chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Laboratory test normal, Left ventricular failure, Liver function test increased, Mitral valve incompetence, Mobility decreased
Clinical narrative: Patient is a 90 y.o. female who presented from home on 9/11/2023 with weakness, fever, found to have covid and acute on chronic HFpEF. Placed on steroids, remdesivir and IV lasix, weaned off O2. PT/OT evaluated, patient elected for SNF on DC.    Acute hypoxic respiratory failure, resolved COVID-19 -Presented with: fevers and generalized weakness -Symptom onset: 9/10/2023 -Positive COVID-19: 9/11/2023 at Hospital -Vaccination status: Vaccinated with Moderna with last dose 4/29/2022 -CTPE on admission showed NO PE. Bilateral effusions with mild backround interstitial edema, reactive LN in the mediastinum. -Oxygen status: 2-3 liters -> 1L-> RA 9/15 -Decadron: Yes. Stopped on discharge as off o2 -Remdesivir: Yes. completed -DVT prophylaxis: Currently on full anticoagulation -Case Management/Social Services consulted: Yes    Thrombocytopenia  -likely from covid. Hemolysis labs negative. Smear not concerning starting to improve -improvin   Hyponatremia -History of SIADH with chronically low sodium around 130 (was 127 per labs July 2023) -note Na drop on 9/14, asymptomatic. Improved with salt tabs while here, resumption of diurtics   Acute on chronic diastolic heart failure, acute failure resolved Severe Mitral Regurgitation Pulmonary hypertension -Home medications are: torsemide 20 mg daily, with dry weight of 105 pounds, Toprol 25 mg daily, and cozaar. -Echo 7/20/2023 showed EF 50 and severe MR  -Despite being at normal weight, she still has signs of acute CHF ie. CT chest findings, SOB, etc -s/p lasix 40 mg IV BID, strict I/Os. IV lasix as above, resumed torsemide 9/15 -Continue with Toprol and cozaar.   Urinary retention -presumably from acute illness/ decreased mobility. Developed likely stretch injury to bladder with > 1 liter -foley placed 9/12, can plan on voiding trial in 7-10 days   Elevated LFTs -likely from covid, were nml may 2023 -monitor, can resume statin in two weeks   Persistent atrial fibrillation -HR is stable -Continue Eliquis and Toprol-XL Rheumatoid arthritis -Home meds are prednisone 5 mg daily and plaquenil 200 mg daily -Continue with decadron per COVID. held home plaquenil, resume on dc   Essential hypertension -Home medications include: Toprol-XL, losartan, torsemide. -Continue home Toprol-XL and losartan.     Hypothyroidism -Continue with Synthroid   Generalized Anxiety Major Depression in remission -Continue Celexa   Hyperlipidemia -holding statin as above   GERD -Continue with PPI
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary oedema, Pyrexia, SARS-CoV-2 test positive, Smear site unspecified normal, Thrombocytopenia
Clinical narrative: Patient is a 90 y.o. female who presented from home on 9/11/2023 with weakness, fever, found to have covid and acute on chronic HFpEF. Placed on steroids, remdesivir and IV lasix, weaned off O2. PT/OT evaluated, patient elected for SNF on DC.    Acute hypoxic respiratory failure, resolved COVID-19 -Presented with: fevers and generalized weakness -Symptom onset: 9/10/2023 -Positive COVID-19: 9/11/2023 at Hospital -Vaccination status: Vaccinated with Moderna with last dose 4/29/2022 -CTPE on admission showed NO PE. Bilateral effusions with mild backround interstitial edema, reactive LN in the mediastinum. -Oxygen status: 2-3 liters -> 1L-> RA 9/15 -Decadron: Yes. Stopped on discharge as off o2 -Remdesivir: Yes. completed -DVT prophylaxis: Currently on full anticoagulation -Case Management/Social Services consulted: Yes    Thrombocytopenia  -likely from covid. Hemolysis labs negative. Smear not concerning starting to improve -improvin   Hyponatremia -History of SIADH with chronically low sodium around 130 (was 127 per labs July 2023) -note Na drop on 9/14, asymptomatic. Improved with salt tabs while here, resumption of diurtics   Acute on chronic diastolic heart failure, acute failure resolved Severe Mitral Regurgitation Pulmonary hypertension -Home medications are: torsemide 20 mg daily, with dry weight of 105 pounds, Toprol 25 mg daily, and cozaar. -Echo 7/20/2023 showed EF 50 and severe MR  -Despite being at normal weight, she still has signs of acute CHF ie. CT chest findings, SOB, etc -s/p lasix 40 mg IV BID, strict I/Os. IV lasix as above, resumed torsemide 9/15 -Continue with Toprol and cozaar.   Urinary retention -presumably from acute illness/ decreased mobility. Developed likely stretch injury to bladder with > 1 liter -foley placed 9/12, can plan on voiding trial in 7-10 days   Elevated LFTs -likely from covid, were nml may 2023 -monitor, can resume statin in two weeks   Persistent atrial fibrillation -HR is stable -Continue Eliquis and Toprol-XL Rheumatoid arthritis -Home meds are prednisone 5 mg daily and plaquenil 200 mg daily -Continue with decadron per COVID. held home plaquenil, resume on dc   Essential hypertension -Home medications include: Toprol-XL, losartan, torsemide. -Continue home Toprol-XL and losartan.     Hypothyroidism -Continue with Synthroid   Generalized Anxiety Major Depression in remission -Continue Celexa   Hyperlipidemia -holding statin as above   GERD -Continue with PPI
Age: 89.0
Sex: F
Vaccine: COVID19
Symptoms: Urinary retention
