chrisvoncsefalvay/vaers-narrative-generation huggingface dataset:
Age: 49.0
Sex: F
Vaccine: COVID19, FLU4
Symptoms: Tremor, Troponin normal, Urinary incontinence, Urine analysis normal
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 7/19/2022 Discharge Date: Jul 21, 2022  PRESENTING PROBLEM: Seizure (HCC)  Seizure-like activity (HCC)  Anxiety disorder, unspecified type  COVID-19    HOSPITAL COURSE: 50-year-old female history of type 2 diabetes, hypertension, psychiatric illness bipolar/schizophrenia came to local ER were seizure-like event.  She had noted around 16:00 and 7/19 showed episode of involuntary shaking in her hands bilaterally with symmetric vision loss and urinary incontinence.  Patient did say she had seizure-like event in the past secondary to Wellbutrin medication but this was in remote history.  Upon arrival to ER, patient afebrile, normotensive.  Had troponins which were negative and flat.  COVID screen came back positive.  Urinalysis bland.  EKG with sinus tachycardia.  She had CT head negative for any acute intracranial process.  Chest x-ray and CTA thorax negative for acute intrathoracic process.  Patient was satting above 90% on room air.  She was admitted to the hospital observation status for EEG and MRI per neuro request.   Patient's EEG came back showing no evidence of epilepsy.  MRI brain came back showing no evidence of any acute abnormality.  Patient said she was still having some upper chest congestion she thinks related to COVID diagnosis.  Repeat chest x-ray day of discharge was negative for any acute abnormalities.  For duration of stay patient was not hypoxic.  Did prescribe patient albuterol inhaler and Tessalon Perles.  Patient inquired about Paxlovid medications for COVID.  Discussed with inpatient pharmacy and we do offer Paxlovid inpatient.  Patient can follow-up with her PCP to get this medication at discharge as outpatient for COVID.   Neurology discussed with patient seizure precautions for discharge including: "no showering/bathing alone, operation of heavy machinery, use of ladders and driving for 6 months seizure free.  Patient agreed with plan and verbalized understanding."Did reach out to Neurology and per Neurology no need for neuro follow-up at this time.      Discharge stable condition.
Age: 72.0
Sex: F
Vaccine: COVID19
Symptoms: Ear discomfort, Ear swelling, Injection site rash, Pruritus, Rash
Clinical narrative: Patient said after 8 days she developed rash on the same arm she got the vaccine and the same side lower back.  Her daughter gave her antihistamine and it seems to be better but still there.   Her ears also got itchy and a little swollen.
Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: hsopitalized
Age: 11.0
Sex: F
Vaccine: HPV9, MNQ, TDAP
Symptoms: Extremity contracture, Eye movement disorder, Tremor
Clinical narrative: Patient here for seventh grade immunizations. Mom had chosen for daughter to receive TDaP, MCV4, and HPV. Twin brother also here, and received the same vaccinations prior to his sister. Patient did well after receiving the vaccinations. After a few minutes of sitting in the clinic room, patients eyes rolled back, her head fell back, body started shaking and her arms started contracting. EMS was called and nurse was able to arouse patient prior to ambulance arrival. Mom stated patient had not eaten anything yet and has never had a reaction after receiving vaccinations before. BP 110/62. Blood sugar and vitals checked by EMS. Patient was also given crackers and water and stated she felt ok after being checked out by
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Acute respiratory failure, Angiogram normal, Angiogram pulmonary abnormal, Anticoagulant therapy, Blood alkaline phosphatase increased
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Blood culture, Blood lactic acid decreased, Blood phosphorus decreased, Blood pressure abnormal, Body temperature increased
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Brain natriuretic peptide increased, Bronchoscopy, COVID-19, COVID-19 pneumonia, Computerised tomogram normal
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Condition aggravated, Deep vein thrombosis, Dizziness, Electrocardiogram ST segment abnormal, Electrocardiogram T wave inversion
