chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 76.0
Sex: M
Vaccine: COVID19
Symptoms: Streptococcus test negative, Tricuspid valve incompetence
Clinical narrative: Patient is a 77-year-old male with past medical history of nonischemic cardiomyopathy with EF of 60%, paroxysmal AFib on Eliquis, PE in 2020, prostate cancer, chronic obstructive pulmonary disease on 3 L nasal cannula baseline who was admitted for acute hypoxic respiratory failure secondary to COVID. The patient initially was positive on 4/6 with symptoms starting 2 days prior. He was fully vaccinated and boosted.   On admission, the patient was hypoxic in the 80s and required high-flow nasal cannula. He was initially hypotensive but responded well to IV fluids. He was started on IV Solu-Medrol and remdesivir, empirically treated for CAP. Sputum culture grew only normal upper respiratory flora. Legionella and Strep pneumo urine antigens negative. Due to the patient being on high-dose steroids he was started on a basal bolus insulin regimen of Lantus 10 units with moderate dose corrective.  He was given a 1 time dose of IV Lasix 40 mg with appropriate urine output, Cr increased mildly after. Lasix holiday on 4/10. Resumed home dose on 4/11 of 20 mg PO. Was taking every other day at home but discharged on daily to maintain euvolemia. Weaned back to baseline O2 requirement of 3 LPM NC and transitioned to PO steroids on 4/11. Received 5 days of IV CTX for CAP and received remdesivir until day of discharge.    Patient was discharged home in stable condition on 4/11/2022. He was tolerating a general diet and back to his baseline O2 requirement, maintaining appropriate oxygen saturation with ambulation. Blood cultures drawn 4/7 were NGTD x4 days.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Anticoagulant therapy, COVID-19, Cellulitis, Deep vein thrombosis, Influenza A virus test negative
Clinical narrative: Wound Infection     cellulitus on the leg, failed outpatient treatment both         HPI:   This is a 69y.o. female with a past medical hx of cellulitis, HTN, DM, CAD who presented to the ED with complaints of pain and wound infection. Per chart review patient was undergoing treatment with clindamycin and doxycycline. Patient also complained of bilateral lower extremity swelling. Bilateral lower extremity doppler revealed a DVT f right femoral vein. No evidence of DVT in Left lower extremity. Patient was placed on a heparin infusion and placed on vancomycin for lower extremity cellulitis. Patient seen and examined, eating breakfast, states she is doing fine. No CP, N/V/D.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Influenza B virus test, Pain, Peripheral swelling, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
Clinical narrative: Wound Infection     cellulitus on the leg, failed outpatient treatment both         HPI:   This is a 69y.o. female with a past medical hx of cellulitis, HTN, DM, CAD who presented to the ED with complaints of pain and wound infection. Per chart review patient was undergoing treatment with clindamycin and doxycycline. Patient also complained of bilateral lower extremity swelling. Bilateral lower extremity doppler revealed a DVT f right femoral vein. No evidence of DVT in Left lower extremity. Patient was placed on a heparin infusion and placed on vancomycin for lower extremity cellulitis. Patient seen and examined, eating breakfast, states she is doing fine. No CP, N/V/D.
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Ultrasound Doppler abnormal, Wound infection
Clinical narrative: Wound Infection     cellulitus on the leg, failed outpatient treatment both         HPI:   This is a 69y.o. female with a past medical hx of cellulitis, HTN, DM, CAD who presented to the ED with complaints of pain and wound infection. Per chart review patient was undergoing treatment with clindamycin and doxycycline. Patient also complained of bilateral lower extremity swelling. Bilateral lower extremity doppler revealed a DVT f right femoral vein. No evidence of DVT in Left lower extremity. Patient was placed on a heparin infusion and placed on vancomycin for lower extremity cellulitis. Patient seen and examined, eating breakfast, states she is doing fine. No CP, N/V/D.
Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Blister, Burning sensation, Skin warm
Clinical narrative: May 5/8/2021 I felt a burning in leg and saw that there were 3 very large blisters and they continued to grow and was hot to touch, so I went to Urgent Care. Because I was on Prednisone, I've never had any reaction like this. I thought it was bug bites, but it wasn't. I went to Urgent Care. They concluded that it wasn't bug bites. They realized that I had received Humira shot, 2 hours after Moderna vaccine. They told me to use my Clobetasol Inhaler, finished Prednisone then they gave me a prescription for an anti-biotic and sent me home. Advised that I shouldn't Biologic vaccine near the time of the COVID vaccines.
Age: 14.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Adverse event: Mis-stored vaccine administered. Result: revaccinated.
Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Acoustic stimulation tests, Condition aggravated, Magnetic resonance imaging head, Tinnitus
Clinical narrative: Worsening Tinnitus.  I am not 100% sure when it exactly started because it is often masked by other sounds or mental.  However, within a couple of weeks of getting the vaccine, the tinnitus was definitely worse than it was prior to getting the vaccine.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Bradycardia, Cardiac monitoring, Cardiac pacemaker insertion, Condition aggravated, Dyspnoea
Clinical narrative: Soon afterwards, I was bradycardic and I went to hospital and they put a pacemaker in. Unsure of exact dates, probably weeks later. It wasn't right away. I had problems before I went in which was a weird heartbeat and high blood pressure. I was hospitalized at Hospital for a couple of days. I still have shortness of breath.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram, Electrocardiogram, Heart rate irregular, Hypertension, Laboratory test
Clinical narrative: Soon afterwards, I was bradycardic and I went to hospital and they put a pacemaker in. Unsure of exact dates, probably weeks later. It wasn't right away. I had problems before I went in which was a weird heartbeat and high blood pressure. I was hospitalized at Hospital for a couple of days. I still have shortness of breath.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Ultrasound scan
Clinical narrative: Soon afterwards, I was bradycardic and I went to hospital and they put a pacemaker in. Unsure of exact dates, probably weeks later. It wasn't right away. I had problems before I went in which was a weird heartbeat and high blood pressure. I was hospitalized at Hospital for a couple of days. I still have shortness of breath.
Age: 77.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive, Sepsis, Urinary tract infection
Clinical narrative: Pt was a direct admit from Hospital and was admitted for shortness of breath and found to have a UTI with sepsis.  She was tested for COVID prior to transfer and found to  be COVID positive.
Age: 15.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Adverse event: Mis-stored vaccine administered. Result: revaccinated.
Age: 59.0
Sex: F
Vaccine: UNK
Symptoms: COVID-19, Chest discomfort, Cough, Fatigue, Headache
Clinical narrative: I had COVID - breakthrough case with dry cough, headache, chest tightness, sore throat and general tiredness.
Age: 59.0
Sex: F
Vaccine: UNK
Symptoms: Oropharyngeal pain, Vaccine breakthrough infection
Clinical narrative: I had COVID - breakthrough case with dry cough, headache, chest tightness, sore throat and general tiredness.
Age: 3.0
Sex: F
Vaccine: VARCEL
Symptoms: Rash erythematous, Rash papular
Clinical narrative: Pt. is 3 years of age. She was scheduled to receive her first dose of MMR, Varicella (Chicken Pox), and Hepatitis A vaccines. The Screening Checklist for Contraindications was reviewed. Pt. experienced a fever of 103?F after vaccines when she was an infant. It was treated with Tylenol. There were no other contraindications for vaccines today. Pt. was given the MMR vaccine SQ and the Hepatitis A vaccine IM in her Right Arm. The Varicella vaccine was given SQ in her Left Arm. Approximately 3 minutes after the vaccines were given, two pink raised areas approximately 3 mm diameter were noticed on her upper medial Left Arm.  They both resembled pimples with a raised bright pink/red area in the center and fully surrounded by a flat pink area. She also had a few raised areas behind her Left Ear, one 3mm pink raised area on her upper left chest and back. She did not complain of any itching or discomfort. Pt. was monitored for 30 minutes. The raised area on her chest and area behind her ear resolved. There was another 5mm x 3mm area noted on the lumbar spine observed 20 minutes later. Mom was instructed to follow-up with her doctor regarding administration of an antihistamine. Pt. was not in any respiratory distress and mom was instructed to call EMS if she had any swelling of her lips, tongue, difficulty breathing. Mom verbalized understanding and left at 3:45 p.m. with symptoms improving.