Clinical narrative: Patient is a 90 y.o. female who presented from home on 9/11/2023 with weakness, fever, found to have covid and acute on chronic HFpEF. Placed on steroids, remdesivir and IV lasix, weaned off O2. PT/OT evaluated, patient elected for SNF on DC.    Acute hypoxic respiratory failure, resolved COVID-19 -Presented with: fevers and generalized weakness -Symptom onset: 9/10/2023 -Positive COVID-19: 9/11/2023 at Hospital -Vaccination status: Vaccinated with Moderna with last dose 4/29/2022 -CTPE on admission showed NO PE. Bilateral effusions with mild backround interstitial edema, reactive LN in the mediastinum. -Oxygen status: 2-3 liters -> 1L-> RA 9/15 -Decadron: Yes. Stopped on discharge as off o2 -Remdesivir: Yes. completed -DVT prophylaxis: Currently on full anticoagulation -Case Management/Social Services consulted: Yes    Thrombocytopenia  -likely from covid. Hemolysis labs negative. Smear not concerning starting to improve -improvin   Hyponatremia -History of SIADH with chronically low sodium around 130 (was 127 per labs July 2023) -note Na drop on 9/14, asymptomatic. Improved with salt tabs while here, resumption of diurtics   Acute on chronic diastolic heart failure, acute failure resolved Severe Mitral Regurgitation Pulmonary hypertension -Home medications are: torsemide 20 mg daily, with dry weight of 105 pounds, Toprol 25 mg daily, and cozaar. -Echo 7/20/2023 showed EF 50 and severe MR  -Despite being at normal weight, she still has signs of acute CHF ie. CT chest findings, SOB, etc -s/p lasix 40 mg IV BID, strict I/Os. IV lasix as above, resumed torsemide 9/15 -Continue with Toprol and cozaar.   Urinary retention -presumably from acute illness/ decreased mobility. Developed likely stretch injury to bladder with > 1 liter -foley placed 9/12, can plan on voiding trial in 7-10 days   Elevated LFTs -likely from covid, were nml may 2023 -monitor, can resume statin in two weeks   Persistent atrial fibrillation -HR is stable -Continue Eliquis and Toprol-XL Rheumatoid arthritis -Home meds are prednisone 5 mg daily and plaquenil 200 mg daily -Continue with decadron per COVID. held home plaquenil, resume on dc   Essential hypertension -Home medications include: Toprol-XL, losartan, torsemide. -Continue home Toprol-XL and losartan.     Hypothyroidism -Continue with Synthroid   Generalized Anxiety Major Depression in remission -Continue Celexa   Hyperlipidemia -holding statin as above   GERD -Continue with PPI
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: VACCINE WAS STORD IN AN UNAPPROVED STORAGE UNIT
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Arteriosclerosis coronary artery, Asthenia, COVID-19 pneumonia, Chest X-ray abnormal, Coronary artery disease
Clinical narrative: Patient is a 74 y.o. male patient of, CNP with history of HTN presented to Hospital with N/V, weakness .   Covid-19 Virus Pneumonia Sepsis, due to COVID pneumonia, resolved  Date of onset of symptoms: 9/12 Symptoms present on admission: weakness, N/V, dyspnea Date of covid positive test: 9/17 Sepsis criteria: WBC 3,4100, platelet count 104,000, RR 24 Vaccination status: vaccinated Imaging: CXR with basilar infiltrate Medical therapy: remdesivir and dexamethasone started on admission  Anticipated special isolation end date: 9/19 Treated with oxygen support, remdesivir, dexamethasone Initially patient required supplemental oxygen, now his oxygen saturation is 96% on room air. Patient discharged in stable condition.   Deconditioned  Continue physical and Occupational Therapy   Leukopenia Thrombocytopenia White blood cell count 3.41, platelet count 120 Outpatient follow-up   CAD, native heart and coronary, without angina HTN, controlled Continue aspirin, atenolol, statin   DM2, controlled Hyperlipidemia On semaglutide, simvastatin at home A1c 5.8 (3/2023, records) Continue Lantus insulin and sliding scale coverage Continue statin Rheumatoid arthritis Chronic pain Continue Plaquenil and MS Contin Data reviewed   Goals of care Geriatric assessment Goals are somewhat rehabilitative, he would like to return home if possible DNRCCA no intubation Fall precautions, delirium prevention, oral thiamine
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Dyspnoea, Glycosylated haemoglobin, Hyperlipidaemia, Hypertension, Leukopenia
Clinical narrative: Patient is a 74 y.o. male patient of, CNP with history of HTN presented to Hospital with N/V, weakness .   Covid-19 Virus Pneumonia Sepsis, due to COVID pneumonia, resolved  Date of onset of symptoms: 9/12 Symptoms present on admission: weakness, N/V, dyspnea Date of covid positive test: 9/17 Sepsis criteria: WBC 3,4100, platelet count 104,000, RR 24 Vaccination status: vaccinated Imaging: CXR with basilar infiltrate Medical therapy: remdesivir and dexamethasone started on admission  Anticipated special isolation end date: 9/19 Treated with oxygen support, remdesivir, dexamethasone Initially patient required supplemental oxygen, now his oxygen saturation is 96% on room air. Patient discharged in stable condition.   Deconditioned  Continue physical and Occupational Therapy   Leukopenia Thrombocytopenia White blood cell count 3.41, platelet count 120 Outpatient follow-up   CAD, native heart and coronary, without angina HTN, controlled Continue aspirin, atenolol, statin   DM2, controlled Hyperlipidemia On semaglutide, simvastatin at home A1c 5.8 (3/2023, records) Continue Lantus insulin and sliding scale coverage Continue statin Rheumatoid arthritis Chronic pain Continue Plaquenil and MS Contin Data reviewed   Goals of care Geriatric assessment Goals are somewhat rehabilitative, he would like to return home if possible DNRCCA no intubation Fall precautions, delirium prevention, oral thiamine
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Lung infiltration, Nausea, Pain, Physical deconditioning, Platelet count decreased