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Haematoma, Haemoglobin normal, Hypotension, Intensive care, Laboratory test abnormal
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Lung opacity, Myocardial strain imaging abnormal, Pneumomediastinum, Pneumothorax, Procalcitonin
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Pulmonary embolism, Pulmonary infarction, SARS-CoV-2 test positive, Sinus tachycardia, Subcutaneous emphysema
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Superficial vein thrombosis, Syncope, Tachycardia, Thrombectomy, Transfusion
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 63.0
Sex: F
Vaccine: COVID19
Symptoms: Troponin increased, Ultrasound Doppler abnormal, Urine analysis normal, X-ray
Clinical narrative: Discharge Provider:  Primary Care Provider:  Admission Date: 6/28/2022 Discharge Date: Jul 29, 2022  PRESENTING PROBLEM: Hypoxic Bilateral pulmonary embolism Pneumonia due to COVID-19 virus Pulmonary embolism and infarction Hypotension Acute respiratory failure with hypoxia   HOSPITAL COURSE: Patient is a  63 y.o. female with past medical history of mantle cell lymphoma status post chemo and stem cell transplant, ulcerative colitis on mesalamine, latent TB, hemochromatosis, and primary sclerosing cholangitis.  Patient presented to the emergency department secondary to dizziness and syncopal episode. In Emergency department patient was hypoxic and is requiring 4 L of supplemental oxygen.  Temperature was 38° and she was initially tachycardic at 1:41 a.m..  Lab significant for phosphorus 1.9, alk-phos 142, BNP 355, procalcitonin 0.16, lactic acid 1.2-> 0.7, troponin 42-> 45.  COVID was positive.  Blood cultures x2 were drawn.  Urinalysis was without evidence of infection.  EKG showed sinus tachycardia with lateral T-wave inversion and nonspecific ST changes.  CTA thorax showed significant bilateral pulmonary emboli with right heart strain and moderate ground-glass and reticular opacities which favor pulmonary infarct.  Bilateral lower extremity ultrasound showed acute occlusive superficial venous thrombosis in the left greater saphenous vein from the knee to the common femoral vein and tiny acute nonocclusive DVT in the left common femoral vein.  Bilateral upper extremity ultrasounds were without evidence of DVT.  A PERT call was performed and case was discussed with pulmonology and IR who felt patient was a candidate for mechanical thrombectomy.  Recommended she be initiated on heparin drip.     Given overall clot burden patient was taken down for mechanical thrombectomy.  Postprocedure patient became hypotensive.  Patient was transferred to intensive care unit for close monitoring.  Thought to be due to hematoma at the access site so heparin was had.  CT angiogram of abdomen and pelvis are obtained which was negative for acute GI bleed.  1 unit of blood was given.  Blood pressure was improved.As CT was negative on groin site was stable, heparin was restarted and hemoglobin remained stable. She was subsequent transitioned to Eliquis   Her stay was prolonged due to continued high levels of oxygen requirements with activity. She was started on IV Methylprednisolone as per pulmonology given COVID-19.  Had bronchoscopy with pulmonology 7/20, pulmonology recommended gradually tapering steroids, started on Bactrim for PJP prophylaxis.  Developed bilateral small pneumothorax, pneumomediastinum and subcutaneous emphysema post bronchoscopy, which was closely monitor with daily x-ray, CT surgery and pulmonology recommended supportive care.  Evaluated by Pulmonary rehab, oxygen. requirement upon discharge was 4 liters at baseline and 6 liters with exertion with oxygen pendant. She was discharged home with home care.
Age: 74.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Fatigue, Nasopharyngitis, Pyrexia, SARS-CoV-2 test positive
Clinical narrative: I felt like I was coming down with a cold. After getting home from vacation, during that trip my granddaughter had a cold so I did not think too much of it. After two days I was not feeling better so I took a COVID-19 Home Test and it was positive. I started having a fever and was just not doing better so I called my Doctor and I was put on Paxlovid. That resolved all symptoms other than being tired.
