chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 63.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Fibrin D dimer increased, Lumbar radiculopathy, Respiratory symptom, SARS-CoV-2 test positive
Clinical narrative: Admission Date: 7/5/2022 Discharge Date: Jul 7, 2022  1. COVID-19  2. Hypoxia  3. AKI (acute kidney injury) (HCC)  HOSPITAL COURSE 63-year-old gentleman presented with weakness and dehydration.  Had been experiencing several days of fatigue and poor appetite.  Diarrhea one week ago.  No fevers.  Continued his Lasix and Hyzaar while he was ill.  Patient had had a COVID test that was positive on 07/05.  In the ER, creatinine elevated to 1.96 (baseline 1.0-1.2).  D-dimer was normal.  CRP elevated at 15.0.  He was admitted for IV fluids.  Steroids and remdesivir not necessary.  He never required more oxygen than his baseline 2 L. The following day the patient felt much better.  He felt like he was much stronger and back to his baseline (baseline is the use of a wheelchair).  He was eating and drinking well.  He would like to go home.  Creatinine is improved but not back to baseline.  It is 1.42 today.  I have every reason to believe this will continue to improve back to his baseline.  I have told him not to take his Hyzaar or Lasix for the next three days.  He can resume them on Monday 7/11.  I have also sent on order for a BMP to be drawn on 07/11 with results to his cardiologist.
Age: 63.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Wheezing
Clinical narrative: Admission Date: 7/5/2022 Discharge Date: Jul 7, 2022  1. COVID-19  2. Hypoxia  3. AKI (acute kidney injury) (HCC)  HOSPITAL COURSE 63-year-old gentleman presented with weakness and dehydration.  Had been experiencing several days of fatigue and poor appetite.  Diarrhea one week ago.  No fevers.  Continued his Lasix and Hyzaar while he was ill.  Patient had had a COVID test that was positive on 07/05.  In the ER, creatinine elevated to 1.96 (baseline 1.0-1.2).  D-dimer was normal.  CRP elevated at 15.0.  He was admitted for IV fluids.  Steroids and remdesivir not necessary.  He never required more oxygen than his baseline 2 L. The following day the patient felt much better.  He felt like he was much stronger and back to his baseline (baseline is the use of a wheelchair).  He was eating and drinking well.  He would like to go home.  Creatinine is improved but not back to baseline.  It is 1.42 today.  I have every reason to believe this will continue to improve back to his baseline.  I have told him not to take his Hyzaar or Lasix for the next three days.  He can resume them on Monday 7/11.  I have also sent on order for a BMP to be drawn on 07/11 with results to his cardiologist.
Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test
Clinical narrative: Patient contracted COVID
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine expired 04/01/2022.
Age: 92.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with 1 booster
Age: 94.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Dyspnoea
Clinical narrative: Pt presented with covid and shortness of breath. Treated with remdesivir, and doxycycline.  IV dexamethasone given. pt discharged to snf.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Fatigue, Myalgia, Nasal congestion, Oropharyngeal pain
Clinical narrative: 06/13/2022 Vaccination  07/15/2022 I felt fatigue throughout the day.  07/16/2022 I felt normal all day and felt ok. I came home at 3PM in the afternoon. Within 4 hours I had nasal congestion, sore throat, body aches and muscles. COVID-19 POSITIVE.  Had a hard time connecting with Dr. and prescription. Contacted the local health department. I was able to get a prescription for Plaxovid. 07/19/2022 Starting Plaxovid.
Age: 75.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, SARS-CoV-2 test positive
Clinical narrative: 06/13/2022 Vaccination  07/15/2022 I felt fatigue throughout the day.  07/16/2022 I felt normal all day and felt ok. I came home at 3PM in the afternoon. Within 4 hours I had nasal congestion, sore throat, body aches and muscles. COVID-19 POSITIVE.  Had a hard time connecting with Dr. and prescription. Contacted the local health department. I was able to get a prescription for Plaxovid. 07/19/2022 Starting Plaxovid.
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cough, Ear discomfort, Exposure to SARS-CoV-2, Eye irritation
Clinical narrative: My fiancé got COVID-19 and after his diagnosis, he started isolating. As soon as I started getting symptoms, I went for a PCR test on June 7 the day after. It started with a sore throat and then my sinuses were greatly affected. It felt like a bad sinus infection. My eyes were constantly burning and watering. It felt like I was crying nonstop. When I got the confirmed diagnosis on June 8, I called my doctor to see if I could get Paxlovid and I had an appointment on June 9. She prescribed that to me, and I took that right away. It helped by the next day. The sinus infection started to feel better, but I still had the sore throat. After 5 days, I tested to see if I was no longer positive, but I still was. Around Day 9, the line on the tests were getting fainter. I thought that hopefully that it would be negative soon. I finished the 5-day course of the Paxlovid. Day 11, my antigen came back positive before the control line could even show. I never cleared it, it just got worse. Symptom wise, it was the sore throat and pressure in my ears. I just had a slight cough that wasn?t too bad. No fever or body aches. I continued to test positive until Day 17 when I tested negative.
