chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 15.0
Sex: F
Vaccine: HPV9
Symptoms: Slow speech, Syncope, Tilt table test positive, Vomiting
Clinical narrative: My daughter was having a normal day and no history of fainting. She began slurring words, feeling sick, talking slow and vomiting. She became very pale and collapsing. We were in a store and this came on in an instant. The store staff called EMS and she was taken by ambulance to the ER. She fainted again during blood draw. She was given IV fluids and spent many hours in the hospital. She went back to the hospital again the next day for severe dizziness, weakness and was given more fluids. She was then sent to cardiology where she was diagnosed with POTS.
Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Pain
Clinical narrative: Had COVID 2 months earlier and reported joint pain pronounced and reports extreme pain.  Patient reports she felt as if pain after vaccine was worse and as if he had covid again.   Patient reports pain was severe again not versus having other immunizations.
Age: 15.0
Sex: F
Vaccine: HPV9
Symptoms: Dizziness, Head injury, Laboratory test, Postural orthostatic tachycardia syndrome, Syncope
Clinical narrative: Patient began having dizzy spells after the vaccine and light headedness. She fainted in front of me and I tried to catch her, but because of the lack of room in our bathroom, she still managed to hit her head on the tub, She was taken to the ER and given fluids. She ultimately saw the cardiologist where she was diagnosed with POTS along with her twin sister after receiving the HPV vaccine.
Age: 42.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Pain
Clinical narrative: Had COVID 3 months earlier and reported joint pain pronounced and reports extreme pain.  Patient reports she felt as if pain after vaccine was worse and as if he had covid again.  The same initially as COVID vx #1 but did not last as long as the prior VAERs. Biggest symptom reported was pain. Patient reports pain was severe again not versus having other immunizations.
Age: 69.0
Sex: M
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: vial used outside of labeled information vial was at room temp >12hours but <24 hours post first puncture No adverse effects known Patient does not need to be revaccinated as data is on file support
Age: 62.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Arthralgia, Asthma, Blood test, Chest pain, Chronic obstructive pulmonary disease
Clinical narrative: Headaches, Body Aches, Severe Joint Pain, Muscle Spasms, Shortness of Breath, Chest pains, Asthma, Exhaustion.  Two years later I am diagnosed with COPD - Asthma and Emphysema.  I  was perfectly fine and very active, I could run distances, work all day doing labor, now I can hardly breathe, and have the symptoms above.
Age: 62.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Dyspnoea, Electrocardiogram, Emphysema, Fatigue, Headache
Clinical narrative: Headaches, Body Aches, Severe Joint Pain, Muscle Spasms, Shortness of Breath, Chest pains, Asthma, Exhaustion.  Two years later I am diagnosed with COPD - Asthma and Emphysema.  I  was perfectly fine and very active, I could run distances, work all day doing labor, now I can hardly breathe, and have the symptoms above.
Age: 62.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Muscle spasms, Pain, Pulmonary function test, Ultrasonic angiogram
Clinical narrative: Headaches, Body Aches, Severe Joint Pain, Muscle Spasms, Shortness of Breath, Chest pains, Asthma, Exhaustion.  Two years later I am diagnosed with COPD - Asthma and Emphysema.  I  was perfectly fine and very active, I could run distances, work all day doing labor, now I can hardly breathe, and have the symptoms above.
Age: 86.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
Clinical narrative: Breakthrough case admission after 2 vaccines Moderna 1/19/21 lot# 011L20A;  Moderna 2/16/21 lot# 016M20A
Age: 70.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: COVID-19, Death, Vaccine breakthrough infection
Clinical narrative: Patient Deceased
Age: 70.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Death
Clinical narrative: Patient Deceased
Age: 50.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Axillary pain, Breast pain, Pain, Pain in extremity
Clinical narrative: Pain that still radiates down into underarm and breast. Sore breast Sore shoulder Red patch on chest
Age: 50.0
Sex: F
Vaccine: VARZOS, VARZOS
Symptoms: Arthralgia, Axillary pain, Breast pain, Erythema, Pain
Clinical narrative: Pain that still radiates down into underarm and breast. Sore breast Sore shoulder Red patch on chest
Sex: U
Vaccine: MMRV
Symptoms: Interchange of vaccine products, No adverse event, Product storage error
Clinical narrative: No Additional AE; HCP called to report that the patient was given PROQUAD instead of MMR II. The PROQUAD also suffered from a non supported temperature excursion. TE cases 02418202, 02418066.  HCP states they do not wish to be contacted about this and declines  any fo; The PROQUAD also suffered from a non supported temperature excursion; This spontaneous report was received from a pharmacist referring to a patient of unknown age and gender. The patient's historical medications, medical history, concurrent conditions and concomitant medications were not reported.      On 28-JUN-2023, the patient was vaccinated with an improperly stored dose of with measles, mumps, rubella and varicella (oka-merck) virus vaccine live (rHA)(PROQUAD) lot number w029552, expiration date 14-MAR-2023, for prophylaxis instead of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live(M-M-R II) (interchange of vaccine products and product storage error). No adverse event was reported.  The vaccines underwent a temperature excursion of 8 degrees Celsius for 2328 hours.