Age: 44.0
Sex: F
Vaccine: COVID19
Symptoms: Extra dose administered
Clinical narrative: Unqualified employee per  eligibility criteria.  The nurse in the vaccine clinic was auditing employee vaccines and found that an employee 44 years old had received the 2nd booster for covid-19. The information was found in the employees intraportal file. The employee came for their booster. I registered the employee, and followed the protocol of screening questions and checking the vaccine card before the employee received the injection. employee agreed that they were here for the 1st booster and they needed to be vaccinated per policy. the employee did not have their complete vaccine card. After contacting the employee they stated they had more than one vaccine card, and was aware that they had received a 2nd booster but was unware that the 2nd booster does not apply to them. The employee stated that they are well and have not experienced any adverse reaction or injury.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cough, Headache, Oropharyngeal pain, Pulmonary pain
Clinical narrative: I started getting symptoms of sore throat, runny nose, and headaches. My symptoms progressed and I had chest congestion with coughing. I took an at home COVID-19 test that was positive. I contacted my doctor and was told to treat the symptoms with OTC medications. I took Tylenol and cough medication. I did not seem to be getting better and my lungs hurt so I contacted my doctor again and was prescribed a steroid for 7 days. The steroids did help.
Age: 67.0
Sex: F
Vaccine: COVID19
Symptoms: Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
Clinical narrative: I started getting symptoms of sore throat, runny nose, and headaches. My symptoms progressed and I had chest congestion with coughing. I took an at home COVID-19 test that was positive. I contacted my doctor and was told to treat the symptoms with OTC medications. I took Tylenol and cough medication. I did not seem to be getting better and my lungs hurt so I contacted my doctor again and was prescribed a steroid for 7 days. The steroids did help.
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Acute respiratory distress syndrome, COVID-19, COVID-19 pneumonia, Cardio-respiratory arrest, Death
Clinical narrative: MODERNA COVID #3 VACCINE GIVEN 10/25/21,LOT # 011F21A; pt had a positive COVID test on 2/17/22 from Fast Pace Clinic in Lafayette, TN; 2/24/22 pt to ED with increasing SOB and productive cough; admitted; hypoxic; BiPAP; dexamethasone and ABX given; COVID pneumonia with ARDS; pt had a sudden cardiopulmonary arrest; ACLS protocol given; return of pulse 5 times; continued to have cardiopulmonary arrest; family decided to discontinue CPR and pt expired in the hospital
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, Hypoxia, Life support, Positive airway pressure therapy, Productive cough
Clinical narrative: MODERNA COVID #3 VACCINE GIVEN 10/25/21,LOT # 011F21A; pt had a positive COVID test on 2/17/22 from Fast Pace Clinic in Lafayette, TN; 2/24/22 pt to ED with increasing SOB and productive cough; admitted; hypoxic; BiPAP; dexamethasone and ABX given; COVID pneumonia with ARDS; pt had a sudden cardiopulmonary arrest; ACLS protocol given; return of pulse 5 times; continued to have cardiopulmonary arrest; family decided to discontinue CPR and pt expired in the hospital
Age: 80.0
Sex: M
Vaccine: COVID19
Symptoms: Resuscitation, SARS-CoV-2 test positive
Clinical narrative: MODERNA COVID #3 VACCINE GIVEN 10/25/21,LOT # 011F21A; pt had a positive COVID test on 2/17/22 from Fast Pace Clinic in Lafayette, TN; 2/24/22 pt to ED with increasing SOB and productive cough; admitted; hypoxic; BiPAP; dexamethasone and ABX given; COVID pneumonia with ARDS; pt had a sudden cardiopulmonary arrest; ACLS protocol given; return of pulse 5 times; continued to have cardiopulmonary arrest; family decided to discontinue CPR and pt expired in the hospital
Age: 64.0
Sex: F
Vaccine: COVID19
Symptoms: Injection site erythema, Injection site induration, Pyrexia