Clinical narrative: Patient is a 74 y.o. male patient of, CNP with history of HTN presented to Hospital with N/V, weakness .   Covid-19 Virus Pneumonia Sepsis, due to COVID pneumonia, resolved  Date of onset of symptoms: 9/12 Symptoms present on admission: weakness, N/V, dyspnea Date of covid positive test: 9/17 Sepsis criteria: WBC 3,4100, platelet count 104,000, RR 24 Vaccination status: vaccinated Imaging: CXR with basilar infiltrate Medical therapy: remdesivir and dexamethasone started on admission  Anticipated special isolation end date: 9/19 Treated with oxygen support, remdesivir, dexamethasone Initially patient required supplemental oxygen, now his oxygen saturation is 96% on room air. Patient discharged in stable condition.   Deconditioned  Continue physical and Occupational Therapy   Leukopenia Thrombocytopenia White blood cell count 3.41, platelet count 120 Outpatient follow-up   CAD, native heart and coronary, without angina HTN, controlled Continue aspirin, atenolol, statin   DM2, controlled Hyperlipidemia On semaglutide, simvastatin at home A1c 5.8 (3/2023, records) Continue Lantus insulin and sliding scale coverage Continue statin Rheumatoid arthritis Chronic pain Continue Plaquenil and MS Contin Data reviewed   Goals of care Geriatric assessment Goals are somewhat rehabilitative, he would like to return home if possible DNRCCA no intubation Fall precautions, delirium prevention, oral thiamine
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Rheumatoid arthritis, SARS-CoV-2 test positive, Sepsis, Thrombocytopenia, Type 2 diabetes mellitus
Clinical narrative: Patient is a 74 y.o. male patient of, CNP with history of HTN presented to Hospital with N/V, weakness .   Covid-19 Virus Pneumonia Sepsis, due to COVID pneumonia, resolved  Date of onset of symptoms: 9/12 Symptoms present on admission: weakness, N/V, dyspnea Date of covid positive test: 9/17 Sepsis criteria: WBC 3,4100, platelet count 104,000, RR 24 Vaccination status: vaccinated Imaging: CXR with basilar infiltrate Medical therapy: remdesivir and dexamethasone started on admission  Anticipated special isolation end date: 9/19 Treated with oxygen support, remdesivir, dexamethasone Initially patient required supplemental oxygen, now his oxygen saturation is 96% on room air. Patient discharged in stable condition.   Deconditioned  Continue physical and Occupational Therapy   Leukopenia Thrombocytopenia White blood cell count 3.41, platelet count 120 Outpatient follow-up   CAD, native heart and coronary, without angina HTN, controlled Continue aspirin, atenolol, statin   DM2, controlled Hyperlipidemia On semaglutide, simvastatin at home A1c 5.8 (3/2023, records) Continue Lantus insulin and sliding scale coverage Continue statin Rheumatoid arthritis Chronic pain Continue Plaquenil and MS Contin Data reviewed   Goals of care Geriatric assessment Goals are somewhat rehabilitative, he would like to return home if possible DNRCCA no intubation Fall precautions, delirium prevention, oral thiamine
Age: 73.0
Sex: M
Vaccine: COVID19-2
Symptoms: Vomiting, White blood cell count increased
Clinical narrative: Patient is a 74 y.o. male patient of, CNP with history of HTN presented to Hospital with N/V, weakness .   Covid-19 Virus Pneumonia Sepsis, due to COVID pneumonia, resolved  Date of onset of symptoms: 9/12 Symptoms present on admission: weakness, N/V, dyspnea Date of covid positive test: 9/17 Sepsis criteria: WBC 3,4100, platelet count 104,000, RR 24 Vaccination status: vaccinated Imaging: CXR with basilar infiltrate Medical therapy: remdesivir and dexamethasone started on admission  Anticipated special isolation end date: 9/19 Treated with oxygen support, remdesivir, dexamethasone Initially patient required supplemental oxygen, now his oxygen saturation is 96% on room air. Patient discharged in stable condition.   Deconditioned  Continue physical and Occupational Therapy   Leukopenia Thrombocytopenia White blood cell count 3.41, platelet count 120 Outpatient follow-up   CAD, native heart and coronary, without angina HTN, controlled Continue aspirin, atenolol, statin   DM2, controlled Hyperlipidemia On semaglutide, simvastatin at home A1c 5.8 (3/2023, records) Continue Lantus insulin and sliding scale coverage Continue statin Rheumatoid arthritis Chronic pain Continue Plaquenil and MS Contin Data reviewed   Goals of care Geriatric assessment Goals are somewhat rehabilitative, he would like to return home if possible DNRCCA no intubation Fall precautions, delirium prevention, oral thiamine
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute kidney injury, Acute respiratory failure, Anaemia of chronic disease, Anticoagulant therapy, Blood creatinine
Clinical narrative: Patient is a 70 y.o. female with a history of multiple myeloma, DVT on Eliquis, COPD, chronic systolic CHF with EF of 40% who presented to ED with 7-day history of fevers, productive cough, sore throat, and myalgias and was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia. She was transferred to facility 9/18/2023 for further care. There was an inability to rule out bacterial pneumonia and COPD exacerbation based on findings, so she was discharged with a course of antibiotics and steroids. She also had an AKI that improved with IVF and low normal BPs, so her antihypertensives were held on discharge.   1. Acute hypoxic respiratory failure: Not on home O2. Required up to 2 L on admit. Chest x-ray on admit with multifocal pneumonia. Likely due to COVID-19 and possible COPD exacerbation. Weaned to RA prior to discharge. 