chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 1.25
Sex: F
Vaccine: DTAP, HIBV, PNC13
Symptoms: Metabolic function test, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Seizure, Seizure like phenomena
Clinical narrative: Patient received vaccines at approx. 10:20 am on 8/28/23. Later that evening, her parent witnessed seizure-like activity, lasting 5-10 minutes. Paramedics were called and stopped the seizure with medication. Patient was transported to the ER where her temp was 103.6 degrees. Covid, RSV, and flu tests were negative. She was diagnosed with simple febrile seizure and discharged home.
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Dyspnoea, Dyspnoea exertional, Hypoxia, Orthopnoea
Clinical narrative: dialysis pt admitted with worsening SOB, othopnea, dyspnea on exertion. +COVID test, COVID pneumonia and hypoxia, O2 @ 2L and decadron started.  continue pts MWF HD (pt on dialysis prior to admit).  no remdisivir due to RF.  able to wean O2 to RA. Pt DC home
Age: 74.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: dialysis pt admitted with worsening SOB, othopnea, dyspnea on exertion. +COVID test, COVID pneumonia and hypoxia, O2 @ 2L and decadron started.  continue pts MWF HD (pt on dialysis prior to admit).  no remdisivir due to RF.  able to wean O2 to RA. Pt DC home
Age: 60.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Vaccine was expired as of 5/30/2023. Patient did not report any adverse symptoms.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Back pain, COVID-19, Computerised tomogram abdomen abnormal, Lung opacity
Clinical narrative: c/o abd and back pain. pt undergoing chemo for recently dx breast CA. CT abd showed opacities in lung bases, possible COVID PN, + COVID test, O2 @3L, UTI. PT placed on zinc, singulair, remdisivir, and dexamethasone, cefepine and vanc emperically.  Pt is asymptomatic for COVID except for O2 requirement. Day of DC, pt on RA sats 95.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Urinary tract infection
Clinical narrative: c/o abd and back pain. pt undergoing chemo for recently dx breast CA. CT abd showed opacities in lung bases, possible COVID PN, + COVID test, O2 @3L, UTI. PT placed on zinc, singulair, remdisivir, and dexamethasone, cefepine and vanc emperically.  Pt is asymptomatic for COVID except for O2 requirement. Day of DC, pt on RA sats 95.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cough, Deep vein thrombosis
Clinical narrative: c/o SOB, cough, fever, +covid X 10 days ago. sats 86 on RA, placed on 5L O2.  acute resp failure due to COVID Pneumonia, PE, DVT, prolonged hiccups (5 days), on dexamethasone, zinc,  and vit C. no remdisivir due outside of window.  on heparin drip for PE and DVT. O2 needs increased, pt requiring 15 L NRB. Toci given. on 10/18 pt requiring 15 L NRB plus 100% HFNC to increase sats from 86 to 91%.  PT a DNR, does not want intubation.  pt continued to declined, transferred to inpt hospice.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, General physical health deterioration, Hiccups, Pulmonary embolism, Pyrexia
Clinical narrative: c/o SOB, cough, fever, +covid X 10 days ago. sats 86 on RA, placed on 5L O2.  acute resp failure due to COVID Pneumonia, PE, DVT, prolonged hiccups (5 days), on dexamethasone, zinc,  and vit C. no remdisivir due outside of window.  on heparin drip for PE and DVT. O2 needs increased, pt requiring 15 L NRB. Toci given. on 10/18 pt requiring 15 L NRB plus 100% HFNC to increase sats from 86 to 91%.  PT a DNR, does not want intubation.  pt continued to declined, transferred to inpt hospice.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: c/o SOB, cough, fever, +covid X 10 days ago. sats 86 on RA, placed on 5L O2.  acute resp failure due to COVID Pneumonia, PE, DVT, prolonged hiccups (5 days), on dexamethasone, zinc,  and vit C. no remdisivir due outside of window.  on heparin drip for PE and DVT. O2 needs increased, pt requiring 15 L NRB. Toci given. on 10/18 pt requiring 15 L NRB plus 100% HFNC to increase sats from 86 to 91%.  PT a DNR, does not want intubation.  pt continued to declined, transferred to inpt hospice.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Asthma, COVID-19 pneumonia, Cough, Dyspnoea, Fatigue
Clinical narrative: c/o headache, cough, fatigue and SOB. hypoxia, COVID Pneumonia,  asthma, pt on 2L O2. Dexamethasone & Zinc given. Physician wrote Remdisivir per ID. No notes from ID, not remdisivir documented. walk study done, weaned to RA.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Headache, Walking distance test
Clinical narrative: c/o headache, cough, fatigue and SOB. hypoxia, COVID Pneumonia,  asthma, pt on 2L O2. Dexamethasone & Zinc given. Physician wrote Remdisivir per ID. No notes from ID, not remdisivir documented. walk study done, weaned to RA.
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, COVID-19, Gastrointestinal haemorrhage, Productive cough, Pseudomonas infection
Clinical narrative: GI bleed, acute on crhonic resp failure, COVID +; sepsis, decadron, zinc, Vit K given for INR 7.5; TOBI given, no COVID symptoms other than increased O2 requirements. PT on 6L O2. remdisivir given. O2 weaned to 1.5 L. Sputum +for pseudomonus, IV cefepime for 14 days. home with IV abx
Age: 37.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Sepsis
Clinical narrative: GI bleed, acute on crhonic resp failure, COVID +; sepsis, decadron, zinc, Vit K given for INR 7.5; TOBI given, no COVID symptoms other than increased O2 requirements. PT on 6L O2. remdisivir given. O2 weaned to 1.5 L. Sputum +for pseudomonus, IV cefepime for 14 days. home with IV abx
Age: 62.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Vaccine was expired as of 5/30/2023. Patient did not report any adverse symptoms.
