perfusion scan was negative for PE.          Assessment and Plan   Acute hypoxemic respiratory failure Covid 19 infection Asthma Exacerbation -He has asthma exacerbation in the setting of underlying Covid-19 infection, OSA, and obesity.  -Tested positive for Covid-19 by home test on 12/31/22. Respiratory PCR panel on admission negative for everything except for COVID. -Initial O2 sat was 89% on room air and he required up to 5 L O2 nasal cannula. -CXR on admission showed no acute process and VQ scan without perfusion defect. -At home on Trelegy inhaler and pharmacy equivalent started here along with albuterol and Decadron. -With incentive spirometry and pulmonary toilet oxygen was weaned off by 1/6/2023 and O2 sats were in the 90s on room air. -Home bronchodilator regimen (Trelegy and albuterol nebulizer as needed) continued as before and he was discharged to home with plans to complete 10 days total of once daily Decadron.   Obstructive sleep apnea -Followed by Dr. of pulmonology as an outpatient. -Continue CPAP at bedtime.   Type 2 diabetes mellitus with peripheral neuropathy Chronic bilateral lower extremity edema Diabetic ulcer of right foot -Foot ulcer managed with 3X weekly dressing changes with silver alginate applied to wound bed, 4 x 4's, ABDs, Kerlix guaze and Ace  -Wound care nurse followed during this admission and he will need ongoing follow-up after discharge.   CKD 3B due to type 2 diabetes Solitary kidney with history of renal cell carcinoma -History of right nephrectomy in 2012 for renal cell carcinoma -Followed by Dr. of nephrology as an outpatient. -Baseline creatinine was running around 1.4 but then was up to 1.9 in June 2022. -Currently 1.7 and generally stable. -Continue ongoing outpatient follow-up after discharge.   Type 2 diabetes mellitus on insulin and with hyperglycemia -A1c used to be around 9 but was 7.6 in June 2022. -Home Farxiga, Trulicity, and U500 insulin pump continued as before. -Blood sugars were under good control during this admission.   Anemia of chronic disease -Per review of outpatient labs, baseline hemoglobin appears to run around 9-11 and is generally stable. -Continue ongoing outpatient monitoring after discharge. Chronic HFpEF -Last echo February 2022 showed LVEF 72% with mild concentric LVH. -No evidence for acute decompensation -Continue bumetanide and lisinopril.   Essential hypertension -Continue amlodipine, lisinopril, and bumetanide -Blood pressure stable.  GERD -Continue proton pump therapy   Morbid obesity (BMI 42) -He would benefit from lifestyle modification
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, Respiratory viral panel, SARS-CoV-2 test positive, Ventilation/perfusion scan normal, Wheezing
Clinical narrative: Patient is a 67 y.o. male h/o asthma, type 2 diabetes mellitus with CKD, hypertension, and chronic anemia who was recently diagnosed with COVID-19.  He presented to ER on 1/3/2023 with cough, shortness of breath, and fever and pulse ox was 88% on room air, he had extensive wheezing, chest x-ray showed nothing acute, and perfusion scan was negative for PE.          Assessment and Plan   Acute hypoxemic respiratory failure Covid 19 infection Asthma Exacerbation -He has asthma exacerbation in the setting of underlying Covid-19 infection, OSA, and obesity.  -Tested positive for Covid-19 by home test on 12/31/22. Respiratory PCR panel on admission negative for everything except for COVID. -Initial O2 sat was 89% on room air and he required up to 5 L O2 nasal cannula. -CXR on admission showed no acute process and VQ scan without perfusion defect. -At home on Trelegy inhaler and pharmacy equivalent started here along with albuterol and Decadron. -With incentive spirometry and pulmonary toilet oxygen was weaned off by 1/6/2023 and O2 sats were in the 90s on room air. -Home bronchodilator regimen (Trelegy and albuterol nebulizer as needed) continued as before and he was discharged to home with plans to complete 10 days total of once daily Decadron.   Obstructive sleep apnea -Followed by Dr. of pulmonology as an outpatient. -Continue CPAP at bedtime.   Type 2 diabetes mellitus with peripheral neuropathy Chronic bilateral lower extremity edema Diabetic ulcer of right foot -Foot ulcer managed with 3X weekly dressing changes with silver alginate applied to wound bed, 4 x 4's, ABDs, Kerlix guaze and Ace  -Wound care nurse followed during this admission and he will need ongoing follow-up after discharge.   