2. COVID-19 pneumonia, possible CAP: Recent travel history and productive cough. Chest x-ray on admit with multifocal pneumonia. Urine antigens negative, procalcitonin positive. Improved with steroids and antibiotics, discharged with 7 day total course. Held off on remdesivir given AKI and ultimately weaned to room air with rapid improvement in symptoms. 3. Possible COPD exacerbation: Due to above. S/p Solu-Medrol in the ED. Continued home inhalers. Steroids as above. 4. AKI: Creatinine normal at baseline. Creatinine up to 1.33 on admit.  Likely due to dehydration. Held home diuretics and ARB. Resolved with IV fluids. Resumed diuretic on discharge, but held ARB due to borderline low BP. Check BP and BMP and resume outpatient if appropriate. 5. Acute on chronic thrombocytopenia: baseline platelets 60-70.  Platelets 48 on admit. Likely due to above.  Trend. 6. Anemia of chronic disease: Hemoglobin baseline 10-11.  Hemoglobin 11.2 on admit.  Monitor. 7. Acute LLE DVT: Diagnosed 8/8/2023. Continued Eliquis 8. History of multiple myeloma: Follows with Dr. (oncology). Held home chemotherapy given active infection. Follow-up as outpatient 9. Chronic systolic CHF: Follows with Dr. (cardiology).  History of nonischemic cardiomyopathy.  TTE 11/16/2022 with EF of 42%.  Held ARB, beta-blocker and diuretics given AKI and soft blood pressures. Resumed BB and diuretic on discharge, resume ARB and HCTZ as able outpatient.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Deep vein thrombosis, Dehydration, Diuretic therapy
Clinical narrative: Patient is a 70 y.o. female with a history of multiple myeloma, DVT on Eliquis, COPD, chronic systolic CHF with EF of 40% who presented to ED with 7-day history of fevers, productive cough, sore throat, and myalgias and was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia. She was transferred to facility 9/18/2023 for further care. There was an inability to rule out bacterial pneumonia and COPD exacerbation based on findings, so she was discharged with a course of antibiotics and steroids. She also had an AKI that improved with IVF and low normal BPs, so her antihypertensives were held on discharge.   1. Acute hypoxic respiratory failure: Not on home O2. Required up to 2 L on admit. Chest x-ray on admit with multifocal pneumonia. Likely due to COVID-19 and possible COPD exacerbation. Weaned to RA prior to discharge. 2. COVID-19 pneumonia, possible CAP: Recent travel history and productive cough. Chest x-ray on admit with multifocal pneumonia. Urine antigens negative, procalcitonin positive. Improved with steroids and antibiotics, discharged with 7 day total course. Held off on remdesivir given AKI and ultimately weaned to room air with rapid improvement in symptoms. 3. Possible COPD exacerbation: Due to above. S/p Solu-Medrol in the ED. Continued home inhalers. Steroids as above. 4. AKI: Creatinine normal at baseline. Creatinine up to 1.33 on admit.  Likely due to dehydration. Held home diuretics and ARB. Resolved with IV fluids. Resumed diuretic on discharge, but held ARB due to borderline low BP. Check BP and BMP and resume outpatient if appropriate. 5. Acute on chronic thrombocytopenia: baseline platelets 60-70.  Platelets 48 on admit. Likely due to above.  Trend. 6. Anemia of chronic disease: Hemoglobin baseline 10-11.  Hemoglobin 11.2 on admit.  Monitor. 7. Acute LLE DVT: Diagnosed 8/8/2023. Continued Eliquis 8. History of multiple myeloma: Follows with Dr. (oncology). Held home chemotherapy given active infection. Follow-up as outpatient 9. Chronic systolic CHF: Follows with Dr. (cardiology).  History of nonischemic cardiomyopathy.  TTE 11/16/2022 with EF of 42%.  Held ARB, beta-blocker and diuretics given AKI and soft blood pressures. Resumed BB and diuretic on discharge, resume ARB and HCTZ as able outpatient.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Echocardiogram, Ejection fraction decreased, Haemoglobin, Infection, Myalgia
Clinical narrative: Patient is a 70 y.o. female with a history of multiple myeloma, DVT on Eliquis, COPD, chronic systolic CHF with EF of 40% who presented to ED with 7-day history of fevers, productive cough, sore throat, and myalgias and was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia. She was transferred to facility 9/18/2023 for further care. There was an inability to rule out bacterial pneumonia and COPD exacerbation based on findings, so she was discharged with a course of antibiotics and steroids. She also had an AKI that improved with IVF and low normal BPs, so her antihypertensives were held on discharge.   1. Acute hypoxic respiratory failure: Not on home O2. Required up to 2 L on admit. Chest x-ray on admit with multifocal pneumonia. Likely due to COVID-19 and possible COPD exacerbation. Weaned to RA prior to discharge. 2. COVID-19 pneumonia, possible CAP: Recent travel history and productive cough. Chest x-ray on admit with multifocal pneumonia. Urine antigens negative, procalcitonin positive. Improved with steroids and antibiotics, discharged with 7 day total course. Held off on remdesivir given AKI and ultimately weaned to room air with rapid improvement in symptoms. 3. Possible COPD exacerbation: Due to above. S/p Solu-Medrol in the ED. Continued home inhalers. Steroids as above. 4. AKI: Creatinine normal at baseline. Creatinine up to 1.33 on admit.  Likely due to dehydration. Held home diuretics and ARB. Resolved with IV fluids. Resumed diuretic on discharge, but held ARB due to borderline low BP. Check BP and BMP and resume outpatient if appropriate. 5. Acute on chronic thrombocytopenia: baseline platelets 60-70.  Platelets 48 on admit. Likely due to above.  Trend. 6. Anemia of chronic disease: Hemoglobin baseline 10-11.  Hemoglobin 11.2 on admit.  Monitor. 7. Acute LLE DVT: Diagnosed 8/8/2023. Continued Eliquis 8. History of multiple myeloma: Follows with Dr. (oncology). Held home chemotherapy given active infection. Follow-up as outpatient 9. Chronic systolic CHF: Follows with Dr. (cardiology).  History of nonischemic cardiomyopathy.  TTE 11/16/2022 with EF of 42%.  Held ARB, beta-blocker and diuretics given AKI and soft blood pressures. Resumed BB and diuretic on discharge, resume ARB and HCTZ as able outpatient.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Oropharyngeal pain, Platelet count decreased, Pneumonia, Procalcitonin increased, Productive cough
