chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Arterial therapeutic procedure, COVID-19, Duodenal ulcer, Dyspnoea, Endotracheal intubation
Clinical narrative: Patient is a 71 YO male who presented to Facility on 11/3/2023 for operative management of left shoulder rotator cuff tear with impingement syndrome. At the end of the case the patient failed SBT, and given underlying lung disease and concern for possible hemidiaphragmatic paralysis due to nerve block, the patient remained intubated and was admitted to the CCU service for further evaluation and management. He was eventually able to be extubated. However, after extubation, the patient had onset of BRBPR with hemodynamic instability, for which he remained under CCU care. GI, General Surgery, and IR were consulted during this hospitalization. EGD on 11/5/23 showed one non-bleeding cratered duodenal ulcer with visible vessel in the duodenal bulb which was treated with epinephrine and clipped. He had recurrence of BRBPR and IR performed empiric GDA microcoil embolization on 11/8/23. He subsequently had improvement in his BRBPR. He received in total 7 units PRBCs as well as 1 unit of FFP and 1 unit of of platelets this admission. He was transferred to floor status with recurrence of hematochezia or melena. During his hospitalization, he tested positive for COVID-19 and completed a treatment course of remdesivir and completed 10 days of isolation precautions. He had improvement in his dyspnea symptoms and by discharge was clinically stable and was maintaining adequate oxygenation at room air. He underwent PT and OT, with plan to continue PT at SNF on discharge. He will continue with Protonix 40 mg BID with GI referral placed given his duodenal PUD. He was discharged to SNF in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Haematochezia, Haemodynamic instability, Haemostasis, Intensive care, Melaena
Clinical narrative: Patient is a 71 YO male who presented to Facility on 11/3/2023 for operative management of left shoulder rotator cuff tear with impingement syndrome. At the end of the case the patient failed SBT, and given underlying lung disease and concern for possible hemidiaphragmatic paralysis due to nerve block, the patient remained intubated and was admitted to the CCU service for further evaluation and management. He was eventually able to be extubated. However, after extubation, the patient had onset of BRBPR with hemodynamic instability, for which he remained under CCU care. GI, General Surgery, and IR were consulted during this hospitalization. EGD on 11/5/23 showed one non-bleeding cratered duodenal ulcer with visible vessel in the duodenal bulb which was treated with epinephrine and clipped. He had recurrence of BRBPR and IR performed empiric GDA microcoil embolization on 11/8/23. He subsequently had improvement in his BRBPR. He received in total 7 units PRBCs as well as 1 unit of FFP and 1 unit of of platelets this admission. He was transferred to floor status with recurrence of hematochezia or melena. During his hospitalization, he tested positive for COVID-19 and completed a treatment course of remdesivir and completed 10 days of isolation precautions. He had improvement in his dyspnea symptoms and by discharge was clinically stable and was maintaining adequate oxygenation at room air. He underwent PT and OT, with plan to continue PT at SNF on discharge. He will continue with Protonix 40 mg BID with GI referral placed given his duodenal PUD. He was discharged to SNF in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Oesophagogastroduodenoscopy abnormal, Peptic ulcer, Platelet transfusion, Rectal haemorrhage, Red blood cell transfusion
Clinical narrative: Patient is a 71 YO male who presented to Facility on 11/3/2023 for operative management of left shoulder rotator cuff tear with impingement syndrome. At the end of the case the patient failed SBT, and given underlying lung disease and concern for possible hemidiaphragmatic paralysis due to nerve block, the patient remained intubated and was admitted to the CCU service for further evaluation and management. He was eventually able to be extubated. However, after extubation, the patient had onset of BRBPR with hemodynamic instability, for which he remained under CCU care. GI, General Surgery, and IR were consulted during this hospitalization. EGD on 11/5/23 showed one non-bleeding cratered duodenal ulcer with visible vessel in the duodenal bulb which was treated with epinephrine and clipped. He had recurrence of BRBPR and IR performed empiric GDA microcoil embolization on 11/8/23. He subsequently had improvement in his BRBPR. He received in total 7 units PRBCs as well as 1 unit of FFP and 1 unit of of platelets this admission. He was transferred to floor status with recurrence of hematochezia or melena. During his hospitalization, he tested positive for COVID-19 and completed a treatment course of remdesivir and completed 10 days of isolation precautions. He had improvement in his dyspnea symptoms and by discharge was clinically stable and was maintaining adequate oxygenation at room air. He underwent PT and OT, with plan to continue PT at SNF on discharge. He will continue with Protonix 40 mg BID with GI referral placed given his duodenal PUD. He was discharged to SNF in stable condition.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Rotator cuff repair, Rotator cuff syndrome, SARS-CoV-2 test positive, Transfusion
Clinical narrative: Patient is a 71 YO male who presented to Facility on 11/3/2023 for operative management of left shoulder rotator cuff tear with impingement syndrome. At the end of the case the patient failed SBT, and given underlying lung disease and concern for possible hemidiaphragmatic paralysis due to nerve block, the patient remained intubated and was admitted to the CCU service for further evaluation and management. He was eventually able to be extubated. However, after extubation, the patient had onset of BRBPR with hemodynamic instability, for which he remained under CCU care. GI, General Surgery, and IR were consulted during this hospitalization. EGD on 11/5/23 showed one non-bleeding cratered duodenal ulcer with visible vessel in the duodenal bulb which was treated with epinephrine and clipped. He had recurrence of BRBPR and IR performed empiric GDA microcoil embolization on 11/8/23. He subsequently had improvement in his BRBPR. He received in total 7 units PRBCs as well as 1 unit of FFP and 1 unit of of platelets this admission. He was transferred to floor status with recurrence of hematochezia or melena. During his hospitalization, he tested positive for COVID-19 and completed a treatment course of remdesivir and completed 10 days of isolation precautions. He had improvement in his dyspnea symptoms and by discharge was clinically stable and was maintaining adequate oxygenation at room air. He underwent PT and OT, with plan to continue PT at SNF on discharge. He will continue with Protonix 40 mg BID with GI referral placed given his duodenal PUD. He was discharged to SNF in stable condition.