Age: 61.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Metabolic disorder, SARS-CoV-2 test, Systemic inflammatory response syndrome
Clinical narrative: Systemic inflammatory response syndrome Most likely due to acute metabolic derangement however COVID-19 positive as well. Monitor physiological parameters closely. No indication for antibiotic treatment.
Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19, COVID19-2
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: Patient vaccinated against and then tested positive for COVID19
Age: 68.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Vaccine was expired as of 5/30/2023.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Clostridium difficile colitis, Gastrointestinal haemorrhage
Clinical narrative: admit for GI bleed, had _COVID 2 days prior to admit. started on remdisivir, steroids, O2 @ 2L. On Vanc for CDIFF. DC home on flagyl.  H&H remained stable. O2 weaned
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Concussion, Fall, Rib fracture, SARS-CoV-2 test positive
Clinical narrative: admit for multiple falls. found to be COVID +, asymptomatic, empiracly placed on decadron.  8-10th rib fractures from falls. concussion.on RA, on 10/21 nurse document pt on 6 L O2.  no other notes on weaning O@ or dc with O2. dc to SNH. Dc with dethamethasone and zinc
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cough, Diarrhoea, Lung infiltration
Clinical narrative: dry cough, diarrhea. dx with covid pneumonia, bilat cavitary infiltrates. IV abx,  zinc, O2 @ 2L. no other treatments. pulmonologist thinks lesions are old. DC with home O2.
Age: 11.0
Sex: M
Vaccine: HEP
Symptoms: Wrong product administered
Clinical narrative: Patient placed in room with younger sister who was set to receive Hep B dose, pt was set to receive TDAP. Vaccines switched accidentally and patient given Hep B when not due. Immediately informed provider and patient's guardian. Pt is not at risk of harm from 4th Hep B dose. Given TDAP as ordered in right deltoid. Addressed with patient safety to eliminate room for error in future.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Acute kidney injury, Acute myocardial infarction, Aggression, Anuria, Asthenia
Clinical narrative: admit with CHF, weakness, SOB x 1 week, sats 75% on RA. placed on bipap in ER O2 at 25L, sats up to 92%.  BG was 417. DX: Pneumonia, sepsis, COVID +, DKA, NSTEMI; avoid remdisivir an toci. start dexamethasone.  sepsis and AKI. Insulin drip for DKA.  O2 @ 10 L Oxymask. Renal function worsening, pt does not want HD - states would not want more than 1-2 HD treatments. met with palliative care.  pt not making urine. 11/21 becomes more confused, needs sitter.  11/22 more confused, combative and uncooperative. family and physician discussion options of HD vs hospice. pt becoming more lethargic.   placed on hospcie
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Blood glucose increased, COVID-19, Cardiac failure congestive, Confusional state, Diabetic ketoacidosis
Clinical narrative: admit with CHF, weakness, SOB x 1 week, sats 75% on RA. placed on bipap in ER O2 at 25L, sats up to 92%.  BG was 417. DX: Pneumonia, sepsis, COVID +, DKA, NSTEMI; avoid remdisivir an toci. start dexamethasone.  sepsis and AKI. Insulin drip for DKA.  O2 @ 10 L Oxymask. Renal function worsening, pt does not want HD - states would not want more than 1-2 HD treatments. met with palliative care.  pt not making urine. 11/21 becomes more confused, needs sitter.  11/22 more confused, combative and uncooperative. family and physician discussion options of HD vs hospice. pt becoming more lethargic.   placed on hospcie
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Lethargy, Patient uncooperative, Pneumonia, Positive airway pressure therapy
Clinical narrative: admit with CHF, weakness, SOB x 1 week, sats 75% on RA. placed on bipap in ER O2 at 25L, sats up to 92%.  BG was 417. DX: Pneumonia, sepsis, COVID +, DKA, NSTEMI; avoid remdisivir an toci. start dexamethasone.  sepsis and AKI. Insulin drip for DKA.  O2 @ 10 L Oxymask. Renal function worsening, pt does not want HD - states would not want more than 1-2 HD treatments. met with palliative care.  pt not making urine. 11/21 becomes more confused, needs sitter.  11/22 more confused, combative and uncooperative. family and physician discussion options of HD vs hospice. pt becoming more lethargic.   placed on hospcie
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Renal impairment, SARS-CoV-2 test positive, Sepsis
Clinical narrative: admit with CHF, weakness, SOB x 1 week, sats 75% on RA. placed on bipap in ER O2 at 25L, sats up to 92%.  BG was 417. DX: Pneumonia, sepsis, COVID +, DKA, NSTEMI; avoid remdisivir an toci. start dexamethasone.  sepsis and AKI. Insulin drip for DKA.  O2 @ 10 L Oxymask. Renal function worsening, pt does not want HD - states would not want more than 1-2 HD treatments. met with palliative care.  pt not making urine. 11/21 becomes more confused, needs sitter.  11/22 more confused, combative and uncooperative. family and physician discussion options of HD vs hospice. pt becoming more lethargic.   placed on hospcie
Age: 31.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Vaccine was expired as of 5/30/2023. Patient did not report any adverse symptoms.
Age: 38.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Vaccine was expired as of 5/30/2023. Patient did not report any adverse symptoms.