Clinical narrative: Patient is a 70 y.o. female with a history of multiple myeloma, DVT on Eliquis, COPD, chronic systolic CHF with EF of 40% who presented to ED with 7-day history of fevers, productive cough, sore throat, and myalgias and was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia. She was transferred to facility 9/18/2023 for further care. There was an inability to rule out bacterial pneumonia and COPD exacerbation based on findings, so she was discharged with a course of antibiotics and steroids. She also had an AKI that improved with IVF and low normal BPs, so her antihypertensives were held on discharge.   1. Acute hypoxic respiratory failure: Not on home O2. Required up to 2 L on admit. Chest x-ray on admit with multifocal pneumonia. Likely due to COVID-19 and possible COPD exacerbation. Weaned to RA prior to discharge. 2. COVID-19 pneumonia, possible CAP: Recent travel history and productive cough. Chest x-ray on admit with multifocal pneumonia. Urine antigens negative, procalcitonin positive. Improved with steroids and antibiotics, discharged with 7 day total course. Held off on remdesivir given AKI and ultimately weaned to room air with rapid improvement in symptoms. 3. Possible COPD exacerbation: Due to above. S/p Solu-Medrol in the ED. Continued home inhalers. Steroids as above. 4. AKI: Creatinine normal at baseline. Creatinine up to 1.33 on admit.  Likely due to dehydration. Held home diuretics and ARB. Resolved with IV fluids. Resumed diuretic on discharge, but held ARB due to borderline low BP. Check BP and BMP and resume outpatient if appropriate. 5. Acute on chronic thrombocytopenia: baseline platelets 60-70.  Platelets 48 on admit. Likely due to above.  Trend. 6. Anemia of chronic disease: Hemoglobin baseline 10-11.  Hemoglobin 11.2 on admit.  Monitor. 7. Acute LLE DVT: Diagnosed 8/8/2023. Continued Eliquis 8. History of multiple myeloma: Follows with Dr. (oncology). Held home chemotherapy given active infection. Follow-up as outpatient 9. Chronic systolic CHF: Follows with Dr. (cardiology).  History of nonischemic cardiomyopathy.  TTE 11/16/2022 with EF of 42%.  Held ARB, beta-blocker and diuretics given AKI and soft blood pressures. Resumed BB and diuretic on discharge, resume ARB and HCTZ as able outpatient.
Age: 69.0
Sex: F
Vaccine: COVID19-2
Symptoms: Pyrexia, Thrombocytopenia, Urine antigen test
Clinical narrative: Patient is a 70 y.o. female with a history of multiple myeloma, DVT on Eliquis, COPD, chronic systolic CHF with EF of 40% who presented to ED with 7-day history of fevers, productive cough, sore throat, and myalgias and was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia. She was transferred to facility 9/18/2023 for further care. There was an inability to rule out bacterial pneumonia and COPD exacerbation based on findings, so she was discharged with a course of antibiotics and steroids. She also had an AKI that improved with IVF and low normal BPs, so her antihypertensives were held on discharge.   1. Acute hypoxic respiratory failure: Not on home O2. Required up to 2 L on admit. Chest x-ray on admit with multifocal pneumonia. Likely due to COVID-19 and possible COPD exacerbation. Weaned to RA prior to discharge. 2. COVID-19 pneumonia, possible CAP: Recent travel history and productive cough. Chest x-ray on admit with multifocal pneumonia. Urine antigens negative, procalcitonin positive. Improved with steroids and antibiotics, discharged with 7 day total course. Held off on remdesivir given AKI and ultimately weaned to room air with rapid improvement in symptoms. 3. Possible COPD exacerbation: Due to above. S/p Solu-Medrol in the ED. Continued home inhalers. Steroids as above. 4. AKI: Creatinine normal at baseline. Creatinine up to 1.33 on admit.  Likely due to dehydration. Held home diuretics and ARB. Resolved with IV fluids. Resumed diuretic on discharge, but held ARB due to borderline low BP. Check BP and BMP and resume outpatient if appropriate. 5. Acute on chronic thrombocytopenia: baseline platelets 60-70.  Platelets 48 on admit. Likely due to above.  Trend. 6. Anemia of chronic disease: Hemoglobin baseline 10-11.  Hemoglobin 11.2 on admit.  Monitor. 7. Acute LLE DVT: Diagnosed 8/8/2023. Continued Eliquis 8. History of multiple myeloma: Follows with Dr. (oncology). Held home chemotherapy given active infection. Follow-up as outpatient 9. Chronic systolic CHF: Follows with Dr. (cardiology).  History of nonischemic cardiomyopathy.  TTE 11/16/2022 with EF of 42%.  Held ARB, beta-blocker and diuretics given AKI and soft blood pressures. Resumed BB and diuretic on discharge, resume ARB and HCTZ as able outpatient.
Age: 79.0
Sex: M
Vaccine: VARZOS
Symptoms: Chills, Pain in extremity, Pyrexia, Vomiting
Clinical narrative: Very painful upper arm, fever of 101, chills & vomit.  Fever lasted a day in half, painful upper arm still going on, taking Tylenol.
