chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Respiratory symptom, SARS-CoV-2 test positive, Speech disorder, Troponin increased, Urinary retention
Clinical narrative: Patient Is a 79 y.o. male with PMH of OSA< CVA, GERD, DM#, CAD, CKD, PAF who presented to hospital with acute on chronic AMS, generally thought to be unwell and was found to have COVID with viral sepsis.    Covid 19 viral infection- improved Acute hypoxic respiratory failure- resolved Viral sepsis, POA  Septic on admission, requiring 2L O2  Covid + 10/30/23, (unclear sx onset)  10/30 CXR w/ prominent pulm vasculature and hazy opacities bilat (Edema vs pna)  Remaining infectious w/u negative  Decadron 10/30-11/8, DC with 5 additional days  Will be out of special isolation 11/10 (10/30 day 0, out on day 11)  Has been on room air since 11/1, respiratory symptoms resolved   Acute metabolic encephalopathy - resolving Chronic cognitive impairments Reportedly w/ lethargy/decreased mental status at ECF, only oriented to self. Repetitive answers to questions, non sensicle responses & refusing care at times.  At baseline he is able to hold a conversation per his brother, watches sport games, interactive etc.  Suspect exacerbated by Covid/fever/hypoxia  Recent CVA Sept '23 w/ concerns for underlying dementia  10/30 CTH evolving subacute/chronic R periventricular infarcts (c/w prior) No new focal deficits, hold repeat MRI  Huge improvements from 11/1 to 11/3 Now very near previous baseline  Sitting up, interactive, able to recall events from days prior, conversational OK with DC plan home; spoke w brother and LVM for son  Returning to SNF  Hx of CVA 9/2023 Admitted Sept '23, new subacute R periventricular infacrt, chronic small vessel disease, chronic lacunar infarct  Admit imaging fairly unchanged  Continue ASA/Plavix, Statin and risk factor mgmt  Follow up neurology as OP  Reminded brother of Stroke clinic f/u; info on AVS    CAD  Prior stents, asymptomatic on arrival   Chronically elevated troponin in setting of CKD   EKG no new ischemic changes  Continue medical therapy     Diabetes, type II A1c 6.6% on 9/16/23. Continue basal regimen  SSI added and monitor    CKD III Admit Cr 1.62 ( baseline ~1.8 -2) At baseline during admission    Emphysema NSCLC s/p RUL lobectomy for NSCLC 7/14/23, stage IA2 No active wheezing  outpatient follow up    OSA CPAP ordered    Hypertension, essential BP variable and elevated  Continue home medications and monitor High when his BP meds wear off May need titration of meds as OP   Prostate cancer Urinary retention per note Jan 2023, patient declined surgical option but elected for radiation treatment Continue oxybyutynin
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Viral sepsis
Clinical narrative: Patient Is a 79 y.o. male with PMH of OSA< CVA, GERD, DM#, CAD, CKD, PAF who presented to hospital with acute on chronic AMS, generally thought to be unwell and was found to have COVID with viral sepsis.    Covid 19 viral infection- improved Acute hypoxic respiratory failure- resolved Viral sepsis, POA  Septic on admission, requiring 2L O2  Covid + 10/30/23, (unclear sx onset)  10/30 CXR w/ prominent pulm vasculature and hazy opacities bilat (Edema vs pna)  Remaining infectious w/u negative  Decadron 10/30-11/8, DC with 5 additional days  Will be out of special isolation 11/10 (10/30 day 0, out on day 11)  Has been on room air since 11/1, respiratory symptoms resolved   Acute metabolic encephalopathy - resolving Chronic cognitive impairments Reportedly w/ lethargy/decreased mental status at ECF, only oriented to self. Repetitive answers to questions, non sensicle responses & refusing care at times.  At baseline he is able to hold a conversation per his brother, watches sport games, interactive etc.  