Age: 17.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Adverse event: Mis-stored vaccine administered. Result: revaccinated.
Age: 14.0
Sex: M
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: Adverse event: Mis-stored vaccine administered. Result: revaccinated.
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase normal, Albumin CSF increased, Aspartate aminotransferase normal, Asthenia, Blood creatinine normal
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Blood culture negative, Blood glucose normal, Bone disorder, C-reactive protein normal, CSF culture negative
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: CSF glucose increased, CSF immunoglobulin increased, CSF protein increased, CSF red blood cell count positive, CSF test
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Enterovirus test negative, Eyelid ptosis, Gait disturbance, Guillain-Barre syndrome, Haematocrit increased
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Haemoglobin increased, Headache, Hemiparesis, Herpes simplex test negative, Human herpes virus 6 serology negative
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Immunoglobulin therapy, Intracranial pressure increased, Joint injury, Lumbar puncture, Magnetic resonance imaging head abnormal
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Magnetic resonance imaging spinal normal, Meningitis aseptic, Metastases to meninges, Muscular weakness, Mycoplasma test negative
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Nausea, Nerve root injury, Neutrophil count decreased, Papilloedema, Platelet count normal
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Red blood cell sedimentation rate normal, Sitting disability, Varicella virus test negative, Venogram normal, Viral test negative
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Vision blurred, Weight bearing difficulty, White blood cell count normal, X-ray limb abnormal, X-ray of pelvis and hip abnormal
Clinical narrative: 12/4/21: 2nd dose of Pfizer Covid vaccine 12/23/21: FIrst symptom of LEFT sided ptosis (did not resolve) 1/13/22: Noticable worsening of LEFT ptosis 1/23/22: Limping began  1/24/22: Limping worsened with LEFT leg splinting (knee pointed inwards) 1/26/22: Presented to PCP; labs obtained:  WBC 9.4 (37N, 55L), H&H 14.2/41.9, Plts 274. ESR 2, CRP <1.0. Glu 84, cr 0.38, AST 33, ALT 17. Left lower extremity XR done and showed a "cortical irregularity of the left femoral head".  1/29/22: Presented to ED: Pelvis XR showing LEFT femoral head flattening and irregularity, possible AVN vs benign variant. Ortho consulted and felt consistent with LCP.  ***PLEASE SEE PAGE 2 FOR CONTINUED TIMELINE*** 2/3/22: Seen at clinic  was unable to bear weight, had a positive Gower's sign prompting non-con spine MRI which was normal.  2/4/22: Seen by Neuro for LEFT sided headache, LEFT eye ptosis and LEFT leg weakness; referred to ED and admitted.  2/4/22  2/11/22: Admitted for progressive LEFT sided weakness. Brain MRI showed diffuse cauda equine nerve root thickening and enhancement (greatest ventrally) and mild leptomeningeal enhancement circumscribing the conus; all suggestive of an acute inflammatory demyelinating polyradiculopathy (AIDP, GBS). Labs showed WBC 6.9, Hct 31.7, Plts 188; ANC 1173; ESR 19, CRP <0.8. Blood cultures from 2/7/22 were negative. LP done on 2/5/22 which showed CSF WBC 2, RBC 1, Prot 263, Glucose 50; Albumin 162.0, Synthesis Rate 32.43, IgG 17.4, IgG/Albumin Ratio 0.11, IgG Index 0.73. CSF Mycoplasma PCR neg. CSF cultures were negative. He received IVIG 2/5/22  2/7/22 which was subsequently complicated by symptoms of aseptic meningitis.  