Age: 11.0
Sex: F
Vaccine: HPV9
Symptoms: No adverse event, Product storage error
Clinical narrative: no adverse event; Indicate at which point in the process the medication error occurred? Storage in clinical practice/Temperature excursion - vaccine not viable according to manufacturer; This spontaneous report was received from a nurse, and refers to an 11-year-old female patient. The patient's medical history and concurrent conditions were not reported. Concomitant vaccination included meningococcal vaccine a/c/y/w conj (dip tox) (MENACTRA) and diphtheria vaccine toxoid (+) pertussis vaccine acellular (+) tetanus vaccine toxoid (TDAP). Historical vaccines included:  diphtheria vaccine toxoid (+) pertussis vaccine acellular (+) tetanus vaccine toxoid (TDAP); influenza vaccine; hepatitis a vaccine inact (manufacturer unknown), Hepatitis B Vaccine (Recombinant)(manufacturer unknown); polio vaccine; measles vaccine, mumps vaccine, rubella vaccine (manufacturer unknown); diphtheria vaccine toxoid, hib vaccine conj (tet tox), pertussis vaccine acellular 5-component, polio vaccine inact 3v (mrc 5),tetanus vaccine toxoid (PENTACEL); pneumococcal vaccine conj 13v (crm197) (PREVNAR 13), rotavirus vaccine live reassort oral 5v (ROTATEQ), and varicella vaccine (manufacturer unknown).  On 22-JUN-2023, the patient was vaccinated with an improperly stored hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) injection, dose 1, lot #W004648, expiration date: 06-OCT-2024, on the right arm administered for prophylaxis (strength, exact dose, and route of administration were not provided) following a temperature excursion, it was stated that a data logger was invloived. No adverse events occurred.    This is one of several cases of the same patient.
Sex: U
Vaccine: PPV
Symptoms: Expired product administered
Clinical narrative: Patients involved have not experienced any symptoms related to this adverse event at this time / No additional AE; Pharmacist calling to report adverse event regarding expired doses of PNEUMOVAX 23 that were inadvertently administered on 6/22/2023; This spontaneous report was received from a pharmacist, concerning a patient of unknown age and gender.  The patient's medical history, concurrent conditions, historical drugs, and concomitant therapies were not reported.  On 22-JUN-2023, the patient was inadvertently vaccinated with an expired dose of pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX23) injection, 0.5 ml, once (lot number U022984 was verified to be valid, expiration date reported and confirmed as 29-JAN-2023) (route of administration and anatomical location were not provided) (Expired product administered). The patient did not experienced any symptoms related to this adverse event at this time.  This is one of two reports received from the same reporter. ; Sender's Comments:  US-009507513-2307USA011007:
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Illness, Nasopharyngitis, Pain in extremity
Clinical narrative: Sore arm; Bad cold; Sick; This spontaneous case was reported by a patient and describes the occurrence of PAIN IN EXTREMITY (Sore arm), NASOPHARYNGITIS (Bad cold) and ILLNESS (Sick) in a 75-year-old male patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch nos. AS7647B and 057F22A) for COVID-19 prophylaxis.     The patient's past medical history included COVID-19 in April 2022. Concurrent medical conditions included Thyroid disorder and Heart disorder.   On 27-Oct-2022, the patient received fifth dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) 1 dosage form. On 12-Jul-2023, received sixth dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (Sore arm), NASOPHARYNGITIS (Bad cold) and ILLNESS (Sick). At the time of the report, PAIN IN EXTREMITY (Sore arm), NASOPHARYNGITIS (Bad cold) and ILLNESS (Sick) had resolved.        For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications were reported. On 05-Jan-2021, the patient received first dose of moderna covid-19 vaccine (batch/lot number: 011J20A), Second dose was on 04-Feb-2021 (batch/lot number: 0787721), third dose was on 09-Nov-2021 (batch/lot number: 011F21A) and fourth dose on 01-Aug-2022 (batch/lot number: 006M21A) for covid-19 prophylaxis.  It was unknown that the patient received any other vaccines in the 4 weeks prior to COVID-19  vaccine.  Patient has received 6 doses of  the Moderna COVID-19 vaccine so far and has only had a sore arm each time he has received  the shot. Patient's wife reported that does not know which arm received the vaccine in and how long the sore arm  lasted for. Patient was also sick in DEC-2022 with the same symptoms and had (bad cold). However, patient never  tested on own for COVID so it was is unsure if had COVID again at that time.  No treatment medications were reported.   This case was linked to US-MODERNATX, INC.-MOD-2023-733910 (Linked Report).; Sender's Comments:  US-MODERNATX, INC.-MOD-2023-733910:Monovalent
Age: 48.0
Sex: M
Vaccine: COVID19-2
Symptoms: Pyrexia
Clinical narrative: Mild Fever; This spontaneous case was reported by an other health care professional and describes the occurrence of PYREXIA (Mild Fever) in a 48-year-old male patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. AS5051C) for COVID-19 prophylaxis.     No Medical History information was reported.    On an unknown date, the patient received third dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) 1 dosage form. On 08-Jun-2023, the patient experienced PYREXIA (Mild Fever). At the time of the report, PYREXIA (Mild Fever) outcome was unknown.        For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Unknown), the reporter did not provide any causality assessments.   Concomitant medications were not reported.  Treatment information was not reported.   Reporter did not allow further contact
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Vaccine was past the beyond use date of 07/05/23 when administered to patient
Age: 20.0
Sex: F
Vaccine: COVID19-2
Symptoms: Expired product administered
Clinical narrative: Vaccine was past the beyond use date of 07/05/23 when administered to patient
Age: 11.0
Sex: U
Vaccine: HPV9
Symptoms: Product storage error
