chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Heart rate increased, Heart rate irregular, Nausea, Pain, Pain in extremity
Clinical narrative: 10/13/23 Friday, Approx 7:00 pm, about 5 hours after Moderna COVID19 vaccine injection: shaking chills, headache, fatigue, which continued all night and through Saturday, 10/14/23. On 10/14/23, I had bad diarrhea 3x, splitting headache, nausea, shaking chills, body aches, left arm soreness, I also had some weird heartbeats similar to fast heartbeats and skipped heartbeats.
Age: 26.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Syncope
Clinical narrative: Syncope lasting 1-2 minutes. Patient recovered.
Age: 71.0
Sex: M
Vaccine: RSV
Symptoms: Chills, Diarrhoea, Headache, Malaise, Myalgia
Clinical narrative: Fever 102.6 shaking chills malaise myalgia nausea diarrhea headache
Age: 71.0
Sex: M
Vaccine: RSV
Symptoms: Nausea, Pyrexia, Tremor
Clinical narrative: Fever 102.6 shaking chills malaise myalgia nausea diarrhea headache
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Diarrhoea, Pyrexia, Vomiting
Clinical narrative: Diarrhea , vomiting x2, fever
Age: 70.0
Sex: F
Vaccine: COVID19-2
Symptoms: Headache, Interchange of vaccine products, Nausea, Nervousness
Clinical narrative: Previous vaccines were all Pfizer and had no adverse reaction. Unknown to me until arrival, pharmacy only had Moderna vax available. Have read it is okay to mix/match various manufacturers vaccines so I took the Moderna vax.  That afternoon began an almost constant headache, nausea, and shaky feeling. I have not been around anyone to have been exposed to any illnesses and therefore believe my symptoms are a reaction to the Moderna vaccine.  If I had it to do over, I would not take Moderna and wait until Pfizer vaccine was available.
Age: 53.0
Sex: F
Vaccine: FLU4, VARZOS
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Pruritus, Skin warm
Clinical narrative: Patient called on 10/13/23 to report that her arm was hurting, was red, was swollen, was itching, and felt warm to the touch. She said it had progressively gotten worse since she received her vaccine on 10/10/23. I told her to ice the area periodically, to watch to see if the red area grows, and to apply anti-itch cream (i.e. hydrocortisone) if it kept itching. I told her to follow up with her doctor for guidance on Monday 10/16/23 if she was still having trouble.
Age: 70.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19, Malaise, SARS-CoV-2 test positive
Clinical narrative: No symptoms prior to the shot.  Developed mild symptoms shortly thereafter that got worse over the next 24 hours. Tested positive for Covid in the evening of 10/12/2023.  I know of 2 other people who had exactly the same experience.
Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Condition aggravated, Electrocardiogram, Nodal rhythm
Clinical narrative: Accelerated Junctional Rhythm
Age: 16.0
Sex: F
Vaccine: HPV9, MENB, MNQ
Symptoms: Activated partial thromboplastin time prolonged, Anticoagulant therapy, Antiphospholipid antibodies positive, Coagulation test abnormal, Deep vein thrombosis
Clinical narrative: right arm pain and swelling 5/15/23, evaluated by ER at hospital, found to have DVT of right radial and brachial vein as well as superficial thrombosis of the right cephalic and basilic veins transferred to another Hospital in another location, admitted 5/15/23 to 5/18/23, initially started on heparin drip and completed treatment with lovenox consulted by hematology with coagulation workup resolution of thromboses by doppler ultrasound
Age: 16.0
Sex: F
Vaccine: HPV9, MENB, MNQ
Symptoms: Pain in extremity, Peripheral swelling, Protein C decreased, Prothrombin time prolonged, Superficial vein thrombosis
Clinical narrative: right arm pain and swelling 5/15/23, evaluated by ER at hospital, found to have DVT of right radial and brachial vein as well as superficial thrombosis of the right cephalic and basilic veins transferred to another Hospital in another location, admitted 5/15/23 to 5/18/23, initially started on heparin drip and completed treatment with lovenox consulted by hematology with coagulation workup resolution of thromboses by doppler ultrasound