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Asthenia, Blood creatinine, COVID-19, Chest X-ray normal, Computerised tomogram head normal
Clinical narrative: Patient is an 82 year old  male with a history of PAF on Eliquis, CKD-III, cognitive impairment,  tested positive for COVID-19 on 9/16/23, who presented to Hospital 9/18/23 with weakness, cough and confusion with reported recent fall. Managed for COVID infection. Course complicated by confusion.    1. COVID 19 with Hypoxia: symptom onset and positive home test on 9/16/23. Confirmed on admission. CXR non acute. Started on Decadron and Remdesivir. On RA as of 9/20/23. Remdesiver stopped. Special Isolation precautions. 2. Acute Metabolic Encephalopathy: Likely related to above with know cognitive dysfunction-> delirium. Patient being followed at Senior ceneter. Steroids contributing.AAO x 3 at the time of admission.CT brain non acute. Placed on PRN haldol and scheduled depakote. Behavioral Health followed.  3. Reported Fall: per ED documentation. Patient denied. No evidence of major trauma. CT head on admission nonacute. PT/OT recommended HHA PT/OT on discharge  4. Atrial Fibrillation/Atrial Flutter: per history. s/p ablation 2013. Follows with Dr. (Cardiology). Continued home Eliquis. Rate controlled Atrial Fibrillation  on admit ECG.  5. CKD stage 3a: Baseline Cr ~1.4-1.6. Stable on admit.   6. Pituitary Adenoma: Diagnosed 2015 incidentally. Follows with Dr (Endocrinology). On Cabergoline  7. Cognitive impairment : Noted cognitive deficits at baseline but no formal dementia diagnosis. Continued follow up at Senior center recommended  8. Code status: Full code.
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Confusional state, Cough, Delirium, Electrocardiogram abnormal, Fall
Clinical narrative: Patient is an 82 year old  male with a history of PAF on Eliquis, CKD-III, cognitive impairment,  tested positive for COVID-19 on 9/16/23, who presented to Hospital 9/18/23 with weakness, cough and confusion with reported recent fall. Managed for COVID infection. Course complicated by confusion.    1. COVID 19 with Hypoxia: symptom onset and positive home test on 9/16/23. Confirmed on admission. CXR non acute. Started on Decadron and Remdesivir. On RA as of 9/20/23. Remdesiver stopped. Special Isolation precautions. 2. Acute Metabolic Encephalopathy: Likely related to above with know cognitive dysfunction-> delirium. Patient being followed at Senior ceneter. Steroids contributing.AAO x 3 at the time of admission.CT brain non acute. Placed on PRN haldol and scheduled depakote. Behavioral Health followed.  3. Reported Fall: per ED documentation. Patient denied. No evidence of major trauma. CT head on admission nonacute. PT/OT recommended HHA PT/OT on discharge  4. Atrial Fibrillation/Atrial Flutter: per history. s/p ablation 2013. Follows with Dr. (Cardiology). Continued home Eliquis. Rate controlled Atrial Fibrillation  on admit ECG.  5. CKD stage 3a: Baseline Cr ~1.4-1.6. Stable on admit.   6. Pituitary Adenoma: Diagnosed 2015 incidentally. Follows with Dr (Endocrinology). On Cabergoline  7. Cognitive impairment : Noted cognitive deficits at baseline but no formal dementia diagnosis. Continued follow up at Senior center recommended  8. Code status: Full code.
Age: 81.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia, Metabolic encephalopathy, SARS-CoV-2 test positive
Clinical narrative: Patient is an 82 year old  male with a history of PAF on Eliquis, CKD-III, cognitive impairment,  tested positive for COVID-19 on 9/16/23, who presented to Hospital 9/18/23 with weakness, cough and confusion with reported recent fall. Managed for COVID infection. Course complicated by confusion.    1. COVID 19 with Hypoxia: symptom onset and positive home test on 9/16/23. Confirmed on admission. CXR non acute. Started on Decadron and Remdesivir. On RA as of 9/20/23. Remdesiver stopped. Special Isolation precautions. 2. Acute Metabolic Encephalopathy: Likely related to above with know cognitive dysfunction-> delirium. Patient being followed at Senior ceneter. Steroids contributing.AAO x 3 at the time of admission.CT brain non acute. Placed on PRN haldol and scheduled depakote. Behavioral Health followed.  3. Reported Fall: per ED documentation. Patient denied. No evidence of major trauma. CT head on admission nonacute. PT/OT recommended HHA PT/OT on discharge  4. Atrial Fibrillation/Atrial Flutter: per history. s/p ablation 2013. Follows with Dr. (Cardiology). Continued home Eliquis. Rate controlled Atrial Fibrillation  on admit ECG.  5. CKD stage 3a: Baseline Cr ~1.4-1.6. Stable on admit.   6. Pituitary Adenoma: Diagnosed 2015 incidentally. Follows with Dr (Endocrinology). On Cabergoline  7. Cognitive impairment : Noted cognitive deficits at baseline but no formal dementia diagnosis. Continued follow up at Senior center recommended  8. Code status: Full code.
Age: 1.0
Sex: M
Vaccine: HEPA, MMRV, VARCEL
Symptoms: Product administration error
Clinical narrative: MD ordered Proquad and Varicella for 12 month old.  Staff administered both vaccines. It was discovered later in a chart review that both vaccines were given together.
Age: 69.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Eye swelling, Swelling
Clinical narrative: She got the vaccine on Monday and woke up Tuesday morning with some swelling, the worst of which was her eyes.  It did resolve itself as the day went on, and was back to normal when I talked to her on Wednesday.