Clinical narrative: No additional AE/PQC; GARDASIL 9 that were improperly stored and inadvertently administered to 2 patients; This spontaneous report has been received from a nurse practitioner referring to an 11-year-old patient of unknown gender. The patient's medical history, concurrent conditions, and concomitant therapies were not reported.  On an unknown date, the patient was vaccinated with an improper storage dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast) (GARDASIL 9) injection, administered for prophylaxis (strength, dose, anatomical location, dose number, lot #, expiry date, and route of administration were not provided) (improper storage of product in use). The excursion occurred with a temperature above 47 grades Farenheit (F) (48.6F) for 16 hours 30 minutes and 0 seconds and below 36 grades F(28.0F) for 22 hours 0 minutes and 0 seconds. Cumulative time of 38 hours 30 minutes 0 seconds. There was no previous temperature excursion reported. No additional adverse event provided.; Sender's Comments:  US-009507513-2307USA008495:
Age: 42.0
Sex: M
Vaccine: COVID19-2
Symptoms: Immunisation reaction
Clinical narrative: Vaccination adverse reaction; This spontaneous case was reported by an other health care professional and describes the occurrence of IMMUNISATION REACTION (Vaccination adverse reaction) in a 42-year-old male patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. AS5051C) for COVID-19 prophylaxis.     No Medical History information was reported.    On an unknown date, the patient received fourth dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) 1 dosage form. On 12-Jun-2023, the patient experienced IMMUNISATION REACTION (Vaccination adverse reaction). At the time of the report, IMMUNISATION REACTION (Vaccination adverse reaction) outcome was unknown.        For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Unknown), the reporter did not provide any causality assessments.   Concomitant medications were not reported.  Treatment information was not reported.   Reporter did not allow further contact
Age: 2.0
Sex: M
Vaccine: MMRV, PNC20
Symptoms: Decreased appetite, Lethargy, Malaise, Pyrexia
Clinical narrative: High fever of 102.3 started on day 10 after MMRV vaccine, along with lethargy, loss of appetite, and not feeling well in general. Fever would break after dose of Tylenol and come back again 6 hours later
Sex: U
Vaccine: MMR
Symptoms: Product storage error
Clinical narrative: HCP calling to report an AE regarding the MMR II vaccine. HCP reported that a patient was administered an improperly stored vaccine. Permission was provided to contact the HCP. AE case 02425114 filed. Case 02425105 filed. No additional AE/PQC rep; This spontaneous report was received from a nurse and referred to a patient. The patient's medical history, concurrent conditions and concomitant therapies were not reported.  On 10-JUL-2023, the patient was vaccinated with an improperly stored vaccine as measles, mumps, and rubella (WISTAR RA 27-3) virus vaccine, live (rHA) (M-M-R II) subcutaneous injection, lot #U029793, expiration date: 23-SEP-2023, administered for prophylaxis (strength, dose, and route of administration were not provided) (Product storage error).; Sender's Comments:  US-009507513-2307USA007771:
Age: 43.0
Sex: U
Vaccine: COVID19-2
Symptoms: Expired product administered, No adverse event
Clinical narrative: No adverse event; Patient given expired dose; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient given expired dose) and NO ADVERSE EVENT (No adverse event) in a 43-year-old patient of an unknown gender who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. 010H22A) for COVID-19 prophylaxis.     No Medical History information was reported.    In 2023, the patient received first dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Intramuscular) .5 milliliter. In 2023, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient given expired dose). On an unknown date, the patient experienced NO ADVERSE EVENT (No adverse event). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Patient given expired dose) and NO ADVERSE EVENT (No adverse event) outcome was unknown.        For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Intramuscular), the reporter considered NO ADVERSE EVENT (No adverse event) to be not related. No further causality assessment was provided for EXPIRED PRODUCT ADMINISTERED (Patient given expired dose).    It was unknown if the patient had experienced any additional symptoms/events.  Concomitant medications were not reported.  No treatment information was provided by the reporter.
Age: 46.0
Sex: F
Vaccine: COVID19
Symptoms: Arthralgia, Chills, Myalgia, Nausea, Pyrexia
Clinical narrative: Myalgia, Arthralgia, Fever, NauseaVomiting, chills Narrative:
Age: 46.0
Sex: F
Vaccine: COVID19
Symptoms: Vomiting
Clinical narrative: Myalgia, Arthralgia, Fever, NauseaVomiting, chills Narrative:
Age: 71.0
Sex: M
Vaccine: COVID19-2
Symptoms: Febrile neutropenia, Obstructive sleep apnoea syndrome
Clinical narrative: ADULT OBSTRUCTIVE SLEEP APNEA NEUTROPENIC FEVER, UNSPECIFIED
Age: 84.0
Sex: F
Vaccine: VARZOS
Symptoms: Diplegia, Guillain-Barre syndrome, Laboratory test
Clinical narrative: paralysis in legs, guillian-barre syndrome
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient Deceased
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia, Symptom recurrence
Clinical narrative: HYPOXEMIA 2/16/2023  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 76.0
Sex: M
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Myocardial ischaemia, Symptom recurrence
Clinical narrative: DEMAND ISCHEMIA ACUTE HYPOXEMIC RESPIRATORY FAILURE ACUTE ON CHRONIC RESPIRATORY FAILURE 3/11/2023  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient Deceased
Age: 10.0
Sex: F
Vaccine: HEP, HEPA, IPV, TD
Symptoms: Circumstance or information capable of leading to medication error
Clinical narrative: Client came to the Health Dept 7/24/23 the error originated with the clients name being incorrect on the face sheet. Clients name was misspelled. No treatment needed. Parent made aware.
Age: 64.0
Sex: F
Vaccine: COVID19-2
Symptoms: Obstructive sleep apnoea syndrome
Clinical narrative: ADULT OBSTRUCTIVE SLEEP APNEA, MODERATE
Age: 5.0
Sex: F
Vaccine: DTAPIPV
Symptoms: Injection site swelling
Clinical narrative: Localized swelling at injection site. Patient was seen at urgent care. Per mom, within 24 hours, swelling has improved.