Clinical narrative: patient called in 8/3/22 2:10pm states that monday the day of injection no issues. states that tuesday it was a little red at the injection site and then in the evening it had gotten bigger and hard. she states that she had fever as well but figured it was all normal. on wednesday she got up and there is a 3 inch diameter hard red spot at injection site. she states she has not taken any meds for it so far b/c she is on other meds for another pain issue going on. she states she has had no breathing difficulty. she states that her first two doses of moderna she did not have any trouble with.  i encouraged her to call her dr for their advice on how to handle since she didn't want to start anything over the counte. she states that she is feeling better today just has the red hard spot 8/3/2022 2:10p
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cough, Fatigue, Headache, Malaise
Clinical narrative: I had a fever, heavy congestion, muscle aches, headaches, and body aches. I just felt really exhausted and just thought it was travel lag from my flight the day before. On 07/21/2022, I went to a pharmacy to get a COVID-19 PCR test done because my symptoms continued to get worse. The doctor said because of the current medications I was on, I wasn't a good candidate for the PAXLOVID prescription. They told me to go home and treat my symptoms with medication like cough suppressant and TYLENOL. Over the days, my cough eventually suppressed as well as my body aches and slight fever. As of now, I feel pretty recovered with residual cough.
Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Myalgia, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
Clinical narrative: I had a fever, heavy congestion, muscle aches, headaches, and body aches. I just felt really exhausted and just thought it was travel lag from my flight the day before. On 07/21/2022, I went to a pharmacy to get a COVID-19 PCR test done because my symptoms continued to get worse. The doctor said because of the current medications I was on, I wasn't a good candidate for the PAXLOVID prescription. They told me to go home and treat my symptoms with medication like cough suppressant and TYLENOL. Over the days, my cough eventually suppressed as well as my body aches and slight fever. As of now, I feel pretty recovered with residual cough.
Age: 68.0
Sex: F
Vaccine: COVID19
Symptoms: Unevaluable event
Clinical narrative: hospitalization
Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: vaccine was expired, no temperature excursions occurred and Moderna determined the vial "maintained the activity necessary to protect against the SARS CoV-2 virus at the time of administration".  Patient reported no adverse reactions.
Age: 1.42
Sex: F
Vaccine: COVID19
Symptoms: Diarrhoea
Clinical narrative: Diarrhea for 2+ weeks
Age: 58.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine was given Beyond Use Date.
Age: 55.0
Sex: M
Vaccine: UNK
Symptoms: Dyspnoea, Flushing, Headache
Clinical narrative: Client experienced facial flushing, severe headache, and labored breathing 15 minutes post vaccination. Pt vital signs were stable. Pt provided oxygen, Benadryl and was transported via EMS to local Emergency department for further evaluation.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Aphasia, Cerebrovascular accident, Eyelid ptosis, Hyporesponsive to stimuli, Lethargy
Clinical narrative: The resident was noted with left-hand grasp weakness, left eye drooping, lethargy, and slow response. Able to let needs known, then could not verbalizing became difficult. 911 was called and patient was transferred to ER to rule out CVA. Resident admitted with diagnosis of Stroke.
Age: 70.0
Sex: F
Vaccine: COVID19
Symptoms: Muscular weakness
Clinical narrative: The resident was noted with left-hand grasp weakness, left eye drooping, lethargy, and slow response. Able to let needs known, then could not verbalizing became difficult. 911 was called and patient was transferred to ER to rule out CVA. Resident admitted with diagnosis of Stroke.
Age: 30.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered, No adverse event
Clinical narrative: vaccine was expired, no temperature excursion occurred and Moderna determined the vial "maintained the activity necessary to protect against the SARS CoV-2 virus at the time of administration".  Patient reported no adverse reaction.