Age: 16.0
Sex: F
Vaccine: HPV9, MENB, MNQ
Symptoms: Ultrasound Doppler abnormal
Clinical narrative: right arm pain and swelling 5/15/23, evaluated by ER at hospital, found to have DVT of right radial and brachial vein as well as superficial thrombosis of the right cephalic and basilic veins transferred to another Hospital in another location, admitted 5/15/23 to 5/18/23, initially started on heparin drip and completed treatment with lovenox consulted by hematology with coagulation workup resolution of thromboses by doppler ultrasound
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Injection site pain, Injection site pruritus, Injection site rash
Clinical narrative: Covid arm rash at injection site with redness, itching and pain lasting four days
Age: 72.0
Sex: M
Vaccine: FLUA4
Symptoms: Incorrect dose administered, Myalgia, Wrong product administered
Clinical narrative: pt request one Prevnar 20 and one Fluad. I accidently gave pt 2 Fluad on the same day (different arm). I informed pt possible muscle pain and followed up with pt on the next day
Age: 72.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Condition aggravated, Dysstasia, Full blood count, Laboratory test, Muscular weakness
Clinical narrative: Patient reports experiencing extreme leg weakness to the point he was unable to stand and needed to call an ambulance. He was admitted to hospital were Urine, CBC and Other (pt could not recall other test names) tests were ran, but no significant findings were found. After spending 1 night in the hospital some of the strength has returned, but he still reports more weakness than usual. According to his wife he has a history of weakness in his legs/ difficulty walking , but not to the extent he is currently having.
Age: 72.0
Sex: M
Vaccine: COVID19, FLU4
Symptoms: Urine analysis
Clinical narrative: Patient reports experiencing extreme leg weakness to the point he was unable to stand and needed to call an ambulance. He was admitted to hospital were Urine, CBC and Other (pt could not recall other test names) tests were ran, but no significant findings were found. After spending 1 night in the hospital some of the strength has returned, but he still reports more weakness than usual. According to his wife he has a history of weakness in his legs/ difficulty walking , but not to the extent he is currently having.
Age: 3.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered
Clinical narrative: Incorrect dose given. Contents of entire vial of Moderna Covid-19 Vaccine  2023-2024 for 6 months to 11 years was administered instead of 0.25ml. Once error was identified patient's parents were contacted.
Age: 75.0
Sex: M
Vaccine: COVID19-2, RSV
Symptoms: Aphasia, Blood test, Computerised tomogram, Gait disturbance, Hyperhidrosis
Clinical narrative: came back from walk, had nausea, was unsteady, sweating profusely, low BP, having difficulty completely sentences
Age: 75.0
Sex: M
Vaccine: COVID19-2, RSV
Symptoms: Hypotension, Nausea
Clinical narrative: came back from walk, had nausea, was unsteady, sweating profusely, low BP, having difficulty completely sentences
Age: 61.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Tinnitus
Clinical narrative: Tinnitus or  noise in head that makes hearing difficult
Age: 19.0
Sex: M
Vaccine: HEP
Symptoms: Disorientation, Dizziness, Glassy eyes, Muscle contracture, Pallor
Clinical narrative: Pt stated he had a history of passing out after vaccination. Pt placed in chair for vaccination. Post vaccination pt had loss of color in his face. Pt leaned forward stating he was dizzy. Pt tensed with muscles contracted forward, eyes glassed over and vocalized a cooing sound. Pt maintained contracted position for aprox 30 seconds. Pt reoriented on day and place. Pt answered appropriately. Pt questioned if he has ever had a seizure before, which he stated he did. Pt instructed to stay seated while we requested for Dr. assessment. Pt stated he felt as though he was getting dizzy again, as he went into the same episode, again lasting aprox 30 seconds, which he was reoriented again post episode.