CKD 3B due to type 2 diabetes Solitary kidney with history of renal cell carcinoma -History of right nephrectomy in 2012 for renal cell carcinoma -Followed by Dr. of nephrology as an outpatient. -Baseline creatinine was running around 1.4 but then was up to 1.9 in June 2022. -Currently 1.7 and generally stable. -Continue ongoing outpatient follow-up after discharge.   Type 2 diabetes mellitus on insulin and with hyperglycemia -A1c used to be around 9 but was 7.6 in June 2022. -Home Farxiga, Trulicity, and U500 insulin pump continued as before. -Blood sugars were under good control during this admission.   Anemia of chronic disease -Per review of outpatient labs, baseline hemoglobin appears to run around 9-11 and is generally stable. -Continue ongoing outpatient monitoring after discharge. Chronic HFpEF -Last echo February 2022 showed LVEF 72% with mild concentric LVH. -No evidence for acute decompensation -Continue bumetanide and lisinopril.   Essential hypertension -Continue amlodipine, lisinopril, and bumetanide -Blood pressure stable.  GERD -Continue proton pump therapy   Morbid obesity (BMI 42) -He would benefit from lifestyle modification
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Wound treatment
Clinical narrative: Patient is a 67 y.o. male h/o asthma, type 2 diabetes mellitus with CKD, hypertension, and chronic anemia who was recently diagnosed with COVID-19.  He presented to ER on 1/3/2023 with cough, shortness of breath, and fever and pulse ox was 88% on room air, he had extensive wheezing, chest x-ray showed nothing acute, and perfusion scan was negative for PE.          Assessment and Plan   Acute hypoxemic respiratory failure Covid 19 infection Asthma Exacerbation -He has asthma exacerbation in the setting of underlying Covid-19 infection, OSA, and obesity.  -Tested positive for Covid-19 by home test on 12/31/22. Respiratory PCR panel on admission negative for everything except for COVID. -Initial O2 sat was 89% on room air and he required up to 5 L O2 nasal cannula. -CXR on admission showed no acute process and VQ scan without perfusion defect. -At home on Trelegy inhaler and pharmacy equivalent started here along with albuterol and Decadron. -With incentive spirometry and pulmonary toilet oxygen was weaned off by 1/6/2023 and O2 sats were in the 90s on room air. -Home bronchodilator regimen (Trelegy and albuterol nebulizer as needed) continued as before and he was discharged to home with plans to complete 10 days total of once daily Decadron.   Obstructive sleep apnea -Followed by Dr. of pulmonology as an outpatient. -Continue CPAP at bedtime.   Type 2 diabetes mellitus with peripheral neuropathy Chronic bilateral lower extremity edema Diabetic ulcer of right foot -Foot ulcer managed with 3X weekly dressing changes with silver alginate applied to wound bed, 4 x 4's, ABDs, Kerlix guaze and Ace  -Wound care nurse followed during this admission and he will need ongoing follow-up after discharge.   CKD 3B due to type 2 diabetes Solitary kidney with history of renal cell carcinoma -History of right nephrectomy in 2012 for renal cell carcinoma -Followed by Dr. of nephrology as an outpatient. -Baseline creatinine was running around 1.4 but then was up to 1.9 in June 2022. -Currently 1.7 and generally stable. -Continue ongoing outpatient follow-up after discharge.   Type 2 diabetes mellitus on insulin and with hyperglycemia -A1c used to be around 9 but was 7.6 in June 2022. -Home Farxiga, Trulicity, and U500 insulin pump continued as before. -Blood sugars were under good control during this admission.   Anemia of chronic disease -Per review of outpatient labs, baseline hemoglobin appears to run around 9-11 and is generally stable. -Continue ongoing outpatient monitoring after discharge. Chronic HFpEF -Last echo February 2022 showed LVEF 72% with mild concentric LVH. -No evidence for acute decompensation -Continue bumetanide and lisinopril.   Essential hypertension -Continue amlodipine, lisinopril, and bumetanide -Blood pressure stable.  GERD -Continue proton pump therapy   Morbid obesity (BMI 42) -He would benefit from lifestyle modification
Age: 55.0
Sex: U
Vaccine: FLUA4
Symptoms: Product storage error
Clinical narrative: VACCINE STORAGE TEMP ISSUE, ADVISED TO REPEAT.
Age: 39.0
Sex: M
Vaccine: FLUA4
Symptoms: Product storage error
Clinical narrative: VACCINE STORAGE TEMP ISSUE, ADVISED TO REPEAT.
Age: 11.0
Sex: M
Vaccine: FLU4, MNQ
Symptoms: Urticaria
Clinical narrative: Hive like rash
Age: 10.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered, No adverse event
Clinical narrative: NO ADVERSE EVENTS REPORTED. PARENT GAVE INCORRECT DATE OF BIRTH, RESULTING IN WRONG VACCINE GIVEN FOR AGE (GRAY CAP FOR AGES 12+ WAS ADMINISTERED INSTEAD OF ORANGE CAP FOR AGES 5-11)
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood glucose normal, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal
Clinical narrative: Patient is a 66 y.o. female patient local DO with history of migraines and environmental allergens presented with fever    Covid-19 Virus Infection Multifocal pneumonia Acute respiratory failure with hypoxia On arrival, SPO2 88% on RA Date of onset of symptoms: 12/9/2022 (approximately 1 wk before testing) Symptoms present on admission: Fever, shortness of breath, drenching sweats Date of covid positive test: 12/16/2022 Vaccination status: vaccinated Imaging: CT pulmonary arteries - diffuse airspace disease throughout all lobes; extensive hilar and mediastinal lymphadenopathy; CXR - Bilateral pulmonary opacities suggesting edema or pneumonia. Small left basilar effusion is not excluded.  Oxygen requirements on admission: 2L Current oxygen requirements: Oxygen saturation 93% on 2 L nasal cannula Medical therapy: outpatient Rx Paxlovid therapy pack x 5 days started 12/16/2022 and only completed 3 days due to migraine development  Anticipated special isolation end date: 12/26/2022  The patient was treated with steroids and incentive spirometry.  She gradually improved with treatment. Patient's oxygen levels improved and she tolerated room air by the time of discharge. Patient was discharged in stable condition.   Hypokalemia Potassium replacement   Hyperglycemia, likely reactive Initial glucose 125 A1c 5.4 8/2022 Continue to monitor and treat as needed   History of migraine headaches Patient reports triggered easily with many common medications
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Dyspnoea, Glycosylated haemoglobin normal, Hilar lymphadenopathy, Hyperglycaemia
Clinical narrative: Patient is a 66 y.o. female patient local DO with history of migraines and environmental allergens presented with fever    Covid-19 Virus Infection Multifocal pneumonia Acute respiratory failure with hypoxia On arrival, SPO2 88% on RA Date of onset of symptoms: 12/9/2022 (approximately 1 wk before testing) Symptoms present on admission: Fever, shortness of breath, drenching sweats Date of covid positive test: 12/16/2022 Vaccination status: vaccinated Imaging: CT pulmonary arteries - diffuse airspace disease throughout all lobes; extensive hilar and mediastinal lymphadenopathy; CXR - Bilateral pulmonary opacities suggesting edema or pneumonia. Small left basilar effusion is not excluded.  Oxygen requirements on admission: 2L Current oxygen requirements: Oxygen saturation 93% on 2 L nasal cannula Medical therapy: outpatient Rx Paxlovid therapy pack x 5 days started 12/16/2022 and only completed 3 days due to migraine development  Anticipated special isolation end date: 12/26/2022  The patient was treated with steroids and incentive spirometry.  She gradually improved with treatment. Patient's oxygen levels improved and she tolerated room air by the time of discharge. Patient was discharged in stable condition.   Hypokalemia Potassium replacement   Hyperglycemia, likely reactive Initial glucose 125 A1c 5.4 8/2022 Continue to monitor and treat as needed   History of migraine headaches Patient reports triggered easily with many common medications
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Hyperhidrosis, Hypokalaemia, Incentive spirometry, Lung opacity, Lymphadenopathy mediastinal
Clinical narrative: Patient is a 66 y.o. female patient local DO with history of migraines and environmental allergens presented with fever    Covid-19 Virus Infection Multifocal pneumonia Acute respiratory failure with hypoxia On arrival, SPO2 88% on RA Date of onset of symptoms: 12/9/2022 (approximately 1 wk before testing) Symptoms present on admission: Fever, shortness of breath, drenching sweats Date of covid positive test: 12/16/2022 Vaccination status: vaccinated Imaging: CT pulmonary arteries - diffuse airspace disease throughout all lobes; extensive hilar and mediastinal lymphadenopathy; CXR - Bilateral pulmonary opacities suggesting edema or pneumonia. Small left basilar effusion is not excluded.  Oxygen requirements on admission: 2L Current oxygen requirements: Oxygen saturation 93% on 2 L nasal cannula Medical therapy: outpatient Rx Paxlovid therapy pack x 5 days started 12/16/2022 and only completed 3 days due to migraine development  Anticipated special isolation end date: 12/26/2022  The patient was treated with steroids and incentive spirometry.  She gradually improved with treatment. Patient's oxygen levels improved and she tolerated room air by the time of discharge. Patient was discharged in stable condition.   Hypokalemia Potassium replacement   Hyperglycemia, likely reactive Initial glucose 125 A1c 5.4 8/2022 Continue to monitor and treat as needed   History of migraine headaches Patient reports triggered easily with many common medications
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Migraine, Oxygen saturation abnormal, Pleural effusion, Pneumonia, Pulmonary oedema
Clinical narrative: Patient is a 66 y.o. female patient local DO with history of migraines and environmental allergens presented with fever    Covid-19 Virus Infection Multifocal pneumonia Acute respiratory failure with hypoxia On arrival, SPO2 88% on RA Date of onset of symptoms: 12/9/2022 (approximately 1 wk before testing) Symptoms present on admission: Fever, shortness of breath, drenching sweats Date of covid positive test: 12/16/2022 Vaccination status: vaccinated Imaging: CT pulmonary arteries - diffuse airspace disease throughout all lobes; extensive hilar and mediastinal lymphadenopathy; CXR - Bilateral pulmonary opacities suggesting edema or pneumonia. Small left basilar effusion is not excluded.  Oxygen requirements on admission: 2L Current oxygen requirements: Oxygen saturation 93% on 2 L nasal cannula Medical therapy: outpatient Rx Paxlovid therapy pack x 5 days started 12/16/2022 and only completed 3 days due to migraine development  Anticipated special isolation end date: 12/26/2022  The patient was treated with steroids and incentive spirometry.  She gradually improved with treatment. Patient's oxygen levels improved and she tolerated room air by the time of discharge. Patient was discharged in stable condition.   Hypokalemia Potassium replacement   Hyperglycemia, likely reactive Initial glucose 125 A1c 5.4 8/2022 Continue to monitor and treat as needed   History of migraine headaches Patient reports triggered easily with many common medications
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test positive
Clinical narrative: Patient is a 66 y.o. female patient local DO with history of migraines and environmental allergens presented with fever    Covid-19 Virus Infection Multifocal pneumonia Acute respiratory failure with hypoxia On arrival, SPO2 88% on RA Date of onset of symptoms: 12/9/2022 (approximately 1 wk before testing) Symptoms present on admission: Fever, shortness of breath, drenching sweats Date of covid positive test: 12/16/2022 Vaccination status: vaccinated Imaging: CT pulmonary arteries - diffuse airspace disease throughout all lobes; extensive hilar and mediastinal lymphadenopathy; CXR - Bilateral pulmonary opacities suggesting edema or pneumonia. Small left basilar effusion is not excluded.  Oxygen requirements on admission: 2L Current oxygen requirements: Oxygen saturation 93% on 2 L nasal cannula Medical therapy: outpatient Rx Paxlovid therapy pack x 5 days started 12/16/2022 and only completed 3 days due to migraine development  Anticipated special isolation end date: 12/26/2022  The patient was treated with steroids and incentive spirometry.  She gradually improved with treatment. Patient's oxygen levels improved and she tolerated room air by the time of discharge. Patient was discharged in stable condition.   Hypokalemia Potassium replacement   Hyperglycemia, likely reactive Initial glucose 125 A1c 5.4 8/2022 Continue to monitor and treat as needed   History of migraine headaches Patient reports triggered easily with many common medications
Age: 9.0
Sex: M
Vaccine: COVID19-2, FLU4
Symptoms: Rash, Rash erythematous
Clinical narrative: Immunizations were given at 1607, at 1615 a red rash was noticed around pt's eyes and also forehead and cheeks. Also noticed red rash to arms bilat.  Pt denied that he was short of breath or that his throat itched.  Pt was also afebrile.  Checked pt's 02 saturation and level was at 88% on room air.  Brought pt and guardian over to the clinic to be evaluated by a provider.  Pt was brought back to clinic room by clinic staff to be triaged and evaluated.  Pt was placed on 2L of 02 per nasal cannula by clinic nurse and sats then when up to 93%.