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Blood thyroid stimulating hormone normal, COVID-19, Cardiac telemetry, Electrocardiogram, Headache
Clinical narrative: 61yoF hx below presented for acute left-sided weakness, started 3:10pm on 11/19, associated migraine and URI symptoms positive for COVID. Given TNKase in ER for suspected ischemic CVA, neuroimaging negative and symptoms resolved the follow day whilst in the ICU. Neurology evaluated and difficult to ascertain if complex migraine or true ischemic stroke, Neurology felt CVA less likely and did not strongly recommend secondary prevention meds, therapy evaluated and recommended IPR but patient was doing well enough on discharge to defer IPR and return home independently.  Other issues:  Headache/migraine- likely cause of presenting symptoms, Neurology outpatient referral, prn tylenol o ?SVT- reportedly brief but not seen on telemetry or able to capture on EKG, possible related to COVID, did not recur and defer heart monitor on discharge o COVID-19- no oxygen requirements, minimal symptoms, supportive care o Hypothyroidism- synthroid, TSH wnl
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Hemiparesis, Hypothyroidism, Imaging procedure, Intensive care, Migraine
Clinical narrative: 61yoF hx below presented for acute left-sided weakness, started 3:10pm on 11/19, associated migraine and URI symptoms positive for COVID. Given TNKase in ER for suspected ischemic CVA, neuroimaging negative and symptoms resolved the follow day whilst in the ICU. Neurology evaluated and difficult to ascertain if complex migraine or true ischemic stroke, Neurology felt CVA less likely and did not strongly recommend secondary prevention meds, therapy evaluated and recommended IPR but patient was doing well enough on discharge to defer IPR and return home independently.  Other issues:  Headache/migraine- likely cause of presenting symptoms, Neurology outpatient referral, prn tylenol o ?SVT- reportedly brief but not seen on telemetry or able to capture on EKG, possible related to COVID, did not recur and defer heart monitor on discharge o COVID-19- no oxygen requirements, minimal symptoms, supportive care o Hypothyroidism- synthroid, TSH wnl
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory symptom, SARS-CoV-2 test positive, Supraventricular tachycardia
Clinical narrative: 61yoF hx below presented for acute left-sided weakness, started 3:10pm on 11/19, associated migraine and URI symptoms positive for COVID. Given TNKase in ER for suspected ischemic CVA, neuroimaging negative and symptoms resolved the follow day whilst in the ICU. Neurology evaluated and difficult to ascertain if complex migraine or true ischemic stroke, Neurology felt CVA less likely and did not strongly recommend secondary prevention meds, therapy evaluated and recommended IPR but patient was doing well enough on discharge to defer IPR and return home independently.  Other issues:  Headache/migraine- likely cause of presenting symptoms, Neurology outpatient referral, prn tylenol o ?SVT- reportedly brief but not seen on telemetry or able to capture on EKG, possible related to COVID, did not recur and defer heart monitor on discharge o COVID-19- no oxygen requirements, minimal symptoms, supportive care o Hypothyroidism- synthroid, TSH wnl
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Anaemia, Blood creatinine increased, Brain natriuretic peptide increased, COVID-19
Clinical narrative: Patient is a 74 YO female with a history of HFrEF (EF 35-40%), COPD, CKD stage IV, CAD s/p PCI 8/2023, T2DM, HTN, and HLD who presented to Facility on 11/21/2023 with difficulty in breathing. She reports having one week preceding onset of worsening bilateral lower extremity edema. Her dyspnea came on suddenly shortly before arrival to the ED. On arrival, she was noted to have substantially increased work of breathing, for which she was placed on BiPAP. She was mildly tachypneic but otherwise hemodynamically stable and able to maintain adequate oxygenation on BiPAP. Intake lab work was notable for COVID, which she reports testing positive for on 11/11/2023, anemia of Hgb 8.8 which is near her baseline, Cr 3.1 with baseline Cr of 1.4 in September 2022, elevated transaminases, BNP 3.3K, and troponin 107 with 2-hr downtrend to 101 with EKG that did not reveal ST or T wave ischemic changes consistent with type 2 NSTEMI. CXR showed a small left pleural effusion and suspected mild pulmonary vascular congestion and patient was noted to be volume over-loaded on exam. Her presentation was consistent with COPD exacerbation in setting of recent COVID infection for which she was treated with systemic corticosteroids and scheduled duonebs treatments, treatment with remdesivir and antibiotics were not indicated. Her volume over-loaded state was also consistent with CHF exacerbation for which she was diuresed. She was quickly able to be weaned off of BiPAP down to room air and maintaining adequate oxygenation with resolution of her respiratory distress over the course of this admission. She was otherwise clinically stable and discharged in good condition. She was prescribed prednisone burst to complete treatment for her COPD exacerbation. Initiation of diuretic therapy on discharge was deferred given her AKI, with outpatient CMP ordered and can be addressed further on outpatient PCP follow up if appropriate for patient to initiate diuretic therapy.  Discharged to home.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Diuretic therapy