Age: 19.0
Sex: M
Vaccine: HEP
Symptoms: Speech disorder, Tension
Clinical narrative: Pt stated he had a history of passing out after vaccination. Pt placed in chair for vaccination. Post vaccination pt had loss of color in his face. Pt leaned forward stating he was dizzy. Pt tensed with muscles contracted forward, eyes glassed over and vocalized a cooing sound. Pt maintained contracted position for aprox 30 seconds. Pt reoriented on day and place. Pt answered appropriately. Pt questioned if he has ever had a seizure before, which he stated he did. Pt instructed to stay seated while we requested for Dr. assessment. Pt stated he felt as though he was getting dizzy again, as he went into the same episode, again lasting aprox 30 seconds, which he was reoriented again post episode.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Confusional state, Disorientation
Clinical narrative: patient's daughter reported that he was experiencing confusion and disorientation the day following vaccination and wet himself.  was taken to emergency room for observation and released later that day.
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Ageusia, Asthenia, Constipation, Decreased appetite, Headache
Clinical narrative: EXTREME WEAKNESS, HIGH FEVER, LOSS OF APPETITE, NO TASTE, POUNDING HEADACHE, NUMBNESS IN MY FINGERTIPS, UNABLE TO HAVE A BOWEL MOVEMENT
Age: 65.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoaesthesia, Pyrexia
Clinical narrative: EXTREME WEAKNESS, HIGH FEVER, LOSS OF APPETITE, NO TASTE, POUNDING HEADACHE, NUMBNESS IN MY FINGERTIPS, UNABLE TO HAVE A BOWEL MOVEMENT
Age: 61.0
Sex: F
Vaccine: FLU4
Symptoms: Dysphagia, Gingival bleeding, Swelling
Clinical narrative: Large hive like swelling in back of neck, bleeding gums, difficulty swallowing
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Feeling of body temperature change, Headache, Myalgia, Nausea
Clinical narrative: Serious rolling muscle pain, blistering headache, nausea, fatigue, hot and cold.
Age: 72.0
Sex: F
Vaccine: COVID19-2
Symptoms: Arthralgia, Erythema, Fatigue, Headache, Myalgia
Clinical narrative: Red, itchy arm, burning pain in elbow, headache, muscle aches, fatigue.  Arm and elbow pain continue still, headache lasted 36 hours, the rest resolved in 24 hours.
Age: 72.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pain, Pain in extremity, Pruritus
Clinical narrative: Red, itchy arm, burning pain in elbow, headache, muscle aches, fatigue.  Arm and elbow pain continue still, headache lasted 36 hours, the rest resolved in 24 hours.
Age: 84.0
Sex: F
Vaccine: FLU4
Symptoms: Injection site bruising
Clinical narrative: Pt experienced extreme bruising at admin site after receiving vaccine.
Age: 54.0
Sex: F
Vaccine: HEPA, MMRV, TD, VARCEL, VARZOS
Symptoms: Product administered to patient of inappropriate age
Clinical narrative: Patient was given Proquad and varivax vaccine.
Age: 59.0
Sex: F
Vaccine: COVID19, UNK, VARZOS
Symptoms: Anxiety, Blood pressure decreased, Blood test normal, Chest X-ray normal, Computerised tomogram normal
Clinical narrative: No problems other than sore at site until 6:20am on October6, 2023. When walking to the bathroom I began flushing and became lightheaded. I went back to my bed, and called in sick, as I knew something was wrong. I had more issues with flushing and light-headedness throughout the morning. Slept from 9:15a - 11:30a. I thought it had passed. Walked to the Kitchen to get a glass of water. As I was at the sink filling the cup, I had a sudden onset of othrostatichypotension, and crumpled to the floor, hitting my chin on the counter and my knee on the cupboard handle (EMS does not work with computer.) After 4 attempts to connect with someone, I finally resorted to calling my Mom. Luckily her In-Home Service Provider was there and came down the hill to help me. She called the ambulance for me that took me to the local ER, where I remained the next 5 hours. I was pretty sure I was having a side-effect from the vaccine, but Dr was focused on my BP medication instead. I KNOW that was not the issue...I hadn't even taken any meds the day of the event! I worked with my family doctor at lowering my BP meds a year prior, and we determined the lowest I could safely go was 4omg. At any rate, Dr ordered chest x-rays and a CT scan. Both came back fine. I was released around 5:30pm. I was repetitious about WALKING out, but with hubby at my side I did. I had some anxiety about it after all I had been through, but there was no more issues with light-headedness. I was fine from there.as I went down. I was unconscious between 5-7minutes, traced by my use of computer which I used to try to call for help.
Age: 59.0
Sex: F
Vaccine: COVID19, UNK, VARZOS
Symptoms: Dizziness, Electrocardiogram normal, Face injury, Fall, Flushing
Clinical narrative: No problems other than sore at site until 6:20am on October6, 2023. When walking to the bathroom I began flushing and became lightheaded. I went back to my bed, and called in sick, as I knew something was wrong. I had more issues with flushing and light-headedness throughout the morning. Slept from 9:15a - 11:30a. I thought it had passed. Walked to the Kitchen to get a glass of water. As I was at the sink filling the cup, I had a sudden onset of othrostatichypotension, and crumpled to the floor, hitting my chin on the counter and my knee on the cupboard handle (EMS does not work with computer.) After 4 attempts to connect with someone, I finally resorted to calling my Mom. Luckily her In-Home Service Provider was there and came down the hill to help me. She called the ambulance for me that took me to the local ER, where I remained the next 5 hours. I was pretty sure I was having a side-effect from the vaccine, but Dr was focused on my BP medication instead. I KNOW that was not the issue...I hadn't even taken any meds the day of the event! I worked with my family doctor at lowering my BP meds a year prior, and we determined the lowest I could safely go was 4omg. At any rate, Dr ordered chest x-rays and a CT scan. Both came back fine. I was released around 5:30pm. I was repetitious about WALKING out, but with hubby at my side I did. I had some anxiety about it after all I had been through, but there was no more issues with light-headedness. I was fine from there.as I went down. I was unconscious between 5-7minutes, traced by my use of computer which I used to try to call for help.
Age: 59.0
Sex: F
Vaccine: COVID19, UNK, VARZOS
Symptoms: Impaired work ability, Injection site pain, Joint injury, Loss of consciousness, Orthostatic hypotension
Clinical narrative: No problems other than sore at site until 6:20am on October6, 2023. When walking to the bathroom I began flushing and became lightheaded. I went back to my bed, and called in sick, as I knew something was wrong. I had more issues with flushing and light-headedness throughout the morning. Slept from 9:15a - 11:30a. I thought it had passed. Walked to the Kitchen to get a glass of water. As I was at the sink filling the cup, I had a sudden onset of othrostatichypotension, and crumpled to the floor, hitting my chin on the counter and my knee on the cupboard handle (EMS does not work with computer.) After 4 attempts to connect with someone, I finally resorted to calling my Mom. Luckily her In-Home Service Provider was there and came down the hill to help me. She called the ambulance for me that took me to the local ER, where I remained the next 5 hours. I was pretty sure I was having a side-effect from the vaccine, but Dr was focused on my BP medication instead. I KNOW that was not the issue...I hadn't even taken any meds the day of the event! I worked with my family doctor at lowering my BP meds a year prior, and we determined the lowest I could safely go was 4omg. At any rate, Dr ordered chest x-rays and a CT scan. Both came back fine. I was released around 5:30pm. I was repetitious about WALKING out, but with hubby at my side I did. I had some anxiety about it after all I had been through, but there was no more issues with light-headedness. I was fine from there.as I went down. I was unconscious between 5-7minutes, traced by my use of computer which I used to try to call for help.