Age: 18.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine expired 1/13/23 with no known extension on the expiration date. Vaccine was administered to patient when it was expired
Age: 10.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered, No adverse event
Clinical narrative: NO ADVERSE EVENTS REPORTED. PARENT PROVIDED WRONG DATE OF BIRTH, RESULTING IN WRONG VACCINE ADMINISTERED FOR AGE (GRAY CAP FOR AGES 12+ WAS ADMINISTERED INSTEAD OF ORANGE CAP FOR AGES 5-11)
Age: 65.0
Sex: M
Vaccine: FLUA4
Symptoms: Product storage error
Clinical narrative: VACCINE STORAGE TEMP ISSUE, ADVISED TO REPEAT.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood creatinine increased, Blood urea increased, Bronchitis, COVID-19
Clinical narrative: Patient is a 68-year-old female with history of COPD, HFpEF, and other problems who presented from home with shortness of breath, cough, and fever.  She was found to have COVID-19 and likely concomitant upper respiratory tract infection.  She improved with oral steroids, but developed signs of URI/bronchitis and was placed on empiric antibiotics with further improvement in all of her symptoms.  She qualified for home oxygen likely on the basis of COVID-19 and her chronic bronchitis with acute component.  She improved and was clinically ready for discharge on Thursday, January 5.  She was released home in stable condition on oxygen.  She will complete a total 10-day course of dexamethasone for COVID, and a total 5-day course of antibiotics (p.o. azithromycin) for URI/bronchitis.  She will follow-up with her primary care physician in 1-2 weeks.   Acute hypoxemic respiratory failure COVID-19 infection URI/bronchitis  COPD exacerbation HFpEF, chronic -Hypoxic likely related to COVID, COPD and underlying heart failure with URI/bronchitis  - likely with superimposed upper respiratory tract infection URI - repeat CXR 1/3 with nonspecific hazy and linear opacities in the lung bases - COVID positive 12/31 (symptoms started 12/30); developed purulent sputum 1/2 - clinically improved, afebrile - received Rocephin/Azithro in the hospital, plan Azithromycin PO to complete total 5-day course of antibiotics at discharge -Complete 10-day course of dexamethasone 6 mg daily for COVID --Continue albuterol MDI, singulair, symbicort for COPD -Home oxygen was arranged, recommend 2 L around-the-clock and at nighttime while sleeping until she sees PCP for further follow-up.  Also follows with Dr. (OP pulm)    Unilateral RLE edema -Chronic per patient, noted per chart review since 6/2020. Unclear etiology, consider impaired RLE lymphatic drainage. -Prior RLE duplex 7/2020 without evidence of DVT. -Negative duplex this admission   Elevated creatinine, resolved - BUN 35 sCr 1.28 1/4; likely dehydration, acute illness -Creatinine 1.12 on 1/5.   Hypertension -Home regimen: coreg 25 mg BID,  - BP mostly acceptable here with some elevations in the setting of acute illness -Okay to resume home meds at discharge discharge today   Hyperlipidemia -Home lipitor 20 mg daily   Obesity -BMI 35.15, weight loss to be recommended