Clinical narrative: Patient is a 74 YO female with a history of HFrEF (EF 35-40%), COPD, CKD stage IV, CAD s/p PCI 8/2023, T2DM, HTN, and HLD who presented to Facility on 11/21/2023 with difficulty in breathing. She reports having one week preceding onset of worsening bilateral lower extremity edema. Her dyspnea came on suddenly shortly before arrival to the ED. On arrival, she was noted to have substantially increased work of breathing, for which she was placed on BiPAP. She was mildly tachypneic but otherwise hemodynamically stable and able to maintain adequate oxygenation on BiPAP. Intake lab work was notable for COVID, which she reports testing positive for on 11/11/2023, anemia of Hgb 8.8 which is near her baseline, Cr 3.1 with baseline Cr of 1.4 in September 2022, elevated transaminases, BNP 3.3K, and troponin 107 with 2-hr downtrend to 101 with EKG that did not reveal ST or T wave ischemic changes consistent with type 2 NSTEMI. CXR showed a small left pleural effusion and suspected mild pulmonary vascular congestion and patient was noted to be volume over-loaded on exam. Her presentation was consistent with COPD exacerbation in setting of recent COVID infection for which she was treated with systemic corticosteroids and scheduled duonebs treatments, treatment with remdesivir and antibiotics were not indicated. Her volume over-loaded state was also consistent with CHF exacerbation for which she was diuresed. She was quickly able to be weaned off of BiPAP down to room air and maintaining adequate oxygenation with resolution of her respiratory distress over the course of this admission. She was otherwise clinically stable and discharged in good condition. She was prescribed prednisone burst to complete treatment for her COPD exacerbation. Initiation of diuretic therapy on discharge was deferred given her AKI, with outpatient CMP ordered and can be addressed further on outpatient PCP follow up if appropriate for patient to initiate diuretic therapy.  Discharged to home.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Dyspnoea, Electrocardiogram normal, Haemoglobin decreased, Hypervolaemia, Oedema peripheral
Clinical narrative: Patient is a 74 YO female with a history of HFrEF (EF 35-40%), COPD, CKD stage IV, CAD s/p PCI 8/2023, T2DM, HTN, and HLD who presented to Facility on 11/21/2023 with difficulty in breathing. She reports having one week preceding onset of worsening bilateral lower extremity edema. Her dyspnea came on suddenly shortly before arrival to the ED. On arrival, she was noted to have substantially increased work of breathing, for which she was placed on BiPAP. She was mildly tachypneic but otherwise hemodynamically stable and able to maintain adequate oxygenation on BiPAP. Intake lab work was notable for COVID, which she reports testing positive for on 11/11/2023, anemia of Hgb 8.8 which is near her baseline, Cr 3.1 with baseline Cr of 1.4 in September 2022, elevated transaminases, BNP 3.3K, and troponin 107 with 2-hr downtrend to 101 with EKG that did not reveal ST or T wave ischemic changes consistent with type 2 NSTEMI. CXR showed a small left pleural effusion and suspected mild pulmonary vascular congestion and patient was noted to be volume over-loaded on exam. Her presentation was consistent with COPD exacerbation in setting of recent COVID infection for which she was treated with systemic corticosteroids and scheduled duonebs treatments, treatment with remdesivir and antibiotics were not indicated. Her volume over-loaded state was also consistent with CHF exacerbation for which she was diuresed. She was quickly able to be weaned off of BiPAP down to room air and maintaining adequate oxygenation with resolution of her respiratory distress over the course of this admission. She was otherwise clinically stable and discharged in good condition. She was prescribed prednisone burst to complete treatment for her COPD exacerbation. Initiation of diuretic therapy on discharge was deferred given her AKI, with outpatient CMP ordered and can be addressed further on outpatient PCP follow up if appropriate for patient to initiate diuretic therapy.  Discharged to home.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Percutaneous coronary intervention, Pleural effusion, Positive airway pressure therapy, Pulmonary congestion, Respiratory distress
Clinical narrative: Patient is a 74 YO female with a history of HFrEF (EF 35-40%), COPD, CKD stage IV, CAD s/p PCI 8/2023, T2DM, HTN, and HLD who presented to Facility on 11/21/2023 with difficulty in breathing. She reports having one week preceding onset of worsening bilateral lower extremity edema. Her dyspnea came on suddenly shortly before arrival to the ED. On arrival, she was noted to have substantially increased work of breathing, for which she was placed on BiPAP. She was mildly tachypneic but otherwise hemodynamically stable and able to maintain adequate oxygenation on BiPAP. Intake lab work was notable for COVID, which she reports testing positive for on 11/11/2023, anemia of Hgb 8.8 which is near her baseline, Cr 3.1 with baseline Cr of 1.4 in September 2022, elevated transaminases, BNP 3.3K, and troponin 107 with 2-hr downtrend to 101 with EKG that did not reveal ST or T wave ischemic changes consistent with type 2 NSTEMI. CXR showed a small left pleural effusion and suspected mild pulmonary vascular congestion and patient was noted to be volume over-loaded on exam. Her presentation was consistent with COPD exacerbation in setting of recent COVID infection for which she was treated with systemic corticosteroids and scheduled duonebs treatments, treatment with remdesivir and antibiotics were not indicated. Her volume over-loaded state was also consistent with CHF exacerbation for which she was diuresed. She was quickly able to be weaned off of BiPAP down to room air and maintaining adequate oxygenation with resolution of her respiratory distress over the course of this admission. She was otherwise clinically stable and discharged in good condition. She was prescribed prednisone burst to complete treatment for her COPD exacerbation. Initiation of diuretic therapy on discharge was deferred given her AKI, with outpatient CMP ordered and can be addressed further on outpatient PCP follow up if appropriate for patient to initiate diuretic therapy.  Discharged to home.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Tachypnoea, Transaminases increased, Troponin increased