Age: 62.0
Sex: F
Vaccine: FLU4, TDAP
Symptoms: Eye pain, Ocular discomfort
Clinical narrative: Patient called the pharmacy on 10/14/23 and said she was experiencing eye pain that began shortly after her two immunizations on 10/12/23 and continued until today. She did not describe them as very painful, but said she could feel pressure in her eyes. I instructed her to go to an urgent care/er immediately to have a doctor examine her.
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Arthritis, Back pain, Condition aggravated, Joint swelling, Pain in extremity
Clinical narrative: This was for SpikeVax. I have undifferentiated arthritis with a high ANA and have had pretty strong flare of symptoms since last night. My distal joints are swollen and my hands are painful enough to have woken me up several times last night. In addition, I'm suffering from severe back and side pain, though that may not be the arthritis. I am submitting this because I realize some researchers are following vaccine reactions in persons with autoimmune disorders. I always react strongly to Covid vaccines, btw.
Age: 62.0
Sex: F
Vaccine: COVID19
Symptoms: Sleep disorder
Clinical narrative: This was for SpikeVax. I have undifferentiated arthritis with a high ANA and have had pretty strong flare of symptoms since last night. My distal joints are swollen and my hands are painful enough to have woken me up several times last night. In addition, I'm suffering from severe back and side pain, though that may not be the arthritis. I am submitting this because I realize some researchers are following vaccine reactions in persons with autoimmune disorders. I always react strongly to Covid vaccines, btw.
Age: 68.0
Sex: M
Vaccine: FLU4
Symptoms: Diarrhoea, Hot flush, Myalgia, Nausea, Vomiting
Clinical narrative: Patient received flu shot and about 2 hours after vaccine was given patient experienced diarrhea, nausea, vomiting, hot flashes and muscle aches
Age: 9.0
Sex: F
Vaccine: COVID19
Symptoms: No adverse event
Clinical narrative: none yet but pt has heart disease
Age: 71.0
Sex: F
Vaccine: FLU4
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site reaction, Injection site swelling
Clinical narrative: Started with tenderness  at injection site within an hour,  then swelling started around injection site about 8-9 hours later,  then redness, itchiness and welt ( welt felt feverish)  developed running down my arm towards inner elbow next morning about 22-24 hours after injection.  Welt lasted for about 3 days but redness and itchiness lasted for  10-12 days.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Chills, Fatigue, Headache, Injection site pain, Myalgia
Clinical narrative: Pain at injection site, headache, chills, fever, fatigue, myalgia. Symptoms severe at 10-12 hours post-injection, fever resolved approximately 24 hours later, headache resolved after 36 hours. Pain at injection site resolved after 3 days.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia
Clinical narrative: Pain at injection site, headache, chills, fever, fatigue, myalgia. Symptoms severe at 10-12 hours post-injection, fever resolved approximately 24 hours later, headache resolved after 36 hours. Pain at injection site resolved after 3 days.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Intermenstrual bleeding, Swelling
Clinical narrative: this pharmacy did not give a sticker as previous vaccines with lot # just an RX number.  All my previous vaccines were on my Left arm last 9/17/2022 I had swelling for 2 weeks. I decided to use right arm for this vaccine. No swelling but on 10/13 started to have bleeding (spotting only)  similar to a light menses. I had Covid in 2020 and had same symptom.
Age: 0.17
Sex: M
Vaccine: DTPPVHBHPB, PNC20, RV5
Symptoms: Blood electrolytes normal, Blood glucose normal, Chest X-ray, Crying, Electrocardiogram
Clinical narrative: Patient cried immediately following injections but had no breath-holding spells.  Mom consoled baby and began to place him in his car seat 5-7 minutes after vaccines given.  Mom immediately noted that he was becoming very pale, limp, and poorly responsive (not apneic) and brought him out of the exam room to the Nurses' station calling for help.  The nurses and I saw him at that time.  He was (1) diffusely very pale, including his lips, (2) breathing shallowly, (3) eyes were open mostly, (4) very hypotonic, and (5) minimally responsive..  We took him back to the exam room.  Heart rate was 60-80.  No resuscitation needed.  Color and tone slowly improved over a  30-minute period and he was transferred to a local pediatric ED for evaluation.
Age: 0.17
Sex: M
Vaccine: DTPPVHBHPB, PNC20, RV5
Symptoms: Hypopnoea, Hyporesponsive to stimuli, Hypotonia, Immediate post-injection reaction, Pallor
Clinical narrative: Patient cried immediately following injections but had no breath-holding spells.  Mom consoled baby and began to place him in his car seat 5-7 minutes after vaccines given.  Mom immediately noted that he was becoming very pale, limp, and poorly responsive (not apneic) and brought him out of the exam room to the Nurses' station calling for help.  The nurses and I saw him at that time.  He was (1) diffusely very pale, including his lips, (2) breathing shallowly, (3) eyes were open mostly, (4) very hypotonic, and (5) minimally responsive..  We took him back to the exam room.  Heart rate was 60-80.  No resuscitation needed.  Color and tone slowly improved over a  30-minute period and he was transferred to a local pediatric ED for evaluation.
Age: 77.0
Sex: M
Vaccine: VARZOS
Symptoms: Hypersensitivity, Rash, Rash pruritic
Clinical narrative: HYPERSENSITIVITY RASH THAT REPORTEDLY STARTED ON FACE AND NOW SPREADING ALL OVER UPPER EXTREMETIES. I RECOMMENDED TO GET CHECKED OUT BY THE ER SINCE IT HAD SPREAD FROM FACE TO NOW ALL OVER UPPER PARTS OF BODY. HE SAID IT'S JUST ITCHY LIKE POISON IVY. IT SOUNDED LIKE HE WAS GOING TO GO TO THE ER AFTER I COUNSELED HIM TO DO SO.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Contusion, Dizziness, Fall, Headache, Loss of consciousness
Clinical narrative: MI Ft very dizzy th morning after the shot . I had a slight headache in my left temple. I then blacked out and fell to the floor. I do not remember falling , and becoming conscious while on the floor. I have no idea how long that I was there before waking.. I had a slight bruise to the back of my head.This happened only once.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Memory impairment
Clinical narrative: MI Ft very dizzy th morning after the shot . I had a slight headache in my left temple. I then blacked out and fell to the floor. I do not remember falling , and becoming conscious while on the floor. I have no idea how long that I was there before waking.. I had a slight bruise to the back of my head.This happened only once.
Age: 31.0
Sex: F
Vaccine: YF
Symptoms: Urticaria
Clinical narrative: Patient states her arm initially broke out in hives and the spread to her legs. She noticed this on the morning after the vaccination. She called the pharmacy at 1:30pm to report the reaction, stating the hives were already fading from this morning. I suggested she take a dose of benadryl and reach out to her primary care provider. She reported not other issues.