2/11/22  2/18/22:  Transferred to inpatient rehab, where he showed improvement by the time of discharge.  3/1/22  3/5/22 Admitted to hospital again due to gradual decline in LE strength to point of not being able to sit or walk independently. CIDP started to rise higher on the differential. Toto received another round of IVIG 2g/kg over 2 days  had again post-infusion reaction. Upon discharge had improvement in lower extremity muscle function.  4/4/22  4/7/22 Re-admitted to hospital due to worsening ascending weakness, and new progress nausea / headache in morning, worsening of his ptosis (which had never completely resolved since first appearing on 12/23/21) and blurry vision. He was found to have increased ICP and papilledema on brain MRI; notably, no evidence of demyelination of brain or brainstem. MRI head venogram was normal. Had an LP confirming increased ICP with opening pressure 26-42; WBC 26 (0% polys, 100% other cell types), RBC 2, Prot 150, Glucose 138.  CSF viral PCR panel negative (CMV, HSV, HHV6, ENV, Parecho, VZV PCRs). Culture negative. Elevated WBCs and Protein thought to be secondary to prior IVIG treatments and high protein supportive of CIDP diagnosis. Received IV Methylpred 30 mg/kg from 4/5-4/7. Started on Acetazolamide.   4/16/22 - Continues to follow with Neurology and Rehab / Therapy
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test normal, Chest X-ray normal, Dyspnoea, Dyspnoea at rest, Dyspnoea exertional
Clinical narrative: Out of the blue I noticed I had trouble getting a deep breath while laying on couch or daily activities. I was walking doing my normal walks and couldn't get a deep breath. After a couple of weeks I called my doc and was told to go to ER. Did EKG, COVID test, checked fluid around heart and everything came back fine. Was told to f/u with family doctor. Went to see her and she put me on Singulair and was told to take 1 pill a day. Also had albuterol and was told to do two puff several times a day. I was also told to take Prilosec for a month. Only did Singulair for two weeks because I had side effects only did Prilosec for 3 weeks. The symptoms stopped after 2- 3 months.
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram normal, Laboratory test normal, SARS-CoV-2 test negative
Clinical narrative: Out of the blue I noticed I had trouble getting a deep breath while laying on couch or daily activities. I was walking doing my normal walks and couldn't get a deep breath. After a couple of weeks I called my doc and was told to go to ER. Did EKG, COVID test, checked fluid around heart and everything came back fine. Was told to f/u with family doctor. Went to see her and she put me on Singulair and was told to take 1 pill a day. Also had albuterol and was told to do two puff several times a day. I was also told to take Prilosec for a month. Only did Singulair for two weeks because I had side effects only did Prilosec for 3 weeks. The symptoms stopped after 2- 3 months.
Age: 52.0
Sex: M
Vaccine: COVID19
Symptoms: Differential white blood cell count, Full blood count, Iron deficiency anaemia
Clinical narrative: Developed iron deficiency anemia.