Clinical narrative: Patient is a 74 YO female with a history of HFrEF (EF 35-40%), COPD, CKD stage IV, CAD s/p PCI 8/2023, T2DM, HTN, and HLD who presented to Facility on 11/21/2023 with difficulty in breathing. She reports having one week preceding onset of worsening bilateral lower extremity edema. Her dyspnea came on suddenly shortly before arrival to the ED. On arrival, she was noted to have substantially increased work of breathing, for which she was placed on BiPAP. She was mildly tachypneic but otherwise hemodynamically stable and able to maintain adequate oxygenation on BiPAP. Intake lab work was notable for COVID, which she reports testing positive for on 11/11/2023, anemia of Hgb 8.8 which is near her baseline, Cr 3.1 with baseline Cr of 1.4 in September 2022, elevated transaminases, BNP 3.3K, and troponin 107 with 2-hr downtrend to 101 with EKG that did not reveal ST or T wave ischemic changes consistent with type 2 NSTEMI. CXR showed a small left pleural effusion and suspected mild pulmonary vascular congestion and patient was noted to be volume over-loaded on exam. Her presentation was consistent with COPD exacerbation in setting of recent COVID infection for which she was treated with systemic corticosteroids and scheduled duonebs treatments, treatment with remdesivir and antibiotics were not indicated. Her volume over-loaded state was also consistent with CHF exacerbation for which she was diuresed. She was quickly able to be weaned off of BiPAP down to room air and maintaining adequate oxygenation with resolution of her respiratory distress over the course of this admission. She was otherwise clinically stable and discharged in good condition. She was prescribed prednisone burst to complete treatment for her COPD exacerbation. Initiation of diuretic therapy on discharge was deferred given her AKI, with outpatient CMP ordered and can be addressed further on outpatient PCP follow up if appropriate for patient to initiate diuretic therapy.  Discharged to home.
Age: 77.0
Sex: M
Vaccine: RSV
Symptoms: Chills, Diarrhoea, Feeling cold, Malaise, Vomiting
Clinical narrative: Pt's daughter called to inform that his father got sick (chill, feeling cold) a day after receiving RSV vaccine.  Pt  told temperature is at 97 F, he had Vomited once had Diarrhea which stopped. He consumed food that was 2 days old(cooked on Friday) vaccine made him sick.
Age: 43.0
Sex: M
Vaccine: COVID19
Symptoms: Lung disorder
Clinical narrative: patient said the first and only J&J vaccine put a whole in his lung and patient was sent to the hospital. No additional information available.
Age: 0.17
Sex: M
Vaccine: DTAPHEPBIP, HIBV, PNC13, RV1
Symptoms: Extra dose administered, Inappropriate schedule of product administration, No adverse event
Clinical narrative: Pt was seen early for his 2-month physical on 8/30/23 and was given 2-month vaccines at that time, pt was brought back in by parents for a two-month physical on 9/21/23 and was given the two-month vaccines again.   Error was not caught until a recent visit on 11/16/23 for a four-month physical and realized child had another set of 2-month vaccines done that did not count, provider was made aware at time of visit which was the same provider that had seen the patient prior.   Parents were also made aware at the time of the visit.  Denies any know injury to child at this time.  Staff did not inform manager until 11/22/23 regarding error that was found.
Age: 25.0
Sex: M
Vaccine: SMALLMNK
Symptoms: Incorrect route of product administration, No adverse event
Clinical narrative: Subcutaneous MPOX vaccine given intramuscularly. Discussed with urgent care provider, patient monitored for 45 minutes in clinic, no adverse reaction occured. Patient reported feeling well and having no side effects prior to leaving the clinic.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Acute pulmonary oedema, Acute respiratory failure, Angiogram pulmonary abnormal, Blood creatinine abnormal, COVID-19
Clinical narrative: This evening was feeling short of breath; checked oxygen saturation at home and it went as low as 77%. Was wheezing tonight.   Has a chronic cough which is sometimes productive of clear phlegmn with nor recent exacerbation. Lives with a smoker. Chronically sleeps with 3-4 pillows. Has been using a cane due to "sciatic pain" in his right leg.     Denies use of home oxygen. Denies recent exposure to known sick contacts, travel from local area, fever, chills, significant weight changes, marked fatigue, headaches, runny nose, sore throat, chest discomfort, leg swelling, abdominal discomfort, nausea, vomiting, diarrhea, constipation, pain with urination, lightheadedness, dizziness, falls, open skin sores or rashes. (HPI per, NP)  Hospital Course: No notes on file Patient is a 71yr old male with a history of HTN, CAD, Cardiomyopathy, COPD, Glaucoma, BPH who presented with SOB and hypoxia. He was also found to have COVID. Today he feels better and says he wants to to home. He is still on oxygen and feels that he really needs it at home.  Acute on Chronic HFrEF with acute pulm edema - Echo revealed severely decreased systolic function with EF of 25-30% - further reduced from previous. No LE edema but CTA reveals trace bilateral pleural effusions with findings suspicious for mild pulm edema. Improved on IV furosemide. Cards consulted - There is no evidence of acute pulmonary embolism. Cards recommends transitioning to oral diuretic therapy once he is euvolemic, and continue GDMT including BB, ARB (once BP able to tolerate) as well as clopidogrel 75 mg day for treatment of known coronary artery disease  He improved somewhat, IV diuretics held yesterday due to worsening Cr level, improved today. Plan is to discharge today on oral furosemide.   