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Atrial fibrillation, Cardioversion, Laboratory test
Clinical narrative: Afib heart event 2 day after injection requiring medication and electroconversion (100 joules)
Age: 75.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Apathy, Condition aggravated, Confusional state, Depressed mood, Depression
Clinical narrative: Severe depressive episode with tearfulness. suicidal ideation. Lack of motivation, psychomotor retardation. confusion I  negative thinkinghave not had this severe depression for at  least 10 years.  Previous curent depressions 4 hours or so, easily dealt with  Severity startin better after 4 days, Currently still not at baseline, sad,
Age: 75.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Negative thoughts, Psychomotor retardation, Suicidal ideation, Tearfulness
Clinical narrative: Severe depressive episode with tearfulness. suicidal ideation. Lack of motivation, psychomotor retardation. confusion I  negative thinkinghave not had this severe depression for at  least 10 years.  Previous curent depressions 4 hours or so, easily dealt with  Severity startin better after 4 days, Currently still not at baseline, sad,
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Alanine aminotransferase increased, Anticoagulant therapy, Aspartate aminotransferase increased
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood creatinine, Blood culture negative, Blood glucose, Brain natriuretic peptide increased, COVID-19
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19 pneumonia, Cardiac failure acute, Cardiac failure congestive, Cardiogenic shock, Chest X-ray abnormal
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Congestive hepatopathy, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Ejection fraction decreased
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Electrocardiogram normal, Encephalopathy, Gastrooesophageal reflux disease, Glycosylated haemoglobin, Hepatitis A
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hepatitis A antibody positive, Hepatitis B core antigen, Hepatitis B surface antibody negative, Hyperglycaemia, Hypervolaemia
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypokalaemia, Hypokinesia, Hypotension, Intensive care, International normalised ratio increased
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Ischaemic hepatitis, Lactic acidosis, Left ventricular failure, Liver function test increased, Lung infiltration
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms
Age: 85.0
Sex: M
Vaccine: COVID19-2
Symptoms: Metabolic acidosis, Myocardial ischaemia, Pleural effusion, Prerenal failure, Renal tubular necrosis
Clinical narrative: Patient is a 86 y.o. male with a history of Afib on eliquis, CAD, HLD, and HTN, tested positive for COVID-19 on 9/15/23 who presented to hospital 9/18/2023 with dyspnea and found to be hypotensive, COVID-19 positive. Admitted to the ICU and placed on vasopressor support. Course complicated by AKI, cardiogenic shock, and elevated LFTS with hep A. Medone was consulted to assume care upon transfer out of the ICU. Weaned to RA. Family and patient refused SNF. Discharged home    1. Acute Hypoxemic Respiratory Failure due to COVID-19: pneumonia. tested positive for COVID-19 on 9/15/23, CXR with bilateral effusions and right lower lobe infiltrate.s/p paxlovid  PTA. Required HHFNC, weaned to RA. S/p decadron while inpatient.  Not a candidate for Remdesivir given elevated LFTs. Continue airborne precautions until 9/25/2023.  Weaned to room air. 2. Mixed Cardiogenic and Septic Shock: TTE 9/19/23 showed EF ~30% with septal and anteroseptal hypokinesis. 9/18/23 blood cultures negative, S/p lasix and dobutamine drip. S/p zosyn and Rocephin.  Daughter requested Augmentin at discharge. 3. Acute on Chronic Systolic CHF: Echo 9/19/23 with EF 30%, overloaded on admit, BNP 4100, s/p lasix drip. Transitioned to home oral lasix 9/20/23,  4. Acute Renal Failure with hypkalemia: creat 3.64 on admit, baseline normal. Prerenal/ATN in setting of cardiogenic shock. Down-trended to creat 1.96 on 9/21/23.  Improved 5. Anion Gap Acidosis with metabolic acidosis with lactic acidosis: secondary to sepsis/AKI. Resolved  6. Elevated LFT's: On admit AST/ALT 1444/1268, AP 166. INR 2.2. multifactorial in setting of  shock liver, congestive hepatopathy  and possibly worsened in the setting of hepatitis A infection and Paxlovid use. Hep A IgM positive; Hep B core antigen and surface antibody negative. RUQ ultrasound unremarkable. 7. Paroxysmal Afib: hx PPM, continued eliquis.  Patient cannot  Continued home nifedipine and toprol 8. Steroid Induced Hyperglycemia: SSI added while on steroids, inpatient  . A1c and Blood sugar trend with PCP. Stopped steroids at dc 9. Acute Encephalopathy: suspect metabolic etiology, s/p precedex-weaned off.  Resolved  10. Elevated Troponin: troponin 50, secondary to demand ischemia. EKG without ischemic changes. 11. GERD: refused Protonix, reports relief with TUMS 12. Hep A: positive 9/20/23. Improved symptoms