Age: 66.0
Sex: M
Vaccine: COVID19, FLUA4
Symptoms: Paraesthesia
Clinical narrative: patinet had tingling sensation 3 days after the vaccine was given, which subsided over time but still has symptoms. discussed with primary doctor and will monitor the symptoms
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Angiogram pulmonary abnormal, Atelectasis, COVID-19, COVID-19 pneumonia, Cough
Clinical narrative: Patient is a 66 y.o. female with a history of RA on chronic prednisone recently found to be positive for COVID 19 on 8/29/23 with multiple ED visits for worsening dyspnea sent home on steroids and antibiotics who presented to RMH 9/13/2023 with persistent shortness of breath, hemoptysis, fever. CTPA on admit showed no PE, mild bilateral lower lobe infiltrates vs atelectasis. Improved with supportive care.    1. COVID 19 pneumonia: positive on 8/29/23. Vaccinated. Patient immunocompromised on chronic prednisone. Has had persistent fevers, dyspnea since. Did not want paxlovid at the time. Was prescribed prednisone taper and antibiotics as OP. Given 2 weeks since diagnosis, no benefit of starting any antivirals per ID. Isolation to end 9/18/23 as immunocompromised. Received IV Rocephin with limited improvement, doubt bacterial superinfection. Symptoms improved at discharge, expectant resolution. 2. Hemoptysis: likely due to above pneumonia with coughing. CTPA negative for PE. Management as above, resolved.  3. Diarrhea: due to above, resolved.  4. RA: h/o. On chronic prednisone. Follows rheumatology as OP. Refused to be on azathioprine, hydroxychloroquine. Continued prednisone.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Diarrhoea, Dyspnoea, Haemoptysis, Lung infiltration, Pyrexia
Clinical narrative: Patient is a 66 y.o. female with a history of RA on chronic prednisone recently found to be positive for COVID 19 on 8/29/23 with multiple ED visits for worsening dyspnea sent home on steroids and antibiotics who presented to RMH 9/13/2023 with persistent shortness of breath, hemoptysis, fever. CTPA on admit showed no PE, mild bilateral lower lobe infiltrates vs atelectasis. Improved with supportive care.    1. COVID 19 pneumonia: positive on 8/29/23. Vaccinated. Patient immunocompromised on chronic prednisone. Has had persistent fevers, dyspnea since. Did not want paxlovid at the time. Was prescribed prednisone taper and antibiotics as OP. Given 2 weeks since diagnosis, no benefit of starting any antivirals per ID. Isolation to end 9/18/23 as immunocompromised. Received IV Rocephin with limited improvement, doubt bacterial superinfection. Symptoms improved at discharge, expectant resolution. 2. Hemoptysis: likely due to above pneumonia with coughing. CTPA negative for PE. Management as above, resolved.  3. Diarrhea: due to above, resolved.  4. RA: h/o. On chronic prednisone. Follows rheumatology as OP. Refused to be on azathioprine, hydroxychloroquine. Continued prednisone.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Patient is a 66 y.o. female with a history of RA on chronic prednisone recently found to be positive for COVID 19 on 8/29/23 with multiple ED visits for worsening dyspnea sent home on steroids and antibiotics who presented to RMH 9/13/2023 with persistent shortness of breath, hemoptysis, fever. CTPA on admit showed no PE, mild bilateral lower lobe infiltrates vs atelectasis. Improved with supportive care.    1. COVID 19 pneumonia: positive on 8/29/23. Vaccinated. Patient immunocompromised on chronic prednisone. Has had persistent fevers, dyspnea since. Did not want paxlovid at the time. Was prescribed prednisone taper and antibiotics as OP. Given 2 weeks since diagnosis, no benefit of starting any antivirals per ID. Isolation to end 9/18/23 as immunocompromised. Received IV Rocephin with limited improvement, doubt bacterial superinfection. Symptoms improved at discharge, expectant resolution. 2. Hemoptysis: likely due to above pneumonia with coughing. CTPA negative for PE. Management as above, resolved.  3. Diarrhea: due to above, resolved.  4. RA: h/o. On chronic prednisone. Follows rheumatology as OP. Refused to be on azathioprine, hydroxychloroquine. Continued prednisone.
Age: 65.0
Sex: F
Vaccine: FLU4
Symptoms: Parosmia
Clinical narrative: phantosmia
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Injection site dryness
Clinical narrative: Patient stated he developed a dry, patchy area around the injection site a couple weeks after his first shot at this facility.
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Fatigue, Muscle spasms
Clinical narrative: Severe leg cramps for first 2 nights;  extreme fatigue on and off for over 1 week
Age: 0.5
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product packaging quantity issue
Clinical narrative: More than 0.25ml administered as single dose vials were overfilled.
Age: 37.0
Sex: F
Vaccine: TDAP
Symptoms: Caesarean section, Electrocardiogram, Exposure during pregnancy, Palpitations, Uterine contractions during pregnancy
Clinical narrative: 28 weeks pregnant with twins. About 8 hours after vaccine I experienced heart palpitations and uterine contractions. Delivered at 34 weeks gestation via csection. Twin A 5 pounds 5 ounces. Twin B 4 pounds 15 ounces.