Hx of CAD Elevated Troponin - Markedly elevated though trending down with negative delta.  Cards consulted - His presentation is not consistent with acute coronary syndrome but troponin elevation is rather consistent with supply-demand imbalance in the setting of acute exacerbation of COPD, pulmonary edema, and COVID-19 infection. Heparin infusion discontinued.  Acute on Chronic Respiratory insufficiency - this is likely multifactorial due to HFrEF, COPD, COVID infection. Diuretics on hold for now as patient is euvolemic and Cr is worsening. Will continue LABA, duoneb, steroids, supplemental oxygen.  COVID infection - could be contributing to above. Continue supportive treatment including mucinex, acetaminophen and supplemental oxygen.  SAT 87%   Testing at rest without Oxygen  SAT %   Testing during exercise without Oxygen- Not tested due to low Sat and increased work of breathing on room air at rest.  SAT 92%   Testing during exercise with Oxygen applied (to demonstrate improvement)  Patient will therefore require 2L Oxygen via NC on discharge as nebulizers have proven insufficient. He will also need portable tank for ambulation inside and outside his  home. Discharged to home.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac failure acute, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea
Clinical narrative: This evening was feeling short of breath; checked oxygen saturation at home and it went as low as 77%. Was wheezing tonight.   Has a chronic cough which is sometimes productive of clear phlegmn with nor recent exacerbation. Lives with a smoker. Chronically sleeps with 3-4 pillows. Has been using a cane due to "sciatic pain" in his right leg.     Denies use of home oxygen. Denies recent exposure to known sick contacts, travel from local area, fever, chills, significant weight changes, marked fatigue, headaches, runny nose, sore throat, chest discomfort, leg swelling, abdominal discomfort, nausea, vomiting, diarrhea, constipation, pain with urination, lightheadedness, dizziness, falls, open skin sores or rashes. (HPI per, NP)  Hospital Course: No notes on file Patient is a 71yr old male with a history of HTN, CAD, Cardiomyopathy, COPD, Glaucoma, BPH who presented with SOB and hypoxia. He was also found to have COVID. Today he feels better and says he wants to to home. He is still on oxygen and feels that he really needs it at home.  Acute on Chronic HFrEF with acute pulm edema - Echo revealed severely decreased systolic function with EF of 25-30% - further reduced from previous. No LE edema but CTA reveals trace bilateral pleural effusions with findings suspicious for mild pulm edema. Improved on IV furosemide. Cards consulted - There is no evidence of acute pulmonary embolism. Cards recommends transitioning to oral diuretic therapy once he is euvolemic, and continue GDMT including BB, ARB (once BP able to tolerate) as well as clopidogrel 75 mg day for treatment of known coronary artery disease  He improved somewhat, IV diuretics held yesterday due to worsening Cr level, improved today. Plan is to discharge today on oral furosemide.   Hx of CAD Elevated Troponin - Markedly elevated though trending down with negative delta.  Cards consulted - His presentation is not consistent with acute coronary syndrome but troponin elevation is rather consistent with supply-demand imbalance in the setting of acute exacerbation of COPD, pulmonary edema, and COVID-19 infection. Heparin infusion discontinued.  Acute on Chronic Respiratory insufficiency - this is likely multifactorial due to HFrEF, COPD, COVID infection. Diuretics on hold for now as patient is euvolemic and Cr is worsening. Will continue LABA, duoneb, steroids, supplemental oxygen.  COVID infection - could be contributing to above. Continue supportive treatment including mucinex, acetaminophen and supplemental oxygen.  SAT 87%   Testing at rest without Oxygen  SAT %   Testing during exercise without Oxygen- Not tested due to low Sat and increased work of breathing on room air at rest.  SAT 92%   Testing during exercise with Oxygen applied (to demonstrate improvement)  Patient will therefore require 2L Oxygen via NC on discharge as nebulizers have proven insufficient. He will also need portable tank for ambulation inside and outside his  home. Discharged to home.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Echocardiogram abnormal, Ejection fraction decreased, Hypoxia, Left ventricular failure, Oxygen saturation decreased
Clinical narrative: This evening was feeling short of breath; checked oxygen saturation at home and it went as low as 77%. Was wheezing tonight.   Has a chronic cough which is sometimes productive of clear phlegmn with nor recent exacerbation. Lives with a smoker. Chronically sleeps with 3-4 pillows. Has been using a cane due to "sciatic pain" in his right leg.     Denies use of home oxygen. Denies recent exposure to known sick contacts, travel from local area, fever, chills, significant weight changes, marked fatigue, headaches, runny nose, sore throat, chest discomfort, leg swelling, abdominal discomfort, nausea, vomiting, diarrhea, constipation, pain with urination, lightheadedness, dizziness, falls, open skin sores or rashes. (HPI per, NP)  Hospital Course: No notes on file Patient is a 71yr old male with a history of HTN, CAD, Cardiomyopathy, COPD, Glaucoma, BPH who presented with SOB and hypoxia. He was also found to have COVID. Today he feels better and says he wants to to home. He is still on oxygen and feels that he really needs it at home.  Acute on Chronic HFrEF with acute pulm edema - Echo revealed severely decreased systolic function with EF of 25-30% - further reduced from previous. No LE edema but CTA reveals trace bilateral pleural effusions with findings suspicious for mild pulm edema. Improved on IV furosemide. Cards consulted - There is no evidence of acute pulmonary embolism. Cards recommends transitioning to oral diuretic therapy once he is euvolemic, and continue GDMT including BB, ARB (once BP able to tolerate) as well as clopidogrel 75 mg day for treatment of known coronary artery disease  He improved somewhat, IV diuretics held yesterday due to worsening Cr level, improved today. Plan is to discharge today on oral furosemide.   