Age: 50.0
Sex: F
Vaccine: COVID19
Symptoms: Lacrimation increased, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus disorder
Clinical narrative: My fiancé got COVID-19 and after his diagnosis, he started isolating. As soon as I started getting symptoms, I went for a PCR test on June 7 the day after. It started with a sore throat and then my sinuses were greatly affected. It felt like a bad sinus infection. My eyes were constantly burning and watering. It felt like I was crying nonstop. When I got the confirmed diagnosis on June 8, I called my doctor to see if I could get Paxlovid and I had an appointment on June 9. She prescribed that to me, and I took that right away. It helped by the next day. The sinus infection started to feel better, but I still had the sore throat. After 5 days, I tested to see if I was no longer positive, but I still was. Around Day 9, the line on the tests were getting fainter. I thought that hopefully that it would be negative soon. I finished the 5-day course of the Paxlovid. Day 11, my antigen came back positive before the control line could even show. I never cleared it, it just got worse. Symptom wise, it was the sore throat and pressure in my ears. I just had a slight cough that wasn?t too bad. No fever or body aches. I continued to test positive until Day 17 when I tested negative.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Asthenia, Atypical pneumonia, COVID-19, Cerebral small vessel ischaemic disease, Chest X-ray abnormal
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 7/5/2022 Discharge Date: Jul 12, 2022  PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1] Acute encephalopathy [G93.40]   HOSPITAL COURSE: 94 y.o. male with known BPH, symptomatic bradycardia s/p pacemaker, CKD, HTN who presented on 07/05/2022 with acute encephalopathy from Assisted Living Facility.  At baseline patient is oriented to 4, still his own decision maker, hard of hearing.  COVID infection going around his facility, developed worsening weakness that started last week June 28. Patient tested positive at facility the day that patient was sent to emergency department.  There was a plan hospice meeting by family on 07/06 but facility unable to take care of patient hence sent here to Hospital. In ED, pt VSS. CXR showing atypical pneumonia. CBC showing mild leukocytosis. CMP showing stable renal dysfunction. Pt had right femur and pelvic x-ray unremarkable. CT head w/o contrast showing no acute process, old ischemic changes and possible NPH.    Patient was given a course of Remdesivir with liver and renal function monitored.  Patient had shown improvement of his metabolic encephalopathy after the 1st 48 hours of stay.  Was then was able to evaluate and patient started on soft diet.  Hospice meeting with health hospice and 2nd hospice occurred.  Patient met hospice criteria.  Planned to sign up for hospice with Hospice.  He was made comfort measures inpatient. Placement was arranged on 7/12/22.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram head abnormal, Encephalopathy, Exposure to SARS-CoV-2, Full blood count abnormal, Hypoacusis
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 7/5/2022 Discharge Date: Jul 12, 2022  PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1] Acute encephalopathy [G93.40]   HOSPITAL COURSE: 94 y.o. male with known BPH, symptomatic bradycardia s/p pacemaker, CKD, HTN who presented on 07/05/2022 with acute encephalopathy from Assisted Living Facility.  At baseline patient is oriented to 4, still his own decision maker, hard of hearing.  COVID infection going around his facility, developed worsening weakness that started last week June 28. Patient tested positive at facility the day that patient was sent to emergency department.  There was a plan hospice meeting by family on 07/06 but facility unable to take care of patient hence sent here to Hospital. In ED, pt VSS. CXR showing atypical pneumonia. CBC showing mild leukocytosis. CMP showing stable renal dysfunction. Pt had right femur and pelvic x-ray unremarkable. CT head w/o contrast showing no acute process, old ischemic changes and possible NPH.    Patient was given a course of Remdesivir with liver and renal function monitored.  Patient had shown improvement of his metabolic encephalopathy after the 1st 48 hours of stay.  Was then was able to evaluate and patient started on soft diet.  Hospice meeting with health hospice and 2nd hospice occurred.  Patient met hospice criteria.  Planned to sign up for hospice with Hospice.  He was made comfort measures inpatient. Placement was arranged on 7/12/22.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Leukocytosis, Liver function test, Metabolic function test abnormal, Renal function test, Renal impairment
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 7/5/2022 Discharge Date: Jul 12, 2022  PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1] Acute encephalopathy [G93.40]   HOSPITAL COURSE: 94 y.o. male with known BPH, symptomatic bradycardia s/p pacemaker, CKD, HTN who presented on 07/05/2022 with acute encephalopathy from Assisted Living Facility.  At baseline patient is oriented to 4, still his own decision maker, hard of hearing.  COVID infection going around his facility, developed worsening weakness that started last week June 28. Patient tested positive at facility the day that patient was sent to emergency department.  There was a plan hospice meeting by family on 07/06 but facility unable to take care of patient hence sent here to Hospital. In ED, pt VSS. CXR showing atypical pneumonia. CBC showing mild leukocytosis. CMP showing stable renal dysfunction. Pt had right femur and pelvic x-ray unremarkable. CT head w/o contrast showing no acute process, old ischemic changes and possible NPH.    Patient was given a course of Remdesivir with liver and renal function monitored.  Patient had shown improvement of his metabolic encephalopathy after the 1st 48 hours of stay.  Was then was able to evaluate and patient started on soft diet.  Hospice meeting with health hospice and 2nd hospice occurred.  Patient met hospice criteria.  Planned to sign up for hospice with Hospice.  He was made comfort measures inpatient. Placement was arranged on 7/12/22.
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive, Scan with contrast abnormal, X-ray normal, X-ray of pelvis and hip normal
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 7/5/2022 Discharge Date: Jul 12, 2022  PRESENTING PROBLEM: Weakness [R53.1] COVID-19 [U07.1] Acute encephalopathy [G93.40]   HOSPITAL COURSE: 94 y.o. male with known BPH, symptomatic bradycardia s/p pacemaker, CKD, HTN who presented on 07/05/2022 with acute encephalopathy from Assisted Living Facility.  At baseline patient is oriented to 4, still his own decision maker, hard of hearing.  COVID infection going around his facility, developed worsening weakness that started last week June 28. Patient tested positive at facility the day that patient was sent to emergency department.  There was a plan hospice meeting by family on 07/06 but facility unable to take care of patient hence sent here to Hospital. In ED, pt VSS. CXR showing atypical pneumonia. CBC showing mild leukocytosis. CMP showing stable renal dysfunction. Pt had right femur and pelvic x-ray unremarkable. CT head w/o contrast showing no acute process, old ischemic changes and possible NPH.    Patient was given a course of Remdesivir with liver and renal function monitored.  Patient had shown improvement of his metabolic encephalopathy after the 1st 48 hours of stay.  Was then was able to evaluate and patient started on soft diet.  Hospice meeting with health hospice and 2nd hospice occurred.  Patient met hospice criteria.  Planned to sign up for hospice with Hospice.  He was made comfort measures inpatient. Placement was arranged on 7/12/22.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Drainage, Headache, Pain
Clinical narrative: Tested positive for COVID-19 on July 17. Slight headache, body aches, coughing and drainage. Prescribed Paxlovid on July 18.
Age: 65.0
Sex: M
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Tested positive for COVID-19 on July 17. Slight headache, body aches, coughing and drainage. Prescribed Paxlovid on July 18.
Age: 49.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Gait disturbance
Clinical narrative: Sudden on/off joint pain in hips and shoulders. Shoulder pain went away after 3  months. Hip pain continues and comes and goes in severity throughout the day, from zero pain to noticeably altering how I walk.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: VACCINE EXPIRED 04/01/2022
Age: 56.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with 2 boosters
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Ear pain, Fatigue, Feeling abnormal, Feeling hot
Clinical narrative: May 22 I had to go to out of town and in route home I started to feel nasus beyond belief and vomited on my flight home. I took tums and Advil because my head was hurting. By the time we landed I went home, and my entire family was asleep, so no one was exposed to me. I immediately took a COVID-19 test and the results were positive, and I put on a mask and went to the basement and went to sleep.    May23 Called my PCP for direction and they wanted me to get a PCR test. I did just that at 9 am which was positive. I was told to isolate and stay hydrated and keep them updated on any changes. Complete exhaustions slept all night.  May 24 I was taking Mucinex Dayquil to treat the congestion and buildup.  For the next 5-7 May28 Woke up with a high fever 103.0 just completely burning up. Took Advil for the fever and headache. Congestion started this day, and it was so bad that I had ear pain. Keep masked up around other people for five more days  June 2  I was recovered and better by this date. I did have some limitations on the activities, but I was on a track of recovery at times I still have some COVID fog when it comes to memory.  The Mucinex Dayquil was still in rotation days later to decrease to congestion sinus pressure along with a saline flush that was done on a daily basis.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Headache, Loss of personal independence in daily activities, Memory impairment, Nausea, Paranasal sinus discomfort
Clinical narrative: May 22 I had to go to out of town and in route home I started to feel nasus beyond belief and vomited on my flight home. I took tums and Advil because my head was hurting. By the time we landed I went home, and my entire family was asleep, so no one was exposed to me. I immediately took a COVID-19 test and the results were positive, and I put on a mask and went to the basement and went to sleep.    May23 Called my PCP for direction and they wanted me to get a PCR test. I did just that at 9 am which was positive. I was told to isolate and stay hydrated and keep them updated on any changes. Complete exhaustions slept all night.  May 24 I was taking Mucinex Dayquil to treat the congestion and buildup.  For the next 5-7 May28 Woke up with a high fever 103.0 just completely burning up. Took Advil for the fever and headache. Congestion started this day, and it was so bad that I had ear pain. Keep masked up around other people for five more days  June 2  I was recovered and better by this date. I did have some limitations on the activities, but I was on a track of recovery at times I still have some COVID fog when it comes to memory.  The Mucinex Dayquil was still in rotation days later to decrease to congestion sinus pressure along with a saline flush that was done on a daily basis.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Vomiting
Clinical narrative: May 22 I had to go to out of town and in route home I started to feel nasus beyond belief and vomited on my flight home. I took tums and Advil because my head was hurting. By the time we landed I went home, and my entire family was asleep, so no one was exposed to me. I immediately took a COVID-19 test and the results were positive, and I put on a mask and went to the basement and went to sleep.    May23 Called my PCP for direction and they wanted me to get a PCR test. I did just that at 9 am which was positive. I was told to isolate and stay hydrated and keep them updated on any changes. Complete exhaustions slept all night.  May 24 I was taking Mucinex Dayquil to treat the congestion and buildup.  For the next 5-7 May28 Woke up with a high fever 103.0 just completely burning up. Took Advil for the fever and headache. Congestion started this day, and it was so bad that I had ear pain. Keep masked up around other people for five more days  June 2  I was recovered and better by this date. I did have some limitations on the activities, but I was on a track of recovery at times I still have some COVID fog when it comes to memory.  The Mucinex Dayquil was still in rotation days later to decrease to congestion sinus pressure along with a saline flush that was done on a daily basis.
Age: 76.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Nasal congestion, SARS-CoV-2 test positive
Clinical narrative: I would not say my symptoms were severe. It was mostly a stuffy head. I wasn't even sure what it was but my sister and I were at an outdoor event and she had the same symptoms I had. She tested the next day and was positive so I checked as well and was positive. It was mostly a stuffy nose and that was mainly it. I didn't take the antiviral because I didn't feel it was needed.
Age: 75.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Asymptomatic COVID-19, Cerebrovascular accident, Hypertensive encephalopathy, Mental status changes, SARS-CoV-2 test positive
Clinical narrative: Pt presented to hospital with altered mental status with acute cva, and hypertensive encepalopathy. Related to lack of gaudianship and placement pt has an extended hopital stay and tested positive for covid asymptomatic, Pt was able to be discharged to a residential facility.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Blood uric acid normal, Gouty arthritis, Joint swelling
Clinical narrative: Acute pain and swelling in the first right proximal metatarsophangel joint. Rest, elevation, ice and naprosyn provided relief over the next several days. One recrudescence of symptoms approximately three weeks later of lesser symptomatic severity that responded to rest and naprosyn. Visit to primary physician some time after resolution on June 30 confirmed clinical impression of gouty arthritis of joint as indicated above. Serum uric acid 6.4 mg/dl, normal lab. range 3.5 - 7.2. Prescribed colchicine for use p.r.n. Allopurinol offered as a remedy by not initiated as per patient preference. Hydration, exercise and dietary control are the current therapeutic approaches.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Arthrodesis, Asthenia, Asymptomatic COVID-19, Blood loss anaemia
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 6/2/2022 Discharge Date: Jul 15, 2022  PRESENTING PROBLEM: Weakness generalized Weakness Spinal stenosis  Spinal stenosis at L4-L5 level    HOSPITAL COURSE:   Patient is a 68 y.o. female with past medical history significant for CKD stage 3, DM type 2 with peripheral neuropathy and retinopathy, coronary artery disease, hypertension, dyslipidemia, TIA, iron deficiency anemia, urinary tract infection, urinary incontinence, GERD presented with generalized weakness.  Labs mostly unremarkable apart from chronic anemia, CKD stage 3. Did have hgb drop less than 7 on 6/11 and given 1 unit PRBC; no signs/symptoms of bleeding; did get CT scan of leg due to hip pain and was negative for hematoma.  PT and OT recommended skilled nursing facility, awaiting placement.  While awaiting for placement, patient was noted to have further decline in her  generalized weakness, was only able to tolerate brief standing. Upon further chart review, patient had a MRI of the lumbar spine in April at which time she was noted to have severe L4-5 spinal canal stenosis.  She did see Ortho Spine at that time but surgery was not pursued.  Due to progressive weakness and risk of becoming bed-bound/wheelchair-bound, I did request to repeat Ortho input.  Upon evaluation, it was decided that patient will be a suitable candidate for surgery given her degree of spinal canal stenosis.  Orthopedics requested patient be transferred to hospital for possible surgery on 06/21.   She underwent a  L4-L5, L5-S1 laminectomy, instrumentation, arthrodesis on  06/21. Postop acute blood loss anemia requiring 1 unit of PRBC. Her Hemoglobin stabilized above 8 and JP drain was removed.    PT/OT recommended SAR. Patient remained in the hospital for extended period of time due to difficulty in finding accepting SAR. She was finally able to discharge to subacute rehabilitation in stable condition on 7/15.  Patient contracted Covid during hospital stay, testing positive on 7/4/2022.  COVID-19 positive - screened for placement, tested positive on 7/4, last tested on 6/15 and was negative but was positive on 5/12/22 - patient asymptomatic, not hypoxic - she is s/p 2 doses of Janssen vaccine in 7/31/21 and 2/26/22 - in severe respiratory precautions - daughter updated
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Chronic kidney disease, Computerised tomogram normal, Condition aggravated, Drain removal, Dysstasia
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 6/2/2022 Discharge Date: Jul 15, 2022  PRESENTING PROBLEM: Weakness generalized Weakness Spinal stenosis  Spinal stenosis at L4-L5 level    HOSPITAL COURSE:   Patient is a 68 y.o. female with past medical history significant for CKD stage 3, DM type 2 with peripheral neuropathy and retinopathy, coronary artery disease, hypertension, dyslipidemia, TIA, iron deficiency anemia, urinary tract infection, urinary incontinence, GERD presented with generalized weakness.  Labs mostly unremarkable apart from chronic anemia, CKD stage 3. Did have hgb drop less than 7 on 6/11 and given 1 unit PRBC; no signs/symptoms of bleeding; did get CT scan of leg due to hip pain and was negative for hematoma.  PT and OT recommended skilled nursing facility, awaiting placement.  While awaiting for placement, patient was noted to have further decline in her  generalized weakness, was only able to tolerate brief standing. Upon further chart review, patient had a MRI of the lumbar spine in April at which time she was noted to have severe L4-5 spinal canal stenosis.  She did see Ortho Spine at that time but surgery was not pursued.  Due to progressive weakness and risk of becoming bed-bound/wheelchair-bound, I did request to repeat Ortho input.  Upon evaluation, it was decided that patient will be a suitable candidate for surgery given her degree of spinal canal stenosis.  Orthopedics requested patient be transferred to hospital for possible surgery on 06/21.   She underwent a  L4-L5, L5-S1 laminectomy, instrumentation, arthrodesis on  06/21. Postop acute blood loss anemia requiring 1 unit of PRBC. Her Hemoglobin stabilized above 8 and JP drain was removed.    PT/OT recommended SAR. Patient remained in the hospital for extended period of time due to difficulty in finding accepting SAR. She was finally able to discharge to subacute rehabilitation in stable condition on 7/15.  Patient contracted Covid during hospital stay, testing positive on 7/4/2022.  COVID-19 positive - screened for placement, tested positive on 7/4, last tested on 6/15 and was negative but was positive on 5/12/22 - patient asymptomatic, not hypoxic - she is s/p 2 doses of Janssen vaccine in 7/31/21 and 2/26/22 - in severe respiratory precautions - daughter updated
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: General physical health deterioration, Haemoglobin decreased, Laboratory test abnormal, Lumbar spinal stenosis, Magnetic resonance imaging spinal abnormal
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 6/2/2022 Discharge Date: Jul 15, 2022  PRESENTING PROBLEM: Weakness generalized Weakness Spinal stenosis  Spinal stenosis at L4-L5 level    HOSPITAL COURSE:   Patient is a 68 y.o. female with past medical history significant for CKD stage 3, DM type 2 with peripheral neuropathy and retinopathy, coronary artery disease, hypertension, dyslipidemia, TIA, iron deficiency anemia, urinary tract infection, urinary incontinence, GERD presented with generalized weakness.  Labs mostly unremarkable apart from chronic anemia, CKD stage 3. Did have hgb drop less than 7 on 6/11 and given 1 unit PRBC; no signs/symptoms of bleeding; did get CT scan of leg due to hip pain and was negative for hematoma.  PT and OT recommended skilled nursing facility, awaiting placement.  While awaiting for placement, patient was noted to have further decline in her  generalized weakness, was only able to tolerate brief standing. Upon further chart review, patient had a MRI of the lumbar spine in April at which time she was noted to have severe L4-5 spinal canal stenosis.  She did see Ortho Spine at that time but surgery was not pursued.  Due to progressive weakness and risk of becoming bed-bound/wheelchair-bound, I did request to repeat Ortho input.  Upon evaluation, it was decided that patient will be a suitable candidate for surgery given her degree of spinal canal stenosis.  Orthopedics requested patient be transferred to hospital for possible surgery on 06/21.   She underwent a  L4-L5, L5-S1 laminectomy, instrumentation, arthrodesis on  06/21. Postop acute blood loss anemia requiring 1 unit of PRBC. Her Hemoglobin stabilized above 8 and JP drain was removed.    PT/OT recommended SAR. Patient remained in the hospital for extended period of time due to difficulty in finding accepting SAR. She was finally able to discharge to subacute rehabilitation in stable condition on 7/15.  Patient contracted Covid during hospital stay, testing positive on 7/4/2022.  COVID-19 positive - screened for placement, tested positive on 7/4, last tested on 6/15 and was negative but was positive on 5/12/22 - patient asymptomatic, not hypoxic - she is s/p 2 doses of Janssen vaccine in 7/31/21 and 2/26/22 - in severe respiratory precautions - daughter updated
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Red blood cell transfusion, SARS-CoV-2 test positive, Spinal laminectomy, Spinal stenosis
Clinical narrative: Discharge Provider: MD Primary Care Provider: DO Admission Date: 6/2/2022 Discharge Date: Jul 15, 2022  PRESENTING PROBLEM: Weakness generalized Weakness Spinal stenosis  Spinal stenosis at L4-L5 level    HOSPITAL COURSE:   Patient is a 68 y.o. female with past medical history significant for CKD stage 3, DM type 2 with peripheral neuropathy and retinopathy, coronary artery disease, hypertension, dyslipidemia, TIA, iron deficiency anemia, urinary tract infection, urinary incontinence, GERD presented with generalized weakness.  Labs mostly unremarkable apart from chronic anemia, CKD stage 3. Did have hgb drop less than 7 on 6/11 and given 1 unit PRBC; no signs/symptoms of bleeding; did get CT scan of leg due to hip pain and was negative for hematoma.  PT and OT recommended skilled nursing facility, awaiting placement.  While awaiting for placement, patient was noted to have further decline in her  generalized weakness, was only able to tolerate brief standing. Upon further chart review, patient had a MRI of the lumbar spine in April at which time she was noted to have severe L4-5 spinal canal stenosis.  She did see Ortho Spine at that time but surgery was not pursued.  Due to progressive weakness and risk of becoming bed-bound/wheelchair-bound, I did request to repeat Ortho input.  Upon evaluation, it was decided that patient will be a suitable candidate for surgery given her degree of spinal canal stenosis.  Orthopedics requested patient be transferred to hospital for possible surgery on 06/21.   She underwent a  L4-L5, L5-S1 laminectomy, instrumentation, arthrodesis on  06/21. Postop acute blood loss anemia requiring 1 unit of PRBC. Her Hemoglobin stabilized above 8 and JP drain was removed.    PT/OT recommended SAR. Patient remained in the hospital for extended period of time due to difficulty in finding accepting SAR. She was finally able to discharge to subacute rehabilitation in stable condition on 7/15.  Patient contracted Covid during hospital stay, testing positive on 7/4/2022.  COVID-19 positive - screened for placement, tested positive on 7/4, last tested on 6/15 and was negative but was positive on 5/12/22 - patient asymptomatic, not hypoxic - she is s/p 2 doses of Janssen vaccine in 7/31/21 and 2/26/22 - in severe respiratory precautions - daughter updated
Age: 28.0
Sex: F
Vaccine: SMALLMNK
Symptoms: Peripheral swelling, Pruritus, Rash
Clinical narrative: Pt stated she developed a rash on her legs and itching on her back on Saturday 7/16/22.  She went to urgent care. Per pt, no treatment given. Was told to follow up with Public Health. Pt stated she took benadryl on Sunday night 7/17 and early Monday morning  7/18 but continues to have mild rash on legs itching in back and a few bumps in upper arms. No SOB or swollen lymph nodes reported.
Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Flushing, Hyperhidrosis, Pallor, Syncope
Clinical narrative: Pt had a syncopal episode w/ associated flushing/sweating, and paleness.  Pt states that he has eaten meds and drank.  Pt wheeled to med ba y for exam, placed.  Pt reported that he feels ok @16:04.  Released in ambulatory status to home w/ female relative.  Advised pt in increase PO H2O intake, gatoraide, bland foods.  Pt states "I'm Ok & I known my body" Pt stable and released from the vaccination site.  Recommended that pt f/u w/ thier healthcare provider, follow up instructions provided. Vitals: 15:59 97/56, 68, 16, 97% -- > 16:04 99/64, 72, 16, 97%
Age: 56.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: VACCINE EXPIRED 04/01/2022
Age: 33.0
Sex: M
Vaccine: COVID19
Symptoms: Extra dose administered, Lymph node pain, Pain in extremity, Pyrexia
Clinical narrative: A second booster of Pfizer Covid 19 was given to a 33 year old healthy male.  Upon realizing the mistake the client was called on 7/19/2022 to inform him that he received a dose that is currently not approved to be given to a person under 50 years of age.  Client states he is not experiencing any complications that he did not experience with his other vaccines.  The fever and arm soreness was gone with 24 hours, his lymph node is still sore but he states it is geting better.
Age: 99.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with 2 boosters
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Feeling abnormal, Headache, Pyrexia
Clinical narrative: On July 14, 2022 I wasn't feeling and took an at home COVID-19 test and it was positive. I had a cough, headache, runny nose and low grade fever. I spoke to my doctor but we did not do anything, just waited it out. My symptoms lasted for 3 days.
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: On July 14, 2022 I wasn't feeling and took an at home COVID-19 test and it was positive. I had a cough, headache, runny nose and low grade fever. I spoke to my doctor but we did not do anything, just waited it out. My symptoms lasted for 3 days.
Age: 78.0
Sex: M
Vaccine: COVID19
Symptoms: Extra dose administered, Inappropriate schedule of product administration, No adverse event
Clinical narrative: Patient received a 3rd booster vaccine. Received 1st booster (0.25 mL) in 10/2021, then received a 2nd booster in 4/2022, and received a 3rd booster on 7/18/22. Experienced no side effects from any of the vaccines.
Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Product storage error
Clinical narrative: The patient was vaccinated with medication from a vial that had last been used 42 hours prior to the vaccination.
Age: 55.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: VACCINE EXPERT 04/01/2022
Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive
Clinical narrative: hospitalized with covid; fully vaccinated with booster
Age: 64.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Asymptomatic COVID-19, Cerebrovascular accident, Dialysis, Intensive care
Clinical narrative: pt presented with cva, and asymptomatic covid. Pt treated in the icu with biarbonate infusion and dialysis. pt discharged home when stable.
Sex: U
Vaccine: COVID19
Symptoms: Impaired work ability, Lung disorder, Pneumonia, Respiratory arrest, Staphylococcal infection
Clinical narrative: Pneumonia and mrsa got worse and was hospitalized. Stopped breathing  was on leave from January to April. St experiencing issues with lungs and mrsa infections.
Age: 74.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Abdominal pain, Asymptomatic COVID-19, Cholelithiasis
Clinical narrative: Pt presented with abd pain with cholelithiasis. No interention needed, asymptomatic covid pt discharged home.
Age: 3.0
Sex: M
Vaccine: COVID19
Symptoms: Incorrect dose administered
Clinical narrative: Patient given Pfizer age 5-11 10ug dose
Age: 52.0
Sex: M
Vaccine: VARZOS
Symptoms: Injection site pain
Clinical narrative: Patient came to the pharmacy, almost a month after the vaccine was administered, stated that it still hurts at the injection site. His provider suggested that it might have been an arm injury due to the vaccine
Age: 6.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: A VACCINE WAS ADMINISTERED PAST ITS BEYOND USE DATE. THE BEYOND USE DATE WAS 7/1/22 BUT THE PHARMACIST LOOKED AT THE EXPIRATION DATE (8/31/22) WHEN DETERMINING IF IT WAS OKAY TO GIVE.
Age: 67.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea
Clinical narrative: Pt presented to hospital with worsening shortness of breath. remdesivir and other antibiotics given. iv dexamethasone given and oxygen. Pt was discharged home.
Age: 13.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered, No adverse event, Product administered to patient of inappropriate age
Clinical narrative: Patient given 4th dose/2nd booster dose even though not immunocompromised and not of age to be eligible. Patient observed after for 15 min. No sign of adverse reaction. Patient's parent informed and told to watch for any unusual side effects and seek medical care if needed. Patient's parent verbalized understanding.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, Pyrexia
Clinical narrative: After my tour bus trip returned on June 26, 2022, I tested negative for COVID 19 for the next several days. I began to feel tired with raspy throat and congestion on July 2, 2022. I tested again on July 3, 2022 and was positive. I also had a slight fever. I lost my taste and smell during this infection, but didn't actually realize it until a couple of weeks later. My fever went away after 3 days. My other symptoms improved by the 28th. I didn't regain my taste and smell until July 16th.
Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Respiratory tract congestion, SARS-CoV-2 test positive, Throat irritation
Clinical narrative: After my tour bus trip returned on June 26, 2022, I tested negative for COVID 19 for the next several days. I began to feel tired with raspy throat and congestion on July 2, 2022. I tested again on July 3, 2022 and was positive. I also had a slight fever. I lost my taste and smell during this infection, but didn't actually realize it until a couple of weeks later. My fever went away after 3 days. My other symptoms improved by the 28th. I didn't regain my taste and smell until July 16th.
Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Exposure to SARS-CoV-2, SARS-CoV-2 test positive
Clinical narrative: Tested COVID positive following exposure
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: High fever (102.9); headache and fatigue.
Age: 11.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: VACCINATION WAS ADMINISTERED PAST ITS BEYOND USE DATE. THE BEYOND USE DATE (7/1/22) WAS BEFORE THE EXPIRATION DATE (8/31/22) THAT THE PHARMACIST USED TO DETERMINE IF IT WAS OKAY TO GIVE.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Fatigue, Feeling abnormal, Headache, Pain
Clinical narrative: I was feeling feverish and lousy, I took an at home COVID-19 test and it was positive. I had body aches, headache and feverish. I called my doctor and they prescribed PAXLOVID. After taking that a few days later I started to fell better, just a little tired.
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Pyrexia, SARS-CoV-2 test positive
Clinical narrative: I was feeling feverish and lousy, I took an at home COVID-19 test and it was positive. I had body aches, headache and feverish. I called my doctor and they prescribed PAXLOVID. After taking that a few days later I started to fell better, just a little tired.
Age: 36.0
Sex: M
Vaccine: COVID19
Symptoms: Inflammation, Injury, Pain in extremity, Rheumatoid arthritis
Clinical narrative: Chronic arm pain and inflammation since vaccination.    Prior to vaccine I had no history of tendinitis or arthritis in my left side.  Now post Covid vaccine I am dealing with symptoms like RA
Age: 91.0
Sex: F
Vaccine: COVID19
Symptoms: Dizziness, Vomiting
Clinical narrative: AstraZeneca 10/6/21 and 11/8/21. Vaccinated: 14:14. Reaction: 14:34. Episode of vomiting and dizziness. Vitals: 168/92, 110, 22. EMS called at 14:58. EMS arrived. Placed IV and administered IVF bolus x1. Taken to ER. No further info available.
Age: 95.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: COVID-19, Metabolic encephalopathy
Clinical narrative: Pt admitted to with metabloic encephalopathy, and covid. No covid treatment required. pt discharged home
Age: 96.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Apraxia, COVID-19, Death, Inappropriate schedule of product administration, Lethargy
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Received Pfizer-BioNTech COVID Vaccines on 1/31/2021 and 3/18/2021. Arrived to ED acutely ill and was found to be very lethargic and barely able to open eyes. COVID+ x1 week. Placed on non-rebreather mask and O2 sat remained in low 80s. Pt was transitioned to DNR/DNI and comfort care. Pt expired 7/10/22. Given cefepime and vancomycin.
Age: 96.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Malaise, SARS-CoV-2 test positive
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Received Pfizer-BioNTech COVID Vaccines on 1/31/2021 and 3/18/2021. Arrived to ED acutely ill and was found to be very lethargic and barely able to open eyes. COVID+ x1 week. Placed on non-rebreather mask and O2 sat remained in low 80s. Pt was transitioned to DNR/DNI and comfort care. Pt expired 7/10/22. Given cefepime and vancomycin.
Age: 6.0
Sex: M
Vaccine: COVID19
Symptoms: Feeling hot, Immediate post-injection reaction, Lethargy, Pallor
Clinical narrative: Immediately after vaccination, patient became very hot, pale and lethargic. We administered cold rag, checked patient temperature, gave cold water and monitored patient  for about 10 minutes.  Color returned and he began talking again.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Dyspnoea
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Received Pfizer-BioNTech COVID Vaccines on 7/13/2021 and 8/10/2021. Arrived to ED 7/12/22 c/o progressively worsening SOB. Previously seen 7/7/22, dx'd w/COVID-19 PNA, and was COVID+ 10 days prior to ED visiti on 7/7/22. Placed on non-rebreather mask en route to hospital by EMS and hypoxia improved. Admitted to ED, O2 requirements progressed to Airvo. Pt removed Airvo and was found with O2 in 50s. Went into cardiac arrest and underwent compressions. Family decided to remove resuscitative measures. Pt expired 7/12/22. Pt given zosyn.
Age: 79.0
Sex: M
Vaccine: COVID19
Symptoms: Hypoxia, Inappropriate schedule of product administration, Resuscitation, SARS-CoV-2 test positive
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Received Pfizer-BioNTech COVID Vaccines on 7/13/2021 and 8/10/2021. Arrived to ED 7/12/22 c/o progressively worsening SOB. Previously seen 7/7/22, dx'd w/COVID-19 PNA, and was COVID+ 10 days prior to ED visiti on 7/7/22. Placed on non-rebreather mask en route to hospital by EMS and hypoxia improved. Admitted to ED, O2 requirements progressed to Airvo. Pt removed Airvo and was found with O2 in 50s. Went into cardiac arrest and underwent compressions. Family decided to remove resuscitative measures. Pt expired 7/12/22. Pt given zosyn.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Haemoglobin decreased, Headache, Nasopharyngitis, Oropharyngeal pain
Clinical narrative: 04/18/2022 Vaccination 06/08/2022 Low hemoglobin presented when giving blood.  07/05/2022 I started to get a sore throat, one side. I thought maybe allergies as  post nasal drip. I started to get achy and headache as day went on and I did a COVID test; POSITIVE.  07/06/2022 Contacted PCM 07/07/2022 Went to Urgent Care. They prescribed Plaxovid.  07/19/2022 I am feeling fine now. I had a cold virus immediately following COVID-19. It took 10 days before I tested negative.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: Pain, SARS-CoV-2 test positive, Upper-airway cough syndrome
Clinical narrative: 04/18/2022 Vaccination 06/08/2022 Low hemoglobin presented when giving blood.  07/05/2022 I started to get a sore throat, one side. I thought maybe allergies as  post nasal drip. I started to get achy and headache as day went on and I did a COVID test; POSITIVE.  07/06/2022 Contacted PCM 07/07/2022 Went to Urgent Care. They prescribed Plaxovid.  07/19/2022 I am feeling fine now. I had a cold virus immediately following COVID-19. It took 10 days before I tested negative.
Age: 81.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood gases, Blood lactic acid, Brain natriuretic peptide increased, COVID-19, Death
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 1/30/2021 and 2/20/2021.Pt presented from outside residential facility after sliding out of wheelchair and presented to ED with SOB. Pt was hypoxic en route with EMS, and was tachypneic, tachycardic, and hypoxic in ED. Was placed on 2L NC. Workup revealed Lactic 2.2, BNP 140, VBG O2 sat 43%, INR 1.3, Hgb 9.0, and COVID+ swab. Pt was admitted to floor and experienced significant deconditioning. He was unable to wean from oxygen.  Pt was to be discharged to hospice as dyspnea worsened and pt was transitioned to comfort care. Pt expired 7/8/22. Pt given decadron.
Age: 81.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Fall, Haemoglobin decreased, Hypoxia, International normalised ratio increased
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 1/30/2021 and 2/20/2021.Pt presented from outside residential facility after sliding out of wheelchair and presented to ED with SOB. Pt was hypoxic en route with EMS, and was tachypneic, tachycardic, and hypoxic in ED. Was placed on 2L NC. Workup revealed Lactic 2.2, BNP 140, VBG O2 sat 43%, INR 1.3, Hgb 9.0, and COVID+ swab. Pt was admitted to floor and experienced significant deconditioning. He was unable to wean from oxygen.  Pt was to be discharged to hospice as dyspnea worsened and pt was transitioned to comfort care. Pt expired 7/8/22. Pt given decadron.
Age: 81.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Physical deconditioning, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
Clinical narrative: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 1/30/2021 and 2/20/2021.Pt presented from outside residential facility after sliding out of wheelchair and presented to ED with SOB. Pt was hypoxic en route with EMS, and was tachypneic, tachycardic, and hypoxic in ED. Was placed on 2L NC. Workup revealed Lactic 2.2, BNP 140, VBG O2 sat 43%, INR 1.3, Hgb 9.0, and COVID+ swab. Pt was admitted to floor and experienced significant deconditioning. He was unable to wean from oxygen.  Pt was to be discharged to hospice as dyspnea worsened and pt was transitioned to comfort care. Pt expired 7/8/22. Pt given decadron.
Age: 45.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Moderna COVID-19 vaccine was drawn up and administered to client during home visit 5 days after the use by date.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test, COVID-19, Dyspnoea, Exposure to SARS-CoV-2, X-ray
Clinical narrative: I did develop Covid-19.  My daughter tested positive on 6/3/22.  I found out hours after receiving my 4th vaccination.   I was having a hard time breathing and went into the urgent care, had blood work done and 2 X-rays.  They treated me at the clinic with a nebulizer treatment and sent me home with an albuterol or HFA 90 mcg/actuation inhaler and a new medication for covid that you take one pill in the Moring and one at Night.  I don't remember the name.  It worked wonderfully!  I am very sure I would have ended up on a vent without it.  Dr. did asked me to come back in the following week for a recheck on my lungs.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Pain
Clinical narrative: 7/10/2022 Woke up with a cough.  7/12 I had body aches and couldn't taste or smell.  I took a home COVID 19 Rapid test and it was positive.  Telemedicine with Doctor who prescribed Paxlovid.  Began to feel better 7/18.  Cough lingers.
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: 7/10/2022 Woke up with a cough.  7/12 I had body aches and couldn't taste or smell.  I took a home COVID 19 Rapid test and it was positive.  Telemedicine with Doctor who prescribed Paxlovid.  Began to feel better 7/18.  Cough lingers.
Age: 54.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Blood testosterone, Ejaculation failure, Erectile dysfunction, Injection
Clinical narrative: loss of maintaining erectile firmness and not ejaculating.
Age: 66.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Chills, Cough, Decreased appetite, Fatigue
Clinical narrative: I had very bad sore throat, coughing, body aches (mainly in my hands), loss of appetite, extreme fatigue, chills. No fever or shortness of breath or breathing difficulties. I called my doctor and started Paxlovid. I started it on a Monday and by Wednesday I felt completely like myself. The duration was not long at all.