Age: 2.0
Sex: F
Vaccine: DTAP
Symptoms: Rash
Clinical narrative: CHILD HAS A RASH; WAS SEEN IN CLINIC ON 09/01/2023; TX: BENADRYL 12.5MG/5ML ORAL LIQUID TAKE 5ML QID X 5 DAYS CETIRIZINE 5MG/5ML TAKE 2.50ML QD FAMOTIDINE 40MG/5ML TAKE 0.80ML BID X 14 DAYS
Age: 5.0
Sex: M
Vaccine: MMRV
Symptoms: Extra dose administered
Clinical narrative: 2 Varicella given in one day from two different healthcare facilities.  At Public Health, parent circled on the Vaccine questionnaire that the patient has had a vaccine in the past four weeks. I, RN, saw that question was circled and I specifically asked which vaccines that this patient had in the last four weeks. The mother stated Covid. I repeated to her that the patient only received a Covid in the last four weeks and the mother stated, yes.    Also, I reviewed database for this patient and confirmed that this patient needed a MMRV. At that point, I went to draw and administer the MMRV.  Once the MMRV was administered I noticed that a Varicella was given this morning on the same day from peds, which was not there earlier in database.   Immediately, I informed the mother, my boss, and the patient's provider, FNP's office staff from peds.    I educated mother to look for symptoms of a possible reaction and if there are any reactions to call the patients provider, FNP.    Patient stayed in office 15 mins after injection, no sign or symptoms of a reaction in office.
Age: 80.0
Sex: F
Vaccine: RSV
Symptoms: Cough, Dyspnoea, Fatigue, Headache, Throat irritation
Clinical narrative: started with headache, next day a slight cough, then as the days went on the cough got worse, and at times like I cant' catch my breath.  this a week now and starting to feel some improvements .  Still very  tired and throat a little scratchy, not raw like it had been.  I didnt go to doc. just treated the systems
Age: 17.0
Sex: M
Vaccine: MENB, MNQ
Symptoms: C-reactive protein normal, Electrocardiogram QT prolonged, Full blood count normal, Metabolic function test normal, Syncope
Clinical narrative: Syncope and collapse-transported to Medical Center; Released after IV fluids and observation
Age: 4.0
Sex: M
Vaccine: MMR, VARCEL
Symptoms: Cough, Urticaria
Clinical narrative: Coughing, hives
Age: 36.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: Vaccine was expired as of 5/30/2023. Patient did not report any adverse symptoms.
Age: 10.0
Sex: M
Vaccine: HEP, HEPA, MMR, VARCEL
Symptoms: Extra dose administered, No adverse event
Clinical narrative: Patient was given vaccines per electronic record and medical record. Patient's father presented us with another name the patient goes by following the vaccine administration. We looked him up under other name in electronic record and this showed that he had already completed the above vaccine series. He received the vaccines on 8/31/23 as additional doses. Patient tolerated well and no side effects noted following administration.
Age: 60.0
Sex: F
Vaccine: PNC20
Symptoms: Chills, Injection site erythema, Injection site warmth, Night sweats, Pyrexia
Clinical narrative: Fever, chills, and sweats the night of injection for two days. Redness and warmth at injection site the next day and persistent redness and warmth 4 days later.
Age: 34.0
Sex: F
Vaccine: HEP
Symptoms: No adverse event, Underdose
Clinical narrative: Adverse event is described as giving an incomplete dose of Hep B vaccine to the patient at the clinic visit.  Error was not detected while the patient was in the office.  Pediatric dose given (0.5ml) at the time of the visit instead of an adult dose, (1 ml).  There were no symptoms reported.  Treatment is to re-call the patient in to clinic to administer the correct adult dose of Hep B per CDC guidelines.
Age: 94.0
Sex: M
Vaccine: UNK
Symptoms: No adverse event
Clinical narrative: No vaccine was given.  The entry in system, for a covid vaccine with no lot number, 0n 9/28/202, at clinic, is completely in error.  There is a covid booster given five days later, which is why the discrepancy was noted.  Per the resident and his wife, on 9/28/22, no vaccine was given.  This is in error and makes it look like a reportable.  The resident did have: a covid booster on 10/03/2022 and a flu shot on 10/18/2022.  No side effects were reported from those.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Cognitive disorder, Death, Decreased appetite, Dizziness, Fall
Clinical narrative: Immediately following the shot, patient had loss of appetite, cognitive decline and Dizziness...resulting in falling and severe injury. While visiting nurses came in to bandage back, Son (CNA and later Nurse educated/trained)   also stayed with dad to provide Nursing care. Patient had heart attack in front of Son. Ambulanced to hospital and 2-3 days later discharged. Found Deceased 27 August 2021.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Immediate post-injection reaction, Injury, Myocardial infarction, Myocarditis, Pericarditis
Clinical narrative: Immediately following the shot, patient had loss of appetite, cognitive decline and Dizziness...resulting in falling and severe injury. While visiting nurses came in to bandage back, Son (CNA and later Nurse educated/trained)   also stayed with dad to provide Nursing care. Patient had heart attack in front of Son. Ambulanced to hospital and 2-3 days later discharged. Found Deceased 27 August 2021.
Age: 33.0
Sex: M
Vaccine: HEP
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Adverse event was the administration of an incomplete dose of Heb B vaccine. Patient was given a pediatric dose, (0.5ml) and was not given the adult dose of Hep B vaccine, (1.ml). Adverse event was not detected while the patient was in the clinic. Treatment is to re-call the patient back to clinic to administer the correct adult dose of Hep B vaccine.  There were no symptoms reported with the event.