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory failure, Blood glucose increased, COVID-19, Cough, Fatigue
Clinical narrative: Date of Consultation:  3/18/2022  Time of Consultation:  10:38 AM    Assessment & Plan:   Respiratory Acute hypoxemic respiratory failure due to COVID-19 (CMS/HCC) Assessment & Plan Symptoms of altered mental status cough sore throat fatigue requiring supplemental O2.   Vaccination status: partially last dose 5/5/2021 Symptom onset: Approximately 3/14 Test date: 3/17 O2 Management NC 3L SpO2: 95 %   Periods of desaturation, multifactorial, underlying sleep apnea plus minus superimposed Covid. Out of caution and high risk for progression, have offered dexamethasone along with remdesivir.  Patient appreciates and understands. This was addressed with internal medicine. Additionally it was recommended that he should reconnect with a sleep clinic to address sleep apnea.       Reason for Consultation: COVID 19   History of Present Illness: Patient is a 61y.o. year old male    This patient is very pleasant 61-year-old male who provides his own history.  He is not completely aware of the the circumstances precipitating admission however his fiancée indicates he was not appropriate mentally.  He also had elevated blood sugars.  In discussion today he indicates he had a sore throat and a cough associated with fatigue over the course of the 48 to 72 hours prior to admission.  He is not had previous infections with Covid virus.  He was vaccinated x2 injections last being in May.  He attempted to get his third dose of vaccine but was not able to coordinate.  Since admission he has been on nasal cannula.  This morning nursing found him to be sleeping but the setting into the upper 80s.  He was aroused placed on higher amounts of nasal cannula i.e. 5 to 6 L/min and recovered quickly.  During my evaluation he was placed on nasal cannula.  After about 15 to 20 minutes he was satting at about 88 to 89% without tachycardia.  Placement of nasal cannula back to 2 to 3 L yielded an SPO2 of approximately 93 to 95%.  He does admit to wearing a nocturnal mask at about 2008 following a sleep study test by a physician previously practicing.  He only used the mask for about 6 months.  He never did return for subsequent evaluations and knows that the clinic is currently closed.     Addressed primary therapy for mild to moderate Covid.  Patient concurs with the combination of steroids and remdesivir.     Vaccination status: partially last dose 5/5/2021 Symptom onset: Approximately 3/14 Test date: 3/17 O2 Management NC 3L SpO2: 95 %   COVID 19 INFLAMMATORY MARKERS:
Age: 60.0
Sex: M
Vaccine: COVID19
Symptoms: Influenza A virus test negative, Influenza B virus test, Mental status changes, Oropharyngeal pain, Oxygen saturation decreased
Clinical narrative: Date of Consultation:  3/18/2022  Time of Consultation:  10:38 AM    Assessment & Plan:   Respiratory Acute hypoxemic respiratory failure due to COVID-19 (CMS/HCC) Assessment & Plan Symptoms of altered mental status cough sore throat fatigue requiring supplemental O2.   Vaccination status: partially last dose 5/5/2021 Symptom onset: Approximately 3/14 Test date: 3/17 O2 Management NC 3L SpO2: 95 %   Periods of desaturation, multifactorial, underlying sleep apnea plus minus superimposed Covid. Out of caution and high risk for progression, have offered dexamethasone along with remdesivir.  Patient appreciates and understands. This was addressed with internal medicine. Additionally it was recommended that he should reconnect with a sleep clinic to address sleep apnea.       Reason for Consultation: COVID 19   History of Present Illness: Patient is a 61y.o. year old male    This patient is very pleasant 61-year-old male who provides his own history.  He is not completely aware of the the circumstances precipitating admission however his fiancée indicates he was not appropriate mentally.  He also had elevated blood sugars.  In discussion today he indicates he had a sore throat and a cough associated with fatigue over the course of the 48 to 72 hours prior to admission.  He is not had previous infections with Covid virus.  He was vaccinated x2 injections last being in May.  He attempted to get his third dose of vaccine but was not able to coordinate.  Since admission he has been on nasal cannula.  This morning nursing found him to be sleeping but the setting into the upper 80s.  He was aroused placed on higher amounts of nasal cannula i.e. 5 to 6 L/min and recovered quickly.  During my evaluation he was placed on nasal cannula.  After about 15 to 20 minutes he was satting at about 88 to 89% without tachycardia.  Placement of nasal cannula back to 2 to 3 L yielded an SPO2 of approximately 93 to 95%.  He does admit to wearing a nocturnal mask at about 2008 following a sleep study test by a physician previously practicing.  He only used the mask for about 6 months.  He never did return for subsequent evaluations and knows that the clinic is currently closed.     Addressed primary therapy for mild to moderate Covid.  Patient concurs with the combination of steroids and remdesivir.     Vaccination status: partially last dose 5/5/2021 Symptom onset: Approximately 3/14 Test date: 3/17 O2 Management NC 3L SpO2: 95 %   COVID 19 INFLAMMATORY MARKERS: