chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 96.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pleural effusion, Respiratory distress, SARS-CoV-2 test positive, Sinus bradycardia, Troponin increased
Clinical narrative: Patient is a 96 y.o. male with history of porcelain gallbladder s/p cholecystectomy 2017, glaucoma, arthritis, CKD stage 3a, atrial flutter presented with generalized weakness and shortness of breath. He daughter is present with him in the ED. Patient states that for the past 2 days he has been having shortness of breath, and intermittent mild pleuritic left sided chest discomfort. Daughter reports that 2 days ago he was having some mild respiratory distress at home. He is currently having no shortness of breath, palpitations, chest pain. He is sating 94% on RA without respiratory distressed. Presumed possible exposure during recent admission. He was just recently admitted and discharged from another hospital 2/5 for pancreatitis, MRCP was performed showing area of inflammation, and no mass. It was recommended that he have follow up EUS in 4-6 weeks. He is currently reporting no abdominal pain, no nausea or emesis, has been having regular BM.    In the ED vitals are as follows, temperature 97.9F, blood pressure 138/52, heart rate 48, RR 21, and oxygen saturation of 94% on RA. Labs results were significant for D dimer 1.91, BNP 7521, Hgb 10.0, GFR 56. The rest of the CBC and CMP were within normal limits. Troponin 280 and on repeat 243.. Flu swab negative. Covid positive. Chest x-ray mild diffuse infiltrates overlying chronic emphysematous changes, no acute findings. CT with no evidence of PE, small bilateral pleural effusions with associated compressive atelectasis, mildly enlarged hilar lymphadenopathy. Patient was given 1 dose of paxlovid. Patient admitted for observation.      Clinical Summary Patient was admitted to observation for dyspnea and elevated troponin in the setting of COVID-19.  His troponin was trended and initially decreased and then remained flat at around 205.  Patient had a echocardiogram which showed no regional wall motion abnormality or RV dysfunction.  He was monitored on telemetry and no significant cardiac arrhythmias were noted.  He was seen by cardiology who felt his troponin elevation was most likely related to COVID-19 as well as some mild respiratory distress that he experienced on presentation.  No further cardiac work-up was recommended.  Patient was not noted to be hypoxic during his hospital stay.  On 2/11/2023 the patient has no active chest pain and overall is feeling well in his usual state of health.  He is stable for discharge home.  He was sent a prescription for Paxlovid from the ED.  He should follow-up with his primary care provider within the next 1 week.  Patient will be discharged home with isolation instructions and he should undergo routine COVID isolation as instructed.   Discharge diagnosis COVID 19 Type II NSTEMI - resolved CKD stage IIIa RBBB Hx atrial flutter Sinus bradycardia POA
Age: 58.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Fatigue, Headache, Lymphadenopathy, Oropharyngeal pain
Clinical narrative: Woke up Christmas day with a sore throat. I tested positive with an at home COVID-19 test, positive on 12/27. Called in prescription for PAXLOVID. Within a day or so, I was really congested and very tired. Axillary and posterior cervical lymph nodes swollen. Fever peaked at 101, with a little headache and body aches for a couple of days. Slight rebound of symptoms after PAXLOVID. Felt better on 1/6/2023.
Age: 58.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: Woke up Christmas day with a sore throat. I tested positive with an at home COVID-19 test, positive on 12/27. Called in prescription for PAXLOVID. Within a day or so, I was really congested and very tired. Axillary and posterior cervical lymph nodes swollen. Fever peaked at 101, with a little headache and body aches for a couple of days. Slight rebound of symptoms after PAXLOVID. Felt better on 1/6/2023.
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 RNA, SARS-CoV-2 test positive
Clinical narrative: HOSPITALIZATION RELATED TO COVID-19 FOLLOWING COMPLETION OF PRIMARY COVID VACCINE SERIES
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: Asthenia, COVID-19, Cough, Nasal congestion, Pyrexia
Clinical narrative: The symptoms started March 1, 2023. That day, I took a rapid COVID-19 test. The result was negative. The next day, the symptoms were worse. I had a dry cough, stuffiness, and loss of energy. I also had a slight fever. On March 2, 2023, I took another rapid COVID-19 test. The result was positive. I called my doctor's office to see if the recommended treatment. First, the nurse said no due to my age, but I asked the nurse to ask the doctor specifically due to my diabetes and hypertension. The doctor said it was reasonable to prescribe PAXLOVID. I stated PAXLOVID the evening on March 2, 2023. Since then, every day has gotten a little better. I'm on day five now. I have two doses left. The PAXLOVID has given me diarrhea and a bitter taste in the back of my mouth.
Age: 63.0
Sex: F
Vaccine: COVID19-2
Symptoms: SARS-CoV-2 test positive
Clinical narrative: The symptoms started March 1, 2023. That day, I took a rapid COVID-19 test. The result was negative. The next day, the symptoms were worse. I had a dry cough, stuffiness, and loss of energy. I also had a slight fever. On March 2, 2023, I took another rapid COVID-19 test. The result was positive. I called my doctor's office to see if the recommended treatment. First, the nurse said no due to my age, but I asked the nurse to ask the doctor specifically due to my diabetes and hypertension. The doctor said it was reasonable to prescribe PAXLOVID. I stated PAXLOVID the evening on March 2, 2023. Since then, every day has gotten a little better. I'm on day five now. I have two doses left. The PAXLOVID has given me diarrhea and a bitter taste in the back of my mouth.
Age: 81.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Fatigue, Feeling abnormal, Hypersomnia, Oropharyngeal pain
Clinical narrative: I had a runny nose, low-grade fever for a couple days, sore throat and felt really bad for a couple days. I took a home COVID-19 test that came back positive, I took another 12 hours later waited another 12 hours when that one also came back positive, I called my doctor and had a telehealth visit. She discussed my symptoms; she prescribed the antiviral that I started to take immediately. I started to feel better within  fives after taking the medication. On day seven I slept all day, by day 10 I had some fatigue but I was feeling much better. I did test positive until the 16th day.
Age: 81.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: I had a runny nose, low-grade fever for a couple days, sore throat and felt really bad for a couple days. I took a home COVID-19 test that came back positive, I took another 12 hours later waited another 12 hours when that one also came back positive, I called my doctor and had a telehealth visit. She discussed my symptoms; she prescribed the antiviral that I started to take immediately. I started to feel better within  fives after taking the medication. On day seven I slept all day, by day 10 I had some fatigue but I was feeling much better. I did test positive until the 16th day.
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Adrenal mass, Atrial fibrillation, COVID-19, Cardiac arrest
Clinical narrative: The patient is a 66 y.o. female patient of Physician with a history of atrial fibrillation, IDDM2, asthma, COPD, chronic respiratory failure on 4L of O2, HLD, HTN, and depression/anxiety who initially presented to another hospital and transferred to reporting hospital's ICU on 01/29/23 with respiratory failure requiring BIPAP, found to be in shock secondary to COVID-19, and subsequently intubated on 02/03/23. Hospital course complicated by atrial fibrillation with RVR versus SVT, elevated transaminases requiring N-acetylcysteine, acute parotiditis, and acute encephalopathy. Was eventually extubated on 02/10/23 but rapid clinical decline hours after with hypotension unresponsive to vasopressors. Eventually went into PEA arrest but decision was made to end the code after exhaustive measures were performed and all reversible causes were considered.    Discharge Diagnoses: PEA arrest Shock, unspecified Acute on chronic respiratory failure with hypoxemia  COVID-19 viral pneumonia Atrial fibrillation with RVR Acute parotiditis Acute encephalopathy  Incidental CT finding of adrenal mass - Time of death 23:19. Contacted family during cardiac arrest. Resident met with patient's family on their arrival and offered emotional support (see quick notes).
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Cardio-respiratory arrest, Computerised tomogram abnormal, Condition aggravated, Death, Encephalopathy
Clinical narrative: The patient is a 66 y.o. female patient of Physician with a history of atrial fibrillation, IDDM2, asthma, COPD, chronic respiratory failure on 4L of O2, HLD, HTN, and depression/anxiety who initially presented to another hospital and transferred to reporting hospital's ICU on 01/29/23 with respiratory failure requiring BIPAP, found to be in shock secondary to COVID-19, and subsequently intubated on 02/03/23. Hospital course complicated by atrial fibrillation with RVR versus SVT, elevated transaminases requiring N-acetylcysteine, acute parotiditis, and acute encephalopathy. Was eventually extubated on 02/10/23 but rapid clinical decline hours after with hypotension unresponsive to vasopressors. Eventually went into PEA arrest but decision was made to end the code after exhaustive measures were performed and all reversible causes were considered.    Discharge Diagnoses: PEA arrest Shock, unspecified Acute on chronic respiratory failure with hypoxemia  COVID-19 viral pneumonia Atrial fibrillation with RVR Acute parotiditis Acute encephalopathy  Incidental CT finding of adrenal mass - Time of death 23:19. Contacted family during cardiac arrest. Resident met with patient's family on their arrival and offered emotional support (see quick notes).
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Endotracheal intubation, General physical health deterioration, Hypotension, Intensive care, Parotitis
Clinical narrative: The patient is a 66 y.o. female patient of Physician with a history of atrial fibrillation, IDDM2, asthma, COPD, chronic respiratory failure on 4L of O2, HLD, HTN, and depression/anxiety who initially presented to another hospital and transferred to reporting hospital's ICU on 01/29/23 with respiratory failure requiring BIPAP, found to be in shock secondary to COVID-19, and subsequently intubated on 02/03/23. Hospital course complicated by atrial fibrillation with RVR versus SVT, elevated transaminases requiring N-acetylcysteine, acute parotiditis, and acute encephalopathy. Was eventually extubated on 02/10/23 but rapid clinical decline hours after with hypotension unresponsive to vasopressors. Eventually went into PEA arrest but decision was made to end the code after exhaustive measures were performed and all reversible causes were considered.    Discharge Diagnoses: PEA arrest Shock, unspecified Acute on chronic respiratory failure with hypoxemia  COVID-19 viral pneumonia Atrial fibrillation with RVR Acute parotiditis Acute encephalopathy  Incidental CT finding of adrenal mass - Time of death 23:19. Contacted family during cardiac arrest. Resident met with patient's family on their arrival and offered emotional support (see quick notes).
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Pneumonia viral, Positive airway pressure therapy, Pulseless electrical activity, Respiratory failure, Shock
Clinical narrative: The patient is a 66 y.o. female patient of Physician with a history of atrial fibrillation, IDDM2, asthma, COPD, chronic respiratory failure on 4L of O2, HLD, HTN, and depression/anxiety who initially presented to another hospital and transferred to reporting hospital's ICU on 01/29/23 with respiratory failure requiring BIPAP, found to be in shock secondary to COVID-19, and subsequently intubated on 02/03/23. Hospital course complicated by atrial fibrillation with RVR versus SVT, elevated transaminases requiring N-acetylcysteine, acute parotiditis, and acute encephalopathy. Was eventually extubated on 02/10/23 but rapid clinical decline hours after with hypotension unresponsive to vasopressors. Eventually went into PEA arrest but decision was made to end the code after exhaustive measures were performed and all reversible causes were considered.    Discharge Diagnoses: PEA arrest Shock, unspecified Acute on chronic respiratory failure with hypoxemia  COVID-19 viral pneumonia Atrial fibrillation with RVR Acute parotiditis Acute encephalopathy  Incidental CT finding of adrenal mass - Time of death 23:19. Contacted family during cardiac arrest. Resident met with patient's family on their arrival and offered emotional support (see quick notes).
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Supraventricular tachycardia, Transaminases increased
Clinical narrative: The patient is a 66 y.o. female patient of Physician with a history of atrial fibrillation, IDDM2, asthma, COPD, chronic respiratory failure on 4L of O2, HLD, HTN, and depression/anxiety who initially presented to another hospital and transferred to reporting hospital's ICU on 01/29/23 with respiratory failure requiring BIPAP, found to be in shock secondary to COVID-19, and subsequently intubated on 02/03/23. Hospital course complicated by atrial fibrillation with RVR versus SVT, elevated transaminases requiring N-acetylcysteine, acute parotiditis, and acute encephalopathy. Was eventually extubated on 02/10/23 but rapid clinical decline hours after with hypotension unresponsive to vasopressors. Eventually went into PEA arrest but decision was made to end the code after exhaustive measures were performed and all reversible causes were considered.    Discharge Diagnoses: PEA arrest Shock, unspecified Acute on chronic respiratory failure with hypoxemia  COVID-19 viral pneumonia Atrial fibrillation with RVR Acute parotiditis Acute encephalopathy  Incidental CT finding of adrenal mass - Time of death 23:19. Contacted family during cardiac arrest. Resident met with patient's family on their arrival and offered emotional support (see quick notes).
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Aphonia, Chest discomfort, Cough, Dysphonia, Ear pain
Clinical narrative: Symptoms started on the 21st of February and by the 24th my glands were swollen, my head and nose hurt, and I developed a cough sporadically and I wouldn't be able to stop. I had green phlegm so it was obviously an infection. I went to Urgent Care and they said it was an infection and he prescribed me an antibiotic, Flonase, and a cough syrup. I lost my voice in the process, he said it was sinuses, ears, and chest. I've never had any type of sinus infection before so this was all new to me. Its been about two weeks now and my ears seem clear but one ear seems a little bit sore still, my cough is almost completely gone, my voice is hoarse, and my chest feels a lot better.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Headache, Lymphadenopathy, Rhinalgia, SARS-CoV-2 test negative, Sinusitis
Clinical narrative: Symptoms started on the 21st of February and by the 24th my glands were swollen, my head and nose hurt, and I developed a cough sporadically and I wouldn't be able to stop. I had green phlegm so it was obviously an infection. I went to Urgent Care and they said it was an infection and he prescribed me an antibiotic, Flonase, and a cough syrup. I lost my voice in the process, he said it was sinuses, ears, and chest. I've never had any type of sinus infection before so this was all new to me. Its been about two weeks now and my ears seem clear but one ear seems a little bit sore still, my cough is almost completely gone, my voice is hoarse, and my chest feels a lot better.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Sputum discoloured
Clinical narrative: Symptoms started on the 21st of February and by the 24th my glands were swollen, my head and nose hurt, and I developed a cough sporadically and I wouldn't be able to stop. I had green phlegm so it was obviously an infection. I went to Urgent Care and they said it was an infection and he prescribed me an antibiotic, Flonase, and a cough syrup. I lost my voice in the process, he said it was sinuses, ears, and chest. I've never had any type of sinus infection before so this was all new to me. Its been about two weeks now and my ears seem clear but one ear seems a little bit sore still, my cough is almost completely gone, my voice is hoarse, and my chest feels a lot better.
Age: 36.0
Sex: F
Vaccine: COVID19-2
Symptoms: Fatigue
Clinical narrative: Fatigue, feeling tired.
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Blood test abnormal, Fatigue, Pain, Productive cough
Clinical narrative: I experienced body aches, a wet cough, and fatigue. The fatigue lasted two to three weeks after the other symptoms went away. I called my physician, and they referred me to an internet doctor who prescribed PAXLOVID.
Age: 3.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect product formulation administered
Clinical narrative: The patient received a Primary Moderna 6m-4yrs instead of a Moderna Bivalent 6m-yrs.
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal distension, Acute kidney injury, Atrial fibrillation, Behaviour disorder, Blood folate normal
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Bradycardia, COVID-19, Chest X-ray abnormal, Chest pain, Constipation
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Dementia, Diastolic dysfunction, Disorientation, Echocardiogram, Ejection fraction normal
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Electrocardiogram abnormal, Fall, Hyperkalaemia, Hypophosphataemia, Hypoxia
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Insomnia, Leukocytosis, Magnetic resonance imaging head abnormal, Memory impairment, Metabolic encephalopathy
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Paranoia, Pleural calcification, Troponin normal, Ultrasound bladder normal, Ultrasound kidney normal
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 83.0
Sex: M
Vaccine: COVID19
Symptoms: Vitamin B12 normal, Vitamin D decreased, Vitamin D deficiency
Clinical narrative: Patient is a 84 y.o. male with history of dementia, CAD, CHF, Afib, HTN transferred from Psych facility to with chest pain radiating to left arm, work-up unremarkable. Hospital course complicated by COVID and prolonged due to placement issues.   Presumed Dementia with behavioral disturbances Toxic metabolic encephalopathy - (Resolved) Approximately 4-5 months of disorientation, marked paranoia resulting in psychiatric admission.  Family does admit to some memory changes prior  Has had several changes in setting from home, jail, medical hospital, psych hospital, son's house BH consulted: unlikely primary psychological disorder given age, no need for inpatient psych Workup generally unrevealing  Old strokes/microvascular changes on MRI, at risk for vascular dementia  Remains no AMA, Wife is surrogate decision maker but currently in SNF Patient is not able to consistently name a POA Continue donepezil, memantine, nightly olanzapine  Patient needs outpatient neurocognitive evaluation  Discharging to the Facility on Tuesday 2/14 at 11 am    Falls Twice this admit Fall precautions, E companion in place  PT/OT-- AM-PAC 19 Recommend out of bed TID with nursing B12 and folate normal    Vitamin D insufficiency Vitamin D: 29, started replacement   Insomnia  Scheduled melatonin nightly  PRN trazodone    Stable/Chronic or Resolved Medical Conditions Covid 19 infection with Hypoxia (Resolved) -- Required 2L NC, weaned to RA (12/14); treated with Decadron 6 mg (12/12 - 12/22). Isolation ended 12/19 Chest pain -- Troponin negative; EKG a.fib. Cardio c/s, no ischemic testing recommended  CAD S/p CABG (2005) subsequent PCI 2015 Chronic HFpEF -- euvolemic. TTE (10/2022): EF 60%, diastolic dysfunction. Continue Toprol, Cardura, Lisinopril. Lasix stopped d/t AKI, resumed at 20 mg (12/29). Check weekly weights Bradycardia (Resolved) -- HR down ~30's while sleeping / soft pressures  Toprol reduced, stopped clonidine Essential HTN -- Continue home cardura, lisinopril and Toprol w/ hold parameters. Dose of lisinopril reduced (parameters added) for soft pressures  Chronic A. Fib -- Continue home Toprol and Xarelto Abdominal Distention (Resolved) -- KUB no acute, PVR WNL (12/21)  Leukocytosis (Resolved)   AKI and Hyperkalemia - (Resolved) -- Baseline Cr ~1.0; Renal/bladder US (12/25): without obstruction. Follow RFP intermittently. Hypophosphatemia-- (Resolved) --  supplement given Pleural Calcifications  CXR (12/22/22): Extensive bilateral calcified pleural plaquing consistent with asbestos related pleural disease Currently stable on RA  Can follow with PCP OP for PFTs and referral to pulmonology as needed  Constipation Continue bowel regimen
Age: 18.0
Sex: F
Vaccine: MMRV
Symptoms: Unevaluable event
Clinical narrative: none a this time
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Aspiration, Barium swallow abnormal, COVID-19 pneumonia
Clinical narrative: Patient admitted for acute hypoxic respiratory failure, multifocal pneumonia, COVID-pneumonia, aspiration pneumonia.  He received treatment for COVID with remdesivir, steroids.  During his stay he had worsening of his respiratory status with oxygen demand increased.  He was noted to need BiPAP for improvement of oxygen. Due to his aspiration plans were for PEG tube however PEG tube was unable to be placed because of his poor respiratory status.  Despite antibiotics, steroids BiPAP, nebs patient continued to deteriorate.  Repeat imaging with CTA ruled out PE and confirmed worsening pneumonia.  Patient and family eventually decided on DNR CCA and later DNR CC.  Patient later passed away at 6:25pm 2/7/23 with family at bedside. RIP.   Clinical Summary   Assessment and Plan The patient is a 83 y.o. male with history of recently diagnosed dementia prostate cancer hyperlipidemia diabetes diverticulosis DVT status post 6 months of therapy GERD presented to the Hospital with worsening shortness of breath and cough from primary care's office.   Acute respiratory failure with hypoxia, worsening Sepsis 2/2 Multifocal pneumonia Probably aspiration pneumonia Covid pneumonia Patient on BiPAP, wean as tolerated Completed remdesivir and dexamethasone Received duo nebs every 4 every 6 as needed ID consulted IV Zosyn Repeat CTA - no PE, worsening Lung disease DC bipap, transition DNRCC   COVID PNA Completed remdesevir and decadron DC'd COVID isolation 2/5/23   Ileus- resolved KUB shows mild distention of small bowel large bowel with persistent contrast throughout the colon continue bowel regimen continue tube feeds   Dysphagia with aspiration S/p modified barium swallow study No need for PEG tube now Remove NG tube- DNRCC   Depression Mirtazapine   DM Sliding scale   Hyponatremia-resolved Mild, continue to monitor
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Cough, Death, Depression, Diabetes mellitus, Dysphagia
