chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Blood test, Cardiac stress test, Chest X-ray, Computerised tomogram, Electrocardiogram abnormal
Clinical narrative: Since taking the Pfizer vaccine dose 1, then dose 2.  During 1st dose the symptoms were mild, dose 2 unleashed a roller coaster ride feeling sick, racing heart, poor health. I am 52-year-old active, healthy male in law enforcement and was transport to the Hospital emergency department with excessive heart rate, floating high blood pressure and tachycardia identified by EKG on 9/20/2022.  Since this day, most medical professionals have not made any conclusion to cause.  However, the only thing that changed in my health was the administration of the COVID-19 Pfizer vaccine.  Since this date and occurring at random, my heart rate, and blood pressure is worsening palpitations associated with increased fatigue and reduced effort tolerance. I started noticing palpitations 4?days after the vaccine.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Exercise tolerance decreased, Fatigue, General physical health deterioration, Heart rate increased, Hypertension
Clinical narrative: Since taking the Pfizer vaccine dose 1, then dose 2.  During 1st dose the symptoms were mild, dose 2 unleashed a roller coaster ride feeling sick, racing heart, poor health. I am 52-year-old active, healthy male in law enforcement and was transport to the Hospital emergency department with excessive heart rate, floating high blood pressure and tachycardia identified by EKG on 9/20/2022.  Since this day, most medical professionals have not made any conclusion to cause.  However, the only thing that changed in my health was the administration of the COVID-19 Pfizer vaccine.  Since this date and occurring at random, my heart rate, and blood pressure is worsening palpitations associated with increased fatigue and reduced effort tolerance. I started noticing palpitations 4?days after the vaccine.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Malaise, Palpitations, Tachycardia, Ultrasound scan, Urine analysis
Clinical narrative: Since taking the Pfizer vaccine dose 1, then dose 2.  During 1st dose the symptoms were mild, dose 2 unleashed a roller coaster ride feeling sick, racing heart, poor health. I am 52-year-old active, healthy male in law enforcement and was transport to the Hospital emergency department with excessive heart rate, floating high blood pressure and tachycardia identified by EKG on 9/20/2022.  Since this day, most medical professionals have not made any conclusion to cause.  However, the only thing that changed in my health was the administration of the COVID-19 Pfizer vaccine.  Since this date and occurring at random, my heart rate, and blood pressure is worsening palpitations associated with increased fatigue and reduced effort tolerance. I started noticing palpitations 4?days after the vaccine.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, COVID-19, Chest X-ray abnormal
Clinical narrative: Patient is a 62 y.o. male patient of Physician with history of COPD, GAD, T2DM, GERD, PAF, HTN who presented with dyspnea, found to have worsening respiratory failure, COPD exacerbation and COVID-19 infection. He improved with steroids, COPD care and was weaned back to his home 2L NC and discharged home.    Acute on Chronic hypoxic/hypercarbic respiratory failure COPD with acute exacerbation Multifactorial, including COVID, volume overload, OSA/OHS Requiring 4L NC on admission, baseline O2 requirement: 2L  CXR w/bilateral interstitial infiltrates, no focal consolidation Resume home Advair; add Spiriva and continue levalbuterol nebs Aggressive pulm toilet   Covid-19 Virus Infection Date of onset of symptoms: 1/15 Symptoms present on admission: Dyspnea, hypoxia, cough Date of covid positive test: 1/16 Vaccination status: vaccinated, booster x1 (11/2021) Imaging: CXR w/bilateral interstitial infiltrates, no focal consolidation Oxygen requirements on admission: 4L NC Current oxygen requirements: 2L NC (baseline 2L at home) Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 1/26   Uncontrolled Hypertension  Secondary to medication non-compliance BP 220/110 on admission Improved on home regimen -- resumed on discharge   Permanent AF Chronic, rate-controlled Resumed home PO Amiodarone, BB, Eliquis   T2DM, non-insulin dependent A1c 6.0  Resume home metformin    Morbid Obesity OSA/OHS
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea, Glycosylated haemoglobin increased
Clinical narrative: Patient is a 62 y.o. male patient of Physician with history of COPD, GAD, T2DM, GERD, PAF, HTN who presented with dyspnea, found to have worsening respiratory failure, COPD exacerbation and COVID-19 infection. He improved with steroids, COPD care and was weaned back to his home 2L NC and discharged home.    Acute on Chronic hypoxic/hypercarbic respiratory failure COPD with acute exacerbation Multifactorial, including COVID, volume overload, OSA/OHS Requiring 4L NC on admission, baseline O2 requirement: 2L  CXR w/bilateral interstitial infiltrates, no focal consolidation Resume home Advair; add Spiriva and continue levalbuterol nebs Aggressive pulm toilet   Covid-19 Virus Infection Date of onset of symptoms: 1/15 Symptoms present on admission: Dyspnea, hypoxia, cough Date of covid positive test: 1/16 Vaccination status: vaccinated, booster x1 (11/2021) Imaging: CXR w/bilateral interstitial infiltrates, no focal consolidation Oxygen requirements on admission: 4L NC Current oxygen requirements: 2L NC (baseline 2L at home) Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 1/26   Uncontrolled Hypertension  Secondary to medication non-compliance BP 220/110 on admission Improved on home regimen -- resumed on discharge   Permanent AF Chronic, rate-controlled Resumed home PO Amiodarone, BB, Eliquis   T2DM, non-insulin dependent A1c 6.0  Resume home metformin    Morbid Obesity OSA/OHS