Hx of CAD Elevated Troponin - Markedly elevated though trending down with negative delta.  Cards consulted - His presentation is not consistent with acute coronary syndrome but troponin elevation is rather consistent with supply-demand imbalance in the setting of acute exacerbation of COPD, pulmonary edema, and COVID-19 infection. Heparin infusion discontinued.  Acute on Chronic Respiratory insufficiency - this is likely multifactorial due to HFrEF, COPD, COVID infection. Diuretics on hold for now as patient is euvolemic and Cr is worsening. Will continue LABA, duoneb, steroids, supplemental oxygen.  COVID infection - could be contributing to above. Continue supportive treatment including mucinex, acetaminophen and supplemental oxygen.  SAT 87%   Testing at rest without Oxygen  SAT %   Testing during exercise without Oxygen- Not tested due to low Sat and increased work of breathing on room air at rest.  SAT 92%   Testing during exercise with Oxygen applied (to demonstrate improvement)  Patient will therefore require 2L Oxygen via NC on discharge as nebulizers have proven insufficient. He will also need portable tank for ambulation inside and outside his  home. Discharged to home.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Pain in extremity, Passive smoking, Pleural effusion, Productive cough, Respiratory failure
Clinical narrative: This evening was feeling short of breath; checked oxygen saturation at home and it went as low as 77%. Was wheezing tonight.   Has a chronic cough which is sometimes productive of clear phlegmn with nor recent exacerbation. Lives with a smoker. Chronically sleeps with 3-4 pillows. Has been using a cane due to "sciatic pain" in his right leg.     Denies use of home oxygen. Denies recent exposure to known sick contacts, travel from local area, fever, chills, significant weight changes, marked fatigue, headaches, runny nose, sore throat, chest discomfort, leg swelling, abdominal discomfort, nausea, vomiting, diarrhea, constipation, pain with urination, lightheadedness, dizziness, falls, open skin sores or rashes. (HPI per, NP)  Hospital Course: No notes on file Patient is a 71yr old male with a history of HTN, CAD, Cardiomyopathy, COPD, Glaucoma, BPH who presented with SOB and hypoxia. He was also found to have COVID. Today he feels better and says he wants to to home. He is still on oxygen and feels that he really needs it at home.  Acute on Chronic HFrEF with acute pulm edema - Echo revealed severely decreased systolic function with EF of 25-30% - further reduced from previous. No LE edema but CTA reveals trace bilateral pleural effusions with findings suspicious for mild pulm edema. Improved on IV furosemide. Cards consulted - There is no evidence of acute pulmonary embolism. Cards recommends transitioning to oral diuretic therapy once he is euvolemic, and continue GDMT including BB, ARB (once BP able to tolerate) as well as clopidogrel 75 mg day for treatment of known coronary artery disease  He improved somewhat, IV diuretics held yesterday due to worsening Cr level, improved today. Plan is to discharge today on oral furosemide.   Hx of CAD Elevated Troponin - Markedly elevated though trending down with negative delta.  Cards consulted - His presentation is not consistent with acute coronary syndrome but troponin elevation is rather consistent with supply-demand imbalance in the setting of acute exacerbation of COPD, pulmonary edema, and COVID-19 infection. Heparin infusion discontinued.  Acute on Chronic Respiratory insufficiency - this is likely multifactorial due to HFrEF, COPD, COVID infection. Diuretics on hold for now as patient is euvolemic and Cr is worsening. Will continue LABA, duoneb, steroids, supplemental oxygen.  COVID infection - could be contributing to above. Continue supportive treatment including mucinex, acetaminophen and supplemental oxygen.  SAT 87%   Testing at rest without Oxygen  SAT %   Testing during exercise without Oxygen- Not tested due to low Sat and increased work of breathing on room air at rest.  SAT 92%   Testing during exercise with Oxygen applied (to demonstrate improvement)  Patient will therefore require 2L Oxygen via NC on discharge as nebulizers have proven insufficient. He will also need portable tank for ambulation inside and outside his  home. Discharged to home.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Sciatica, Systolic dysfunction, Troponin increased, Walking aid user, Wheezing
Clinical narrative: This evening was feeling short of breath; checked oxygen saturation at home and it went as low as 77%. Was wheezing tonight.   Has a chronic cough which is sometimes productive of clear phlegmn with nor recent exacerbation. Lives with a smoker. Chronically sleeps with 3-4 pillows. Has been using a cane due to "sciatic pain" in his right leg.     Denies use of home oxygen. Denies recent exposure to known sick contacts, travel from local area, fever, chills, significant weight changes, marked fatigue, headaches, runny nose, sore throat, chest discomfort, leg swelling, abdominal discomfort, nausea, vomiting, diarrhea, constipation, pain with urination, lightheadedness, dizziness, falls, open skin sores or rashes. (HPI per, NP)  Hospital Course: No notes on file Patient is a 71yr old male with a history of HTN, CAD, Cardiomyopathy, COPD, Glaucoma, BPH who presented with SOB and hypoxia. He was also found to have COVID. Today he feels better and says he wants to to home. He is still on oxygen and feels that he really needs it at home.  