Age: 36.0
Sex: M
Vaccine: HEP
Symptoms: Incorrect dose administered, Underdose
Clinical narrative: Adverse event was the administration of an incomplete dose of Heb B vaccine. Patient was given a pediatric dose, (0.5ml) and was not given the adult dose of Hep B vaccine, (1.ml). Adverse event was not detected while the patient was in the clinic. Treatment is to re-call the patient back to clinic to administer the correct adult dose of Hep B vaccine. There were no symptoms reported with this event.
Age: 11.0
Sex: M
Vaccine: TDAP
Symptoms: Dizziness, Eye movement disorder, Headache, Nausea, Seizure like phenomena
Clinical narrative: Mother called reporting Headache and nauseam then dizziness and eyes moving side to side while sitting like a "small seizure" in her words.
Age: 33.0
Sex: F
Vaccine: HEP
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Adverse event was the administration of an incomplete dose of Heb B vaccine. Patient was given a pediatric dose, (0.5ml) and was not given the adult dose of Hep B vaccine, (1.ml). Adverse event was not detected while the patient was in the clinic. Treatment is to re-call the patient back to clinic to administer the correct adult dose of Hep B vaccine. There were no symptoms reported with this event.
Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19 pneumonia, Cough, Dyspnoea, Fibrin D dimer, SARS-CoV-2 test positive
Clinical narrative: ED with SOB/cough x3-4 days; +covid PNA; VSS; Labs:  D-dimer 0.56;     TX: steroids, antibiotics (doxycycline, maxipime), Vit C, Vit D3, Vit b12, Zinc, Tessalon Perles, supplemental O2 (2L NC); back to room air baseline by d/c
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Blood potassium decreased, COVID-19 pneumonia, Cystitis, Diarrhoea, Fibrin D dimer
Clinical narrative: ED with n/v/diarrhea; CT + Covid PNA; no supplement O2 needed; also dx with acute cystitis and mesenteric adenitis (tx with ab's); Labs: D-dimer 0.94 (peak) K+ 2.5 with admit;      Meds: merrem, zosyn, vancomycin, Tessalon Perles, florastor (probiotic), zinc; Also rec'd K+ for hypokalemia; symptoms much improved upon discharge and back to baseline
Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Hypokalaemia, Mesenteric lymphadenitis, Nausea, SARS-CoV-2 test positive, Vomiting
Clinical narrative: ED with n/v/diarrhea; CT + Covid PNA; no supplement O2 needed; also dx with acute cystitis and mesenteric adenitis (tx with ab's); Labs: D-dimer 0.94 (peak) K+ 2.5 with admit;      Meds: merrem, zosyn, vancomycin, Tessalon Perles, florastor (probiotic), zinc; Also rec'd K+ for hypokalemia; symptoms much improved upon discharge and back to baseline
Age: 65.0
Sex: F
Vaccine: VARZOS
Symptoms: Incorrect route of product administration, Injection site erythema
Clinical narrative: Immunization was giving sub-q instead of IM. Patient called three days later reporting site reaction of redness, but she did not seek medical attention and reaction was improving.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein, COVID-19 pneumonia, Chest X-ray abnormal, Dyspnoea, Fibrin D dimer
Clinical narrative: Presented with SOB/hypoxia; dx Covid PNA; + covid 4 days PTA; CXR with infiltrates Labs: D-dimer: 0.59; CRP: 6.83;  Tx: Antibiotics (rocephin) Steroids; Remdesivir, Zinc, Lovenox, nebulizers; Initially 100% FiO2 per HF; 12 L by 1/26; back to normal baseline of 6 LPM via NC by discharge
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, Lung infiltration, SARS-CoV-2 test positive
Clinical narrative: Presented with SOB/hypoxia; dx Covid PNA; + covid 4 days PTA; CXR with infiltrates Labs: D-dimer: 0.59; CRP: 6.83;  Tx: Antibiotics (rocephin) Steroids; Remdesivir, Zinc, Lovenox, nebulizers; Initially 100% FiO2 per HF; 12 L by 1/26; back to normal baseline of 6 LPM via NC by discharge
Age: 12.0
Sex: M
Vaccine: HEPA
Symptoms: Incorrect dose administered, Product administered to patient of inappropriate age, Wrong product administered
Clinical narrative: Adult dose of Hepatitis A vaccine was given instead of the Pediatric dose of Hepatitis A.
Age: 59.0
Sex: M
Vaccine: HEP
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Adverse event was the administration of an incomplete dose of Heb B vaccine. Patient was given a pediatric dose, (0.5ml) and was not given the adult dose of Hep B vaccine, (1.ml). Adverse event was not detected while the patient was in the clinic. Treatment is to re-call the patient back to clinic to administer the correct adult dose of Hep B vaccine. There were no symptoms reported with this event.
Age: 69.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood potassium abnormal, Renal failure
Clinical narrative: Patient experience kidney failure suspected to be caused by the vaccination. Spent several days in local hospital. Potassium levels also reported to be disrupted.
Age: 9.0
Sex: M
Vaccine: HEPA
Symptoms: Incorrect dose administered, Product administered to patient of inappropriate age, Wrong product administered
Clinical narrative: Adult dose of Hepatitis A vaccine was given instead of a Pediatric dose.
Age: 12.0
Sex: F
Vaccine: HEPA
Symptoms: Incorrect dose administered, Product administered to patient of inappropriate age
Clinical narrative: Adult dose of Hepatitis A vaccine was given instead of Pediatric dose.