Age: 50.0
Sex: M
Vaccine: FLU4, VARZOS
Symptoms: Mouth injury, Mouth swelling, Pyrexia, Stomatitis
Clinical narrative: He had a fever swollen from his mouth, irritation/cuts inside his mouth
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Autonomic nervous system imbalance, Bacteriuria, Blood culture negative, Blood potassium decreased, COVID-19
Clinical narrative: Patient is a 82 y.o. female with a history of parkinsons disease, orthostatic hypotension, and NIDDM who presented to Hospital 9/17/2023 with AMS. She was found to be COVID positive. ID econsulted, after discussion with patient/ family elected to pursue remdesivir, 9/18- 9/20. She has symptomatically improved, worked with therapy and is medically stable for discharge to a SNF.    1. COVID 19 infection, Improving: No hypoxia. Complicated by encephalopathy, and appears to be fatigued and hypotensive. ID followed- Paxlovid would interact with patient's quietapine, this was not given. Discussed with family who favored remdesivir, 9/18- 9/20. Follow up outpatient for monitoring of symptom resolution. Tessalon pearls PRN at disscharge.  2. Sepsis, Resolved: Likely 2/2 above with hypotension exacerbated by history of autonomic dysfunction. However, Vanc & Zosyn started on admission given significant hypotension, sepsis fluids, lactate. Blood cultures 9/18 no growth. Urine cultures with coagulase negative staph likely contaminant. She was deescalated to doxy/ rocephin for CAP coverage 9/18. These were discontinued 9/19 due to low concern for bacterial infection. Follow up outpatient for monitoring of resolution of COVID symptoms as above.  3. Hypokalemia: K 3.0 on admit, repleted as needed. Recommend repeat BMP in one week. Encourage good PO intake.  4. Parkinsons disease with dementia: Patient able to ambulate and talk at baseline. Home medications continued.  5. Autonomic dysfunction: Previous hospital admissions for syncope within the past year. Home midodrine provided with hold parameters for SBP >140, continue on discharge. 6. Bacteriuria: With >100k colonies coagulase negative staph on urine culture. With possible symptoms including dysuria/ increased frequency. Repeat UA without evidence of infection. Continue to monitor for s/s dysuria in the outpatient and repeat UA if needed.  7. NIDDM: on metformin, continue to address outpatient.  8. HTN: held amlodipine, ok to continue on discharge with hold parameters. 9. Constipation: Significant hx of constipation, continue home meds on discharge.  10. Moderate/non-severe, protein calorie malnutrition: related to chronic illness, per RD assessment. BMI 17.45, daughter reports loss of 5lbs over the past week PTA, poor appetite. Recommend Boost glucose control with breakfast and dinner. Encourage good PO intake.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Constipation, Culture urine positive, Decreased appetite, Dementia
Clinical narrative: Patient is a 82 y.o. female with a history of parkinsons disease, orthostatic hypotension, and NIDDM who presented to Hospital 9/17/2023 with AMS. She was found to be COVID positive. ID econsulted, after discussion with patient/ family elected to pursue remdesivir, 9/18- 9/20. She has symptomatically improved, worked with therapy and is medically stable for discharge to a SNF.    1. COVID 19 infection, Improving: No hypoxia. Complicated by encephalopathy, and appears to be fatigued and hypotensive. ID followed- Paxlovid would interact with patient's quietapine, this was not given. Discussed with family who favored remdesivir, 9/18- 9/20. Follow up outpatient for monitoring of symptom resolution. Tessalon pearls PRN at disscharge.  2. Sepsis, Resolved: Likely 2/2 above with hypotension exacerbated by history of autonomic dysfunction. However, Vanc & Zosyn started on admission given significant hypotension, sepsis fluids, lactate. Blood cultures 9/18 no growth. Urine cultures with coagulase negative staph likely contaminant. She was deescalated to doxy/ rocephin for CAP coverage 9/18. These were discontinued 9/19 due to low concern for bacterial infection. Follow up outpatient for monitoring of resolution of COVID symptoms as above.  3. Hypokalemia: K 3.0 on admit, repleted as needed. Recommend repeat BMP in one week. Encourage good PO intake.  4. Parkinsons disease with dementia: Patient able to ambulate and talk at baseline. Home medications continued.  5. Autonomic dysfunction: Previous hospital admissions for syncope within the past year. Home midodrine provided with hold parameters for SBP >140, continue on discharge. 6. Bacteriuria: With >100k colonies coagulase negative staph on urine culture. With possible symptoms including dysuria/ increased frequency. Repeat UA without evidence of infection. Continue to monitor for s/s dysuria in the outpatient and repeat UA if needed.  7. NIDDM: on metformin, continue to address outpatient.  8. HTN: held amlodipine, ok to continue on discharge with hold parameters. 9. Constipation: Significant hx of constipation, continue home meds on discharge.  10. Moderate/non-severe, protein calorie malnutrition: related to chronic illness, per RD assessment. BMI 17.45, daughter reports loss of 5lbs over the past week PTA, poor appetite. Recommend Boost glucose control with breakfast and dinner. Encourage good PO intake.
Age: 80.0
Sex: F
Vaccine: COVID19
Symptoms: Encephalopathy, Fatigue, Hypertension, Hypokalaemia, Hypotension
Clinical narrative: Patient is a 82 y.o. female with a history of parkinsons disease, orthostatic hypotension, and NIDDM who presented to Hospital 9/17/2023 with AMS. She was found to be COVID positive. ID econsulted, after discussion with patient/ family elected to pursue remdesivir, 9/18- 9/20. She has symptomatically improved, worked with therapy and is medically stable for discharge to a SNF.    1. COVID 19 infection, Improving: No hypoxia. Complicated by encephalopathy, and appears to be fatigued and hypotensive. ID followed- Paxlovid would interact with patient's quietapine, this was not given. Discussed with family who favored remdesivir, 9/18- 9/20. Follow up outpatient for monitoring of symptom resolution. Tessalon pearls PRN at disscharge.  2. Sepsis, Resolved: Likely 2/2 above with hypotension exacerbated by history of autonomic dysfunction. However, Vanc & Zosyn started on admission given significant hypotension, sepsis fluids, lactate. Blood cultures 9/18 no growth. Urine cultures with coagulase negative staph likely contaminant. She was deescalated to doxy/ rocephin for CAP coverage 9/18. These were discontinued 9/19 due to low concern for bacterial infection. Follow up outpatient for monitoring of resolution of COVID symptoms as above.  3. Hypokalemia: K 3.0 on admit, repleted as needed. Recommend repeat BMP in one week. Encourage good PO intake.  4. Parkinsons disease with dementia: Patient able to ambulate and talk at baseline. Home medications continued.  5. Autonomic dysfunction: Previous hospital admissions for syncope within the past year. Home midodrine provided with hold parameters for SBP >140, continue on discharge. 6. Bacteriuria: With >100k colonies coagulase negative staph on urine culture. With possible symptoms including dysuria/ increased frequency. Repeat UA without evidence of infection. Continue to monitor for s/s dysuria in the outpatient and repeat UA if needed.  7. NIDDM: on metformin, continue to address outpatient.  8. HTN: held amlodipine, ok to continue on discharge with hold parameters. 9. Constipation: Significant hx of constipation, continue home meds on discharge.  10. Moderate/non-severe, protein calorie malnutrition: related to chronic illness, per RD assessment. BMI 17.45, daughter reports loss of 5lbs over the past week PTA, poor appetite. Recommend Boost glucose control with breakfast and dinner. Encourage good PO intake.