Acute on Chronic HFrEF with acute pulm edema - Echo revealed severely decreased systolic function with EF of 25-30% - further reduced from previous. No LE edema but CTA reveals trace bilateral pleural effusions with findings suspicious for mild pulm edema. Improved on IV furosemide. Cards consulted - There is no evidence of acute pulmonary embolism. Cards recommends transitioning to oral diuretic therapy once he is euvolemic, and continue GDMT including BB, ARB (once BP able to tolerate) as well as clopidogrel 75 mg day for treatment of known coronary artery disease  He improved somewhat, IV diuretics held yesterday due to worsening Cr level, improved today. Plan is to discharge today on oral furosemide.   Hx of CAD Elevated Troponin - Markedly elevated though trending down with negative delta.  Cards consulted - His presentation is not consistent with acute coronary syndrome but troponin elevation is rather consistent with supply-demand imbalance in the setting of acute exacerbation of COPD, pulmonary edema, and COVID-19 infection. Heparin infusion discontinued.  Acute on Chronic Respiratory insufficiency - this is likely multifactorial due to HFrEF, COPD, COVID infection. Diuretics on hold for now as patient is euvolemic and Cr is worsening. Will continue LABA, duoneb, steroids, supplemental oxygen.  COVID infection - could be contributing to above. Continue supportive treatment including mucinex, acetaminophen and supplemental oxygen.  SAT 87%   Testing at rest without Oxygen  SAT %   Testing during exercise without Oxygen- Not tested due to low Sat and increased work of breathing on room air at rest.  SAT 92%   Testing during exercise with Oxygen applied (to demonstrate improvement)  Patient will therefore require 2L Oxygen via NC on discharge as nebulizers have proven insufficient. He will also need portable tank for ambulation inside and outside his  home. Discharged to home.
Age: 65.0
Sex: F
Vaccine: VARZOS
Symptoms: Urticaria, Vaccination site reaction
Clinical narrative: Hives on arm where vaccine was administered.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging head normal, Magnetic resonance imaging spinal abnormal, Neurological symptom, Spinal osteoarthritis
Clinical narrative: Patient is a 75 YO female with past medical history significant for depression, SLE, DM2, GERD, HLD, hypertension, paroxysmal atrial fibrillation(on apixaban), PFO with ASD s/p closure 2015, CVA (Brainstem infarct occurring 10/26/2014 with residual mild right hemiataxia)  who presented to ED 11/22/23 sent over by PCP office for concerns for stroke.  Patient was admitted and symptoms improved. MRI did not reveal acute abnormalities of brain, MRI lumbar spine revealed multilevel lumbar spondylosis.   She is presently back to baseline mental status.  Family members are present at bedside and are agreeable to rehabilitation per PT/OT/PM&R recommendation.    Upon exam this morning, patient feeling overall better. Mental status is at baseline. Patient was medically optimized. Vital signs were stable for discharge. Discharged to Rehab facility.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Asthenia, Blood creatine phosphokinase normal, Blood sodium decreased, COVID-19, Chest X-ray normal
Clinical narrative: Pt is a 81 YO female with PMHx of HTN, hypothyroidism, chronic neck pain that presented to the ED with c/o weakness. Patient reports not being able to get out of her recliner today. She reports being extremely weak. She reports associated productive cough with clear sputum. She reports she was at her pcp on the 20th of November and she was doing ok then. She reports recent spinal fusion. She reports her son is sick at home. She reports decrease in appetite for the past two months. No changes in weight. She denies smoking and alcohol use. Patient denies chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, headache, dizziness or lightheadedness. Patient is urinating without difficulty or pain and bowels are moving appropriately.     In the ED, patient febrile otherwise hemodynamically stable. Labs reviewed and notes Na 129, covid positive.   ED treatments: patient given ofirmev, solu-medrol, norflex, 1 L IV fluids  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  Active Problems:  Generalized weakness due to COVID viral infection. Likely COVID myopathy.  Pt unable to ambulate and needs 2 person assist to get out of bed. CPK okay. PT, OT to continue eval. Recommending rehab. No focal arm or leg weakness. IPR accepting - DC to IPR today   COVID-19 virus infection - no hypoxia. Lungs clear. CXR negative.has low grade temp.  No need to treat. Monitor for hypoxia. Try throat lozenges for sore throat.    Hypotension - will hold BP meds. Not septic.    Hyponatremia - due to poor po intake , viral infection. Stable.     Essential hypertension, benign - on lisinopril - hold.  BP stable    Hypothyroid - on supplement.  Discharged to Rehab facility.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Decreased appetite, Gait inability, Hyponatraemia, Hypophagia, Hypotension
Clinical narrative: Pt is a 81 YO female with PMHx of HTN, hypothyroidism, chronic neck pain that presented to the ED with c/o weakness. Patient reports not being able to get out of her recliner today. She reports being extremely weak. She reports associated productive cough with clear sputum. She reports she was at her pcp on the 20th of November and she was doing ok then. She reports recent spinal fusion. She reports her son is sick at home. She reports decrease in appetite for the past two months. No changes in weight. She denies smoking and alcohol use. Patient denies chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, headache, dizziness or lightheadedness. Patient is urinating without difficulty or pain and bowels are moving appropriately.     In the ED, patient febrile otherwise hemodynamically stable. Labs reviewed and notes Na 129, covid positive.   