Age: 68.0
Sex: M
Vaccine: COVID19
Symptoms: Arthralgia, Mobility decreased, Pain
Clinical narrative: Painful ache in both knees when I would move the knee. The ache was 24/7.  If I didn't move the knee I did not feel it. Any movement to change position, stand, or walk, would cause the ache. I've never had anything like that before. Taking 2 Advil would alleviate the pain for roughly 8 hours only to then return. The pain was always the same, never more or less. On July 6, 2022 I went to Dr, my Orthopedic doctor, who gave me a corticosteroid injection in each knee. That eliminated the pain to this date. Time will tell if the pain returns.
Age: 4.0
Sex: F
Vaccine: COVID19
Symptoms: Incorrect dose administered, Product administered to patient of inappropriate age
Clinical narrative: Patient had a scheduled appointment with provider for school physical and immunizations.  Administered 3 vaccines (MMR, Varicella, Dtap/Polio ordered by provider.  After giving the 3 vaccines,  Patient's guardian, decided to add the pediatric covid vaccine. I let the guardian sign consent form for the patient.  Prepared  pfizer covid vaccine, unfortunately,  prepared the covid vaccine for 5-11 year old instead of the Pfizer (6mos-4yrs). After realization of administration error,  I contacted the clinics charge nurses and also notified the director of clinical services, FNP.  I also informed guardian and instructed to observe for any side effects and also informed when to seek urgent care.  I also  notified guardian when to come back to get the appropriate dose for patient. Guardian stated patient is doing well.
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: COVID-19, Cough, Myalgia, Oropharyngeal pain, Pyrexia
Clinical narrative: Covid infection with muscle aches, mild fever, sore throat, sporadic cough
Age: 73.0
Sex: F
Vaccine: COVID19
Symptoms: SARS-CoV-2 test positive
Clinical narrative: Covid infection with muscle aches, mild fever, sore throat, sporadic cough
Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine was administered beyond use date.
Age: 3.0
Sex: M
Vaccine: COVID19
Symptoms: Intentional medical device removal by patient
Clinical narrative: While administering vaccine patient moved his arm and the needle came out of his arm. Less than half of the dose went into his arm due to him moving.  Per CDC Appendix C patient returned for a repeat dose the next day 7/6. Occurred without incident.
Age: 39.0
Sex: F
Vaccine: TDAP
Symptoms: Back pain, Cardiovascular evaluation, Chest pain, Electrocardiogram normal, Injection site erythema
Clinical narrative: Patient reported tenderness and muscle pain to left deltoid after immunization. Two days later the pain worsened radiating to her back and chest. Six days later she developed an area or erythema and induration to her left shoulder.
Age: 39.0
Sex: F
Vaccine: TDAP
Symptoms: Injection site induration, Injection site pain, Injection site warmth, Pain
Clinical narrative: Patient reported tenderness and muscle pain to left deltoid after immunization. Two days later the pain worsened radiating to her back and chest. Six days later she developed an area or erythema and induration to her left shoulder.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Expired product administered
Clinical narrative: Vaccine was Administered past the beyond use date
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Malaise, Pain in extremity, SARS-CoV-2 test positive
Clinical narrative: I had a little soreness in the arm for a couple days. On 06/24/2022 I tested positive for COVID-19 with a home test. I had a telehealth visit with my doctor and she prescribed Paxlovid.  After taking all the Paxlovid two days later I had the symptoms again and tested positive again.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Blood lactic acid increased, COVID-19, Chest X-ray normal, Computerised tomogram head normal, Confusional state
Clinical narrative: Patient received pfizer vaccine on 3/30/21 and 4/27/21. Presented to ER on 7/18/22. Found to be COVID positive on 7/19/22. presents to er brought in by wife due to confusion. He has a hx of tbi, ich as well. He has been more lethargic as well. He was not taking any of his evening meds which concerned here. Patient is not able to provide any hx currently. In ER COVID was positive. Head CT was negative. UA is pending. He was noted to be febrile with temp of 100.9. Lactic also elevated. Will admit as he is confused and not taking PO. Also needs workup for his fever/lactic acidosis. Placed on ceftriaxone and azithromycin. Discharged on 8/1/22.