Age: 26.0
Sex: F
Vaccine: HPV9
Symptoms: Cough, Hypersensitivity
Clinical narrative: Allergies, cough
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 25.0
Sex: F
Vaccine: HEP
Symptoms: No adverse event, Underdose
Clinical narrative: Adverse event was the administration of an incomplete dose of Heb B vaccine. Patient was given a pediatric dose, (0.5ml) and was not given the adult dose of Hep B vaccine, (1.ml). Adverse event was not detected while the patient was in the clinic. Treatment is to re-call the patient back to clinic to administer the correct adult dose of Hep B vaccine. There were no symptoms reported with this event.
Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received a vaccine after BUD
Age: 30.0
Sex: F
Vaccine: HEP
Symptoms: No adverse event, Underdose
Clinical narrative: Adverse event was the administration of an incomplete dose of Heb B vaccine. Patient was given a pediatric dose, (0.5ml) and was not given the adult dose of Hep B vaccine, (1.ml). Adverse event was not detected while the patient was in the clinic. Treatment is to re-call the patient back to clinic to administer the correct adult dose of Hep B vaccine. There were no symptoms reported with this event.
Age: 86.0
Sex: F
Vaccine: RSV, VARZOS
Symptoms: Dyspnoea, Fatigue, Injection site pain, Malaise, Pain
Clinical narrative: Patient presented to the dr's office on 8/29/23 with shortness of breath, fever, general fatigue and malaise and pain at injection site. She was given an albuterol nebulizer treatment on 8/29/23 at the office and then was prescribed an albuterol inhaler and tylenol for fever and pain. She was also instructed to get a pulse oximeter and take her oxygen levels, temperature and blood pressure and report to the office the next day. On 8/31/23 she was admitted to the hospital.
Age: 86.0
Sex: F
Vaccine: RSV, VARZOS
Symptoms: Pyrexia
Clinical narrative: Patient presented to the dr's office on 8/29/23 with shortness of breath, fever, general fatigue and malaise and pain at injection site. She was given an albuterol nebulizer treatment on 8/29/23 at the office and then was prescribed an albuterol inhaler and tylenol for fever and pain. She was also instructed to get a pulse oximeter and take her oxygen levels, temperature and blood pressure and report to the office the next day. On 8/31/23 she was admitted to the hospital.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Computerised tomogram thorax abnormal, Death, Hypervolaemia, Positive airway pressure therapy, Urine output decreased
Clinical narrative: Pt was admitted with slowly increasing O2 requirement and volume retention as DC PO dose of lasix may have been inadequate. Pt was re-initiated on diamox within a few days of admission in an attempt to improve UOP, but this was inadequate. Despite multiple attempts to get pt to wear CPAP or BIPAP she would not. Repeat evaluation with CT chest showed slowly worsening volume overload and/or possible pneumonitis presumed related to her decitabine. On 7/10/23 she precipitously declined in the afternoon and family requested her goals of care be moved to comfort. Comfort measures were initiated and pt passed peacefully with family at bedside early on 7/13/2023.
Age: 82.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal distension, Acidosis hyperchloraemic, Bradycardia, Critical illness, Diarrhoea
Clinical narrative: He remained chronically critically ill and medically complex. Mental status remained very poor. He made some progress with vent weaning, tolerating 8 hours off the ventilator 7/22. He had hypokalemia and non-anion gap metabolic acidosis attributed to diarrhea. K and bicarb repleted. He was tolerating TF and having BMs. I updated his daughter twice. She was able to do a televisit 7/22 and felt he looked better, and that his abdomen was less distended.   He suffered a sudden brady-PEA arrest 7/22 in the evening. He was DNR per my prior discussion with his daughter on the day of admission.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Hypokalaemia, Mechanical ventilation, Mental status changes, Pulseless electrical activity
Clinical narrative: He remained chronically critically ill and medically complex. Mental status remained very poor. He made some progress with vent weaning, tolerating 8 hours off the ventilator 7/22. He had hypokalemia and non-anion gap metabolic acidosis attributed to diarrhea. K and bicarb repleted. He was tolerating TF and having BMs. I updated his daughter twice. She was able to do a televisit 7/22 and felt he looked better, and that his abdomen was less distended.   He suffered a sudden brady-PEA arrest 7/22 in the evening. He was DNR per my prior discussion with his daughter on the day of admission.
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 0.17
Sex: F
Vaccine: UNK
Symptoms: Extra dose administered, No adverse event
Clinical narrative: Extra dose of Polio Vaccine was given by mistake, mom was contact and aware. No symptoms or contraindications
Age: 0.75
Sex: F
Vaccine: COVID19-2
Symptoms: Underdose
Clinical narrative: The patient presented with the mother on 7/25/23 to receive the child's first dose of COVID vaccine. This nurse administered 0.2 ml of the vaccine in the maroon cap, blue writing, yellow-banded vial labeled "BOOSTER DOSES ONLY Age 6m-5y", but because it was the first dose the child should have received 0.25 ml of the vaccine in the blue cap, blue writing, grey banded vial labeled, " BOOSTER DOSES ONLY Multidose Vial Booster Dose: 0.5 ml or 0.25ml based on age". This resulted in the child receiving an inadequate first dose and per guidance received from our state immunization nurse consultant, the child will need an additional dose in 2-3 months. I realize this is my oversight and the responsibility is ultimately my own, however, there is absolutely no reason why we should have to be administering mislabeled vaccines. The labels both state "BOOSTER DOSE ONLY'" but only one is to be given as a first dose but not labeled as such. This is absolutely unacceptable and I hope these companies will be held to higher standards and will stop having exceptions made for their poor choices for product labeling when the reformulated fall 2023 version becomes available.