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Hypercapnia, Hypertension, Hypervolaemia, Hypoxia, Lung infiltration
Clinical narrative: Patient is a 62 y.o. male patient of Physician with history of COPD, GAD, T2DM, GERD, PAF, HTN who presented with dyspnea, found to have worsening respiratory failure, COPD exacerbation and COVID-19 infection. He improved with steroids, COPD care and was weaned back to his home 2L NC and discharged home.    Acute on Chronic hypoxic/hypercarbic respiratory failure COPD with acute exacerbation Multifactorial, including COVID, volume overload, OSA/OHS Requiring 4L NC on admission, baseline O2 requirement: 2L  CXR w/bilateral interstitial infiltrates, no focal consolidation Resume home Advair; add Spiriva and continue levalbuterol nebs Aggressive pulm toilet   Covid-19 Virus Infection Date of onset of symptoms: 1/15 Symptoms present on admission: Dyspnea, hypoxia, cough Date of covid positive test: 1/16 Vaccination status: vaccinated, booster x1 (11/2021) Imaging: CXR w/bilateral interstitial infiltrates, no focal consolidation Oxygen requirements on admission: 4L NC Current oxygen requirements: 2L NC (baseline 2L at home) Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 1/26   Uncontrolled Hypertension  Secondary to medication non-compliance BP 220/110 on admission Improved on home regimen -- resumed on discharge   Permanent AF Chronic, rate-controlled Resumed home PO Amiodarone, BB, Eliquis   T2DM, non-insulin dependent A1c 6.0  Resume home metformin    Morbid Obesity OSA/OHS
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Obesity, Obstructive sleep apnoea syndrome, Pickwickian syndrome, Respiratory failure, SARS-CoV-2 test positive
Clinical narrative: Patient is a 62 y.o. male patient of Physician with history of COPD, GAD, T2DM, GERD, PAF, HTN who presented with dyspnea, found to have worsening respiratory failure, COPD exacerbation and COVID-19 infection. He improved with steroids, COPD care and was weaned back to his home 2L NC and discharged home.    Acute on Chronic hypoxic/hypercarbic respiratory failure COPD with acute exacerbation Multifactorial, including COVID, volume overload, OSA/OHS Requiring 4L NC on admission, baseline O2 requirement: 2L  CXR w/bilateral interstitial infiltrates, no focal consolidation Resume home Advair; add Spiriva and continue levalbuterol nebs Aggressive pulm toilet   Covid-19 Virus Infection Date of onset of symptoms: 1/15 Symptoms present on admission: Dyspnea, hypoxia, cough Date of covid positive test: 1/16 Vaccination status: vaccinated, booster x1 (11/2021) Imaging: CXR w/bilateral interstitial infiltrates, no focal consolidation Oxygen requirements on admission: 4L NC Current oxygen requirements: 2L NC (baseline 2L at home) Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 1/26   Uncontrolled Hypertension  Secondary to medication non-compliance BP 220/110 on admission Improved on home regimen -- resumed on discharge   Permanent AF Chronic, rate-controlled Resumed home PO Amiodarone, BB, Eliquis   T2DM, non-insulin dependent A1c 6.0  Resume home metformin    Morbid Obesity OSA/OHS
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Treatment noncompliance, Type 2 diabetes mellitus
Clinical narrative: Patient is a 62 y.o. male patient of Physician with history of COPD, GAD, T2DM, GERD, PAF, HTN who presented with dyspnea, found to have worsening respiratory failure, COPD exacerbation and COVID-19 infection. He improved with steroids, COPD care and was weaned back to his home 2L NC and discharged home.    Acute on Chronic hypoxic/hypercarbic respiratory failure COPD with acute exacerbation Multifactorial, including COVID, volume overload, OSA/OHS Requiring 4L NC on admission, baseline O2 requirement: 2L  CXR w/bilateral interstitial infiltrates, no focal consolidation Resume home Advair; add Spiriva and continue levalbuterol nebs Aggressive pulm toilet   Covid-19 Virus Infection Date of onset of symptoms: 1/15 Symptoms present on admission: Dyspnea, hypoxia, cough Date of covid positive test: 1/16 Vaccination status: vaccinated, booster x1 (11/2021) Imaging: CXR w/bilateral interstitial infiltrates, no focal consolidation Oxygen requirements on admission: 4L NC Current oxygen requirements: 2L NC (baseline 2L at home) Medical therapy: remdesivir and steroids Consultants following: None Anticipated special isolation end date: 1/26   Uncontrolled Hypertension  Secondary to medication non-compliance BP 220/110 on admission Improved on home regimen -- resumed on discharge   Permanent AF Chronic, rate-controlled Resumed home PO Amiodarone, BB, Eliquis   T2DM, non-insulin dependent A1c 6.0  Resume home metformin    Morbid Obesity OSA/OHS
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Atrial fibrillation, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia
Clinical narrative: Patient is a 82 y.o. female with a hx of atrial fibrillation (on Eliquis), DM, and HTN who presented to hospital 1/9/23 from ECF with dyspnea and several days of cough. Admitted with COVID 19 PNA and CHF exacerbation.      1. COVID 19: vaccinated and boosted. Symptom onset ~1/7/23; COVID-19 positive on 1/9/23. Discontinued Decadron 1/16/2023 as patient weaned to room air.  2. Acute Hypoxic Respiratory Failure: no hx of O2 dependence. Required 6L NC on admit. Admit CXR with pulmonary edema. In setting of CHF exacerbation and COVID 19. Weaned to room air 1/16/2023.  3. Acute on Chronic HFpEF: Follows with Dr. (cardio). Admit BNP 1.9k, CXR as above. Echo on 1/10/22 with EF of 67% and RVSP of 45-50. Diuresed with IV lasix, discharged on PO lasix.  4. Permanent A fib: s/p AV junction ablation. Pt has known dual chamber pacemaker. Follows with Dr. Continued home Toprol-XL and Eliquis. 5. HTN: per hx. Continued home BB.  6. IDDM2: A1c 7.9 on admit. Continued home insulin regimen.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardiac ablation, Cardiac failure, Cardiac failure acute, Cardiac failure congestive, Chest X-ray abnormal
Clinical narrative: Patient is a 82 y.o. female with a hx of atrial fibrillation (on Eliquis), DM, and HTN who presented to hospital 1/9/23 from ECF with dyspnea and several days of cough. Admitted with COVID 19 PNA and CHF exacerbation.      1. COVID 19: vaccinated and boosted. Symptom onset ~1/7/23; COVID-19 positive on 1/9/23. Discontinued Decadron 1/16/2023 as patient weaned to room air.  2. Acute Hypoxic Respiratory Failure: no hx of O2 dependence. Required 6L NC on admit. Admit CXR with pulmonary edema. In setting of CHF exacerbation and COVID 19. Weaned to room air 1/16/2023.  3. Acute on Chronic HFpEF: Follows with Dr. (cardio). Admit BNP 1.9k, CXR as above. Echo on 1/10/22 with EF of 67% and RVSP of 45-50. Diuresed with IV lasix, discharged on PO lasix.  4. Permanent A fib: s/p AV junction ablation. Pt has known dual chamber pacemaker. Follows with Dr. Continued home Toprol-XL and Eliquis. 5. HTN: per hx. Continued home BB.  6. IDDM2: A1c 7.9 on admit. Continued home insulin regimen.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Condition aggravated, Cough, Diuretic therapy, Dyspnoea, Echocardiogram normal
Clinical narrative: Patient is a 82 y.o. female with a hx of atrial fibrillation (on Eliquis), DM, and HTN who presented to hospital 1/9/23 from ECF with dyspnea and several days of cough. Admitted with COVID 19 PNA and CHF exacerbation.      1. COVID 19: vaccinated and boosted. Symptom onset ~1/7/23; COVID-19 positive on 1/9/23. Discontinued Decadron 1/16/2023 as patient weaned to room air.  2. Acute Hypoxic Respiratory Failure: no hx of O2 dependence. Required 6L NC on admit. Admit CXR with pulmonary edema. In setting of CHF exacerbation and COVID 19. Weaned to room air 1/16/2023.  3. Acute on Chronic HFpEF: Follows with Dr. (cardio). Admit BNP 1.9k, CXR as above. Echo on 1/10/22 with EF of 67% and RVSP of 45-50. Diuresed with IV lasix, discharged on PO lasix.  4. Permanent A fib: s/p AV junction ablation. Pt has known dual chamber pacemaker. Follows with Dr. Continued home Toprol-XL and Eliquis. 5. HTN: per hx. Continued home BB.  6. IDDM2: A1c 7.9 on admit. Continued home insulin regimen.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Ejection fraction normal, Glycosylated haemoglobin increased, Malaise, Pulmonary oedema, Right ventricular systolic pressure
Clinical narrative: Patient is a 82 y.o. female with a hx of atrial fibrillation (on Eliquis), DM, and HTN who presented to hospital 1/9/23 from ECF with dyspnea and several days of cough. Admitted with COVID 19 PNA and CHF exacerbation.      1. COVID 19: vaccinated and boosted. Symptom onset ~1/7/23; COVID-19 positive on 1/9/23. Discontinued Decadron 1/16/2023 as patient weaned to room air.  2. Acute Hypoxic Respiratory Failure: no hx of O2 dependence. Required 6L NC on admit. Admit CXR with pulmonary edema. In setting of CHF exacerbation and COVID 19. Weaned to room air 1/16/2023.  3. Acute on Chronic HFpEF: Follows with Dr. (cardio). Admit BNP 1.9k, CXR as above. Echo on 1/10/22 with EF of 67% and RVSP of 45-50. Diuresed with IV lasix, discharged on PO lasix.  4. Permanent A fib: s/p AV junction ablation. Pt has known dual chamber pacemaker. Follows with Dr. Continued home Toprol-XL and Eliquis. 5. HTN: per hx. Continued home BB.  6. IDDM2: A1c 7.9 on admit. Continued home insulin regimen.
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Patient is a 82 y.o. female with a hx of atrial fibrillation (on Eliquis), DM, and HTN who presented to hospital 1/9/23 from ECF with dyspnea and several days of cough. Admitted with COVID 19 PNA and CHF exacerbation.      1. COVID 19: vaccinated and boosted. Symptom onset ~1/7/23; COVID-19 positive on 1/9/23. Discontinued Decadron 1/16/2023 as patient weaned to room air.  2. Acute Hypoxic Respiratory Failure: no hx of O2 dependence. Required 6L NC on admit. Admit CXR with pulmonary edema. In setting of CHF exacerbation and COVID 19. Weaned to room air 1/16/2023.  3. Acute on Chronic HFpEF: Follows with Dr. (cardio). Admit BNP 1.9k, CXR as above. Echo on 1/10/22 with EF of 67% and RVSP of 45-50. Diuresed with IV lasix, discharged on PO lasix.  4. Permanent A fib: s/p AV junction ablation. Pt has known dual chamber pacemaker. Follows with Dr. Continued home Toprol-XL and Eliquis. 5. HTN: per hx. Continued home BB.  6. IDDM2: A1c 7.9 on admit. Continued home insulin regimen.
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cardiac failure, Condition aggravated, Cough
Clinical narrative: 74 yo male with a hx of ILD/IPF on 7L O2 chronically, AF on xarelto, HTN, HLD, presented with shortness of breath and hypoxia. He reports a hx of pulmonary fibrosis that was onset in Oct 2020 after a severe pneumonia. Follows w/ Dr for pulmonology. He reports increase hypoxia and SOB w/ exertion for the last 5+ days. He typically wears between 7 and 10 liters of oxygen. Over the last week he has noticed more SOB w/ exertion, desaturates quickly with minimal exertion such as walking out to the garage. He does report a dry cough.  He decided to utilize EMS services for today's ER visit; typically he arrived by private vehicle.  Upon arrival EMS documented he was in marked respiratory distress with a pulse oximetry of 68% on 8 L.  He was given 2 DuoNeb's, Solu-Medrol 125 mg, and placed on CPAP in route.  Pulse oximetry and respiratory distress had improved on arrival to the emergency department. He was admitted to the hospital for further management. He was ultimately diagnosed with COVID pneumonia causing an ILD/IPF flair. He was started on decadron and remdesvir and able to complete both courses while in the hospital. His oxygen requirement was able to be weaned to 9L which is in his home range of 7-10 liters. While in the hospital, he was seen by pulmonology who started him on ppx bactrim given chronic steroid use (15 mg prednisone daily). Near the end of his hospitalization, there were many conversations regarding GOC and disposition including an LTACH for ongoing oxygen weaning. Ultimately, patient met with the hospice team and decided to pursue home hospice after discharge. He was hemodynamically stable and discharged home on 1/1 with an oxygen requirement of 9-10 liters. He plans to enroll in home hospice this coming Friday. A new script for his home prednisone was provided as was a script for Bactrim.    Discharge diagnosis   #Acute on chronic hypoxic respiratory failure  #Idiopathic pulmonary fibrosis #ILD flair #COVID-19 pneumonia #HFpEF #Hx AF  #Thrombocytopenia, resolved #Hypokalemia #HTN #HLD #Diarrhea, chronic
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Diarrhoea, Dyspnoea, Dyspnoea exertional, Hyperlipidaemia, Hypertension
Clinical narrative: 74 yo male with a hx of ILD/IPF on 7L O2 chronically, AF on xarelto, HTN, HLD, presented with shortness of breath and hypoxia. He reports a hx of pulmonary fibrosis that was onset in Oct 2020 after a severe pneumonia. Follows w/ Dr for pulmonology. He reports increase hypoxia and SOB w/ exertion for the last 5+ days. He typically wears between 7 and 10 liters of oxygen. Over the last week he has noticed more SOB w/ exertion, desaturates quickly with minimal exertion such as walking out to the garage. He does report a dry cough.  He decided to utilize EMS services for today's ER visit; typically he arrived by private vehicle.  Upon arrival EMS documented he was in marked respiratory distress with a pulse oximetry of 68% on 8 L.  He was given 2 DuoNeb's, Solu-Medrol 125 mg, and placed on CPAP in route.  Pulse oximetry and respiratory distress had improved on arrival to the emergency department. He was admitted to the hospital for further management. He was ultimately diagnosed with COVID pneumonia causing an ILD/IPF flair. He was started on decadron and remdesvir and able to complete both courses while in the hospital. His oxygen requirement was able to be weaned to 9L which is in his home range of 7-10 liters. While in the hospital, he was seen by pulmonology who started him on ppx bactrim given chronic steroid use (15 mg prednisone daily). Near the end of his hospitalization, there were many conversations regarding GOC and disposition including an LTACH for ongoing oxygen weaning. Ultimately, patient met with the hospice team and decided to pursue home hospice after discharge. He was hemodynamically stable and discharged home on 1/1 with an oxygen requirement of 9-10 liters. He plans to enroll in home hospice this coming Friday. A new script for his home prednisone was provided as was a script for Bactrim.    Discharge diagnosis   #Acute on chronic hypoxic respiratory failure  #Idiopathic pulmonary fibrosis #ILD flair #COVID-19 pneumonia #HFpEF #Hx AF  #Thrombocytopenia, resolved #Hypokalemia #HTN #HLD #Diarrhea, chronic
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypokalaemia, Hypoxia, Idiopathic pulmonary fibrosis, Interstitial lung disease, Oxygen saturation decreased
Clinical narrative: 74 yo male with a hx of ILD/IPF on 7L O2 chronically, AF on xarelto, HTN, HLD, presented with shortness of breath and hypoxia. He reports a hx of pulmonary fibrosis that was onset in Oct 2020 after a severe pneumonia. Follows w/ Dr for pulmonology. He reports increase hypoxia and SOB w/ exertion for the last 5+ days. He typically wears between 7 and 10 liters of oxygen. Over the last week he has noticed more SOB w/ exertion, desaturates quickly with minimal exertion such as walking out to the garage. He does report a dry cough.  He decided to utilize EMS services for today's ER visit; typically he arrived by private vehicle.  Upon arrival EMS documented he was in marked respiratory distress with a pulse oximetry of 68% on 8 L.  He was given 2 DuoNeb's, Solu-Medrol 125 mg, and placed on CPAP in route.  Pulse oximetry and respiratory distress had improved on arrival to the emergency department. He was admitted to the hospital for further management. He was ultimately diagnosed with COVID pneumonia causing an ILD/IPF flair. He was started on decadron and remdesvir and able to complete both courses while in the hospital. His oxygen requirement was able to be weaned to 9L which is in his home range of 7-10 liters. While in the hospital, he was seen by pulmonology who started him on ppx bactrim given chronic steroid use (15 mg prednisone daily). Near the end of his hospitalization, there were many conversations regarding GOC and disposition including an LTACH for ongoing oxygen weaning. Ultimately, patient met with the hospice team and decided to pursue home hospice after discharge. He was hemodynamically stable and discharged home on 1/1 with an oxygen requirement of 9-10 liters. He plans to enroll in home hospice this coming Friday. A new script for his home prednisone was provided as was a script for Bactrim.    Discharge diagnosis   #Acute on chronic hypoxic respiratory failure  #Idiopathic pulmonary fibrosis #ILD flair #COVID-19 pneumonia #HFpEF #Hx AF  #Thrombocytopenia, resolved #Hypokalemia #HTN #HLD #Diarrhea, chronic
Age: 74.0
Sex: M
Vaccine: COVID19-2
Symptoms: Positive airway pressure therapy, Respiratory distress, Respiratory failure, Thrombocytopenia
Clinical narrative: 74 yo male with a hx of ILD/IPF on 7L O2 chronically, AF on xarelto, HTN, HLD, presented with shortness of breath and hypoxia. He reports a hx of pulmonary fibrosis that was onset in Oct 2020 after a severe pneumonia. Follows w/ Dr for pulmonology. He reports increase hypoxia and SOB w/ exertion for the last 5+ days. He typically wears between 7 and 10 liters of oxygen. Over the last week he has noticed more SOB w/ exertion, desaturates quickly with minimal exertion such as walking out to the garage. He does report a dry cough.  He decided to utilize EMS services for today's ER visit; typically he arrived by private vehicle.  Upon arrival EMS documented he was in marked respiratory distress with a pulse oximetry of 68% on 8 L.  He was given 2 DuoNeb's, Solu-Medrol 125 mg, and placed on CPAP in route.  Pulse oximetry and respiratory distress had improved on arrival to the emergency department. He was admitted to the hospital for further management. He was ultimately diagnosed with COVID pneumonia causing an ILD/IPF flair. He was started on decadron and remdesvir and able to complete both courses while in the hospital. His oxygen requirement was able to be weaned to 9L which is in his home range of 7-10 liters. While in the hospital, he was seen by pulmonology who started him on ppx bactrim given chronic steroid use (15 mg prednisone daily). Near the end of his hospitalization, there were many conversations regarding GOC and disposition including an LTACH for ongoing oxygen weaning. Ultimately, patient met with the hospice team and decided to pursue home hospice after discharge. He was hemodynamically stable and discharged home on 1/1 with an oxygen requirement of 9-10 liters. He plans to enroll in home hospice this coming Friday. A new script for his home prednisone was provided as was a script for Bactrim.    Discharge diagnosis   #Acute on chronic hypoxic respiratory failure  #Idiopathic pulmonary fibrosis #ILD flair #COVID-19 pneumonia #HFpEF #Hx AF  #Thrombocytopenia, resolved #Hypokalemia #HTN #HLD #Diarrhea, chronic
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Angiogram pulmonary normal, Asthenia, Blood sodium decreased, COVID-19, Chronic obstructive pulmonary disease
Clinical narrative: Patient is 87 years old with past medical history of COPD, diabetes, GERD, hyperlipidemia, hypertension, obstructive sleep apnea presented to the hospital with a chief complaint of shortness of breath associated with fatigue and weakness.  Patient had a recent admission to the hospital January 17 for COPD exacerbation.  He was discharged home on oxygen.  He has been encountering difficulty ambulating at home and fulfilling daily needs.  Otherwise patient has no fever, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, difficulty urination, dysuria.   In the ED, patient had CT angio of the chest which was negative for pulmonary embolism.  Labs significant for mildly low sodium level.      Clinical Summary   Patient was admitted to the medical surgical unit due to chronic respiratory failure related to COPD exacerbation secondary to COVID-19 infection.  He did not meet criteria for remdesivir.  He was treated with steroids, azithromycin, and bronchodilators.  On hospitalization day 3 patient was feeling improved and agreeable to discharge.  He was assessed on his new baseline oxygen of 2 L and did well.  He did not require further titration of his home oxygen.  Notably, he did have an element of hyperglycemia during hospitalization related to steroid use.  He is discharged on short course of sliding scale insulin while on steroids.  He has a glucometer at home and understands how to check his glucose and insulin administration which was reinforced by myself and nursing.  He has been started on a maintenance inhaler.  He has an appointment with his primary care doctor on Monday.  Patient denied further questions or concerns and was agreeable for discharge.  Home health referrals been placed.   Discharge diagnosis Acute exacerbation of COPD COVID-19 infection Chronic hypoxic respiratory failure Debility/generalized weakness Type 2 diabetes Hypertension Hodgkin's lymphoma Obstructive sleep apnea COVID-19 infection Protein calorie malnutrition next
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Chronic respiratory failure, Condition aggravated, Dyspnoea, Fatigue, Gait disturbance
Clinical narrative: Patient is 87 years old with past medical history of COPD, diabetes, GERD, hyperlipidemia, hypertension, obstructive sleep apnea presented to the hospital with a chief complaint of shortness of breath associated with fatigue and weakness.  Patient had a recent admission to the hospital January 17 for COPD exacerbation.  He was discharged home on oxygen.  He has been encountering difficulty ambulating at home and fulfilling daily needs.  Otherwise patient has no fever, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, difficulty urination, dysuria.   In the ED, patient had CT angio of the chest which was negative for pulmonary embolism.  Labs significant for mildly low sodium level.      Clinical Summary   Patient was admitted to the medical surgical unit due to chronic respiratory failure related to COPD exacerbation secondary to COVID-19 infection.  He did not meet criteria for remdesivir.  He was treated with steroids, azithromycin, and bronchodilators.  On hospitalization day 3 patient was feeling improved and agreeable to discharge.  He was assessed on his new baseline oxygen of 2 L and did well.  He did not require further titration of his home oxygen.  Notably, he did have an element of hyperglycemia during hospitalization related to steroid use.  He is discharged on short course of sliding scale insulin while on steroids.  He has a glucometer at home and understands how to check his glucose and insulin administration which was reinforced by myself and nursing.  He has been started on a maintenance inhaler.  He has an appointment with his primary care doctor on Monday.  Patient denied further questions or concerns and was agreeable for discharge.  Home health referrals been placed.   Discharge diagnosis Acute exacerbation of COPD COVID-19 infection Chronic hypoxic respiratory failure Debility/generalized weakness Type 2 diabetes Hypertension Hodgkin's lymphoma Obstructive sleep apnea COVID-19 infection Protein calorie malnutrition next
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Hodgkin's disease, Hyperglycaemia, Hypertension, Laboratory test abnormal, Loss of personal independence in daily activities
Clinical narrative: Patient is 87 years old with past medical history of COPD, diabetes, GERD, hyperlipidemia, hypertension, obstructive sleep apnea presented to the hospital with a chief complaint of shortness of breath associated with fatigue and weakness.  Patient had a recent admission to the hospital January 17 for COPD exacerbation.  He was discharged home on oxygen.  He has been encountering difficulty ambulating at home and fulfilling daily needs.  Otherwise patient has no fever, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, difficulty urination, dysuria.   In the ED, patient had CT angio of the chest which was negative for pulmonary embolism.  Labs significant for mildly low sodium level.      Clinical Summary   Patient was admitted to the medical surgical unit due to chronic respiratory failure related to COPD exacerbation secondary to COVID-19 infection.  He did not meet criteria for remdesivir.  He was treated with steroids, azithromycin, and bronchodilators.  On hospitalization day 3 patient was feeling improved and agreeable to discharge.  He was assessed on his new baseline oxygen of 2 L and did well.  He did not require further titration of his home oxygen.  Notably, he did have an element of hyperglycemia during hospitalization related to steroid use.  He is discharged on short course of sliding scale insulin while on steroids.  He has a glucometer at home and understands how to check his glucose and insulin administration which was reinforced by myself and nursing.  He has been started on a maintenance inhaler.  He has an appointment with his primary care doctor on Monday.  Patient denied further questions or concerns and was agreeable for discharge.  Home health referrals been placed.   Discharge diagnosis Acute exacerbation of COPD COVID-19 infection Chronic hypoxic respiratory failure Debility/generalized weakness Type 2 diabetes Hypertension Hodgkin's lymphoma Obstructive sleep apnea COVID-19 infection Protein calorie malnutrition next
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Malnutrition, Obstructive sleep apnoea syndrome, Respiratory failure, Type 2 diabetes mellitus
Clinical narrative: Patient is 87 years old with past medical history of COPD, diabetes, GERD, hyperlipidemia, hypertension, obstructive sleep apnea presented to the hospital with a chief complaint of shortness of breath associated with fatigue and weakness.  Patient had a recent admission to the hospital January 17 for COPD exacerbation.  He was discharged home on oxygen.  He has been encountering difficulty ambulating at home and fulfilling daily needs.  Otherwise patient has no fever, chills, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, difficulty urination, dysuria.   In the ED, patient had CT angio of the chest which was negative for pulmonary embolism.  Labs significant for mildly low sodium level.      Clinical Summary   Patient was admitted to the medical surgical unit due to chronic respiratory failure related to COPD exacerbation secondary to COVID-19 infection.  He did not meet criteria for remdesivir.  He was treated with steroids, azithromycin, and bronchodilators.  On hospitalization day 3 patient was feeling improved and agreeable to discharge.  He was assessed on his new baseline oxygen of 2 L and did well.  He did not require further titration of his home oxygen.  Notably, he did have an element of hyperglycemia during hospitalization related to steroid use.  He is discharged on short course of sliding scale insulin while on steroids.  He has a glucometer at home and understands how to check his glucose and insulin administration which was reinforced by myself and nursing.  He has been started on a maintenance inhaler.  He has an appointment with his primary care doctor on Monday.  Patient denied further questions or concerns and was agreeable for discharge.  Home health referrals been placed.   Discharge diagnosis Acute exacerbation of COPD COVID-19 infection Chronic hypoxic respiratory failure Debility/generalized weakness Type 2 diabetes Hypertension Hodgkin's lymphoma Obstructive sleep apnea COVID-19 infection Protein calorie malnutrition next
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, Bacteraemia, Blood culture positive, C-reactive protein increased, COVID-19
Clinical narrative: Patient is a 76 y.o. female presenting from SNF with c/o patient presents to the emergency department from nursing facility due to increased confusion/altered mental status.  Per report from nursing home patient has refused to eat all day and been altered.  Per report patient is positive for COVID.  Patient is full code.  At baseline patient is nonambulatory.  Per history patient has history of "renal issues and sepsis:" No family present at initial exam to give any additional history.  Patient is awake and answer some questions.  Many questions she does not answer.  History is extremely limited from patient.            Hospital course as below.  Patient improved with medical treatment.  Patient discharged back to SNF in stable condition.   1.  COVID, +1/10: -Chest x-ray without pneumonia -No hypoxia at this time, no indication for remdesivir -CRP elevated, start Decadron  -Home Eliquis DVT prophylaxis  2.  Bacteremia: -Infectious disease consulted -1/11 blood cultures 2 out of 2 positive for staph hominis -1/13 blood cultures no growth to date -antibiotics per ID, likely contamination no further abx  3.  UTI: -UA concerning for infection -Urine culture came back contaminated -abx completed  4.  AMS, baseline cognitive dysfunction: -CT head nonacute -Likely in setting of above -Delirium precautions  5.  Status post fall during hospital stay: -CT head nonacute, scalp hematoma present -CT C-spine nonacute -X-ray bilateral lower extremity no fractures, right lower leg with hematoma
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Chest X-ray normal, Computerised tomogram head normal, Computerised tomogram spine, Confusional state, Culture urine
Clinical narrative: Patient is a 76 y.o. female presenting from SNF with c/o patient presents to the emergency department from nursing facility due to increased confusion/altered mental status.  Per report from nursing home patient has refused to eat all day and been altered.  Per report patient is positive for COVID.  Patient is full code.  At baseline patient is nonambulatory.  Per history patient has history of "renal issues and sepsis:" No family present at initial exam to give any additional history.  Patient is awake and answer some questions.  Many questions she does not answer.  History is extremely limited from patient.            Hospital course as below.  Patient improved with medical treatment.  Patient discharged back to SNF in stable condition.   1.  COVID, +1/10: -Chest x-ray without pneumonia -No hypoxia at this time, no indication for remdesivir -CRP elevated, start Decadron  -Home Eliquis DVT prophylaxis  2.  Bacteremia: -Infectious disease consulted -1/11 blood cultures 2 out of 2 positive for staph hominis -1/13 blood cultures no growth to date -antibiotics per ID, likely contamination no further abx  3.  UTI: -UA concerning for infection -Urine culture came back contaminated -abx completed  4.  AMS, baseline cognitive dysfunction: -CT head nonacute -Likely in setting of above -Delirium precautions  5.  Status post fall during hospital stay: -CT head nonacute, scalp hematoma present -CT C-spine nonacute -X-ray bilateral lower extremity no fractures, right lower leg with hematoma
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Diet refusal, Fall, Haematoma, Mental status changes, SARS-CoV-2 test positive
Clinical narrative: Patient is a 76 y.o. female presenting from SNF with c/o patient presents to the emergency department from nursing facility due to increased confusion/altered mental status.  Per report from nursing home patient has refused to eat all day and been altered.  Per report patient is positive for COVID.  Patient is full code.  At baseline patient is nonambulatory.  Per history patient has history of "renal issues and sepsis:" No family present at initial exam to give any additional history.  Patient is awake and answer some questions.  Many questions she does not answer.  History is extremely limited from patient.            Hospital course as below.  Patient improved with medical treatment.  Patient discharged back to SNF in stable condition.   1.  COVID, +1/10: -Chest x-ray without pneumonia -No hypoxia at this time, no indication for remdesivir -CRP elevated, start Decadron  -Home Eliquis DVT prophylaxis  2.  Bacteremia: -Infectious disease consulted -1/11 blood cultures 2 out of 2 positive for staph hominis -1/13 blood cultures no growth to date -antibiotics per ID, likely contamination no further abx  3.  UTI: -UA concerning for infection -Urine culture came back contaminated -abx completed  4.  AMS, baseline cognitive dysfunction: -CT head nonacute -Likely in setting of above -Delirium precautions  5.  Status post fall during hospital stay: -CT head nonacute, scalp hematoma present -CT C-spine nonacute -X-ray bilateral lower extremity no fractures, right lower leg with hematoma
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Scalp haematoma, Staphylococcus test positive, Urinary tract infection, Urine analysis, X-ray limb normal
Clinical narrative: Patient is a 76 y.o. female presenting from SNF with c/o patient presents to the emergency department from nursing facility due to increased confusion/altered mental status.  Per report from nursing home patient has refused to eat all day and been altered.  Per report patient is positive for COVID.  Patient is full code.  At baseline patient is nonambulatory.  Per history patient has history of "renal issues and sepsis:" No family present at initial exam to give any additional history.  Patient is awake and answer some questions.  Many questions she does not answer.  History is extremely limited from patient.            Hospital course as below.  Patient improved with medical treatment.  Patient discharged back to SNF in stable condition.   1.  COVID, +1/10: -Chest x-ray without pneumonia -No hypoxia at this time, no indication for remdesivir -CRP elevated, start Decadron  -Home Eliquis DVT prophylaxis  2.  Bacteremia: -Infectious disease consulted -1/11 blood cultures 2 out of 2 positive for staph hominis -1/13 blood cultures no growth to date -antibiotics per ID, likely contamination no further abx  3.  UTI: -UA concerning for infection -Urine culture came back contaminated -abx completed  4.  AMS, baseline cognitive dysfunction: -CT head nonacute -Likely in setting of above -Delirium precautions  5.  Status post fall during hospital stay: -CT head nonacute, scalp hematoma present -CT C-spine nonacute -X-ray bilateral lower extremity no fractures, right lower leg with hematoma
Age: 45.0
Sex: M
Vaccine: COVID19-2
Symptoms: Bladder discomfort, Mechanical urticaria, Perineal pain, Pruritus, Rash erythematous
Clinical narrative: After a week, I had perineal pain, bladder discomfort. got better in 2 days.   ITCHING, UTRICARIA, patches of red  itchy rash,  with dermographism.  itchy skin generalized.  started 11-12 days after he vaccine.  have to take Allegra to get relief and to suppress it from coming. Without Allegra it causes itchy rash and  burning and hot patches  multiple areas of utricaria.   I am a physician and i never had any side effects after a vaccine so far. I kept waiting it will abate, but it keeps coming back without Allegra. its frustrating.
Age: 45.0
Sex: M
Vaccine: COVID19-2
Symptoms: Rash pruritic, Urticaria
Clinical narrative: After a week, I had perineal pain, bladder discomfort. got better in 2 days.   ITCHING, UTRICARIA, patches of red  itchy rash,  with dermographism.  itchy skin generalized.  started 11-12 days after he vaccine.  have to take Allegra to get relief and to suppress it from coming. Without Allegra it causes itchy rash and  burning and hot patches  multiple areas of utricaria.   I am a physician and i never had any side effects after a vaccine so far. I kept waiting it will abate, but it keeps coming back without Allegra. its frustrating.