ED treatments: patient given ofirmev, solu-medrol, norflex, 1 L IV fluids  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  Active Problems:  Generalized weakness due to COVID viral infection. Likely COVID myopathy.  Pt unable to ambulate and needs 2 person assist to get out of bed. CPK okay. PT, OT to continue eval. Recommending rehab. No focal arm or leg weakness. IPR accepting - DC to IPR today   COVID-19 virus infection - no hypoxia. Lungs clear. CXR negative.has low grade temp.  No need to treat. Monitor for hypoxia. Try throat lozenges for sore throat.    Hypotension - will hold BP meds. Not septic.    Hyponatremia - due to poor po intake , viral infection. Stable.     Essential hypertension, benign - on lisinopril - hold.  BP stable    Hypothyroid - on supplement.  Discharged to Rehab facility.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Mobility decreased, Myopathy, Oropharyngeal pain, Productive cough, Pyrexia
Clinical narrative: Pt is a 81 YO female with PMHx of HTN, hypothyroidism, chronic neck pain that presented to the ED with c/o weakness. Patient reports not being able to get out of her recliner today. She reports being extremely weak. She reports associated productive cough with clear sputum. She reports she was at her pcp on the 20th of November and she was doing ok then. She reports recent spinal fusion. She reports her son is sick at home. She reports decrease in appetite for the past two months. No changes in weight. She denies smoking and alcohol use. Patient denies chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, headache, dizziness or lightheadedness. Patient is urinating without difficulty or pain and bowels are moving appropriately.     In the ED, patient febrile otherwise hemodynamically stable. Labs reviewed and notes Na 129, covid positive.   ED treatments: patient given ofirmev, solu-medrol, norflex, 1 L IV fluids  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  Active Problems:  Generalized weakness due to COVID viral infection. Likely COVID myopathy.  Pt unable to ambulate and needs 2 person assist to get out of bed. CPK okay. PT, OT to continue eval. Recommending rehab. No focal arm or leg weakness. IPR accepting - DC to IPR today   COVID-19 virus infection - no hypoxia. Lungs clear. CXR negative.has low grade temp.  No need to treat. Monitor for hypoxia. Try throat lozenges for sore throat.    Hypotension - will hold BP meds. Not septic.    Hyponatremia - due to poor po intake , viral infection. Stable.     Essential hypertension, benign - on lisinopril - hold.  BP stable    Hypothyroid - on supplement.  Discharged to Rehab facility.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Spinal fusion surgery, Viral infection
Clinical narrative: Pt is a 81 YO female with PMHx of HTN, hypothyroidism, chronic neck pain that presented to the ED with c/o weakness. Patient reports not being able to get out of her recliner today. She reports being extremely weak. She reports associated productive cough with clear sputum. She reports she was at her pcp on the 20th of November and she was doing ok then. She reports recent spinal fusion. She reports her son is sick at home. She reports decrease in appetite for the past two months. No changes in weight. She denies smoking and alcohol use. Patient denies chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, headache, dizziness or lightheadedness. Patient is urinating without difficulty or pain and bowels are moving appropriately.     In the ED, patient febrile otherwise hemodynamically stable. Labs reviewed and notes Na 129, covid positive.   ED treatments: patient given ofirmev, solu-medrol, norflex, 1 L IV fluids  Brief Summary of Hospital Stay: (Include Significant Findings and Invasive Procedures)  Active Problems:  Generalized weakness due to COVID viral infection. Likely COVID myopathy.  Pt unable to ambulate and needs 2 person assist to get out of bed. CPK okay. PT, OT to continue eval. Recommending rehab. No focal arm or leg weakness. IPR accepting - DC to IPR today   COVID-19 virus infection - no hypoxia. Lungs clear. CXR negative.has low grade temp.  No need to treat. Monitor for hypoxia. Try throat lozenges for sore throat.    Hypotension - will hold BP meds. Not septic.    Hyponatremia - due to poor po intake , viral infection. Stable.     Essential hypertension, benign - on lisinopril - hold.  BP stable    Hypothyroid - on supplement.  Discharged to Rehab facility.
Age: 73.0
Sex: F
Vaccine: RSV
Symptoms: Injection site erythema
Clinical narrative: Continued redness at injection site.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, Atrial fibrillation, COVID-19, Cardioversion, Malaise
Clinical narrative: 74-year-old female with a past medical history of coronary artery disease PCI 10/25, chronic obstructive pulmonary disease, hyperthyroidism, left lung nodule presented with bilateral leg weakness.  Patient found to be COVID positive on admission, however symptoms noted to start over 2 weeks ago.  Suspect weakness is secondary to COVID infection which presumably started on 11/21 per patient's husband.  Of note, patient found to be in new onset AFib with RVR and AKI.  Cardiology was consulted and recommended not starting anticoagulation due to high bleeding risk.  AFib RVR treated with propranolol 60 mg, uptitrated from home 40 mg.  On review of telemetry, patient cardioverted to normal sinus rhythm to heart rate of 80s today after receiving propranolol 60 mg. No indication for COVID therapies.  Incidentally, patient was found to have a left lung nodule "1.1 cm nodule in the posterior left costophrenic sulcus is increased in size compared to the previous exam." She will need to follow up outpatient with pulmonology for further evaluation of the lung nodule.  PT or evaluated patient, recommended rehab.  However, patient refused to go to rehab and opted for home physical therapy.  Currently, patient is medically stable for discharge home.