chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Aphasia, Asthenia, Blood pressure increased, Bundle branch block right, COVID-19
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Cardiac pacemaker insertion, Chest X-ray abnormal, Cognitive disorder, Cough, Dyspnoea
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Echocardiogram, Ejection fraction, Electrocardiogram normal, Fall, Fluid overload
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Gastrointestinal haemorrhage, Headache, Hypertension, Hypoxia, Infection
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Left ventricular hypertrophy, Myocardial infarction, Nasal congestion, Pain, Pleural effusion
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: SARS-CoV-2 test positive, Troponin increased, Weight increased
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Echocardiogram, Ejection fraction, Electrocardiogram, Electrocardiogram normal, Fall
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Gastrointestinal haemorrhage, Headache, Hypertension, Hypervolaemia, Hypoxia
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Infection, Left ventricular hypertrophy, Myocardial infarction, Nasal congestion, Pain
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Pleural effusion, SARS-CoV-2 test, SARS-CoV-2 test positive, Troponin, Troponin increased
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 83.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Vaccination failure, Weight increased
Clinical narrative: Brief history and medical decision making:  Volume over loaf, secondary to missed HD on Monday 08/23. Break through Covid -19 infection, continue isolation per infection control. Hold off Steroids ( anticipating HD will help with breathing) Elevated troponin mostly due to ESRD and volume overload.  Asymptomatic. History CVA with expressive aphasia: Cognitive impairment: Patient have guardian. HD per Nephrology.    Shortness of breath  Volume overload  ESRD MWF    In setting of missed dialysis on Monday and patient being 5 kg above dry weight.  Chest x-ray with evidence of congestion and small bilateral pleural effusions.  Differentials also include breakthrough COVID-19 infection and possibility of flash pulmonary edema. History defers from patient shortness of breath worsening over last week worse in last 3 days compared to facility awareness of acutely short of breath last evening.    Plan: -consult nephrology discussed with Doctor regarding dialysis today -assess SOB hypoxia with activity after -Lasix if delayed planned to start round 1pm    Hypertensive urgency  In setting of volume overload with no antihypertensives given on day of dialysis even though missed dialysis and without blood pressure medications today.    -Continue amlodipine, imdur, coreg initial dose now and continue on none dialysis days    Breakthrough COVID-19 infection Symptomatic with positive test in November 2020, vaccinated  Johnson Johnson vaccine 3/2021, negative testing previously now positive test 8/24.  No COVID outbreak at facility.  Patient has been afebrile.  Does have cough, headache.    -discussed with infection control will place in isolation 10 days -Received 6 mg dexamethasone in ED. Currently not hypoxic on RA. Will hold on additional treatment currently.  -With ESRD would not be candidate for remdesivir. -With current volume overload will avoid convalescent plasma unclear utility with past infection and COVID vaccination.       Elevated troponin Myocardial injury In setting of ESRD with volume overload with elevated blood pressure without EKG changes remains atrial paced with right bundle-branch block previously seen. Denies chest pain. Troponin 224 -- > 224. Previous admissions 150 to 250s.    Diastolic heart failure Status post permanent pacemaker Afib not on anticoagulation due to GI bleed.  Last echo 3/2021. EF 57% mild LVH.  Atrial paced.       Dementia Prior CVA with expressive aphasia General debility Frequent falls Currently AOx3/4 name, place, president not to date.    Has court-appointed guardian.  -PT/OT   Chronic pain -Continue fentanyl patch q 72 hr      Code Status: full unknown. Call out to guardian  DVT PPX: SQH  Diet: Renal fluid and sodium resricted Dispo: Obs assess after HD.     Discussed with Doctor, please see their addendum.   Internal Medicine Resident PGY-3
Age: 21.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Tested positive for COVID 8/30/21 after being fully vaccinated.
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Dry mouth, Dyspnoea, Hypertension
Clinical narrative: Patient came in with cough, hyper -tension, dry mouth and shortness of breath and Covid positive. Patient discharged home
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Patient came in with cough, hyper -tension, dry mouth and shortness of breath and Covid positive. Patient discharged home
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Arterial thrombosis, Myocardial infarction
Clinical narrative: Patient suffered a heart attack within 2 weeks of receiving vaccine. Patient had 99% blood clotting in his artery.
Age: 78.0
Sex: F
Vaccine: COVID19
Symptoms: Peripheral swelling, Rash
Clinical narrative: Red  spots  --  raised  and  enlarging  --  started  on  left  leg  --  now  has  spread  to  right  arm  with  swelling  --  also  left  brest  and  Right  leg  and  Right  sholder  --    continue  symptoms  --
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient passed away on 08/21/2021.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray, SARS-CoV-2 test positive, Wheezing
Clinical narrative: Pt came to ER c/o wheezing.
Sex: U
Vaccine: COVID19
Symptoms: Arthralgia, Magnetic resonance imaging, Periarthritis
Clinical narrative: Sore shoulder became frozen shoulder
Age: 38.0
Sex: F
Vaccine: COVID19
Symptoms: Cystitis
Clinical narrative: bladder infection, treated with antibiotics and cleared up within a couple of days.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Blood glucose increased, Renal disorder
Clinical narrative: In April, the issue was he had not checked his blood glucose in years.  He went to see his internist, for a check up.  The doctor called in and said his blood sugars were  very high.  It took  3 weeks, for the doctor to call to say his blood sugar was so high he  needed to be hospitalized. and they started him on a lot of insulins.  He was hospitalized. They started pumping insulin through an IV and he spent the night there. And they gave him 3 prescriptions for 3 different types of insulins,  Ozempic, Tresiba, Insulin lispro injection.  He took all 3 insulins until 06/02/2021, and he went down from 20 units to 0 , from April to June 2, 2021.  His endocrinologist  is watching him because his kidneys were going into renal failure and they are observing his numbers to make sure he is okay. When this whole deal happened, the COVID-19 , our life style did not change, his diet never changed, I tried to call the Health Dept and CDC did not help. This is the first time someone has contacted us and I would like to say Thank you.  It is a concern in the back of my mind for him to get the 3rd booster-COVID . But we have all these insulins just in case something happens.
Age: 77.0
Sex: M
Vaccine: COVID19
Symptoms: Biopsy skin abnormal, Urticaria chronic
Clinical narrative: Chronic Urticaria that is not responding to conventional treatments.
Age: 38.0
Sex: M
Vaccine: COVID19
Symptoms: Pain in extremity
Clinical narrative: Sharp pain in left leg in the quadricep area.  Coming and going throughout the day, did not have these pains before the vaccine.
Age: 37.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Dyspnoea, Throat tightness
Clinical narrative: within five minutes, patient felt her throat was closing and that it was hard to breathe. She also had abdominal pain.
Age: 84.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient passed away on 08/20/2021
Age: 5.0
Sex: F
Vaccine: DTAPIPV, MMRV
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
Clinical narrative: Itching, redness, and swelling at the injection sites. 30 mL of liquid diphenhydramine given (error, Poison Control consulted, situation cleared as not requiring medical attention). Client's mother advised to continue monitoring and report incident to pediatrician. Also encouraged to call  EMS is symptoms return/worsen. Client and family discharged to home (ambulatory, A&O) with no itching and significantly reduced redness and swelling.
Age: 91.0
Sex: M
Vaccine: COVID19
Symptoms: Angioplasty, Cardiac arrest, Chest pain, Dyspnoea, Feeling of body temperature change
Clinical narrative: 11th - I started having chest pains - classic symptoms - difficulty breathing;  radiating down the left arm; hot and cold at the same time. Call -9-1-1 and they took me to the hospital. I went into Ventricular afibulation and they transferred me to another hospital and I went into Cardiac arrest.  Angioplasty - implanted three stents in the main vessels of the heart itself- as far as I understand. I was in the hospital until the 16th.