Clinical narrative: Patient admitted for acute hypoxic respiratory failure, multifocal pneumonia, COVID-pneumonia, aspiration pneumonia.  He received treatment for COVID with remdesivir, steroids.  During his stay he had worsening of his respiratory status with oxygen demand increased.  He was noted to need BiPAP for improvement of oxygen. Due to his aspiration plans were for PEG tube however PEG tube was unable to be placed because of his poor respiratory status.  Despite antibiotics, steroids BiPAP, nebs patient continued to deteriorate.  Repeat imaging with CTA ruled out PE and confirmed worsening pneumonia.  Patient and family eventually decided on DNR CCA and later DNR CC.  Patient later passed away at 6:25pm 2/7/23 with family at bedside. RIP.   Clinical Summary   Assessment and Plan The patient is a 83 y.o. male with history of recently diagnosed dementia prostate cancer hyperlipidemia diabetes diverticulosis DVT status post 6 months of therapy GERD presented to the Hospital with worsening shortness of breath and cough from primary care's office.   Acute respiratory failure with hypoxia, worsening Sepsis 2/2 Multifocal pneumonia Probably aspiration pneumonia Covid pneumonia Patient on BiPAP, wean as tolerated Completed remdesivir and dexamethasone Received duo nebs every 4 every 6 as needed ID consulted IV Zosyn Repeat CTA - no PE, worsening Lung disease DC bipap, transition DNRCC   COVID PNA Completed remdesevir and decadron DC'd COVID isolation 2/5/23   Ileus- resolved KUB shows mild distention of small bowel large bowel with persistent contrast throughout the colon continue bowel regimen continue tube feeds   Dysphagia with aspiration S/p modified barium swallow study No need for PEG tube now Remove NG tube- DNRCC   Depression Mirtazapine   DM Sliding scale   Hyponatremia-resolved Mild, continue to monitor
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dyspnoea, Feeding tube user, Gastrointestinal tube removal, General physical health deterioration, Hyponatraemia
Clinical narrative: Patient admitted for acute hypoxic respiratory failure, multifocal pneumonia, COVID-pneumonia, aspiration pneumonia.  He received treatment for COVID with remdesivir, steroids.  During his stay he had worsening of his respiratory status with oxygen demand increased.  He was noted to need BiPAP for improvement of oxygen. Due to his aspiration plans were for PEG tube however PEG tube was unable to be placed because of his poor respiratory status.  Despite antibiotics, steroids BiPAP, nebs patient continued to deteriorate.  Repeat imaging with CTA ruled out PE and confirmed worsening pneumonia.  Patient and family eventually decided on DNR CCA and later DNR CC.  Patient later passed away at 6:25pm 2/7/23 with family at bedside. RIP.   Clinical Summary   Assessment and Plan The patient is a 83 y.o. male with history of recently diagnosed dementia prostate cancer hyperlipidemia diabetes diverticulosis DVT status post 6 months of therapy GERD presented to the Hospital with worsening shortness of breath and cough from primary care's office.   Acute respiratory failure with hypoxia, worsening Sepsis 2/2 Multifocal pneumonia Probably aspiration pneumonia Covid pneumonia Patient on BiPAP, wean as tolerated Completed remdesivir and dexamethasone Received duo nebs every 4 every 6 as needed ID consulted IV Zosyn Repeat CTA - no PE, worsening Lung disease DC bipap, transition DNRCC   COVID PNA Completed remdesevir and decadron DC'd COVID isolation 2/5/23   Ileus- resolved KUB shows mild distention of small bowel large bowel with persistent contrast throughout the colon continue bowel regimen continue tube feeds   Dysphagia with aspiration S/p modified barium swallow study No need for PEG tube now Remove NG tube- DNRCC   Depression Mirtazapine   DM Sliding scale   Hyponatremia-resolved Mild, continue to monitor
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Ileus, Intestinal dilatation, Lung disorder, Pneumonia, Pneumonia aspiration
Clinical narrative: Patient admitted for acute hypoxic respiratory failure, multifocal pneumonia, COVID-pneumonia, aspiration pneumonia.  He received treatment for COVID with remdesivir, steroids.  During his stay he had worsening of his respiratory status with oxygen demand increased.  He was noted to need BiPAP for improvement of oxygen. Due to his aspiration plans were for PEG tube however PEG tube was unable to be placed because of his poor respiratory status.  Despite antibiotics, steroids BiPAP, nebs patient continued to deteriorate.  Repeat imaging with CTA ruled out PE and confirmed worsening pneumonia.  Patient and family eventually decided on DNR CCA and later DNR CC.  Patient later passed away at 6:25pm 2/7/23 with family at bedside. RIP.   