Age: 71.0
Sex: M
Vaccine: COVID19
Symptoms: Lactic acidosis, Lethargy, Pyrexia, SARS-CoV-2 test positive, Urine analysis
Clinical narrative: Patient received pfizer vaccine on 3/30/21 and 4/27/21. Presented to ER on 7/18/22. Found to be COVID positive on 7/19/22. presents to er brought in by wife due to confusion. He has a hx of tbi, ich as well. He has been more lethargic as well. He was not taking any of his evening meds which concerned here. Patient is not able to provide any hx currently. In ER COVID was positive. Head CT was negative. UA is pending. He was noted to be febrile with temp of 100.9. Lactic also elevated. Will admit as he is confused and not taking PO. Also needs workup for his fever/lactic acidosis. Placed on ceftriaxone and azithromycin. Discharged on 8/1/22.
Age: 3.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Product preparation issue
Clinical narrative: Vaccine administered with out diluent prior to dose being given. Reported to Pfzier Medical Information department.
Age: 3.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Overdose, Pain in extremity, Product preparation error, Pyrexia
Clinical narrative: Vaccine administered with out diluent prior to dose being given. Reported to Pfzier Medical Information department.
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: COVID-19, Cholecystectomy, Cough, Death, Decreased appetite
Clinical narrative: 8/17/21 pt had a cholecystecomy; pt back to hospital on 8/25/21 with increasing SOB, cough, poor appetite; family members positive for COVID; pt's COVID test came back positive; hypotensive; O2 supplement; remdesivir, dexamethasone, IV fluids; pt's condition worsened; transitioned to comfort care and sent home on hospice; pt passed away at home
Age: 75.0
Sex: M
Vaccine: COVID19
Symptoms: Dyspnoea, General physical health deterioration, Hypotension, SARS-CoV-2 test positive
Clinical narrative: 8/17/21 pt had a cholecystecomy; pt back to hospital on 8/25/21 with increasing SOB, cough, poor appetite; family members positive for COVID; pt's COVID test came back positive; hypotensive; O2 supplement; remdesivir, dexamethasone, IV fluids; pt's condition worsened; transitioned to comfort care and sent home on hospice; pt passed away at home
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Appetite disorder, Atypical pneumonia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
Clinical narrative: Patient received moderna vaccine on 3/18/21, 4/16/21, and 11/2/21. Unsure of lot or site location. Presented to ER on 7/26/22 and found to be COVID positive. PMH of emphysema/COPD on 4-5 L at home. brought by EMS from home because of worsening SOB, fever- 102, cough with yellow sputum production, headache, appetite, diarrhea,Patient received albuterol, xanax, ketorolac, normal saline, potassium magnesium, patient is diagnosed and admitted as hypoxia with COVID-19 pneumonia, received Rocephin, doxycycline, Decadron and remdesivir. Discharged on 8/1/22
Age: 67.0
Sex: M
Vaccine: COVID19
Symptoms: Diarrhoea, Dyspnoea, Headache, Hypoxia, Productive cough
Clinical narrative: Patient received moderna vaccine on 3/18/21, 4/16/21, and 11/2/21. Unsure of lot or site location. Presented to ER on 7/26/22 and found to be COVID positive. PMH of emphysema/COPD on 4-5 L at home. brought by EMS from home because of worsening SOB, fever- 102, cough with yellow sputum production, headache, appetite, diarrhea,Patient received albuterol, xanax, ketorolac, normal saline, potassium magnesium, patient is diagnosed and admitted as hypoxia with COVID-19 pneumonia, received Rocephin, doxycycline, Decadron and remdesivir. Discharged on 8/1/22