Suspect exacerbated by Covid/fever/hypoxia  Recent CVA Sept '23 w/ concerns for underlying dementia  10/30 CTH evolving subacute/chronic R periventricular infarcts (c/w prior) No new focal deficits, hold repeat MRI  Huge improvements from 11/1 to 11/3 Now very near previous baseline  Sitting up, interactive, able to recall events from days prior, conversational OK with DC plan home; spoke w brother and LVM for son  Returning to SNF  Hx of CVA 9/2023 Admitted Sept '23, new subacute R periventricular infacrt, chronic small vessel disease, chronic lacunar infarct  Admit imaging fairly unchanged  Continue ASA/Plavix, Statin and risk factor mgmt  Follow up neurology as OP  Reminded brother of Stroke clinic f/u; info on AVS    CAD  Prior stents, asymptomatic on arrival   Chronically elevated troponin in setting of CKD   EKG no new ischemic changes  Continue medical therapy     Diabetes, type II A1c 6.6% on 9/16/23. Continue basal regimen  SSI added and monitor    CKD III Admit Cr 1.62 ( baseline ~1.8 -2) At baseline during admission    Emphysema NSCLC s/p RUL lobectomy for NSCLC 7/14/23, stage IA2 No active wheezing  outpatient follow up    OSA CPAP ordered    Hypertension, essential BP variable and elevated  Continue home medications and monitor High when his BP meds wear off May need titration of meds as OP   Prostate cancer Urinary retention per note Jan 2023, patient declined surgical option but elected for radiation treatment Continue oxybyutynin
Age: 13.0
Sex: M
Vaccine: COVID19
Symptoms: No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Patient given vaccine manufactured for 6month-11years, given at age 13. No symptoms reported
Age: 8.0
Sex: F
Vaccine: COVID19
Symptoms: Flushing, Injection site erythema, Thirst, Urticaria
Clinical narrative: Patient has received 2 Pfizer COVID vaccine 5-11 year (11/07/2021 and 12/03/2021) , COVID vaccine pfizer bivalent 5-11 year (11/22/2022). Today patient received dose of Moderna 2023-2024 spike protein COVID vaccine 6mo-11year (12/27/2023) patient waited 15 minute per protocol and upon assessment after waiting patient developed a round red half inch circle at the injection site, and located under the adhesive bandage placed, patient had 2 hives on left lower arm region and flushed red cheeks. Patient reported no itching however, scratching her above her left  arm (neck) and above left arm, and lower leg. Patient had no reports of breathing concerns, dizziness, lightheaded, diarrhea, nausea vomiting, and constipation. Patient did develop an increase in thirst had 2 glass full of water (20 oz) total approximately. Per provider vitals obtained all WNL. Given Benadryl 33.7 mg at 11:47 am. Patient was doing well and discharged per provider.
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, COVID-19, Cardiac failure acute, Chest X-ray abnormal, Condition aggravated
Clinical narrative: 89 y.o. male patient of MD with history of previous hip fracture and cva presented to Hospital with shortness of breath, covid and possible hip infection   Acute Hypoxic Respiratory Failure  Suspected combination of covid infection with possible heart failure exacerbation CXR with Pulmonary edema Will follow treatment of covid an HF as below Improved   Covid-19 Virus Infection Date of onset of symptoms: 10/29 Symptoms present on admission: shortness of breath Date of covid positive test: 10/31 per son Vaccination status: vaccinated Imaging: CXR with Pulmonary edema  Oxygen requirements on admission: 9L Current oxygen requirements: RA Medical therapy: steroids Consultants following: none Isolation precautions to end 11/12   Acute on Chronic HFpEF  Suspected exacerbation CXR with Pulmonary edema 2L fluid and then lasix IV given in the ED Will favor dry lung with comorbid covid infection and possible heart failure Continue IV lasix, decreased dose I&O Discharge on small dose of lasix   Right hip fracture, periprosthetic Patient fell during transferring and injured right hip on previous admission S/p open reduction internal fixation of femur on 10/31 Question possible possible post op infection initially  Rocephin and Levaquin given  in the ED - will change to vanc and zosyn Ortho consulted -- no concerns for infection -- stopping antibiotics   CAD Last DES in April 2021 Continue aspirin, plavix and statin   Celiac disease Gluten-free diet   History of CVA Delirium With residual right sided weakness On ASA, plavix, statin at home
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dry lung syndrome, Dyspnoea, Fall, Hip fracture, Left ventricular failure
Clinical narrative: 89 y.o. male patient of MD with history of previous hip fracture and cva presented to Hospital with shortness of breath, covid and possible hip infection   Acute Hypoxic Respiratory Failure  Suspected combination of covid infection with possible heart failure exacerbation CXR with Pulmonary edema Will follow treatment of covid an HF as below Improved   Covid-19 Virus Infection Date of onset of symptoms: 10/29 Symptoms present on admission: shortness of breath Date of covid positive test: 10/31 per son Vaccination status: vaccinated Imaging: CXR with Pulmonary edema  Oxygen requirements on admission: 9L Current oxygen requirements: RA Medical therapy: steroids Consultants following: none Isolation precautions to end 11/12   Acute on Chronic HFpEF  Suspected exacerbation CXR with Pulmonary edema 2L fluid and then lasix IV given in the ED Will favor dry lung with comorbid covid infection and possible heart failure Continue IV lasix, decreased dose I&O Discharge on small dose of lasix   Right hip fracture, periprosthetic Patient fell during transferring and injured right hip on previous admission S/p open reduction internal fixation of femur on 10/31 Question possible possible post op infection initially  Rocephin and Levaquin given  in the ED - will change to vanc and zosyn Ortho consulted -- no concerns for infection -- stopping antibiotics   CAD Last DES in April 2021 Continue aspirin, plavix and statin   Celiac disease Gluten-free diet   History of CVA Delirium With residual right sided weakness On ASA, plavix, statin at home
Age: 88.0
Sex: M
Vaccine: COVID19-2
Symptoms: Open reduction of fracture, Periprosthetic fracture, Pulmonary oedema, SARS-CoV-2 test positive
Clinical narrative: 89 y.o. male patient of MD with history of previous hip fracture and cva presented to Hospital with shortness of breath, covid and possible hip infection   Acute Hypoxic Respiratory Failure  Suspected combination of covid infection with possible heart failure exacerbation CXR with Pulmonary edema Will follow treatment of covid an HF as below Improved   Covid-19 Virus Infection Date of onset of symptoms: 10/29 Symptoms present on admission: shortness of breath Date of covid positive test: 10/31 per son Vaccination status: vaccinated Imaging: CXR with Pulmonary edema  Oxygen requirements on admission: 9L Current oxygen requirements: RA Medical therapy: steroids Consultants following: none Isolation precautions to end 11/12   Acute on Chronic HFpEF  Suspected exacerbation CXR with Pulmonary edema 2L fluid and then lasix IV given in the ED Will favor dry lung with comorbid covid infection and possible heart failure Continue IV lasix, decreased dose I&O Discharge on small dose of lasix   Right hip fracture, periprosthetic Patient fell during transferring and injured right hip on previous admission S/p open reduction internal fixation of femur on 10/31 Question possible possible post op infection initially  Rocephin and Levaquin given  in the ED - will change to vanc and zosyn Ortho consulted -- no concerns for infection -- stopping antibiotics   CAD Last DES in April 2021 Continue aspirin, plavix and statin   Celiac disease Gluten-free diet   History of CVA Delirium With residual right sided weakness On ASA, plavix, statin at home
Age: 0.33
Sex: F
Vaccine: RV1
Symptoms: Inappropriate schedule of product administration, No adverse event
Clinical narrative: Gave first dose of rota to 4 month old patient. No reaction, no treatment
Age: 40.0
Sex: M
Vaccine: HEPA
Symptoms: Underdose
Clinical narrative: Patient came in on 06/05/2023 to receive 2nd Hep A Vaccine but Pediatric/Adolescent Hep A dose was administered instead. Patient only received 0.5-mL does and not the 1-mL dose.
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Blood bicarbonate, Blood creatinine increased, Blood glucose normal
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Blood pH normal, Blood pressure inadequately controlled, COVID-19, Cardiac failure acute, Cardiomegaly
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Chest X-ray abnormal, Chest pain, Computerised tomogram thorax abnormal, Condition aggravated, Culture urine positive
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Diastolic dysfunction, Dyspnoea, Echocardiogram, Electrocardiogram abnormal, Glomerular filtration rate
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Glycosylated haemoglobin, Haemoglobin decreased, Hilar lymphadenopathy, Klebsiella test positive, Klebsiella urinary tract infection
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Left ventricular failure, Leukocytosis, Lung consolidation, Lymphadenopathy mediastinal, N-terminal prohormone brain natriuretic peptide increased
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: PCO2 normal, PO2 decreased, Pericardial effusion, Pleural effusion, Pneumonia
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pneumonia bacterial, Procalcitonin increased, Pulmonary congestion, Pulmonary hypertension, SARS-CoV-2 test positive
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 77.0
Sex: F
Vaccine: COVID19-2
Symptoms: Sepsis, Staphylococcus test positive, Troponin increased, Ventricular extrasystoles
Clinical narrative: Patient is a 78 y.o. female patient of, DO with history of CKD, A-fib, anemia, depression, GERD, hyperlipidemia, diabetes mellitus type 2, hypertension, and overactive bladder, who presented to Hospital with shortness of breath.     Acute hypoxic respiratory failure Bilateral pleural effusion Large pericardial effusion -ruled out on echocardiogram CAP Acute on chronic diastolic CHF Presentation with shortness of breath and chest pain.. labs significant for troponin 30> 31 with negative delta, proBNP 6.8K, leukocytosis 17 K, Hgb 8.5, VBG pH 7.34/PCO2 40/PO2 28/bicarb 21. CXR showed vascular congestion with bilateral pleural effusion, cardiomegaly with pacing leads. CT chest showed marked cardiomegaly with a large pericardial effusion, bilateral pleural effusion with moderate size on the left, bilateral lower lobe partial consolidation suspecting infectious etiology, mild mediastinal and hilar lymphadenopathy. proBNP 6872  EKG with ventricular paced rhythm with PVCs. TTE on 11/2 showed normal LV size and systolic function, grade 2 diastolic dysfunction, small pericardial effusion without tamponade, moderate pulmonary hypertension Cardiology consulted and echo reviewed.  Trivial pericardial effusion.  Signed off Home Eliquis resumed 11/3. IV Lasix 40x1 on 11/3.  Monitor electrolytes and creatinine.  Discharge to home on p.o. Lasix   Sepsis POA- now resolved Coag negative staph bacteremia likely contamination Klebsiella UTI Suspected community-acquired bacterial pneumonia  COVID-19 infection Patient started on Zosyn and Vanco IV empirically in ED. procalcitonin elevated and MRSA swab positive.  Blood cultures growing coag negative staph likely contamination.  We will continue Zosyn for suspected pneumonia and UTI Pro-Cal 0.9 Blood cultures growing coag negative staph likely contamination Urine cultures growing Klebsiella pneumonia.  On IV cefepime. MRSA DNA positive, MRSA PNA less likely  COVID-19 positive.  Not a candidate for remdesivir or Tocilizumab.  On Decadron 6mg x 10 days   AKI on CKD stage III-improving creatinine 2.26, GFR 22 as baseline creatinine 1.3, and GFR 39. Keep monitor renal function. Avoid nephrotoxic medications. Received IV Lasix 40x1 on 11/3. Nephrology consulted and following.  Creatinine improved to 1.9 on 11/4   History of A-fib PPM Hypertension Hyperlipidemia BP is uncontrolled admission 140s/50s. EKG as above with paced rhythm. Continued amlodipine, metoprolol and atorvastatin. Continue Eliquis   Depression Continue home Cymbalta Diabetes mellitus type 2 with peripheral neuropathy Blood glucose 83 on admission, last A1c is 7.4% on 10/18/2023. Continue home Lantus 20 units nightly, and SSI during admission. Hold home oral hypoglycemic meds. Continue gabapentin.   Chronic anemia like IDA Admission labs showed Hgb 8.5 which is around baseline. Continue home iron supplement.   Morbid obesity BMI 41.79 kg/M2. Lifestyle modification is advised
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cardioversion, Echocardiogram normal, Ejection fraction, Ejection fraction normal, Electrocardiogram abnormal
Clinical narrative: after receiving Spikevax, she was noted to have tachycardia. She was sent to Medical Center on December 15, 2023 where EKG revealed supraventricular tachycardia. She was treated with IV adenosine with conversion to sinus rhythm. Thyroid function test were within normal limits. Echocardiogram revealed normal LVEF. Troponins were elevated slightly and cardiology was consulted and they felt that elevated troponin is likely secondary to tachycardia and not from obstructive coronary artery disease. She was started on low-dose beta-blockers and was transferred back to the nursing home where she is a long-term care resident. She has had a decline in functional status and ADLs since return from the hospital. She is now needing moderate to maximal assist with toileting and hygiene.
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: General physical health deterioration, Loss of personal independence in daily activities, Sinus rhythm, Supraventricular tachycardia, Tachycardia
Clinical narrative: after receiving Spikevax, she was noted to have tachycardia. She was sent to Medical Center on December 15, 2023 where EKG revealed supraventricular tachycardia. She was treated with IV adenosine with conversion to sinus rhythm. Thyroid function test were within normal limits. Echocardiogram revealed normal LVEF. Troponins were elevated slightly and cardiology was consulted and they felt that elevated troponin is likely secondary to tachycardia and not from obstructive coronary artery disease. She was started on low-dose beta-blockers and was transferred back to the nursing home where she is a long-term care resident. She has had a decline in functional status and ADLs since return from the hospital. She is now needing moderate to maximal assist with toileting and hygiene.
Age: 78.0
Sex: F
Vaccine: COVID19-2
Symptoms: Thyroid function test normal, Troponin increased
Clinical narrative: after receiving Spikevax, she was noted to have tachycardia. She was sent to Medical Center on December 15, 2023 where EKG revealed supraventricular tachycardia. She was treated with IV adenosine with conversion to sinus rhythm. Thyroid function test were within normal limits. Echocardiogram revealed normal LVEF. Troponins were elevated slightly and cardiology was consulted and they felt that elevated troponin is likely secondary to tachycardia and not from obstructive coronary artery disease. She was started on low-dose beta-blockers and was transferred back to the nursing home where she is a long-term care resident. She has had a decline in functional status and ADLs since return from the hospital. She is now needing moderate to maximal assist with toileting and hygiene.
Age: 28.0
Sex: F
Vaccine: MMR
Symptoms: Exposure during pregnancy, No adverse event, Pregnancy test positive
Clinical narrative: MMR vaccination administered SQ to right upper arm 11/9/2023. No adverse reactions noted. Copy of immunization record provided to patient. Pt left in no acute distress.  12/19/23, presents with for visit, Pregnancy test completed with outcome of 8 week, 2 day pregnancy.
Age: 57.0
Sex: F
Vaccine: HEPA
Symptoms: Product administered to patient of inappropriate age, Underdose, Wrong product administered
Clinical narrative: Patient came in on 10/26/2023 to receive 1st Hep A Vaccine but Pediatric/Adolescent Hep A dose was administered instead. Patient only received 0.5-mL does and not the 1-mL dose.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Blood thyroid stimulating hormone normal, Bronchial hyperreactivity, Bronchitis, Bundle branch block right
Clinical narrative: Patient is a 77 y.o. male patient with history of HTN, HLD, Hypothyroidism, DM2, dementia, MRDD, COPD  presented to Hospital with weakness. Noted to have COVID, no O2 requirement. Started on paxlovid from ID recommendation. Stop statin/fibrate at this time. Complete paxlovid and recommend following with PCP to discus restarting statin/fibrate. Also, recommend stopping glipizde given risk of hypoglycemia especially in elderly. Defer to PCP regarding medication addition for DM. Patient with 24 hour care at home and will resume on DC.    Discharge Diagnoses:   Weakness  Covid-19 Virus Infection COPD, not in exacerbation  Patient with weakness in setting of COVID-19 Per caregiver history, patient usually ambulates with walker however in the ER required 2 person assist just to get up Date of onset of symptoms: 11/10/2023 Symptoms present on admission: Weakness, shortness of breath Date of covid positive test: 11/10/2023 Vaccination status: vaccinated Imaging: CXR?bronchial wall cuffing, consistent with bronchitis or reactive airway disease.  No consolidative pneumonia or other acute pulmonary findings. Oxygen requirements on admission: None Current oxygen requirements: None ID consulted and giving patient paxlovid   Continue inhalers, incentive spirometry, Tessalon for cough, Mucinex for congestion PT/OT consulted, appears to have 24/7 care per nursing. Will likely just go home and continue his health aide   Elevated troponin In setting of COVID-19 Initial troponin 34 then repeat 36 EKG showed NSR with RBBB present on previous  No prior troponin on file Currently denying any chest pain Continue telemetry   Hypothyroidism Continue home levothyroxine TSH WNL Type 2 diabetes On metformin, glipizide at home Recommend likely stopping glipizide at home given risk of hypoglycemia, especially in elderly  Sliding scale insulin while inpatient    GERD Continue home PPI   Anxiety/depression Continue Lexapro   Hyperlipidemia Hold home statin and fenofibrate
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Cough, Depression
Clinical narrative: Patient is a 77 y.o. male patient with history of HTN, HLD, Hypothyroidism, DM2, dementia, MRDD, COPD  presented to Hospital with weakness. Noted to have COVID, no O2 requirement. Started on paxlovid from ID recommendation. Stop statin/fibrate at this time. Complete paxlovid and recommend following with PCP to discus restarting statin/fibrate. Also, recommend stopping glipizde given risk of hypoglycemia especially in elderly. Defer to PCP regarding medication addition for DM. Patient with 24 hour care at home and will resume on DC.    Discharge Diagnoses:   Weakness  Covid-19 Virus Infection COPD, not in exacerbation  Patient with weakness in setting of COVID-19 Per caregiver history, patient usually ambulates with walker however in the ER required 2 person assist just to get up Date of onset of symptoms: 11/10/2023 Symptoms present on admission: Weakness, shortness of breath Date of covid positive test: 11/10/2023 Vaccination status: vaccinated Imaging: CXR?bronchial wall cuffing, consistent with bronchitis or reactive airway disease.  No consolidative pneumonia or other acute pulmonary findings. Oxygen requirements on admission: None Current oxygen requirements: None ID consulted and giving patient paxlovid   Continue inhalers, incentive spirometry, Tessalon for cough, Mucinex for congestion PT/OT consulted, appears to have 24/7 care per nursing. Will likely just go home and continue his health aide   Elevated troponin In setting of COVID-19 Initial troponin 34 then repeat 36 EKG showed NSR with RBBB present on previous  No prior troponin on file Currently denying any chest pain Continue telemetry   Hypothyroidism Continue home levothyroxine TSH WNL Type 2 diabetes On metformin, glipizide at home Recommend likely stopping glipizide at home given risk of hypoglycemia, especially in elderly  Sliding scale insulin while inpatient    GERD Continue home PPI   Anxiety/depression Continue Lexapro   Hyperlipidemia Hold home statin and fenofibrate