Clinical Summary   Assessment and Plan The patient is a 83 y.o. male with history of recently diagnosed dementia prostate cancer hyperlipidemia diabetes diverticulosis DVT status post 6 months of therapy GERD presented to the Hospital with worsening shortness of breath and cough from primary care's office.   Acute respiratory failure with hypoxia, worsening Sepsis 2/2 Multifocal pneumonia Probably aspiration pneumonia Covid pneumonia Patient on BiPAP, wean as tolerated Completed remdesivir and dexamethasone Received duo nebs every 4 every 6 as needed ID consulted IV Zosyn Repeat CTA - no PE, worsening Lung disease DC bipap, transition DNRCC   COVID PNA Completed remdesevir and decadron DC'd COVID isolation 2/5/23   Ileus- resolved KUB shows mild distention of small bowel large bowel with persistent contrast throughout the colon continue bowel regimen continue tube feeds   Dysphagia with aspiration S/p modified barium swallow study No need for PEG tube now Remove NG tube- DNRCC   Depression Mirtazapine   DM Sliding scale   Hyponatremia-resolved Mild, continue to monitor
Age: 83.0
Sex: M
Vaccine: COVID19-2
Symptoms: Positive airway pressure therapy, Respiratory disorder, Sepsis, Urogram
Clinical narrative: Patient admitted for acute hypoxic respiratory failure, multifocal pneumonia, COVID-pneumonia, aspiration pneumonia.  He received treatment for COVID with remdesivir, steroids.  During his stay he had worsening of his respiratory status with oxygen demand increased.  He was noted to need BiPAP for improvement of oxygen. Due to his aspiration plans were for PEG tube however PEG tube was unable to be placed because of his poor respiratory status.  Despite antibiotics, steroids BiPAP, nebs patient continued to deteriorate.  Repeat imaging with CTA ruled out PE and confirmed worsening pneumonia.  Patient and family eventually decided on DNR CCA and later DNR CC.  Patient later passed away at 6:25pm 2/7/23 with family at bedside. RIP.   Clinical Summary   Assessment and Plan The patient is a 83 y.o. male with history of recently diagnosed dementia prostate cancer hyperlipidemia diabetes diverticulosis DVT status post 6 months of therapy GERD presented to the Hospital with worsening shortness of breath and cough from primary care's office.   Acute respiratory failure with hypoxia, worsening Sepsis 2/2 Multifocal pneumonia Probably aspiration pneumonia Covid pneumonia Patient on BiPAP, wean as tolerated Completed remdesivir and dexamethasone Received duo nebs every 4 every 6 as needed ID consulted IV Zosyn Repeat CTA - no PE, worsening Lung disease DC bipap, transition DNRCC   COVID PNA Completed remdesevir and decadron DC'd COVID isolation 2/5/23   Ileus- resolved KUB shows mild distention of small bowel large bowel with persistent contrast throughout the colon continue bowel regimen continue tube feeds   Dysphagia with aspiration S/p modified barium swallow study No need for PEG tube now Remove NG tube- DNRCC   Depression Mirtazapine   DM Sliding scale   Hyponatremia-resolved Mild, continue to monitor
Age: 9.0
Sex: M
Vaccine: FLU4, PPV
Symptoms: Vaccination site cellulitis
Clinical narrative: cellulitis, appears to be at flu vaccine site
Age: 70.0
Sex: M
Vaccine: COVID19
Symptoms: Loss of personal independence in daily activities, Mobility decreased, Muscular weakness
Clinical narrative: Patient reported symptoms of significant generalized muscular weakness with onset within 24 hours of vaccination.  Resulted in the inability to arise from the bed or to sit in a chair that following day.  Generalized weakness remained to a lesser degree for up to 9 months limiting his ability to do his normal daily activities.  Did not report symptoms to a healthcare provider at that time to allow for further evaluation.  Discussed during the course of a routine visit on date of entry of report.
Age: 49.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Arthralgia, Bladder disorder, Cardiac disorder, Decreased appetite, Dizziness
Clinical narrative: The week I got my first shot I had excruciating pain in my joints. CDC and I talked for 4 days. After both shots and about 6-9 months later I started having a lack of hunger which has been on and off since the shots. I now have heart issues and bladder/ kidney issues. Tests were done and no results were found yet I was told no more shots. I've continued to have more health problems as time goes on and the heart/bladder & kidney issues keep rearing their ugly head. It has taken me out of work because of the dizziness and pain. I know have dot hemes and flame hemes which come and go with the heart issue and are causing great headaches and eye problems.