Age: 88.0
Sex: M
Vaccine: RSV
Symptoms: Erythema, Rash, Rash pruritic, Skin discolouration, Sleep disorder
Clinical narrative: Patient reported full body rash and discoloration of the skin resembling erythema. Of  note, he also complained of itchiness from rash disturbing sleep.
Age: 37.0
Sex: F
Vaccine: COVID19-2, COVID19-2
Symptoms: Injection site swelling
Clinical narrative: Swelling at injection site
Age: 37.0
Sex: F
Vaccine: COVID19-2, COVID19-2
Symptoms: Injection site swelling
Clinical narrative: Swelling  at injection site.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac arrest, Resuscitation, Ventricular tachycardia
Clinical narrative: On 7/23 he suffered an asystolic arrest, brief VT, ACLS x30 minutes. Resuscitation stopped at the request of his brother whom Dr. reached by phone.
Age: 4.0
Sex: M
Vaccine: DTAPIPV
Symptoms: Injection site erythema, Injection site swelling
Clinical narrative: left thigh at injection site without redness or swelling but redness and swelling generalized medially left leg extends thigh to knee, non fluctuant, no abscess seen TREATED WITH PREDNISOLONE 15MG/5ML 1/2 TSP BID
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 46.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 55.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 9.0
Sex: F
Vaccine: COVID19-2
Symptoms: No adverse event
Clinical narrative: None reported
Age: 20.0
Sex: F
Vaccine: HEP
Symptoms: Dizziness, Nausea, Oxygen saturation decreased, Urticaria
Clinical narrative: Hives, nausea, dizziness, drop in O2 saturation level .  Seen and discharged from Hospital ED.
Age: 0.33
Sex: M
Vaccine: DTPPVHBHPB, PNC15, RV5, DTPPVHBHPB, PNC15, RV5
Symptoms: Gaze palsy, Tremor
Clinical narrative: Brief 10-15 second upward eye deviation, bilateral arm jerking and bilateral leg jerking. self resolved
Age: 0.33
Sex: M
Vaccine: DTPPVHBHPB, PNC15, RV5, DTPPVHBHPB, PNC15, RV5
Symptoms: Dyskinesia, Gaze palsy
Clinical narrative: Brief 10-15 second upward eye deviation, bilateral arm jerking and bilateral leg jerking. self resolved
Age: 21.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Injection expired upon administration
Age: 59.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 64.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Chills, Decreased appetite, Eye irritation, Myalgia, Nausea
Clinical narrative: fever, chills, nausea, loss of appetite, myalgia, burning, itching rash. The rash appeared on BLE and BUE with vesicles and that ulcerated
Age: 64.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Pyrexia, Rash pruritic
Clinical narrative: fever, chills, nausea, loss of appetite, myalgia, burning, itching rash. The rash appeared on BLE and BUE with vesicles and that ulcerated
Age: 64.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Decreased appetite, Disturbance in attention, Dizziness, Eye disorder, Genital blister
Clinical narrative: fever, chills, nausea, loss of appetite, myalgia, burning, itching rash. The rash appeared on BLE and BUE with vesicles and that ulcerated
Age: 64.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Insomnia, Nausea, Pain, Pain in extremity, Palpitations
Clinical narrative: fever, chills, nausea, loss of appetite, myalgia, burning, itching rash. The rash appeared on BLE and BUE with vesicles and that ulcerated
Age: 64.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Rash vesicular, Skin burning sensation
Clinical narrative: fever, chills, nausea, loss of appetite, myalgia, burning, itching rash. The rash appeared on BLE and BUE with vesicles and that ulcerated
Age: 31.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 58.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Patient received vaccine after BUD
Age: 17.0
Sex: F
Vaccine: HEP
Symptoms: Extra dose administered
Clinical narrative: Patient received a 4th Hepatitis-B vaccine, had already completed series of 3 as infant
Age: 11.0
Sex: F
Vaccine: HPV9
Symptoms: Drainage, Haemangioma of skin, Lipoatrophy, Pustule, Scar
Clinical narrative: Pt reports first felt like a "BB" under the skin after vaccination,  but grew over time with concern for a pustular head emerging. Saw PCP in March 2023, was put on Clindamycin and mupirocin ointment. May 2023, had drainage now with appearance of a cap hemangioma to area and a dimple to skin so was referred to Dermatology. Saw Derm and diagnosed with atropic scar with lipoatrophy right anterior proximal thigh.
Age: 11.0
Sex: F
Vaccine: MNQ, TDAP
Symptoms: Dizziness
Clinical narrative: patient felt faint after vaccine administration.
Age: 4.0
Sex: M
Vaccine: HEPA, PNC13
Symptoms: No adverse event
Clinical narrative: no adverse events reported.
Age: 18.0
Sex: M
Vaccine: TDAP
Symptoms: Wrong product administered
Clinical narrative: Trainee received TDAP vaccination today instead of second dose of HEP B. Trainee received 1st dose of TDAP 7 weeks ago. Trainee was briefed on the error, expected side effects, the need to receive the HEP B vaccination in the next few weeks, and to seek medical attention for any medical concerns.
Age: 0.33
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV1
Symptoms: Abnormal behaviour, Breath holding, Hyperreflexia, Infant irritability, Infantile back arching
Clinical narrative: Patient had been very fussy and when mom picked baby up had become very tense and arched back and then proceeded to be hyperflexed for a few seconds. then was "out of it" for about 30 seconds. seen in ED had recovered and was diagnosed as breath holding spell. patient seen in clinic and is back to normal with feeds etc. afebrile through whole incident.
Age: 0.33
Sex: F
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV1
Symptoms: Muscle tightness
Clinical narrative: Patient had been very fussy and when mom picked baby up had become very tense and arched back and then proceeded to be hyperflexed for a few seconds. then was "out of it" for about 30 seconds. seen in ED had recovered and was diagnosed as breath holding spell. patient seen in clinic and is back to normal with feeds etc. afebrile through whole incident.
Age: 35.0
Sex: F
Vaccine: VARZOS
Symptoms: Wrong product administered
Clinical narrative: Provider ordered Varicella  RN administered Shingrex  Provider and pt notified.   Awaiting ID consult to advise on next steps
Age: 4.0
Sex: F
Vaccine: DTAPIPV
Symptoms: Injection site pain, Injection site swelling
Clinical narrative: Patient had redness and swelling at the injection site
Age: 84.0
Sex: F
Vaccine: VARZOS
Symptoms: Erythema, Pain in extremity, Skin warm, Swelling
Clinical narrative: Starting about 4 hours after vaccine administration, patient started to experience the following at the site of administration: arm soreness, hot to touch, redness and swelling which continued for 5 days. Patient reported these to us on 9/1/23 by which all her symptoms had resolved completely with once exception: a puffy, soft, painless lump just below the elbow, not bothersome but patient believes it was not there prior to vaccine administration. Patient said she will see her doctor about it.
Age: 11.0
Sex: F
Vaccine: COVID19-2
Symptoms: Unevaluable event
Clinical narrative: Parent requested the COVID vaccine to be given in office for the patient. The wrong presentation was given. I contacted the health department and they stated it will not be a risk to the patient. Parent will be notified by me via phone call.
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Blood pressure increased, Brain natriuretic peptide increased, COVID-19, Cardiac failure
Clinical narrative: Patient is a 79 y.o. female patient of MD with history of Guillain-Barre Syndrome, COPD, type 2 diabetes presented to Medical Center with shortness of breath and fluid overload on chest imaging found to have  Acute HFpEF, Acute Respiratory failure. Hospitalization complicated by COVID.   Acute on chronic hypoxic respiratory failure COVID-19 Infection, URI  COPD OSA Dyspnea, orthopnea, hypoxia >3LNC from home 2LNC Due to COVID-19 infection and acute on chronic HFpEF exacerbation In setting of recent GBS, but no suspicion for GBS recurrence, NIF's -40 and appropriate Symptoms POA, symptom start date 7/21, + COVID test 7/23 Patient is vaccinated End isolation date: 8/2  Pulmonology consul Pulmonology consulted: continue decadron x 10 days and azithromycin (now finished), signed off 7/27 BiPAP nightly, will need OP sleep study and CPAP titration OP Weaned back to home 2L NC, unlabored, feels breathing is stable (7/31) 10d quarantine ended on 8/1 before return to SNF 8/2/23 AMPAC 21, discussed with case management, patient, ok for home at discharge with HHC Acute on chronic HFpEF (Resolved) Dependent edema (Improved) Mild AS BNP 800's, CXR: pulmonary edema Echo (7/19/23): LVEF 60%, mild AS Has been on PO Lasix for 20 years Started on IV Lasix > now on Lasix 40 mg daily  Wrap lower ext and keep elevated prn BiPAP initiated on admission> now PRN only  Cardiology consulted: diuresis, fluid restriction, and prn BiPAP Decreased home Norvasc to help with LE swelling, but BP trending up so resumed home dose (7/31) Continue home ASA, losartan, coreg, and lasix   Recent Guillain-Barre Syndrome Admitted to MC in June, received 5 days of IVIG Discharged to IPR and has been residing at a SNF Pt feels her leg/arm numbness and weakness is improving Was not able to make her neurology f/u appointment due to being at SNF for rehab Neurology consulted NIF -40 and reassuring against respiratory neuromuscular weakness.  Pulm/CC followed, plan outpatient follow-up with neuromuscular re-scheduled for 8/22/23  PT/OT consulted - improving, AMPAC 21    HTN, Essential Benign, controlled Cont Norvasc, coreg and Cozaar Norvasc originally lowered for LE edema but resumed home dose (7/31) due to highs Coreg dose increased due to continued highs (8/1) Seems to have improved somewhat (8/2) - awaiting repeat before discharge but if still high might add scheduled hydralazine at discharge. Encouraged PCP F/u and will provide BP kit script   Elevated troponin Mild elevation to 26 EKG is without ischemic changes No chest pain at admission Likely demand ischemia from respiratory failure Cardiology consulted-no further ischemic workup anticipated   Right Otitis Externa (Resolved) Right ear pain and drainage Significant swelling and TTP of ear canal unable to visualize inner ear Ciprodex otic drops with significant improvement since 7/26   Type 2 diabetes Hgb A1c (6/8/23): 7.6 Home regimen: basaglar 8 units nights, SSI
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardiac failure acute, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Diuretic therapy