Age: 91.0
Sex: M
Vaccine: COVID19
Symptoms: Laboratory test, Stent placement, Ventricular fibrillation
Clinical narrative: 11th - I started having chest pains - classic symptoms - difficulty breathing;  radiating down the left arm; hot and cold at the same time. Call -9-1-1 and they took me to the hospital. I went into Ventricular afibulation and they transferred me to another hospital and I went into Cardiac arrest.  Angioplasty - implanted three stents in the main vessels of the heart itself- as far as I understand. I was in the hospital until the 16th.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Acute left ventricular failure, Acute respiratory failure, Anaemia, Anticoagulant therapy, Asthenia
Clinical narrative: Admitted to the hospital;  COVID-19 positive.  8.24.21 CHIEF COMPLAINT: Fall  Assessment/Plan   ASSESSMENT/PLAN:  1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease-  9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion  Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis)    Subjective   HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling.  He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home.  He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees.  In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum.  With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer.  This was discussed in depth with ER doctor, myself, and patient.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, Bone lesion, COVID-19, Cardiac failure acute, Cardiac telemetry
Clinical narrative: Admitted to the hospital;  COVID-19 positive.  8.24.21 CHIEF COMPLAINT: Fall  Assessment/Plan   ASSESSMENT/PLAN:  1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease-  9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion  Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis)    Subjective   HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling.  He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home.  He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees.  In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum.  With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer.  This was discussed in depth with ER doctor, myself, and patient.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Chronic kidney disease, Chronic left ventricular failure, Condition aggravated, Coronary artery disease, Critical illness
Clinical narrative: Admitted to the hospital;  COVID-19 positive.  8.24.21 CHIEF COMPLAINT: Fall  Assessment/Plan   ASSESSMENT/PLAN:  1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease-  9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion  Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis)    Subjective   HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling.  He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home.  He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees.  In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum.  With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer.  This was discussed in depth with ER doctor, myself, and patient.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Diabetic diet, Dyspnoea, Fall, Fibrin D dimer increased, Gastrooesophageal reflux disease
Clinical narrative: Admitted to the hospital;  COVID-19 positive.  8.24.21 CHIEF COMPLAINT: Fall  Assessment/Plan   ASSESSMENT/PLAN:  1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease-  9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion  Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis)    Subjective   HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling.  He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home.  He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees.  In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum.  With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer.  This was discussed in depth with ER doctor, myself, and patient.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Haemoglobin, Haemoptysis, Hyperlipidaemia, Hypertension, Hypoxia
Clinical narrative: Admitted to the hospital;  COVID-19 positive.  8.24.21 CHIEF COMPLAINT: Fall  Assessment/Plan   ASSESSMENT/PLAN:  1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease-  9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion  Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis)    Subjective   HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling.  He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home.  He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees.  In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum.  With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer.  This was discussed in depth with ER doctor, myself, and patient.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: Intensive care, Oxygen saturation decreased, Prostate cancer metastatic, Pulmonary embolism, SARS-CoV-2 test positive
Clinical narrative: Admitted to the hospital;  COVID-19 positive.  8.24.21 CHIEF COMPLAINT: Fall  Assessment/Plan   ASSESSMENT/PLAN:  1. Acute resp failure with hypoxia- now on HFNC 2. Acute on chronic diastolic heart failure with hemoptysis 3. CAD 4. Elevated ddimer with sudden SOB/hypoxia and tachycardia 5. CKD3 6. DM2-insulin dependent 7. Fall/weakness 8. Anemia- hx iron deficient and chronic disease-  9. Afib 10. HTN 11. HLD 12. GERD 13. Prostate ca-metastatic with right rib lesion  Plan: Admit to ICU-he refused transfer FULL code Oxygen keep sat >88% Lasix 40mg IV bid, first dose now VQ scan in am- >DDimer with covid and clinical status suspect PE Trend Hgb- transfuse <8 Telemetry, frequent VS CM for placement/dc planning- will need placement PT/OT Diabetic diet, and continue basal insulin PPI/heparin sq if hgb stable (hemoptysis)    Subjective   HISTORY OF PRESENT ILLNESS: Patient is a 87 y.o. male who presents today after a fall-though he denies falling.  He was recently here and treated for COVID, hypoxia and CHF- refused SNF and went home.  He has been difficult to care for per his son and needs help with placement. The patient begrudgingly agrees.  In the ER he was completing his workup when he suddenly dropped his 02 satus- thus requiring eventually HFNC- he also had reports of scant blood in his sputum.  With family at bedside and help of the ER doctor- advance care planning was discussed. The patient is guarded and very critically ill- family was in agreement for DNR/comfort care however the patient wishes for FULL code and does not want transfer.  This was discussed in depth with ER doctor, myself, and patient.