Age: 59.0
Sex: M
Vaccine: UNK
Symptoms: Arrhythmia, Magnetic resonance imaging, Muscle spasms, SARS-CoV-2 antibody test, X-ray
Clinical narrative: After vaccination 02-11-22 the next day in the morning severe cramping in bilateral feet ( toes ) and bilateral calves, pain in bilateral knees but more in left knee and left hip. MD- ordered ultrasound duplex  spectral analysis.  After couple of weeks pain increase and advance to my shoulders and elbows especially my left elbow very strong pain.  Im doing this report until now because symptoms getting worse.  Pain getting worse and I noticed cardiac arrhythmias .
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Tinnitus
Clinical narrative: Significant worsening of previous tinnitus symptoms
Age: 50.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough
Clinical narrative: Admission Date: 2/1/2023 Discharge Date: 2/16/23  PRESENTING PROBLEM: Acute respiratory insufficiency  Acute respiratory failure with hypoxia    HOSPITAL COURSE: Patient is a 51-year-old female with PMH significant for hypertension, OSA/CPAP, epilepsy on antiepileptics, type 2 diabetes, history of malignant brain tumor status post excision/VP shunt, thyroid cancer, anoxic brain injury/developmental delay and right hemiplegia with associated dysphagia/feeding tube, nonverbal/non communicative, wheelchair-bound complete care at baseline at home with mom as being primary caregiver, hypothyroidism presents to the hospital on 2/1---with complaints of increased blood pressure at home, facial swelling, abdominal distension and labored breathing. Patient was noted to be hypoxic in ER at 88%, tachypneic, needing supplemental oxygen and chest x-ray showing cardiomegaly and pulmonary congestion.  Patient was admitted with suspicion for pulmonary congestion related to uncontrolled blood pressures, echo without any significant findings, was given diuretics.  Echo showed EF of 70%.  Blood pressure medications were further adjusted resulting in better control. Patient developed fever and 2/6 and with continued hypoxia further workup  with chest x-ray that showed infiltrates, CT thorax/abdomen and pelvis without any acute changes.  Urinalysis was negative.  Patient did not have any meningeal signs.  Ultimately she did test positive for COVID-19 on film array and interestingly her film array was negative at admit with prior COVID infection in Dec 2022.  Patient was started on remdesivir and antibiotics discontinued. Her hypoxia and respiratory status worsened so she was started on dexamethasone with gradual improvement. Patient also developed increased lethargy around 2/5 of unclear etiology.  Further workup with CT head without any acute changes, TSH, VBG, ammonia, B12 were all normal.  Neurology consultation was obtained who recommended MRI brain (no acute changes), EEG (which was abnormal with occasional LR DA and GRDA and interictal epileptiform discharges) her home Keppra and Tegretol doses were increased. She had significant improvement with steroids. She was weaned down to RA and ultimately discharged home is stable conditions with plans to continue increased dose of BP meds and to finish steroids. It was discussed to the mother/caregiver to return if respiratory status worsened after stopping steroids for covid with the possibility of post-covid ILD.
Age: 50.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Lung opacity, SARS-CoV-2 test positive
Clinical narrative: Admission Date: 2/1/2023 Discharge Date: 2/16/23  PRESENTING PROBLEM: Acute respiratory insufficiency  Acute respiratory failure with hypoxia    HOSPITAL COURSE: Patient is a 51-year-old female with PMH significant for hypertension, OSA/CPAP, epilepsy on antiepileptics, type 2 diabetes, history of malignant brain tumor status post excision/VP shunt, thyroid cancer, anoxic brain injury/developmental delay and right hemiplegia with associated dysphagia/feeding tube, nonverbal/non communicative, wheelchair-bound complete care at baseline at home with mom as being primary caregiver, hypothyroidism presents to the hospital on 2/1---with complaints of increased blood pressure at home, facial swelling, abdominal distension and labored breathing. Patient was noted to be hypoxic in ER at 88%, tachypneic, needing supplemental oxygen and chest x-ray showing cardiomegaly and pulmonary congestion.  Patient was admitted with suspicion for pulmonary congestion related to uncontrolled blood pressures, echo without any significant findings, was given diuretics.  Echo showed EF of 70%.  Blood pressure medications were further adjusted resulting in better control. Patient developed fever and 2/6 and with continued hypoxia further workup  with chest x-ray that showed infiltrates, CT thorax/abdomen and pelvis without any acute changes.  Urinalysis was negative.  Patient did not have any meningeal signs.  Ultimately she did test positive for COVID-19 on film array and interestingly her film array was negative at admit with prior COVID infection in Dec 2022.  Patient was started on remdesivir and antibiotics discontinued. Her hypoxia and respiratory status worsened so she was started on dexamethasone with gradual improvement. Patient also developed increased lethargy around 2/5 of unclear etiology.  Further workup with CT head without any acute changes, TSH, VBG, ammonia, B12 were all normal.  Neurology consultation was obtained who recommended MRI brain (no acute changes), EEG (which was abnormal with occasional LR DA and GRDA and interictal epileptiform discharges) her home Keppra and Tegretol doses were increased. She had significant improvement with steroids. She was weaned down to RA and ultimately discharged home is stable conditions with plans to continue increased dose of BP meds and to finish steroids. It was discussed to the mother/caregiver to return if respiratory status worsened after stopping steroids for covid with the possibility of post-covid ILD.