Clinical narrative: Patient is a 79 y.o. female patient of MD with history of Guillain-Barre Syndrome, COPD, type 2 diabetes presented to Medical Center with shortness of breath and fluid overload on chest imaging found to have  Acute HFpEF, Acute Respiratory failure. Hospitalization complicated by COVID.   Acute on chronic hypoxic respiratory failure COVID-19 Infection, URI  COPD OSA Dyspnea, orthopnea, hypoxia >3LNC from home 2LNC Due to COVID-19 infection and acute on chronic HFpEF exacerbation In setting of recent GBS, but no suspicion for GBS recurrence, NIF's -40 and appropriate Symptoms POA, symptom start date 7/21, + COVID test 7/23 Patient is vaccinated End isolation date: 8/2  Pulmonology consul Pulmonology consulted: continue decadron x 10 days and azithromycin (now finished), signed off 7/27 BiPAP nightly, will need OP sleep study and CPAP titration OP Weaned back to home 2L NC, unlabored, feels breathing is stable (7/31) 10d quarantine ended on 8/1 before return to SNF 8/2/23 AMPAC 21, discussed with case management, patient, ok for home at discharge with HHC Acute on chronic HFpEF (Resolved) Dependent edema (Improved) Mild AS BNP 800's, CXR: pulmonary edema Echo (7/19/23): LVEF 60%, mild AS Has been on PO Lasix for 20 years Started on IV Lasix > now on Lasix 40 mg daily  Wrap lower ext and keep elevated prn BiPAP initiated on admission> now PRN only  Cardiology consulted: diuresis, fluid restriction, and prn BiPAP Decreased home Norvasc to help with LE swelling, but BP trending up so resumed home dose (7/31) Continue home ASA, losartan, coreg, and lasix   Recent Guillain-Barre Syndrome Admitted to MC in June, received 5 days of IVIG Discharged to IPR and has been residing at a SNF Pt feels her leg/arm numbness and weakness is improving Was not able to make her neurology f/u appointment due to being at SNF for rehab Neurology consulted NIF -40 and reassuring against respiratory neuromuscular weakness.  Pulm/CC followed, plan outpatient follow-up with neuromuscular re-scheduled for 8/22/23  PT/OT consulted - improving, AMPAC 21    HTN, Essential Benign, controlled Cont Norvasc, coreg and Cozaar Norvasc originally lowered for LE edema but resumed home dose (7/31) due to highs Coreg dose increased due to continued highs (8/1) Seems to have improved somewhat (8/2) - awaiting repeat before discharge but if still high might add scheduled hydralazine at discharge. Encouraged PCP F/u and will provide BP kit script   Elevated troponin Mild elevation to 26 EKG is without ischemic changes No chest pain at admission Likely demand ischemia from respiratory failure Cardiology consulted-no further ischemic workup anticipated   Right Otitis Externa (Resolved) Right ear pain and drainage Significant swelling and TTP of ear canal unable to visualize inner ear Ciprodex otic drops with significant improvement since 7/26   Type 2 diabetes Hgb A1c (6/8/23): 7.6 Home regimen: basaglar 8 units nights, SSI
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Dyspnoea, Ear pain, Ear swelling, Echocardiogram abnormal, Ejection fraction
Clinical narrative: Patient is a 79 y.o. female patient of MD with history of Guillain-Barre Syndrome, COPD, type 2 diabetes presented to Medical Center with shortness of breath and fluid overload on chest imaging found to have  Acute HFpEF, Acute Respiratory failure. Hospitalization complicated by COVID.   Acute on chronic hypoxic respiratory failure COVID-19 Infection, URI  COPD OSA Dyspnea, orthopnea, hypoxia >3LNC from home 2LNC Due to COVID-19 infection and acute on chronic HFpEF exacerbation In setting of recent GBS, but no suspicion for GBS recurrence, NIF's -40 and appropriate Symptoms POA, symptom start date 7/21, + COVID test 7/23 Patient is vaccinated End isolation date: 8/2  Pulmonology consul Pulmonology consulted: continue decadron x 10 days and azithromycin (now finished), signed off 7/27 BiPAP nightly, will need OP sleep study and CPAP titration OP Weaned back to home 2L NC, unlabored, feels breathing is stable (7/31) 10d quarantine ended on 8/1 before return to SNF 8/2/23 AMPAC 21, discussed with case management, patient, ok for home at discharge with HHC Acute on chronic HFpEF (Resolved) Dependent edema (Improved) Mild AS BNP 800's, CXR: pulmonary edema Echo (7/19/23): LVEF 60%, mild AS Has been on PO Lasix for 20 years Started on IV Lasix > now on Lasix 40 mg daily  Wrap lower ext and keep elevated prn BiPAP initiated on admission> now PRN only  Cardiology consulted: diuresis, fluid restriction, and prn BiPAP Decreased home Norvasc to help with LE swelling, but BP trending up so resumed home dose (7/31) Continue home ASA, losartan, coreg, and lasix   Recent Guillain-Barre Syndrome Admitted to MC in June, received 5 days of IVIG Discharged to IPR and has been residing at a SNF Pt feels her leg/arm numbness and weakness is improving Was not able to make her neurology f/u appointment due to being at SNF for rehab Neurology consulted NIF -40 and reassuring against respiratory neuromuscular weakness.  Pulm/CC followed, plan outpatient follow-up with neuromuscular re-scheduled for 8/22/23  PT/OT consulted - improving, AMPAC 21    HTN, Essential Benign, controlled Cont Norvasc, coreg and Cozaar Norvasc originally lowered for LE edema but resumed home dose (7/31) due to highs Coreg dose increased due to continued highs (8/1) Seems to have improved somewhat (8/2) - awaiting repeat before discharge but if still high might add scheduled hydralazine at discharge. Encouraged PCP F/u and will provide BP kit script   Elevated troponin Mild elevation to 26 EKG is without ischemic changes No chest pain at admission Likely demand ischemia from respiratory failure Cardiology consulted-no further ischemic workup anticipated   Right Otitis Externa (Resolved) Right ear pain and drainage Significant swelling and TTP of ear canal unable to visualize inner ear Ciprodex otic drops with significant improvement since 7/26   Type 2 diabetes Hgb A1c (6/8/23): 7.6 Home regimen: basaglar 8 units nights, SSI