Age: 72.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia, Respiratory failure
Clinical narrative: HYPOXEMIC RESPIRATORY FAILURE, UNSPECIFIED ACUITY HYPOXIA
Age: 82.0
Sex: M
Vaccine: COVID19-2
Symptoms: Chronic respiratory failure, Respiratory failure, Symptom recurrence
Clinical narrative: CHRONIC HYPOXEMIC RESPIRATORY FAILURE 1/24/2023  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 15.0
Sex: F
Vaccine: COVID19-2
Symptoms: Incorrect dose administered
Clinical narrative: Patient was supposed to receive Covid Moderna Bivalent 0.5ml and only received Covid Moderna Bivalent 0.25ml
Age: 66.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypotension, Symptom recurrence
Clinical narrative: HYPOTENSION 3/5/2023  --  RECURRENCE OF HOSPITALIZATION WITH SAME SYMPTOMS
Age: 3.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute respiratory failure, Hypoxia
Clinical narrative: ACUTE RESPIRATORY FAILURE ACUTE HYPOXEMIC RESPIRATORY FAILURE HYPOXIA
Age: 34.0
Sex: F
Vaccine: HPV9
Symptoms: Blood potassium decreased, Blood test normal, Chills, Computerised tomogram abdomen, Fatigue
Clinical narrative: Night Sweat/Chills: 48 hours after injection Pain at injection sight: Within a few hours of having injection exhaustion:Within 24 hours vomiting/nausea: 48 hours after injection Fever (101-103): 72 hours after injection  Went to ER after sleeping all day, not being able to keep down food, had a fever of 103.2
Age: 34.0
Sex: F
Vaccine: HPV9
Symptoms: Injection site pain, Nausea, Night sweats, Pyrexia, Somnolence
Clinical narrative: Night Sweat/Chills: 48 hours after injection Pain at injection sight: Within a few hours of having injection exhaustion:Within 24 hours vomiting/nausea: 48 hours after injection Fever (101-103): 72 hours after injection  Went to ER after sleeping all day, not being able to keep down food, had a fever of 103.2
Age: 34.0
Sex: F
Vaccine: HPV9
Symptoms: Urine analysis, Vomiting
Clinical narrative: Night Sweat/Chills: 48 hours after injection Pain at injection sight: Within a few hours of having injection exhaustion:Within 24 hours vomiting/nausea: 48 hours after injection Fever (101-103): 72 hours after injection  Went to ER after sleeping all day, not being able to keep down food, had a fever of 103.2
Age: 54.0
Sex: F
Vaccine: TD
Symptoms: Injection site cellulitis, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth
Clinical narrative: By telephone the patient calls on July 24, 2023 to notify that the where she was immunized is observed red with swelling, the size of a lemon. She is oriented about the effects of vaccination, a red, hard and hot area in addition she is oriented about visiting her primary care Doctor for an evaluation of the area since cellulite may have formed. It was oriented to her about applying cold cloths to the area and not Ice. On July 21, 2023 the patient was immunized under aseptic measures and was guided on adverse effects.
Age: 72.0
Sex: M
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Pt. Deceased
Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Tinnitus
Clinical narrative: After 6 weeks I began to have tinnitus in my left ear. It got worse and then moved to my right ear also. It has not gone away.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Cerebral artery occlusion, Cerebrovascular accident, Lethargy
Clinical narrative: I63.511 ACUTE STROKE DUE TO OCCLUSION OF RIGHT MIDDLE CEREBRAL ARTERY 3/18/2023 LETHARGY I63.511 ACUTE STROKE DUE TO OCCLUSION OF RIGHT MIDDLE CEREBRAL ARTERY 3/18/2023 ACUTE STROKE DUE TO OCCLUSION OF RIGHT MIDDLE CEREBRAL ARTERY
Age: 32.0
Sex: F
Vaccine: COVID19
Symptoms: Hypoxia, Sepsis
Clinical narrative: R09.02 HYPOXIA 4/26/2023 SEPSIS WO ACUTE ORGAN DYSFUNCTION
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Pulmonary embolism
Clinical narrative: I26.99 ACUTE PULMONARY EMBOLISM 4/26/2023 HX OF LUNG CANCER, RIGHT LUNG
Age: 1.0
Sex: M
Vaccine: MMR
Symptoms: Expired product administered
Clinical narrative: Vaccine expired on 7/14/23
Age: 69.0
Sex: F
Vaccine: COVID19
Symptoms: Loss of consciousness, Obstructive sleep apnoea syndrome
Clinical narrative: OBSTRUCTIVE SLEEP APNEA 11/4/2022 UNCONSCIOUSNESS, UNSPECIFIED
Age: 65.0
Sex: F
Vaccine: COVID19
Symptoms: Death
Clinical narrative: Patient deceased
Age: 63.0
Sex: F
Vaccine: PNC20
Symptoms: Computerised tomogram head normal, Electrocardiogram normal, Laboratory test normal, Malaise, Tremor
Clinical narrative: 1d after receiving PCV 20 noted acute onset of shaking throughout body, tremors (no prior history), felt ill, concern for potential hypoglycemia although blood sugar in 90s at the time
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute myocardial infarction, Cardiac stress test abnormal, Chest pain
Clinical narrative: I21.4 ACUTE NON ST ELEVATION MI 4/24/2023 CHEST PAIN I21.4 ACUTE NON ST ELEVATION MI 4/24/2023 ABNL CARDIOVASCULAR STRESS TEST
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Cardiac failure congestive, Coronary artery disease, Diabetic nephropathy, Dilated cardiomyopathy, Dyspnoea
Clinical narrative: HYPOTENSION 4/20/2023 DYSPNEA HYPOTENSION 4/20/2023 CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED  HYPOTENSION 4/20/2023 CAD (CORONARY ARTERY DISEASE) WO ANGINA    DM 2 W CKD, UNSPECIFIED STAGE HYPOTENSION 4/20/2023 NONISCHEMIC DILATED CARDIOMYOPATHY
Age: 61.0
Sex: M
Vaccine: COVID19
Symptoms: Hypotension, Type 2 diabetes mellitus
Clinical narrative: HYPOTENSION 4/20/2023 DYSPNEA HYPOTENSION 4/20/2023 CHF (CONGESTIVE HEART FAILURE), UNSPECIFIED  HYPOTENSION 4/20/2023 CAD (CORONARY ARTERY DISEASE) WO ANGINA    DM 2 W CKD, UNSPECIFIED STAGE HYPOTENSION 4/20/2023 NONISCHEMIC DILATED CARDIOMYOPATHY
Age: 54.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Adenocarcinoma pancreas, Hypoxia, Sepsis
Clinical narrative: R09.02 HYPOXIA 4/19/2023 ABDOMINAL PAIN R09.02 HYPOXIA 4/19/2023 SEPSIS WO ACUTE ORGAN DYSFUNCTION R09.02 HYPOXIA 4/19/2023 ADENOCARCINOMA, TAIL OF PANCREAS R09.02 HYPOXIA 4/19/2023 ABDOMINAL PAIN
Age: 15.0
Sex: F
Vaccine: DTAP, HPV9, MMR, VARCEL
Symptoms: Wrong product administered
Clinical narrative: Provider order an Polio vaccine, MA administer DTAP instead. She stated she heard provider had said DTAP
Age: 75.0
Sex: M
Vaccine: COVID19-2
Symptoms: Facial paresis
Clinical narrative: RIGHT FACIAL MUSCLE WEAKNESS
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Acute left ventricular failure, Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Atrial fibrillation
Clinical narrative: Patient is a 75 y.o. female patient of, DO with history of breast cancer, anxiety, depression, GERD, vascular dementia, stroke, MI, subdural hematoma, seizures, and Afib on coumadin presented to Hospital as direct transfer from short stay unit for an episode of A fib with RVR. Her tachycardia improved with IV metoprolol and her home dose of her betablocker was increased to 50mg BID without recurrence of her tachycardia. She was provided with remdesivir and prednisone. She completed 2 days of remdesivir and was discharged home to complete a 5 day course of prednisone. Recommended follow up with cardiology, PCP, and oncology as needed outpatient.   Acute Hypoxic Respiratory Failure - resolved Covid-19 Virus Infection Date of onset of symptoms: 6/11/2023 Symptoms present on admission: shortness of breath Date of covid positive test: 6/11/2023 Vaccination status: vaccinated Imaging: CXR with streaky opacities bilaterally Oxygen requirements on admission: RA Current oxygen requirements: RA (has been for 24 hours) Medical therapy: patient has confusion and memory loss with dexamethasone, remdesivir not initiated on admission Consultants following: none Anticipated special isolation end date: 6/18/2023 Required oxygen overnight on 6/13 for desats to 88% ID consulted, appreciate recs Provide one more dose of remdesivir Complete final dose of prednisone on 6/16 at discharge Paroxysmal Atrial Fibrillation - improved Acute event evening of 6/11 with response to IV metoprolol Elevated HR overnight on 6/12, required 10mg lopressor Has stayed in FACILITY after med adjustments on coumadin therapy INR therapeutic Pharmacy to dose warfarin Continue to monitor on tele Will hold off on cardiology consult given hemodynamic stability Continue increased home lopressor dose at 50mg BID   Acute Diastolic Heart Failure Follows with cardiology Recent Echocardiogram on record with EF of 55-60% Patient reports having echocardiogram in state as well that was reportedly normal Was placed on oxygen at short stay unit CTPA without evidence of PE; trace pleural effusions Lasix switched to PO daily Daily weights Strict I's and O's Will defer echocardiogram given recent study findings in March 2023   Breast Cancer Follows with oncology S/p left partial mastectomy and sentinel lymph node biopsy on 9/2022 S/p meniscectomy on the right Continue home anaztrozole   Hyperglycemia No history of diabetes SSI during hospital stay A1c in March was 6.1   Seizures Seizure free for several years Continue home lamictal Seizure precautions   HLD Will hold statin as patient was receiving paxlovid
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Echocardiogram normal, Ejection fraction normal
Clinical narrative: Patient is a 75 y.o. female patient of, DO with history of breast cancer, anxiety, depression, GERD, vascular dementia, stroke, MI, subdural hematoma, seizures, and Afib on coumadin presented to Hospital as direct transfer from short stay unit for an episode of A fib with RVR. Her tachycardia improved with IV metoprolol and her home dose of her betablocker was increased to 50mg BID without recurrence of her tachycardia. She was provided with remdesivir and prednisone. She completed 2 days of remdesivir and was discharged home to complete a 5 day course of prednisone. Recommended follow up with cardiology, PCP, and oncology as needed outpatient.   Acute Hypoxic Respiratory Failure - resolved Covid-19 Virus Infection Date of onset of symptoms: 6/11/2023 Symptoms present on admission: shortness of breath Date of covid positive test: 6/11/2023 Vaccination status: vaccinated Imaging: CXR with streaky opacities bilaterally Oxygen requirements on admission: RA Current oxygen requirements: RA (has been for 24 hours) Medical therapy: patient has confusion and memory loss with dexamethasone, remdesivir not initiated on admission Consultants following: none Anticipated special isolation end date: 6/18/2023 Required oxygen overnight on 6/13 for desats to 88% ID consulted, appreciate recs Provide one more dose of remdesivir Complete final dose of prednisone on 6/16 at discharge Paroxysmal Atrial Fibrillation - improved Acute event evening of 6/11 with response to IV metoprolol Elevated HR overnight on 6/12, required 10mg lopressor Has stayed in FACILITY after med adjustments on coumadin therapy INR therapeutic Pharmacy to dose warfarin Continue to monitor on tele Will hold off on cardiology consult given hemodynamic stability Continue increased home lopressor dose at 50mg BID   Acute Diastolic Heart Failure Follows with cardiology Recent Echocardiogram on record with EF of 55-60% Patient reports having echocardiogram in state as well that was reportedly normal Was placed on oxygen at short stay unit CTPA without evidence of PE; trace pleural effusions Lasix switched to PO daily Daily weights Strict I's and O's Will defer echocardiogram given recent study findings in March 2023   Breast Cancer Follows with oncology S/p left partial mastectomy and sentinel lymph node biopsy on 9/2022 S/p meniscectomy on the right Continue home anaztrozole   Hyperglycemia No history of diabetes SSI during hospital stay A1c in March was 6.1   Seizures Seizure free for several years Continue home lamictal Seizure precautions   HLD Will hold statin as patient was receiving paxlovid
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Glycosylated haemoglobin normal, Heart rate increased, Hyperglycaemia, Hyperlipidaemia, Lung opacity
Clinical narrative: Patient is a 75 y.o. female patient of, DO with history of breast cancer, anxiety, depression, GERD, vascular dementia, stroke, MI, subdural hematoma, seizures, and Afib on coumadin presented to Hospital as direct transfer from short stay unit for an episode of A fib with RVR. Her tachycardia improved with IV metoprolol and her home dose of her betablocker was increased to 50mg BID without recurrence of her tachycardia. She was provided with remdesivir and prednisone. She completed 2 days of remdesivir and was discharged home to complete a 5 day course of prednisone. Recommended follow up with cardiology, PCP, and oncology as needed outpatient.   Acute Hypoxic Respiratory Failure - resolved Covid-19 Virus Infection Date of onset of symptoms: 6/11/2023 Symptoms present on admission: shortness of breath Date of covid positive test: 6/11/2023 Vaccination status: vaccinated Imaging: CXR with streaky opacities bilaterally Oxygen requirements on admission: RA Current oxygen requirements: RA (has been for 24 hours) Medical therapy: patient has confusion and memory loss with dexamethasone, remdesivir not initiated on admission Consultants following: none Anticipated special isolation end date: 6/18/2023 Required oxygen overnight on 6/13 for desats to 88% ID consulted, appreciate recs Provide one more dose of remdesivir Complete final dose of prednisone on 6/16 at discharge Paroxysmal Atrial Fibrillation - improved Acute event evening of 6/11 with response to IV metoprolol Elevated HR overnight on 6/12, required 10mg lopressor Has stayed in FACILITY after med adjustments on coumadin therapy INR therapeutic Pharmacy to dose warfarin Continue to monitor on tele Will hold off on cardiology consult given hemodynamic stability Continue increased home lopressor dose at 50mg BID   Acute Diastolic Heart Failure Follows with cardiology Recent Echocardiogram on record with EF of 55-60% Patient reports having echocardiogram in state as well that was reportedly normal Was placed on oxygen at short stay unit CTPA without evidence of PE; trace pleural effusions Lasix switched to PO daily Daily weights Strict I's and O's Will defer echocardiogram given recent study findings in March 2023   Breast Cancer Follows with oncology S/p left partial mastectomy and sentinel lymph node biopsy on 9/2022 S/p meniscectomy on the right Continue home anaztrozole   Hyperglycemia No history of diabetes SSI during hospital stay A1c in March was 6.1   Seizures Seizure free for several years Continue home lamictal Seizure precautions   HLD Will hold statin as patient was receiving paxlovid
Age: 74.0
Sex: F
Vaccine: COVID19-2
Symptoms: Oxygen saturation decreased, Pleural effusion, SARS-CoV-2 test positive, Sinus rhythm, Tachycardia
Clinical narrative: Patient is a 75 y.o. female patient of, DO with history of breast cancer, anxiety, depression, GERD, vascular dementia, stroke, MI, subdural hematoma, seizures, and Afib on coumadin presented to Hospital as direct transfer from short stay unit for an episode of A fib with RVR. Her tachycardia improved with IV metoprolol and her home dose of her betablocker was increased to 50mg BID without recurrence of her tachycardia. She was provided with remdesivir and prednisone. She completed 2 days of remdesivir and was discharged home to complete a 5 day course of prednisone. Recommended follow up with cardiology, PCP, and oncology as needed outpatient.   Acute Hypoxic Respiratory Failure - resolved Covid-19 Virus Infection Date of onset of symptoms: 6/11/2023 Symptoms present on admission: shortness of breath Date of covid positive test: 6/11/2023 Vaccination status: vaccinated Imaging: CXR with streaky opacities bilaterally Oxygen requirements on admission: RA Current oxygen requirements: RA (has been for 24 hours) Medical therapy: patient has confusion and memory loss with dexamethasone, remdesivir not initiated on admission Consultants following: none Anticipated special isolation end date: 6/18/2023 Required oxygen overnight on 6/13 for desats to 88% ID consulted, appreciate recs Provide one more dose of remdesivir Complete final dose of prednisone on 6/16 at discharge Paroxysmal Atrial Fibrillation - improved Acute event evening of 6/11 with response to IV metoprolol Elevated HR overnight on 6/12, required 10mg lopressor Has stayed in FACILITY after med adjustments on coumadin therapy INR therapeutic Pharmacy to dose warfarin Continue to monitor on tele Will hold off on cardiology consult given hemodynamic stability Continue increased home lopressor dose at 50mg BID   Acute Diastolic Heart Failure Follows with cardiology Recent Echocardiogram on record with EF of 55-60% Patient reports having echocardiogram in state as well that was reportedly normal Was placed on oxygen at short stay unit CTPA without evidence of PE; trace pleural effusions Lasix switched to PO daily Daily weights Strict I's and O's Will defer echocardiogram given recent study findings in March 2023   Breast Cancer Follows with oncology S/p left partial mastectomy and sentinel lymph node biopsy on 9/2022 S/p meniscectomy on the right Continue home anaztrozole   Hyperglycemia No history of diabetes SSI during hospital stay A1c in March was 6.1   Seizures Seizure free for several years Continue home lamictal Seizure precautions   HLD Will hold statin as patient was receiving paxlovid
Age: 61.0
Sex: M
Vaccine: COVID19-2
Symptoms: Hypoxia
Clinical narrative: HYPOXEMIA
Age: 5.0
Sex: F
Vaccine: MMRV
Symptoms: Expired product administered
Clinical narrative: dose of MMRV given on 07/25/2023, vaccine expired on 07/24/2023
Age: 93.0
Sex: M
Vaccine: COVID19
Symptoms: Chronic respiratory failure, Hyponatraemia, Pneumonia, Respiratory failure
Clinical narrative: CHRONIC HYPOXEMIC RESPIRATORY FAILURE 3/28/2023 BILAT PNEUMONIA CHRONIC HYPOXEMIC RESPIRATORY FAILURE 3/28/2023 HYPONATREMIA
Age: 0.5
Sex: M
Vaccine: DTPPVHBHPB, PNC13, RV5, DTPPVHBHPB, PNC13, RV5
Symptoms: Eye swelling, Rash
Clinical narrative: rash and eye swelling
Age: 41.0
Sex: F
Vaccine: PNC20, VARZOS
Symptoms: Pruritus, Swelling
Clinical narrative: July 17 2023 patient received Prevnar 20, July 24th patient came in to receive Shingrix, indicated that after she received her Prevnar20, she had swelling from neck to the top of left shoulder.  Indicated she took ibuprofen and the swelling went down.  Shingrix given 07/24/23, patient called approximately 2 hours after and indicated she was itching all over her body but no rash.  Asked if she could take Benadryl to help with the itching.  Patient was also instructed to follow up with her provider and that a report would be submitted.  Pharmacist also tried to follow up with doctors office,  but had to leave a voicemail.
Age: 67.0
Sex: M
Vaccine: COVID19-2
Symptoms: Polyneuropathy
Clinical narrative: DRUG INDUCED POLYNEUROPATHY
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: COVID-19 pneumonia, Computerised tomogram thorax abnormal, Diuretic therapy, Economic problem, Glycosylated haemoglobin normal
Clinical narrative: I agree with the resident plan of discharge.  The patient did have findings of COVID-pneumonia on his CT scan in addition to pulmonary edema.  We diuresed him and his oxygenation improved notably from when he was on nasal Oxymizer on admission and was discharged on low flow nasal cannula.  Patient was profoundly concerned about his ability to afford being in the hospital.  He did have a home O2 evaluation that showed that he desatted to 86% when he was on nasal cannula.  However he recovered when his nasal cannula was turned up from 2 L to 5 L within 30 seconds to goal O2 of 91%.  We discussed extensively at the bedside what his home O2 accesses.  He states that at home he has an oxygen concentrator that can range from 2 L at 93% concentration up to 5 L at a 79% concentration.  He did not have oxygen to go home with however and so he did require a face-to-face completion for an O2 tank to be dispensed to him for discharge.  We will continue Decadron to complete a total of 10 days.   Of note, he was noted to have an A1c of 5.2% and it does not appear that the patient is aware of if he does have any episodes of low blood sugar.  He was placed on 10 units of Lantus with his metformin and Trulicity being held and he was controlled on this.  The patient states that he takes 31 units of Basaglar in the home setting in addition to his metformin and Trulicity.  Given that he will be receiving Decadron, I recommended that he continue his home insulin regimen and then after he finishes steroids may reduce his Basaglar to 10 units daily in addition to metformin and Trulicity as the patient is well below his goal A1c given his age for which she should be likely closer to 7.5%.
Age: 78.0
Sex: M
Vaccine: COVID19-2
Symptoms: Oxygen saturation decreased, Pulmonary oedema
Clinical narrative: I agree with the resident plan of discharge.  The patient did have findings of COVID-pneumonia on his CT scan in addition to pulmonary edema.  We diuresed him and his oxygenation improved notably from when he was on nasal Oxymizer on admission and was discharged on low flow nasal cannula.  Patient was profoundly concerned about his ability to afford being in the hospital.  He did have a home O2 evaluation that showed that he desatted to 86% when he was on nasal cannula.  However he recovered when his nasal cannula was turned up from 2 L to 5 L within 30 seconds to goal O2 of 91%.  We discussed extensively at the bedside what his home O2 accesses.  He states that at home he has an oxygen concentrator that can range from 2 L at 93% concentration up to 5 L at a 79% concentration.  He did not have oxygen to go home with however and so he did require a face-to-face completion for an O2 tank to be dispensed to him for discharge.  We will continue Decadron to complete a total of 10 days.   Of note, he was noted to have an A1c of 5.2% and it does not appear that the patient is aware of if he does have any episodes of low blood sugar.  He was placed on 10 units of Lantus with his metformin and Trulicity being held and he was controlled on this.  The patient states that he takes 31 units of Basaglar in the home setting in addition to his metformin and Trulicity.  Given that he will be receiving Decadron, I recommended that he continue his home insulin regimen and then after he finishes steroids may reduce his Basaglar to 10 units daily in addition to metformin and Trulicity as the patient is well below his goal A1c given his age for which she should be likely closer to 7.5%.
Age: 67.0
Sex: F
Vaccine: COVID19-2
Symptoms: Epilepsy
Clinical narrative: EPILEPSY, UNSPECIFIED
Age: 82.0
Sex: F
Vaccine: COVID19-2
Symptoms: Cerebrovascular accident, Chronic respiratory failure, Respiratory failure
Clinical narrative: ACUTE STROKE, UNSPECIFIED TYPE AND ARTERY CHRONIC HYPOXEMIC RESPIRATORY FAILURE
Sex: F
Vaccine: COVID19
Symptoms: Acute kidney injury, COVID-19, Epistaxis, Fatigue, Glycosylated haemoglobin increased
Clinical narrative: Patient is a 50 y.o. female with a history of Afib (on Eliquis), DM-2, HTN, ovarian cancer with bilateral oophorectomy, breast cancer with right mastectomy who is currently undergoing chemotherapy. She presented to ED 6/5/23 with sore throat, runny nose, headache and fatigue. Found to have COVID and neutropenia. She was transferred to Hospital 6/6/2023 for management. Completed Paxlovid. ANC improved with neupogen and >3K on 6/11/23. Discharged home on 6/12/23.  1. COVID 19 Infection: Pt immunocompromised as she is currently on chemo for breast cancer. S/p vaccinated and boosted x 1. Symptoms: sore throat, no fever, no hypoxia on admit. Paxlovid initiated 6/8/23; complete course on 6/12/23. ID following.  2. Neutropenia: ANC 540, in setting of chemotherapy. No fever on admit. ANC 380 on 6/7/23. Neutropenic precautions continued. Oncology added daily neupogen until ANC >3000; last dose given on 6/10/23. ANC improved to >3K on 6/11/23. 3. Pancytopenia: due to chemotherapy. Last chemo 1 week PTA. Hgb down to 6.8 on 6/7/23, transfused 1u pRBC 6/7/23 and again on 6/11/23. WBC and Plt counts stable.  4. AKI: mild to 1.19 on 6/11/23. Diuretics held on 6/11/23. Encouraged increased PO intake. Stable on 6/12/23.  5. Epistaxis: rhino rocket placed in L nare 6/8/23 per ENT; removed 6/9/23 per patient request. ENT recommended outpatient follow up. S/p Empiric keflex. 6. Breast Cancer: Triple Negative Invasive Ductal Carcinoma. S/p right mastectomy 10/2021 with Dr. (Breast Surgery). Follows with Dr. (Medical Oncology). Currently receiving adjuvant chemotherapy (missed session 6/6/23 and to hold on 6/13/23 per Dr.). Oncology followed.  7. Chronic HFrEF with Dilated Cardiomyopathy: Per history, initially related to postpartum cardiomyopathy 16 years ago. S/p AICD in 2012. NYHA Class II. Follows with Dr. (Cardiology). Continued home HDMT. Statin held while on paxlovid; OK to resume 6/15/23. 8. Pulmonary HTN: per history. Continued Tadalafil at reduced dose while on paxlovid; OK to resume home dose on 6/15/23. 9. Persistent Atrial Fibrillation: Continued home BB and Eliquis. (Eliquis dose reduced while on paxlovid; OK to resume home dose on 6/15/23) 10. Hypertension: continued home meds.  11. DM2: Uncontrolled, A1c 10 on 6/6/23. Insulin continued, oral agents resumed on DC.  12. History of Ovarian Cancer: History of yolk sac tumor/endodermal sinus tumor of the left ovary with right ovary serous cystadenoma ~28 years ago, received chemotherapy at that time. S/p bilateral oophorectomy (left 1994, right 2007).  13. Toenail Injury: to Left great toe nail from stubbed toe 1 week prior to admit. Toenail removed 6/7/23 by Dr. (podiatry). No sign of infection--OTA as noted 6/12/23. . 14. Obesity: BMI 36. Lifestyle modifications advised
Sex: F
Vaccine: COVID19
Symptoms: Haemoglobin decreased, Headache, Laboratory test, Nail injury, Nail operation
Clinical narrative: Patient is a 50 y.o. female with a history of Afib (on Eliquis), DM-2, HTN, ovarian cancer with bilateral oophorectomy, breast cancer with right mastectomy who is currently undergoing chemotherapy. She presented to ED 6/5/23 with sore throat, runny nose, headache and fatigue. Found to have COVID and neutropenia. She was transferred to Hospital 6/6/2023 for management. Completed Paxlovid. ANC improved with neupogen and >3K on 6/11/23. Discharged home on 6/12/23.  1. COVID 19 Infection: Pt immunocompromised as she is currently on chemo for breast cancer. S/p vaccinated and boosted x 1. Symptoms: sore throat, no fever, no hypoxia on admit. Paxlovid initiated 6/8/23; complete course on 6/12/23. ID following.  2. Neutropenia: ANC 540, in setting of chemotherapy. No fever on admit. ANC 380 on 6/7/23. Neutropenic precautions continued. Oncology added daily neupogen until ANC >3000; last dose given on 6/10/23. ANC improved to >3K on 6/11/23. 3. Pancytopenia: due to chemotherapy. Last chemo 1 week PTA. Hgb down to 6.8 on 6/7/23, transfused 1u pRBC 6/7/23 and again on 6/11/23. WBC and Plt counts stable.  4. AKI: mild to 1.19 on 6/11/23. Diuretics held on 6/11/23. Encouraged increased PO intake. Stable on 6/12/23.  5. Epistaxis: rhino rocket placed in L nare 6/8/23 per ENT; removed 6/9/23 per patient request. ENT recommended outpatient follow up. S/p Empiric keflex. 6. Breast Cancer: Triple Negative Invasive Ductal Carcinoma. S/p right mastectomy 10/2021 with Dr. (Breast Surgery). Follows with Dr. (Medical Oncology). Currently receiving adjuvant chemotherapy (missed session 6/6/23 and to hold on 6/13/23 per Dr.). Oncology followed.  7. Chronic HFrEF with Dilated Cardiomyopathy: Per history, initially related to postpartum cardiomyopathy 16 years ago. S/p AICD in 2012. NYHA Class II. Follows with Dr. (Cardiology). Continued home HDMT. Statin held while on paxlovid; OK to resume 6/15/23. 8. Pulmonary HTN: per history. Continued Tadalafil at reduced dose while on paxlovid; OK to resume home dose on 6/15/23. 9. Persistent Atrial Fibrillation: Continued home BB and Eliquis. (Eliquis dose reduced while on paxlovid; OK to resume home dose on 6/15/23) 10. Hypertension: continued home meds.  11. DM2: Uncontrolled, A1c 10 on 6/6/23. Insulin continued, oral agents resumed on DC.  12. History of Ovarian Cancer: History of yolk sac tumor/endodermal sinus tumor of the left ovary with right ovary serous cystadenoma ~28 years ago, received chemotherapy at that time. S/p bilateral oophorectomy (left 1994, right 2007).  13. Toenail Injury: to Left great toe nail from stubbed toe 1 week prior to admit. Toenail removed 6/7/23 by Dr. (podiatry). No sign of infection--OTA as noted 6/12/23. . 14. Obesity: BMI 36. Lifestyle modifications advised